# Presentation: 049596

## Emergency Management:Principles and Practicesfor Health Systems

- Emergency Management Training Conference
- November 28, 2004

- Veterans Health Administration

- 112804

## IntroductionsCourse AdministrationCourse Overview

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## Course Objectives

- Describe a general process of EMP development, including the roles of the EM Committee and EM Program Coordinator.
- Explain the various types of planning, including development of comprehensive emergency management strategies for priority hazards.
- Describe the process of risk identification, probability/vulnerability assessment and consequence analysis.

- Veterans Health Administration

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## Course Objectives (con’t)

- Demonstrate the ability to write a Standard Operating Procedure and explain how it relates to the Emergency Operations Plan (EOP).

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## Agenda

- Introduction to EM
- Health and Medical Activities
- Lessons from the Disaster Research
- Establishing  Leadership and Direction
- Continuity of Operations/Recovery Planning and Mitigation Activities
- Preparedness Activities

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## Introduction toEmergency Management

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## Module Objectives

- Explain the evolution of the civil defense/emergency management discipline in the U.S.
- Describe the activities which relate to each of the four phases of Comprehensive Emergency Management (CEM).
- Explain the Integrated Emergency Management System (IEMS).

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## Module Objectives (con’t)

- Define the emergency management function and discuss the relationship to other functional areas.
- Identify some key terms and various elements of an emergency management program.
- Differentiate between the “EM plan” and “EM program.”
- Discuss two EM accreditation programs.

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## Emergency Management

-    “Is the discipline and profession of applying science, technology, planning and management to deal with extreme events that can injure or kill large numbers of people, do extensive damage to property, and disrupt community life.”

- Hoetmer

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## Emergency Management

- Term for U.S. civil protection agencies at the Federal, State and local levels.
- Program - Set of concepts , principles and practices that apply to any organization as well as to the overall jurisdiction.
- Different than “Incident Management.”

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## Jurisdiction

- A State, or a political subdivision of the State (county, parish and/or municipality)
- Responsibility for ensuring public safety, health and welfare within its legal authorities and geographic area

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## 1950s

-    Two laws began the fragmentation that would continue until FEMA’s creation in 1978:
- Civil Defense Act - preparedness for civil defense against enemy attack.
- Disaster Relief Act - funds set aside to provide assistance to State and local governments.

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## 1960s

- Civil defense from enemy attack a priority, vast Federal programs to identify and supply fallout shelters.
- Cuban Missile Crisis (1961)
- Significant natural disasters:
- Alaskan earthquake (1964)
- Hurricane(s) Betsy (1965) and Camille (1969)

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## 1970s

- Crisis Relocation Planning a priority.
- Governor’s cry for “dual use,” less fragmentation of Federal aid.
- “1st Assessment” of disaster research (1975).
- FIRESCOPE created (1972)
- First disaster preparedness standard (NFPA)
- FEMA created (1978)
- Big events:
**San Fernando earthquake (1973)**
**Tropical Storm Agnes (1972)**
**Three Mile Island (1979)**

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## 1980s

- “All-hazards” now a priority.
- ICS rolled out (1982).
- Hazmat comes on the scene (Bhopal).
- Big Events:
**Mount St. Helens (1980)**
**Bhopal (1984)**
**Chernobyl (1986)**
**Hurricane Hugo (1989)**
**Loma Prieta earthquake (1989)**

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## 1990s

- Urban Search & Rescue program begun.
- Federal Response Plan (1992)
**Hurricane(s) Andrew/Iniki (1992)**
- Emergency Management Assistance Compact (1993)
- Midwest Floods (1993)
- Standardized Emergency management System (1994)
**Northridge earthquake and Berkeley Hills Fire (1994)**

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## 1990s (con’t)

- Terrorism arrives:
**World Trade Center (1993)**
**Alfred P. Murrah Federal Building (1995)**
**Tokyo Subway (1995)**
**U.S. Embassy bombings (1998)**
- Capability Assessment for Readiness (1997)
- 2nd Assessment of disaster research
- Critical Infrastructure & COOP
**Y2K**
- NFPA 1600 (2000)

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## 2001

- Tropical Storm Allison, producing record flooding in Houston, crippled health care delivery.
- September 11th, synchronized suicide bombing of the World Trade Center and the Pentagon by means of hijacked commercial airliners.
- Anthrax contaminated mail, targeted at political and media figures.

- Veterans Health Administration

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## Homeland Security Strategy

-    “{The Department of Homeland Security} will continue FEMA’s efforts to reduce the loss of life and property and protect our Nation’s institutions from all types of hazards through a comprehensive, risk-based, all-hazards emergency management program of mitigation, preparedness, response and recovery.”
- _[http://www.whitehouse.gov/deptofhomeland/book.pdf](http://www.whitehouse.gov/deptofhomeland/book.pdf)_

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## Trends in the Practice of Emergency Management

- Hazard-specific to all-hazard
- Agent focus to response focus
- Command & control to continuity, coordination & cooperation
- Catastrophic to what is likely
- Reaction to proaction

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## Key Concepts

- Comprehensive Emergency Management (CEM)
- Integrated Emergency Management System (IEMS)
- Incident Command System (ICS)
- Disaster research

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## ComprehensiveEmergency Management:4 Phases

- Mitigation
- Preparedness
- Response
- Recovery

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## ImportantMitigation Steps

- Hazards Analysis - Internal & External
- Vulnerability Analysis
- Actions taken to reduce the impacts

**- What types of natural, technological and man-caused**
**  ****events threaten the Environment of Care?**

**- For each threat, ask “What will be the likely impacts**
**  ****(considering both direct and indirect effects) ?”**

**- What can be done to ensure operating systems**
**  ****remain functional?  (And have back-ups...)**

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## ImportantPreparedness Steps

- Resources Listing
- Pre-arranged agreements
- Staff orientation and training on basic response actions
- Facility-wide rehearsals

**- That provide the back-up for damage to the plant,**
**  ****supplies, equipment, communications, and people.**

**- Simple guidelines covering how you expect each**
**  ****employee to behave during any emergency.**

**- That stress organizational mobilization**
**  ****coordination, and communications**

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## ImportantResponse Steps

- Situation assessment
- Warning and notifications
- Setting objectives and priorities
- Facility-wide instructions
- Plan for what happens next
- Liaison with external systems

- Take appropriate actions to protect life and conserve property
- Notify persons in charge
- Continue to organize and manage

- All Staff

- Mgmt.

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## ImportantRecovery Steps

- Determine present level and extent of patient care capability
- Adjust patient care policies
- Set objectives and priorities for the re-establishment of operating systems
- Make stress debriefing services available to patients and staff
- Schedule and conduct an incident critique
- Make improvements to the CEM program

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## Integrated Emergency Management System (IEMS) is...

- Strategic framework for implementing Comprehensive Emergency Management  - a _set of program development steps_ tied to the four phases:
**Mitigation**
**Preparedness**
**Response**
**Recovery**

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## IEMS (1983)

**Maximum**
**Capability**
**Required**

**Optimally**
**Integrated**
**Plans**

**Continual**
**Maintenance**

**CAPABILITY**
**ASSESSMENT**

**EMERGENCY**
**OPERATIONS**
**PLANS**

**CAPABILITY**
**MAINTENANCE**

**MITIGATION**
**EFFORTS**

**EMERGENCY**
**OPERATIONS**

**CAPABILITY**
**SHORTFALL**

**MULTI-YEAR**
**DEVELOPMENT**
**PLAN**

**ANNUAL**
**DEVELOPMENT**
**INCREMENT**

**HAZARDS**
**ANALYSIS**

**EVALUATION**

**STATE/**
**LOCAL**
**RESOURCES**

**FEDERAL**
**RESOURCES**

**ANNUAL**
**WORK**
**INCREMENT**

**1**

**2**

**3**

**4**

**5**

**6**

**7**

**8**

**9**

**10**

**11**

**12**

**13**

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## IEMS is Also...

- A _philosophy of inclusiveness_ - thoe groups that will respond to disasters are brought into the planning process.
- A _method of organization - around functions_ generic to all disasters, not around specific hazards, agencies or people.

- Veterans Health Administration

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## Functional Areas

- Transportation
- Communications
- Public Works
- Firefighting
- Information/Planning
- Mass Care
- Resource Support

- Health & Medical
- Search & Rescue
- Hazardous Materials
- Food
- Energy
- Law Enforcement
- Military Support

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## Entities & Disciplines

- Government
- Business & Industry
- Academia
- Non-profit
- Religious
- Emergent Groups

- Public Administration
- Engineering
- Medicine
- Social Work
- Public Safety
- Legal

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## Emergency Manager’s Duties

- Identify and analyze effects of hazards that threaten the organization/jurisdiction
- Work closely on a cooperative basis with other hospitals, local government agencies and community organizations to:
- Inventory personnel and material resources
- Assist in the establishment of mutual aid and cooperative agreements

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## Duties (con’t)

- Work with engineering, safety and risk managers to develop a hazard mitigation program
- Develop an education program for management, staff and patients
- Create an Emergency Operations Center (EOC) capability
- Develop and maintain emergency warning and communications system(s)

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## “Police Power”

- The fundamental power to cope with disasters is a police power - the general power to make laws for the protection of health, safety, welfare and morals of the people.
- Police power resides at the State, not Federal level.
- The protection of life and preservation of property is a governmental function.

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## Responsibility & Authority

- Governors, not the President, are responsible for the health and welfare of the citizens.
- Emergency powers of the Governor include:
- Suspend State statutes, issue declarations
- Commandeer private property
- Direct evacuations
- Control access to disaster areas
- Authorize release of emergency funds
- Apply for and monitor Federal disaster assistance
- Quarantine the population

- Veterans Health Administration

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## Standard EMProgram Components

- Program Management
- Program Administration
- Program Coordinator
- Advisory Committee
- Program Evaluation
- Program Elements
- General
- Laws and Authorities
- Hazard Identification, Risk Assessment & Impact Analysis
- Hazard Mitigation
- Resource Management

- NFPA 1600

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## Standard EM Program Components (con’t)

- Program Elements (continued)
- Mutual-aid
- Plans
- Direction, Control & Coordination
- Communications & Warning
- Operations & Procedures
- Logistics & Facilities
- Training
- Exercises, Evaluations & Corrective Actions
- Crisis Communications & Public Information
- Finance & Administration

- Veterans Health Administration

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## JCAHO Emergency Management Standards

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## An Important Distinction

- The term _“program”_ includes all activities necessary to support the effective administration of the emergency management responsibility.
- Mitigation and preparedness activities are carried out on a day-to-day basis, guided by the mitigation and strategic administrative plan(s).

- Veterans Health Administration

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## The  ‘EOP”

- Response and initial recovery activities are carried out after recognition that a threat or event exists and are guided by the _Emergency Operations Plan (EOP)._
- Longer-term recovery is guided initially by the the list of recovery priorities.

- Veterans Health Administration

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## JCAHO Program Standards

- Day-to-day:
- Defining/integrating hospital’s role in community program
- Conducting the hazards vulnerability analysis
- Establishing priorities among potential emergencies
- For each priority event, identify specific procedures

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## Program Standards (con’t)

- Day-to-day (con’t):
- Cooperative planning among health care organizations to facilitate sharing of information such as:
- Command structures and control centers
- Names, roles and telephone numbers
- Resources and assets that could potentially be shared

- Veterans Health Administration

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## Program Standards (con’t)

- Day-to-day (con’t):
- Staff education
- Drills
- Performance measures
- Annual evaluations

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## Standards that are addressed in the EOP

- Initiating Response
- External Notifications
- Internal Notifications
- Identifying staff
- Assigning staff
- Patient management
- Staff support

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## “EOP” Standards (con’t)

- Critical Supplies
- Security
- News Media
- Patient evacuation
- Alternate care site
- Re-establishing operations
- Essential utilities
- Backup Communications
- Isolation/Decontamination

- Veterans Health Administration

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## Accreditation Programs

- Purposes:
- JCAHO - Hospitals
- EMAP – EM agencies
- Approaches:
- Documentation
- Interviews
- Observation

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## Questions?

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