National Health Care for the Homeless Conference and Policy Symposium

2. National Health Care for the Homeless Conference and Policy Symposium One Size Doesn’t Fit All: Emergency Management for Healthcare for the Homeless Programs Phoenix, AZ Mollie Melbourne June 14, 2008

3. Presentation Objectives • Review the principles of emergency management • Review BPHC PINs 07-15 and 07-16 as they relate to 330 HCH programs • Outline the role of Health Centers in emergencies and how to get started • Identify resources available to help

4. Principles of Emergency Management Mitigation Preparedness Response Recovery

5. Emergency Management Phases

6. Mitigation Pre-event planning and actions which are intended to lessen the impact of a potential disaster • Long-term effort • Risk identification – HVA • Structural • Reinforcing / strengthening / anchoring • Non-structural • Light fixtures / HazMat Containers

7. Preparedness Actions taken before an emergency to prepare for response • Develop emergency management plan • Develop Communication Plan – internal and external to program • Know emergency plans for community and partners • Identify community planning efforts specific to those experiencing homelessness – if none exist, educate partners on needs of your population • Drills and Exercises to test plan and integration with partners • Stockpile or arrange for access to supplies/ meds/ equipment through community partnership (LHD, EMA) • Equip an EOC • Obtain contact information for local EOC • Identify needs for response and develop MOAs and MAAs to support them

8. Response Activities to address immediate and short-term effects of a disaster • Implement emergency management plan • Adopt Incident Command System (ICS) structure • Activate Emergency Operations Center (EOC) • Save lives • Protect property • Meet basic human needs

9. Recovery Restore essential functions and normal operation • Starts with preparedness • Develop BCP / COOP • Adequate insurance coverage • Back-up systems • Cash reserve • Assess damage / impact of disaster • File insurance claims / assistance • Address psychological needs of patients and staff • Produce after action debriefing and report

10. HRSA PIN 2007-15 Health Center Emergency Management Program Expectations

11. Definition of Emergency “An event affecting the overall target population and/or the community at large, which precipitates the declaration of a state of emergency at a local, State, regional, or national level by an authorized public official such as governor, the Secretary of the Department of Health and Human Services, or the President of the United States”

12. Health Center Emergency Management Program Expectations PIN 2007-15 • Emergency Management Planning • Linkages and Collaboration • Communications and Information Sharing • Maintaining Financial and Operational Stability

13. Applicability • Applies to FQHC Look-Alikes and all HCs funded under the Health Center Program • Community Health Center Programs – 330(e) • Migrant Health Center Programs – 330(g) • Health Care for the Homeless Programs – 330(h) • Public Housing Primary Care Programs – 330(i)

14. Expectations • Emergency Management must be integrated into a health center’s risk management program • Comprehensive – includes all departments • Ongoing – part of business as usual • HCs need to fit their approach to their centers capabilities • Size of facility and staff • Location(s) • Resources • Type of center – CHC, MHC, HCH, PHPC • Population served

15. A. Emergency Management Planning – The Plan • Based on Hazard Vulnerability Assessment (HVA) • All hazards approach • Addresses 4 phases of EM • Board, Senior Mgt, and clinical staff should have lead role in developing plan • Include process for staff training • Annual exercises, at a minimum

16. The Planning Process • HC plans should align with State and/or local plans • HCs are encouraged to connect with any ongoing efforts in their communities • HCs need to define their role in response • Consider MOAs with other community health care providers for resources – personnel, equipment, supplies • HCs should help staff prepare their families for emergencies

17. B. Linkages and Collaboration • Health Centers should integrate with emergency management system at all levels in their states: • State/local emergency management agencies • State and local health departments • Hospitals • Mental health agencies • National organizations • PCA / PCO • Establish relationships with key decision makers before an emergency • Participate in community exercises

18. C. Communications and Information Sharing • HCs should have a communications plan as part of their EMP • HCs should have policies and procedures re: communication during an emergency to cover: • Who is responsible for communicating important information • Which agencies/groups should receive this information • How will the information be communicated • What types of information should be communicated • Health centers should have and test back-up, or redundant, communication system • Two-way radios • Mobile/cell phones • Wireless messaging • Health centers should use an all-hazards command structure – ICS • Health centers are encouraged to have systems in place to collect and organize data for anticipated/required reporting

19. D. Maintaining Financial and Operational Stability • Health centers should build, or develop a plan to build, cash reserves • Insurance coverage should be reviewed and adjusted as needed or able • Backup information technology systems are needed to ensure that electronic financial and medical records are available during and after an emergency • Off-site or safe storage options for equipment and data should be investigated for efficient temporary location set-up (in anticipated events) • Health centers should develop strategies for resuming key functions for resuming operations • Billing systems for obtaining payment and reimbursement quickly • Track charges and sustain flow of reimbursement • Track patients being treated due to an emergency • Grantees can use grant funds to provide services during an emergency as long as they are within scope of project and the terms of grant award

20. HRSA PIN 2007-16 FTCA Coverage for Health Center Program Grantees Responding to Emergencies

21. FTCA Coverage Within the Service Area • FTCA coverage for health center providers delivering primary care services at temporary locations (PODs, ACFs, Shelters) • Services are provided on a temporary basis • Temporary location is within the service area or neighboring counties, parishes, or other subdivisions adjacent to health centers service area • Services provided within the approved scope of project • All activities of health center providers are conducted on behalf of the health center – won’t cover health center providers volunteering their services • Patients served by FTCA-deemed providers are considered health center patients • Health centers do NOT need prior approval but must notify HRSA of temporary location within 15 days or less

22. FTCA Coverage Outside of the Service Area • Prior approval to establish a temporary location outside of service area required • Must demonstrate purpose of site is to provide medical care primarily to the health center’s target population and to other medically underserved populations that may have been displaced • Services are provided on a temporary basis • Services provided within the approved scope of project • All activities of health center providers are conducted on behalf of the health center – won’t cover health center providers volunteering their services

23. FTCA Coverage for Non-Impacted Health Centers • May assist at temporary sites WITHIN the same service area and within neighboring counties, parishes, subdivisions • May operate temporary sites WITHIN the same service area and within neighboring counties, parishes, subdivisions • NOT ALLOWED: health centers providing care during emergencies outside their service area and beyond neighboring counties, parishes, subdivisions

24. Healthcare for the Homeless Programs & Emergency Management

25. Importance of Planning • You serve the most vulnerable population in your community • You have an existing relationship with your patients based on trust – and they will come to you in times of disaster • No-one knows the needs of your patients better than you – this allows you to serve as an advocate for their needs

26. Importance of Planning • Mission driven organizations – serve your patients • Closely linked with hospitals and health departments • Financially lean – need fast recovery • In a large scale event, you may be on your own for at least 72 hours • Accreditation standards • HRSA Expectations

27. Potential Roles for Health Care for the Homeless Programs • Maintain services for patients and other underserved, vulnerable populations • Outreach to patients to provide treatment, meds, information, resources • Increase access to care through mobile vans • Provide mental health care for ‘worried & concerned’ • Disease or syndromic surveillance If staffing allows… • Increase hospital surge capacity • Provide care for 1st Responders • Provide medical/dental/MH/support staff for alternate care sites, PODs, shelters, etc.

28. Three Components to Preparedness Prepare your Program/Health Center Prepare your Staff Prepare Your Patients

29. Getting Started • Obtain buy-in from senior leaders, Board • Establish Emergency Management Committee • Appoint EM Coordinator • Define Role of Coordinator • Chair EM Committee • Develop/revise EMP • Attend local meetings • Meet with key partners • Coordinate staff training • Facilitate/arrange exercises

30. Next Steps • Familiarize yourself with local and state EM activities • Get involved in local planning groups – ESF 8 • Evaluate availability of funds to support your EM efforts – HPP or CDC PHEP • Determine to-date efforts and needs of community around planning for your population • Identify staff training needs and available resources to train them

31. Conduct a Hazard Vulnerability Analysis ‘It will not do to leave a live dragon out of your plans if you live near one’ -J.R.R Tolkien, The Hobbit • What are your risks? • How likely are they to occur? • How severely would they impact • People – staff, patients, community? • Property? • Business? • How prepared are you for these risks?

32. Naturally Occurring Hurricane Tornado Flood Epidemic Technologic Electric failure Fuel shortage HVAC failure Supply shortage Human Related Terrorism Hostage situation Bomb threat Civil disturbance Hazardous Materials Chemical release Radiologic exposure Chemical terrorism HVA Events to Consider

33. Planning Process • Determine the role of your program – internal and external response • Meet with LHD, hospitals, community agencies to discuss role • Train staff – Basic EM, NIMS, Basic IC, Donning/Doffing PPE, Gross Decontamination, Risk Communication, PERSONAL and FAMILY PREPAREDNESS • Educate patients – what to do in an emergency and where to go for help • Work with other agencies serving the same population to understand their plans, how it will impact your patients and ability to serve them, and how you can collaborate to maximize scarce resources

34. Create the EM Plan • Consider it a living document • Follow NIMS compliance principles • Identify and execute needed MOAs • Test, revise, repeat • SHARE with LHD, hospitals, health centers, partner agencies • Incorporate role in emergency into job description

35. Keep it Going • Maintain regular meetings of EM committee • Report to progress to Board quarterly • Provide ongoing info to staff about EM activities • Incorporate EM into annual trainings and orientation

36. Helping Staff Prepare Personal and Family Plans

37. Create a Personal / Family Plan • Choose an out of town contact • Choose 2 meeting spots • 1 place right outside home • 1 place outside neighborhood • Family communication plan – carry copy at all times • Work, cell, home, school, & other places where your family members may spend a lot of time – boy/girlfriend, place of worship, neighbor, etc • Information for out of town contact • Meeting locations • Escape routes and safe places • Have at least 2 escape routes from each room

38. Family Emergency Plan Plan

39. Don’t forget Fido! • Take your pets with you if you evacuate – but most emergency shelters do not allow them • Compile list of care-givers for pets: • Family or friends • Boarding facilities • Veterinarians • Pet-friendly hotels

40. Other Preparedness Activities • Utilities – know how and when to shut of water, gas, electricity • Fire extinguishers – place in easily accessible areas and make sure all everyone knows how to work them • Smoke alarms – install one on each level of home and outside bedrooms – be sure to have alarms with strobe lights and/or vibrating pads for those with sensory disabilities. Also consider carbon monoxide alarms. • Review insurance coverage / safeguard vital documents and records

41. Disaster Supplies Kit • 3 day supply of nonperishable food per person and manual can opener • 3 day supply of water (1 gal/person/day) • Radio/flashlight/1st Aid kit/sanitation & hygiene items/matches/batteries/whistle etc. • 1 extra month of prescription meds, eye glasses, contact lens supplies, hearing aid batteries • Pet supplies/tools/maps of community/cash

42. Maintain Your Plan • Review plan with family every 6 months • Conduct fire and evacuation drills • Restock/rotate food and water supplies • Read indicator on fire extinguisher and recharge as needed. Test smoke/CO alarm monthly and replace batteries every 6 months

43. How to Help Your Patients in an Emergency • What will your patients need to know in an emergency? • What is happening • How they can stay safe • Where to find shelter • Where to find food • Where to get medical treatment

44. Helping Your Patients • What you can do now: • Work with first responders, health department, emergency management agency and other local government entities to ensure that your program/other advocate plays a liaison role to your patients • Provide information about emergency preparedness in your community to your patients – handouts, posters, incorporate into encounter • Talk to your patients about the role of your program in emergency response • Work with partner agencies to identify gaps in community planning and try to fill them through collaboration and education of emergency planners

45. Helping Your Patients Pre-Event • Determine the following for a 7-10 day period: • Frequently prescribed medications and quantities needed by patient population • Supplies and equipment needed to provide treatment • Anything else that is vital to the operation of your program • Be sure that multiple people in your organization know where to find your patients • Develop method to track activities, staff time, and expenditures during event During Event • Get information and instructions (if any) from community PIO: • Send outreach workers to places where your population spends time • Post information in every exam room and waiting areas • Work with partner agencies to help spread the word – shelters, soup kitchens, community mental health centers • Consistency and accuracy are key! Same message from multiple sources will be more trustworthy • Maintain log of encounters and expenditures Post Event • Plan for significant increase in need for mental health service • Work with your local emergency management agency to access state/federal disaster assistance, if available

46. Resources

47. Training • Principles of Emergency Management: • FEMA Independent Study Program IS 230 (http://training.fema.gov/EMIWeb/IS/is230.asp) • NIMS: • FEMA Independent Study Program (http://training.fema.gov/IS/NIMS.asp) • Yale New Haven Center for Emergency Preparedness and Disaster Response EM 103 or 140 (http://ynhhs.emergencyeducation.org/) • Risk Communication • CDC Emergency and Risk Communication (http://www.bt.cdc.gov/erc/training.asp)

48. Training (cont) • Personal and Family Preparedness • Be Red Cross Ready (http://www.redcross.org/services/prepare/0,1082,0_239_,00.html) • FEMA – Are You Ready? (http://training.fema.gov/EMIWeb/IS/is22.asp • Psychological 1st Aid for Non-Mental Health Providers (http://ynhhs.emergencyeducation.org/)

49. Planning • Health Center Preparedness Assessment Tools • California Primary Care Association (http://www.cpca.org/resources/cepp/) • Community Health Center Association of New York State (http://www.chcanys.org/index.php?src=gendocs&link=ep_forcenters&category=Main) • Emergency Management Plans for Health Centers • California Primary Care Association (CPCA) (http://www.cpca.org/resources/cepp/) • Community Health Center Association of New York State (CHCANYS) (http://www.chcanys.org/index.php?src=gendocs&link=ep_forcenters&category=Main) • Community Health Center, Inc. (http://www.chc1.com)

50. Planning (cont) • Hazard Vulnerability Analysis • Kaiser Permanente (http://www.calhealth.org/public/press/Article%5C103%5CHazard%20&%20Vulnerability%20Analysis_kaiser_model.xls) • Standard Operating Procedures (SOPs) Template • Indiana Primary Care Association (http://www.indianapca.org/downloads/SOPTemplate.doc ) • Mental Health Resources • Centers for Disease Control and Prevention (http://emergency.cdc.gov/mentalhealth/)