Disaster Preparedness for Your Oncology Practice. Owen J. Dahl, MBA, FACHE, CHBC ANCO June 30, 2007 Santa Rosa, CA. Disclaimer

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1 Disaster Preparedness for Your Oncology Practice Owen J. Dahl, MBA, FACHE, CHBC ANCO June 30, 2007 Santa Rosa, CA Disclaimer The content and materials are strictly the opinion of the presenter and do not necessarily represent the opinion of host, its members or officers. 1

2 Objectives Identify the various disaster scenarios that could affect the practice Identify a plan of action for any oncology practice to deal with a pending or recent disaster, and Develop a business continuity plan for patient care and practice survival Two perspectives on disasters Clinical taking care of patients What are the basic services patients expect to receive from your practice? What can your practice do to help in a community-wide disaster Business taking care of the business What services are absolutely essential to your practice? 2

3 HIPAA Requirement Disaster preparedness is now required since the Health Information Portability and Accountability Act regulations state that health care organizations must implement contingency planning and disaster recovery processes. Disaster and Natural disaster a sudden calamitous event bringing great damage, loss, or destruction; broadly : a sudden or great misfortune or failure (Webster) Natural disasters occur when forces of nature damage the environment and manmade structures (healthline.com) 3

4 Natural Disasters 2006 Major Catastrophic Events Coal mine, snow, mudslide, building collapse, plane crash, train de-rail, ship sinking, gas explosion, wild fires, tornadoes, collapsed dam, earthquakes, tornadoes, building fires, bus accident, pipeline explosion, heavy rain, drought, extreme heat, typhoon, hurricane, chemical factory explosion Act of terrorism Definitions Title 22 US code premeditated, politically motivated violence against non-combatant targets by sub-national groups Dept. of Defense the calculated use of violence or the threat of violence to inculcate fear; intended to coerce or to intimidate governments or societies in the pursuit of goals that are generally political, religious, or ideological. 4

5 Common Elements of Terrorism Committed by groups who do not possess the political power to change policies they view as intolerable Choose targets and actions to maximize the psychological effect on a society or government Plan their acts to get as much media exposure as possible Justify their acts on ideological or religious grounds arguing they are responding to a greater wrong or are promoting a greater good Acts of Terrorism World Trade Center 9/11/01 Pentagon Attack Heroes of Flight 93 USS Cole US Embassy Bombings Khobar Towers Bombings Oklahoma City Bombing World Trade Center Bombing

6 Explosive devices & Nuclear Terrorists have frequently used explosive devices as one of their most common weapons. Terrorists do not have to look far to find out how to make explosive devices; the information is readily available in books and other information sources. The materials needed for an explosive device can be found in many places including variety, hardware, and auto supply stores. Explosive devices are highly portable using vehicles and humans as a means of transport. They are easily detonated from remote locations or by suicide bombers. Conventional bombs have been used to damage and destroy financial, political, social, and religious institutions. Attacks have occurred in public places and on city streets with thousands of people around the world injured and killed. A nuclear blast is an explosion with intense light and heat, a damaging pressure wave, and widespread radioactive material that can contaminate the air, water, and ground surfaces for miles around. A nuclear device can range from a weapon carried by an intercontinental missile launched by a hostile nation or terrorist organization, to a small portable nuclear devise transported by an individual. All nuclear devices cause deadly effects when exploded, including blinding light, intense heat (thermal radiation), initial nuclear radiation, blast, fires started by the heat pulse, and secondary fires caused by the destruction. Biological & Chemical Biological agents are organisms or toxins that can kill or incapacitate people, livestock, and crops. The three basic groups of biological agents that would likely be used as weapons are bacteria, viruses, and toxins. Chemical agents are poisonous vapors, aerosols, liquids, and solids that have toxic effects on people, animals, or plants. They can be released by bombs or sprayed from aircraft, boats, and vehicles. They can be used as a liquid to create a hazard to people and the environment. Some chemical agents may be odorless and tasteless. They can have an immediate effect (a few seconds to a few minutes) or a delayed effect (2 to 48 hours). From: FEMA.gov 6

7 Pandemic flu event A pandemic is a global disease outbreak. An influenza pandemic occurs when a new influenza A virus emerges for which there is little or no immunity in the human population, begins to cause serious illness and then spreads easily person-to-person worldwide. 20 th Century Events 1918 caused at least 675,000 US deaths and up to 50 million worldwide 1957 caused at least 70,000 US deaths and 1 2 million deaths worldwide 1968 caused about 34,000 US deaths and 700,000 deaths worldwide 7

8 Characteristics and challenges Rapid Worldwide Spread When breaks out, assume worldwide spread inevitable Health System Overloaded Little or no immunity Inadequate facilities, staff, equipment Medical Supplies Inadequate Vaccine and anti viral drug shortage Economic and Social Disruption Travel bans, school and business closings, care for family Differences: seasonal & pandemic Seasonal flu Seasonal patterns, annual Some immunity Healthy at less risk Systems meet demand Vaccine developed Supplies adequate 36,000 deaths annually Modest impact on society Pandemic flu Rare occurrence Little/no immunity Healthy at equal risk Systems overwhelmed Vaccine not available Supplies limited Deaths very high Major impact on society See 8

9 Major Disasters California /13 Severe Freeze /05 Severe Storms, Flooding, Landslides, and Mudslides /03 Severe Storms, Flooding, Mudslides, and Landslides /14 Severe Storms, Flooding, Landslides, and Mud and Debris Flows /04 Severe Storms, Flooding, Debris Flows, and Mudslides /30 Flooding As A Result Of A Levee Break /13 Earthquake /27 Wildfires /14 Earthquake /07 Severe Freeze /09 Severe Winter Storms and Flooding /04 Severe Storms/Flooding /12 Severe Winter Storms, Flooding, Landslides, Mud Flows /10 Severe Winter Storms, Flooding, Landslides, Mud Flows /13 El Nino Effect (The Salmon Industry) /17 Northridge Earthquake /28 Fires, Mud & Landslides, Soil Erosion, Flooding /03 Severe Storm, Winter Storm, Mud & Landslides, Flooding /29 Old Gulch, Fountain Fires See for additional information Work within your community Pre-hospital care Hospital and acute care Alternative care sites Palliative care 9

In General Be proactive good planning Build and maintain relationships Device, model, and exercise your plan Establish clear channels of communication Clarify the process

10 In General Be proactive good planning Build and maintain relationships Device, model, and exercise your plan Establish clear channels of communication Clarify the process for leadership & coordination Your office Financial implications Vulnerable populations Security plans TPSI Saturday August 27 Note pathway Hit Florida First, Six dead! 10

11 11

9/9 9/9 Katrina = 8/29/05 9/9 9/19 9/19 12/19?? HOS Geography 11/01 9/19 1/16/06??? The following check list is intended as the guideline for a practice disaster plan.

12 9/9 9/9 Katrina = 8/29/05 9/9 9/19 9/19 12/19?? HOS Geography 11/01 9/19 1/16/06??? The following check list is intended as the guideline for a practice disaster plan. The planning team should consider pre-, during-, and post-activity in the development of the plan. The plan goals To anticipate as many issues as possible and develop plans to address each issue To have a document guide for leaders To have a mechanism in place to effectively communicate to all patients To have a mechanism in place for training and communication for all practice personnel To insure review of plan following any drill or real event to insure as complete as possible plan Item Decision Matrix Issue/Action Responsible Date Complete Who Evaluation Who will make what decisions, when Insure that there is adequate review of the plan following any drill or real event Communications Telephones Internet service, bring phones Fax Cell service SEE Pages 2 5 of guidebook 12

Assessment Furniture Equipment Telephones PC, related See

13 Resources required over time: Function/resources 24 hrs 48 hrs 72 hrs 1 week 2 weeks 1 month Location: Staff Assessment Furniture Equipment Telephones PC, related See page 12 Communications Telephone Fax Cellular Information systems 13

14 IT operations Backup Off site operation Restoration Communication Patients Schedule Records EMR a MUST Notification Printing 14

15 Employees Calling tree Payroll Training Communication Stay home vs. EOC Employee training for disaster plan: Location: Conducted by: Activity Date Conducted # of participants Comments Orientation Annual update Office drill Practice wide drill Other See page 9 15

16 Vendors Their plans Communication Contact information Critical Vendor List: Product/Service: Vendor Name: Street Address: City/State/Zip: Contact person: Alternate Contact: Comments: Phone No. 24 Hour Phone No Fax No Phone No Product/Service: Vendor Name: Street Address: City/State/Zip: Contact person: Alternate Contact: Comments: Phone No. 24 Hour Phone No Fax No Phone No See page 7 16

17 Hospital Their plans Requirements for attendance Patients Insurance General policy Flood coverage Basic Excess Business interruption 17

18 Financial Internal accounting Your bank plans Contact information Documents Blue prints Area and regional maps Payroll Telephone directory Patient records 18

Comments Condition/location Equipment: Other: See page 11

19 Critical Documents to retrieve: The following documents must be retrieved or retrievable: Items to retrieve Critical records: Comments Condition/location Equipment: Other: See page 11 Initial notice of plan Contacts When to start Updates Return notice Media 19

20 Emergency Operations Center EOC Location Travel Housing Communication Staffing Options for support Your family Above all prepare for disaster with your family How, where, communicate, train all the same things we have been talking about for the business See last four pages of guidebook for outline 20

Resources Federal Emergency Management Agency http://www.fema.gov Department of Health & Human Services - http://www.dhhs.gov/emergency/index.html Center for Disease Control & Prevention http://www.

21 Resources Federal Emergency Management Agency Department of Health & Human Services - Center for Disease Control & Prevention Pandemic flu - Agency for Healthcare Research & Quality Several books on emergency management on line or in book stores For questions or comments About this presentation Please contact me: Owen J. Dahl, FACE, CHBC odahl@owendahlconsulting.com Recently published: Greenbranch Publishing, Inc. (800)

Module 2 - Public Health Preparedness

Module 2 - Public Health Preparedness Objectives Define a public health emergency List examples of types of public health events and emergencies Overview Protecting the public from health threats involves