Please read the attached article which articulates the relationships between law enforcement and health care – related to the release of information requests that can be made.
This is a follow up to the Respiratory Protection newsletter posed in July of 2017.
The following information/link provides a tool to support your facility when dealing with a pandemic outbreak.
Please read the attached document about Chicken pox.
Thank you Dave Miller for providing this information.
On October 10, 2017, FEMA released the third edition of the National Incident Management System (NIMS), which serves as the framework of emergency management and incident response for public and private sector organizations across the U.S.
It means that you now have access to the very latest processes, protocols and procedures to effectively manage “a full spectrum of potential hazards, and impacts, regardless of size, location or complexity,” as explained by FEMA. And, that you should take the necessary steps to review, understand, and comply with NIMS in order to remain eligible for federal preparedness assistance.
NIMS Third Edition includes pertinent information, including recommendations and best practices, pertaining to three key areas. These are:
- Resource Management
- Command and Coordination
- Communication and Information Management
So, why the update, and why now? FEMA knows all too well that the landscape has changed (and changed drastically) since the original release of NIMS in 2004, and the publishing of its second edition in 2008. Besides, the Agency is charged with “managing and maintaining it in accordance with the Post-Katrina Emergency Management Reform Act.”
Per Brock Long, Administrator for FEMA, “…our Nation has made great strides in working together before, during, and after emergencies and planned events.” NIMS Third Edition incorporates these advancements, along with various other best practices and recommendations, to provide relevant, expert guidance to any organization with an active role in emergency management and incident response.
FEMA started the revision process in May 2006. Stakeholder input was obtained through working groups representing over 100 entities from Federal, state, tribal and local governments, the private sector and non-government organizations. Furthermore, stakeholders represented a broad spectrum of emergency management and incident response disciplines.
As stated in NIMS Third Edition, “Three national comment periods were used to gather widespread and diverse stakeholder input for the NIMS document. During the comment periods, more than 280 individuals and organizations provided approximately 6,000 comments. This process allowed the NIC (National Integration Center) to receive and incorporate a wide range of feedback from stakeholders, while maintaining the core concepts of NIMS.”
Hurricane Harvey caused havoc in the Southern Central United States region. According to the National Hurricane Center, Harvey was downgraded to a tropical depression on Wednesday August 30th, 2017. The storm continues to have fierce winds and rain moving into Northern Mississippi and Central Tennessee as shown in the picture to the right. CNN statistics reported the following numbers, on Sept 1st, 2017:
- Harvey dropped 27 trillion gallons of rain (51 inches) over Texas and Louisiana in 6 days
- 72,000 people have been rescued
- Estimated 30,000 people needing temporary shelter (Griggs, 2017).
- Current estimated cost of this devastating storm is 75 billion (Elam, 2017)
Hurricane Harvey was named on August 17th, 2017 as it moved through the Caribbean Sea. Harvey strengthened when it started moving through the Gulf of Mexico hitting Texas land as a Category 4 hurricane on late August 25th, 2017. Picture to the left gives a synapse of Harvey’s history. On Aug. 23rd, Governor Greg Abbott ordered the, already assembled, State Operations Center to elevate their readiness to level three with further levels of elevation to occur on Aug. 24th. Governor Abbott, also expressed the importance of his citizens that are in the path to make “their own emergency preparations” (Office of the Texas Governor, 2017). While hurricane Harvey stalled over Texas, record rainfall occurred requiring the Governor of Texas to request federal assistance.
Federal Emergency Management Agency (FEMA) released a report on August 25th, 2017. The Department of Homeland Security (DHS) and FEMA briefed President Trump on the potential for disaster and with this information Trump declared a Major Disaster allowing for federal funding to be made available for the state of Texas. FEMA’s National Response Coordination Center in Washington, D.C. and Regional Response Coordination Center in Denton, TX were activated. FEMA provided Incident Management Assistance Teams to support Texas and Louisiana state Emergency Operation Centers. In preparation of the storm 96,000 liters of water, 306,000 meals and 4,500 tarps were staged at incident Support Bases. Additional support for Hurricane included:
- Three Incident Support Bases
- Six Urban Search and Rescue task forces
- Mobile Emergency Response Support personnel and equipment are in Fort Worth, TX
- National Flood Insurance Program are staged to support assessments following event (already preparing recovery operations)
- American Red Cross opened seven shelters
- U.S. Army Corps of Engineers has deployed liaison officers to state emergency operation centers
- U.S. Bureau of Safety and Environmental Enforcement (BSEE) hurricane response team is observing Gulf of Mexico oil and gas activities
- Corporation for National and Community Service has placed more than 700 members of AmeriCorps disaster response team
- U.S. Department of Health and Human Services has deployed 460 personnel from National Disaster Medical System and the Office of the Assistant Secretary for Preparedness and Response (ASPR)
As Harvey stalled over Texas additional resources continued to arrive at Incident Support bases increasing food, water, tarps, and now staging generators. August 27th ASPR reported that the National Business Emergency Operations Center was activated providing coordination between government and private sector organizations.
On September 1st, Houston Mayor, Sylvester Turner, declared the city “is open for business.” With minor improvements of receding waters and slow increase of metro transit the community is starting the road to recovery (Sanchez, Yan, and Simon; 2017).
As of Sept. 5th, 2017, the Salvation Army response team were focusing on recovery with a 25% focus on continued rescue support (quoted by Elam, 2017). ASPR Critical Infrastructure Protection (CIP) reports current recovery operations are:
Patient Direct Care
- Hospitals are preparing their financial impact reports.
- Pharmacies continue to open and has begun supporting the community needs.
- Community health centers are starting to operate in the area.
- Hospitals that are functioning off generators continue to have fuel supply issues.
Other recovery operations noted
- Mass fatality management continues to wind down.
- Disaster task force remains in Texas with no related needs, at this point.
FEMA has started employing Houston residents for cleanup, providing small business support, and is working to prevent spread of disease through mosquito control. Association of State and Territorial Health Officials (ASTHO) reports that U.S. Small Business Administration (SBA) has opened two recovery centers and will open more soon. Currently the SBA is offering more than 9,200 loans with 1,000 for businesses in hopes that communities can rebuild and support themselves. As of Sept. 15th, FEMA closes this disaster incident; although, a long road to recovery continues with FEMA and many other organizations continuing to lend their support to the several counties in need.
Association of State and Territorial Health Officials Harvey/Irma Sit Rep #9.
Elam, Stephanie (Sept. 8th, 2017). Parts of Texas still in rescue and recovery mode, 2 weeks after Hurricane Harvey. CNN. http://www.cnn.com/2017/09/08/us/hurricane-harvey-recovery/index.html
Federal Emergency Management Agency (FEMA) (August 25th, 2017) Federal Government Mobilized to support Federal, State, Local, and Tribal Partners as Hurricane Harvey Approaches the Gulf Coast. FEMA https://www.fema.gov/news-release/2017/08/25/federal-government-mobilized-support-federal-state-local-and-tribal-partners
FEMA (2017). Texas Hurricane Harvey (DR-4332). FEMA. https://www.fema.gov/disaster/4332
Griggs, Brandon (Sept. 1st, 2017). Harvey’s Devastating Impact by the Numbers. CNN. http://www.cnn.com/2017/08/27/us/harvey-impact-by-the-numbers-trnd/index.html
Office of the Texas Governor (August 23rd, 2017). Governor Abbott Increases Readiness Of State Operations Center As Tropical Depression Harvey Approaches Gulf Coast. https://gov.texas.gov/news/post/governor-abbott-increases-readiness-of-state-operations-center-as-tropical-
The Weather Channel (Sept. 2nd, 2017). Historic Hurricane Harvey’s Recap. The Weather Channel. https://weather.com/storms/hurricane/news/tropical-storm-harvey-forecast-texas-louisiana-arkansas
Sanchez, Ray; Yan, Holly; and Simon, Darran (Sept. 1st, 2017). Harvey Aftermath: Houston ‘Open for Business’; Other Cities Suffering. CNN. http://www.cnn.com/2017/08/31/us/harvey-houston-texas-flood/index.html
As we live in turbulent times it is important to be prepared for any unplanned events or disasters. Many may say that Minnesota is safe from devastating disasters like we have seen in the Southern United States, however, it is important to not be complacent and keep vigilant of what can happen to any Minnesotan.
Historically we have seen devastating winter storms, floods, and tornadoes. According to the Minnesota Department of Natural Resources (DNR) statistics, the State of Minnesota has had an annual average of 36 tornadoes between the years of 1950 – 2016, there were a total of 99 deaths and 1,982 injuries related to tornadoes. During this period, we saw the greatest numbers of tornadoes in history. During 2010 there was 113 tornadoes for the year; 71 tornadoes in the month of June alone. On June 17th, there were 48 tornadoes which is when Wadena, MN and several other towns were extremely hard hit. Winter storms usually create many power outages and minor injuries, but occasionally there is a storm that many are not ready for. The Halloween Blizzard of 1991 is one of those storms. The winter storm lasted 3 days, thousands were without power for days to weeks, and there were many injuries and some deaths. In other years, snow accumulation has created flooding disasters, such as the Red River flood in Grand Forks during the spring of 1997.
Much of the success in responding to these disasters were from prior preparedness efforts. The Federal Emergency Management Agency’s (FEMA) theme for the September Preparedness Month is: Disasters Don’t Plan Ahead. YOU CAN. The goal of Preparedness Month is all individuals increase their engagement in preparedness actions in their daily lives. FEMA has broken down the overarching theme into 4 categories, each week will focus on one category.
- Week 1: September 1-9 Make a plan for Yourself, Family, and Friends
- Week 2: September 10-16 Plan to help your Neighbor and Community
- Week 3: September 17-23 Practice and Build Out Your Plans
- Week 4: September 24-30 Get Involved! Be a Part of Something Larger
For the first week, the goal is to create a plan for yourself, family, and friends. As a Healthcare Coalition, we spend many hours creating plans and discussing how each facility can help out another facility. But, does any of your facilities provided planning opportunities for your staff? Do your employees have a plan so they can support your facility during a medical surge or evacuation? During the first preparedness week, a great strategy for any facility would be:
- Audit your facilities mass notification plan and make sure all employees are in the system annually.
- Review your facilities emergency management plan.
- Create and/or review your emergency management financial plans for your facility.
Strategies to be used at home would be:
- Ensure your insurance, mortgage, and bank records stored in a safe location where water and fire cannot get to them
- Create emergency response and evacuation plans for power outage, flooding, snow storms, and tornadoes for your family.
For the second week, the goal is to create plans to help your neighbor and community. As a healthcare facility, the neighbors can be other healthcare entities and your employees; The community can be your government entities, and the Healthcare Coalition that may need support at any given time and vice versa. Many of the facilities have already created Mutual Aid agreements with other healthcare facilities, but does your facility have agreements with community entities? It is important that your facility has plans in place on how the local government will support your facility and how your facility will support the local government. Ready.gov has some suggestions for your personnel’s home communities:
- Take the You are the Help Until Help Arrives training. (https://community.fema.gov/until-help-arrives)
- Check on your neighbors. Create a program where neighbors come together and are prepared to help others. This is crucial for those families who have a loved one who will be called to provide disaster relief (nurses, hospital staff, police, firefighters, etc.), and those families can work together with other families to create safety and accountability.
- On National Preparedness Day– Sept. 15th. Hold or go to an event that can bring together neighbors and create community plans.
In the coming weeks, Week three and four, it will be important to build out the plans, practice the plans, evolve the plans, and to get involved with facility and community events. Many of the facilities that are involved with the Coalition this month are doing just that. West Central Coalition long term care (LTC) will have a Shelter in place exercise and both West Central and Central Coalition will participate in an High Consequence Infectious Disease exercise in the coming month. For the Home, everyone can practice their home emergency plans. Ready.gov suggests completing an Emergency Financial First Aid Kit (EFFAK) and knowing your community resources (food shelves, shelter locations, etc.). To get involved, any person can support the community resources or help plan and prepare with one of your community organizations you belong to.
Through proper preparation and training your work and home life will run smoother during any emergency. Your employer will be able to count on you as you will be able to count on your family, neighbors, and community. National preparedness day is coming up in a few days; look around for an event to join in your community or at your facility. Keep this year’s theme, Disasters Don’t Plan Ahead. YOU CAN, in mind as it will remind you that you can control much of the outcomes of a disaster through planning and community support.
Department of Natural Resources (DNR), 2017; Minnesota Tornado History and Statistics. http://www.dnr.state.mn.us/climate/summaries_and_publications/tornadoes.html)
Department of Homeland Security, N/A; National Preparedness Month. www.ready.gov/september
On July 19, 2017, St. Cloud Hospital worked with Gold Cross Ambulance, St. Cloud Police Department, St. Cloud Fire Department and St. Cloud State University to do an Active threat/Explosion exercise. The action started at the University where there was an explosion in an extremely busy common area. There were multiple victims. The scenario required police securing the scene, triage of multiple victims at the scene, transportation of victims, and a surge situation at the hospital.
This exercise emphasized the importance of working with community partners in developing an exercise. There were lots of lessons learned by all participants.
Central and West Central Health Care Preparedness Coalition Completes Another Successful Functional Exercise
On May 24th and 25th, 2017 both the West Central and Central Health Care Preparedness Coalitions participated in a Severe Weather Functional Exercise to create an opportunity for facilities to practice evacuation or an influx/surge of patients. As the Center for Medicare and Medicaid Services (CMS) increased their guidelines for participation in functional emergency preparedness exercises the coalitions had a great opportunity to open this exercise up to Long Term Care, Clinics, Homecare, and Hospice organizations. With this increased participation, the exercise design became unique in trying to create interagency, interactive injects. An aspect of this interactive inject was the use of Simulation Deck, which is an emergency management social media software program that allows groups to create unscheduled and scheduled social media postings. It was a great learning experience seeing how social media can play a role during any disaster by creating avenues of sharing information or deescalating public relation nightmares. Some organizations used it to disperse how families can look for loved ones.
- All participants
o Regional method of tracking and prioritization when Electronic Medical Records (EMR) are down.
o Enhance existing evacuation plans to include a more robust transportation plan.
o Have key staff prepared for social media management and continued training.
o To have prepared action plans for specific emergency crisis allowing for appropriate assignment of incident command staff positions creating appropriate training.
o Using community resources (i.e. churches, restaurants, etc.) will support any facility during a disaster.
o Identified that a focus should be better placed on how to identify and work with at-risk populations.
o Additional internal training on 800Mhz radios to staff that could potentially need to use the radios during the disaster.
o Facility emergency managers (EM) should place others in facilitator/controller position allowing for EM’s to train and guide command center participants during exercise.
- Long Term Care (LTC)
o Provide LTC with appropriate access to MNTrac and training of MNTrac to support region patient tracking and movement.
o Found that patient transfer paperwork including patient equipment needs helped to provide appropriate focus on at-risk population.
This exercise was a great success with many strengths and opportunities noted for future development. Due to the change in CMS Emergency Preparedness guidelines, the coalitions will continue to provide exercises to ALL health care organizations. If you are one of those organizations looking for support in emergency preparedness and being a part of comprehensive functional exercise you have found the place. Any organization can register and join the website or contact us through the link in the top right hand corner of the website. www.cwchealthcarecoalitions.org