HURRICANE PREPAREDNESS Working with Your Insurance: The Good, The Bad, The Ugly TAHFM Hospital Hurricane Conference By Jeffrey H. Peters, P.E. and Paul

HURRICANE PREPAREDNESSHURRICANE PREPAREDNESSWorking with Your Insurance:Working with Your Insurance:The Good, The Bad, The UglyThe Good, The Bad, The Ugly

TAHFMTAHFMHospital Hurricane Hospital Hurricane

ConferenceConference

By By Jeffrey H. Peters, P.E. and Paul G. Phillips, P.E.Jeffrey H. Peters, P.E. and Paul G. Phillips, P.E.

Rimkus Consulting Group, Inc.Rimkus Consulting Group, Inc.

MAY 19, 2006MAY 19, 2006

May 19, 2006May 19, 2006Hospital Hurricane ConferenceHospital Hurricane Conference

TAHFMTAHFM Rimkus Consulting Group, Inc.

Are YOU Ready?Are YOU Ready?

A NOAA-18 satellite picture of Hurricane Rita as of 1900 UTC on September 21.

YOU ARE HEREYOU ARE HERE

What – What – me worry?me worry?

I’ve gotI’ve gotInsurance!!Insurance!!

Mr. I. B. A. Mr. I. B. A. Facilities ManagerFacilities Manager



http://www.nhc.noaa.gov/gifs/GC13516.GIF

Does Does YOURYOUR Insurance Insurance Cover Wind Damage?Cover Wind Damage?

Does Does YOURYOUR Insurance Insurance Cover Wind Damage?Cover Wind Damage?



www.txdps.state.tx.us/dem/ Hurricanewww.txdps.state.tx.us/dem/ Hurricanemapsmaps/GalvestonStudyAreaMap.pdf /GalvestonStudyAreaMap.pdf

Does Does YOURYOUR Insurance Insurance Cover Flood Damage?Cover Flood Damage?Does Does YOURYOUR Insurance Insurance Cover Flood Damage?Cover Flood Damage?



Do Do YOUYOU Know Know YOURYOUR Insurance Coverage?Insurance Coverage?Do Do YOUYOU Know Know YOURYOUR Insurance Coverage?Insurance Coverage?



HURRICANE PREPAREDNESSHURRICANE PREPAREDNESSWorking with Your Insurance:Working with Your Insurance:

The GoodThe Good– Prepare for the Worst, Hope for the BestPrepare for the Worst, Hope for the Best

The BadThe Bad – Cutting Your LossesCutting Your Losses

The UglyThe Ugly– Where’s My Money?Where’s My Money?




The Good – Prepare for the WorstThe Good – Prepare for the Worst




The Good – Prepare for the WorstThe Good – Prepare for the Worst

Preparing the PeoplePreparing the People Preparing the DocumentationPreparing the Documentation

Preparing the BuildingPreparing the Building




The Good – Preparing the PeopleThe Good – Preparing the People





NIMS - National Incident Management NIMS - National Incident Management SystemSystem

Collaboration with Community RespondersCollaboration with Community Responders ICS – Incident Command SystemICS – Incident Command System JCAHO – EC 4.1JCAHO – EC 4.1 OSHAOSHA



http://www.fema.gov/emergency/nims/index.shtmhttp://www.fema.gov/emergency/nims/index.shtm



ICS Basic StructureICS Basic StructureIncident

Commander

Safety andSecurity

PublicInformation

Officer

Medical Officer

Liaison

LogisticsChief

PlanningChief

FinanceChief

OperationsChief



NIMS/ICS – Basic PrinciplesNIMS/ICS – Basic Principles• Span of ControlSpan of Control• Common TerminologyCommon Terminology• Personnel AccountabilityPersonnel Accountability• Patient AccountabilityPatient Accountability• Integrated CommunicationsIntegrated Communications• Resource ManagementResource Management• Incident Action PlanIncident Action Plan



NIMS/ICS – Basic PrinciplesNIMS/ICS – Basic Principles

• Management by functionManagement by function

• Modular (flexible) ResponseModular (flexible) Response

• Unity and Chain of CommandUnity and Chain of Command

• Transfer of CommandTransfer of Command

• Organizational FlexibilityOrganizational Flexibility

• Unified Command and ManagementUnified Command and Management

• Designated Functional AreasDesignated Functional Areas



Why Do We Need An Incident Why Do We Need An Incident Management System ?Management System ?

JCAHO says (EC 4.1)JCAHO says (EC 4.1)……a hospital needs to have an emergency a hospital needs to have an emergency

management plan that comprehensively management plan that comprehensively describes its approach to emergencies in describes its approach to emergencies in the hospital or in its community.the hospital or in its community.



http://www.jointcommission.org/NewsRoom/PressKits/PlanningGuide/http://www.jointcommission.org/NewsRoom/PressKits/PlanningGuide/



Federal RegulationsFederal Regulations

29 CFR 1910.120 (29 CFR 1910.120 (OSHAOSHA))

““The IncidentThe Incident Command System shall be Command System shall be established by those employers for the established by those employers for the incidents that will be under their control incidents that will be under their control and shall be interfaced with the other and shall be interfaced with the other organizations or agencies who may organizations or agencies who may

respond to such an incident.” respond to such an incident.”





Risk Manager Team buildingRisk Manager Team building Facilities Evaluation by Insurance Co.Facilities Evaluation by Insurance Co. Understanding Insurance Policy Issues – Understanding Insurance Policy Issues –

Deductibles, Coverage, LimitsDeductibles, Coverage, Limits Train Management Team on Insurance Train Management Team on Insurance

IssuesIssues




The Good – Preparing the DocumentationThe Good – Preparing the Documentation





ICS - Job DescriptionsICS - Job Descriptions Paper Forms (backup for loss of computers)Paper Forms (backup for loss of computers) Document Existing Conditions –video, photosDocument Existing Conditions –video, photos Secure storage critical building plans & mapsSecure storage critical building plans & maps Contact information and negotiate agreements Contact information and negotiate agreements

with vendors, suppliers, contractorswith vendors, suppliers, contractors





Determine what Insurance Documentation Determine what Insurance Documentation will be needed for a claim.will be needed for a claim.

Determine Insurance – Deductibles, Limits, Determine Insurance – Deductibles, Limits, Coverage.Coverage.

When do you need to notify Risk Manager of When do you need to notify Risk Manager of a loss?a loss?




The Good – Preparing the BuildingThe Good – Preparing the Building



HURRICANE PREPAREDNESSHURRICANE PREPAREDNESSWorking with Your Insurance:Working with Your Insurance:The Good – Preparing the BuildingThe Good – Preparing the Building

Hardening the FacilityHardening the Facility– WindWind– FloodFlood

UtilitiesUtilities– Stored vs. alternate sourcesStored vs. alternate sources




Encarta DictionaryEncarta Dictionary

““Harden: to become or make somebody or Harden: to become or make somebody or something become something become strongerstronger or more or more

resistantresistant””






Wind HardenWind Harden– EquipmentEquipment– WindowsWindows

– RoofsRoofs

Flood HardenFlood Harden– Equipment locationsEquipment locations

– Doors and gateDoors and gate





WIND HARDENINGWIND HARDENING Equipment Equipment

– AnchorAnchor– HardenHarden

Building EnvelopeBuilding Envelope– WindowsWindows

– DoorsDoors– RoofRoof




Wind force is NOT just on the side.Wind force is NOT just on the side.– The wind causes DRAG and LIFTThe wind causes DRAG and LIFT

You’ll be surprised – 140 MPH overturn force:You’ll be surprised – 140 MPH overturn force:– 25 Ton RTU - 3,500 lb.25 Ton RTU - 3,500 lb.– 2000 CFM fan – 500 lb.2000 CFM fan – 500 lb.

Drag Drag

Lift

Lift

Pivot Point Pivot Point

Weig

ht

Weig

ht





The Good – Preparing the BuildingThe Good – Preparing the Building Anchoring may be very simple:Anchoring may be very simple:

Or more complex:Or more complex:– Threaded rods and roof through-bolts for more strengthThreaded rods and roof through-bolts for more strength

Figure 6-51, FEMA 424Figure 6-51, FEMA 424 Figure 6-49, FEMA 424Figure 6-49, FEMA 424




OR don’t OR don’t tie it tie it down:down:

Maybe Maybe you’ll be you’ll be luckylucky

Courtesy of Terry Scott - Memorial Hermann Courtesy of Terry Scott - Memorial Hermann Baptist HospitalBaptist Hospital

Figure 6-50, FEMA 424Figure 6-50, FEMA 424






Envelope Damage Envelope Damage →→ Rain Damage Rain Damage Envelope damage comes from Envelope damage comes from

several things:several things:

– Impact from debris and projectilesImpact from debris and projectiles– Pressures exceed designPressures exceed design– Stresses from structural movement Stresses from structural movement





Protect your EnvelopeProtect your Envelope Windows and DoorsWindows and Doors

– ShuttersShutters– PanelsPanels– AccordionAccordion– Roll upRoll up– Debris Resistant Glass?Debris Resistant Glass?

– SealsSeals RoofRoof

– FlashingFlashing– StructuralStructural





http://chps.sam.usace.army.mil/USHESDATA/Assessments/alicia/buildings_damage.htm

DEBRISDEBRIS

Courtesy of Terry Scott - Memorial Hermann Courtesy of Terry Scott - Memorial Hermann Baptist HospitalBaptist Hospital

OVERPRESSUREOVERPRESSURE









LIFTLIFT





FLOOD HARDENINGFLOOD HARDENING OpeningsOpenings

– Ramps – elevate or flood gateRamps – elevate or flood gate– Doors – elevate or flood gateDoors – elevate or flood gate– Tunnels – submarine doorsTunnels – submarine doors

EquipmentEquipment– Location – up and outLocation – up and out

– Location – protected in placeLocation – protected in placeLOCATION LOCATION




The Good – Preparing the BuildingThe Good – Preparing the BuildingExamples flood protectionExamples flood protection

http://www.floodgateireland.com/GalleryProtectiveBarriers.htmhttp://www.floodgateireland.com/GalleryProtectiveBarriers.htm






http://www.floodbarriers.com/flood_gates/fg-c.htm










http://www.texaschildrenshospital.org/...http://www.texaschildrenshospital.org/...




http://www.med.uth.tmc.edu/construction/http://www.med.uth.tmc.edu/construction/images/flooded.jpgimages/flooded.jpg

http://www.ringstones.com/znj/images/2001/06Flood/downtown5.jpghttp://www.ringstones.com/znj/images/2001/06Flood/downtown5.jpg






UTILITY PREPAREDNESSUTILITY PREPAREDNESS PowerPower WaterWater

Medical GasesMedical Gases InfrastructureInfrastructure





POWER POWER On-site generation capacity?On-site generation capacity?

What do you want to run? What do you want to run? What is connected?What is connected?

Protect your generatorsProtect your generators Were is it located?Were is it located? Is it wind hardened?Is it wind hardened? Don’t forget your SWITCHGEARDon’t forget your SWITCHGEAR

Fuel capacityFuel capacity How long can you run?How long can you run? Is it flood hardened?Is it flood hardened?

Hook-upsHook-ups Can you easily connect what you don’t have on-site?Can you easily connect what you don’t have on-site?





WATERWATER – what if it goes out? – what if it goes out?

How reliableHow reliable is the utility? is the utility? On-site wellsOn-site wells On-site storageOn-site storage

PotablePotable Needs Needs Food and DrinkingFood and Drinking Infection ControlInfection Control Flush waterFlush water

Non-potableNon-potable Users Users Cooling TowersCooling Towers Steam/SterilizersSteam/Sterilizers Chilled water makeupChilled water makeup

Hook-upsHook-ups Can you easily connect what you don’t have on-site?Can you easily connect what you don’t have on-site?





MEDICAL GASES – MEDICAL GASES – got to have the gas!got to have the gas!

ON-SITE?ON-SITE? How long will your on-site stores last?How long will your on-site stores last? On-site storageOn-site storage

WIND HARDENED?WIND HARDENED? How about that big bulk OHow about that big bulk O22 tank? tank?

FLOOD HARDENED?FLOOD HARDENED? Will you bottles and manifolds flood?Will you bottles and manifolds flood? Can you get in to fill tanks and replace bottles?Can you get in to fill tanks and replace bottles?

Hook-upsHook-ups Are your emergency connections protected?Are your emergency connections protected?




The Good – Preparing the BuildingThe Good – Preparing the BuildingINFRASTRUCTURE – INFRASTRUCTURE – what’s that?what’s that?

What you need to get things doneWhat you need to get things done Chilled WaterChilled Water

Steam - SterilizersSteam - Sterilizers

Electrical – not just the emergencyElectrical – not just the emergency

FLOOD HARDENED?FLOOD HARDENED? Have your protected your central plant?Have your protected your central plant?

Your cooling towers?Your cooling towers?

Your electrical closets?Your electrical closets?

Hook-upsHook-ups Emergency connections give you a second chance if you Emergency connections give you a second chance if you

lose you plant.lose you plant.




– FacilityFacility EnvelopeEnvelope

– RoofRoof– RampsRamps– DoorsDoors– WindowsWindows

EquipmentEquipment– RooftopRooftop– IndoorIndoor


– UtilityUtility PowerPower

– GenerationGeneration– ProtectionProtection– Emergency HookupEmergency Hookup– Fuel Storage/SourcesFuel Storage/Sources

WaterWater– Wells/Storage/Other sourcesWells/Storage/Other sources– Emergency HookupsEmergency Hookups

Medical GasesMedical Gases– Storage/SourcesStorage/Sources– ProtectionProtection

InfrastructureInfrastructure– Emergency HookupEmergency Hookup

HAVE YOU DONE YOURHAVE YOU DONE YOUR

FACILTY SURVEYFACILTY SURVEY??




The Bad – Cutting Your LossesThe Bad – Cutting Your Losses




The Bad – Cutting Your LossesThe Bad – Cutting Your Losses

Protecting the BuildingProtecting the Building Protecting the PeopleProtecting the People

Protecting the FinancesProtecting the Finances




The Bad – Protecting the BuildingThe Bad – Protecting the Building



HURRICANE PREPAREDNESSHURRICANE PREPAREDNESSWorking with Your Insurance:Working with Your Insurance:The Bad – Protecting the BuildingThe Bad – Protecting the Building

DURING THE STORM - Hunker DownDURING THE STORM - Hunker Down1.1. Protect PEOPLEProtect PEOPLE

2.2. React and MoveReact and Move

3.3. Check your Wind and Flood protection Check your Wind and Flood protection

4.4. Protect EQUIPMENTProtect EQUIPMENT

5.5. Everyone take Photos and VideosEveryone take Photos and Videos



HURRICANE PREPAREDNESSHURRICANE PREPAREDNESSWorking with Your Insurance:Working with Your Insurance:The Bad – Protecting the BuildingThe Bad – Protecting the Building

AFTER THE STORM – Incident ManagementAFTER THE STORM – Incident Management1.1. Protect PEOPLEProtect PEOPLE

2.2. Facility TriageFacility Triage– Everyone take photos and videosEveryone take photos and videos

3.3. Protect the Envelope Protect the Envelope

4.4. Dry it out in Dry it out in <<48 hours48 hours

5.5. Restore utilitiesRestore utilities– You might not think to but:You might not think to but:

CHECK YOUR FLUSH VALVESCHECK YOUR FLUSH VALVES





Supplies for temporary repairs to minimize Supplies for temporary repairs to minimize damages:damages:– PlywoodPlywood– TarpsTarps– Small pumpsSmall pumps– Small generatorsSmall generators– Sand bagsSand bags





People to HELP, People to MANAGEPeople to HELP, People to MANAGE Incident Management Team ControlsIncident Management Team Controls

– Your own TeamYour own Team– Restoration Companies – they will be FIRST!Restoration Companies – they will be FIRST!– Engineers, Architects, VendorsEngineers, Architects, Vendors

Facility Triage guidesFacility Triage guides




The Bad – Protecting the PeopleThe Bad – Protecting the People





You are on your own +0-3 days, local help You are on your own +0-3 days, local help maybe in 3-5 days, national in 5-7 days.maybe in 3-5 days, national in 5-7 days.

Federal aid must wait for State request, Federal aid must wait for State request, (however this may change soon).(however this may change soon).

Know and understand NIMS-ICSKnow and understand NIMS-ICS





You can only provide for so many people:You can only provide for so many people:– Limited food/water/care, Lock Down procedureLimited food/water/care, Lock Down procedure– Liability/Negligence claimsLiability/Negligence claims

PPE, Rain gear, flashlights, eye protection, PPE, Rain gear, flashlights, eye protection, shots – protect workersshots – protect workers

Watch for Fatigue, increased potential for Watch for Fatigue, increased potential for personal injuries personal injuries




The Bad – Protecting the FinancesThe Bad – Protecting the Finances



HURRICANE PREPAREDNESSHURRICANE PREPAREDNESSWorking with Your Insurance:Working with Your Insurance:The Bad – Protecting the FinancesThe Bad – Protecting the Finances

Document EVERYTHING with PAPER.Document EVERYTHING with PAPER. First You spend your money, then Insurance First You spend your money, then Insurance

reimburses, how are you going to pay?reimburses, how are you going to pay?– Credit Accounts (pre establish with one time Credit Accounts (pre establish with one time

vendors)vendors)– Purchase Orders (can you issue manually?)Purchase Orders (can you issue manually?)– CASH is KING!CASH is KING!



HURRICANE PREPAREDNESSHURRICANE PREPAREDNESSWorking with Your Insurance:Working with Your Insurance:The Bad – Protecting the FinancesThe Bad – Protecting the Finances

Video tapes, photos – assign someoneVideo tapes, photos – assign someone Work Logs for staffWork Logs for staff Diaries/Journals/Meeting Notes of Diaries/Journals/Meeting Notes of

EVERYTHING - who, what, when, why.EVERYTHING - who, what, when, why. Contractor Logs – count ever person, major Contractor Logs – count ever person, major

pieces of equipment and all materials used.pieces of equipment and all materials used.




The Ugly – Where’s My Money?The Ugly – Where’s My Money?




The Ugly – Where’s My Money?The Ugly – Where’s My Money?

How Insurance WorksHow Insurance Works Who are all these Other People?Who are all these Other People?

Document, Document, Document…Document, Document, Document…




The Ugly – How Insurance WorksThe Ugly – How Insurance Works





Facilities notifies Risk ManagerFacilities notifies Risk Manager Risk Manager notifies Insurance CompanyRisk Manager notifies Insurance Company Insurance Adjuster inspects the damage Insurance Adjuster inspects the damage

and makes an estimate of costs.and makes an estimate of costs. Adjuster set aside “Reserves” based on Adjuster set aside “Reserves” based on

estimate of damages.estimate of damages.





Adjuster may ask multiple Experts to Adjuster may ask multiple Experts to investigate Causation or Damages in greater investigate Causation or Damages in greater detail.detail.

Adjuster reviews DOCUMENTATION you Adjuster reviews DOCUMENTATION you have provided and Reports from Experts and have provided and Reports from Experts and “adjusts” claim based on policy coverage, “adjusts” claim based on policy coverage, deductibles and limits.deductibles and limits.





Adjuster pays claim.Adjuster pays claim. The process can take months maybe years The process can take months maybe years

for large losses.for large losses.




The Ugly – Who are all these Other People?The Ugly – Who are all these Other People?




The Ugly – Who are all these Other People?The Ugly – Who are all these Other People?

Restoration Companies – they will be FIRST!Restoration Companies – they will be FIRST! Public AdjustersPublic Adjusters Subrogation Claim Managers/AttorneysSubrogation Claim Managers/Attorneys Causation/Damage ExpertsCausation/Damage Experts Salvage ExpertsSalvage Experts Clerk of WorksClerk of Works




The Ugly – Document, Document, Document...The Ugly – Document, Document, Document...





Document EVERYTHING.Document EVERYTHING. Keep/preserve/secure all damaged items as Keep/preserve/secure all damaged items as

long as possible, video/photo everything if it long as possible, video/photo everything if it absolutely has to be thrown away, record any absolutely has to be thrown away, record any data such as descriptions, models, serial data such as descriptions, models, serial numbers.numbers.

Take eye-witness accounts.Take eye-witness accounts.





Save relevant newspaper/Internet articles Save relevant newspaper/Internet articles about extent of damage, intensity of storm.about extent of damage, intensity of storm.

Preserve security tapes (do NOT allow re-use Preserve security tapes (do NOT allow re-use of tapes recorded during incident).of tapes recorded during incident).

Preserve all computer data, such as security Preserve all computer data, such as security alarms, building automation, dispatch alarms, building automation, dispatch recordings.recordings.





Save all expenses, invoices from contractors, Save all expenses, invoices from contractors, equipment rental and setup costs.equipment rental and setup costs.

Assign task of documentation gathering, “Clerk Assign task of documentation gathering, “Clerk of Works”.of Works”.

Without proper Documentation, your claim Without proper Documentation, your claim may be denied.may be denied.



Do Do YOUYOU Know Know YOURYOUR Insurance Coverage?Insurance Coverage?Do Do YOUYOU Know Know YOURYOUR Insurance Coverage?Insurance Coverage?

Insurance doesn’t care if it’s a Insurance doesn’t care if it’s a Hurricane, So Use Your Hurricane, So Use Your

Knowledge of Insurance for Knowledge of Insurance for AllAll Disasters Disasters

HURRICANE PREPAREDNESSHURRICANE PREPAREDNESSWorking with Your Insurance:Working with Your Insurance:The Good, The Bad, The UglyThe Good, The Bad, The Ugly

By By Jeffrey H. Peters, P.E. and Paul G. Phillips, P.E.Jeffrey H. Peters, P.E. and Paul G. Phillips, P.E.

Rimkus Consulting Group, Inc.Rimkus Consulting Group, Inc.

MAY 19, 2006MAY 19, 2006

Documents

HURRICANE PREPAREDNESS Working with Your Insurance: The Good, The Bad, The Ugly TAHFM Hospital Hurricane Conference By Jeffrey H. Peters, P.E. and Paul