Chapter 1 PLANNING INFRASTRUCTURE [ENTER FACILITATOR’S NAME AND CONTACT INFORMATION] Developed by Troutman Sanders LLP Developed for the Virginia Department.

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PLANNING INFRASTRUCTURE

[ENTER FACILITATOR’S NAME AND CONTACT INFORMATION]

Developed by Troutman Sanders LLPDeveloped for the Virginia Department of Health

Funded by Centers for Disease Control and Prevention

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Toolkit Presentations Instructions for Use

Toolkit Presentations are intended to be a companion to the Hospital Implementation Guide and should not be used in isolation.

The Presentations are intended to serve as a starting point for the facilitator. The facilitator should thoroughly review the Presentation prior to use in Implementation Team, CRAG or Subcommittee meetings and customize the Presentation to meet the unique needs of the meeting participants.

Pay particular to attention to the information provided in brackets ([ ]), which must be completed by the facilitator prior to use.

Included in the “Notes” section of each slide are the following types of information:

• Slide Type, which indicates whether the slide is for information or discussion, serves as a placeholder, or is some combination thereof

• Planning Guide Section(s), which will direct the facilitator to the corresponding sections of the Planning Guide and Hospital Implementation Guide for further information

• Special Instructions, which provides directions for the facilitator to customize the slide for the intended audience

• Speaker’s Notes, which provides more detailed information to supplement the material on the slide

Refer to the Hospital Implementation Guide for further guidance and helpful hints on effectively completing the process described in the Planning Guide.

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Implementation Team

[Enter names and departments of each Implementation Team member]

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Chapter Overview

Identify the “Convener”Establish an “Implementation Team”Identify a resource to facilitate the

planning activitiesDetermine the Planning Unit for key

activitiesEstablish CRAGs for each Planning UnitSet forth clear expectations for planning

process

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Add slides from Altered Standards Overview presentation, as needed, to introduce the Implementation Team to the concept of altered standards and critical resource shortage response planning.

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Introduction to Planning Guide

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Background

Hospitals have done extensive planning for disasters and public health emergencies

Planning for modifying the delivery of care or allocating specific resources and services has lagged behind other planning efforts

A comprehensive framework for dealing with shortages of critical resources was lacking

This is complex and requires a multi-disciplinary approach that combines input from many perspectives- Medical - Operational- Ethics - Public Health- Legal

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Critical Resource Shortages Planning GuideContributors

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Planning Guide Framework Develop the critical resource shortage planning infrastructure Conduct a Critical Resource Vulnerability Analysis Develop an ethical framework Develop an operational infrastructure Identify or develop resource-specific Protocols Create an ad hoc infrastructure Engage in collaborative planning with other HMDOs Determine how the CRSRP will be evaluated and maintained Obtain approval of the CRSRP and integrate into relevant

EOPs Develop comprehensive communication plans for key

audiences

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Terms to Know

Allocation Critical resource Critical resource shortage event (CRSE) Critical Resource Shortage Response Plan (CRSRP) Disaster or emergency EMS provider Goal Health and Medical Delivery Organization (HMDO) Modification Planning Unit Protocols

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Hospital Implementation Guide

“Teacher’s Edition” of the Planning Guide Written for the Implementation Coordinator and Team Chapter Overviews include:

• Introduction• Responsibility• Goals for Chapter

Subsections include:• Planning Guide text • Goal• Rationale for inclusion in Planning Guide• Real World Examples• Action Items for conducting the activity• Helpful Hints for implementation• Implementation Aids

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Implementation Toolkit

Planning GuideHospital Implementation GuideProject Management Tools and ResourcesMeeting Facilitation and Consensus Building

Tools and ResourcesOther Helpful Resources

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Planning Infrastructure

Convener

Implementation Team

Planning Unit

Planning Unit

Planning Unit

CRAG CRAG CRAG

Subcommittee

Subcommittee

Subcommittee

Subcommittee

Subcommittee

Subcommittee

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Planning Units

State

Hospital

Health System

Community

Region

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Considerations for Choosing a Planning Unit

Size

Authority

Expertise

Existing relationships

Existing planning efforts

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Considerations for Choosing CRAG Members

Skills and resources needed for assigned key activitiy(ies)

Represent a broad spectrum of disciplines

Strong combination of stakeholders

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Expectations

Roles of CRAG members CRAG meeting logistics Budget

• Cost• Contributions from CRAG members• Other funding sources

Incentives for CRAG members

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Key Activities

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Strong Foundation

Ethical Framework

Operational Infrastructure

Education & Communication

Building the CRSRP

Protocol

Protocol

Protocol

Protocol

Protocol

Protocol

Protocol

Protocol

Ad Hoc

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Critical Resource Vulnerability Analysis

Develop a list of critical resourcesPrioritize the list of critical resourcesIdentify mechanisms for mitigating

depletion of the resourcesDetermine which critical resources should

be immediately considered for Protocol development

Revisit the CRVA at appropriate intervals

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Which is the appropriate Planning Unit?

State

Hospital

Health System

Community

Region

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Who should be on Who should be on the CRAG?the CRAG?

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Expectations

There will be [#] meetings for this CRAG.The meetings will be held [dates] at

[place].[Name] will facilitate each meeting.[$] will be budgeted to this group for

expenses incurred.Each member will be compensated [$].

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Ethical Framework

Identify ethical principlesDefine the ethical GoalDetermine implementation specifications

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Which is the appropriate Planning Unit?

State

Hospital

Health System

Community

Region

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Who should be on Who should be on the CRAG?the CRAG?

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Expectations

There will be [#] meetings for this CRAG.The meetings will be held [dates] at

[place].[Name] will facilitate each meeting.[$] will be budgeted to this group for

expenses incurred.Each member will be compensated [$].

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Operational Infrastructure

Determine process for activation and termination of the CRSRP

Determine process for activation and termination of each Protocol

Develop structure for making resource allocation decisions

Develop infrastructure for reviewing and revising CRSRP during a CRSE

Define “essential documentation”

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Operational Infrastructure cont.

Develop process for responding to non-compliance

Identify resources for psychological and emotional support

Develop a communication plan Develop strategy for providing palliative care

during a critical resource shortage event• Determine goal• Develop standard definition• Identify mechanisms for providing palliative care

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Which is the appropriate Planning Unit?

State

Hospital

Health System

Community

Region

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Who should be on Who should be on the CRAG?the CRAG?

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Expectations

There will be [#] meetings for this CRAG.The meetings will be held [dates] at

[place].[Name] will facilitate each meeting.[$] will be budgeted to this group for

expenses incurred.Each member will be compensated [$].

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Protocol Development

Identify existing surge plan Identify any relevant Governmental Protocols Develop Protocol

• Determine modifications• Develop allocation algorithm

Develop an operational plan• Identify triage officer(s) and/or triage committee(s)• Identify information needed to finalize, revise, modify, or

enhance the Protocol during a CRSE• Develop a mechanism for revising the Protocol during a CRSE• Determine when the Protocol will be activated• Determine how and when you will move between tiers of the

Protocol• Determine when the Protocol will be terminated

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Protocol Development cont.

Identify essential documentationCoordinate with other ProtocolsMemorialize Protocol in writingConduct training

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Which is the appropriate Planning Unit?

State

Hospital

Health System

Community

Region

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Who should be on Who should be on the CRAG?the CRAG?

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Expectations

There will be [#] meetings for this CRAG.The meetings will be held [dates] at

[place].[Name] will facilitate each meeting.[$] will be budgeted to this group for

expenses incurred.Each member will be compensated [$].

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Ad Hoc Protocols

Determine how the Planning Unit will decide when the development of an Ad Hoc Protocol is required

Develop the process by which an Ad Hoc Protocol will be created in the midst of a disaster

Develop a standard mechanism for communicating the creation, implementation, and operationalization of Ad Hoc Protocols

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Which is the appropriate Planning Unit?

State

Hospital

Health System

Community

Region

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Who should be on Who should be on the CRAG?the CRAG?

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Expectations

There will be [#] meetings for this CRAG.The meetings will be held [dates] at

[place].[Name] will facilitate each meeting.[$] will be budgeted to this group for

expenses incurred.Each member will be compensated [$].

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Coordination with HMDOs

Identify HMDOs for coordination Create a communication strategy with other HMDOs Understand how HMDOs’ responses to the CRSE will

impact other HMDOs Engage in discussions regarding changes to scope of

services• Expansion of scope• Reduction of scope

Discuss cooperative initiatives with other HMDOs Establish parameters regarding “essential

documentation”

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Which is the appropriate Planning Unit?

State

Hospital

Health System

Community

Region

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Who should be on Who should be on the CRAG?the CRAG?

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Expectations

There will be [#] meetings for this CRAG.The meetings will be held [dates] at

[place].[Name] will facilitate each meeting.[$] will be budgeted to this group for

expenses incurred.Each member will be compensated [$].

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Evaluation and Maintenance

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Which is the appropriate Planning Unit?

State

Hospital

Health System

Community

Region

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Who should be on Who should be on the CRAG?the CRAG?

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Expectations

There will be [#] meetings for this CRAG.The meetings will be held [dates] at

[place].[Name] will facilitate each meeting.[$] will be budgeted to this group for

expenses incurred.Each member will be compensated [$].

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Approval and Integration

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Which is the appropriate Planning Unit?

State

Hospital

Health System

Community

Region

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Who should be on Who should be on the CRAG?the CRAG?

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Expectations

There will be [#] meetings for this CRAG.The meetings will be held [dates] at

[place].[Name] will facilitate each meeting.[$] will be budgeted to this group for

expenses incurred.Each member will be compensated [$].

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Communication Plans Develop a communication strategy tailored to providers

Develop a communication strategy tailored to patients

Develop a communication strategy tailored to partners of the hospital(s) in the Planning Unit

Develop a communication strategy tailored to the public

Develop a communication strategy tailored to the press

Develop a communication strategy tailored to politicians

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Which is the appropriate Planning Unit?

State

Hospital

Health System

Community

Region

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Who should be on Who should be on the CRAG?the CRAG?

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Expectations

There will be [#] meetings for this CRAG.The meetings will be held [dates] at

[place].[Name] will facilitate each meeting.[$] will be budgeted to this group for

expenses incurred.Each member will be compensated [$].

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Questions?Questions?