Emergency Management Midterm Exam
Emergency Operations Plan (EOP)
Should be a living document, flexible, and routinely updated and with backup plans; purpose is to provide an all hazards approach to emergency mgmt to eliminate or minimize the disruptions that affect a facility's ability to provide care and support to clients; contents include: crisis staffing, surge capacity, emergency phone system, child care, etc.
After-action review (AAR)
Should be conducted immediately after an incident, even if you are exhausted; take time to evaluate your plan, figure out what worked and what didn't and make adjustments
National Fire Protection Association 1600
Standard on disaster, emergency management, and business continuity and continuity of operations programs that contains requirements for the development, implementation, assessment, and maintenance of programs for prevention, mitigation, preparedness, response, continuity, and recovery
National Fire Protection Association 1561
Standards on emergency services incident management system and command safety; includes requirements for emergency services oriented toward ensuring the safety of emergency responders and others during an incident
National preparedness guidelines and strategy
States four major goals to focus on: 1) Prevent and disrupt terrorist attacks, 2) Protect the American people, our critical infrastructure, and key resources, 3) Respond to and recover from incidents, 4) Continue to strengthen the emergency-preparedness foundation
Hospital Incident Management Team (HIMT)
Structure depicts HICS functions with identified roles for how responsibilities are distributed among the assigned team members (command, finance and administration, logistics, operations, planning); there should always be a "3-deep" succession plan for key roles
Recovery
Takes place after an emergency; one of 5 National Preparedness Goal mission areas; involves focusing on timely restoration, strengthening and revitalization of infrastructure, housing, and sustainable economy, as well as the health, social, cultural, historic, and environmental fabric of communities affected by a catastrophic incident; can take weeks, months, and sometimes years
Mitigation
Takes place before and after emergencies; one of 5 National Preparedness Goal mission areas; includes any activities that prevent an emergency, reduce the chance an emergency will happen, or reduce the damaging effects of unavoidable emergencies
56
The # of times the Stafford Act is used on average
Phases of the media
The three reactions include: 1) Stunned by tragedy 2) Accusation (shortly after the shock, the hunt for someone to blame begins) 3) The story behind the news or the search for controversy (what really happened and why)
Costliest catastrophes in U.S. history
The top 10 into three general categories: 1) Earthquake, 2) Hurricane, 3) Terrorist attack
Rosy assumptions from hospitals made about disasters
These tend to not be true in a disaster: 1) There will be an equal distribution of casualties, 2) Casualties will arrive uncontaminated, 3) Casualties will all be brought in by ambulance with ample radio warning, 4) There will be prompt and comprehensive community services if the hospitals need it
Interactions between public health and emergency management
They used to be rare; closer alignment started in the 70s when the field of emergency management began to shift away from its orientation toward civil defense (typically focused on nuclear attacks) and more toward a greater range of natural and human-caused accidents; the wider range of interests came to be called "all hazards"; 9/11 strengthened ties
Main focus of public health departments
To protect communities in both manmade and natural disasters beyond just infectious diseases
Types of disaster declarations
Two types include: 1) Presidential declaration of disaster under Stafford Act which requires a formal request by a state governor, 2) Public Health Emergency declaration which the HHS secretary can declare without a formal request
National Response Framework
Works by 1) Setting out the roles and responsibilities of key implementers at the local, tribal, state, and federal levels, 2) Provides roles of private sector and NGOs, 3) Provides objectives of preserving the lives and social welfare and protecting the property of a defined population, 4) Helping to define mitigation, preparation, response, and recovery
Public Health Accreditation Board
32 standards linked to the 10 essential public health services for use by agencies seeking public health accreditation (e.g., requirements for emergency plans, policies, procedures, training, exercises, 24/7 operations, surge staffing, etc.)
National Public Health Performance Standards
40 standards linked to 10 essential public health services, devoted to driving improvement at a public health system level with additional content related to legal authority in emergencies
Emergency
A common, routine adverse event that is handled well by the local emergency medical services system; impact is limited to the affected individual or family; causes no disruption to the social order or psyche of the community or population; ex. broken bone, heart attack, stroke
400
Average # of disasters with damage per year in the U.S.
Protection Federal Interagency Operational Plan (FIOP)
Describes how the federal departments and agencies work together to deliver Protection core capabilities through eight coordinating activities; enable the federal government to execute the critical tasks associated with each core capability
Pandemic and All-Hazards Preparedness Act of 2006
Designates the Secretary of the Department of Health and Human Services as the lead for all federal public health and medical responses to public health emergencies covered by the National Response Plan
Logistics section chief
Leader in an incident responsible for: providing communication for planning and establishing resources, setting up and maintaining incident facilities, managing food services, all support needs of the incident, and acquiring resources from internal and external sources; wears a yellow vest
Order of response to an incident
Local > adjacent city or county > region > state > federal
HICS command staff
Maintains the overall management of an incident through setting incident objectives, strategies, and response priority; leader wears white vest; team includes liaison officer, safety officer, public information officer, medical/technical specialists
Narcissistic leader
One of the three common aberrant personalities; self-centered, egocentric, self-absorbed; seeks constant reassurance of his self-worth; primary leader is to himself; seek advisors who prop up their self-esteem; believe they are principled and scrupulous individuals
President
Role is to lead the federal government response through the Homeland Security Council and National Security Council; receives national strategic and policy advice from cabinet officers and other dept agency heads; can issue a formal declaration of a disaster to access federal resources and federal disaster reimbursement mechanisms
9 key domains of public health emergency management
1) Facilities, management, and operations 2) Policies, plans, procedures, and partnerships 3) Internal communications and IT 4) Crisis and emergency risk communication and public info and warning 5) Surveillance and control 6) Info collection, integration, and sharing 7) Incident mgmt and response 8) Coordination and logistics support of field operations 9) Training, exercising, and evaluation
Public Health Preparedness Capabilities: National Standards for State and Local Planning
15 capabilities related to tasks that state and local health departments are expected to be able to do based upon the resources they are expected to have
Emergency management cycle
A heuristic to understand between public health and emergency management- lately found increasing applicability to public health sector; steps include: 1) Coordinating select public health response functions across multiple entities; 2) Collecting, integrating, and analyzing epidemiologic, lab testing, and other data; 3) Sharing information with partners; 4) Developing and disseminating guidance, emergency risk communication messages, and other recommendation to targeted audiences or at-risk populations; 5) Coordinating the implementation of control measures such as the distribution and dispensing of appropriate medical countermeasures
Staffing
A major priority as a leader for preparing for an influx of patients or the need to evacuate
Joint Operation Center (JOC)
A regional multi-jurisdictional, interagency operations center to lead and coordinate the operational law enforcement response; led by the FBI on-scene commanders; acts as the focal point for the management and direction of on-scene law enforcement activities
Disaster
A severe event such as a massive flood, destructive tornado, or hurricane, or human-caused or terrorist attack; community-wide impact which requires outside assistance from the state or federal government; disrupts the social order, psyche, and sense of security of the area or region
Incident Command System
A standardized approach to the command, control, and coordination of emergency response incident management; has evolved to a system for all hazards and can be used in any sized incident that impacts daily operations; examples include: HAZMAT incidents, high census, and mass casualty incidents
Catastrophe
An unusually extreme, rare event that affects an entire nation or part of the world; require extensive assistance from outside the region and a global response; damage to those affected may be profound and prolonged; ex. 9/11, Haiti earthquakes, Japan tsunamis
Response
Activities occur during an emergency; one of 5 National Preparedness Goal mission areas; involves responding quickly to save lives, protect property and the environment, and meet basic human needs; involves putting your preparedness plans in action (ex. seeking shelter from a tornado)
Hospital Incident Command System (HICS)
An ICS structure specifically designed for hospitals; principles presented in the framework overlap the mission areas (prevention, protection, mitigation, response, recovery); can be used in both emergent incidents or non-emergent events; functions performed by the Hospital Incident Management Team
Public health emergency management (PHEM)
An emerging field that draws on specific sets of knowledge, techniques, and organizing principles found in the fields of emergency management and public health that are necessary for the effective management of complex health events and emergencies with serious health impacts
How to manage the media
Best practices: 1) Added security will help manage, especially when it comes to protecting pt privacy and confidentiality; most members of the media are not concerned about HIPAA, infection control, privacy, or your image; 2) Establish fair and uniform rules and scrupulously enforce them; 3) Never put yourself in an adversarial position, no matter the provocation; 4) Establish a good access for your media person, and make sure they remain fully informed so that they can maintain credibility with the media; 5) Don't let questions put words in your mouth; 6) Be the media's conscience and don't let them force the situation out of control
Great catastrophe
Classification to distinguish when a region's ability to help itself is distinctly overtaxed, making supraregional or international assistance necessary; # of fatalities exceeds 2,000, # of homeless exceeds 200,000, overall losses exceed 5% of the country's GDP, or the country is dependent on international aid
National Incident Management System
Comparison document to the National Response Plan; provides standard command and management structures that apply to response activities and a consistent nationwide template; provides the common operational concepts and basic organizational structure to ensure seamless transitions and integration of resources; ensures responders anywhere can work together regardless of the nature or location of the incident; five key components: 1) Adoption of NIMS, 2) Planning, 3) Training and exercises, 4) Communications and information management, 5) Command and control
1135 waiver
Created by Section 143 of the Public Health Security and Bioterrorism Preparedness and Response Act of 2002; authorizes the HHS secretary to temporarily waive or modify Medicare, Medicaid, or CHIP requirements when the president declares an emergency or disaster; waivers can include conditions of participation, pre-approval requirements, state licensing, EMTALA sanctions for transfers, HIPAA noncompliance
National Association of City and County Health Officials
Criteria-based emergency preparedness program developed for local public health departments emphasizing documentation of an all-hazards preparedness plan and comprehensive exercise plan
Key findings of the HPP
Discovered by the ASPR; includes: 1) Disaster preparedness of hospitals has improved since start of HPP, 2) Emergence of healthcare coalitions is creating foundation of U.S. healthcare preparedness, 3) Planning for catastrophic emergencies still in early stages, 4) Progress requires additional national assistance and direction; 5) Most useful indicators for preparedness are: surge capacity, capability goals, assessment of training and analysis of performance during actual events or exercises, 6) HPP should focus on coalitions for a national disaster response system, 7) Admin adjustments to HPP can improve effectiveness, 8) DHHS should provide leadership to address problems in disaster standards, 9) Catastrophic emergency preparedness is a national security issue
HICS general staff
Divided into sections and led by corresponding section chiefs from operations, planning, logistics, and finance and administration
Reasons our vulnerability to disasters is increasing
Includes 1) Climate change, 2) Relocation to hazard-prone areas, 3) No financial means to avoid hazard-prone areas, 4) Rising insurance density
International Organization for Standardization-Societal Security
Establishes common understanding on the protection of society and response to incidents caused by intentional and unintentional acts
Emergency Management Accreditation Program
Establishes voluntary standards, assessment, and accreditation process for disaster preparedness programs across the nation; the gold standard of emergency management programs in the U.S.
Incident commander
Every incident will have one as part of the command staff; typically the most senior person on duty at the time of the incident and have the authority to make decisions for the org and provide direction for the HIMT; first person responding fills this role until someone with more expertise/training has arrived
Four "C"s of a successful integration for a disaster response
Includes 1) Communication, 2) Cooperation, 3) Collaboration, and 4) Coordination
5 key principles of the National Response Framework
Includes 1) Engaged partnership, 2) Tiered response, 3) Scalable, flexible, and adaptable operational capabilities, 4) Unity of effort through unified command, 5) Readiness to act
Regional Response Coordination Centers (RRCC)
FEMA has 10 regional offices and each maintains one of these; supports deployment of FEMA assets
Healthcare Preparedness and Response Capabilities
Four capabilities that describe what entities in healthcare should do to effectively prepare for and respond to emergencies
Non-Stafford Act incidents
In these situations where the federal government is involved, the president may designate a federal agency to serve as the Lead Federal Agency (LFA) for the response; the LFA will employ NIMS to coordinate the federal response
HSPD
Homeland Security Presidential Directives; #5 mandates the National Incident Management System to manage incidents; #8 requires a national all-hazards preparedness goal
HPP
Hospital Preparedness Program; sponsored by the ASPR
Recipient of preparedness funds
In order to be one, you are required to develop an incident management framework that complies with the National Incident Management System
Key influencers to staff willingness to report to work
Include: 1) The type of disaster, 2) Concern for family, 3) Concerns for personal safety, 4) Pet care needs, 5) Lack of PPE
Disaster with mass fatalties
In this type of situation, make sure that you: 1) Assign a casualty assistance officer, 2) Assign an experience chaplain as the personal representative to meet with the next of kin and care for their needs, 3) Casualties are news, and this news travels rapidly. Your timely reactions will ease the burden on the next of kin, 4) Provide for survivor needs, 5) A public memorial service where participants can share their sense of pride and loss may help survivors, 6) Assign the necessary security personnel to protect the privacy of survivors. Usually, survivors are in no condition to talk to the media, investigators, or law enforcement, 7) Coordinate and communicate with orgs and individuals who want to help- without supervision, they can create chaos, 8) Anticipate a delayed stress reaction during the aftermath- make sure medical officers and chaplains remain available
What the most effective leaders in a crisis do
Include: 1) Are visible by walking around, 2) Are calm and focused, 3) Are rested, 4) Assume nothing, 5) Communicate constantly, 6) Have a plan and know how to execute it, 7) Realize they may be unable to rely on outside help, 8) Have prepared the organization to be self-sufficient, 9) Are prepared to deal with personal challenges, 10) Are not afraid to challenge authority, 11) Define primary elements of the situation, 12) Consider major values, interests, and objectives, 12) Search for alternative courses of action, 13) Estimate costs and risks of alternatives, 14) Discriminate between relevant and irrelevant info, 15) Assess situation from other perspectives, 16) Resist defensive procrastination and premature closure, 17) Monitor feedback from the developing situation, 18) Make adjustments to make real changes in the environment
Guidelines for managing during a crisis
Include: 1) Don't make it worse, 2) Capture control of the information flow, 3) The problem is usually too much info, not too little, 4) Establish filters to help isolate you from all the input clamoring for your attention, 5) Save yourself for the main events, 6) Put problems into boxes and delegate, 7) Refuse to be drawn into trivial matters, 8) Insist helpers get adequate rest; and if you don't follow it, neither will other, 9) Make sure that everyone knows what is happening; voids are filled with rumors, 10) Select a good boss, 11) Return to normal operations ASAP, 12) Litigation may follow; keep good records and an audit trail, 13) Beware of abdicators; don't let individuals or organizations abdicate their responsibilities, 14) Know your own territory; capabilities; limitations; lines of communications; a crisis is not the time to "get to know people", 15) Critically re-examine assumptions, 16) Feed the media
Basic considerations for medical staff issues
Include: 1) It is not uncommon for medical staff to be on staff at multiple hospitals- which one can they staff?; 2) Call paid medical staff officers, medical directors, section chiefs, and other medical staff administrators to have them in house to deal with these issues; 3) Make medical command a part of the incident command center, or have the medical command center adjacent to the incident command center; 4) Make sure that your emergency and critical care centers are all covered along with radiology, lab, and anesthesia; make sure you have at least one general surgeon in house, and if you have L&D and/or a NICU at least one neonatologist in house; 5) Use your house staff to the fullest extent (residents, etc.)
6 symptoms of defective decision making in a crisis
Includes 1) Giving diminished attention to an action's long-range consequences, 2) Perceived requirement for decisional closure leading to premature action, 3) Tendency toward irrational procrastination, 4) Cognitive rigidity, 5) Tendency to reduce cognitive complexity and uncertainty, 6) Tendency to reduce the range of options considered, 7) Tendency to bolster, 8) Viewing the present in terms of the past, 9) Tendency to seek familiar patterns, 10) Diminished creativity, 11) Tendency toward the fundamental attribution bias, 12) Tendency to fall into the actor-observer discrepancy
Public health department role over the "state of catastrophic health emergencies"
Includes 1) Planning and executing the catastrophic health emergency assessment, mitigation, preparedness, response, and recovery for the state; 2) Coordinating the catastrophic health emergency response between state and local authorities, 3) Collaborating with relevant federal govt authorities, elected officials of other states, private orgs, or companies; 4) Coordinating recovery operations and mitigation initiatives, 5) Organizing public information activities
Reasons for not "getting serious" about disasters
Includes 1) Preparedness costs $, 2) Never think disasters will happen to you, 3) Lack of expertise in healthcare emergency management, 4) Business risk of preparedness, 5) Rosy assumptions from hospitals
Role of state government
Includes 1) Supplement and facilitate local efforts before, during, and after incidents, 2) When state resources are scarce or the event exceeds the state's ability to response, make a formal request for federal assistance
States with most federal disaster declarations
Includes 1) Texas, 2) California, 3) Florida, 4) Oklahoma, 5) New York, and 6) Louisiana
National Preparedness Goal
Includes five mission areas and 32 core capabilities
Local level partners
Includes public safety (local police, fire, hazmat, EMS), local school districts and higher ed, city and county DOTs, welfare and homeless services, social services agencies, local public health depts, city utility companies, local media outlets
Five factors that promote hospital preparedness
Includes: 1) Availability of funding, 2) Federal govt focus and guidance, 3) Standards and regulations, 4) Experience with or examples of adverse outcomes from inadequate prep, 5) Community standards for supporting local hospitals
Benefits of using HICS
Includes: flexibility and adaptability to meet specific needs and capabilities of hospitals (can staff anywhere from 1-70 positions as needed); customizable; component of an Emergency Operations Plan; efficient response; integration with community; federal preparedness and response grant compliant; accreditation compliance; resource management
Preparation
Involves having enough supplies to last for 3-5 days on your own, having your generators topped off to run continuously for 3 days or longer, and having a backup plan in place to get additional diesel on demand
Fire
Kills more Americans than any other cause, when medical causes of death are eliminated
Planning section chief
Leader in an incident responsible for: developing plans for incident documentation, tracking the status of all resources given to the incident, gathering, evaluating, and disseminating situational awareness info, developing tactics for demobilization, and preparing the Incident Action Plan and leading the briefing; wears a blue vest
Operations section chief
Leader in an incident responsible for: implementing tactics based on incident objectives, organizing, allocating, and directing the strategic resources, managing the staging area, and determining the need to assign resources to support mission objectives; wears a red vest
Finance and administration section chief
Leader in an incident responsible for: monitoring personnel time, negotiating and monitoring any necessary contracts, analyzing costs, and completing necessary reimbursement documentation related to compensation for injury and damage to property/fatalities; wears a green vest
Unity of command
Means that every individual has a designated supervisor to whom he or she reports when managing the incident; ex. each nurse has a single supervisor the report to in an incident
Security issues
Must be prepared for the following: 1) Sometimes employees and their families or general members of the community may flock to the hospital out of the perception that the hospital is a secure place, sturdily built, with emergency power and plenty of food, etc.; 2) It may be necessary to limit access to your building down to 1 or 2 entrances/exits, 3) Those approved to enter/exit will be ID by their security badges; bring in extra security and have a lockdown plan completed in advance
ASPR
Office of the Secretary for Preparedness and Response; sponsors and has charge of the Hospital Preparedness Program; falls under the purview of the U.S. Department of Health and Human Services
Prevention
One of 5 National Preparedness Goal mission areas; involves preventing, avoiding, stopping an imminent, threatened, or actual act of terrorism
Protection
One of 5 National Preparedness Goal mission areas; involves protecting citizens, residents, visitors, and assets against greatest threats and hazards in a manner that allows our interests, aspirations, and way of life to thrive
Paranoid personality
One of the three common aberrant personalities; feels surrounded by enemies and is extremely suspicious of the motivations of others; has trouble trusting others
Compulsive leader
One of the three common aberrant personalities; often becomes paralyzed by indecision and tends toward irrational procrastination for fear of making a mistake- most comfortable applying set policies and procedures to solve problems; sensitive to the leadership hierarchy, overly response to superiors, competes with peers
Stafford Act
Passed in 1988, gives president power to declare a national emergency as a response to a national disaster and access funds and disaster relief assistance set aside by Congress; two levels: 1) "Emergency declaration"- more limited in scope, 2) "Major disaster declaration"- provides more federal programs
National Security Council (NSC)
Principal policy body for consideration of national security policy issues requiring presidential determination; advices and assists the president in integrating all aspects of national security policy as it affects the U.S. (domestic, foreign, military, intelligence, economic)
WHO Framework for a Public Health Emergency Operations Center
Recently published guidance by WHO for use by ministries of health and other health authorities outlining "key concepts and essential requirements for developing and managing a PHEOC for the purpose of enabling a goal-oriented response to public health emergencies"
Chain of command
Refers to the orderly line of authority within the ranks of the incident management structure
Common terminology
Required by the Incident Command System so all agencies have the ability to collaborate; goal is to ensure efficient, clear communication among all parties involved in managing an incident
CMS
Requires organizations to develop emergency plans, communications, training plans, policies, and procedures; implementation of exercises to receive Medicare and Medicaid $
Failure to coordinate distribution of supplies
The cause of most logistics problems faced during many U.S. disasters
285
The number of great catastrophes since 1950
Miami
The one U.S. city on. the list of 10 cities accounting for 50% of the worldwide exposure to coastal flooding and high winds
Preston v. Tenet Health System- Memorial Medical Center
The outcome of the court case was that Tenet settled for 45 preventable deaths that occurred in the hospital during Hurricane Katrina following the levy breaking