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Adopting an All‐Hazard Approach to Emergency Management – Productively
Utilizing the National Incident Management System (NIMS)
Thomas D. Brown Pharm.D., MBADirector – Jefferson
Home Infusion ServicePhiladelphia, PA
Greg Jakubowski,P.E., CSP, FSFPEPrincipal – Fire
Planning Assocs., Inc.Washington Crossing, PA
CE Credit in Five Easy Steps!1. Scan your badge as you enter each session.2. Carry your Evaluation Packet to every session so you can add session evaluation forms to it.3. Track your hours on the “Statement of Session Attendance Form” as you go.4. At your last session, total the hours and sign both pages of your Statement of Session
Attendance Form. Keep the PINK copy for your records. Put the YELLOW and WHITE copies in your Evaluation Packet. Make sure a completed Session Evaluation Form is in your Evaluation Packet for each session
you attended.• Missing one? Extras are in a file near Registration.
5. Complete the General Attendance Evaluation Form located in your Evaluation Packet—and place it back in your envelope. Write your name on the outside of your Evaluation Packet envelope, seal it, and drop it in the
box near Registration. Applying for Pharmacy CPE? If you have not yet registered for an NABP e‐Profile ID, please
visit www.MyCPEmonitor.net to do so before submitting your packet. You must enter your NABP e‐Profile ID in order to receive CE credit this year!
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Disclosure Slide
The speakers declare no conflicts of interest or financial interest in any service or product mentioned in this program.
Clinical trials and off‐label/investigational uses will not be discussed during this presentation.
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Plain English Objectives• Traditional approaches to Emergency Management• Response to accrediting agency standards • What do we mean by “All‐Hazards”?• National Incident Management System (NIMS)• Incident Command System (ICS)• Risk Analysis• Policy & Procedures• Training• Testing via table top exercises
Preparing for Emergencies• Must understand credible scenarios• What is an “emergency”?• An “emergency” is an event that jeopardizes
– The occupants of a facility– The facility– The contents of the facility– A community
• Types of emergencies – Natural– Human based
Credible ScenariosNatural Hazards
– Hurricane– Tornado– Lightning– Snow > 6”– Snow > 12”– Ice Storm– Flood– Drought– Forest/Range Fire– Extreme Temps
Credible ScenariosNatural Hazards (Continued)
– Geological• Earthquake• Tsunami• Landslide/Mudslide/ Subsidence
Human Based ‐ Mass Casualty Event‐ Infectious Outbreak‐ Bioterrorism
Credible ScenariosHuman Based (Continued)‐ VIP‐ Civil Unrest‐ Bomb Threat‐ Hostage Situation‐ Labor Action‐ Staff Security
Technological Based‐ Sewer/Water/Electric‐ Public Transportation‐ Fuel‐ Phones‐ Radio‐ Heating / Cooling‐ IT Infrastructure
National Incident Management System
“NIMS provides a systematic, proactive approach to guide departments and agencies of all levels of government, non-governmental organizations and private sector to work seamlessly to prevent, protect against, respond to, recover from and mitigate the effects of incidents, regardless of cause, size, location or complexity, in order to reduce the loss of life, property and harm to the environment”
Components of NIMS• Preparedness‐ Planning‐ Procedures and protocols‐ Training and exercises‐ Personnel qualifications‐ Licensure and certification‐ Equipment certification
Components of NIMS• Communications and Information Management– Interoperability– Reliability– Scalability– Portability– Resiliency / Redundancy
Components of NIMS• Resource Management‐ Personnel / equipment / supplies‐ Fluid / adaptable / scalable‐ Order / acquire / mobilize‐ Track / report‐ Recover / demobilize‐ Reimbursement
Components of NIMS
• Command and Management‐ Effective and efficient‐ Standardized system‐ Flexible‐ Scalable
Incident Command System (ICS)• Developed 30 years ago by first responders• Mandated in certain types of events• Can manage any type of incident including planned events
• Standardized management tool that allows for better coordination and use of resources
• Uses common terminology• Allows for smooth transfer of command• Consists of 5 major command components
Span of Control• “The number of individuals or resources that one supervisor can manage effectively during an incident”
• Usual number is between 3 and 7, optimal is 5• Less than 3• More than 7• Complexity of the event determines exact number
Incident Command• Sets incident objectives, strategies and priorities• Has overall responsibility for the incident• Only position that has to be filled• Responsible for all management functions unless delegated
• Can be filled by any highly qualified individual• Transfer of command
Command Staff• Examples include; Safety Officer, Public Information Officer, Liaison and Legal
• Serve as an overall resource to the Incident Command or the General Staff
• If not staffed, role is assumed by the Incident Commander
Operations• Conducts operations to reach incident objectives
• Establishes tactics and directs all operational resources
• Based on span of control, additional managers can be added
• Role of managers are often based on geography or function
Planning• Tracks resources, collects/analyzes information and documents the incident
• Situational Status • Resource Status• Documentation
Logistics• Arranges for resources and services to support the incident objectives
• Sole function is to “get things”• Common areas of focus include: medical supplies, transportation of people and items, food and basic necessities
Finance• Monitors costs related to the incident• Provides accounting, procurement, time records and cost analysis
• Documentation is crucial for future Federal and / or insurance reimbursement
What Does this All Sound Like?• Good Business Practices Adapted for managing incidents!
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Photo Credit Brian Wozniak Photo Credit 6abc.com
It Couldn’t Happen Here???• Loss of Office/Administration• Transportation Limitations
– Severe Weather• Snow/Ice/Storms‐Flooding
• Utility Loss (Electric, Water)• Hazmat• Major Wildfire• Health Emergency• WHAT ARE YOUR RISKS?
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Is Your Team/Facility Ready???• Backup Operations Location• Backup Communications• Emergency Power• Logistics
– Ability to hold staff over– Staff protected from hazard? Vaccinated?
• You may be on your own!• WHAT IS YOUR PLAN?
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TJC/Agency Considerations• Requires that you:
– Have an Emergency Operations plan and;– Activate it yearly at each site, either with a real incident or a drill
– Table top exercises no longer specifically excluded, and TJC has observed these exercises
• Centers for Medicare & Medicaid Services• National Association for Home Care & Hospice• State Standards
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TJC Drill ConsiderationsRevised 1 Jan 2013• Confirm staff communications and assigned roles• Confirm patient communications• Confirm response partner communications• Confirm business continuity and recovery strategies
• Tests patient acuity assignment and tracking• Tests treatment/service processes
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42 CFR Proposed EP Req’ts 27 DEC 2013
42 CFR Parts 403, 416, 418, et al. ‐Medicare and Medicaid Programs; Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers; ProposedRule
• Risk Assessment and Planning• Policies and Procedures• Communications Plan• Training and Testing
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Review of Emergency Response Roles• Protect your safety & safety of your people• Establish incident priorities• Initiate incident command• Initiate coordination with local emergency services• Make appropriate notifications/sssignments• Track situation/needs/resources• Communicate!• BESIDES – IT JUST MAKES SENSE!
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What Does Assuring Safety of Those Assigned to You Mean?
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Sample Client Triage Plans For• Med‐Surg Program• Mother‐Child Program• Oncology Visit Priorities• Hospice/Palliative Care• Ortho‐Rehab Program• Cardiopulmonary Program• Infusion Therapy Program• Home Health Aide Skilled Home Care• Therapy
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Initial ICS • Primary Meeting Location
– With tools in place – designate ahead of time– Can participate remotely– Backup location
• Initial Incident Management (IM)– Setup – Checklists!– Delegate to others as they arrive
• Might not always be “chosen” role
– Transfer to designated IM once he/she arrives
Tabletop• Choose a credible scenario• Walk before you run• Involve as many as possible• Make it realistic
– Pull online videos and photos
• Evaluate severity/impact on your team• Use as a learning experience
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Tabletop Sample ‐ Ice Storm• Light rain falling all night• Storm moving up coast ‐ temps. Hovering around 32‐
33oF• Around 4‐5 am, temperature drops to 31oF
throughout the region, and the rain begins to freeze, first on trees and power lines
• Predictions were for the storm to be further inland, with the temps warmer and no freezing expected
• However, the storm moved further off the coast, making the rain lighter and the temperatures colder
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Tabletop Example ‐ Nor’easter• Heavy rain falling for past 24 hours over the region• At least 6” fallen so far – forecast to continue for the
next 24 hours. Winds from the N and NE• Flash flooding and major creek and stream flooding
occurring throughout the region. Temps. Hovering around 55oF
• Major river flooding forecast• Predictions were for the storm to be fast mover• However, the storm stalled, continuing to pound the
area with rain and wind from the N and NE. Flash flood and flood watches and warnings throughout region until 5 pm
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What is Really Going to Happen???
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Critique
• Held within 1‐2 weeks• Focus on lessons learned• Do not use to assign blame• Develop assignments w/assignees and target dates
• Modify emergency plan/preplans
Sample Tabletop• Break into groups• Brainstorm credible scenarios that could impact your organization– Give several examples of the impact of these scenarios
– Give several examples of how your organization could respond
– 10 MINUTES!!!
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Summary• Stuff happens• You can plan for it
– Takes some time/effort
• Need to plan for response through recovery• All hazards approach
– Integrate with community plan– Similar to business management
• It CAN happen here!
