AHA Federal Update

1

• AHA Federal Update
• Roslyne Schulman
• Senior Associate Director, Policy Development
• October 4, 2007

2
TODAYS UPDATE

• Homeland Security Landscape
• Health Sector Coordinating Council
• Top Officials 4 Exercise
• DHS Chemical Facility Anti-Terrorism Regulation
• NIMS Requirements for Healthcare Facilities

3
The Homeland Security Process--1

• Plans and Reports
• Sector Specific Plan (SSP)
• Focus Critical Infrastructure/Key Resources
• Develop July?December
• Integrate January?May
• National Response Plan/Framework (NRF)
• Develop January?May
• Integrate June?Fall
• Sector Annual Report (SAR)
• Late Spring
• National Incident Management System (NIMS)
• HICS IV
• On-going training requirements

4
The Homeland Security Process--2

• Advisory Bodies
• Sector Coordinating Councils (17-18)
• Health Sector Coordinating Council (HSCC)
• 9 Sub-councils
• Government Coordinating Council (GCC)
• Emergency Support Function 8 (ESF-8) HHS
• Partnership for Critical Infrastructure Security
  (PCIS)
• 17 Sector Coordinating Councils together

5
Healthcare and Public Health Sector Government
Coordinating Council (HPHGCC) High-level
federal, state and local government officials
available to interact with HSCC
Healthcare Sector Coordinating Council
(HSCC) The HSCC is comprised of representatives
and alternates from each sub-council. Issue will
be identified by Subcouncils. Coordination across
Subcouncils and with the HPHGCC will be organized
through the HSCC.

Cross-cutting Work Groups will be established to
address priority issues that cut across
Subcouncils

• Medical Materiel
• Includes
• Manufacturers, suppliers and distributors of
  medial supplies and equipment
• Tasks
• Developed supply formulary for 15 disaster
  scenarios identified by DHS

Pharmaceutical and Biotechnology Includes Manu
facturers, suppliers and distributors of
pharmaceuticals and biological supplies and
equipment

• Occupational Health
• Includes
• Occupational Health physicians, nurses and
  professionals from academia and private industry
• Priorities
• Sector-wide education and information sharing
  targeted at the response to public health
  emergencies

Healthcare Professionals Includes Doctors,
nurses Pharmacists, dentists, and other
clinicians and practitioners with direct
involvement in healthcare delivery Note
emergency response prior to patient arrival at a
facility is Emergency Services
Medical Treatment Facilities Includes Hospital
s, clinics, and other facilities where medical
treatment is delivered.
Labs and Blood Includes Laboratory Industry,
lab support services separate from medical
treatment facilities, companies and associations
from the blood, tissue and organ industry
Fatality Services Includes The spectrum of
services needed after death, medical examiners,
coroners, funeral directors, Past Focus
Ensuring capability to handle surge of deaths in
event of disaster and improving coordination
among Fed., state and local authorities
Healthcare Information and Medical
Technology Includes All IT systems,
capabilities and networks supporting delivery of
healthcare services
Insurers, Payers, HMOs Includes Third-party
payers for medical treatment and healthcare
delivery
Each Subcouncil is responsible for organizing
itself Sample Priority Issues for Sub-Councils
Emergency Preparedness, Emergency Response
Research and Development (Includes
Detection) Vulnerability Assessment /
Prioritization Communication Information
Sharing among members and Community and
Educational Outreach
6
Homeland Security Process Frustrations

• Heavy focus on critical infrastructure protection
• Health care More useful to use resilience
• Health care More attention to response
• Limited focus of surge capacity rather than mass
  casualties
• Unused reserve rather than plan B
• Continuing absence of fatality management
• History of dominant idea rather than all-hazards
• Smallpox
• Bioterrorism
• Pandemic flu
• Vendors overselling NIMS compliance
• Last minute opportunities to participate

7
Our Findings

• Whats Working
• SCC convenes talented people in leadership roles
• Increased info sharing among sector partners
• Better contacts with govt. agencies
• Good flow of information

• Whats Not Working
• Lack of government action and follow through
• Advice and recommendations are largely ignored
• Poor understanding within govt. of how our sector
  works
• Govt. bureaucracy complex, redundant, no clear
  lead, lack of coordination
• Partnership has a lack of relevance to state and
  local personnel

8
Our Recommendations

• Serious dialogue with DHS and HHS to improve the
  partnership
• Create a working group to assess cross sector
  issues related to the health sector
• Ask DHS and HHS to create an inventory of
  government efforts related to HSCC interests
• Take action on stockpiling white paper
• Take action on fatality plan

9
TOPOFF 4

• Main exercise taking place Oct 15-19, 2007. AHA
  will observe but not actively participate.
• Locations
• Oregon Full scale exercise
• Arizona Not full scale (table top)
• Territory of Guam Full scale exercise
• Involves radioactive dispersion device but
  additional details not yet available.
• AHA staff will report back on next A Squared
  call. Hope involved states will report on their
  experience as well.

10
DHS Chemical Facility Anti-Terrorism Reg

• Authority Section 550 of DHS Appropriations Act
  of 2007
• Status Interim final regulation 4/9/07, no
  final chemical list yet.
• Purpose Establishes risk-based performance
  standards for security at covered chemical
  facilities
• Applicability Facilities that possess certain
  amount of any listed chemicals List not yet
  final.
• Requirements
• Complete Top Screen -- risk assessment
  screening tool
• Facilities deemed high risk submit Security
  Vulnerability Assessment (SVA) and Site Security
  Plan (SSP), followed by DHS Site Inspection
  and/or Audit
• Penalties
• Civil Money Penalties and/or Order to Cease
  Operations
• Concerns
• Are hospitals intended to be covered?
• Proposed list has chemicals commonly found in
  hospitals and threshold as any amount
• Definition of facility

11
NIMS Requirements for Hospitals

• FEMA/NIMS Support Center meeting Aug. 6-7 to
  review NIMS implementation activities and metrics
  for FY 2008.
• Everything open for comment but not clear what
  will be accepted.
• Many in group agreed
• Keep activities simple and manageable for all
  healthcare organizations. Reduce number of
  elements.
• Delay FY 2008 activities to FY 2009
• Cant require that hospitals coordinate with
  fire, law enforcement, etc., on updated plans and
  procedures.
• Cross-walk all activities to relevant
  standards/regulations (JCAHO, CMS, others).
• Provide adequate funding for successful
  implementation activities.
• Time we were given was not adequate and we
  expressed hope to bring group back together to do
  further work.