Utilizing the Marylands Emergency Preparedness Manual Diane Link

Utilizing the Maryland’s Emergency Preparedness Manual Diane Link RN, MHA

Overview • • Why agencies need a plan Hazard vulnerability assessment Agency assessment Planning by event Incident command Business continuity Community resources 484. 22 Condition of Participation: Emergency Preparedness

Why Does an Agency Need a Plan? • Increasing number of disasters o Natural o Man Made • • • Home Health cares for vulnerable population Protect workforce Protect agency Limit impact on operations Financial impact Emergency Preparedness Final Rule 2016

Hazard Vulnerability Assessment • Tool designed to identify and evaluate agency level of risk and preparedness for a variety of emergencies. • Events categories: o Natural disasters – heat/cold; thunderstorms, flooding, blizzards, tornado, earthquake, fire o Biological/environmental – epidemic flu, chemical spill, nuclear incident, air pollution o Man Made – civil disturbance, bomb threat, terrorist threat, workplace violence, mass casualty, active shooter o Operational – electric power failure, communication failure, water failure, information system failure, transportation

Scoring • Key Words: o Probability - frequency or likelihood an event will occur • 3 – very likely to occur - history of every 1 to 3 years • 2 – likely to occur – history every 3 – 10 years • 1 – unlikely to occur – history over 10 years o Vulnerability - degree which agency will be impacted consider items such as service disruption, infrastructure damage, financial impact, potential for health hazard or life threatening • 3 – total disruption – unable to provide services, use facility • 2 – moderate disruption – unable to provide services, use facility for short period of time • 1 – Low disruption little or no impact o Preparedness – agency’s experience in dealing with events • 1 – Good – plan in place or encountered event with success • 2 – Fair – plan is in place but could be improved, past challenge • 3 – Poor – no plan in place or agency unable to overcome past challenges

Agency Assessment • Review current emergency preparedness plan • Compare current plan to Home Care Emergency Preparedness Assessment Tool (pg 8) • Any no answers should be reviewed for need • Update and /or create comprehensive emergency preparedness plan NOW “We can not stop natural disasters but we can arm ourselves with knowledge: so many lives wouldn’t have to be lost if there was enough disaster preparedness” Petra Nemcova – Tsunami survivor

Agency Assessment

Assessment • On admission and updated as needed: o o o Patient demographics Caregiver contact Medical procedures/treatments ADLS Durable Medical Equipment Medical Supplies Identify patient emergency plan in the event of disaster. Acuity Scale 1 - High risk – assistance is needed, no caregiver available; needs care in 24 hours 2 - Moderate risk – caregiver available but needs support; requires visit within 24 – 48 hours 3 – Low risk – caregiver is available, visit can be postponed >48 hours

Emergency Planning by Event • Using hazard vulnerability assessment identify risks • Develop written plans for all 2 and 3 probability and vulnerability areas • Develop education staff, caregivers and patients • Review plan at least yearly

Civil Disturbance An act of disorder or violence to the public law and order such as riots, acts of violence, unlawful obstructions • • As soon as you are aware of event – implement communication plan Staff should remain calm and leave/ avoid area of disturbance Triage patient visits If visits must be made – visits should be made in pairs or with escort If needed transfer patients to safe area All doors should remain locked and entrance by verification of ID only If necessary evacuate building or relocate personnel

Workplace Violence Pre-emergency Plan Any act or threat of physical violence, harassment, intimidation or threatening behavior that occurs at worksite including patient homes • • Continual identification and mitigation of potential violence Admission staff should screen patient’s environment for potential threats and follow policy for removal Communication to all visiting staff regarding potential issues or disruptive situation in patient’s home Encourage staff to report any incident or questionable behavior to supervisor Keep unobstructed exit from room at all times Recognize and respond to escalating behaviors If feeling threatened leave immediately and contact supervisor

Active Workplace Violence • Immediately leave the area • If active shooter occurrence – evacuate leaving belongings behind if unsafe then evacuate call 911 • Hide Out – find place to hide out of the view of the shooter, Call 911 then turn off cell phones, do not talk, remain calm and hide behind large items. • Take Action – as last resort and if in imminent danger such as throwing items, improvising weapon, yelling BE COMMITTED AND PREPARED TO ACT • After police arrive – police priority is to stop active shooter. Police will proceed directly to area where last shots occurred. Follow orders and keep hands up and visible at all times

Communication Interruption Communication interruption can include telephone and information systems. • Telephone Interruption o o Transfer or forward calls to working number Utilize cell phones to communicate with patients staff Contact telephone company Keep communication with office emergency use only • Information System Interruption o o Planned interruption – prepare hard copy of records for visiting staff Longer than 24 hours – alternative documentation plan Administrative staff ensures paper forms of documentation available Plan for data entry after resolution of interruption

Influenza Emergency preparedness plan is focused on taking measures to protect staff and prevent further spread of illness. Influenza is spread mostly through airborne droplets Seasonal flu – strain or type of flu that circulates typically October to late May Pandemic flu – a new strain of flu with little or no immunity for people. Pandemic virus is spread over several continents. Can cause severe consequences including high rates of worker absenteeism, overcrowding health systems and death.

Influenza Preparation • Encourage annual influenza vaccination • Identify essential staff members • Identify contact and monitor local health department communications • Educate staff of s/s of influenza (fever and resp. sx) • Educate staff on standard precautions • Staff should prepare individual response planning for backup for family or child care arrangements • Assess supplies on hand o 2 to 3 weeks of supplies including o Gloves, gowns, antimicrobial soap, alcohol sanitizer, N 95 face mask

Influenza – Infection Control Standard precautions including: • • Hand hygiene Gloves Gowns Instruct patient on respiratory hygiene Move patient to separate room away from others Wear mask upon entering room Instruct patient to wear mask when leaving home and limit visitors

Tornado A violent windstorm characterized by a rotating funnel – shaped cloud that can spawn thunderstorms Tornado watch – issued when conditions are favorable formation of tornado Tornado warning – issued when tornado has been sighted or indicated by weather radar • Close all curtains/blinds and move to secure location • • Small interior room, hallways on lowest level available Visiting staff o In home follow above o If lives in mobile home leave area o In vehicle – drive to secure location or storm shelter • Avoid parking under overpass or bridge • Get out of car lie in a ditch or low lying area away from vehicle • If unable to exit – with seat belt on cover head/neck with arms and any padded material

Incident Commands Incident Command System is designed for collaboration between agency and emergency operations with an established chain of command Terminology: • Management by Objective – during emergency not business as usual prepare by having clearly defined objectives and tasks based on agencies policy • Incident Action Planning – documentation of event and reflect overall strategy for managing incident • Resource Management – tactical resources include staff and equipment Support resources are other resources to support the event such as food, equipment, supplies, vehicles, communication tools • Integrated communication – communication devices and communication policy and plan for sharing information internally and externally

Command Structure

Roles and Responsibilities • Incident Commander – ALWAYS activated in an incident regardless of size or extent of incident o Sets the objectives, devises strategies, prioritizes, maintains overall responsibility for managing the incident o Determines level of emergency response • Operations o Responsible for tactile operations – staff and equipment • Planning o Collects and evaluates information and data for decision support, maintains resource status, responsible for documentation • Logistics o Provides support, resources and other essential services (food, transportation, supplies) • Finance o Monitors costs related to incident, procurement of items, time recording and cost analysis

Additional Roles • Public Information Officer • Developing and releasing information about incident to staff and other organizations • Safety Officer o Overall safety of response activities. Evaluates data and communicates updates to incident command. Ensures internal locations are hazard free • Liaison Officer o Link between external partners and agency. Includes relay of information to community, county/state emergency officials, public health authorities or other agencies • Patient Care Branch Director o Responsible for continuation of patient care services and provision of care to injured staff /volunteers

Documentation

Business Continuity Plan that incorporates prevention, preparedness, response and recovery as part of the planning process. Address critical processes in each department essential to maintaining operations Checklist in manual is designed as a guide to start preparing continuity plan

Business Impact Analysis Identifies and prioritizes essential processes in each department.

Emergency Contacts Employee Contacts External resources include • • • Police/emergency services Health department Insurance company Suppliers Utilities

Business Records • Business Records Identify all business records including contracts, employment records and patient related information. The business record includes where records are located and other storage/backed up areas. • Vendor Listing of all vendors with contact information • Information Systems Data Back Up Plan Identification of all systems that are backed up, frequency of back up and assigned person • Information Systems Reports Listing of all reports utilized in daily operations including description, report function and retrieval method • Information System Software List Software application, vendor and platform along with recovery priority

Event Log Upon initiation of incident command event log should be started and maintained throughout incident.

Financial Tracker Records all expenses related to incident and may be used for reporting reimbursements.

Risk Management Plan Identification of potential risks and actions that can be done to minimize impact.

Community Resources Agencies should create a list of local, state and federal resources. Examples • Federal Emergency Management Agency • Maryland Emergency Management Agency • County Emergency Preparedness Offices • Maryland Department of Health and Mental Hygiene • County Health Department • Local hospitals • Evacuation / emergency shelters

484. 22 Co. P: Emergency Preparedness • Establish and maintain an emergency preparedness program that includes • Emergency Plan reviewed and updated annually • Policies and Procedures based on risk assessment • Reviewed and updated annually • Communication plan o Reviewed and updated annually • Training and testing o Initial training o Annual exercise that is full scale experience community based or agency based If agency experiences emergency requiring activation of plan then would be exempt for 1 year after event

Questions? Contact information: Diane Link RN, MHA 443 -340 -4646 dianelink@Black. Tree. Healthcare. com