Hospital Senior Management Briefing

1
Hospital Senior Management Briefing

• Wisconsin Hospital Association
• Wisconsin Division of Public Health

2
Thank You

• for participating in this Briefing
• for your participation in and commitment to
  Wisconsins Hospital Emergency Preparedness
  Programs
• that 100 of all hospitals are participating (n
  140)

3
Thank You To

• the person(s), who leads emergency preparedness
  at your hospital
• the staff of your Emergency Management Committee
• your staff serving in state leadership roles
• Regional HRSA Boards
• State Expert Panels
• HRSA Leadership Group

4
From the very inception, this preparedness
program has been your program, based on your
needs and your recommendations

• Much Has Been
• Accomplished

5
Objectives for Today

• Review of major accomplishments of the Hospital
  Disaster Preparedness Program
• Discuss the role of senior hospital management in
  emergency preparedness

6
Preparedness Goals

• Enhance our surge capacity
• Collaboration and integration of plans of all
  emergency response partners
• Ability to maintain hospital services in a
  sustained event

7
Dual Use Philosophy

• To ensure that all preparedness funds have a
  dual-use
• Funding is not only for disaster preparedness
• All funding should also be for projects that have
  day-to-day usefulness

8
What Are We Preparing For?

• Preparing for the unthinkable also prepares us
  for the most likely.

9
Leadership

• To think that the worst will not happen at my
  hospital is natural
• ...to lead in preparing for the worst at my
  hospital is a moral imperative.

10
Each Hospital Is Critical

• Every disaster is LOCAL.
• What matters most to your community is not the
  state and national response...
• what matters most is the response of your
  hospital

11
Leadership Is You

• At the Pentagon disaster, on September 11th, the
  leader was not one of the Joint Chiefs of
  Staff, not the Secretary of Defense, but the
  Arlington Fire Department Chief, a local leader

12
The Question Everyone Asks

• Are you prepared?

13
Hard Question To Answer

• Lets try to answer this question by
• listing our accomplishments
• listing what we still need to do

14
What Has Been Accomplished?

• Qualitative Enhancements
• Capacity Enhancements
• Capability Enhancements

15
Qualitative Accomplishments

• Memoranda of Understanding among all hospitals to
  assist one another
• One Response Plan consistent across the entire
  state
• Sharing of time and expertise

16
Collaboration and Cooperation

• All hospitals are working together with one
  another
• Example water main break and support given to
  Froedtert Hospital by area hospitals
• All hospitals are working together with other
  emergency responders

17
Capacity Accomplishments

• Plans
• Supplies
• Equipment
• Resources

18
State Expert Panels

• Pediatric Preparedness
• Disaster Preparedness Pediatric Guidelines
• Survey of the pediatric capacity and capabilities
  of hospitals and EDs
• PEPP (Pediatric Education of Pre-Hospital
  Professionals) training for EMS and First
  Responders
• Patient At Risk program
• Evacuation
• one consistent policy used by all healthcare
  facilities

19
State Expert Panels

• Management of Radiation Emergencies
• guidance for hospitals, Emergency Departments,
  EMS and physician offices
• Ventilation Capacity
• creation of additional capacity to treat
  ventilator dependent patients
• Disaster Ethics
• guidance for clinicians and hospital
  administration
• involvement of clinicians and the public in the
  discussion of these issues

20
State Expert Panels

• Human Resources
• policies and checklists to deploy volunteers at
  your hospital in a disaster
• Materials Management
• guidance for providing additional supplies and
  equipment
• Dispatch
• the development of consistent dispatch protocols
  in a disaster

21
State Expert Panels

• Physician Offices
• Mass Casualty Preparedness Checklist
• Management of Decon Waste Water
• guidelines from the EPA and DNR and your local
  POTW
• Disaster Reimbursement
• 17 recommendations
• Billing Coding Guidance is coming

22
State Expert Panels

• Communications
• 4 levels of communications redundancy
• Landlines and cellular telephones
• UHF/VHF two-way radio
• Satellite Telephones (voice, email, data)
• Amateur HAM Radio (internal and external
  communications)
• 3 million in funding

23
Legal Workgroups

• Follow-up to issues not addressed in Hospitals
  Guide to Mass Casualty Incidents a summary of
  federal and state law re emergencies
• Guide can be found at www.mbf-law.com or at
  www.wha.org
• Phase II identification of unresolved issues
  all legal work channeled through WHA

24
Minimum Level of Preparedness Indicators

• Guidance for what is minimally recommended for
  all hospitals
• This is a completely voluntary program
• Indicators can be cross-walked to Joint
  Commission standards

25
Hazards Vulnerability Analysis

• Regional HVAs developed by hospitals, local
  health departments, FBI, emergency management and
  other emergency response partners
• Top 5 hazards for the state
• pandemic influenza
• tornado
• cyber attack or incident
• infectious disease outbreak
• ice/snow storm

26
Tiered-Response System

• Tier 1 individual hospital response
• Tier 2 multiple hospital response
• Tier 3 multiple emergency responders
• Tier 4 multiple regions response
• Tier 5 multiple state response
• Tier 6 federal response
• (see handout)

27
Surge Capacity

• Inpatient and Outpatient Surge Plan
• 12 worksheets (think through the process)
• defining basic nursing care
• conservation and rationing of resources
• Med/Surg Cots and mattresses pre-positioned
  (6,000)
• Surge Exercise in CY 2007
• Pandemic Influenza
• Total funding of 9,000 for participation

28
Surge Capacity

• May 2004 Exercise
• 11,000 staffed beds
• 11,000 surge beds
• Assignment of beds, staff, supplies and
  equipment, based on level of incident
• Beds designated for RED, YELLOW and BLACK
  patients
• GREEN patients to be treated at Alternative
  Outpatient Treatment Sites

29
WITrac

• Wisconsin Tracking Resources Alerting and
  Communications
• A web-based system that allows anywhere, anytime
  access in times of emergency to
• diversion status, bed, pharmaceuticals,
  supplies, equipment and resource availability
• other features include an alerting system,
  emergency chat rooms, mapping, resource library
  and more
• System in southeast Wisconsin for 8 years
  State-wide on April 1, 2007

30
Personal Protective Equipment

• Increased inventories of PPE at each hospital
• State Hospital Stockpile of 1,000 kits of PPE
  (1 kit serves 25 patients for one day)
• Hospitals have received medical PAPRs (powered
  air-purifying respirators)
• Demonstration Project with Madison United Health
  Laundry increased inventories of reusables

31
ChemPacks

• 32 ChemPacks (nerve agent anti-dotes) are placed
  strategically throughout the state (no further
  than 1 county away)
• HOSPITAL packs (immediate and long-term
  treatment)
• EMS packs (immediate treatment in the field)
• Not one hospital said NO!

32
Chemical Decontamination

• All hospitals have a portable decontamination
  shelter
• decontamination suits
• pre and post decontamination patient kits
• decontamination training
• Funds awarded to construct/renovate fixed
  decontamination rooms

33
Interim Pharmaceutical Stockpile

• The IPS (7 caches) are strategically placed
  around the state
• Amoxicillin
• Doxycycline
• Ciprofloxacin
• (no pediatric dosages at the present time
  instructions for dispensing in tablet format)
• The IPS can be deployed within 4 hours of request

34
Interim Pharmaceutical Stockpile

• Intended recipients
• Hospital staff and family
• Medical Staff and family
• First Responders and family
• Purpose maintain integrity of healthcare and
  critical services infrastructure
• Strategic National Stockpile (SNS) arrives within
  12 hours with medications for the general public
  (to be dispensed by public health)

35
Hospital Laboratory Preparedness

• Wisconsin State Laboratory of Hygiene has trained
  hospital labs in the packaging and transport of
  biological and chemical specimens
• Funding for BioSafety Cabinets and centrifuges
  with sealed carriers has been awarded

36
Patient Tracking

• Electronic database to track patients from the
  field to the hospital to yet another hospital(s)
• Trigger is any incident where 5 or more
  patients will be transported to one or more
  hospitals
• Triage Tag Number is the identifier that is used
• (triage tag number will also be the identifier in
  an evacuation)

37
Burn Resource Hospitals

• Enhancing the ability of hospitals (those that so
  choose) to manage a surge of burn patients for up
  to 72 hours
• through education (Advanced Burn Life Support)
  and
• through the purchase of burn supplies and
  equipment and
• through the availability of consultation
  resources

38
APIC Project

• Infection Control Practitioners presently
  visiting 2,000 physician offices and clinics (gt
  1,000 visited so far)
• Infection Control Measures for 1) day-to-day and
  2) for outbreaks
• Reporting of Unusual Occurrences
• Guidelines for Disasters
• Alert messaging

39
Regional Trauma Advisory Councils

• EMS and First Responders are being trained in the
  Wisconsin EMS Emergency Preparedness Plan
• including training for triage, using START and
  JumpSTART (pediatric) protocols
• START Simple Triage and Rapid Treatment

40
Triage Tuesday

• All hospitals and EMS are applying triage tags to
  all patients brought to the ED on a given day
• Goal is simply to become familiar with the use of
  triage tags and START and JumpSTART
• Color-Codes GREEN ambulatory YELLOW delayed
  care RED immediate care BLACK deceased or
  expectant

41
Wisconsin Disaster Credentialing

• A web-based, password-protected system to allow
  for
• Primary Source Verification (all licensed HCWs)
• Verification of quality and competency
  (physicians)
• In compliance with Joint Commission standards for
  Disaster Privileging
• Available to all hospitals at no cost

42
Capability Enhancements

• Training
• HICS, NIMS, Decontamination and more
• more than 34,759 trained in FY 2006
• Exercises
• more than 238 exercises (21 actual occurrences)
  with more than 20,066 persons involved

43
Emergency Preparedness Responsibilities of
Senior Management
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How Much Preparedness is Enough? Too Little?

• How do you know when you have invested
  sufficient?
• time, resources and staff
• How deep is preparedness at your hospital?
• Emergency Management Committee, Senior
  Management, Middle Management and all staff

45
The Bar Has Been Raised

• The country has higher expectations of us
• The country expects us to be prepared
• The plaintiff, after the disaster, will claim
  that
• all hospitals have received funding to enhance
  preparedness
• all hospitals are required by Joint Commission to
  be prepared

46
Proposed Definition of Preparedness
47
A hospital can consider itself prepared if it has
the necessary supplies and equipment and also
plans, conducts and evaluates annually with its
emergency response partners (including other
hospitals) a full-scale exercise and takes the
Lessons Learned from the After Action Report to
enhance its capability-based planning by making
adjustments to its Emergency Management Plan from
these Lessons Learned along with having the
financial and human resources to implement these
adaptations.
48
Responsibilities

• Recognize that there are plans in place do not
  create plans in an emergency (remember Katrina
  where feds did not follow their own plans)
• How does your hospital integrate with local
  Emergency Management, with fire, with EMS, with
  police

49
Responsibilities

• Use Incident Command for all emergencies and not
  just disasters, e.g. water main breaks, power
  outage, loss of telephone service
• Role of Board of Directors
• oversight of quality of care leads to
• oversight of quality of response to an incident

50
Incident Command System

• The Incident Command System is the structure used
  by all emergency responders
• Hospitals are required to be compliant with the
  National Incident Management System to receive
  federal funds after October 1, 2007
• All hospitals have been encouraged to deploy the
  top 8 positions

51
National Incident Management System

• Courses that you should take
• IS-700 NIMS An Introduction
• IS 800 National Response Plan An Introduction
• ICS 100 HC An Introduction to Incident Command
• ICS 200 HC ICS (for persons likely to assume a
  supervisory position in Incident Command)
• All courses are available on-line at
• http//www.fema.gov/emergency/nims

52
Emergency Management

• We and your staff realize that emergency
  preparedness cannot be the top priority
• But, emergency preparedness needs to be on the
  list of your top priorities

53
Wisconsin HRSA Operations Report

• Summary of Projects and Funding Available to Your
  Hospital
• (available soon on the WHA website)

54
Keeping Up-to- Date

• The HRSA Bi-Monthly Up-Date provides information
  on recent accomplishments and upcoming activates
  (published the 1st Wednesday of all the even
  months)
• Put this on your Administrative Council agenda to
  review briefly propjets that may affect your
  hospital
• Put on Board of Directors agenda to give periodic
  up-dates on your preparedness activities
• Share with all your Directors and Managers

55
Comments, Questions, andDiscussion
56
Contact Information

• Bill Bazan
• Wisconsin Hospital Association
• 414-431-0105
• bbazan_at_mailbag.com

57
Contact Information

• Dennis Tomczyk
• Wisconsin Division of Public Health
• 608-266-3128
• tomczdj_at_dhfs.state.wi.us