Emergency

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Emergency Disaster Medical-Health Response in
Santa Clara County
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Welcome from OConnor

• Ron Galonsky, Interim CEO
• OConnor Hospital

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Housekeeping

• Emergency exits
• Restrooms
• Please limit distractions
• Introductions

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Todays Agenda

• The Santa Clara County Medical Health System
• Communicating with the County
• Your role and the role of the County
• Break Static display
• MVDR
• NIMS/SEMS Mandates
• Training links
• Establishing Workgroups
• CAHF
• Open Forum QA and static display

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Why We Asked You To Attend

• Santa Clara County will experience a wide spread
  medical-health emergency event, either man-made
  or naturally occurring.
• We want you to know what we can and can not do
  for you.
• We want you to know what resources we have
  available to you to assist in your planning and
  exercise efforts now.
• We want to tie you together with our response
  partners.
• We want to help you prepare to management
  emergency and disaster situations in your
  facility.

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Objectives

• Review the components of the Countywide Medical
  Response System (CMRS).
• Review key target hazards and the expected
  response from the EMS Agency/Public Health
  Department.
• Understand your role and the role of the County.

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Objectives

• Introduce the concept of the Allied Healthcare
  Facility Working Group
• Provide an overview of available resources to
  include training, exercises, subject matter
  expertise, etc.
• Enhance communication between facilities and the
  County related to medical-health preparedness,
  mitigation, response, and recovery.

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Bruce H. LeeDirector of Emergency Medical
Services
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Leadership
Santa Clara County CMRS System
CBOs
EMA
EMS
Hospitals
CMRS
Fire
PH Dept.
Law
Clinics
Schools
CMRS
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General Concepts

• When a single facility is experiencing an
  emergency, many resources are available and the
  pubic safety response will be great.

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General Concepts

• Public safety partners are able to support
  facilities better if they are prepared to provide
  the following information quickly
• (1) explain what has occurred,
• (2) what has been done, and
• (3) what assistance is requested

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General Concepts

• Public safety partners support the facility at
  the time of an emergency, but the facility
  maintains the responsibility for preparedness,
  mitigation, response, and recovery.

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General Concepts

• In general the bigger a non-single site event
  is (earthquake), the longer a facility with
  medical care services is expected to operate
  without government support.

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General Concepts

• Your facility must be able to be self-sufficient
  for at least 72 hours.
• Plans should not assume any assistance for at
  least 72 hours and should also assume that
  assistance may not arrive for 96 hours or
  greater, depending on the size and nature of an
  event.
• Emergency plans should identify procedures for
  the first 72 and 96 hours, three weeks, and three
  months from the time of an emergency at a minimum.

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Mobile Medical Supply
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Food Water
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Medical Care
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Facility Notification

• Primary
• California Health Alert Network (CAHAN) -
  Optional
• Santa Clara County Emergency Integrated
  Management System
• Medical-Health event information and
  instructions.
• Electronic media notifications.
• To sign-up for CAHAN -
• Kirsten Muehlenberg
• Kirsten.Muehlenberg_at_hhs.sccgov.org

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Facility Notification
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Facility Notification

• Secondary
• Physician Alerts (slower/non-urgent)
• Emergency Alert System (EAS)
• Reverse 911 Other (city, associations, etc.).

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Countywide Emergency/Disaster
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Disaster and Emergency Operational Area
(Government)

• Exceed all available resources..
• Cities
• County (Operational Area)
• Region
• State
• Federal

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Disaster and Emergency Operational Area
(Private)

• Exceed all available resources..
• Exhaust all internal and network resources
• Exhaust all MOUs and Service Agreements
• City for Support Services (life threat)
• County for Medical-Health Specific (life threat)
• Must be a SEMS/NIMS compliant entity to quality
  for reimbursement.

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Operational Area Delegations
Sec. A8-7. County/operational area mutual aid
coordinators. The following are named for the
purpose of coordinating emergency mutual aid
requests made through established state
procedures Building inspector mutual
aid--County Chief Building Official. Emergency
management mutual aid--County Emergency Services
Manager. Fire and rescue mutual aid--Chief,
Santa Clara County Fire Department. Law
enforcement mutual aid--County Sheriff. Medical
Examiner-Coroner mutual aid--County Medical
Examiner-Coroner. Medical/health mutual
aid--County Public Health Officer. Public works
mutual aid--Director, County Roads and Airports.
(Ord. No. NS-300.600, 2, 5-13-97)
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EMS/Public Health Response

• What to Expect

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General Approach

• Support facilities emergency plan.
• Assist with access to resources.
• Facilitate public safety/government response
  activities.
• Evaluate the potential or actual public health
  emergency.
• If a facility is not able to manage an event, the
  role of the County changes.

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General Approach

• The priority mission of the Public Health
  Department/EMS Duty Chief is to mitigate any
  potential or actual threats to public health and
  welfare.
• Therefore, if a facility is not effectively
  managing an emergency, the County Health Officer
  may take any actions necessary. This means that
  the facility is liable for all costs, actions or
  lack thereof, etc. necessary for the government
  to manage the event.

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What Do We Need?
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What Do We Need?

• Single point of contact waiting outside, with
  authority to make decisions for the facility.
• Medical records ready to go.
• Packaged patients.
• Patient destinations.
• Internal prioritization of patients.

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Records and Communication
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Tags, Triage, Treatment
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Fire

• Evacuation and patient care
• Ability to reoccupy the facility
• Communication and inspection by DHS (state)
• Relocation of patients by the facility.
• Emergency relocation (public safety).
• Health Officer EMS Duty Chief

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How would your facility respond?

• You are alerted to a fire in the attic space
  above several patient rooms. Smoke has filled a
  wing of the facility, the fire department is
  responding.
• You are able to evacuate all of the patients to
  the parking lot of the facility, a safe distance
  from the fire that is now extinguished.

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• The fire is out, staff are tending to patients in
  the parking lot evacuation area. The fire
  department cut large openings in the roof to put
  out the fire, a few rooms are no able to be
  occupied due to water damage and openings in the
  roof.
• What happens next? The fire department and EMS
  are packing up and heading home.

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Heat and Cold

• Efforts in place by the facility.
• Timeliness
• Patients wishes/rights custodian preference
• Potential or Actual Public Health Emergency
• Quick fixes/long-term fixes.
• Prevention/Mitigation efforts.

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How would your facility respond?

• The cooling systems have failed in your facility.
  The internal temperature is over 100 degrees.
• The EMS Duty Chief/Health Department is made
  aware of the event by a family member and shows
  up at the facility. What can you expect?

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Earthquake

• Shelter in Place
• Prepare for longer-term self-sufficiency

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Hazardous Materials

• Shelter in Place
• Follow instructions
• May require increased surveillance
• May require additional reporting

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Multiple Casualty Incident

• Triage of patients
• Recommend standard triage tags
• Exercise with local fire/EMS services
• Treatment of patients
• START
• Routing of patients to facilities
• Coordination with public safety priorities

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Patient Transfers

• Resource selection
• Review of Guide
• MOUs/Contracts
• Emergency (single-site)
• Cost

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Mass Prophylaxis

• Anthrax
• Prophylactic treatment is antibiotics for 10
  days.
• How do you plan to provide prophylaxis for your
  population
• Become a Private Point of Dispensing (POD)
• Use Public POD

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Pandemic Influenza

• Not enough facilities in the County.
• Stringent admission criteria for acute care
  hospitals.
• How does your facility plan to address your
  patients during a pandemic event?
• Do you have a plan?
• Have you exercised the plan?
• Does your plan integrate with the Public Health
  Departments Plan?

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Take-Home Message

• Your facility must be self-sufficient.
• This means..
• You must have current plans/procedures.
• You must exercise the plans/procedures.
• You must make your facility self-sufficient for
  72-96 hours minimum.

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Contact Information

• Kirsten Muehlenberg
• Emergency Medical Services Planner
• Santa Clara County EMS Agency
• Kirsten.Muehlenberg_at_hhs.sccgov.org
• www.sccemsagency.org

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We will now take a 15 minute break.
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(No Transcript)
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What Do Volunteers Do?

• Volunteers will be assigned duties that are
  within the scope of their current professional
  license and skill set
• Medical professionals who register as MVDR
  volunteers will support and assist the Public
  Health Department in providing care during a
  declared disaster or public health emergency

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Who Can Volunteer

• All medical professionals that are currently
  licensed to practice in the state of California.
• Includes registered physicians, nurse, physician
  assistants, dentists, pharmacists, veterinarians,
  paramedics, E.M.Ts, mental health professionals,
  and other
• MVDR also welcomes all medical professional
  medical students, including nursing students, MD
  students, social work students, public health
  students, and other health/medical profession
  students.

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Current Volunteers

• We currently have over 360 sworn volunteers
• 67 Physicians
• 190 Nurses
• 73 Misc (DDS, EMT, CSW, PSY, etc.)
• We have over 280 interested volunteers

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Non-Sworn Disaster Service Workers

• Level II
• Pre-event registration via CALMED system or EVC.
• Credentialed
• Not a DSW (in advance)
• Just-in-Time Training
• Used to fill needs after Level III and IV
  volunteers.
• May attending training sessions.
• No time commitments
• Not uniformed

• Level I
• Spontaneous volunteers.
• Emergency Credentialing
• Not a DSW (in advance)
• Just-in-Time Training
• Last to be used to fill emergency needs.
• May attending training sessions.
• Not uniformed.

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Sworn Disaster Service Workers

• Level III
• Credentialed
• Sworn DSWs
• Registry Only
• Primarily called to service in disaster events
  and attached to existing infrastructure.
• May or may not participate in training,
  exercises, and drills.

• Level IV
• All Level III plus
• Deployable with little notice
• Trained
• Established Team/Uniformed
• Regular exercises and team functions
• Meets MRC Core Competencies.
• May be called into service absent a disaster.

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MVDR Program Contacts

• MVDR Program Manager
• Kirsten Muehlenberg
• Kirsten.Muehlenberg_at_hhs.sccgov.org
• MVDR Coordinator
• MVDR_at_hhs.sccgov.org
• 408-885-4250

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NIMS/SEMS Mandates

• NIMS Implementation Objectives for Healthcare
  Organizations

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National Incident Management System

• Presidential Directive (HSPD)-5 Management of
  Domestic Incidents called for the establishment
  of a single, comprehensive national incident
  management system.
• The U.S. Department of Homeland Security released
  the National Incident Management System (NIMS) in
  March 2004.

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NIMS

• NIMS provides a systematic approach to working
  seamlessly to prepare for, prevent, respond to,
  recover from, and mitigate the effects of
  incidents
• This consistency is utilized for all incidents,
  ranging from daily occurrences to incidents
  requiring a coordinated Federal response.

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NIMS Implementation

• FY 2008 and 2009 NIMS Implementation Objectives
  for Healthcare Organizations
• 14 objectives for FY 2008 and 2009. Healthcare
  organizations will be expected to implement and
  achieve all 14 objectives by September 30, 2009.

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NIMS Implementation Objectives

• Adopt NIMS throughout the healthcare organization
  including all appropriate departments and
  business units.
• Revise and update emergency operations plans
  (EOPs), standard operating procedures (SOPs), and
  standard operating guidelines (SOGs) to include
  planning, training, response, exercises,
  equipment, evaluation, and corrective actions.

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NIMS Implementation Objectives

• Participate in interagency mutual aid and/or
  assistance agreements, to include agreements with
  public and private sector and nongovernmental
  organizations.
• Identify the appropriate personnel to complete
  ICS-100, ICS-200, and IS-700, or equivalent
  courses.
• Identify the appropriate personnel to complete
  IS-800 or an equivalent course.

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NIMS Implementation Objectives

• Utilize systems, tools, and processes that
  facilitate the collection and distribution of
  consistent and accurate information during an
  incident or event.
• Ensure that Public Information procedures and
  processes gather, verify, coordinate, and
  disseminate information during an incident or
  event.

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NIMS Implementation Objectives

• Manage all emergency incidents, exercises, and
  preplanned (recurring/special) events in
  accordance with ICS organizational structures,
  doctrine, and procedures, as defined in NIMS.
• ICS implementation must include the consistent
  application of Incident Action Planning (IAP) and
  common communications plans, as appropriate.

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Standardized EmergencyManagement System (SEMS)
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SEMS

• The Standardized Emergency Management System
  (SEMS) is the system required by Government Code
  Section 8607(a) for managing emergencies
  involving multiple jurisdictions and agencies.

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SEMS

• SEMS provides the structure for managing the
  response to emergencies in California and
  facilitates coordination among all responding
  agencies.
• Within SEMS, the Incident Command System (ICS)
  provides a flexible structure at the field level
  for coordination of response activities
• Unified command allows agencies that have
  responsibility for an incident to coordinate the
  response and restoration of an event.

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SEMS Requirements

• SEMS must be viewed as a structural system only.
• Pre-planning and training must be continuous.
• Cooperation and consensus must be a priority.
• Establishment of the unified command structure
  must be expedited.
• Proper integration into the ICS structure is
  essential.

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Education Opportunities

• NIMS, SEMS, ICS 100 200, and IS 700 800

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NIMS Training Guidelines

• Entry level first responders disaster workers
• Hospital staff, skilled support personnel, and
  other emergency management response, support,
  volunteer personnel at all levels
• ICS-100 Introduction to ICS or equivalent
• FEMA IS-700 NIMS, An Introduction

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NIMS Training Guidelines

• First Line Supervisors and Mid-Level Management
• ICS-100 Introduction to ICS or equivalent
• ICS-200 Basic ICS or equivalent
• ICS-300 Intermediate ICS or equivalent
• FEMA IS-700 NIMS, An Introduction
• FEMA IS-800.A National Response Plan (NRP), An
  Introduction

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NIMS Training Sites

• To obtain the ICS-100 course go to
  http//www.training.fema.gov/EMIWeb/IS/is100.asp
• To obtain the ICS-200 course go to
  http//www.training.fema.gov/EMIWeb/IS/is200.asp
• To obtain the IS-700 course go to
  http//www.training.fema.gov/EMIWeb/IS/is700.asp
  
• To obtain the IS-800a course go to
  http//training.fema.gov/emiweb/IS/is800a.asp

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SEMS Training Site

• http//www.oes.ca.gov
• Self Training
• May be done as a NIMS, SEMS, ICS 100 and ICS 200
  combo course.
• http//www.oes.ca.gov/Operational/OESHome.nsf/ALL/
  2694BCCF302EBC0B882571300076A116?OpenDocument

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Other Training and Exercises

• Take a Community Emergency Response Team (CERT)
  course from FEMA or a local city.
• http//www.citizencorps.gov/cert/
• Work with city and county first responders to
  practice the following items
• Evacuations
• Medical/Health response to your facility
• Light search and rescue
• Fire extinguisher use

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Grant Funding Available

• State Homeland Security Grant Program (SHSGP).
• Must be NIMS, SEMS, and ICS compliant
• Must have an Memorandum of Understanding (MOU)
  established with the Santa Clara County Office of
  Emergency Services (OES).
• Coordinate through the Santa Clara County
  Emergency Medical Services (EMS) Agency.

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Questions?
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Allied Healthcare Facility Work Group

• Concept

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The Goal

• Facilities will be able to form work group
  related to county wide disaster preparedness
• Working Group will be able to develop training
  and exercises related to disaster preparedness as
  evidenced by increased awareness of prevention
  and mitigation
• Long- Term/ Non- Acute Facilities in Santa Clara
  County will be self-sustainable for a period of
  time related to a county wide disaster as
  evidenced by ability to store adequate amounts of
  supplies and ability to utilize available
  resources

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The Concept

• Plotting location of Skilled Nursing, Long-Term
  Care and other Non-Acute Facilities
• Clustering of facilities according to cities
• Participation in workgroup

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City Clusters

• Information and Communication between City and
  Facility is important to be prepared
• Information for City Emergency Managers of
  location and capacity of facility
• Encourage involvement in city disaster
  preparedness through cluster representative
• Encourage communication with representative of
  cluster with city Emergency Managers

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Example of a City Cluster
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Planning Stage

• Organize Clusters
• Spokesperson to relate information for group
• Concept maps are available to see neighboring
  facilities and facilitate organization
• Communication with city emergency managers and
  citys Office of Emergency Services (OES) through
  spokesperson
• Local initiative meetings within cluster

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Planning Stage

• Work Group
• Group meetings quarterly (suggested)
• Assess facilities level of preparedness
• Assist facilities in achieving increased
  awareness of preparedness through education
• Assist in increasing level of preparedness for
  all facilities through exercises and training

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Our Role

• We can assist with facilitation and locations for
  meetings
• Demographic material to identify locations within
  suggested cluster
• Liaison related to availability of training and
  exercises
• Liaison in facilitation of work group meetings

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Take Home Message

• Get involved in preparedness
• Talk to your staff about preparedness
• Follow up with neighboring facilities
• Network and exchange information
• Attend follow up meeting in February

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Next Meeting

• February 24, 2009
• 1100 - 1300
• Location to be determined
• Tentative Agenda
• Mass Prophylaxis for Long- Term and Non-Acute
  Facilities
• Emergency Planning updates

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Contact

• Kirsten Muehlenberg
• EMS Planning Coordinator
• Kirsten.Muehlenberg_at_hhs.sccgov.org