Hospital Preparedness Program HPP Public Health Emergency Preparedness

Hospital Preparedness Program (HPP) & Public Health Emergency Preparedness (PHEP) Grant Alignment 10/2012 Kansas Regional Preparedness Training 2012 1

Grant Alignment Requirement • White House directed – Better alignment of emergency preparedness programs • HPP and PHEP awardee requested – Reduce duplicative/conflicting activities and redundancies § DHHS preparedness awards nearing $1 billion annually • Funding sustainability requires demonstration of how funding has: – Increased operational efficiencies – Improved preparedness integration across the federal government, with partners and with the public – Improved national public health and medical preparedness 10/2012 Kansas Regional Preparedness Training 2012 2

HPP-PHEP Cooperative Agreement • Capabilities-based approach • Building upon the strong preparedness foundation already in place • Benefits – More coordinated and integrated public health and healthcare service delivery system planning and response – Improved ability to leverage funding for applicable activities and infrastructure – Reduced burden regarding duplicative and conflicting activities and reporting 10/2012 Kansas Regional Preparedness Training 2012 3

Shift from Building to Strengthening • Aims to broaden the scope of the healthcare service delivery systems preparedness from individual facilities to diverse regional healthcare coalitions (HCC) • Allows program to identify gaps in preparedness, determine specific priorities, and develop plans for building and sustaining specific capabilities 10/2012 Kansas Regional Preparedness Training 2012 4

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WHAT? Healthcare Coalition (HCC) 10/2012 6

WHAT? Healthcare Coalition (HCC) Health and Human Services Definition of healthcare coalition (HCC): A collaborative network of healthcare organizations and their respective public and private sector response partners that serve as a multiagency coordinating group to assist with preparedness, response, recovery, and mitigation activities related to healthcare organization disaster operations. 10/2012 Kansas Regional Preparedness Training 2012 7

WHAT? IS • A Multi-agency coordination group that includes multiple healthcare organization members (HCOs) within the response community • A collective team that assists Emergency Management and Emergency Support Function (ESF) #8 partners • A collaborative effort to plan, organize, equip, train, exercise, evaluate and outline corrective actions 10/2012 IS NOT · One individual agency/organization · Two individual agencies/organizations · Hospital-only regional group · Public health-only regional group · A deployable response team · Made up primarily of individuals, but of organizations 8

WHAT? DOES • Focus on the cycle of preparedness, response, recovery, and mitigation activities • Promote situational awareness for HCOs • Conduct regional healthcare coalition meetings • Engage partners in Hazard Vulnerability Assessment (HVA) discussions 10/2012 DOES NOT • Conduct non-preparedness or non-response related activities or business • “Command” the actions of Coalition members or any other response entities it might interact with during an emergency • Use only one county-level Hazard Vulnerability Assessment (HVA) for substitution of the entire regional HVA 9

WHAT? DOES • Have the ability to share Essential Elements of Information (EEIs) data electronically across the HCC (e. g. , bed status) • Utilize subject matter experts from across the region for information sharing 10/2012 DOES NOT • Have to own the electronic systems being shared or utilized within the region • Have to have the resources locally, but have access to resources within the region 10

WHAT? Healthcare Coalition (HCC) Purpose of HCC Healthcare system-wide approach for preparing for, responding to, and recovering from incidents that have a public health and medical impact in the short-and long-term. Primary Function of HCC 10/2012 Sub-state regional healthcare system emergency preparedness activities involving the healthcare member organizations (HCOs). This includes planning, organizing, equipping, training, exercises and evaluation. 11

WHAT? Healthcare Coalition (HCC) Response of HCCs should represent healthcare organizations by providing multi-agency coordination advice on decisions made by incident management regarding information & resource coordination Advice through: • A multi-agency coordination group to assist incident management (area command or unified command) OR 10/2012 • Through coordinated plans to guide decisions regarding healthcare organization support 12

WHO? Healthcare Coalition Member Organizations (HCO) • • 10/2012 • • Hospitals (at least 1) healthcare (e. g. , Hospital associations) Public health • Support service providers (e. g. , laboratories, pharmacies, blood banks, EMS providers poison control) Emergency Management • Federal entities (e. g. , NDMS, VA Mental/behavioral health providers hospitals, IHS facilities, Department of Long-term care providers Defense) Specialty service providers (e. g. , dialysis, • Volunteer Organizations Active in pediatrics, woman’s health, stand alone Disaster (VOAD) surgery, urgent care) • Faith-based Organizations (FBOs) Primary care providers • Community-based Organizations (CBOs) Community Health Centers • Volunteer medical organizations (e. g. , Tribal Healthcare American Red Cross) Other healthcare providers County Coroner Public safety Kansas Regional Preparedness Training Private entities associated with 13 2012

WHO? Healthcare Coalition (HCC) 10/2012 Kansas Regional Preparedness Training 2012 14

WHERE? • Regional-based preparedness programs already in place • Common purpose: – To serve as a collaborative network of healthcare organizations to assist with preparedness, response, recovery, and mitigation activities related to healthcare organization disaster operations. 10/2012 Kansas Regional Preparedness Training 2012 15

WHERE? Kansas Healthcare Coalitions Don’t Recreate the wheel! Use existing networks. 10/2012 Kansas Regional Preparedness Training 2012 16

WHERE? Non-Kansas Healthcare Coalitions • Most states are choosing to utilize their current regional structure for healthcare coalitions • Some are using State as one coalition • Few states are using city or county based communities 10/2012 Kansas Regional Preparedness Training 2012 17

WHEN? Five Year Grant Period Working in close collaboration with internal and external subject matter experts (SMEs), ASPR and CDC developed a set of new performance measures for 2012 -2013 that enable ASPR and its HPP awardees to: • Enhance situational awareness • Provide technical assistance • Support program improvement and inform policy • Increase transparency • Promote sound stewardship of Federal tax dollars by using the data to assess impact of public funding and ensure that the American taxpayer sees a return on his or her investment. – The development of program measures and continuous quality improvement enables Healthcare Systems Evaluation Branch (HSEB) within ASPR to critically evaluate the ability of the HPP program to perform its intended goals. 10/2012 Kansas Regional Preparedness Training 2012 18

WHY? The Assistant Secretary for Preparedness and Response (ASPR) has always supported region-based approaches for preparedness planning. This has been a part of the preparedness program for many years. You can learn more from the ASPR 2009 report, From Hospitals to Healthcare Coalitions: Transforming Health Preparedness & Response in Our Communities. In this report, ASPR highlighted the seven Kansas regional hospital groups as a best practice for collaborative efforts resulting in shared resources and stronger relationships. This is the structure that will continue to be used moving forward. 10/2012 Kansas Regional Preparedness Training 2012 19

WHY? 10/2012 Kansas Regional Preparedness Training 2012 20

HOW? Challenges & Solutions Challenge Example #1: Preparedness funding realities Possible Solutions: • Capitalize on policy initiatives and resources • Military. Force Multiplier--A capability that, when added to and employed by a combat force, significantly increases the combat potential of that force and thus enhances the probability of successful mission accomplishment. • Racing. Drafting or slipstreaming is a technique where two vehicles or other moving objects are caused to align in a close group reducing the overall effect of drag • Collaboration Effect 10/2012 Kansas Regional Preparedness Training 2012 21

HOW? Collaboration Effect 100% Prepared Regional Preparedness Gap Coalitions National Healthcare System 10/2012 Kansas Regional Preparedness Training 2012 22

HOW? Collaboration Effect 100% Prepared Regional Preparedness Gap Coalitions National Healthcare System 10/2012 Kansas Regional Preparedness Training 2012 23

HOW? Achieving Success 100% Prepared National Healthcare System 10/2012 Kansas Regional Preparedness Training 2012 24

HOW? Challenges & Solutions Challenge Example #2: Coalition integration into disaster response Possible Solution: 10/2012 Kansas Regional Preparedness Training 2012 25

HOW? Challenges & Solutions Challenge Example #3: “surge” capacity “Surge” capacity is shrinking Possible Solution: Coalition immediate bed availability q. Immediate bed availability (IBA) is built into the existing system q. Uses regional capacity q. Expanding local capabilities q. Builds on current regional structures q. Builds on regional collaboration IBA principles Constant acuity monitoring across the coalition Patient awareness and continuous discharge planning 20% acute care offload (IBA) 10/2012 Kansas Regional Preparedness Training 2012 26

Immediate Bed Availability 10/2012 Kansas Regional Preparedness Training 2012 27

Coalitions & Immediate Bed Availability Hospitals Stroke/MIs Coalition Partners Long Term Care High Acuity Psychiatric patients ICU Patients EVENT Acute Surgical Patients Community Health Centers Imminent OB delivery Lesser Acuity Awaiting discharge 20% Behavioral Health Issues Social Issues Acute Home Post Operative Patients Elective Procedures Cancelled 10/2012 Kansas Regional Preparedness Training 2012 28

HOW? Challenges & Solutions Case Study: Madrid 3/11/2004 • Coordinated nearsimultaneous attacks targeting commuter trains • 191 dead • More than 2, 600 injured 10/2012 Kansas Regional Preparedness Training 2012 29

HOW? Challenges & Solutions Case Study: Madrid 3/11/2004 10/2012 Kansas Regional Preparedness Training 2012 30

HOW? Challenges & Solutions Case Study: Madrid 3/11/2004 10/2012 Kansas Regional Preparedness Training 2012 31

HOW? Challenges & Solutions Functional IBA? Discussions across HCCs 1000 acute care beds/coalition 20% IBA Results in 200 beds immediately avail/coalition 100 coalitions in the United States Across the U. S. , 20, 000 beds available— immediately • Madrid = 2, 000 patients - Require 10 coalitions engaged • • • 10/2012 Kansas Regional Preparedness Training 2012 32