# Presentation: 181463

## PreparednessActivities

- Emergency Management Training Conference
- November 28, 2004

## Module Objectives

- Explain some of the criteria for effective disaster planning.
- Describe the purpose and structure of an Emergency Operations Plan (EOP).
- Explain some resource management strategies.

- Veterans Health Administration

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## Module Objectives (con’t)

- Identify some resources for employee/public education programs.
- Cite some examples of competencies for public health and hospital leaders and staff.
- Discuss various training and exercise resources and strategies.

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## Preparedness/Response Tasks

- Inventory critical resources & develop agreements with suppliers.
- Purchase and maintain equipment.
- Build the Emergency Operations plan based on processes that will be used to implement it.
- Conduct education, training and exercises.
- Perform evaluations and corrective actions.

**C**

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## Disaster Planning is..

- Continuous
- Aimed at reducing the unknowns
- Evokes appropriate actions
- Answers what is likely to happen?
- Is an educational process

- Quarantelli

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## “Good” Disaster Planning

- Focuses on the planning process, not the production of a document
- Recognizes that disasters are more than just big emergencies
- Is generic, not agent-specific
- Is based on an emergent resource coordination model, not command and control

- Quarantelli

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## “Good” Planning (con’t)

- Focuses on principles, not specific details
- Is based on what is likely to happen
- Is both vertically and horizontally integrated
- Strives to evoke appropriate actions by anticipating likely problems and possible solutions
- Uses the best social science available, not myths

- Quarantelli

- Veterans Health Administration

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## Discussion Question

- Which of the factors contributing to effective disaster planning are the most difficult on an inter-organizational level?

- Veterans Health Administration

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## Types ofPlanning in Emergency Management Programs

- Strategic administrative
- Recovery
- Mitigation
- Emergency operations

- NFPA 1600

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**Notes:**
NFPA 1600, Standard for Disaster/Emergency Management and Business Continuity Programs states, “An emergency management program shall include, but not be limited to a strategic plan, an emergency operations plan, a mitigation plan, and a recovery plan that are contained in either single or multiple documents.” 

## Emergency Operations Planning

- The EOP:
- Groups areas of responsibility and assigns organizational units
- Establishes command, control and coordination relationships
- Describes strategies for response and recovery activities
- Addresses all hazards

- Veterans Health Administration

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**Notes:**
...”The emergency operations/response plan assigns responsibilities to organizations and individuals for carrying out specific actions at projected times and places in an emergency or disaster.”  In the section that addresses direction, control and coordination, the standard explains, “the entity shall develop the capability to direct, control, and coordinate response and recovery operations.  An incident management system shall be utilized.  The specific organizational roles, titles and responsibilities shall be identified for each incident management function as specified in the emergency operations plan.”

## All-Hazards Plan Format

- Hazard-specific emergency plans (e.g. earthquake plan) resulted in too many plans
- Practitioners realized what disaster researchers had been saying all along (e.g. there are similar demands created by different events)
- _Organization by generic emergency function_ (e.g., Federal Response Plan, 1992)

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## Federal Response Plan (FRP)

- Basic Plan
- “Emergency Support” Functions
- ESF 1	Communications
- ESF 2	Transportation
- ESF 3	Public Works & Engineering
- ESF 4	Firefighting
- ESF 5	Information & Planning
- ESF 6	Mass Care

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## FRP (con’t)

- ESF 7	Resource Support
- ESF 8	Health & Medical Services
- ESF 9	Urban Search & Rescue
- ESF 10	Hazardous Materials
- ESF 11	Food
- ESF 12	Energy
- Support Annexes
- Incident Annexes (Terrorism)
- Appendices

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## 4 Parts of anAll-Hazards EOP

**Basic Plan**

**Groups Org. Units**
**And Assigns  **
**Responsibilities**

**An Overview**

**Functional**
**Annexes**

**SOPs**

**concerned with:**

**Checklists**

**concerned with:**

**Individual Roles,**
**Lists, etc****.**

**1**

**2**

**3**

**4**

**Guidance on how to**
**accomplish a task**

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## Plan Format

***Is The Plan’s Format Important?***

_***Yes !***_

**The plan’s format should be designed to**
**align with the emergency plans of other**
**organizations or levels if government**
**that the health care facility may provide**
**support to, or request support from...**

**Common Terminology**

**Standard Organization**

***yields***

**A More Coordinated**
**Inter-Agency Effort**

***Remember, Disaster Response Is ***_***Multi-Organizational ***_***In Nature!***

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## VHA GuidebookEOP Structure

- Basic Plan
- “Essential” Functions
- _Management & Planning _
- _Logistics & Finance_
- _Operations_:
- Business Continuity
- Equipment, Plant & Utilities
- Safety & Security
- Health & Medical
- Standard Operating Procedures
- Job Action Sheets

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## VHA GuidebookEOP Structure

- Basic Plan
- “Essential” Functions
- _Management & Planning _
- _Logistics & Finance_
- _Operations_:
- Business Continuity
- Equipment, Plant & Utilities
- Safety & Security
- Health & Medical
- Standard Operating Procedures
- Job Action Sheets

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## Converting to EOP/ICS Functions

- Plan.

- Logs

- Fin.

- Opts.

- Activities

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## Converting to EOP/ICS Functions

- Plan.

- Logs

- Fin.

- Opts.

- Activities

- Triage

- Labor Pool

- Communications

- Liaison

- Assessment

- Security

- Backup Utilities

- Cost Accounting

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## EOP Development Process

*Through Emergency Management Committee:*
- Establish “domains” or roles of each Department, Service or Group
- Align Departments/Services’ roles under appropriate functional area
- Determine lead Department/Service
- Accomplish detailed planning activities

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## Use the Organization’s Disaster “Mission Statement”

- What was the primary mission, purpose or activity of each Department, Service or Group?
- With Group(s) does your organization support in disasters?
***   ***

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## Determine “Lead” Department/Service/Position

- Establish “Lead” Designations:
**Management****	****	****	****Director’s Office**
- Planning			EPC / AEM
- Logistics			AM&M
- Finance			Fiscal
**Operations****	****	****	****Associate Director ?**
- Business Continuity		IRM
- Equip., Plant & Utilities	Engineering
- Safety & Security		Police & Security
**Health & Medical****	****	****Chief of Staff**

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## Service/FunctionAssignment Matrix

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## Voluntary

- Director’s Office

- Canteen

- A&MM

- Ambulatory Care

- Chaplain

- Chief of Staff

- Dental

- Nutrition & Food

- Emer. Manager

- Engineering

- Env. Management

- Fiscal

- Human Resources

- IT

- Pathology-Laboratory

- MAS

- Medicine

- Nursing

- Pharmacy

- Police & Security

- Psychiatry

- Public Affairs

- Radiology

- Management
- & Planning

- Finance
- & Logistics

- Equipment, Plant
- & Utilities

- Safety
- & Security

- Health
- & Medical

- Safety

- Social Work

**LS-M**

**LS-P**

**LS-L**

**LS-F**

**LS**

**LS**

**LS**

- Business
- Continuity

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## “Lead Agent” Responsibilities 

- Coordinate detailed planning activities
- Participate in training & exercises
- Implement, manage/coordinate response and recovery activities
- Determine weaknesses and take corrective actions

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## Detailed Planning Activities

- Review/revise “Key Activities”
- Review/revise Standard Operating Procedures
- Refine ICS Position Descriptions
- Create other necessary checklists (e.g. notification lists, equipment lists, etc.)

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## Cooperative Planning

- JCAHO requires health care organizations in a community to share information about resources and assets that could potentially be shared during an emergency
- Historically, local and State emergency management agencies have devoted a lot of attention to resource identification and inventories

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## Inventory Critical Resources& Develop Agreements

- Inventory Critical Resources& Develop Agreements

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## Purchase/maintainEquipment & Supplies

- Equipment needs were prioritized in development of the COOP/Recovery Plan
- What can’t you reliably borrow or improvise?
- Equipment without daily/regular use may not operate when needed.

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## Principles of Mutual Aid 

- Mutual aid is an agreement between organizations that they will assist each other in an emergency
- Resources are provided following a formal request
- Terms can be in-kind or reimbursement
- An organization providing personnel retains responsibility for their pay, insurance, etc. even though they under the operational control of the requestor

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## Liability

- Liability of disaster workers is covered, as long as they operate within the scope of their employment and act without reckless disregard for life and property
- The declaration of a State of Emergency by the local jurisdiction or the State protects all “emergency management workers”

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## Training, Exercises, EvaluationsAND Corrective Action

## Training Needs Assessment

- Who are the target audiences?
- What subjects do they need to know, and to what level?
- What is their current level of knowledge?
- How should we evaluate proficiency, how often?
- What are the priorities given resource constraints?

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## Competencies

- Knowledge vs. Performance
- All Staff:
**Self and family preparedness**
**Awareness of role in Emergency Operations Plan**
**Who to notify**
- Supervisors
**Departmental role in Emergency Operations Plan**
**Able to direct the actions of others**
- Leaders/Key Operating Unit Managers
**Leadership – focusing on what happens next**

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## Education & Training Strategies

- Include EM education at events for all employees, such as new employee orientation, annual safety fair, etc.
- Offer training sessions at several times per day
- Provide information via email to staff prior to JCAHO
- Vary the format
- Use the facility as a location for community training, or to hold satellite teleconferences

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## Education & Training Resources

- Get to know the staff – there are many experts at work right under our noses
- Explore what EM courses are available in the community and from the State
- Network with other hospitals and community groups to leverage budgets for outside speakers
- Build a library of websites that offer/advertise  training of various forms

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## Exercise Program

- Attend an Exercise Design Course offered by the local or State EMA
- _Type__	__	__	__Example_
- Seminar		Orientation on EOP
- Drills		Tasks (decon, assessment)
- Tabletop		Integration with community
- Functional	Test of backup 						communications
- Full-scale	Patient reception as part of 				community-wide exercise.

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## Seminar

- Designed to familiarize those responsible about a new or updated procedure or as an  orientation for new staff
- Discussion to focus on role identification, walk-through of actions and negotiation of shared responsibility
- Minimal cost and preparation time (2 weeks)
- Requires a strong lead presenter

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## Drill

- An activity that tests, develops or evaluates skills of a single or relatively limited set of procedures, e.g. fire drill, communications drill
- Involves a field response, simulating real conditions
- 1 month prep time

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## Tabletop

- An activity where key staff are presented with a simulated emergency situation without time constraints
- Designed to elicit discussion and stimulate coordination necessary to solve problems
- May include message injects
- 1 month prep time

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## Functional Exercise

- An activity designed to test or evaluate decision-making, communications and coordination
- Involves message injects requiring action to resolve within time constraints
- Requires a team with considerable experience to develop, conduct/control and evaluate
- 3 months prep time

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## Full-scale Exercise

- An activity designed to test the operational capability of the emergency management system
- It includes the components of a functional exercise with field response
- Creates public attention
- Requires a team of experienced personnel to design, conduct/control and evaluate _*at least*_ 3 months

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## Exercise Design Process:Ground Rules

- Exercises should not be one-time “shows”
- An exercise program is based upon the needs of the facility
- Part of quality improvement
- Best developed by a team, not an individual
- Train staff on the current Standard Operating Procedures

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## Benefits of Exercises

- Improve operational readiness
- Reveal planning weaknesses
- Identify resource shortfalls
- Improve coordination
- Clarify roles and responsibilities
- Builds confidence

- Stoffel

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## Preparing for an Exercise

- Needs assessment
- Selection of exercise type
- Determine resource requirements - location, facilities, staffing, budget, etc.
- Developing specific objectives
- Obtaining executive support
- Developing the scenario and adjunct materials
- Pre-exercise arrangements

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## Needs Assessment

- Why are we conducting an exercise?
- Who should be involved?
- What activities should we focus on?
- What is their level of knowledge/proficiency?
- What degree of realism is necessary?
- Has such an exercise been conducted before?
- What are some limitations we can expect?

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## Selecting an Exercise Type

- What is your capability to design and conduct the exercise?
- Skills and experience
- Resources and staff availability
- Facilities and equipment
- Management support
- Time...
- Which type seems most appropriate to needs assessment?

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## Establishing Exercise Objectives

- An objective clearly and briefly states what you plan to accomplish by conducting the exercise
- General objectives define the overall purpose of the exercise
- Behavioral objectives specify what you are expect exercise players (groups or individuals) to know and/or do

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## Exercise Objectives

- Must be:
- Realistic – are they measurable?
- Consistent with current SOPs?
- Adequate in view of time available?
- Represent the needs of those involved
- Remember, the evaluation form and critique are based on these

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## Tie Exercises to Each Step in the

- EM Program Development Process

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## Training and Exercises Should Focus on the Ability to Problem-solve

- Link disaster-relevant groups
- Maintain pre-existing authority & autonomy
- Encourage regular inter-organizational contact
- Establish joint operating facilities
- Create a process to collect & share information, establish priorities & make decisions

- Dynes

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## Evaluations & Program Assessments

- Opportunities:
- Annual life safety reviews
- JCAHO surveys
- After-action reviews/critiques
- Methods:
- Assessment tool
- Internal & external audits
- Interviews
- Review of documents

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## Critiques – After Action Reviews

- What happened ? – purpose is to gather honest, constructive evaluations from all participants
- Must focus on the objectives of the training session or exercise
- Important to hold the critique as close to the end of the exercise or real event as possible

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## Corrective Action Program

- Is a process that follows an actual occurrence or exercise to identify program shortfalls and necessary corrective actions to address them
- Begins after the critique or “after-action” meeting
- Deficiencies are usually rooted in procedures, training or equipment, and relate to one or more of the following program elements:

- NFPA 1600

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## Emergency Management Program Elements

- Laws and authorities
- Hazard identification, risk assessment & impact analysis
- Hazard mitigation
- Resource management
- Mutual aid
- Planning
- Direction, control & coordination
- Communications & warning

- Operations & procedures
- Logistics & facilities
- Training
- Exercises, evaluations & corrective actions
- Crisis communications & public information
- Finance & administration

- NFPA 1600

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## Sample Process

- A task group is assigned to identify:
- Options for corrective action
- Recommend a preferred option
- Implementation steps, including training
- The task group should ensure that the item(s) are evaluated in the next exercise or actual event

- NFPA 1600

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## Corrective Action Program

- Statement that identifies the problem and impact
- Review history of evaluations and corrective actions
- Select a corrective action strategy
- Identify the resources required
- Provide authority and resources to individuals/groups assigned to implement the strategy

- NFPA 1600

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## CAP (con’t)

- Monitor progress of implementation
- Resolve problems
- Test the solution through an exercise

- NFPA 1600

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## Corrective Action =Organizational Learning

- Data collected in evaluation forms is organized using EOP management structure
- Choices/comments are directed at this structure and comprehension/performance of task(s)
- Corrective actions include clarification or improvement in task description or training approach/frequency

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## Summary

- Results of after action reviews drive program goals and objectives, which drive the design of education, training and exercise activities
- Organizational readiness, individual development and staff and patient awareness are one way to organize these efforts
- While JCAHO compliance is the hammer, the goal should be quality improvement

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## Perform Evaluations &Corrective Actions

**JCAHO Requirements**
**Local Program Goals**
**FEMA Guidance**
**Incident Management System**

**“****A continuous cycle of planning, training, **
**evaluation and program improvement...**
**Closely related to theories and practices of**
**“****Continuous Quality Improvement”**

**Standards**

**Process**

**Capability**

**Compliance**

***Continuity***
***of Care***

**C5**

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## Questions?