Emergency Management Michael Whalen RN BSN Objectives Understand

Emergency Management Michael Whalen RN, BSN

Objectives: • Understand the basic principles of the 2014 CMS Emergency Management Standards • Learn the benefits of engaging in the regional Health Care Coalition • Identify training and exercise gaps within your organizational Emergency Management program

CMS Overview “These regulations are conditions of participation (COP) for Medicare and Medicaid participating providers and suppliers, meaning that they must comply with the regulations and be in compliance at the time of survey in order to participate in Medicare and Medicaid reimbursement” • Conditions of Participation (Co. Ps) and Conditions for Coverage (Cf. C) are health and safety regulations which must be met by Medicare and Medicaid-participating providers and suppliers. • They serve to protect all individuals receiving services from those organizations. Major areas: Risk Assessment and Planning o All hazards Policy and procedures o Based on risk assessment o Must include: evacuation, sheltering in place, patient tracking o Reviewed and updated annually Communication Plan Training and exercise Plan

How to Enhance the EM Program • Review and understand CMS Standards https: //asprtracie. hhs. gov/cmsrule • Assign an Emergency Manager • Consider an Emergency Management Committee/Team • • Join your Regional Health Care Coalition (HCC) Document the annual Hazard Vulnerability Assessment (HVA) Begin a all hazards planning template Communications plan development • Consider using “Knowledge Center (KC)” • Develop an appropriate Training and Exercise Plan • Create a Emergency Management survey binder

Emergency Manager role(s) • Overall maintenance of the program • EM Educator • Point of contact for: • Community partners: Emergency Management Agency (EMA), Hospital and Healthsystems Association of Pennsylvania Regional Manager (HAP), Health Care Coalition (HCC), Community Partners • Planned and actual events • Be prepared for and attend the survey

Regional Health Care Coalitions • 8 in Pennsylvania • Participation will fulfill the community participation portion of the CMS ruling • MAY host trainings and exercises • MAY offer support during real emergencies • Networking! • Highly resourceful members • Will provide FREE Knowledge Center training • Regional Operations Plans are in place

https: //www. haponline. org/Initiatives/Emergency-Preparedness

Hospital Association Of Pennsylvania: Emergency Preparedness Mark Ross, Vice President, Emergency Preparedness Jason Brown, Deputy Director, Emergency Preparedness REGIONAL MANAGERS Brian Barth, Southeast Region Matthew Linse, Northwest and Northwest Central Christopher Chamberlain, North Central and East Central Jason Tomashunas, Northeast, East Central Scott Mickalonis, South Central Mountain (Keystone Coalition) “Bbarth@Haponline. org”

Hazard Vulnerability Analysis (HVA) MUST be conducted annually Very subjective Should have input from multiple employees Recommend that three years of HVA remain in the Emergency Management binder. The HVA can also be created and stored in Knowledge Center • Top two in Pennsylvania: Weather and utility failure • • • Document in your Emergency Management meeting minutes how you are mitigating the effects of the top 2 -3 • Kaiser HVA Template https: //www. calhospitalprepare. org/post/revised-hva-toolkaiser-permanente

Planning • Incident Command structure? • Nursing Home Incident Command Systems • Hospital Incident Command Systems • Incorporate Incident Planning and Response Guides • All hazards approach • Based on annual Hazard Vulnerability Assessment (HVA) • Include three phases • Preparedness • Response • Recovery • Review and update annually

Planning • All hazards response • Communications, Evacuation, Shelter-in-place and patient tracking sections • Command structure • The Emergency Management (EM) plan should have a appendix that references supportive plans • Snow emergency plans should be part of the EM Plan • Utility failure • Generator failure • Informatics failure • Infectious disease • Health Care Coalition Plan

Hospital ICS & Nursing Home Incident Command Sysytems • Planning Guides • Response Guides • Job Action Sheets • Forms • Short training videos • Reference page https: //www. cahfdisasterprep. com/nhics https: //www. calhospitalprepare. org/hics

Incident Planning Guides (IPG) • Active Shooter • Chemical Incident • Earthquake • Evacuation, Shelter-in-Place, & Hospital Abandonment • Explosive Incident • Hostage or Barricade Incident • Infectious Disease • Information Technology (IT) Failure • Mass Casualty Incident • Missing Person • Radiation Incident • Severe Weather with Warning • Staff Shortage • Tornado • Utility Failure • Wildland Fire https: //emsa. ca. gov/hospital-incident-command-system-incident-planning-guides-2014/

Incident Response Guide (IRG) • Active Shooter • Chemical Incident • Earthquake • Evacuation, Shelter-in-Place, & Hospital Abandonment • Explosive Incident • Hostage or Barricade Incident • Infectious Disease • Information Technology (IT) Failure • Mass Casualty Incident • Missing Person • Radiation Incident • Severe Weather with Warning • Staff Shortage • Tornado • Utility Failure • Wildland Fire https: //emsa. ca. gov/hospital-incident-command-system-incident-response-guides-2014/

Incident Response Guide: Severe Weather with Warning Mission To provide for the safety of patients, visitors, and staff during a severe weather emergency such as ice storms, snowstorms, rain, flooding, extreme heat and cold, etc. Directions Read this entire response guide and review the Hospital Incident Management Team Activation chart. Use this response guide as a checklist to ensure all tasks are addressed and completed. Objectives Provide for the safety of patients, staff, families, and visitors Initiate hospital protective actions Provide patient care and management

Communications Plan • Local notification: Meet with your County Emergency Management Agency (EMA) • CMS Standard: State and Federal notification process • Notify Hospital and Healthsystems of Pennsylvania (HAP) regional manager • Coalition and community partner notification • In-house notification process • Consider ICS forms 205 a, 214, 258, 260 and or Knowledge Center forms • Patient and family notification process • PEMA Resource Request form

Knowledge Center • Must be a trained and registered user • Cannot share user ID • Free training and assistance is available (HAP Regional Manager) • The use of the platform is free to all medical providers • IS HIPPA protected • Useful to prove community engagement with regulatory agencies • www. padoh-kc. org

Training Plan • All emergency managment training should be documented • Employee orientation • Annual updates to the plan • Can be part of staff meetings but must be documented • Incident Command training (Live, HICS or NIMS) • Active Shooter/acts of violence on-line training: Department of Homeland Security (DHS) • DOCUMENT all trainings, keep records in the Emergency Management book

Exercise Plan • A FIRE DRILL will not count as an emergency management exercise • Unless…add several injuries and partial evacuation • Exercises should be built on the top 3 of the Hazard Vulnerability Analysis (HVA) • Active Shooter exercises • Please include a safety component in your exercise planning activities • Evacuation Exercises: Consider volunteers to act as patients, invite FD and EMS

What should be in place now • • • Emergency Management binder is in place 2019 Annual HVA has been documented EM Education is performed for all new employees Annual training is ready for November Exercise(s) with After Action Reports Letter or in-person meeting with local or County EMA • Plan is submitted to EMA • Connection with community partners • Register to receive ASPR TRACIE (Technical Resources Assistance Center Information Exchange) • https: //asprtracie. hhs. gov/ • CONSIDER an Emergency Power Facility Assessment (EPFAT)

The Berks County community based plan: MAJOR events • All casualties are initially evaluated at the hospitals • Absolute confirmation of isolated injuries • Non-EMS transport to surgery centers • Eye injuries (acute, foreign bodies, irritation) to Eye Centers • Simple suturing to multiple centers • Orthopedic injuries to several surgery centers • Pain management staff will offer to assist at the hospital (after license verification) • Exercised in 2014 and 2018 with success • 2 hospitals, County EMA, HAP, 8 Surgery Centers, EMS

References and links • CMS Ruling: https: //asprtracie. hhs. gov/cmsrule • Hospital and Healthsystems Association of Pennsylvania https: //www. haponline. org/Initiatives/Emergency-Preparedness • Kaiser HVA Template https: //www. calhospitalprepare. org/post/revised-hva-tool-kaiser-permanente • PEMA Resource Request Form https: //www. pema. pa. gov/about/publicinformation/Documents/PEMA%20 Resource%20 Request%20 Fillable%20 Form. p df • ASPR TRACIE: Technical Resources Assistance Center Information Exchange https: //asprtracie. hhs. gov/ • NHICS: https: //www. cahfdisasterprep. com/nhics • HICS: https: //emsa. ca. gov/disaster-medical-services-division-hospital-incident-command-system/ • Hospital Incident Command Training Video: https: //www. youtube. com/watch? v=14 SGKLZM 5 c 0&feature=youtu. be • National Incident Management Systems: IS 100 C and IS 200 HCA https: //training. fema. gov/is/crslist. aspx? all=true • DHS Shooter (posters, pocket guide, planning guide, training video) https: //www. dhs. gov/human-resources-or-securityprofessional

Acronyms • ASPR: Assistant Secretary for Preparedness and Response • TRACIE: Technical Resources Assistance Center Information Exchange • • • CMS: Centers for Medicare and Medicaid Services DHS: Department of Homeland Security EMA: Emergency Management Agency EPFAT: Emergency Power Facility Assessment Tool HAP: Hospital and Healthsystems Association of Pennsylvania HCC: Health Care Coalition HICS: Hospital Incident Command Systems HVA: Hazard Vulnerability Analysis NIMS: National Incident Management System • FAAT: FEMA Acronym, Abbreviations and Terms!

Michael Whalen: Emergency Educators LLC • emergencyedu@me. com • Emergency consultation/assistance: 610. 763. 6441

Emergency Preparedness Resources CMS Ruling: https: //asprtracie. hhs. gov/cmsrule Hospital and Healthsystems Association of Pennsylvania https: //www. haponline. org/Initiatives/Emergency-Preparedness Kaiser HVA Template https: //www. calhospitalprepare. org/post/revised-hva-tool-kaiser-permanente PEMA Resource Request Form https: //www. pema. pa. gov/about/publicinformation/Documents/PEMA%20 Resource%20 Request%20 Fillable%20 Form. pdf ASPR TRACIE: Technical Resources Assistance Center Information Exchange https: //asprtracie. hhs. gov/ NHICS: https: //www. cahfdisasterprep. com/nhics HICS: https: //emsa. ca. gov/disaster-medical-services-division-hospital-incident-command-system/ Hospital Incident Command Training Video: https: //www. youtube. com/watch? v=14 SGKLZM 5 c 0&feature=youtu. b e National Incident Management Systems: IS 100 C and IS 200 HCA https: //training. fema. gov/is/crslist. aspx? all=true DHS Shooter (posters, pocket guide, planning guide, training video) https: //www. dhs. gov/human-resources-or-security-professional Palm Beach County, Florida. (2014) CMS Cross reference for a comprehensive Ambulatory Surgical Center Emergency Plan http: //discover. pbcgov. org/publicsafety/dem/Publications/2014 -ASC -Blank_crosswalk. pdf