Hospital Emergency Preparedness “Where we have been and Where We are Going”

1. Hospital Emergency Preparedness“Where we have been and Where We are Going” Greg Carter Director, Infection Control & BT Coordinator, Reid Hospital & Health Care Services

2. OUTLINE I. Pre and Post 9/11 Hospital Emergency Preparedness and Command Structure. A. Pre 9/11 B. Post 9/11 • Overview of Hospital Pandemic Preparedness

3. OBJECTIVES • Identify and evaluate hospital emergency preparedness, pre and post 9/11, and a need for a unified command structure. • Identify need for a hospital Pandemic Influenza Plan.

4. Internal/External Disasters

5. The term “hospital preparedness” is a catch-all phrase, covering a multitude of medical and non-medical disaster management.Healthcare Organizations such as (JCAHO), (HFAP), (Federal & state licensing agencies) mandates specific standards for hospital preparedness.

6. Hospitals now receive Federal Grant money specifically for hospital emergency preparedness.

7. While each institution is mandated to develop their emergency plans, they have to develop these plans using specific elements which are universally applicable and accepted by multiple agencies all using a common language.

8. Prior to September 11, 2001, hospital preparedness focused on either natural or unintentional man-made mass accidents.Each hospital’s plan was very generalized and usually not communicated and/or shared with other healthcare institutions along with federal, state, or local agencies.

9. Most agencies were not free with sharing information and did not work well together, even within their own agency, much less with others!“Turf Wars”

10. Since 9/11, the reality of U.S. vulnerability from terrorism has translated into an increased sense of urgency to prepare for potential attacks.

11. A hospital’s principal concern now focuses around determination of adequate capabilities.

12. Pre 9/11

17. Pre 9/11 • Few Hospitals and other health related facilities had no comprehensive emergency management plan addressing terrorism, bioterrorism and pandemics. Mainly natural disasters. • Little or no communications with outside agencies such as fire departments, law enforcement, FBI, etc., • Very few hospital employees trained on incident command and unified command structure and language.

18. Pre 9/11 • Many of us thought things like terrorism, bioterrorism, and pandemics were things that happened “over there”, or we read about it in Sci-Fi books. • Things the military, CDC, or WHO took care of.

19. Pre 9/11 • Fire, ambulance and law enforcement always responded to incidents involving mass casualties, whether natural or man-made and we sat home watching it on TV. • Most communities rarely experienced an incident that overwhelmed their resources or tested other aspects of their disaster response planning and training.

20. 9/11/01ChangedEverything !

24. From the Manual of Afghan Jihad “In every country, we should hit their organizations, institutions, clubs and hospitals”, “The targets must be identified, carefully chosen and include their largest gatherings so that any strike should cause thousands of deaths”. From an Associated Press article; Feb 2, 2002 Author: Hamza Hendawi

26. Sarin Gasin Subways

29. AnthraxinFlorida and NYC

32. Post 9/11

33. After the terrorist attacks of September 11, 2001, al-Qaeda (or al-Qa'ida, pronounced al-KYE-da) surpassed the IRA, Hamas, and Hezbollah as the world's most infamous terrorist organization. Al-Qaeda—"the base" in Arabic—is the network of extremists organized by Osama bin Laden.

37. Post 9/11 The escalating threat of terrorism means that more than ever, all emergency services along with public health, hospitals, and emergency management officials must collaborate to develop, train, and rehearse emergency and mass casualty plans that address the possible use of chemical, biological, radiological, and/or explosive weapons of mass destruction.

38. BIRDFLU

41. Appendix 2. Hospital Preparedness ChecklistPreparedness Subject Actions Needed1. Structure for planning and decision making   An internal, multidisciplinary planning committee for influenza preparedness has been created. A person has been designated as the influenza preparedness coordinator.(Insert name)

42. 2. Development of a written pandemic influenza plan  A written plan has been completed or is in progress that includes the elements listed in #3 below. The plan specifies the circumstances under which the plan will be activated. The plan describes the organization structure that will be used to operationalize the plan. Responsibilities of key personnel related to executing the plan have been described. A simulation exercise has been developed to test the effectiveness of the plan. A simulation exercise has been performed.(Date performed _______________________)

43. 3. Elements of an influenza pandemic plan

44. A surveillance plan has been developed. Syndromic surveillance has been established in the emergency room. Criteria for distinguishing pandemic influenza is part of the syndromic surveillance plan. Responsibility has been assigned for reviewing global, national, regional, and local influenza activity trends and informing the pandemic influenza coordinator of evidence of an emerging problem. (Name ___________________________) Thresholds for heightened local surveillance for pandemic influenza have been established. A system has been created for internal review of pandemic influenza activity in patients presenting to the emergency department. A system for monitoring for nosocomial transmission of pandemic has been implemented and tested by monitoring for non-pandemic influenza.

45. A communication plan has been developed. Responsibility for external communication has been assigned. Person responsible for updating public health reporting ____________________________ Clinical spokesperson for the facility ____________________________ Media spokesperson for the facility ____________________________

46. Key points of contact outside the facility have been identified. State health department contact    ___________________________________________ Local health department contact   ___________________________________________ Newspaper contact(s)                 ___________________________________________ Radio contact(s)                          ___________________________________________ Public official(s)                           ___________________________________________

47. A list of other healthcare facilities with whom it will be necessary to maintain communication has been established. A meeting with local healthcare facilities has been held to discuss a communication strategy. A plan for updating key facility personnel on a daily basis has been established. The person(s) responsible for providing these updates are:

48. A system to track pandemic influenza admissions and discharges has been developed and tested by monitoring non-pandemic influenza admissions and discharges in the community. A strategy for regularly updating clinical, ED, and outpatient staff on the status of pandemic influenza, once detected, has been established. (Responsible person ____________________) A plan for informing patients and visitors about the level of pandemic influenza activity has been established.

49. An education and training plan on pandemic influenza has been developed. Language and reading level-appropriate materials for educating all personnel about pandemic influenza and the facility’s pandemic influenza plan, have been identified. Current and potential sites for long-distance and local education of clinicians on pandemic influenza have been identified.

50. Means for accessing state and federal web-based influenza training programs have been identified. A system for tracking which personnel have completed pandemic influenza training is in place. A plan is in place for rapidly training non-facility staff brought in to provide patient care when the hospital reaches surge capacity.