Preparing for a Pandemic Event

Preparing for a Pandemic EventPreparing for a Pandemic Event

Developing a Continuity of Operations Plan (COOP)

Developing a Continuity of Operations Plan (COOP)

Presented by: Scott Aronson, MS860-793-8600 / www.phillipsllc.com

Implementation GoalsImplementation Goals NOT Flu Pandemic Diagnosis/TreatmentNOT Flu Pandemic Diagnosis/Treatment Why Dialysis, Nursing Home, Home Health?Why Dialysis, Nursing Home, Home Health? Detail Approaches for a COOPDetail Approaches for a COOP

Communications & Incident Management Communications & Incident Management Staffing Plan/EducationStaffing Plan/Education Supplies/ResourcesSupplies/Resources TransportationTransportation Facilities/EngineeringFacilities/Engineering Clinical Services / StrategiesClinical Services / Strategies

Utilizing Mutual Aid to Supplement PlanningUtilizing Mutual Aid to Supplement Planning Review Effective ExercisesReview Effective Exercises

Are You Are You Really Really Prepared for Prepared for a Disaster?a Disaster?

The Emergency Managers The Emergency Managers ProblemProblem

The Emergency Managers The Emergency Managers ProblemProblem

$ Money $ Regulatio

n/Statutes

Fear

Ethics

Nursing Home

Higher Level of Flu Reported in Connecticut

Hospitals See Patient Surge – Increase

Discharges

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

Emergency Operations Plan (EOP) Emergency Operations Plan (EOP) and Continuity of Operations Plan and Continuity of Operations Plan

(COOP)(COOP)

Emergency Operations Plan (EOP) Emergency Operations Plan (EOP) and Continuity of Operations Plan and Continuity of Operations Plan

(COOP)(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

Stand Alone Stand Alone Stand Alone Stand Alone Currently Joint Commission, but NFPA Currently Joint Commission, but NFPA

to follow with CMSto follow with CMS Stand Alone for 96 Hours + in 6 critical Stand Alone for 96 Hours + in 6 critical

areaarea CommunicationsCommunications Staff Responsibilities Staff Responsibilities Resources & Assets (supplies, staff)Resources & Assets (supplies, staff) Safety & Security of Residents Safety & Security of Residents Utilities Management (power, HVAC, fuel, Utilities Management (power, HVAC, fuel,

water, etc.)water, etc.) Clinical & Support ServicesClinical & Support Services

If you can’t meet it – say it or fix it!If you can’t meet it – say it or fix it!

Communications and Communications and Incident ManagementIncident Management Communications and Communications and Incident ManagementIncident Management

Communications Communications Communications Communications Ongoing communications to:Ongoing communications to:

StaffStaff On-duty (briefing) and Off-duty (sit-stat)On-duty (briefing) and Off-duty (sit-stat) Phone Number to Call IntoPhone Number to Call Into Website to View with Emergency InformationWebsite to View with Emergency Information

Patients/Residents and Families (staff Patients/Residents and Families (staff families)families)

Preplanning InformationPreplanning Information How do you Inform them of the Situation…and How do you Inform them of the Situation…and

keep them informedkeep them informed See Next PageSee Next Page

Message on website, e-mailed out, blast fax to Message on website, e-mailed out, blast fax to media, paged to staff, on main facility phones media, paged to staff, on main facility phones (briefed internally for staff as well)(briefed internally for staff as well)

Communications Communications Communications Communications FAILURE (immediately post-Katrina)FAILURE (immediately post-Katrina)

2005: Hurricane Rita (Texas/Louisiana)2005: Hurricane Rita (Texas/Louisiana) Same Hospital as Listed on the previous slideSame Hospital as Listed on the previous slide Message from the Governor and the Mayor’s OfficeMessage from the Governor and the Mayor’s Office

““All residents of the City of Corpus Christi MUST evacuate All residents of the City of Corpus Christi MUST evacuate immediately” – followed by the instructions, etc.immediately” – followed by the instructions, etc.

Problem?Problem?

Influenza Pandemic – Governor Declares Influenza Pandemic – Governor Declares State of Emergency: Social Distancing State of Emergency: Social Distancing (i.e. stay at home) is the recommended (i.e. stay at home) is the recommended approachapproach

How do you get staff to come to How do you get staff to come to work?work?

Communications Communications Communications Communications Ongoing communications to:Ongoing communications to:

External Authorities Fire, Police and Public Health; Local EOC; DPH; Fire, Police and Public Health; Local EOC; DPH;

DEMHSDEMHS No set Frequency for Influenza Pandemic No set Frequency for Influenza Pandemic

reporting – Emergency Line Created at Time of reporting – Emergency Line Created at Time of EmergencyEmergency

Regular Communications Failure – HAM/Amateur Regular Communications Failure – HAM/Amateur RadioRadio

Incoming Communications may come in form of:Incoming Communications may come in form of: Blast FaxBlast Fax Direct Phone CallDirect Phone Call Health Alert Network (HAN) when updatedHealth Alert Network (HAN) when updated

All Facilities Should Sign On – IMPORTANTAll Facilities Should Sign On – IMPORTANT Rolling phone, fax, e-mail, pager, etc.Rolling phone, fax, e-mail, pager, etc.

If you are unable to reach DPH or other State If you are unable to reach DPH or other State Agency:Agency:

Use Ethical Judgment on actionsUse Ethical Judgment on actions

Communications Communications Communications Communications

Ongoing communications to:Ongoing communications to: VendorsVendors

24/7 Phone Numbers24/7 Phone Numbers If entering high-risk area (i.e. National Guard If entering high-risk area (i.e. National Guard

controlling access)controlling access) Letter from FacilityLetter from Facility Directions if NecessaryDirections if Necessary Carry their Own Company Badges/IDCarry their Own Company Badges/ID Inform Local EOC of shipmentInform Local EOC of shipment

Use Incident Command System to run Use Incident Command System to run thisthis

Incident Command Incident Command Organizing the Chaos!Organizing the Chaos!

Manageable Span of Control: 3 – 7Manageable Span of Control: 3 – 7

Incident Commander

Safety/Security OfficerPublic Information /

Liaison Officer

Logistics SectionChief

Facility Unit Leader

Materials Supply/Transportation

Unit Leader

CommunicationsUnit Leader

Nutrition SupplyUnit Leader

Planning SectionChief

Labor Pool /Medical StaffUnit Leader

Patient InformationTracking

Unit Leader

Finance SectionChief

Operations SectionChief

Cost /ProcurementUnit Leader

Claims Unit Leader

Time Unit Leader

Ancillary ServicesDirector

Inpatient AreaSupervisor

Treatment AreaSupervisor

CardiopulmonaryUnit Leader

LaboratoryUnit Leader

PharmacyUnit Leader

RadiologyUnit Leader

Critical CareUnit Leader

Maternal/ChildUnit Leader

Triage Unit Leader

ImmediateTreatment

Unit Leader

Delayed TreatmentUnit Leader

Minor TreatmentUnit Leader

DischargeUnit Leader

MorgueUnit Leader

Medical StaffDirector

General NursingUnit Leader

Potentially Injured /Worried WellUnit Leader

DocumentationRecorder

Damage Assessmentand Control Unit Leader

Sanitation Systems /Hazardous Waste Unit

Leader

Situation-Status(Sit-Stat)

Unit Leader

PsychologicalSupport

Team Leader

Staff Support/Dependant Care

Unit Leader

VolunteerUnit Leader

RehabilitationUnit Leader

Behavioral HealthUnit Leader

Haz-Mat GroupSupervisor

Decon PreparationTeam Member

Decon TeamMember

DecontaminationUnit Supervisor

Standby DeconTeam Member

Medical Care Director

Site Safety DeconOperations Officer

Decon Setup TeamMember

HVAC ShutdownOfficer

Security DeconOperations Officer

Radiation SafetyOfficer

TechnicalReferenceSpecialist

SOUTH HOSPITALINCIDENT COMMAND SYSTEM

FUTURE POSITIONS

Surgical ServicesUnit Leader

Incident Command Incident Command Incident Command Incident Command

Incident Commander

(building ops / building

evacuation decisions)

Logistics Section (bldg/

communications/ transp./food/suppl

y)

Planning Section (intel gathering/ overall ops plan/ staffing levels)

Finance Section (provide

$’s/document cost)

Liaison Officer (other HC

facil/emergency agency/monitorin

g of public hlth advisories)

Operations Section (clinical

services/ ancillary services)

Public Information Officer (news media/family)

Document Recorder

(command center set-up/record

incident)

Safety & Security Officer (building security/traffic/

rescue)

CDC ChecklistsCDC ChecklistsCDC ChecklistsCDC 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?

Incident Command EducationIncident Command EducationIncident Command EducationIncident 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)

Communications Tool – Internal / From Field / To Corporate

Staffing Plan / EducationStaffing Plan / Education Staffing Plan / EducationStaffing Plan / Education

Staff Responsibilities Staff Responsibilities Staff Responsibilities Staff Responsibilities

Education, Education, Education:Education, Education, Education: What is expected of you?What is expected of you?

Come to work in a disaster Come to work in a disaster Need to say this; don’t assumeNeed to say this; don’t assume

What are their specific responsibilities?What are their specific responsibilities? Protect themselves (no exception – PPE use – for Protect themselves (no exception – PPE use – for

patient contact or non-patient contact), other staff, patient contact or non-patient contact), other staff, patients/residentspatients/residents

Tasks will be outside of normal daily responsibilityTasks will be outside of normal daily responsibility

Share through your association for all facilities to have consistent education

Staffing PlanStaffing PlanStaffing PlanStaffing Plan How are they Called Back?How are they Called Back?

Red / Yellow / Green Red / Yellow / Green OROR On / Resting / Off On / Resting / Off Impact of changing staff hours on their family/dependants? Impact of changing staff hours on their family/dependants?

If Limited Transportation, what are the If Limited Transportation, what are the Preplanned Pick-up Locations?Preplanned Pick-up Locations? Must Have Facility IDs in the Event of RoadblocksMust Have Facility IDs in the Event of Roadblocks Facilities with Strike Plans – Should already have Facilities with Strike Plans – Should already have

Pick-up LocationsPick-up Locations Facilities with Severe Weather (ice / snow / flood) Facilities with Severe Weather (ice / snow / flood)

Plans – Should already have Pick-up LocationsPlans – Should already have Pick-up Locations Home Health – Any challenges?Home Health – Any challenges?

Are there Plans for Housing ThemAre there Plans for Housing Them Their Dependents? (elderly family, children, Their Dependents? (elderly family, children,

disabled)disabled)

In Need of StaffIn Need of StaffIn Need of StaffIn Need of Staff Where can you get them from if in Where can you get them from if in

trouble?trouble? Your Corporate Office – if applicableYour Corporate Office – if applicable Staffing Agencies – Draw from Outside Staffing Agencies – Draw from Outside

StateState Medical Reserve Corp (MRC)Medical Reserve Corp (MRC) Community Emergency Response Community Emergency Response

Teams (CERT)Teams (CERT) Families (Staff and Patient/Resident)Families (Staff and Patient/Resident) Retired Staff (never burn bridges)Retired Staff (never burn bridges) Sister Facilities or Neighboring FacilitiesSister Facilities or Neighboring Facilities

Staff & Family Staff & Family Education/SupportEducation/Support

Staff & Family Staff & Family Education/SupportEducation/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

Staff & Staff Family SupportStaff & Staff Family SupportStaff & Staff Family SupportStaff & Staff Family Support Staff and Family Support ExamplesStaff and Family Support Examples

Child care, elder care, communication, etc.Child care, elder care, communication, etc. CCRC – Better Ability to have Adult Day Care, CCRC – Better Ability to have Adult Day Care,

Child Care (modifications), Lodging for FamilyChild Care (modifications), Lodging for Family Hotel, on premises, Sr. Independent Living or Assisted Hotel, on premises, Sr. Independent Living or Assisted

Living Residence, etc.Living Residence, etc. Child Care Fears – Child Care Fears –

Are these Real?Are these Real? How to Combat them? Or should you?How to Combat them? Or should you?

Mental Health and Other Family/Staff SupportMental Health and Other Family/Staff Support CONSIDER THEM – These are not required, CONSIDER THEM – These are not required,

just need to be thought through and planned just need to be thought through and planned as to if you are or are not going to provide as to if you are or are not going to provide themthem

Family Disaster PlanningFamily Disaster PlanningFamily Disaster PlanningFamily Disaster Planning Yale-New Haven Office of Emergency Yale-New Haven Office of Emergency

PreparednessPreparedness PamphletPamphlet http://yalenewhavenhealth.org/emergency/http://yalenewhavenhealth.org/emergency/

progsvcs/commprep.html#personal progsvcs/commprep.html#personal Red Cross – Family Disaster Planning GuideRed Cross – Family Disaster Planning Guide

http://www.redcross.org/services/disaster/http://www.redcross.org/services/disaster/0,1082,0_601_,00.html 0,1082,0_601_,00.html

Focal AreasFocal Areas Who has dependents (elderly, special Who has dependents (elderly, special

needs/disability, child)needs/disability, child) Caring for them in a disaster?Caring for them in a disaster?

Supplies & ResourcesSupplies & Resources Supplies & ResourcesSupplies & Resources

Supplies/ResourcesSupplies/ResourcesSupplies/ResourcesSupplies/Resources Where can you get them from?Where can you get them from?

Outside 90 mile agreements Outside 90 mile agreements Don’t do all the work, have someone do it for you Don’t do all the work, have someone do it for you

(networking with other state associations to share (networking with other state associations to share supplier/vendor information)supplier/vendor information)

Your Corporate Office – if applicableYour Corporate Office – if applicable Other State Facilities (if not directly impacted)Other State Facilities (if not directly impacted) Local PharmaciesLocal Pharmacies Local HospitalsLocal Hospitals Strategic National Stockpiles (SNS)/Push PacksStrategic National Stockpiles (SNS)/Push Packs *Rationing**Rationing*

Stockpiling?Stockpiling?Stockpiling?Stockpiling?

Financial BurdenFinancial Burden PPEPPE

How much should you stockpile? How much should you stockpile? Calculate # of patients/residentsCalculate # of patients/residents Calculate # of staff & # of shiftsCalculate # of staff & # of shifts

Delineate difference between clinical and non-clinicalDelineate difference between clinical and non-clinical

Review reuse strategies where safe to do Review reuse strategies where safe to do soso

Home Health – Storage in cars with specific PPE Home Health – Storage in cars with specific PPE that can be reused on the same patientthat can be reused on the same patient

ExampleExampleExampleExample Dialysis CenterDialysis Center

40 patients per day (110 total for the Center)40 patients per day (110 total for the Center) 10 direct patient contact staff10 direct patient contact staff (3 nurses/6 techs, Dialysis Asst)(3 nurses/6 techs, Dialysis Asst) 5 Admin/Support5 Admin/Support (Director, Social Worker, Receptionist, Dietician, Word Clerk)(Director, Social Worker, Receptionist, Dietician, Word Clerk)

Approx. 30 N-95 Respirators (x 2 for staff changes) / Glove Consumption Approx. 30 N-95 Respirators (x 2 for staff changes) / Glove Consumption Varies Based on Patient Contact (saturated N-95 could change life of Varies Based on Patient Contact (saturated N-95 could change life of respirator)respirator)

Up to 8 Week Timeframe: Maximum of 1,200 N-95 Respirators for staff and 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 potentially up to 1,600 respirators per patient (recommend patient reuse which could reduce this to minimal numbers over an 8 week period)which could reduce this to minimal numbers over an 8 week period)

REALITY: Reduction in Staff & Reduction in # of PatientREALITY: Reduction in Staff & Reduction in # of Patient 20 patients per day (110 still remains as #)20 patients per day (110 still remains as #) 5 direct patient contact staff5 direct patient contact staff (2 nurses/3 techs)(2 nurses/3 techs) 3 Admin/Support3 Admin/Support (Social Worker, Receptionist, Dietician) (Social Worker, Receptionist, Dietician)

Approx. 16 N-95 Respirators (x 2 for staff changes) and Glove Consumption 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 Varies Based on Patient Contact (saturated N-95 could change life of respirator)respirator)

Up to 8 Week Timeframe: Maximum of 640 N-95 Respirators for staff and 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 potentially a total of 110 respirators for the patients (recommend patient reuse) reuse)

Estimated Costs: $11 per box with 20 per box; 38 boxes at $11 = $418.00Estimated Costs: $11 per box with 20 per box; 38 boxes at $11 = $418.00

Stockpiling?Stockpiling?Stockpiling?Stockpiling? Food – MREs, non-perishables Food – MREs, non-perishables (sample multi-day menus (sample multi-day menus

and feeding calculation document provided)and feeding calculation document provided) Rationing due to staffing or supply availability could Rationing due to staffing or supply availability could

be necessarybe necessary MedicationsMedications

Home Health – Eliminate vitamins and other baseline Home Health – Eliminate vitamins and other baseline meds as necessarymeds as necessary

Nursing Home – Elimination of non-essential meds via Nursing Home – Elimination of non-essential meds via an Influenza Pandemic Med Listan Influenza Pandemic Med List

Will you work to access vaccines and antiviral meds?Will you work to access vaccines and antiviral meds? Work with Corporate, State DPH, Associations, Local Public Work with Corporate, State DPH, Associations, Local Public

Health and Other Providers to address this during the disasterHealth and Other Providers to address this during the disaster

Supplies (dialysers, lines, meds, saline, Supplies (dialysers, lines, meds, saline, chemicals)chemicals)

Emergency Resources & Emergency Resources & Contacts Contacts

Emergency Resources & Emergency Resources & Contacts Contacts Emergency Agency Phone #’s (shown in Emergency Agency Phone #’s (shown in

communications)communications) Emergency Alert SystemEmergency Alert System Emergency Bedding / Housing PlanEmergency Bedding / Housing Plan Emergency Staffing Agency Phone Numbers by Emergency Staffing Agency Phone Numbers by

SpecialtySpecialty Materials Management / Nutrition / Pharmacy Materials Management / Nutrition / Pharmacy

DepartmentsDepartments Emergency Contractors/Vendor Phone NumbersEmergency Contractors/Vendor Phone Numbers Emergency Supply / Food / Liquid / Meds Sources / LinensEmergency Supply / Food / Liquid / Meds Sources / Linens

Mutual AidMutual Aid Stop-Over Site Agreements (Quarantine???)Stop-Over Site Agreements (Quarantine???) NursingNursing

Emergency Contractors/Vendor Phone NumbersEmergency Contractors/Vendor Phone Numbers Transportation Resources Internal/ExternalTransportation Resources Internal/External Utility SystemsUtility Systems

Emergency Contractors/Vendor Phone NumbersEmergency Contractors/Vendor Phone Numbers

TransportationTransportation TransportationTransportation

TransportationTransportationTransportationTransportation Utilization of Staff Vehicles for Supply Utilization of Staff Vehicles for Supply

Movement – Who has 4-wheel drive or pick-Movement – Who has 4-wheel drive or pick-up trucks to move supplies?up trucks to move supplies?

Patient location analysis to eliminate Patient location analysis to eliminate transportation redundancies:transportation redundancies: Dialysis Patients: Centralized management of Dialysis Patients: Centralized management of

transportation (pick-up other facilities patients: transportation (pick-up other facilities patients: Private Transport Companies)Private Transport Companies)

Pick-up Staff with the patientsPick-up Staff with the patients Leverage Facility Owned Vehicles (typically in Leverage Facility Owned Vehicles (typically in

Long-term care)Long-term care) Why can’t a Nursing Home provide transportation Why can’t a Nursing Home provide transportation

to a Dialysis Center?to a Dialysis Center?

TransportationTransportationTransportationTransportation Home HealthHome Health

Centralized pick-up points for essential administrative Centralized pick-up points for essential administrative and support staffand support staff

Knowledge that gas supply chains could be disruptedKnowledge that gas supply chains could be disrupted Patient location analysis to streamline travel timesPatient location analysis to streamline travel times

i.e. elimination of visits to geographically dispersed patientsi.e. elimination of visits to geographically dispersed patients

Nursing HomesNursing Homes If you do not have, secure a facility shuttle for staff If you do not have, secure a facility shuttle for staff

pick-up points – preplanned arrangementpick-up points – preplanned arrangement If you do have, consider working in Mutual Aid If you do have, consider working in Mutual Aid

Agreements with other providers to support Agreements with other providers to support transportation needstransportation needs

Utilities / FacilitiesUtilities / Facilities Utilities / FacilitiesUtilities / Facilities

System FailuresSystem FailuresSystem FailuresSystem Failures Potential that repair teams will be rendered Potential that repair teams will be rendered

incapable of supporting facilityincapable of supporting facility Know what can shut down your operationsKnow what can shut down your operations

Dialysis Patients: If Reverse Osmosis water is Dialysis Patients: If Reverse Osmosis water is disabled – can you use tap water?disabled – can you use tap water?

Nursing Home: If Generator is down due to power Nursing Home: If Generator is down due to power loss and no extended fuel back-up, do you have loss and no extended fuel back-up, do you have other means of redundancy?other means of redundancy?

All: If your IT system fails and there are no staff to All: If your IT system fails and there are no staff to repair it,repair it,

How will you bill?How will you bill? How will you ensure appropriate clinical data?How will you ensure appropriate clinical data? How will you ensure appropriate family/responsible party How will you ensure appropriate family/responsible party

info?info?

Clinical ServicesClinical Services Clinical ServicesClinical Services

Clinical ServicesClinical ServicesClinical ServicesClinical Services What are the strategies for providing a What are the strategies for providing a

maximally attainable, minimally maximally attainable, minimally acceptable level of care?acceptable level of care? ExerciseExercise

Dialysis: Typically 3 nurses and 6 techs on a Dialysis: Typically 3 nurses and 6 techs on a shiftshift

Down to 2 nurses and 3 techs for 8 weeksDown to 2 nurses and 3 techs for 8 weeks Strategy?Strategy?

Building Lockdown/ Building Lockdown/ Containment StrategyContainment StrategyBuilding Lockdown/ Building Lockdown/

Containment StrategyContainment Strategy Pre-designate What Doors for MonitoringPre-designate What Doors for Monitoring

Stabbing in the Parking LotStabbing in the Parking Lot Threat to Resident or Staff LifeThreat to Resident or Staff Life Labor Action / StrikeLabor Action / Strike Loss of Emergency PowerLoss of Emergency Power Civil UnrestCivil Unrest Pandemic InfluenzaPandemic Influenza

Fever Testing at Entrance (customize off of DPH Plan)Fever Testing at Entrance (customize off of DPH Plan)

What is Fever TestingWhat is Fever TestingWhat is Fever TestingWhat is Fever Testing

Screening Process for Employees, Screening Process for Employees, Family/Responsible Parties and Family/Responsible Parties and Patients/ResidentsPatients/Residents Allow or Deny Access to the Facility Allow or Deny Access to the Facility

>101>101°F: Immediate Denial°F: Immediate Denial <99°F: Access Granted<99°F: Access Granted >99°F and < >99°F and < 101101°F: Follow Series of Questions°F: Follow Series of Questions Determine appropriate infection control protocols for Determine appropriate infection control protocols for

isolation of or potentially to deny access for patients isolation of or potentially to deny access for patients with Influenza Pandemicwith Influenza Pandemic

Policy/Procedure included on CD-Rom to Policy/Procedure included on CD-Rom to customize your facility specific plan for Fever customize your facility specific plan for Fever TestingTesting

Fill In the Plan – Fill In the Plan – Position / Department / Position / Department /

FacilityFacility

Fill In the Plan – Fill In the Plan – Position / Department / Position / Department /

FacilityFacility

Department/Position -Specific Plans

Department/Position -Specific Plans

Each department or position within Each department or position within our organization should have the our organization should have the responsibility to review and update responsibility to review and update critical functions in order for us to critical functions in order for us to continue operations in a disaster. continue operations in a disaster. The plans should be formatted in the The plans should be formatted in the following manner:following manner:

Current staffing #’s / positions by shiftCurrent staffing #’s / positions by shift Overall functions of the position/departmentOverall functions of the position/department

Bullet List the Functions (i.e. Dietary in Nursing Bullet List the Functions (i.e. Dietary in Nursing Home)Home)

Food preparation Food preparation Gather menus from floorsGather menus from floors Prepare carts/trays (specific dietary needs)Prepare carts/trays (specific dietary needs) Prepare linesPrepare lines Deliver mealsDeliver meals Staff kitchen, line and registerStaff kitchen, line and register Clean carts, trays, utensils, dishes, pots, pans and equipmentClean carts, trays, utensils, dishes, pots, pans and equipment Restock food and supplies (liquid consumables, staples, Restock food and supplies (liquid consumables, staples,

meats, dairy, etc.)meats, dairy, etc.) Storage for food and suppliesStorage for food and supplies Reordering of food, liquids, equipment and suppliesReordering of food, liquids, equipment and supplies

Department/Position -Specific Plans

Department/Position -Specific Plans

Functions that must beFunctions that must be maintained maintained and that can and that can bebe suspended suspended in a disaster situation in a disaster situation Dietary (sample list)Dietary (sample list)

Limit food prep to emerg. MenuLimit food prep to emerg. Menu Disposable productsDisposable products Consider moving to 2 meals/day plus snacks based on Consider moving to 2 meals/day plus snacks based on

patient or resident needspatient or resident needs BillingBilling

Need to bill, but what is the frequency?Need to bill, but what is the frequency? Minimal Staffing OperationsMinimal Staffing Operations

Home Health: Nursing / AidesHome Health: Nursing / Aides Suspend Priority 3 Services; Limit Priority 2 Services; Manage Suspend Priority 3 Services; Limit Priority 2 Services; Manage

Priority 1 Patients – Discontinue Hospice Care at Nursing Priority 1 Patients – Discontinue Hospice Care at Nursing HomesHomes

Re-establish Geographic Borders to Maximize Capabilities Re-establish Geographic Borders to Maximize Capabilities (work on alternative plans for geographically dispersed (work on alternative plans for geographically dispersed patients)patients)

Limit initial patient assessment for new patients (rapid Limit initial patient assessment for new patients (rapid assessment)assessment)

Department/Position -Specific Plans

Department/Position -Specific Plans

Department/Position -Specific Plans

Department/Position -Specific Plans

Minimal Staffing OperationsMinimal Staffing Operations

Nursing Home: Nursing / Pharmacy & BillingNursing Home: Nursing / Pharmacy & Billing Higher Acuity vs. Lower Acuity Residents: Reprioritize Higher Acuity vs. Lower Acuity Residents: Reprioritize

Service CapabilitiesService Capabilities Utilize non-certified staff or resident/staff families to Utilize non-certified staff or resident/staff families to

provide direct resident care support (CNA)provide direct resident care support (CNA) Eliminate non-essential meds for Residents based on Eliminate non-essential meds for Residents based on

acuityacuity Billing 2 weeks late vs. getting meds to the floorBilling 2 weeks late vs. getting meds to the floor

DialysisDialysis Extension of patients to spread out dialysis treatmentsExtension of patients to spread out dialysis treatments Work to streamline physician orders – Emergency Work to streamline physician orders – Emergency

Physician Order FormPhysician Order Form Streamline admissions paperworkStreamline admissions paperwork

Department/Position – Other ?’s

Department/Position – Other ?’s

Inability to provide services from the Inability to provide services from the department/area (relocate in the building to department/area (relocate in the building to consolidate staffing or relocate to another consolidate staffing or relocate to another physical location)physical location)

Information Systems down-time operations Information Systems down-time operations (i.e.: coders would go to the books and (i.e.: coders would go to the books and manually code – do you have all the manually code – do you have all the necessary books?)necessary books?)

Inability to secure transportation for patients Inability to secure transportation for patients (dialysis)? Inability to access your patients (dialysis)? Inability to access your patients (home health)?(home health)?

Leadership ConsiderationsLeadership ConsiderationsLeadership ConsiderationsLeadership Considerations Priority of Services that MUST continue (cash Priority of Services that MUST continue (cash

flow / clinical needs)flow / clinical needs) How to pay staff with no revenue coming in?How to pay staff with no revenue coming in? Skeleton Crew – Essential Staff (based on Skeleton Crew – Essential Staff (based on

Dept. Specific Plans)Dept. Specific Plans) When to determine if operations must cease?When to determine if operations must cease? Insurance to support short term or long term Insurance to support short term or long term

business interruptionbusiness interruption Key relationships (if 2Key relationships (if 2ndnd or 3 or 3rdrd in command in command

need to take over) need to take over) FundraisingFundraising

Political FiguresPolitical Figures Financing Short-term EmergenciesFinancing Short-term Emergencies

Banking LeadersBanking Leaders

Mutual Aid Plan (MAP)Mutual Aid Plan (MAP)Mutual Aid Plan (MAP)Mutual Aid Plan (MAP)

MUTUAL AID EVACUATION & SUPPLY MUTUAL AID EVACUATION & SUPPLY PLANPLANMUTUAL AID EVACUATION & SUPPLY MUTUAL AID EVACUATION & SUPPLY PLANPLAN

Agreement among member Agreement among member facilities to provide assistance to facilities to provide assistance to each other at the time of a disastereach other at the time of a disaster

Northeast Ice Storm 1998

Florida Hurricanes 2004

Plan as a group of providers, not as a stand alone facility or corporation

NEED SUPPLIES NEED SUPPLIES

Coordination with the Mutual Aid Plan (MAP)Coordination with the Mutual Aid Plan (MAP) 1) Standard 1) Standard VendorsVendors first first 2) Regional MAP 2) Regional MAP VendorsVendors second second

Continuous interaction with Local EOC for non-medical needs Continuous interaction with Local EOC for non-medical needs 3) Joint Region MAP 3) Joint Region MAP VendorsVendors

Interaction with State EOC for non-medical and medical Interaction with State EOC for non-medical and medical needsneeds

4) State of Emergency Declaration4) State of Emergency Declaration Other facilities in your Regional MAP State of Emergency Other facilities in your Regional MAP State of Emergency

DeclarationDeclaration Other facilities in your Joint Region MAPOther facilities in your Joint Region MAP

SUPPLIESSUPPLIES Request verbally; followed by writtenRequest verbally; followed by written

Vendor MOU Vendor MOU Transport – may be offered by Donor facilityTransport – may be offered by Donor facility Pharmaceuticals – see next pagePharmaceuticals – see next page Summary of Equipment and Supplies – Aggregate Summary of Equipment and Supplies – Aggregate

of all facilitiesof all facilities Facility Specific InfoFacility Specific Info

Plan will include:Plan will include: Specifics that facilities will provideSpecifics that facilities will provide Medical Supply / Equipment VendorsMedical Supply / Equipment Vendors General Supply Vendors (cleaning, waste removal, General Supply Vendors (cleaning, waste removal,

mattresses, linens)mattresses, linens) Personal Protective Equipment (PPE)Personal Protective Equipment (PPE) PharmaceuticalsPharmaceuticals Portable HVACPortable HVAC Generators and FuelGenerators and Fuel Food and LiquidsFood and Liquids

Russell Phillips & Associates, LLC

New York / Connecticut / California

860-793-8600

[email protected]

www.phillipsllc.com