Presented By: Emergency Management Professionals

Dee Grimm RN, JD

MUTAL AID AGREEEMENTS FOR

HOSPITAL EVACUATION

Presentation ObjectivesPresentation Objectives

Examine the need for mutual cooperative Examine the need for mutual cooperative efforts between healthcare agenciesefforts between healthcare agencies

Review different approaches to developing Review different approaches to developing mutual aid agreementsmutual aid agreements

Examine components of a mutual aid Examine components of a mutual aid agreements between facilitiesagreements between facilities

Discuss potential issues that can arise Discuss potential issues that can arise during hospital to hospital evacuationsduring hospital to hospital evacuations

Need For Cooperative EffortsNeed For Cooperative Efforts

We can no longer operate in a siloWe can no longer operate in a silo

Best care for patientsBest care for patients

Federal trend for grant fundingFederal trend for grant funding

NIMS/NRFNIMS/NRF

Streamlines evacuation processStreamlines evacuation process

Mutual Aid Evacuation Agreement Mutual Aid Evacuation Agreement PurposePurpose

“ “To coordinate transportation and care of To coordinate transportation and care of patients who have been evacuated from a patients who have been evacuated from a member hospital in a qualified disaster, member hospital in a qualified disaster, with minimal disruption to the provision of with minimal disruption to the provision of acute emergency care to the community”acute emergency care to the community”

Elements of the PlanElements of the Plan

Assumptions and definitions Assumptions and definitions

Evacuation criteria/Disaster declaration processEvacuation criteria/Disaster declaration process

Patients distribution/transportationPatients distribution/transportation

Pre determined distribution chartsPre determined distribution charts

Hospital responsibilitiesHospital responsibilities

Cross PrivilegesCross Privileges

Supplies, personnel, equipment, recordsSupplies, personnel, equipment, records

Basic AssumptionsBasic AssumptionsOnly one hospital evacuating at a timeOnly one hospital evacuating at a timeNo other emergency occurring in communityNo other emergency occurring in communityEmergency Departments will not be receiving sitesEmergency Departments will not be receiving sitesEvacuating hospital is at high average census minus a Evacuating hospital is at high average census minus a 10% reduction by discharge10% reduction by dischargeEmergency Manager of the jurisdiction will seek an Emergency Manager of the jurisdiction will seek an emergency declarationemergency declarationTransfer will be to a facility with “similar services”Transfer will be to a facility with “similar services”Non-ambulance transport may need to be usedNon-ambulance transport may need to be usedSpecial care patients will be sent directly to receiving Special care patients will be sent directly to receiving hospitals, not to external holding areas (may be the hospitals, not to external holding areas (may be the last patients sent)last patients sent)

DefinitionsDefinitions

Immediate evacuationImmediate evacuation – requires – requires immediate, prompt departure due to immediate, prompt departure due to life threatening conditions. Rapid life threatening conditions. Rapid movement of patients to external movement of patients to external holding areasholding areasUrgent evacuationUrgent evacuation – quick, but – quick, but orderly hospital departure. May orderly hospital departure. May allow for period of internal holdingallow for period of internal holding

Notification and Transfer DecisionsNotification and Transfer Decisions

Accepting numbers have Accepting numbers have been pre-determinedbeen pre-determined

Decision about where Decision about where patients go made by EMS patients go made by EMS authorityauthority

Disbursement based on type Disbursement based on type of patients – not red, yellow, of patients – not red, yellow, greengreen

Types – Not Color CodesTypes – Not Color Codes

Disbursement of patients based on Disbursement of patients based on “types”, not standard MCI color codes“types”, not standard MCI color codes

Why won’t red/yellow/green categories Why won’t red/yellow/green categories work?work?

Based on transportation needs and special Based on transportation needs and special needs needs

ROLE OF MEDICAL DISPATCHROLE OF MEDICAL DISPATCHand TRANSPORTING AGENCYand TRANSPORTING AGENCY

Make notifications to hospitals and othersMake notifications to hospitals and othersNotify receiving facilities of patient Notify receiving facilities of patient information and ETAinformation and ETAReceive updated acceptance information Receive updated acceptance information from receiving facilitiesfrom receiving facilitiesProvide updated acceptance information Provide updated acceptance information to field personnelto field personnelFinal record to go to evacuating facility for Final record to go to evacuating facility for patient trackingpatient tracking

EvacuatingEvacuating Facility ResponsibilitiesFacility Responsibilities

Evacuating Facility willEvacuating Facility will: : – Reduce patient censusReduce patient census– Track patients and documentTrack patients and document– Send records with patientSend records with patient– Send equipment, medications and staffSend equipment, medications and staff– Maintain list of supplies, equipment transferredMaintain list of supplies, equipment transferred– Maintain SNF transfer agreement if applicableMaintain SNF transfer agreement if applicable– Notify family, doctors of patient transfersNotify family, doctors of patient transfers

ReceivingReceiving Facility Responsibilities Facility Responsibilities

Receiving Facility willReceiving Facility will::– Reduce patient censusReduce patient census– Obtain additional equipment and staffObtain additional equipment and staff– Update Medical Dispatch of acceptance numbers if Update Medical Dispatch of acceptance numbers if

neededneeded– Set up non-ER reception sites to receive patientsSet up non-ER reception sites to receive patients– Maintain patient trackingMaintain patient tracking– Notify family, doctors of patients receivedNotify family, doctors of patients received– Be responsible for safety of staff received and Be responsible for safety of staff received and

maintenance of equipmentmaintenance of equipment– Return patients, equipment, and staff when appropriateReturn patients, equipment, and staff when appropriate

INCIDENT COMMANDER

OPERATIONS CHIEF

MEDICAL BRANCH DIRECTOR

MEDICAL GROUP

SUPERVISOR

PATIENT TRANSPORTATION

GROUP SUPERVISOR

MEDICAL COMMUNICATIONS

COORD

GROUND AMBULANCE

STAGING MGR

AIR AMBULANCE STAGING MGR

HOSPITAL AGENCY REPRESENTATIVE

HOSPITAL PLANNING

TECHNICAL SPECIALIST

LINKAGE OF HOSPITAL POSITIONS TO FIELD ICS

Hospital Agency RepresentativeHospital Agency Representative

Assigned by evacuating hospitalAssigned by evacuating hospital

Reports to field IC or Liaison Officer and requests to Reports to field IC or Liaison Officer and requests to

participate in Unified Commandparticipate in Unified Command

Speaks for hospital with full authoritySpeaks for hospital with full authority

Makes decisions in all matters affecting hospitalMakes decisions in all matters affecting hospital

Provides information for media releaseProvides information for media release

Participates in development of Incident Action PlanParticipates in development of Incident Action Plan

Shares incident management information with Shares incident management information with

Hospital Incident CommanderHospital Incident Commander

Hospital Planning Hospital Planning TechnicalTechnical Specialist Specialist

Assigned by evacuating hospitalAssigned by evacuating hospital

Reports to IC or Liaison to participate in Medical Reports to IC or Liaison to participate in Medical Branch Operations as technical specialist to Patient Branch Operations as technical specialist to Patient Transportation Group SupervisorTransportation Group Supervisor

Obtains information from hospital on patients’ Obtains information from hospital on patients’ medical acuity, transportation requirements, medical acuity, transportation requirements, equipment, and staffing needsequipment, and staffing needs

Acts as liaison with evacuating hospital to share Acts as liaison with evacuating hospital to share patient tracking information from the field and to patient tracking information from the field and to obtain updated hospital information for the medical obtain updated hospital information for the medical branchbranch

Special IssuesSpecial Issues

Liability (declared emergency to initiate Liability (declared emergency to initiate limited liability)limited liability)Confidentiality/HIPAAConfidentiality/HIPAACross privileges of staff/credentialingCross privileges of staff/credentialingWorker Compensation and staff paymentWorker Compensation and staff paymentNotification to Bureau of Health Facilities, Notification to Bureau of Health Facilities, Licensure, and CertificationLicensure, and CertificationTransfer of medications (scheduled Transfer of medications (scheduled drugs)drugs)

Guidelines for Hospital ParticipantsGuidelines for Hospital Participants

Become familiar with your hospital’s own planBecome familiar with your hospital’s own plan

Become familiar with the evacuation annex Become familiar with the evacuation annex

and your field ICS roles/responsibilitiesand your field ICS roles/responsibilities

Review the pre-planned patient distribution Review the pre-planned patient distribution

scheme your agency agreed toscheme your agency agreed to

Your hospital agreed to make “best efforts” to Your hospital agreed to make “best efforts” to

accommodate evacuated patientsaccommodate evacuated patients

Overall ResponsibilitiesOverall Responsibilities

Develop facility’s own internal planDevelop facility’s own internal planUse same Patient Evacuation Tracking Use same Patient Evacuation Tracking Sheets Sheets Inform Health Department of changes of Inform Health Department of changes of hospital’s information in the annexhospital’s information in the annexMaintain adequate business interruption Maintain adequate business interruption insuranceinsuranceAttend training, drills and participate in Attend training, drills and participate in debriefing processesdebriefing processes