1. Texas Association of Hospital Facility Managers May, 2006 Planning for the Future Jonathan Huss Intra-Governmental Liaison Texas Department of State Health Services

2. “Good God! What horror and destruction”

3. It seemed as if a total dissolution of nature was taking place.

4. The roaring of the sea and wind

5. The prodigious glare of almost perpetual lightning

6. The crash of falling houses

7. And the ear piercing shrieks of the distressed were sufficient to strike astonishment into Angels

8. A great part of the buildings throughout the island are leveled to the ground

9. Almost all the rest very much shattered – several persons killed and numbers utterly ruined

10. Whole families wandering about the streets, unknowing where to find a place of shelter

11. The sick exposed to the keenness of water and air – without a bed to lie upon – or a dry covering to their bodies

12. And our harbors entirely bare

13. In a word, misery, in its most hideous shapes, spread over the whole face of the country… Alexander Hamilton 18 th Century

17. U.S. Mainland Hurricane Strikes 1851-2004 Category 12345All / Major U.S.1097271183273 / 92 Texas231712 7059 / 19 Source: NOAA

18. DSHS Response Supported local and regional health & medical responses; and worked in support of evacuations (K/R) Facilitated sheltering of medical special needs evacuees (R) Mobilized to solve prescription drug & immunization challenges (K/R) Deployed federal and volunteer medical teams to areas of identified need

19. Coordinated with FEMA and HHS on evacuation, re-evacuation & repatriation (R) Mobilized mental health & substance abuse assets (K/R) Assembled & deployed Public Health Response Teams (K/R) DSHS Response

20. The dogmas of the past are inadequate to the stormy future. - Lincoln Rigorous Honesty Is Required

21. Medical Special Needs Populations Background: Report to the Governor (October 2004) Special Needs defined in four broad categories: Institutionalized Medical Homeless Mental Health/Mental Retardation Home Health/Meals on Wheels July 2005: DSHS charged with developing plan to assist and care for “Special Needs” population March 2006: Have a draft plan ready by April 15

22. We have a plan!

23. Special Needs: Actions Taken Governor’s Special Task Force on Evacuation DSHS After Action Review Coordination meetings with sister agencies Coordination with Governor’s Division of Emergency Management Develop a data base / Refine definition / Train shelter managers Pre-define shelters with appropriate training for managers Coordinate evacuation transportation Revise and tighten regulations regarding regulated care providers’ disaster planning protocols Engage PCPs and Pharmacy communities to prepare SN population for disaster response

24. Clear definitions of medical special populations Pre-registration of people with special needs Transportation arranged in advance with early evacuation plans in place Hub City and Sister City designations Clear expectations of shelter management roles & responsibilities Clear expectations of individuals with medical special needs in institutional and regulated facility settings Medical Special Needs Shelter Plan General Concepts

25. Types of Medical Special Needs Persons Medical Special Needs Shelter Level 1: persons dependent on others for routine care Level 2: persons with disabilities such as blind, hearing impaired, amputation, Level 3: persons needing monitoring by a nurse, dependent on equipment, assistance with medications, mental health disorders.

26. Types of Medical Special Needs Persons Medical Facility Level 4: persons who require extensive medical oversight (i.e. IV chemotherapy, ventilator, dialysis, life support equipment). Level 5: persons in hospitals, long-term care & assisted living facilities

28. Lessons Have a plan and work the plan Sustainability of training, organization and staffing Public health and other governmental agencies awareness and openness to MHSA issues is lacking Plan past the emergency phase Understand the gaps between what the feds can do, what the state can do, and what local agencies can do Appreciate the importance of policy coordination Take care of your people All disasters are local

29. Lessons cont. Preparedness works Communication requires both front channel & back channel options Asking the right questions is critical Improvisation is essential Leadership must be decisive – not risk averse

30. Suggestions for Facility Disaster Planning Sheltering in place? Plan on back-up systems for your back-up systems Generators Water Electrical Medical Gases Security Define “Surge Capacity” Staffed capacity Design capacity Disaster capacity

31. So… What’s ahead?

32. The only thing more difficult than planning for an emergency is having to explain why you didn’t. Be Proactive NOT Reactive! Timing is everything

33. Contact Information Jon Huss Intra-Governmental Liaison Texas Department of State Health Services 1100 West 49 th Street Austin, TX 78756 Jon.huss@dshs.state.tx.us 512-458-7111 x 3182