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 MelbourneJune 14, 2008

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

Principles of Emergency Management

MitigationPreparedness

Response Recovery

Emergency Management Phases

Mitigation

PreparednessResponse

Recovery

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

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

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

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

HRSA PIN 2007-15

Health Center Emergency Management Program Expectations

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”

Health Center Emergency Management Program Expectations PIN 2007-15

A. Emergency Management Planning

B. Linkages and Collaboration

C. Communications and Information Sharing

D. Maintaining Financial and Operational

Stability

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)

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

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

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

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

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

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

HRSA PIN 2007-16

FTCA Coverage for Health Center Program Grantees Responding to Emergencies

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

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

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

Healthcare for the Homeless Programs &

Emergency Management

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

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

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.

Three Components to Preparedness

Prepare your Program/Health Center

Prepare your Staff

Prepare Your Patients

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

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

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?

HVA Events to Consider

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

Human Related – Terrorism– Hostage situation– Bomb threat– Civil disturbance

Hazardous Materials– Chemical release– Radiologic exposure– Chemical terrorism

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

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

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

Helping Staff Prepare

Personal and Family Plans

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

Family Emergency Plan Plan

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

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

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

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

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

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

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

Resources

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)

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/)

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)

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/)

Drills and Exercises

• Templates, Guides, and Training

– Homeland Security Exercise and Evaluation Program (https://hseep.dhs.gov/pages/1001_HSEEP7.aspx)

– California Office of Emergency Services (http://www.oes.ca.gov/Operational/OESHome.nsf/PDF/Tabletop%20Exercise%20Sample/$file/Tabletop%20Exercise%20Development%20Steps.doc)

• Customizable Pandemic Influenza Tabletop Exercise

– Rand Health (http://www.rand.org/health/surveys_tools/panflu_ttx/index.html)

Questions?

Mollie Melbourne, MPH, MEPDirector of Emergency Management

National Association of Community Health Centersmmelbourne@NACHC.com

(203) 256-2773 Direct