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

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

Knox Andress, RN, FAENDesignated Regional CoordinatorLouisiana Region 7 HospitalsEmergency Preparedness CoordinatorCHRISTUS Schumpert Health SystemShreveport, Louisiana

3/6/2007National Emergency Management

Summit – New Orleans

Topics of Discussion Recognizing the potential issues Hospital standards origination The Emergency Management Plan

Command and management Emergency communications Credentialing

Surge capacity

3/6/2007National Emergency Management

Summit – New Orleans

Practical Hospital Applications

Operational goal – recognize and respond to the disaster or incident

Methods - Preparedness, Mitigation, Response and Recovery

3/6/2007National Emergency Management

Summit – New Orleans

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)

3/6/2007National Emergency Management

Summit – New Orleans

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)

3/6/2007National Emergency Management

Summit – New Orleans

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

3/6/2007National Emergency Management

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Standards origination (continued) Hospital industry standards –

The Joint Commissions for the Accreditation of Health Care Organizations (JCAHO)

Professional organization standards- 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.

3/6/2007National Emergency Management

Summit – New Orleans

Issues may arise…..

During deviation from usual standards

When hospital operations are NOT “business as usual”

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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…

3/6/2007National Emergency Management

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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.

3/6/2007National Emergency Management

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HVA exampleSEVERITY = (MAGNITUDE - MITIGATION)

EVENT

PROBABILITY HUMAN IMPACT

PROPERTY IMPACT

BUSINESS IMPACT

PREPARED-NESS

INTERNAL RESPONSE

EXTERNAL RESPONSE

RISK

Likelihood this will occur

Possibility of death or injury

Physical losses and damages

Interuption of services

PreplanningTime,

effectivness, resouces

Community/ Mutual Aid staff

and suppliesRelative threat*

SCORE

0 = N/A 1 = Low 2 = Moderate 3 = High

0 = N/A 1 = Low 2 = Moderate 3 = High

0 = N/A 1 = Low 2 = Moderate 3 = High

0 = N/A 1 = Low 2 = Moderate 3 = High

0 = N/A 1 = High

2 = Moderate 3 = Low or none

0 = N/A 1 = High

2 = Moderate 3 = Low or none

0 = N/A 1 = High

2 = Moderate 3 = Low or none

0 - 100%

Hurricane 0 2 3 2 1 2 1 0%

Tornado 2 2 3 2 2 2 2 48%

Severe Thunderstorm

3 2 3 2 1 2 1 61%

Snow Fall 1 2 2 1 3 3 3 26%

Blizzard 1 2 2 1 3 3 3 26%

Ice Storm 1 2 2 1 3 3 3 26%

Earthquake 2 3 3 3 2 2 2 56%

Tidal Wave 0 3 3 3 3 0 3 0%

Temperature Extremes

3 2 1 1 1 1 1 39%

Drought 2 1 1 1 1 1 1 22%

Flood, External 2 3 3 3 1 2 1 48%

Wild Fire 1 2 3 2 1 3 1 22%

Landslide 0 2 3 2 2 0 2 0%

Dam Inundation 1 3 3 3 2 3 2

Volcano 1 3 3 2 2 3 2 28%

Epidemic 2 3 1 3 2 1 2 44%

AVERAGE SCORE 1.38 2.31 2.44 2.00 1.88 1.94 1.88 32%

*Threat increases with percentage.

22 RISK = PROBABILITY * SEVERITY

199 0.32 0.46 0.69

3/6/2007National Emergency Management

Summit – New Orleans

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

3/6/2007National Emergency Management

Summit – New Orleans

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.

3/6/2007National Emergency Management

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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

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Hospital Incident Command System (HICS)

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HEICS – Katrina & Rita

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Hospital Command Center – Katrina & Rita

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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.

3/6/2007National Emergency Management

Summit – New Orleans

Emergency Communications

3/6/2007National Emergency Management

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Managing Emergency Communications – Equipment Primary –

Telephone Cell phone Email Fax

Secondary – 2 way pagers 800 MHz radio Blackberry Webpage Satellite Ham radio VOIN

Don’t forget extra batteries

3/6/2007National Emergency Management

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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…

3/6/2007National Emergency Management

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“Hospital Relationship to Community Response Partners”

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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

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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

3/6/2007National Emergency Management

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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

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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.

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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.

3/6/2007National Emergency Management

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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

3/6/2007National Emergency Management

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Examples of Surge

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Providing Adequate Surge Capacity

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Flu Surge – Potential Louisiana Region 7 admissions

8 week outbreak – 25% attack rate

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Altered or relaxed standards - Medical response for catastrophic

disasters has and will require relaxed or altered standards for health care facilities.

3/6/2007National Emergency Management

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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/bestpractice

s/firstreceivers_hospital.html http://www.jcaho.org/ http://www.nfpa.org/

3/6/2007National Emergency Management

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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

3/6/2007National Emergency Management

Summit – New Orleans

Thanks

Knox Andress, RN, FAENDesignated Regional CoordinatorLouisiana Region 7 Hospitals

Emergency Preparedness CoordinatorCHRISTUS Schumpert Health System#1 St Mary PlaceShreveport, Louisiana 71101Ph (318) 681-4255; Cell (318) 465-9500Knox.andress@christushealth.org knoxandress@yahoo.com