Module 5: Emergency Management Standards for Health Care Systems

1. Module 5:Emergency Management Standards for Health Care Systems

2. Module Objectives:

3. Unit 5.1:Overview ofNFPA & JCAHO Emergency Management Standards

4. Unit Objectives:

5. National Fire Protection Association (NFPA)Emergency ManagementStandards

6. NFPA • Mission: To reduce the worldwide burden of fire and other hazards on the quality of life by providing and advocating scientifically-based consensus codes and standards, research, training and education. • Organized in 1896 • Membership: 68,000 individuals and 80 national trade and professional hroups.

7. NFPA Activities • Technical: Development, publication and dissemination of timely consensus codes and standards intended to minimize the possibility and effects of fire. • 225 Technical Committees composed of 6,500 representatives serving on an unpaid basis. • Educational: Teaching these codes and standards and the importance of fire safety as a way of life.

8. NFPA Format • Standard • Appendix A: Explanatory Material • Appendix B: Referenced Publications • Appendix C: Additional Information • General Considerations • Personnel Notification and Recall • Special Considerations

9. NFPAEmergency Management Standards • NFPA 99, Chapter 11: Health Care Emergency Management • Pre-dates Joint Commission’s attention to emergency preparedness. • NFPA 1600: Recommended Practice for Emergency Management • Public-private, international consensus

10. 2001NFPA 99, Chapter 11:Health Care Emergency Management

11. NFPA 99, Chapter 11 • Scope: Establishes minimum criteria for an effective health care facility emergency management plan. • Applicability: Any health care facility that intends to provide medical treatment to the victims of a disaster.

12. NFPA 99/11Plan Criteria • Identification of Emergency Response Personnel • Continuity of Essential Building Systems • Staff Management • Patient Management • Logistics

13. NFPA 99/11Plan Criteria (con’t) • Security • Public Affairs • Staff Education • Drills • Operational Recovery

14. 2000 NFPA 1600:Recommended Practice for Emergency Management

15. NFPA 1600 • Purpose: To provide those with a responsibility for emergency management the criteria to assess current programs, or to develop,implement and maintain a program to mitigate, prepare for, response to, or recover from disasters and emergencies.

16. NFPA 1600:Program Elements • Laws & Authorities • Hazard Identification & Risk Assessment • Hazard Management • Resource Management • Planning

17. NFPA 1600:Program Elements (con’t) • Direction, Control & Coordination • Communications & Warning • Operations & Procedures • Logistics & Facilities • Training

18. NFPA 1600:Program Elements (con’t) • Exercises, Evaluations & Corrective Actions • Public Education & Information • Finance & Administration

19. 2001 Joint Commission on the Accreditation of Healthcare Organizations (JCAHO)Environment of Care (EC) 1.4 Emergency ManagementStandards

20. Environment of Care The goal of the Environment of Care (EC) is to provide a safe, functional, supportive and effective environment for patients, staff members and other individuals to the health care facility.

21. Environment of Care Areas • Safety • Life Safety • Security • Hazardous Materials and Wastes • Utility Systems • Medical Devices • Emergency Management

22. Emergency Management The goal of emergency management (EM) is to create and maintain an effective organization to prevent, prepare for, respond to and recover from major threats to lives and livelihoods.

23. Environment of Care (EC) Framework EC 3.1 Collect information about deficiencies EC 3.2 Corrective action EC 1 Design EC 3 Measurement EC 1.4 Design management plan EC 2.9 Drills are conducted EC 2 Teach & Implement EC 2.5 Plan is implemented EC 2.1 Staff can describe/demonstrate

24. Relationship of EC to EM EC 3.1 Collect information about deficiencies EC 3.2 Corrective action EC 1 Design EC 3 Measurement MITIGATION EC 1.4 Design management plan RESPONSE, RECOVERY EC 2.9 Drills are conducted PREPAREDNESS EC 2 Teach & Implement EC 2.5 Plan is implemented EC 2.1 Staff can describe/demonstrate

25. JCAHO EC 1.4:What’s New • Comprehensive Emergency Management • Hazards Vulnerability Analysis • PICE Nomenclature

26. JCAHO EC 1.4:What’s New (con’t) • Plan Activation Criteria • How, When, By Whom? • Hospital-Community Linkage • Who is in charge - when? • Personnel Identification • Preparing for Patient, Staff and Family Needs

27. JCAHO EC 1.4:What’s New (con’t) • Security • Media Relations • Back-up Communications • Internal and External • Facility Evacuation • Horizontal and Vertical

28. JCAHO EC 1.4:What’s New (con’t) • Alternate Care Site • Meet clinical needs of the patient • Patient tracking • Meds • Medical records • Transport patients, staff, equipment • Interfacility communications

29. JCAHO EC 1.4:What’s New (con’t) • Planning for Restoration/Recovery • Utility Systems • Critical Supplies • Continuity of Business Operations • Incident Management System

30. Unit 5.2:Relationship Between the NFPA and JCAHO EM Standards

31. Unit Objectives:

32. Relationship:99/11, 1600 & EC 1.4 • Complementary & consistent. • NFPA 1600 provides an overall emergency management program structure. • 13 functional areas/program elements specified • JCAHO EC 1.4 provides detail on health system specifics. • Align to functional areas/program elements • NFPA 99/11 augments both.

33. NFPA 1600-JCAHO 1.4 NFPA JCAHO • Program Management • Policy • Program Coordinator • Program Committee • Program Assessment q • Program Elements • General Intent • Laws & Authorities • Hazard Ident./Risk Assessment a.

34. NFPA 1600-JCAHO 1.4 (con’t) NFPA JCAHO • Program Elements (con’t) • Hazard Management • Resource Management • Planning c • Direction, Control & Coordination b, ( c ), f, g, h, o • Communications & Warning d, e, m. • Operations & Procedures (a),(h), i, j, k • Logistics & Facilities (h), I, n

35. NFPA 1600-JCAHO 1.4 (con’t) NFPA JCAHO • Program Elements (con’t) • Training p • Exercises, Evaluations & Corrective Actions q, r, 2.9 • Public Education & Information (h) • Finance & Administration

36. Standard Program Description

37. Program Review Tool

38. Unit 5.3:Approaches to the 2001JCAHO EM Standards

39. Unit Objectives:

40. EoC 1.4, Intent Statement • The emergency management plan describes how the organization will establish and maintain a program to ensure effective response to disasters or emergencies affecting the environment of care. The plan should address four phases of emergency management activities: mitigation, preparedness, response, and recovery.

41. ComprehensiveEmergency Management:4 Phases • Mitigation • Preparedness • Response • Recovery

42. Mitigation Activities • Hazards Analysis - Internal & External • Vulnerability Analysis • Actions taken to reduce the impacts - What types of natural, technological and man-caused events threaten the Environment of Care? - For each threat, ask “What will be the likely impacts (considering both direct and indirect effects) ?” - What can be done to ensure operating systems remain functional? (And have back-ups...)

43. Preparedness Activities • Resources Listing • Pre-arranged agreements • Staff orientation and training on basic response actions • Facility-wide rehearsals - That provide the back-up for damage to the plant, supplies, equipment, communications, and people. - Simple guidelines covering how you expect each employee to behave during any emergency. - That stress organizational mobilization coordination, and communications

44. Response Activities • Take appropriate actions to protect life and conserve property • Notify persons in charge • Continue to organize and manage • Situation assessment • Warning and notifications • Setting objectives and priorities • Facility-wide instructions • Plan for what happens next • Liaison with external systems All Staff Mgmt.

45. Recovery Activities • Determine present level and extent of patient care capability • Adjust patient care policies • Set objectives and priorities for the re-establishment of operating systems that support the Environment of Care • Make stress debriefing services available to patients and staff • Schedule and conduct an incident critique • Make improvements to the CEM program

46. Structuring theManagement Plan • NFPA 1600’s 13 Program elements provide an outline for the emergency management program, within which JCAHO 1.4 fits. • Management Plan components: • Laws & Authorities • Policy & Mission statement(s) • Responsibilities • Goals, objectives and strategies • Budget

47. Hazards Vulnerability Assessment (HVA) • A needs assessment for the emergency management program. • Three components : • Hazard identification (what?) • Risk assessment (how likely?) • Appraisal of vulnerabilities (what will we lose • Outputs/uses: • Resource identification and inventory. • Mitigation program • Education program

48. IEMS Maximum Capability Required Optimally Integrated Plans Continual Maintenance 5 MITIGATION EFFORTS CAPABILITY ASSESSMENT EMERGENCY OPERATIONS PLANS CAPABILITY MAINTENANCE 6 7 EMERGENCY OPERATIONS EVALUATION 2 3 4 HAZARDS ANALYSIS 11 STATE/ LOCAL RESOURCES 13 1 CAPABILITY SHORTFALL MULTI-YEAR DEVELOPMENT PLAN ANNUAL DEVELOPMENT INCREMENT ANNUAL WORK INCREMENT 12 FEDERAL RESOURCES 8 9 10

49. Hazard Identification • Types of hazards in the local community: natural, technological, man-caused. • Sources of information: State/Local Emergency Management Agency, Local Emergency Planning Committee • Technical guidance: NFPA 1600, engineering department. • Output: A list used by the facility’s emergency management planning committee.

50. Risk Assessment • Subjective prioritization of hazards identified (probability hazard will occur). • Educational activity for facility emergency management planning committee. • Think in terms of the facility, but also the entire community. • Outputs: Prioritized list of hazards, risk maps.