1. Working Together to Work Wonders. UTMB The Challenges of Recovering When the Patient is your Hospital Mike Mastrangelo: Program Director Institutional Preparedness

2. Working Together to Work Wonders. Emergency Program New Institutional Safety and Security Committee: Executive institutional oversight of emergency program (President and EVPs) Annual Review Executive Input Approval of annual program Preparedness, Prevention, Protection, Mitigation, Response, Recovery

3. Working Together to Work Wonders. Mitigation General Approach: New Construction – critical Infrastructure: 25 feet above Base Flood Elevation Hot water rather than steam (more resilient) Combined heat and power system (if possible) Community Partners: Water and Power Mitigation Plan Approved and Adopted New Mitigation Projects Underway Flood and Wind Retrofits

4. Working Together to Work Wonders. FEMA Approved Mitigation (so far) Emergency Power Systems: Elevate generators Normal Power Distribution: Elevate lines, switchgear, distribution panels Chilled Water: Harden and elevate lines

5. Working Together to Work Wonders. Hospital Incident Command System HICS workshop (TEEX) for senior executives on HICS positions (President, EVPs, Senior VPs, VPs) How UTMB would implement HICS (Hospital/Research Center/National Lab/Academic Enterprise) Filled positions (goal 5 deep) Incident Commander for incidents with warning Staffing of Command Center based on storm severity (Alternate Command Center on Mainland if needed)

6. Working Together to Work Wonders. HICS / Resource Management Incident Action Plan: Incident Commander’s Objectives Strategies and Tactics Resources / Resource Request Map Resources to each Objective Documentation: Work done can be tracked back by date to specific Incident Command objectives

7. Working Together to Work Wonders. HICS / Resource Management and Documentation HICS Documentation Training for Planning, Finance/Admin, Logistics sections Knowledge of Public Assistance / Debris Removal rules and regulations Contract in place to provide Planning Section with documentation support if needed Contract in place to support Public Assistance claims process

8. Working Together to Work Wonders. Damage Assessment Developed a Damage Assessment Process to include contract photographic recording Damage Assessment Teams include Asset Management and Departmental Representatives No work until Damage Assessment is complete Use of Computer Aided Facilities Management software applications Estimating total damage (can you afford to rebuild?)

9. Working Together to Work Wonders. Hurricane Response Saffir - Simpson Scale and 120 hour clock Triggered Response Evacuation Plan based on Hurricane Severity Index 10 phase response plan Coordination with response partners Ambulance Staging Area Communications / COML Team Regional Coordination with CMOC, EMTF-6, and Regional Communications Center for asset mobilization

12. Phase:ORTraditional Time Line UTMB Evacuation Planning Checklist Assigned to Completed Impact Weather Date/TimeInitials Trigger Report 120 Hours + Prepare 1 Coordinate with Public Affairs on general communications as needed Incident Commander Review Evacuation Plan All Confirm Emergency Radio Communications Plan with state and local jurisdictions Liaison Notify Seton that there is a possibility of evacuation. Use UTMB Form A: Initial Patient Evacuation Estimate Evacuation Support Team / Liaison Notify Texas Division of Emergency Management on possibility of evacuation. (Mike Jones 979-864-9411 /David Popoff 713 504 4392) Provide a planning estimate of the support needs for a possible evacuation Use UTMB Form A: Initial Patient Evacuation Estimate Evacuation Support Team / Liaison Notify the Regional Trauma Advisory Council on possibility of evacuation / potential need to activate the Catastrophic Medical Operations Center (CMOC) Liaison 2 120 Hours Activate Emergency Operations Plan Continue to provide updates through Public Affairs Incident Commander Activate the Emergency Operations Plan and Command Center and communicate situation and plans to all hospital and clinic departments Incident Commander Set up and test emergency communications equipment Operational Leaders, PIO, Information Services Alert Health System Liaison Team of potential for deployment to Seton or other receiving hospital(s) Health System Operations Potential Rideout Team members identified: List to Logistics Section for Sheltering Plan Health System Operations Section Chief Request activation of the CMOC (main number 713- 884-4408). This number will reach the City of Houston duty officer 24/7 who will contact the CMOC Chief on Call Liaison Provide hospitals in the region with an update on UTMB status - update EM Resource Health System Operations Emergency Department Update planning information to Seton, other receiving hospitals, and TDEM Use UTMB Form A: Initial Patient Evacuation Estimate Evacuation Support Team Leader / Liaison

13. Working Together to Work Wonders. Hurricane Response Coordination with Receiving Hospital(s) (Primarily Seton Hospital in Austin) MOUs in place Joint Planning – including use of the Texas Emergency Tracking Network Exercises Access to electronic medical records Standardization of forms Improve information flow Staff to accompany patients Equipment that accompanies patients

14. Working Together to Work Wonders. (Not Just) Hurricane Response Hazard Vulnerability Analysis High priority risks Industrial Incidents / Mass Casualty Incidents New Focus on Healthcare Coalitions Tabletops in February and March 2012 Regional Partners Early emphasis on communications planning

15. Working Together to Work Wonders. (Not Just) Hurricane Response On Call system for facilities and health system Response to after-hours no-notice incidents Emergency plans for major scheduled outages and construction activity (especially regarding utilities) Event – outage or construction Objectives Organizational Assignment List (on-call if needed) Communications (notification) Plan Safety Plan

16. Working Together to Work Wonders. (Not Just) Hurricane Response Active Shooter (Violence on Campus) New mass notification system New voice capability – fire alarms Active Shooter Exercises Student / Student Government Participation in planning Threat Assessment Team

17. Working Together to Work Wonders. (Not Just) Hurricane Response Galveston National Lab support for H1N1 outbreak

18. Working Together to Work Wonders. Processes Rules for Force Account Labor Policies on ‘disaster pay’ HICS - Track and certify Time & Effort records (be ready to integrate paper and electronic T&E systems) UT Mutual Aid – ‘a system can’t provide itself ‘mutual aid’’ Use contractors State emergency procurement laws – (use competitive procurement and have contracts in place ready to go) Contract Monitoring Teams: Project Managers

19. Working Together to Work Wonders. Response Contractors Expectation – knowledge of Public Assistance Rules and Regulations (meeting with major contractors) Contractually - Integrate operations into HICS (at UTMB discretion) Work only with signed 213RR with scope of work Any work in excess is volunteer work and will not be compensated Contract amendments Separate ‘supplies’ to degree possible Headcounts included in documentation Debris Removal and Debris Removal Monitoring Plan submitted to TDEM and FEMA Protective Measures: Policy – no assets on ground floors without approval of facilities committee. If approved, a continuity plan is required (Contracts to protect assets) No Time and Materials Contracts

20. Working Together to Work Wonders. Questions