Whole Community Planning

Disaster planning can easily invoke images of generators, regulations, inspections and dollar signs.  There is however another aspect of disaster planning that should be a little less intimidating and at the same time very effective.  In 2011, FEMA issued a report that recognized the need for a “Whole Community” approach to disaster management.  This methodology is a current overarching theme in disaster management that emphasizes the importance of community collaboration and coordination in disaster preparedness, planning, response and recovery.  It stresses building relationships and understanding community interdependencies.

As we get to know our community partners we can contribute valuable input that will aid in developing response plans and supportive relationships that make sense and provide us with an advantage when disaster strikes. Working together as a team and implementing strategies that promote collaborative efforts toward strengthening our communities in the face of disaster is a foundation for effective disaster planning.

The Whole Community approach aims to empower a broad range of players, including faith-based, academia, non-profit, and private sector entities to become a part of the community’s disaster management team.  As members of the healthcare community and caretakers of some of our most vulnerable populations, long term care facilities have a special place in disaster management and in creating disaster resilient communities.   You can learn more about the Whole Community approach to emergency management in FEMA’s brief report, accessed at: https://www.fema.gov/media-library/assets/documents/23781?id=4941

Table Top Exercises

The Disaster planning process can include a wide range of activities from identifying hazards and writing plans, to collaborating with other organizations and conducting drills and exercises.  Of these activities, one simple and effective way to test capabilities, overcome emergency planning resistance, and keep the planning process fresh and current is through the use of tabletop exercises.  Tabletop exercises require few resources, can be fun and can have a big impact.  They provide organizations with the opportunity to discuss important functional aspects of disaster and to bring together a diverse group of individuals, including staff from various departments and even external partners.

Tabletop exercises are discussion based and they are very scalable to your needs and resource availability.  Even a two hour exercise can produce significant insight and provide your facility with ideas for improving your emergency plans.  Writing a brief “Lessons Learned” paper or an “After Action Report” following the exercise can give your facility solid information to use for future planning activities.

You can add value to your tabletop exercises by inviting external partners such as local law enforcement or EMS to the planning team or to the exercise as players.  This will facilitate pre-disaster event communication, diverse perspectives and add an element of realism.  The Florida Health Care Association has developed a Homeland Security Exercise and Evaluation Program (HSEEP) exercise toolkit for nursing homes that may be helpful in your facility’s development of an exercise.  You can access this toolkit at: https://www.fhca.org/facility_operations/format_for_download/.  Click here for a basic tabletop exercise development template.

Sheltering In Place

Only you and your staff can truly understand the unique challenges that your facility will face during a disaster.  Though each organization and facility varies, many threats and considerations are shared. Evacuation of residents is a last resort during a disaster and making the decision to do so is not always easy or obvious.  This is why it is important to develop an understanding of the capabilities and challenges associated sheltering your staff and residents within your facility.

Sheltering-in-place is a common disaster management term used to describe the protective action of staying within a structure and utilizing its protective features in order to avoid exposure to a hazard.  Many scenarios that necessitate sheltering-in-place may also require additional actions that enhance the protective features of the structure and ensure adequate protection. There are some threats that might straightforwardly prompt sheltering–in-place such as a fire at a hazardous waste site or a radiation leak.  In other scenarios the right protective action may not be clear and the pros and cons of evacuation and sheltering-in-place may need to be carefully weighed. It is best to collaborate with local emergency managers before a disaster occurs to ensure that your plans are sufficient and provide your facility with the best available guidance for decision making and shelter-in-place procedures.

The CMS emergency preparedness checklist recommends that healthcare facilities develop a shelter-in-place plan.  The plan does not need to be lengthy, but it should provide easy to understand guidance related to decision making and associated actions.  AHCA Disaster Ready staff are available to assist with drafting these plans.  Please reach out and let our disaster managers support your facility in becoming Disaster Ready!

Continuity of Operations Planning

Disaster resilient communities tend to also be business resilient communities. The CMS Checklist for Emergency Preparedness recommends that healthcare facilities develop Continuity of Operations Plans (COOPs).  These plans aid businesses in maintaining viability in the face of disaster.  As more businesses implement COOP planning, the disaster resiliency of the community is improved as well.

COOPs are different from Emergency Operations Plans (EOPs) but they do work together.  They focus on organizational processes such as insurance claims processing, payroll, clinical documentation and legal and regulatory requirements. Hazard Vulnerability Analyses (HVAs) are typically conducted when developing an EOP, but for COOP development, a Business Impact Analysis (BIA) is conducted.  When planning for continuity of operations, questions that are asked primarily relate to the amount of time the business can operate without a critical processes and what the consequences of business disruption would be for specific scenarios. In asking these questions, back up plans can be developed and critical decisions during disaster can be improved.

A COOP role can also be integrated into the Nursing Home Incident Command System (NHICS).

Redundant Communication

Why do we need to care about having back-up communication systems? Sometimes it is hard to imagine having all of our standard communication methods disrupted at once but this is often the case during disaster. In this scenario, the ability to know the situation and to communicate needs may be the difference between mass casualties and sustaining life.  Mutual Aid Agreements and resource request through incident management may not be able to occur without operational and interoperable communication systems. Are you familiar with the communication strategies of your community response partners?  Do you know what your local first responders use to communicate during disaster? How will you be able to reach them when standard methods are disrupted?

Introducing more redundant communication systems such as satellite phones and ham radios into your facility can require and investment of resources which often deters implementation. Connecting with the first responders near your facility is a good first step in developing cost effective redundant communication strategies and getting them into your emergency plan.  Long term care facilities are considered near critical facilities.  With this in mind it is important that local first responders know your facility capabilities and vulnerabilities so that they can assist during crisis. A written communication strategy and coordination with community partners could save the lives of facility residents and staff in a disaster.

Your local law enforcement may have radios available for your use during a disaster.  Depending on the radio type you may only need to train or license a member of your staff to operate the equipment.  HAM radios require operators to be licensed but often there are very inexpensive training opportunities available. AHCA will be working on identifying resources to assist facilities in further developing strategies for disaster communication redundancy.  Keep an eye on the AHCA Disaster Ready website for new resources!

The All-Hazards Approach

In recent years, the all-hazards approach to disaster management has been a hot topic and adopted by the nation as a new standard. This approach aims to account for the reality that disasters are not wholly predictable and can vary tremendously, from tornados to terrorist events.  It is unrealistic, costly and ineffective to have separate plans for all of these possible but unpredictable occurrences.

The all-hazards approach is based on the understanding that though disasters may vary, all disasters have common challenges and related responsibilities. In order to bolster preparedness for a variety of possibilities, the nation is taking steps to implement strategies that bear in mind the commonalities present in most scenarios, and in doing so make planning more efficient and functional.  Additionally, risk analysis is used to help us assign scarce preparedness resources to the most likely occurrences.

Rather than creating separate plans for every type of disaster scenario, the all-hazards approach calls for the creation of one plan that is adaptable and supportive of a variety of incident types.  All-hazards planning is functional planning.  In most disasters one or more core functions will likely need to be implemented such as evacuation or sheltering in place.  If your facility has prepared for implementation of these core functions through written planning, exercises and drills, resilience during disaster will be considerably increased.

Utilizing the Incident Command System (ICS) is another aspect of planning for all hazard types. A common challenge in all disasters is effective incident management.  Understanding and practicing the Nursing Home Incident Command System (NHICS) will give your facility the management advantage in any disaster scenario by providing enhanced direction and situational control.

AHCA disaster consultants are available to help your facility plan for all hazards.  Contact us and we will assist you in becoming more disaster ready!

The Continuous Planning Process

Adaptability is a cornerstone of preparedness.  Just as your incident command will need to adapt to changing circumstances during a disaster, the same is true before a disaster. When planning for disasters, it is easy to get comfortable with the idea that after completing a plan the job is done.  However, it is important to remember that our environment and knowledge changes continually. Changes may include the nature of threats, resource availability, new capabilities; lessons learned and even technological advances.  Fluctuations within the community planning environment may also greatly impact your level of preparedness. These changes are part of the continual planning process.

In order to maintain an effective level of readiness, it is important continually consider how organizational and environmental variations might influence your disaster planning. This is why the disaster management community encourages facilities to review and update plans regularly.  Written plans will only truly serve the user during disaster if they are current, reflecting the present state of the organization, the threat environment and the community.   If they are not current, they may actually hurt the response rather than help.

Exercises and drills can serve as tools for the reevaluation of the planning process and written products.  When we practice and test capabilities we often identify weaknesses that were previously hidden or see opportunities for improvement. A large part of planning is also not always in written form.  Planning may include training and education opportunities or building relationships within the community.  Continually seeking opportunities for individual and organizational improvement related to readiness are great ways to keep concepts fresh, to learn about changes and new possibilities and to ensure that the planning process is not simply a long forgotten written document.

Leaving Room for Improvisation in Written Plans

The best emergency plans are those that leave room for improvisation.  This can occur through rich content but it must be well organized and avoid minute details. Plans will ideally leave room for meeting the fluid nature of disasters. If plans are too particular they may be increasingly difficult to keep up to date and exercises may prove challenging. They may also be difficult to follow in the heat of the disaster due to unpredictable complexities.

One way that emergency planners manage this need for improvisation is by having a general response component within the emergency operations plan which might include information related to overall incident management such as command, control, coordination and communication.  In addition to the basic plan however, are functional and hazard specific components. Functional components might include evacuation, transportation, or shelter-in-place information. Hazard specific components might include specific provisions and protocols for single hazard events such as a tornado, a hazardous materials incident, or a flood.  This type of plan is tied to the all-hazards approach which aims to enhance capabilities for dealing with a multitude of scenario types, in an efficient non-overwhelming manner.

AHCA disaster consultants are available to assist with your emergency operations planning. You may also want to consider products available to you for disaster planning such as the Med-Pass Emergency Preparedness Planning and Resource Manual. Visit Med-Pass at: https://www.med-pass.com/emergency-preparedness-planning-and-resource-manual-with-cd.html

Situational Awareness

Situational Awareness is a term that has been adapted to a variety of disciplines throughout the years.  The term originated in aviation safety in response to pilot error and has since been adapted for the military, law enforcement, firefighters and in recent years, disaster management. When the term is used in disaster management, it typically refers to a shared situational awareness that contributes to all managers maintaining a common operating picture.  Information sharing and appropriate resource allocation capability are at the heart of its meaning. Predominantly, incident management gains situational awareness by finding out how the community is being impacted, what the response is, critical needs and what resources are available.

There are many challenges associated with maintaining shared situational awareness in domestic disaster management because the community as a whole does not operate like the military or first responders.  There is a lack of shared culture and control practices.  From the standpoint of the healthcare provider there are a couple of ways to utilize this concept to your advantage.

First, the concept of situational awareness can be applied to your facility’s incident management. You can work toward maintaining awareness during an emergency by continually gathering information (internally and externally) necessary to make good decisions. Utilizing the Nursing Home Incident Command System (NHICS) will enhance this capability. Your perception of what is happening should ideally be close to the reality of what is happening.

Secondly, you can contribute to the situational awareness of your local emergency management.  The local incident command and first responders will benefit from receiving timely and accurate information from you about the status of your facility, your critical resource needs and your capabilities.   This information will help local incident management make better decisions not just for your facility but for the community as a whole.

Surge Capacity

The concept of surge capacity is something that we primarily associate with hospitals.  However, during a disaster patient influx may be widespread among local healthcare entities because all healthcare facilities are considered community assets.  From a whole community perspective any facility with trained medical staff, supplies and available beds may be called upon to serve the community by admitting patients.

Even hospitals that manage daily surge regularly, must adapt their strategies for disaster surge where the focus shifts from the individual patient to mass care.  Resources are stretched and routine models of care are reformed in order to enhance outcomes of a greater number of patients.  Supplies, staff, incident management and spatial capacity may all become concerns during a surge event.

How can we prepare for surge? For this week, consider a couple of common challenges:  Staff shortages are common during disaster for a variety of reasons and this can be an issue regardless of new patient admittance.  What planning elements could help your facility manage operations during a temporary staffing shortage?  Volunteers may be requested by your facility or they may arrive spontaneously.  What would be needed to manage the new volunteer workers?  Let us know your thoughts or send us a question!