Preparing for a Pandemic Event

1. Preparing for a Pandemic Event Developing a Continuity of Operations Plan (COOP) Presented by: Scott Aronson, MS 860-793-8600 / www.phillipsllc.com

2. Implementation Goals • NOT Flu Pandemic Diagnosis/Treatment • Why Dialysis, Nursing Home, Home Health? • Detail Approaches for a COOP • Communications & Incident Management • Staffing Plan/Education • Supplies/Resources • Transportation • Facilities/Engineering • Clinical Services / Strategies • Utilizing Mutual Aid to Supplement Planning • Review Effective Exercises

3. The Emergency Managers Problem • Are You Really Prepared for a Disaster?

4. $ Money $ Regulation/Statutes Fear Ethics

5. Higher Level of Flu Reported in Connecticut Hospitals See Patient Surge – Increase Discharges Nursing Home Home Health Dialysis Beds Full and Resident Acuity at Higher Level Provide Short Term Surg to Assist Discharging Hospital Patients Higher Acuity on Dialysis Patients Now At Home / Transportation Failures Staffing Impact Increases and Influenza Pandemic Clearly Identified Why Dialysis, Home Health & Nursing Homes

6. Emergency Operations Plan (EOP) and Continuity of Operations Plan (COOP) • EOP actions are procedural and taking place as the event unfolds (i.e. Bomb Threat, Building Evacuation) • COOP is how you ensure the ability to operate your organization throughout any disaster – special emphasis on Influenza Pandemic • Challenge: Limited to No Incident Command System training (Communication/Redundancy) • Challenge: Emergency responders and State are a resource…do not make them your plan

7. Stand Alone • Currently Joint Commission, but NFPA to follow with CMS • Stand Alone for 96 Hours + in 6 critical area • Communications • Staff Responsibilities • Resources & Assets (supplies, staff) • Safety & Security of Residents • Utilities Management (power, HVAC, fuel, water, etc.) • Clinical & Support Services • If you can’t meet it – say it or fix it!

8. Communications and Incident Management

9. Communications • Ongoing communications to: • Staff • On-duty (briefing) and Off-duty (sit-stat) • Phone Number to Call Into • Website to View with Emergency Information • Patients/Residents and Families (staff families) • Preplanning Information • How do you Inform them of the Situation…and keep them informed • See Next Page • Message on website, e-mailed out, blast fax to media, paged to staff, on main facility phones (briefed internally for staff as well)

11. Communications • FAILURE (immediately post-Katrina) • 2005: Hurricane Rita (Texas/Louisiana) • Same Hospital as Listed on the previous slide • Message from the Governor and the Mayor’s Office • “All residents of the City of Corpus Christi MUST evacuate immediately” – followed by the instructions, etc. • Problem? Influenza Pandemic – Governor Declares State of Emergency: Social Distancing (i.e. stay at home) is the recommended approach How do you get staff to come to work?

12. Communications • Ongoing communications to: • External Authorities • Fire, Police and Public Health; Local EOC; DPH; DEMHS • No set Frequency for Influenza Pandemic reporting – Emergency Line Created at Time of Emergency • Regular Communications Failure – HAM/Amateur Radio • Incoming Communications may come in form of: • Blast Fax • Direct Phone Call • Health Alert Network (HAN) when updated • All Facilities Should Sign On – IMPORTANT • Rolling phone, fax, e-mail, pager, etc. • If you are unable to reach DPH or other State Agency: • Use Ethical Judgment on actions

14. Communications • Ongoing communications to: • Vendors • 24/7 Phone Numbers • If entering high-risk area (i.e. National Guard controlling access) • Letter from Facility • Directions if Necessary • Carry their Own Company Badges/ID • Inform Local EOC of shipment Use Incident Command System to run this

16. Incident Command Organizing the Chaos!Manageable Span of Control: 3 – 7

17. Incident Command

20. CDC Checklists • In the Incident Command System, what position would handle these roles? • Home Health • The Organization point person for external communications (e.g. hospitals, nursing homes, health departments, social services agencies) has been assigned. (Insert name, title and contact information) • Nursing Home • A plan for cohorting symptomatic residents or groups using one or more of the following: • Confining symptomatic residents and their exposed roommates to their room • Placing symptomatic residents together in one area of the facility, or • Closing units where symptomatic and asymptomatic residents (staff who are assigned to work on affected units will not work on other units?

21. Incident Command Education • Free • On-line • Boring – except to people like me  • ICS 100, 200, 700 • IS-100.HC Introduction to the Incident Command System for Healthcare/Hospitals • IS-200.HC Applying ICS to Healthcare Organizations • IS-700 National Incident Management System (NIMS), An Introduction • Yale: EM103 NIMS (meets 100, 700) • Yale: EM140 NIMS (meets 200, 700)

22. Communications Tool – Internal / From Field / To Corporate

26. Staffing Plan / Education

27. Staff Responsibilities Share through your association for all facilities to have consistent education • Education, Education, Education: • What is expected of you? • Come to work in a disaster • Need to say this; don’t assume • What are their specific responsibilities? • Protect themselves (no exception – PPE use – for patient contact or non-patient contact), other staff, patients/residents • Tasks will be outside of normal daily responsibility

28. Staffing Plan • How are they Called Back? • Red / Yellow / Green OR On / Resting / Off • Impact of changing staff hours on their family/dependants? • If Limited Transportation, what are the Preplanned Pick-up Locations? • Must Have Facility IDs in the Event of Roadblocks • Facilities with Strike Plans – Should already have Pick-up Locations • Facilities with Severe Weather (ice / snow / flood) Plans – Should already have Pick-up Locations • Home Health – Any challenges? • Are there Plans for Housing Them • Their Dependents? (elderly family, children, disabled)

29. In Need of Staff • Where can you get them from if in trouble? • Your Corporate Office – if applicable • Staffing Agencies – Draw from Outside State • Medical Reserve Corp (MRC) • Community Emergency Response Teams (CERT) • Families (Staff and Patient/Resident) • Retired Staff (never burn bridges) • Sister Facilities or Neighboring Facilities

30. Staff & Family Education/Support • Education: Staff/Patient/Resident Families • Patient/Resident: Upon Admit or a New Client / Staff: Upon Hire • Provide Info to Staff/Families/Responsible Party on Expectations in a Disaster and Support that May be Requested (ask the question) • Home Health: • Provide direct care for Priority 2 & 3 patients (phone support) • Agency should increase verification process on accuracy of info – frequency determined by Agency • Nursing Home: • Family member may be requested to pick-up patient for discharge and care for them • Family member may be asked to provide on-site volunteer support to care for residents (staff or resident families) • Dialysis: • Provide diet oversight for patient (phone support) • Center should increase verification process on accuracy of info – frequency determined by Center

31. Staff & Staff Family Support • Staff and Family Support Examples • Child care, elder care, communication, etc. • CCRC – Better Ability to have Adult Day Care, Child Care (modifications), Lodging for Family • Hotel, on premises, Sr. Independent Living or Assisted Living Residence, etc. • Child Care Fears – • Are these Real? • How to Combat them? Or should you? • Mental Health and Other Family/Staff Support • CONSIDER THEM – These are not required, just need to be thought through and planned as to if you are or are not going to provide them

32. Family Disaster Planning • Yale-New Haven Office of Emergency Preparedness • Pamphlet • http://yalenewhavenhealth.org/emergency/progsvcs/commprep.html#personal • Red Cross – Family Disaster Planning Guide • http://www.redcross.org/services/disaster/0,1082,0_601_,00.html • Focal Areas • Who has dependents (elderly, special needs/disability, child) • Caring for them in a disaster?

35. Supplies & Resources

36. Supplies/Resources • Where can you get them from? • Outside 90 mile agreements • Don’t do all the work, have someone do it for you (networking with other state associations to share supplier/vendor information) • Your Corporate Office – if applicable • Other State Facilities (if not directly impacted) • Local Pharmacies • Local Hospitals • Strategic National Stockpiles (SNS)/Push Packs • *Rationing*

37. Stockpiling? • Financial Burden • PPE • How much should you stockpile? • Calculate # of patients/residents • Calculate # of staff & # of shifts • Delineate difference between clinical and non-clinical • Review reuse strategies where safe to do so • Home Health – Storage in cars with specific PPE that can be reused on the same patient

38. Example • Dialysis Center • 40 patients per day (110 total for the Center) • 10 direct patient contact staff(3 nurses/6 techs, Dialysis Asst) • 5 Admin/Support(Director, Social Worker, Receptionist, Dietician, Word Clerk) • Approx. 30 N-95 Respirators (x 2 for staff changes) / Glove Consumption Varies Based on Patient Contact (saturated N-95 could change life of respirator) • Up to 8 Week Timeframe: Maximum of 1,200 N-95 Respirators for staff and potentially up to 1,600 respirators per patient (recommend patient reuse which could reduce this to minimal numbers over an 8 week period) • REALITY: Reduction in Staff & Reduction in # of Patient • 20 patients per day (110 still remains as #) • 5 direct patient contact staff(2 nurses/3 techs) • 3 Admin/Support(Social Worker, Receptionist, Dietician) • Approx. 16 N-95 Respirators (x 2 for staff changes) and Glove Consumption Varies Based on Patient Contact (saturated N-95 could change life of respirator) • Up to 8 Week Timeframe: Maximum of 640 N-95 Respirators for staff and potentially a total of 110 respirators for the patients (recommend patient reuse) • Estimated Costs: $11 per box with 20 per box; 38 boxes at $11 = $418.00

39. Stockpiling? • Food – MREs, non-perishables (sample multi-day menus and feeding calculation document provided) • Rationing due to staffing or supply availability could be necessary • Medications • Home Health – Eliminate vitamins and other baseline meds as necessary • Nursing Home – Elimination of non-essential meds via an Influenza Pandemic Med List • Will you work to access vaccines and antiviral meds? • Work with Corporate, State DPH, Associations, Local Public Health and Other Providers to address this during the disaster • Supplies (dialysers, lines, meds, saline, chemicals)

41. Emergency Resources & Contacts • Emergency Agency Phone #’s (shown in communications) • Emergency Alert System • Emergency Bedding / Housing Plan • Emergency Staffing Agency Phone Numbers by Specialty • Materials Management / Nutrition / Pharmacy Departments • Emergency Contractors/Vendor Phone Numbers • Emergency Supply / Food / Liquid / Meds Sources / Linens • Mutual Aid • Stop-Over Site Agreements (Quarantine???) • Nursing • Emergency Contractors/Vendor Phone Numbers • Transportation Resources Internal/External • Utility Systems • Emergency Contractors/Vendor Phone Numbers

44. Transportation

45. Transportation • Utilization of Staff Vehicles for Supply Movement – Who has 4-wheel drive or pick-up trucks to move supplies? • Patient location analysis to eliminate transportation redundancies: • Dialysis Patients: Centralized management of transportation (pick-up other facilities patients: Private Transport Companies) • Pick-up Staff with the patients • Leverage Facility Owned Vehicles (typically in Long-term care) • Why can’t a Nursing Home provide transportation to a Dialysis Center?

46. Transportation • Home Health • Centralized pick-up points for essential administrative and support staff • Knowledge that gas supply chains could be disrupted • Patient location analysis to streamline travel times • i.e. elimination of visits to geographically dispersed patients • Nursing Homes • If you do not have, secure a facility shuttle for staff pick-up points – preplanned arrangement • If you do have, consider working in Mutual Aid Agreements with other providers to support transportation needs

47. Utilities / Facilities

48. System Failures • Potential that repair teams will be rendered incapable of supporting facility • Know what can shut down your operations • Dialysis Patients: If Reverse Osmosis water is disabled – can you use tap water? • Nursing Home: If Generator is down due to power loss and no extended fuel back-up, do you have other means of redundancy? • All: If your IT system fails and there are no staff to repair it, • How will you bill? • How will you ensure appropriate clinical data? • How will you ensure appropriate family/responsible party info?

49. Clinical Services

50. Clinical Services • What are the strategies for providing a maximally attainable, minimally acceptable level of care? • Exercise • Dialysis: Typically 3 nurses and 6 techs on a shift • Down to 2 nurses and 3 techs for 8 weeks • Strategy?