Comprehensive Emergency Management Plan CEMP Developers Guide DOH

Comprehensive Emergency Management Plan (CEMP) Developer’s Guide DOH Charlotte/Sarasota Yamilet Santana-Reyes-Emergency Planning Consultant Carol Jeffers-Government Analyst II, September 20, 2018 1

Abbreviations • Comprehensive Emergency Management Plan (CEMP) • Department of Health (DOH) • Charlotte County Department of Health (CCHD) • Sarasota County Department of Health (SCHD) • Home Health Agencies (HHA) • Nurse Registries (NR) • Hospice Agencies (HA) • Durable Medical Equipment Providers (DME) 2

Definitions • Emergency – Manageable internally and/or with existing resources • Disaster – Requires external resources – Has major widespread and/or prolonged disruptive impact. • Continuity of Operations Plan (COOP) – Plans for emergency operations with alternate processes and/or operations from an alternate location • Succession Plan – Plans for emergency leadership should primary leader(s) become incapacitated 3

DOH CEMP Review Sectors • Home Health Agencies – 400. 497(10)(c), FS – Includes home companion services • Nurse Registries – 400. 506(12)(e), FAC • Hospice Agencies – 400. 610(1)(b), FS – In Home & At Facility • Durable Medical Equipment Providers – 400. 934(20)(b), FS – Including agencies operating a website and/or distribution center 4

CCHD CEMP Logistics • Where To Find Updated Templates ? – Other Planning Criteria's – ACHA Resources • Where to send CEMPs? – Charlotte. Preparedness@flhealth. gov – Due annually 90 days before recertification due date 5

SCHD CEMP Logistics • Where To Find Updated Templates ? – DOH-Sarasota will provide the required template. – ACHA Resources • Where to send CEMPs? – SRQ. Cemp@flhealth. gov – Due annually 90 days before recertification date 6

CEMP Review & Approval Process • Submit Agency CEMP to Local DOH 90 Days Before AHCA Recertification Deadline. – CCHD/SCHD will reply with a CEMP Receipt notice within 2 weeks. • CCHD/SCHD Reviews CEMP and Sends Agency a CEMP Status Notice – Per Florida Statutes DOH has 90 days to review a CEMP after receipt. – Application status email will indicate one of the following: • Approved • More Information Needed, or • Denied 7

CEMP Review & Approval Process • Agencies have 30 days to submit any requested corrections or additions. • Agencies without an approved CEMP at the time of their annual recertification deadline will be out of compliance with ACHA and subject to applicable AHCA fines. 8

CEMP Legal Guidance Provider Type Home Health Agencies Licensure Statute Chapter/Part 400, Part III & 408, Part II, FS Licensure Rules 59 A-8, FAC Rule Authority Agency AHCA Emergency Planning Criteria Regulations 400. 492, FS 59 A-8. 027 FAC Emergency Plan Review & Approval 400. 497(10)(c), FS County Health Dept Submission Timeframe Annually Home Medical Equipment 400, Part VII & 408, Part II, FS 59 A-25, FAC AHCA 400. 934(20)-(22) & 400. 935(9), FS 59 A-25. 006 FAC 400. 934(20)(b), FS County Health Dept Annually Hospice 400, Part IV & 408, Part II, FS 58 A-2, FAC DOEA 400. 610(1)(b), FS 58 A-2. 005(1)(c)1. d. , 58 A-2. 026 FAC 400. 610(1)(b), FS County Health Dept Not stated Hospitals 395, Part I & 408, Part 59 A-3 FAC II, FS AHCA 395. 1055(1)(c), FS 59 A-3. 078 FAC Annually Intermediate Care Facilities 400, Part VIII & 408 , Part II, FS 59 A-26, FAC AHCA 400. 967, FS 59 A-26. 020, FAC Nurse Registry 400, Part III & 408, Part II, FS 59 A-18, FAC AHCA 400. 506(12), FS 59 A-18. 018, FAC 395. 1055(1)(c ), FS Local emergency management agency 400. 967(2)(g), FS Local emergency management agency 400. 506(12)(e), FAC County Health Dept Nursing Homes Emergency Environmental Control Plan (CEMP Supplement) 400, Part II & 408, Part II, FS 59 A-4 FAC AHCA 400. 23(2)(g), FS 59 A-4. 126, FAC 400. 23(2)(g), FS 59 A-4. 126 & 59 A-4. 1265, FAC 400. 23(2)(g), FS Local emergency management agency 59 A-4. 1265, FAC Local emergency management agency Annually Requires approval prior to initial licensure and if a change of ownership occurs (Re-submit annually as a supplement to the CEMP or when substantive changes occur) Annually 9

Standard Content in CEMPs FS 400. 506(15)(16) • Hazard Vulnerability Assessment – (Identify realistic and likely emergencies/Disasters? ) • Operational Plans – Processes to Manage Identified Hazards and Unknowns (What will be done to solve the problem? & Why is it necessary to do so? & How will objectives and goals be prioritized? ) • Tactical Plans – Resources and Strategies Needed to Effectively Respond to and Recover from the Emergency/Disaster (How will the problem be solved? & How will operational plans and goals be achieved? ) 10

Standard Content in CEMPs FS 400. 506(15)(16) • Emergency Leadership & Staffing – Person in Charge – Key Staff – Chain of Command • Emergency Communications – Before, During & After an Emergency/Disaster – Clients, Client Family, Staff, Vendors, MOU Partners, Emergency Management (ESF 8 Desk), DOH – Real Time Call Tree List – Redundant Communication 11

Standard Content in CEMPs FS 400. 506(15)(16) • Emergency Communications Continued – – – AHCA Emergency Status System (ESS) Everbridge (DOH and HCC) Local County Alert System Healthcare Coalition Sarasota County Community Organizations Active in Disaster (COAD) – NOAA All-Hazards Alert Radio 12

Standard Content in CEMPs FS 400. 506(15)(16) • COOP – How alternate processes for critical services are set up, maintained and demobilized onsite and remotely • Disaster Preparedness Training and Exercise – – Staff Clients/Family Vendors MOU, Emergency Management, DOH and Community Partners • Staff assistance to Clients & Caregivers 13

Standard Content in CEMPs FS 400. 506(15)(16) • Remote Support – Medical Needs Shelter – Other Alternate Locations other than that of blue skies • Transportation Plans 14

Special/Medical Needs Clients § Medical/Special Needs (Sp. NS) shelters should be last resort for evacuation § § Level of care can be less than customary Living arrangements can be discomforting § Minimal source of communication 12 -72 hours § Ensure the appropriate clients are enrolled in the Sp. NS/MDEC Shelter Registry 15

Special/Medical Needs Clients § Home Health Agency medically manages and staff MDEC/Sp. NS shelters during emergency 16

HHA Medically Manage & Staff in Sp. NS Shelters 59 A-8. 027(10), F. A. C During emergency situations, when there is not a mandatory evacuation order issued by the local Emergency Management agency; The home health agency must establish procedures, prior to the time of an emergency, which will delineate to what extent the agency will continue care during and immediately following an emergency. The agency shall also ascertain which patients remaining at home will need care from the home health agency and which patients have plans to receive care from their family or caregivers. The agency shall designate staff to continue the services specified in the treatment orders to residents in the assisted living facility or adult family care home during and following the emergency. If the residents should go to a special needs shelter outside of the geographic service area the home health agency is licensed to serve, the home health agency may provide services to the residents at the shelter pursuant to Section 400. 492(4), F. S. 17

Preparing Staff FS 400. 506(15)(16) • Home Preparation (Personal & Family) – Who’s caring for your Staff? • Are they mentally & physically able to deploy to Sp. NS Shelter • Do they have an Emergency Go-Kit ready? – Family Emergency & Communication Plan • Get. APlan. gov • www. alertcharlotte. com – Staying Home • Enough supplies for yourself, each family member, and pets for at least 72 -96 hours. • Before Emergency Safety Tips 18

Hurricane Matthew. Lessons Learned A. Are they outlined in your CEMP plan? i. Facilities did not adhere to their written CEMP plans ii. Decision to evacuate (Hosp and SNF) came too late iii. Internal staff were not familiar with CEMP plan or were hesitant to implement CEMP Evacuation Triggers 19

Hurricane Matthew. Lessons Learned A. Where do you evacuate to? CEMP Evacuation Triggers i. Hurricane impacted multiple jurisdictions simultaneously ii. Evacuation plans to sister facilities was not always possible 20

Hurricane Matthew- Lessons Learned …cont. Critical Vendor Issues A. Healthcare facilities shared the same vendors for critical needs a) Oxygen b) Transportation B. No back-up vendors were identified in advance a) Consider the utilization of vendors from another region/county C. Vendors stopped answering calls/requests once overwhelmed 21

Hurricane Matthew- Lessons Learned …cont. Health Care Facilities Break Down in Communications • Failed to provide situational awareness to ESF 8 • Requests for resources or assistance were vague – On facility activities and conditions. • Failed to follow Communication chain of command – HCF communicate with local ESF 8, not to state ESF 8 or other ESFs • Unrealistic timeframe expectations – Ambulance strike teams and other MRP take time to deploy – Cannot deploy assets into harms way 22

How to Improve writing your CEMPs Establish Relationships with Partners • CCHD office of Emergency Preparedness and Response • Re-Evaluate CEMP Plans • AHCA Emergency Plan Regulations & Review • Highly consider creating memorandums of understandings (MOUs) • Conduct realistic exercises – Affiliate your staff to attend healthcare coalitions meetings (consistent members) • Adhere to designated lines of communication 23

In A Nutshell Concluding Key Points • DOH will review CEMPS for improvement and approval. • AHCA’s CEMP template will be modified to accomplish the following: – Standardize format – Provide additional guidance to agencies as needed – Improve readability 24

In A Nutshell Concluding Key Points • All agencies will need to use the new format. • Critical CEMP must haves: – Complete all sections even if the question seems redundant. Be specific where needed. – Provide all requested supportive documents and client. – Conduct emergency training and exercises with all staff. – Submit CEMP on time, 90 days before 25 recertification deadline.

DOH-Charlotte and DOH-Sarasota strives to Help our Providers seek education and guidance for Success Thank you for your Attention!! 26