IEmergency Management and Preparedness Planning
PINS announced August 22, 2007
HRSA/BPHC Policy Information Notice
Health Center Emergency Management Program Expectations
The PIN provides guidance on emergency management expectations for health centers to assist them in planning and preparing for future emergencies.
Federal Tort Claims Act (FTCA) Coverage for Health Center Program Grantees Responding to Emergencies
The purpose of this PIN is to clarify the circumstances under which FTCA-deemed Health Center Program grantees (section 330(e), (g), (h), (i) grantees) are covered under the FTCA as they respond to emergencies and to address frequently asked questions.
Help Document
This document is intended to aid North Carolina Community Health Centers with emergency preparedness planning efforts. This help document includes Frequently Asked Questions and points Community Health Center EP Coordinators to downloadable files and/or links that are associated with the Annual Emergency Preparedness and Management (EPM) Report.
Emergency Preparedness and Management/Emergency Operations Planning Templates
Q: When do I implement an emergency operations plan (EOP)?
A: An EOP must be implemented when any natural or man-made event occurs that disrupts normal clinic operations which in turn requires preplanned response to internal and external disasters. A disaster is any emergency event which overwhelms or threatens to overwhelm the routine capabilities of the clinic.
Click here to download a copy of the Community Health Center Association of New York State's Community Health Center Emergency Management Plan.
Click here to for a copy of the California Primary Care Association's Community Clinic and Health Center Emergency Operations Plan Template.
The Four Stages of Disaster
Mitigation - Pre-event planning and actions which aim to lessen the effects of potential disaster.
Preparedness - Actions taken before an emergency to prepare the organization for a response.
Response - Activities to address the immediate and short-term effects of an emergency or disaster. Response includes immediate actions to save lives, protect property and meet basic human needs.
Recovery - Activities that occur following a response to disaster that are designed to help an organization and community return to a pre-disaster leverl of function.
Mitigation
Hazards Vulnerability Assessment Tool
Q: What is the goal of a hazard vulnerability analysis (HVA)?
A: An HVA is conducted to identify hazards and the direct and indirect effects these hazards may have on your clinic. An HVA provides a tool for estimating and ranking the probability of occurrence and potential severity of various events and should be performed every 3 to 5 years.
The California Primary Care Association is at the forefront of Emergency Preparedness Planning. Click here to download a copy of their Hazards Vulnerability Assessment Tool.
Q: Why do I have to do an HVA?
A: An HVA is a good business practice and is now required for accreditation by the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO).
Q: How do I prioritize my hazard mitigation process?
A: The following criteria should be used to prioritize local hazard mitigation activities:
-Level of risk to people
-Frequency and likelihood of hazard
-Hazard impact on mission critical business functions
-Project urgency and cost benefit analysis
-Cost effectiveness of measure
The following FEMA document is an excellent resource for pre-disaster hazard mitigation planning.
http://www.fema.gov/pdf/plan/mitplanning/howto4_intro.pdf
Preparedness
Q: How does my clinic develop an internal disaster response team?
A: Your clinic director should appoint an Emergency Response Team (ERT). The ERT consists of clinic staff members who are responsible for key activities in response to internal disasters, such as: authorizing the evacuation of the clinic or call 911 when procedures are not automatic, assisting patients in the evacuation, ensuring all rooms are vacated, turning off gass, and gathering patients at congregation site. ERT members usually include the clinic executive, chief operating officer, medical director, nurse supervisor, safety officer and staff from each department or area of the clinic who are responsible for implementing the plan within their work area.
Q: Do I have to implement all aspects of the Emergency Operations Plan all at once?
A: No. The EOP describes your organization's priorities and general timeline for plan implementation. The implementation schedule and priorities depend on the hazards your clinic faces, its vulnerabilities, funding and other resources and the priorities of the Executive Director and Board of Directors. Typically, priority is given to strengthening the clinic's response to internal disasters because they are more likely to occur and plans are required to meet licensure regulations.
Q: How do I intergrate my EPM plan with local/regional plans?
A: To the extent possible, your clinic should ensure that its response is coordinated with the decisions and actions of the Regional Emergency Response and Recovery Coordinator (RERRC) who operates under the Regional Advisory Committee (RAC) and other health care agencies involved in the response. To view who is your RERRC and what RAC your clinic falls beneath click here. To ensure coordination, clinic staff should:
-Meet with your RAC and RERRC to define the clinic's role in the emergency response system. Determine which response roles are expected by officials and which are beyond the system's response needs or the clinic's response capabilities.
-Participate in planning, training and exercises sponsored by medical and health agencies.
-Participate in the State Medical Asset and Resource Tracking Tool (SMARTT). This reporting system allows for integration of clinic resources with your RAC.
-Define procedures for requesting and obtaining medical resources and for evacuating/transporting patients.
-Each county system is unique in its approach to receiving requests and providing resources, interacting with health care providers and coordinating its medical response to disasters. Clinics should work with their local government agencies to obtain guidance, assistance or referral to sources of information on emergency preparedness.
Q: What is the county Emergency Operations Center (EOC)?
A: The county EOC is the location (usually located at the county seat) at which the operational area's response to a disaster is managed. The contact information for the county EOC may be obtained from your RERRC as the clinic prepares its emergency management program. It is important to note that some cities within counties have EOC's as well.
Q: How do we conduct an internal disaster response drill? How often should we drill?
A: Clinics will participate in drills that assess communication, coordination and the effectiveness of the clinic's and the community's command structures. Exercises should include one or more of the following response issues in their scenarios: clinic evacuation, bioterrorism, mental health response, coordination with government emergency responders, continuity of operations and expanding clinic surge capacity. Clinic will rehearse this disaster response drill at least 2X a year.
Q: What is a back-up communication or redundant communication system?
A: Redundant communication systems are alternate means of communications that allow clinics to communicate if phone or internet service is non-functional due to a disaster. Examples of redundant communication systems are two-way radios, cell phones, voicemail boxes, satellite phones, amateur radio groups, hand radios or wireless messaging. To view the North Carolina Community Health Center Emergency Communications Network Initiative program overview, please click here.
Q: What is a point of distribution (POD)?
A: A site where medications or vaccines intended to prevent disease may be given quickly to a large number of people in the event of a public health emergency. In North Carolina, medical point of distributions are sites allocated by the local health department. Please contact your local health department for more information about PODS in your area.
Q: What is the North Carolina Health Alert Network (NCHAN)?
A: The NCHAN is an internet based system that enables communications between public health officials and their partners about public health emergencies. If you participate in the NCHAN, you will receive alerts via telephone, email and pager about public health issues occuring in the state.
Q: How can my clinic participate in the NCHAN?
A: Please contact Paige Hales-Gordo, Special Projects Coordinator, NCCHCA and she will forward you the application for the NCHAN.
Response
Q: Whom does my clinic set up for surge capacity?
A: Surge capacity encompasses clinic resources required to deliver health care under situations which exceed normal capacity, including potential available space in which patients may be triaged, managed, vaccinated, decontaminated, or simply located; available personnel of all types; necessary medications, supplies and equipment; and even the legal capacity to exceed authorized care capacity.
Normal capacity could be exceeded during any type of emergency for reasons that include the following:
- Random spikes in numbers of presenting patients
- Seasonal or other cyclical spikes (e.g., school required immunizations, flu epidemics, etc.)
- Convergence of ill or injured resulting from disasters
-Psychogenic convergence that results from emergencies
-A combination of any of the above
Recovery
Q: The recovery phase in a disaster is equally as important as the other three phases. How do I begin the recovery?
A: Producing an after-action report is an important step to the road to recovery. This report is produced by the clinic and describes its activities during a response to an emergency. It may also be written based on participation in an exercise along with corrective actions plans that include recommendations for improving response management, communications and coordination.
Sources: http://www.cpca.org
The North Carolina Community Health Center Association would like to thank the California Primary Care Association and the Community Health Center Association of New York State for their excellent online clinic emergency preparedness resources.