1. society
2. welfare
3. healthcare
4. hospital

How to Manage
Healthcare System
Recovery
2014 NH Emergency
Preparedness Conference
Manchester, NH
June 11, 2014
Paul Biddinger, MD, FACEP – Director
Ben Dauksewicz, MA – Program Manager
Harvard School of Public Health Emergency Preparedness
and Response Exercise Program (HSPH-EPREP)
Acknowledgements
The Hospital Recovery Workshop was developed by the Harvard School of Public Health
Emergency Preparedness and Response Exercise Program (HSPH-EPREP) through a
contract with the Office of Preparedness and Emergency Management at the
Massachusetts Department of Public Health, with funding from the Office of Assistant
Secretary for Preparedness and Response (ASPR) Hospital Preparedness Program.
This document is intended to assist hospitals with organizing, developing, and/or refining
their recovery capabilities in accordance with federal guidance. This document is not
intended to supersede any federal guidance; rather, the workshop is structured to help
hospitals incorporate recovery capabilities into comprehensive hospital emergency
operations plans.
The views and opinions expressed in this document do not necessarily represent the
views and opinions of the Office of Assistant Secretary for Preparedness and Response
(ASPR) Hospital Preparedness Program or the Massachusetts Department of Public
Health.
Background
• Recovery is often considered last when organizations
develop emergency preparedness plans
• All-hazards recovery functions can help hospitals
manage recovery just as all-hazards response functions
help hospitals manage incidents
• The federal recovery system relies on local jurisdictions
and hospitals to have robust recovery plans
Background
• Development of Healthcare Preparedness Capability 2:
Healthcare System Recovery
Seminar
Workshop
TTX
Games
Drills
Functional
Full-Scale
C
A
P
A
B
I
L
I
T
I
E
S
COMPLEXITY
Adapted: FEMA
Recovery Workshop: Objectives
1. Identify the key elements and essential functions that
contribute to developing recovery capabilities among
healthcare organizations.
2. Discuss common recovery challenges that hospitals
have faced during past events as well as observed best
practices.
3. Discuss how to organize healthcare system emergency
operations plans in accordance with the National
Disaster Recovery Framework.
Recovery Workshop: Agenda
1. Session 1: Introduction
2. Session 2: Lessons Learned 1-5
•
Essential Functions
•
Triggers
•
Objectives
3. Session 3: Lessons Learned 6-10
•
Essential Functions
•
Assessment
•
Coordination
4. Session 4: National Disaster
Recovery Framework
•
Advocating for recovery planning in your
institution
Source: FEMA
Lessons Learned - Survey
Contacted 25+ hospitals nationwide that went through
major incidents in the past 20 years (12 responses):
1. What worked during recovery?
2. What didn’t work during recovery?
3. What do you know now that you wish you knew
then?
Lessons Learned
Summary of Results:
• For many, recovery was a trial by fire
• Lessons learned includes some successes, but many
more challenges
• Responses generally fell into ten categories
Lessons Learned
Session 2:
Session 3:
• Planning
• Staffing
• Incident Command
• Safety & Security
• Communications
• Utilities
• Resource/Asset
Management
• Finance & Legal
• Clinical Operations
• Volunteer & Donations
Management
Essential Functions
• Triggers
• Objectives
• Assessment
• Coordination
How to Manage
Healthcare System
Recovery
Session 2:
Hospital Recovery Lessons
Learned
2014 NH Emergency Preparedness
Conference
Essential Functions
• Triggers
• Objectives
• Assessment
• Coordination
Triggers
Recovery Scenario # 1: Blackout
Triggers
Recovery Scenario # 1: Blackout
• A blackout impacting your area has been ongoing for three days
following a computer failure and the subsequent explosion of
several major transformers and relays at regional power stations
• Your emergency operations plan (EOP) and your emergency
operations center (EOC) have been activated from the beginning
of the power outage
• Power is slowly being restored throughout the affected area
Triggers
Discussion Question #1:
How and when do you transition into recovery
functions?
Source: Mercy Hospital
Source: Huffington Post
Recovery Scenario # 1:
Blackout
Discussion Question #1: Triggers/Transition
• A blackout impacting your state has been ongoing for three days
following a computer failure and the subsequent explosion of
several major transformers and relays at regional power stations
• Power is slowly being restored throughout the affected area
Source: Huffington Post
Triggers
• Hospitals should consider activating the recovery functions in
their plans as soon as their emergency operations plan
(EOP) is activated
• Hospitals should regularly reassess the value of activating
their recovery functions when involved in extended response
operations (e.g. at least at every shift change)
• Hospitals should consider a tiered or scalable activation of
recovery functions giving consideration to potentially
conflicting response and recovery objectives
Triggers
Lessons Learned
• Planning
• Staffing
• Incident Command
• Safety & Security
• Communications
• Utilities
• Resource/Asset
Management
• Finance & Legal
• Clinical Operations
• Volunteer & Donations
Management
Lessons Learned
Planning – Joplin, MO
Source: Daily Mail (UK)
Lessons Learned
Joplin, MO – Recovery Timeline
• May 22, 2011 – EF5 Tornado strikes Joplin, MO
• May 29, 2011 – St. John’s Hospital medical staff,
supported by state resources, began treating patients
in 60 bed field hospital
←Recovery ←Response
Sunday, May 22, 2011
5:17pm - 6:12pm CDT
 EF5 Tornado hits Joplin, MO and destroys
St. John’s Medical Center (renamed Mercy)
 Three (3) Mobile Medical Units (MMUs) with an
ER configuration are deployed
 6-8 hour response time
Monday, May 23
(+1 day)
 Three (3) MMU ERs arrive and begin treating
patients in Joplin
 Each MMU ER provide 24-29 ER beds
 MO-1 DMAT members meet with Freeman
hospital (overloaded) & Mercy hospital
(destroyed), EMA requests field hospital
deployment
Tuesday, May 24
(+2 days)
 MMU deployment authorized by state officials
 MMU ERs provide emergency care in Joplin
Wednesday, May 25
(+3 days)
 Visits at MMU ERs slow down
 Breakdown of MMU field hospital begins at
Branson Airport, MMU was set up & drying
Thursday, May 26
(+4 days)


10-24 hours to break down MMU field hospital
Breakdown of MMU field hospital complete
Friday, May 27
(+5 days)

Transport/rapid deployment of MMU field
hospital begins
Rapid deployment* supported by National
Guard takes 36 hours
←Recovery

Saturday, May 28
(+6 days)

Setup of MMU field hospital continues
Sunday, May 29
(+ 7 days)

Setup of MMU field hospital complete, patients
seen at 6am CDT
IT/EMR also restored on Sunday
St. Johns staff supported by MO DMAT perform
first surgery in the newly erected field hospital
MMU deployment continues for 4+ months



*NOTE: previous deployment of the MMU had taken ~4 days during training
Lessons Learned
Planning – Key Concepts
• Manage/plan for recovery from the beginning of the
incident
• A timeframe and specific metrics for recovery are
necessary, particularly following catastrophic events
• Relationships and agreements for recovery with
partner agencies are essential
Lessons Learned
• Planning
• Staffing
• Incident Command
• Safety & Security
• Communications
• Utilities
• Resource/Asset
Management
• Finance & Legal
• Clinical Operations
• Volunteer & Donations
Management
Lessons Learned
Incident Command – Galveston, TX
Source: aamc.org
Lessons Learned
Galveston, TX – Incident Command
• Instituted assessment and recovery functions as soon
as winds fell below gale force
• Maintained ICS structure throughout recovery with
senior leadership involvement
Lessons Learned
Incident Command – Key Concepts
• Identify key ICS positions for response/recovery and
activate Finance Section Chief ASAP during response
• Consider the need for more than one Liaison Officer
during recovery
• Clearly outline roles and responsibilities for all staff
during recovery
Lessons Learned
• Planning
• Staffing
• Incident Command
• Safety & Security
• Communications
• Utilities
• Resource/Asset
Management
• Finance & Legal
• Clinical Operations
• Volunteer & Donations
Management
Lessons Learned
Communications – 2013 Blizzard & Transit Disruption
Source: ThePositivePage.com
Lessons Learned
Communications – 2013 Blizzard & Transit Disruption
• Roads closed, transit service suspended
• Timeframe for service restoration was clearly
communicated
Lessons Learned
Communications – Key Concepts
• Communicate current and expected operational status
to staff, partner agencies, and the public
• Manage expectations about recovery with transparent
information
• Share recovery information through all forms of media
including social media
Lessons Learned
• Planning
• Staffing
• Incident Command
• Safety & Security
• Communications
• Utilities
• Resource/Asset
Management
• Finance & Legal
• Clinical Operations
• Volunteer & Donations
Management
Lessons Learned
Resource/Asset Management – Hurricanes Katrina
General Scarcity prior to landfall and Sandy Gasoline
Sources: NBC, Daily News
Lessons Learned
Resource/Asset Management – Hurricanes Katrina
General Scarcity prior to landfall and Sandy Gasoline
• NOLA – Supplies stopped coming before the storm
and were diverted afterwards
• NYC – Hospitals had priority, but NYC fuel resources
were still scarce due to damage in NJ
Lessons Learned
Resource/Asset Management – Key Concepts
• Develop an electronic process, with a redundant
printed document, to formally release and accept all
resources among the lending and receiving hospitals
• Assume at least 7-10 days resource scarcity following
response
• MOAs are often intended for immediate response
coordination only and not sustained recovery efforts
Lessons Learned
• Planning
• Staffing
• Incident Command
• Safety & Security
• Communications
• Utilities
• Resource/Asset
Management
• Finance & Legal
• Clinical Operations
• Volunteer & Donations
Management
Lessons Learned
Clinical Operations – New York City (Sandy)
Source: Reuters
Lessons Learned
Clinical Operations – New York City (Sandy)
• Three weeks after Sandy, four NYC hospitals still
closed
• OR time
• ED waits
• Admitting credentials
Lessons Learned
Clinical Operations – Key Concepts
• Normal volume + boomerang patients stress limited
clinical resources
• Important to create a structured, fair, transparent
process to manage clinical operations
• Returning to “normal levels” can take months or years
Essential Functions
• Triggers
• Objectives
• Assessment
• Coordination
Recovery Objectives
Recovery Scenario #2: Fire
Recovery Objectives
Recovery Scenario #2: Fire
• Your hospital has sustained a fire on a Med/Surg. unit with
smoke damage on the unit above and water damage on
floors below the unit
• Your staff safely evacuated the patients from affected units
and the fire has been extinguished
Recovery Objectives
Discussion Question #2:
How do you define short-term and long-term
objectives during recovery?
Source: Bethlehem Patch
Recovery Scenario # 2:
Fire
Discussion Question #2: Setting Objectives
•
Your hospital has sustained a fire on a Med/Surg. unit with smoke
damage on the unit above and water damage on floors below the
unit
•
Your staff safely evacuated the patients from affected units and the
fire has been extinguished
Source: Bethlehem Patch
Recovery Objectives
Response
Hospital
Recovery
Recovery Objectives
• Objectives
• Prioritize objectives
related to essential
functions
• Be S.M.A.R.T.
• Metrics and timelines
are critical!
Teaching
Administration
Hospital
Healthcare
Research
Recovery Objectives
• Add Recovery Objectives
to your EOP/IAP’s
• Standing Recovery
Objectives
• Incident Specific
Recovery Objectives
Teaching
Administration
Hospital
Healthcare
Research
Recovery Objectives
• Develop Standing Recovery Objective(s)
• Ensure the safety of staff and patients throughout all
recovery efforts
• Prioritize hospital functions as they relate to the mission
of the hospital
Recovery Objectives
Prepare to Establish Incident Specific Objective(s)
• Prioritize short-term and long-term department, unit,
service, facility, organizational, and/or utility recovery
objectives
• Use the hospital-wide damage assessment, short-term
and long-term hospital needs, and community needs to
inform incident specific objectives
How to Manage
Healthcare System
Recovery
Session 3:
Hospital Recovery Lessons
Learned
2014 NH Emergency Preparedness
Conference
Lessons Learned
• Planning
• Staffing
• Incident Command
• Safety & Security
• Communications
• Utilities
• Resource/Asset
Management
• Finance & Legal
• Clinical Operations
• Volunteer & Donations
Management
Lessons Learned
Staffing – Homestead Hospital, Homestead, FL
Source: NPR
Lessons Learned
Staffing – Homestead Hospital, Homestead, FL
• 90% of staff needed temporary housing
• Patient volume was 4x normal following the storm
• One year after Hurricane Andrew, 50-70% of hospital
staff had left
• Bridge the gap until insurance / assistance is
available, support staff working elsewhere
Sources: Colias, Mike. “The disaster after the disaster.” Trustee Magazine, December 2009.
Gregg, Helen. “Natural Disaster Preparation 101: 5 Lessons from Homestead Hospital.” Beckers Hospital Review, 5/13/13.
Lessons Learned
Staffing – Boston Marathon
Source: Boston.com
Lessons Learned
Staffing – Key Concepts
• The incident might not impact your facility directly
• Care for your staff, consider family and staff
psychological needs
• Badging/IDs for staff are critical and each employee
should have backups
• Plan to have staff who can work remotely
Lessons Learned
• Planning
• Staffing
• Incident Command
• Safety & Security
• Communications
• Utilities
• Resource/Asset
Management
• Finance & Legal
• Clinical Operations
• Volunteer & Donations
Management
Lessons Learned
Safety & Security – Joplin, MO
Source: ABC News
Lessons Learned
Safety & Security – Joplin, MO
• Facility security & debris management
• Fences, salvage, and salvage monitoring
Lessons Learned
Safety & Security – Key Concepts
• Recovery can’t succeed if the facility isn’t secure
• Community resources may be limited due to response
and not available during recovery
• Pre-establish debris removal/salvage contracts
Essential Functions
• Triggers
• Objectives
• Assessment
• Coordination
Assessment
Recovery Scenario #3: IT Failure
Assessment
Recovery Scenario #3: IT Failure
• Your hospital information technology system was shutdown
by unknown hackers and is slowly coming back online after a
48 hour disruption
• Reports are coming into your hospital EOC by phone, e-mail,
and on paper via runners as departments and units try to
communicate their status
Assessment
Discussion Question #3:
How does your hospital assess short-term and
long-term damage and needs to inform
recovery efforts?
Recovery Scenario # 3:
IT Failure
Discussion Question #3: Assessment
•
Your hospital information technology system was shutdown by
unknown hackers and is slowly coming back online after a 48 hour
disruption
•
Reports are coming into your hospital EOC by phone, e-mail, and on
paper via runners as departments and units try to communicate their
status
Assessment
Hospital Recovery
Objectives
Assessment of Unit
Needs & Priorities
Assessment of
Department Needs
& Priorities
Assessment of
Service Needs &
Priorities
Assessment of
Community Needs
Assessment
• Hospitals should prepare a simple and transparent
method for conducting a comprehensive damage
assessment that covers all areas of the hospital
• Damage assessments should be standardized to the
greatest extent possible across the entire hospital or
hospital system, need to go beyond HICS 251
• Communication flow of damage assessment information
should be clearly defined from inside the hospital out to
recovery partners
Assessment
• Each department, unit, service should be asked to
identify at least the following:
• Operational status (e.g. Full/partial/non-operational)
• Status of staff
• Damage to physical space
• Damage to medical supplies, non-medical supplies
and equipment
• Immediate needs & long-term needs
• Estimated time to resume department-level, unit-level,
service-level functions
Lessons Learned
• Planning
• Staffing
• Incident Command
• Safety & Security
• Communications
• Utilities
• Resource/Asset
Management
• Finance & Legal
• Clinical Operations
• Volunteer & Donations
Management
Lessons Learned
Utilities – Biloxi, Mississippi
Source: FEMA/Mark Wolfe
Lessons Learned
Utilities – Biloxi, Mississippi
• Drinking water and sewers demolished by Katrina
• Disruptions and water safety issues for 2 years +
Source: FEMA/Mark Wolfe
Lessons Learned
Utilities – Key Concepts
• Determine the appropriate order for utilities to be
turned back on following a catastrophic disaster
• Back-up lighting, back-up lighting, back-up lighting
• Upgrade vs. repair costs
• Anticipate needs for a staged recovery
Lessons Learned
• Planning
• Staffing
• Incident Command
• Safety & Security
• Communications
• Utilities
• Resource/Asset
Management
• Finance & Legal
• Clinical Operations
• Volunteer & Donations
Management
Lessons Learned
Finance & Legal – Columbus, Indiana
In the
United States Court of Appeals
For the Seventh Circuit
No. 12-2007
COLUMBUS REGIONAL HOSPITAL,
Plaintiff-Appellant,
v.
FEDERAL EMERGENCY MANAGEMENT AGENCY,
Defendant-Appellee.
Appeal from the United States District Court for the
Southern District of Indiana, Indianapolis Division.
No. 1:10-cv-01168-SEB-MJD—Sarah Evans Barker, Judge.
ARGUED SEPTEMBER 26, 2012—DECIDED FEBRUARY 20, 2013
Lessons Learned
Finance & Legal – Columbus, Indiana
• $180-210M damage, applied for $90M in assistance,
received $70M
• Court proceeding over replacement costs and
allowable expenses took five years to resolve
Lessons Learned
Finance & Legal – Key Concepts
• Documentation of facility and equipment status
pre/post event
• Plan for dealing with uncompensated care:
Homestead Hospital in FL was reimbursed for less
than 25% of the care they provided following Andrew
• Do not accept resources/donations without first
determining compensation
Lessons Learned
• Planning
• Staffing
• Incident Command
• Safety & Security
• Communications
• Utilities
• Resource/Asset
Management
• Finance & Legal
• Clinical Operations
• Volunteer & Donations
Management
Lessons Learned
Volunteer & Donations Management – September 11
Source: Bloodcenters.org
Lessons Learned
Volunteer & Donations Management – September 11
• Significant events attract large numbers of volunteers
• Hundreds of units of blood were wasted following 9/11
Lessons Learned
Volunteer & Donations Management – Key Concepts
• During a disaster, people and volunteers will selfdeploy often without credentials, lodging, or food and
can become a burden during recovery
• Know what volunteer services or donations you may
need following a disaster
• Plan with your community for where/when to redirect
donors
Essential Functions
• Triggers
• Objectives
• Assessment
• Coordination
Coordination
Recovery Scenario #4: Shooting
• A domestic-violence related shooting has occurred in the
main entrance of your hospital injuring one staff member and
killing one patient
• The shooter fled into your hospital and was found by police
dead in a service elevator from what appears to be a selfinflicted gunshot
Coordination
Discussion Question #4:
How does your hospital manage and
coordinate recovery efforts internally and
with external partners?
Source: Fox News
Recovery Scenario # 4:
Shooting
Discussion Question #4: Coordination
•
A domestic-violence related shooting has occurred in the main
entrance of your hospital injuring one staff member and killing one
patient
•
The shooter fled into your hospital and was found by police dead in a
service elevator from what appears to be a self-inflicted gunshot
Source: Fox News
Coordination
Public
Health
Law
Enforcement
Media
Hospital
Private
Sector
Fire/EMS
NGO
EMA
Coordination
• Routinely engage external partners in recovery planning
• Discuss priorities / potential needs
• Discuss resources / capabilities
• Identify gaps and work with partners to address them
How to Manage
Healthcare System
Recovery
Session 4:
National Disaster
Recovery Framework
in Action & the Case for
Recovery
2014 NH Emergency Preparedness
Conference
Acknowledgements
Melissa Savilonis, MS – Individual and Community
Preparedness
Corey Nygaard – Recovery Planning Coordinator
Federal Emergency Management Agency – Region I
Recovery Continuum
ESF #14
“The NDRF enhances the concept that recovery encompasses more
than the restoration of a community’s physical structures to its predisaster conditions.”
NDRF: Nine Core Principles
• Individual and Family
Empowerment
• Public Information
• Unity of Effort
• Leadership and Local
Primacy
• Timeliness and Flexibility
• Pre-Disaster Recovery
Planning
• Resilience and
Sustainability
• Partnerships and
Inclusiveness
• Psychological and
Emotional Recovery
NDRF: Three Key Elements
Key Element #1: Leadership at every level
•
Local Disaster Recovery Managers
•
State Disaster Recovery Coordinator
•
Federal Disaster Recovery Coordinator
Key Element #2: Pre- & Post-Disaster Recovery Planning
•
Enables effective coordination of recovery activities and expedites a unified
recovery effort
•
Forms the foundation for allocating resources and provides the benchmark for
progress
Key Element #3: Recovery Support Functions (RSFs)
92
RSF Primary Agencies:
Each RSF will:
•
Promote pre-disaster preparedness
•
Encourage resiliency
•
Coordinate with partners
•
Provide technical assistance
•
Identify and leverage funding
Introduction to HSS RSF &
Capabilities
Health and Social Services RSF Coordinating Agency: HHS
Restoring the capacity or assisting in the continuity of; and reconnecting impacted
communities and displaced populations to essential health and social services,
including schools
Health and Social Services RSF Primary Agencies:
•
•
•
Corporation for National and
Community Services (CNCS)
•
Department of the Interior (DOI)
•
Department of Justice (DOJ)
Department of Homeland
Security/Office for Civil Rights and Civil
Liberties (DHS/CRCL)
•
Department of Labor (DOL)
•
Department of Homeland Security
(FEMA and NPPD)
Environmental Protection Agency
(EPA)
•
Department of Education
Health & Social Services RSF
Objectives
Provides assistance in addressing impacts to critical sectors:
• Healthcare impacts (Hospitals, Long-term care, etc.)
• Behavioral health impacts
• Environmental health impacts
• Food safety and regulated medical products
• Long-term health issues specific to responders
• Social service impacts
• Referral to social services/ disaster case management
• School impacts
Determining the Need for the NDRF
Considerations:
• Significant impacts
• Limited community capacity
• Unique issues and challenges
• Extensive damage/Large scale
disaster
• Enhanced coordination needed
• Need for recovery planning support
How will the NDRF work in a disaster scenario?
Activating the NDRF
Three Phases of Activation:
1. Advance Evaluation Team
2. Mission Scoping Assessment
3. Recovery Support Strategy
Advance Evaluation Team – Purpose:
The Advance Evaluation Team (AET) can be activated by the
Federal Coordinating Officer (FCO) or FEMA Regional
Administrator (RA) and will:
• Determine if the activation of an FDRC is warranted
• Provide an initial recommendation on potential RSF activations
• Offer a first glimpse of potential recovery issues and
challenges
Advance Evaluation Team –
Considerations:
• Affected communities have suffered significant impacts
and have limited capacity to recover from these impacts
• The disaster has created unique issues and challenges for
recovery, reconstruction and redevelopment, such that
greater coordination of Federal recovery assets is
required to meet particularly complex recovery issues that
exceed local, state, tribal, territorial and/or insular area
capabilities
• The scale of the disaster is so extensive that enhanced
coordination of traditional and non-traditional recovery
resource providers is anticipated
Mission Scoping Assessment (MSA)
• Assesses recovery related impacts and the breadth of
support needed from each RSF
• Evaluates gaps between recovery needs and capabilities
• Data from RSFs provides synthesis of impacts
• Technical Support from National Disaster Recovery
Support (NDRS) Cadre
Recovery Support Strategy
• Strategy and unified
approach
• Objectives and Milestones
• Level, type and duration of
RSF support
• Living document
• 60 day timeline for
MSA/RSS
• Public document
FDRC Coordination After RSS
Completion
• Monitor federal support of local recovery efforts and
address potential obstacles/needs not foreseen during
RSS planning process
• Document practices to increase risk reduction and
community resilience
• Facilitate adjustments to federal approach
• Host/facilitate coordination, after-action review meetings
• Continue implementation and monitoring mode
FDRC/RSF Activation – Deployment
INITIAL SCOPING OF NEEDS PHASE
MSA & RSS DEVELOPMENT PHASE
5 – 14 days after becoming mission ready
1 – 3 months after determining need for FDRC
RSF National
Coordinators Maintain
Situational Awareness of
Potential Recovery
Concerns
IMPLEMENTATION PHASE
3 months to 5 years after completing
the RSS
FCO or RA
Activates
Advance
Evaluation
Team (AET)
Yes
Advance Team
Recommend
Support
FDRC & RSF
support is
warranted; FDRC
& relevant RSFs
are activated
No
No FDRC or
RSF Recovery
Support
Warranted
FDRC
Activates
RSFs
No
RSFs remotely
provide & monitor
need for recovery
support
RSS Update Loop
Yes
RSF
Appoints
Field
Coordinator
Mission
Scoping
Initiated
Mission Scoping
Identifies level of
effort necessary to
initiate recovery
support
Development
of Recovery
Support
Strategy
(RSS)
Kickoff &
Implement
RSS
Track,
Monitor &
Deliver
Assistance
STATE/TRIBAL/LOCAL COORDINATION & INVOLVEMENT
Transition
& Return
to SteadyState
FDRC/RSF Activation – Deployment
INITIAL SCOPING OF NEEDS PHASE
MSA & RSS DEVELOPMENT PHASE
5 – 14 days after becoming mission ready
1 – 3 months after determining need for FDRC
RSF National
Coordinators Maintain
Situational Awareness of
Potential Recovery
Concerns
IMPLEMENTATION PHASE
3 months to 5 years after completing
the RSS
FCO or RA
Activates
Advance
Evaluation
Team (AET)
Advance Team
Recommend
Support
5 – 14
Days
Yes
FDRC & RSF
support is
warranted; FDRC
& relevant RSFs
are activated
No
No FDRC or
RSF Recovery
Support
Warranted
FDRC
Activates
RSFs
No
RSFs remotely
provide & monitor
need for recovery
support
RSS Update Loop
Yes
RSF
Appoints
Field
Coordinator
Mission
Scoping
Initiated
Mission Scoping
Identifies level of
effort necessary to
initiate recovery
support
Development
of Recovery
Support
Strategy
(RSS)
Kickoff &
Implement
RSS
Track,
Monitor &
Deliver
Assistance
STATE/TRIBAL/LOCAL COORDINATION & INVOLVEMENT
Transition
& Return
to SteadyState
FDRC/RSF Activation – Deployment
INITIAL SCOPING OF NEEDS PHASE
MSA & RSS DEVELOPMENT PHASE
5 – 14 days after becoming mission ready
1 – 3 months after determining need for FDRC
RSF National
Coordinators Maintain
Situational Awareness of
Potential Recovery
Concerns
IMPLEMENTATION PHASE
3 months to 5 years after completing
the RSS
FCO or RA
Activates
Advance
Evaluation
Team (AET)
Advance Team
Recommend
Support
No
No FDRC or
RSF Recovery
Support
Warranted
Yes
FDRC & RSF
support is
warranted; FDRC
& relevant RSFs
are activated
1–3
Months
FDRC
Activates
RSFs
No
RSFs remotely
provide & monitor
need for recovery
support
RSS Update Loop
Yes
RSF
Appoints
Field
Coordinator
Mission
Scoping
Initiated
Mission Scoping
Identifies level of
effort necessary to
initiate recovery
support
Development
of Recovery
Support
Strategy
(RSS)
Kickoff &
Implement
RSS
Track,
Monitor &
Deliver
Assistance
STATE/TRIBAL/LOCAL COORDINATION & INVOLVEMENT
Transition
& Return
to SteadyState
FDRC/RSF Activation – Deployment
INITIAL SCOPING OF NEEDS PHASE
MSA & RSS DEVELOPMENT PHASE
5 – 14 days after becoming mission ready
1 – 3 months after determining need for FDRC
RSF National
Coordinators Maintain
Situational Awareness of
Potential Recovery
Concerns
IMPLEMENTATION PHASE
3 months to 5 years after completing
the RSS
FCO or RA
Activates
Advance
Evaluation
Team (AET)
Advance Team
Recommend
Support
Yes
FDRC & RSF
support is
warranted; FDRC
& relevant RSFs
are activated
No
No FDRC or
RSF Recovery
Support
Warranted
FDRC
Activates
RSFs
Yes
RSF
Appoints
Field
Coordinator
Mission
Scoping
Initiated
No
3 Months
- 5 Years
RSFs remotely
provide & monitor
need for recovery
support
Mission Scoping
Identifies level of
effort necessary to
initiate recovery
support
RSS Update Loop
Development
of Recovery
Support
Strategy
(RSS)
Kickoff &
Implement
RSS
Track,
Monitor &
Deliver
Assistance
STATE/TRIBAL/LOCAL COORDINATION & INVOLVEMENT
Transition
& Return
to SteadyState
How to Approach Recovery
Items for a Disaster Recovery Coordinator to focus on:
1.
Triggers
2.
Objectives
3.
Assessment
4.
Coordination
Making the case
Source: FEMA
Source: Chattanooga Times Free Press
Source: sulekha.com
Source: wickedlocal.com
Source: www.vosizneias.com
Disaster
NYU Medical Center – Sandy
Est. Cost
$700M – $1B+
St. John’s Hospital – Joplin
$950M
University of Texas Galveston
Medical Branch – Ike
$1.2B
Charity Hospital NOLA – Katrina
$23M Initial Damage Assessment
$475M Final Damage Assessment
Columbus Regional Hospital (IN)
$180-210M Damages
$70M Federal Assistance Awarded
$20M Federal Assistance Denied
Disaster
Time
Event
NYU Medical Center – Sandy
Oct. 2012 – Jan. 2013
Reopen
Mercy Hospital – Joplin
May 2011 – Mar. 2015
Scheduled to
reopen
Sept. 2008 – Sept. 2009
Reopened ED
ACS level 1
trauma center
Charity Hospital NOLA – Katrina
August 2005 – current
Discussions
ongoing
Columbus Regional Hospital (IN)
June 2008 – Feb. 2013
Federal
funding
clarified
University of Texas Galveston
Medical Branch – Ike
4 ½ mo. to reopen
Hospital Preparedness Cycle
Mitigation
Preparedness
Response
Recovery
Hospital Preparedness Cycle
Mitigation: Eliminating or reducing the impact of threats and hazards
that could affect a hospital through prevention, avoidance, or risk
reduction.
Preparedness: Readying a hospital for a possible or imminent threat
through planning, training, organizing, or securing resources.
Response: Actions a hospital takes to protect life, property or the
environment during an emergency situation.
Recovery: The process by which a hospital works to resume normal
services and functions following an event which disrupts operations.
TJC Recovery EPs
•
EM 02.01.01 EP4 - The hospital develops and maintains a written Emergency
Operations Plan that describes the recovery strategies and actions designed to
help restore the systems that are critical to providing care, treatment, and services
after an emergency.
•
EM 02.01.01 EP5 - The Emergency Operations Plan describes the processes for
initiating and terminating the hospital's response and recovery phases of the
emergency, including under what circumstances these phases are activated.
•
EM 02.02.03 EP2 – [EOP describes the following] How the hospital will obtain and
replenish medical supplies that will be required throughout the response and
recovery phases of an emergency, including personal protective equipment where
required.
•
EM 02.02.03 EP3 - [EOP describes the following] How the hospital will obtain and
replenish non-medical supplies that will be required throughout the response and
recovery phases of an emergency.
Guiding Principles for Hospital
Recovery Planning
• Do not plan in isolation. Be sure to involve all appropriate areas
within your hospital as well as partner agencies when developing
your recovery procedures and functions.
• Review your hospital’s hazard vulnerability analysis (HVA) and
identify the risks and vulnerabilities that may impede recovery.
• Integrate the recovery plan into your hospital’s emergency
operations plan (EOP).
Guiding Principles for Hospital
Recovery Planning
• Use the hospital incident command system (HICS) to manage
recovery.
• Plan for system failures and/or shortages to occur during response
and recovery.
• Leverage existing local and regional resources in your recovery
plan.
Guiding Principles for Hospital
Recovery Planning
• Plan to communicate recovery information to partner agencies so
they can assist with your recovery (e.g. public, media, local
agencies, vendors, regional partners, State Public Health/ESF#8,
DHHS/Recovery Support Function: Health and Social Services).
• Coordinate with health licensing and regulatory agencies for
guidance with recovery.
Thank You
Hospitals are encouraged to review:
Essential Functions and Considerations for Hospital Recovery
Harvard School of Public Health Emergency Preparedness and
Response Exercise Program
A Quick Guide: FEMA Reimbursement for Acute Care Hospitals
The Yale New Haven Health System Center for Emergency
Preparedness and Disaster Response
Thank You
www.hsph.harvard.edu/eprep
eprep@hsph.harvard.edu