Wednesday, July 26, 2017 10:00AM - 12:00PM Kern County Public - - PowerPoint PPT Presentation

Wednesday, July 26, 2017 10:00AM - 12:00PM Kern County Public Health Department 1800 Mt. Vernon Avenue San Joaquin Room

WELCOME AND INTRODUCTIONS

• Welcome & Introductions
• Additions/Changes to Agenda
• Member Announcements

Health Care Coalition Branding & Logo

Chris Niswonger

Kern County Health Care Coalition

Formerly Known As:

Kern County Health Care Coalition (KCHCC)

Governance Structure

Chrystal Sheppard

What is the Purpose of a Governance?

To define the structure and processes which the Kern County Health Care Coalition (KCHCC), formerly known as (DMPG), uses to develop cooperative disaster response capabilities.

Core Membership Values

• Active participation
• Transparent decision-making
• Mutual assistance
• Fairness in allocation of resources
• Strong working relationships and a common vision

“The mission of Kern County’s Disaster Medical Planning Group (DMPG) is to serve as a healthcare coalition for the purpose of collaborative, interdisciplinary disaster medical health planning.”

The Elements of Governance

• Organizational structure
• Support HCC activities
• Membership guidelines for participation
• Defined roles and responsibilities
• Steering committee
• Policies and procedures
• Charter/Bylaws
• Mechanisms to provide guidance and direction

Partnership Participation Agreement

• Utilize Partner Participation Agreement (PPA) to establish

formal roles and responsibilities.

• Expectation of Coalition members (attendance, participation,

etc.)

• Statewide Medical and Health Exercise
• Preparedness Trainings

What is our Current Organizational Model?

Governance Structure Current Document

Development of Comprehensive Emergency Operations Plan YES Mission/Vision Statement YES Partner Participation Agreement (PPA) used between Coalition Partners YES Ability to rapidly disseminate healthcare information from coalition to incident commander & other entities YES Healthcare coalition notification and duty officer assigned YES

The Governance wants YOU!

• Revisit plans for organizational structure

after Statewide tabletop exercise and full scale exercise are complete.

• Poll members for feedback
• Activate a Steering Committee
• Add further items to agenda as they become

available for review and adoption by members.

Basic EOM

A Quick Overview of Disaster Resource Management Nick Lidgett

LEMSA & LHD (PHEP)

LEMSA Collaborates with Public Health to develop local medical & health disaster plans and coordinate medical & health responses to disasters Coordinates communication, personnel & resources at the local or OA level {EMS & EDs} Coordinates with MHOAC Program regarding communication, personnel & resources for local or OA level PHEP Preparing, responding to & recovering from disasters affecting Public Health Part of the MHOAC Program and at times will second the MHOAC as a point of contact Communicates with the CDPH Duty Officer

RDMHC Program

• H&S Code 1797.152 – an appointed position in each of the six Mutual

Aid Regions

• Coordinates disaster information & medical and health mutual aid

assistance within the mutual aid region

• Coordinates with MHOAC Programs in the region to ensure that all

17 MHOAC functions are met

• RDMHS - a component of the RDMHC Program
• Directly supports regional preparedness, response, mitigation and

recovery activities

• Communicates directly with the EMSA & CDPH Duty Officers
• Region V Counties: Merced, Mariposa, Madera, Fresno, Kings, and

Kern

MHOAC Program

• Based on functional activities in H&S Code 1797.153
• Authorizes county health officer and local EMS Administrator to jointly act as

the MHOAC or appoint an individual to fulfill roles and responsibilities

• Responsible for ensuring the development of a medical and health disaster

plan for the Operational Area

• State Emergency Plan – Sections 8559 & 8560

17 functions

• MHOAC shall assist the Office of Emergency Services (OES) Operational Area

Coordinator in the coordination of medical and health disaster resources within the operational area

• Single Point of contact in that operational area, for coordination with the

LEMSA, LHD, EHD, RDMHC Program, Cal EMA, EMSA & CDPH

MHOAC 17 Functions

(1) Assessment of immediate medical needs. (2) Coordination of disaster medical and health resources. (3) Coordination of patient distribution and medical evaluations. (4) Coordination with inpatient and emergency care providers. (5) Coordination of out-of-hospital medical care providers. (6) Coordination and integration with fire agencies personnel, resources, and emergency fire prehospital medical services. (7) Coordination of providers of non-fire based prehospital emergency medical services. (8) Coordination of the establishment of temporary field treatment sites. (9) Health surveillance and epidemiological analyses of community health status.

MHOAC 17 Functions (cont’d…)

(10) Assurance of food safety. (11) Management of exposure to hazardous agents. (12) Provision or coordination of mental health services. (13) Provision of medical and health public information protective action recommendations. (14) Provision or coordination of vector control services. (mammals, birds, insects & arthropods) (15) Assurance of drinking water safety. (16) Assurance of the safe management of liquid, solid, and hazardous wastes. (17) Investigation and control of communicable disease.

Standardized Emergency Management System (SEMS)

Field Local Government Operational Area Regional State

8/1/2017

MHOAC RDMHS

Incident Considerations

Day-to-Day Activities Unusual Events

• Defined as an incident that significantly impacts or

threatens emergency medical services, public health and/or environmental health

Emergency System Activations

• Defined as DOCs and/or EOCs are activated within the

Operational Area

• 3 Levels within the ESA

Day-to-Day Activities

 This is your daily routine  LEMSA works with providers, EDs, EMSA  LHD works with CDPH  Hospitals work with CDPH L&C  Adhere to normal communication standards and procedures

Unusual Event

 Defined as an incident that significantly impacts or threatens emergency medical services, public health and/or environmental health

 Incident significantly impacts/anticipated to impact safety or public health  Incident disrupts/anticipated to disrupt the medical or public health systems  Resources are needed/anticipated to be needed beyond the OA accessibility  Incident produces media interest or is politically sensitive  Incident leads to regional/state request for information  Increased information flow from OA to state will assist in management/mitigation of incident

EOC Activations

• An Emergency Operations Center (EOC) is the place where

significant individuals from various departments come together to handle an Emergency. These individuals are usually a representative

• f a specific agency (ex. Public Health, Fire, Law Enforcement)
• When an Emergency event is expected to take a significant amount of

resources and/or time to handle, a EOC will be activated under SEMS management.

• There are three different levels in which a EOC will operate under

EOC Activation Levels

Detwiler Fire: Initial Assessment

Started July 16th as a small brush fire and has since grown to burn in excess of 78,000 acres. Evacuations of multiple towns and rural areas and the potential evacuation of a small Community Hospital that provides for the entire community of Mariposa

Detwiler Fire: Current Updates

As of July 25th 2017: Fire is approximately 65% contained. 4 evacuation shelters stood up in a different county causing a separate EOC activation. Town of Mariposa is being repopulated but maintains an open shelter. Currently, there is a count of 60+ single family residences which have been destroyed.

Detwiler Fire: Gaps Identified

Gaps already identified:

• Miscommunication in proper

chain of command.

• Licensing and Certification issues

caused hesitation from hospital.

• Public and private agencies not

clear on the role of the MHOAC program.

Detwiler Fire: Predictions

• This fire is becoming the largest fire in Central California

history

• There are currently 37 total private and public agencies

working to resolve all issues as they arise

• A total of 4,756 personnel are being staffed to aid in the

incident

• Recovery effort isn’t expected to take place until late August

and could take up to two years before full reimbursement of services are completed.

REACHING BEYOND RESPONSE: RECOVERY & RESILIENCE

2017 EPO TRAINING WORKSHOP

CMS RULE

GOALS

• How do you return to your routine mission? Continuity of Operations (COOP)
• Address gaps in your response planning and activities and revise your plan
• Address patient population, delegation of authority/succession planning,

communication, Establish consistency and coordination

• Participate in the 2017 Statewide Medical Health Exercise
• Must meet requirements by November 15, 2017

RED EMERGENCY PLANNER

EMERGENCY PLAN TEMPLATE

• Resource for developing/revising Emergency Plans
• Addresses the CMS Emergency Preparedness Rule

 Emergency Plan  Policies and Procedures  Communication Plan  Training and Testing Program

• Structured to standardize: Facility profile, priority tasks, and disaster response
• Recommended that CMS Providers/Suppliers include:

 Hazard Vulnerability Assessment  Communication  Policies & Procedures  Training & Testing  Shelter in Place  Evacuation  MOUs & Agreements  Top 3 Identified Hazards

WHEN SHELTERING & M*A*S*H COLLIDE

OROVILLE DAM EVACUATION SHELTERS: Nevada County Fairgrounds

• General populations shelter
• Senior Adult Independent Living Center evacuated:
• DOC directed buses with residents from the Sr. Living Center to the fairgrounds
• No plan in place to receive/house the special needs of the seniors
• Seniors were distressed, hungry, without medications, difficulty with mobility,

behavioral health issues, off-routine

• Shelter needed more volunteers to assist with the medical needs of the seniors

WHEN SHELTERING & M*A*S*H COLLIDE

OROVILLE DAM EVACUATION SHELTERS: Nevada County Fairgrounds

• Lessons Learned
• Everyone needs to make a medication list
• Assemble your resources in order in advance
• Logistics personnel need to understand what supplies they are requesting
• Security at the evacuation site(s) are required
• Timely and accurate communication between the evacuation centers and with the DOC.
• Trained staff and volunteers
• Establish at least a virtual JIC to coordinate communication with media/public
• Demobilization – have a resource establish to coordinate the donations and distribute

leftovers to local non-profits (i.e. homeless center, etc.)

DISASTER SHELTERS FOR PEOPLE WITH MEDICAL NEEDS

• Medical Shelters vs Shelter with persons with medical needs
• Temporary location providing medical care and support beyond the general

population shelter

• Not AFN Shelters; not providing acute care hospital services
• Individuals are stable
• Not based on specific medical conditions
• Guest vs Patient
• Guests are free to enter/leave shelters
• Patients are ‘admitted’ to hospitals

DISASTER SHELTERS FOR PEOPLE WITH MEDICAL NEEDS

• Red Cross & DHS sheltering planning
• Co-location of general population shelters, pet shelters, and shelters for people

with medical needs

• DHS training their workers as shelter managers to support Red Cross and co-

location shelters; shelter managers need a good working knowledge of how the city and county works during a disaster response

• Sufficiency of services to sustain independence and level of wellness of the

individual

• MRC and CERT staff can augment shelter staffing roles
• Case Management is key to connect individuals back to their routine; Coordinate

with non-profits in advance

TYING THE KNOT WITH PARTNERS & STAKEHOLDERS IN PH EMERGENCY PLANNING

Comprehensive Preparedness Guide (CPG 101): https://www.fema.gov/pdf/about/divisions/npd/CPG_101_V2.pdf

• Coordinated planning with partner agencies and the community
• Share your plan with partners and socialize the process
• Consider emergency scenarios from a medical health perspective
• Plan for 3 different scenarios to incorporate flexibility – Low, Moderate, High; what is the worse case

scenario for each level of response. Example: EMERGING INFECTIOUS DISEASE

• Identify resources needed as well as what resource will be used frequently/quickly and

where to get that resource from

• Discuss everyone’s planning priorities

LOW MODERATE HIGH Ebola SARS Pandemic Influenza

NEEDS MORE COWBELL!

• Active Shooter planning and exercise with Coalition Partners
• Meets CMS requirements and new OSHA Workplace Violence policy
• Conduct a Hazardous and security assessment for your facility
• Where are the safe areas?
• What areas are locked or can be locked? If you have a lockdown policy, can you physically lock the doors?
• Do you have overhead paging?
• Consider the specific response actions for staff and security
• How do you account for staff?
• How do you communicate? All staff should have access to call 911 directly (not just through Security)
• How do you deal with patients in the midst of a procedure?
• Develop training, exercise, and recovery plans with healthcare partners
• Watch the hospital-based “Run-Hide-Fight” video:

https://www.youtube.com/watch?v=ceCiP4yvYPs

NEEDS MORE COWBELL!

• Active Shooter planning and exercise with Coalition Partners
• Have staff develop their own Individual Action Plan as an activity (handout)
• Conduct a Tabletop exercise to identify gaps and improvements
• Practice Run-Hide-Fight
• Conduct a full scale exercise to meet CMS requirements:

 Nerf guns & cow bell; Party poppers & cow bell  Prepare staff/campus with announcements and notification prior to the day of the exercise; Provide opt-out

• ption for staff when using realistic scenarios; consider Continuity of Operations plans when shutting down to

conduct full scale exercise  Identify staff who did not respond by tagging them with a post-it note  Use an active shooter actor to walk around for 2 minutes and get all the staff involved. (Make sure the actor is followed by a safety monitor and they are only using blanks)  Follow up with a debrief to capture feedback, gaps, and improvements; include Sheriff with the debrief

Statewide Medical Health Exercise

Statewide Medical Health Exercise

• To comply with the CMS requirement of having an

exercise by November 15th we will be conducting the exercise on that day

• Public Health will act as a “simulation cell” for you out in

the facilities

• We want to plan together
• We have a survey we sent out that we hope will aid in

coordinating our efforts

• https://goo.gl/gs3rmM

Statewide Medical Health Exercise

• Scenario
• Earthquake
• Allows us to test multiple things
• Exactly what each facility will test will be

developed in the workgroups

Statewide Medical Health Exercise

Hospitals

Today:

• Break into our sub-groups
• Work together to develop objectives for the exercise
• PH has some objectives we need to interject for the grant requirements

Once we develop exercise objectives:

• How we will test those objectives

Example:

• Power outage
• Will your facility fully test the objective by actually switching on the generator power?
• Will you simulate the event?
• What complications will you interject with the simulation? (i.e. Generator power failed to

power essential functions like kitchen, A/C, the whole Med/Surge Floor)

BREAKOUT SESSION!

Statewide Medical Health Exercise

Goal:

• Develop 5 objectives for the exercise
• Coordinate with subcommittee members to develop a series of interjects to test

the above objectives.

Subcommittees

• Hospitals
• Skilled Nursing, Clinics, & Support Facilities
• Volunteer Organizations
• First Responder Agencies

Statewide Medical Health Exercise Subgroups

• Present objectives
• Present interjects that test those objectives

THANK YOU FOR ATTENDING!

Next Meeting Wednesday, September 27, 2017 10:00A.M. - 12:00P.M. Kern County Public Health Department 1800 Mt. Vernon Avenue San Joaquin Room