Group 3 Extent of Emergency Planning and Preparedness among Selected Hospitals in SOCSKSARGEN? Introduction Objectives of the Study Limitations of the Study This study is limited only to hospitals in the SOCSKSARGEN area Significance of the Study Definition of Terms Chapter II - Conceptual Framework & Related Literatures http://www.msdh.state.ms.us/msdhsite/_static/19,0,252,251.html Hospital Preparedness Program Logic Model Public Health Preparedness Grant Logic Model http://www.naccho.org/topics/emergency/index.cfm Discuss about emergency planning and preparedness Fact Sheet on Emergency Planning and Preparedness Background Following the accident at Three Mile Island in 1979, the Nuclear Regulatory Commission (NRC) reexamined the role of emergency planning for protection of the public in the vicinity of nuclear power plants. The Commission issued regulations requiring that before a plant could be licensed to operate, the NRC must have "reasonable assurance that adequate protective measures can and will be taken in the event of a radiological emergency." The regulations set forth 16 emergency planning standards and define the responsibilities of licensee, and State and local organizations involved in emergency response. Emergency planning has been adopted as an added conservatism to the NRC's "defense-in-depth" safety philosophy. Briefly stated, this philosophy (1) requires high quality in the design, construction and operation of nuclear plants to reduce the likelihood of malfunctions; (2) recognizes that equipment can fail and operators can make errors, therefore requiring safety systems to reduce the chances that malfunctions will lead to accidents that release fission products from the fuel; and (3) recognizes that, in spite of these precautions, serious fuel damage accidents may happen, therefore requiring containment structures and other safety features to prevent the release of fission products offsite. The added feature of emergency planning to the defense-in-depth philosophy provides that, even in the unlikely event of a release of radioactive materials to the environment, there is reasonable assurance that actions can be taken to protect the population around nuclear power plants. Regulations For planning purposes, the Commission has defined a plume exposure pathway emergency planning zone (EPZ) consisting of an area about 10 miles in radius and an ingestion pathway EPZ about 50 miles in radius around each nuclear power plant. EPZ size and configuration may vary in relation to local emergency response needs and capabilities as affected by such conditions as demography, topography, land characteristics, access routes, and jurisdictional boundaries. The Commission's requirements for emergency planning are contained in Title 10 of the Code of Federal Regulations, Part 50.47, and cover the following topics: Assignment of Responsibility Onsite Emergency Organization Emergency Response Support and Resources Emergency Classification System Notification Methods and Procedures Emergency Communications Public Education and Information Emergency Facility and Equipment Accident Assessment Protective Response Radiological Exposure Control Medical and Public Health Support Recovery and Reentry Planning and Post-Accident Operations Exercises and Drills Responsibility for the Planning Effort: Development, Periodic Review, and Distribution of Emergency Plans Radiological Emergency Response Training Detailed information about emergency planning and preparedness is contained in Appendix E of 10 CFR Part 50 and in NUREG-0654, FEMA-REP-1, a joint publication of the NRC and the Federal Emergency Management Agency (FEMA) titled "Criteria for Preparation and Evaluation of Radiological Emergency Response Plans and Preparedness in Support of Nuclear Power Plants." Discussion In the U.S., 104 commercial nuclear power reactors are licensed to operate at 65 sites in 31 states. For each, there are onsite and offsite emergency plans to assure that adequate protective measures are taken to protect the public in the event of a radiological emergency. Federal oversight of emergency planning for licensed nuclear power plants is shared by the NRC and FEMA through a memorandum of understanding. The memorandum is responsive to the President's decision of December 7, 1979, that FEMA take the lead in offsite planning and response, that NRC assist FEMA in carrying out this role, and that NRC continue its statutory responsibility for the radiological health and safety of the public. Each plant owner is required to exercise its emergency plan with offsite authorities at least once every two years to ensure State and local officials remain proficient in implementing the plan. http://www.nrc.gov/reading-rm/doc-collections/fact-sheets/emer-plan-prep.html Chapter III - Methodology Research Design Descriptive in nature Locale In the SOCSKSARGEN area.KINDLY DISCUSS INFORMATION ABOUT SOCSKARGEN (2-3 SENTENCES) Respondents All the hospital administrators of selected tertiary hospitals in the SOCSKSARGEN area. Instrumentation The proponent will use the Bioterrorism Emergency Planning and Preparedness Questionnaire for Healthcare Facilities. by Booz Allen Hamilton (http://www.ahrq.gov/about/cpcr/bioterr.pdf) will be revised and to be content validated by a group of local nursing experts. Procedure The proponent will send a notice for the conduct of research to the hospital administrato. After securing approval from the latter, the proponent will meet him for an interview. Facility visits to observe conditions, review records, and discuss processes with staff; and Manager, staff, and client interviews and discussions. Document Review In Depth Interview Survey Questionnaire Bioterrorism Questionnaire --------------------------------------------------------------------------------- Bioterrorism Emergency Planning and Preparedness Questionnaire for Healthcare Facilities Name of Hospital:_____________________________________________________ Hospital Address:_____________________________________________________ _____________________________________________________ Name and Title of Person(s) Completing Form:_______________________________ ___________________________________________________________________ ___________________________________________________________________ Contact Information: Phone:(____)___________________________ Pager:(____)___________________________ Fax:(____)_____________________________ Email:_________________________________ Healthcare facilities play a vital role in the detection of and response to biological emergencies, including new emerging infections, influenza outbreaks, and terrorist use of biological weapons. The information and data obtained from this questionnaire will be used to help assess the preparedness and capacity of your hospital to respond to and treat victims of a biological incident. Many of the questions only require yes, no, or don't know (DK) responses. Others will require some research. Thank you for taking the time to complete this questionnaire. --------------------------------------------------------------------------------- This questionnaire was developed by Booz-Allen & Hamilton under Contract No. 290-00-0019 ("Understanding Needs for Health System Preparedness and Capacity for Bioterrorist Attacks") from the Agency for Healthcare Research and Quality. This document is in the public domain and may be reproduced without permission. --------------------------------------------------------------------------------- I. Biological Weapons Training for Hospital Personnel 1. Does your hospital conduct in-service training on biological weapons? __Yes __No __DK If yes: a) When was the last training provided?___________________ b) Who is being trained? Medical Staff: __Yes __No __DK Nursing Staff: __Yes __No __DK Medical/Nursing Students: __Yes __No __DK Residents: __Yes __No __DK Administration: __Yes __No __DK Laboratory Personnel: __Yes __No __DK Security Personnel: __Yes __No __DK c) Is training mandatory? Medical Staff: __Yes __No __DK Nursing Staff: __Yes __No __DK Medical/Nursing Students: __Yes __No __DK Residents: __Yes __No __DK Administration: __Yes __No __DK Laboratory Personnel: __Yes __No __DK Security Personnel: __Yes __No __DK d) How often is in-service training on biological weapons provided? __ Quarterly __ Biannually __ Annually __ Other __ Don't Know e) Who provides the biological weapons training to your hospital staff? __ In-house instructor (please list)__________________________________________ __ Outside consultant (please list)__________________________________________ __ Other (please list)____________________________________________________ __ Don't Know f) What type of training was provided (check all that apply)? __ Classroom/seminar training __ Home study manuals (i.e., self-study) __ Computer based training __ Satellite broadcast __ Video __ Other, please specify__________________________________________________ 2. Does your hospital send staff to Bioterrorism training seminars offered outside of the hospital? __Yes __No __DK II. General Hospital & Emergency Preparedness Information 1. What is your average daily inpatient census (averaged over the 2000 Calendar year)? ________________________________________________________________ 2. Approximately how many people work at your hospital?___________________ 3. Please indicate your licensed, operational, and surge bed capacity below: Bed capacity in the following areas Licensed Beds (Under Certificate of Need) Staffed Beds (Operational Capacity) Approximate Surge Bed Capacity* (Estimated maximum number of additional staffed beds created in 6 & 12 hours) Adult medical & surgical / Pediatric medical & surgical / Adult ICU (all units including CCU) / Adult Intermediate Care Ward (Progressive Care Unit) / Pediatric ICU (including NICU) / Pediatric Intermediate Care Ward (Progressive Care Unit) / Emergency department beds / OB/GYN / Psychiatry / Substance Abuse / Transitional Care (e.g., short-term care facility, rehabilitation) / All other departments (including outpatient surgical areas) / Total / * Surge bed capacity: In the event of an emergency, what is the maximum number of additional staffed beds that your institution can create in 6 hours and in 12 hours for the treatment of mass casualties? (e.g., beds made available by opening up closed wards/units; beds made available by canceling elective surgeries; beds obtained from associated clinics; endoscopy suites; outpatient surgical areas; etc.) 4. How many times a month does your hospital reach 100% of operational capacity (i.e., staffed beds)?___________________________________________________ 5. Has your hospital implemented the Incident Command or Management System facility-wide? __Yes __No __DK 6. Does your hospital's emergency preparedness plan address mass casualty incidents involving biological agents (i.e., influenza epidemics, new emerging infections, or terrorist use of biological agents)? __Yes __No __DK If yes: a) How frequently is this facet of your plan exercised and updated? _________________________ b) What was the date of your last exercise involving biological agents? ______________________ c) How is your bio-plan initiated? __________________________________________________________________________ d) How are hospital personnel and medical staff within the hospital notified about the plan's initiation? __________________________________________________________________________ e) How is affiliated medical staff notified about the plan's initiation? __________________________________________________________________________ f) How does the hospital monitor staff's knowledge of the plan? ___________________________ __________________________________________________________________________ 7. Does your hospital have a coordinator designated to oversee all preparedness efforts as it relates to your hospital's bioterrorism preparedness efforts? __Yes __No __DK 8. Does your hospital have a medical director that oversees all training and preparedness efforts as it relates to your hospital's bioterrorism preparedness efforts? __Yes __No __DK 9. Does your hospital's emergency preparedness plan address expanding staff availability? __Yes __No __DK If yes: a) Where would you access additional staff (please check all that apply)? __ Local registry (agency)? __ Change shift length from 8 to 12 hours? __ Change nursing/patient ratios? __ Offer services to keep staff at the hospital (e.g., babysitting, elderly care)? __ Does your hospital's emergency preparedness plan address requesting state or federal resources for assistance? __Yes __No __DK b) Does your hospital participate in multiple facility credentialing procedures to permit rapid recognition of credentialed staff from other facilities or hospitals? __Yes __No __DK 10. Does your hospital experience problems staffing your ED, general medical, pediatrics, and surgical floors with nurses employed by the hospital? __Yes __No __DK If yes: a) During calendar year 2000, how many shifts per week (on average) are you short of nurses for: ___General medical ___Pediatrics ___Surgery (post-surgical care) ___ICU ___ED b) Does your hospital have an on-call nursing policy for the following areas (i.e., where nurses are on-call and will come in when additional staff is required)? General medical: __Yes __No __DK Pediatrics: __Yes __No __DK Surgery (post-surgical care): __Yes __No __DK ICU: __Yes __No __DK ED: __Yes __No __DK 11. Does your hospital's emergency preparedness plan address increasing operational (staffed-bed) capacity by at least: a) 10%: __Yes __No __DK b) 15%: __Yes __No __DK c) 20%: __Yes __No __DK 12. Does your hospital's emergency preparedness plan address canceling elective surgeries in order to make additional beds available for inpatient use? __Yes __No __DK 13. Does your hospital's emergency preparedness plan address early inpatient discharge protocols to create additional beds? __Yes __No __DK If yes: a) Who decides which patients can be discharged early? _______________________________ b) Is this a voluntary policy with your medical staff? __Yes __No __DK c) Is there a staff member involved in early discharge planning? __Yes __No __DK 14. Are you able to utilize hallways as short-term inpatient care areas in the event of a declared disaster? __Yes __No __DK If yes: a) How many additional inpatient beds can be opened using the hallways during a declared disaster? _______________________________________________ b) Can your hospital's computer process orders for patients not residing in traditional patient care areas (i.e., residing in the hallways)? __Yes __No __DK c) Do you have a mechanism to provide privacy to patients residing in the hallway? __Yes __No __DK 15. Do you have other areas of the hospital designated for emergency overflow of patients (e.g., an auditorium, lobby) in the event of a declared disaster? __Yes __No __DK a) If yes: i. Where are these areas located?_______________________________________ ii. Do you have beds or cots available onsite for these alternative patient care areas? __Yes __No __DK iii. Do you have a mechanism to provide privacy to these patients? __Yes __No __DK iv. Do these overflow patient care areas have ready access to: Supplemental oxygen source: __Yes __No __DK Running water: __Yes __No __DK Pharmaceuticals: __Yes __No __DK Bath/showers: __Yes __No __DK Toilets: __Yes __No __DK Suction: __Yes __No __DK Supplies: __Yes __No __DK Monitoring Units: __Yes __No __DK Computer access: __Yes __No __DK Hand washing areas: __Yes __No __DK Food and drink: __Yes __No __DK Telephone: __Yes __No __DK v. In the past five years, have you ever had to expand your bed capacity beyond your licensed number of beds? __Yes __No __DK 16. Does your hospital have a memorandum of agreement (MOA) with nearby extended care facilities (ECF) or rehabilitation hospitals to accept patients during a declared disaster that can be discharged early from the affected hospital but still require nursing care? __Yes __No __DK 17. Does your hospital have a memorandum of agreement (MOA) with outlying hospitals to accept inpatients during a declared disaster? __Yes __No __DK 18. Does your hospital's emergency preparedness plan address processes to increase inpatient treatment capacity within the city? __Yes __No __DK 19. Does your hospital's emergency preparedness plan address extending outpatient clinic hours (on and off-campus) beyond normal scheduled hours? __Yes __No __DK If yes: a) How do you staff these extended hours?_______________________________________ b) Has there ever been a need to extend clinic hours during a disaster situation? __Yes __No __DK 20. Does your hospital's emergency preparedness plan address processes to increase outpatient treatment capacity within the city? __Yes __No __DK 21. Does your hospital's emergency preparedness plan address the provision of the following services if staff had to return to work during a community disaster (check all that apply)? Provided: Day (night) care for their children? __Yes __No __DK Day (night) care for their dependent adults? __Yes __No __DK Day (night) care for their pets? __Yes __No __DK Sleeping quarters? __Yes __No __DK Nourishment? __Yes __No __DK Distribution of medication prophylaxis? __Yes __No __DK 22. Does your hospital have policies concerning emergency department diversion? __Yes __No __DK If yes: a) What are your hospital's criteria to go on diversion?____________________________ _____________________________________________________________________ b) Who is delegated within the hospital to make the decision to go on diversion?________ _____________________________________________________________________ c) List who needs to be notified about your diversion policy outside the hospital?________ _____________________________________________________________________ d) In general, how many times a year does your hospital go on diversion?_____________ _____________________________________________________________________ 23. What is the approximate number of functioning on-site ventilators that belong to your institution?_____ a) How many ventilators, if any, can be mobilized from associated long-term care, rehab facilities, or other satellite clinic facilities?___________________________________ b) How many additional ventilators does your institution rent weekly (average over the past year)? __________________________________________________________________________ c) Do you have access to ventilators that can be rented on an emergency basis? __Yes __No __DK If yes: _____ How many can be obtained? _____ How long does it take your hospital to obtain these additional ventilators? d) Is there a regional plan to provide extra ventilators if needed? __Yes __No __DK If yes: _____ How many additional ventilators can you access within 4 hours? _____ How many additional ventilators can you access within 8 hours? Do other hospitals in your area access ventilators from the same vendor? __Yes __No __DK 24. Does your hospital have an information system that provides the following: a) Inpatient staffing? __Yes __No __DK b) Hospital bed availability? __Yes __No __DK c) Diversion status of other hospitals in the area or region? __Yes __No __DK d) Bed availability of other hospitals in the area or region? __Yes __No __DK e) Information on biological agents and the management of infectious patients? __Yes __No __DK f) Internet access? __Yes __No __DK 25. Does your hospital's emergency preparedness plan address stockpiling antibiotics and supplies? __Yes __No __DK If yes: a) Does your hospital currently maintain a separate cache of antibiotics to treat hospital staff in the event of a bioterrorist incident? __Yes __No __DK If yes: i. What antibiotics are cached (check all that apply)? Name Unit Doses __ Doxycycline _____________ __ Tetracycline _____________ __ Ciprofloxin _____________ __ Levaquin _____________ __ Gentamicin _____________ __ Tobramycin _____________ ii. How quickly can supplies be accessed? ____________________________________ iii. Where are these supplies stored? ________________________________________ 26. How many days supply of antibiotics does your pharmacy maintain (based on current average daily usage)? ______________________________________________________________ 27. Does your hospital stockpile or have 12-hour access to antibiotics (Doxycycline, ciprofloxacin) in order to provide community prophylaxis? __Yes __No __DK 28. During an average 24-hour period, how many additional orders (based on standard dosing) for the following antibiotics would exhaust your current in-hospital pharmaceutical supply (inventory): _____ Doxycycline i.v. _____ Doxycycline p.o. _____ Ciprofloxacin i.v. _____ Ciprofloxacin p.o. _____ Levofloxacin i.v. _____ Levofloxacin p.o. _____ Gentamycin i.v. _____ Tobramycin i.v. a) How long would it take you to replenish these supplies? ________________________________ b) How would you obtain these supplies? _____________________________________________ c) Do other hospitals in your area access these drugs in the same manner and from the same source? __Yes __No __DK 29. During an average 24-hour period, how many prescriptions for the following antibiotics (based on standard dosing) would exhaust your current outpatient pharmaceutical supply (inventory): _____ Doxycycline p.o. _____ Tetracycline p.o. _____ Ciprofloxacin p.o. _____ Levofloxacin p.o. a) How long would it take you to replenish these supplies? ________________________________ b) How would you obtain these supplies? _____________________________________________ c) Who do you obtain these supplies from? ___________________________________________ d) Do other hospitals in your area access these drugs in the same manner and from the same source? __Yes __No __DK 30. Has your hospital ever participated in a community or regional pharmaceutical stockpile? __Yes __No __DK 31. Is your hospital's emergency preparedness plan integrated into the city emergency preparedness plan? __Yes __No __DK 32. Does your hospital's emergency preparedness address the following: a) Designating mental health services (Critical Incident Stress Management - CISM) to care for emergency workers, victims and their families, and others in the community who need special assistance coping with the consequences of a disaster? __Yes __No __DK b) Provisions to provide for the proper examination, care, and disposition of deceased? __Yes __No __DK c) Mass immunization/prophylaxis? __Yes __No __DK d) Mass fatality management? __Yes __No __DK If yes, does the plan address the following: i. Augmenting morgue facility and staff: __Yes __No __DK ii. Expanding morgue capacity: __Yes __No __DK iii. Procedures for decontamination/isolation of human remains: __Yes __No __DK iv. Backup isolation procedures when morgue capacity is exceeded: __Yes __No __DK v. Environmental surety? __Yes __No __DK e) Ensuring adequate bio-protection (Universal Precautions) gear for hospital/clinic personnel? __Yes __No __DK f) Ensuring adequate supplies (including food, linens & patient care items) are available from local or regional suppliers, or that plans are in place to obtain them in a timely manner in order to be self-sufficient for 48-hours? __Yes __No __DK g) Access to portable cots, sheets, blankets and pillows? __Yes __No __DK h) Triage of mass casualties? __Yes __No __DK i) Enhancing hospital security by utilizing community law enforcement assets? __Yes __No __DK j) Tracking expenses incurred during an emergency? __Yes __No __DK k) Coordination with state or local public health authorities? __Yes __No __DK l) Creating additional isolation beds? __Yes __No __DK 33. Does your hospital have an internal health surveillance system in place that tracks patients presenting problems or complaints? __Yes __No __DK If yes: a) Does your hospital's surveillance system track the following (please check all that apply): __ ED visits __ Hospital admissions (total numbers and patterns) __ Presenting patients' complaints __ Influenza-like illness monitoring __ Increased antibiotic prescription rate b) Is this information gathered automatically electronically or done manually? c) When is this information gathered? d) Who gathers this information? e) Who (and how - phone, fax, etc.) does the ED notify when unusual clusters of illnesses present and can they be notified 24-hours per day (check all that apply)? 24-hour Notification How Contacted Hospital infection control personnel __Yes __No __DK _________________ Other designated (resource) in-house personnel __Yes __No __DK _________________ Local Health Department __Yes __No __DK _________________ State Health Department __Yes __No __DK _________________ Other, please specify _____________________ __Yes __No __DK _________________ 34. Is your in-patient laboratory staffed 24 hours a day, 7 days a week? __Yes __No __DK 35. What diagnostic capability does your in-patient laboratory have? (check all that apply) __ Minimal identification of agents __ Identification, confirmation, and susceptibility testing __ Advanced laboratory capacity with some molecular testing 36. What is the highest Biosafety level (BSL) capability of your in-patient lab? __ BSL 1 (basic level of containment for minimal potential hazards) __ BSL 2 (primary containment practices for moderate potential hazards) __ BSL 3 (primary and secondary containment practices for potentially lethal agents) 37. What is the current volume of culture specimens that can be processed in your in-patient lab on a daily basis? _______________ Sputum _______________ Blood _______________ Urine 38. What is the estimated maximum volume of culture specimens that can be processed in your in-patient lab on a daily basis? _______________ Sputum _______________ Blood _______________ Urine 39. Does your hospital have protocols or procedures for the handling of laboratory specimens in the event of a biological terrorism incident? __Yes __No __DK If yes, do these protocols or procedures address the following (please check all that apply) __ Collection __ Labeling __ Chain of custody (similar to rape packages) __ Secure storage __ Processing __ Transportation to secondary laboratory __ Storage __ Referral to Public Health Department (PHD) lab __ Contacting the CDC __ Contacting local law enforcement __ Contacting the FBI __ Decontamination of bio-hazardous waste __ Safe disposal of waste 40. Please check the appropriate box to describe your hospital's in-patient laboratory capacity with regard to the following organisms (check all that apply): Anthrax Culture Rule Out Confirm* None** Plague Culture Rule Out Confirm* None** Tularemia Culture Rule Out Confirm* None** Brucellosis Culture Rule Out Confirm* None** Q-Fever Culture Rule Out Confirm* None** Smallpox Culture Rule Out Confirm* None** * If checked, please indicate how your lab confirms the organism's identification. ________________________________________________________________ ** Checking none means your hospital laboratory does not have the capacity to culture, rule out, or confirm the listed organism. 41. How would you rate your laboratory's ability to identify specimens of biological terrorism? __ Very poor __ Poor __ Fair __ Good __ Very good 42. How would you rate your hospital's ability to manage victims of biological terrorism? __ Very poor __ Poor __ Fair __ Good __ Very good --------------------------------------------------------------------------------- Sources: Questions 1, 2, 3 and 23 in Section II of this questionnaire were adapted from New York City Department of Health, institutional surge capacity questions 1-6 in "Biological, Chemical, and Radiological Emergency Planning/Preparedness Capabilities" survey, dated 11/13/2000. The following documents were also consulted: Marasco Newton Group Ltd., "Hospital Weapons of Mass Destruction Needs and Resource Assessment Survey," dated 2/8/2000; Booz-Allen & Hamilton, WMD Checklist; Institute of Medicine, 2000 MMRS Evaluation Instrument in "Preparing for Terrorism: Tools for Evaluating the Metropolitan Medical Response System"; American Hospital Association, Chemical and Bioterrorism Preparedness Checklist; Disaster Preparedness International, "Hospital Capability to Respond to Pandemic Influenza, Bioterrorism, and Emerging Infectious Disease Outbreaks," dated 12/11/2001.