Legal Issues in Hospital Preparations for Disaster Response – “Operational Considerations”

1. Legal Issues in Hospital Preparations for Disaster Response –“Operational Considerations” Knox Andress, RN, FAEN Designated Regional Coordinator Louisiana Region 7 Hospitals Emergency Preparedness Coordinator CHRISTUS Schumpert Health System Shreveport, Louisiana

2. Topics of Discussion • Recognizing the potential issues • Hospital standards origination • The Emergency Management Plan • Command and management • Emergency communications • Credentialing • Surge capacity National Emergency Management Summit – New Orleans

3. Practical Hospital Applications • Operational goal – recognize and respond to the disaster or incident • Methods - Preparedness, Mitigation, Response and Recovery National Emergency Management Summit – New Orleans

4. Issues - Potential and Reality • AHRQ project “Altered Standards of Care” (August 2004) • 40 experts/3 days • 2 terrorism scenarios • Medical and response resources overwhelmed • Resulted in – recognized extraordinary measures for health care delivery and “altered” or degraded standards of care. • Hurricane Katrina and Rita (August – September 2005) National Emergency Management Summit – New Orleans

5. Louisiana Hospital Impact • Katrina – directly impacted 88 Critical and Non-Critical Care Facilities • Rita – directly impacted 53 Critical and Non-Critical Care Facilities (includes Acute, Critical Access, Limited Services, and Specialty Hospitals) National Emergency Management Summit – New Orleans

6. Standards Origination • Standards – law and statues • Federal – Health Insurance Portability and Accountability Act (HIPAA) • Emergency Medical Treatment and Active Labor Act (EMTALA) • Regulatory standards – OSHA • State licensing requirements National Emergency Management Summit – New Orleans

7. Standards origination (continued) • Hospital industry standards – • The Joint Commissions for the Accreditation of Health Care Organizations (JCAHO) • Professional organizationstandards- • National Fire Protection Association; 1600, Standard on Disaster/Emergency Management and Business Continuity Programs, 2004 ed. • National Incident Management System (NIMS) – • Implementation for Hospitals and Health Care Systems. National Emergency Management Summit – New Orleans

8. Issues may arise….. • During deviation from usual standards • When hospital operations are NOT “business as usual” National Emergency Management Summit – New Orleans

9. Meeting standards • Issues largely met by responsibly planning for and preparing for emergencies and disasters • Done by following and implementing appropriate guidance. • Consider JCAHO, NFPA and NIMS… National Emergency Management Summit – New Orleans

10. The Emergency Management Plan • JCAHO E.C. 4.1 – The hospital has an emergency management plan. • Leadership including medical staff participation • Based on a Hazards Vulnerability Analysis (HVA) • Describes specific procedures for preparedness, mitigation, response and recovery. National Emergency Management Summit – New Orleans

11. HVA example National Emergency Management Summit – New Orleans

12. The Hospital Emergency Management Plan (continued) • NFPA 1600, 4.1 – • Establishes the need for a hospital emergency management plan with goals, objectives, plans and procedures • NIMS, Implementation for Hospitals and Health Care Systems – • requires NIMS be adopted into the hospital emergency management plan National Emergency Management Summit – New Orleans

13. Command and Management - • JCAHO, E.C. 4.10 • Hospitals establish an “all hazards” command structure linking with the community’s (ICS via NIMS) • Provides for - Staff support, logistics, security, communication, staff family support, activities related to care • Planning with other hospitals in contiguous geographic areas including command structures and alternate roles and responsibilities. National Emergency Management Summit – New Orleans

14. Command and Management (continued) • NFPA 1600, 5.8.2 • Addresses the need for hospital emergency management plans with organizational roles, titles and responsibilities for those named in the plan • NIMS Implementation Activities for Hospitals and Health Care Systems, Element 2 • Use of Incident Command System (ICS), organizational structures, doctrine and procedures National Emergency Management Summit – New Orleans

15. Hospital Incident Command System (HICS) National Emergency Management Summit – New Orleans

16. HEICS – Katrina & Rita National Emergency Management Summit – New Orleans

17. Hospital Command Center – Katrina & Rita National Emergency Management Summit – New Orleans

18. Hospital Emergency Communications • JCAHO, E.C. 4.1 – • The plan provides processes for communications. • Internally – patients, staff, family • Externally – community authorities • Backup internal and external systems in event of failure • NFPA 1600, 5.9 – • Regularly tested systems and procedures and protocols to notify officials and alert…interoperable. National Emergency Management Summit – New Orleans

19. Emergency Communications National Emergency Management Summit – New Orleans

20. Primary – Telephone Cell phone Email Fax Secondary – 2 way pagers 800 MHz radio Blackberry Webpage Satellite Ham radio VOIN Don’t forget extra batteries Managing Emergency Communications – Equipment National Emergency Management Summit – New Orleans

21. Hospital Emergency Communications (continued) • NIMS Implementation for Hospitals and Health Care Systems, Elements 2 and 3 – • Emergency operations plan coordinates and supports response through multi agency systems (MACS)…. • Establishes connectivity with local command posts, 911 centers, Emergency Operation Centers… National Emergency Management Summit – New Orleans

22. “Hospital Relationship to Community Response Partners” National Emergency Management Summit – New Orleans

23. Managing Emergency Communications • Develop communications plan • Identify • threats, processes and responses / alternative to communication outage • “Needs – Assessment” • To document & coordinate communication assets and location • Assistance from State and/or local Office of Emergency Management, and/or Hospital Association National Emergency Management Summit – New Orleans

24. Credentialing - • JCAHO, HR 1.25, MS 4.110 • Organizations may grant disaster privileges/responsibilities to volunteer practioners. • Mechanism to identify • Valid government photo ID and appropriate license • Organization oversees independent practioners National Emergency Management Summit – New Orleans

25. Credentialing (continued) • NFPA 1600, 5.5.2; 4 • Resource management shall consider personnel, equipment, training • Liability connected with using involved resources • Donations shall be managed National Emergency Management Summit – New Orleans

26. Credentialing (continued) • NIMS Implementation for Hospitals and Health Care Systems, Elements 15, 16 – • Hospitals will maintain an inventory of organizational response elements. • Ensure relevant national standards and guidance to achieve and incorporate equipment, communications and data interoperability. National Emergency Management Summit – New Orleans

27. Credentialing initiatives are found… • Emergency System Advanced Registration Volunteer Health Professionals (ESAR-VHP) • Federal Disaster Medical Assistance Teams (DMATs) • Individual state programs – Uniformed Badging System (UBS), Nevada. National Emergency Management Summit – New Orleans

28. Surge Capacity • Health care systems’ ability to rapidly expand beyond normal services…demand for personnel, medical and public health…in the event of public health or other emergencies. • Planning provided for by • HRSA – NBHPP (500/1,000.000) • MRC • AHRQ • MMRS • CDC National Emergency Management Summit – New Orleans

29. Examples of Surge National Emergency Management Summit – New Orleans

30. Providing Adequate Surge Capacity National Emergency Management Summit – New Orleans

31. Flu Surge – Potential Louisiana Region 7 admissions8 week outbreak – 25% attack rate National Emergency Management Summit – New Orleans

32. Altered or relaxed standards - • Medical response for catastrophic disasters has and will require relaxed or altered standards for health care facilities. National Emergency Management Summit – New Orleans

33. Resources - • Websites: • http://www.ahrq.gov/browse/bioterbr.htm • http://www.pandemicflu.gov • http://www.emsa.ca.gov • http://www.who.int/en/ • http://www.osha.gov/dts/osta/bestpractices/firstreceivers_hospital.html • http://www.jcaho.org/ • http://www.nfpa.org/ National Emergency Management Summit – New Orleans

34. Acronyms • AHRQ – Agency for Healthcare Research and Quality • CDC – The Center for Disease Control • ESAR-VHP – Emergency System for the Advance Registration of Volunteer Health Professionals • HRSA – Health Resources and Services Administration • JCAHO – Joint Commission on Accreditation of Healthcare Organizations • MMRS – Metropolitan Medical Response System • MRC – Medical Reserve Corps • NFPA – National Fire Protection Association • NIMS – National Incident Management System • VOIN – Voice Over InterNet National Emergency Management Summit – New Orleans

35. Thanks Knox Andress, RN, FAEN Designated Regional Coordinator Louisiana Region 7 Hospitals Emergency Preparedness Coordinator CHRISTUS Schumpert Health System #1 St Mary Place Shreveport, Louisiana 71101 Ph (318) 681-4255; Cell (318) 465-9500 Knox.andress@christushealth.org knoxandress@yahoo.com National Emergency Management Summit – New Orleans