The Flu and 1135 Waivers

Early Wednesday, January 9^th the Mayor of Boston declared a Public Health Emergency in response to a very severe flu season.  In interviews with USA Today Mayor Menino indicates that they are trying to drive home the severity of the flu but other things come with a governmental declaration of disaster, suspension and eligibility for waivers concerning certain rules and ordinances.

As it relates to hospital the major question arises around a waiver for 1135 concerning alternative care sites which was hotly discussed during the H1N1 outbreak of 2009.  It was such a big deal and alternate care sites such as Flu Tents were common that CMS issued an FAQ about it.  One of the key steps or necessities of such a waiver is a governmental disaster declaration. 

Depending on where you read some references a presidential declaration and other places it just mentions a declaration as a necessary element for a waiver of 1135.   There is enough ambiguity for the lawyers to earn their keep.

Here are some links to more documents regarding recent waivers:

Requesting an 1135 Waiver:

http://www.cms.gov/About-CMS/Agency-Information/H1N1/downloads/requestingawaiver101.pdf

CMS Hurricane Sandy Waiver: http://www.nj.gov/health/healthfacilities/documents/hurricane_sandy_1135_blanket_waivers_approved.pdf

Secretary Sebilius Notifying Congress regarding Sandy Waiver:

http://www.cms.gov/About-CMS/Agency-Information/Emergency/Downloads/PHE-Declaration-and-Section-1135-Waiver-for-New-York.pdf

WAIVER OR MODIFICATION OF REQUIREMENTS UNDER  SECTION 1135 OF THE SOCIAL SECURITY ACT as it relates to H1N1:

http://www.cms.gov/About-CMS/Agency-Information/H1N1/downloads/1135WaiverSigned_H1N1.pdf

Thoughts About Sandy with a Katrina Twist

So we are moments away from Hurricane Sandy making landfall in Cape May, NJ and I cannot help but be reminded of Katrina. That disaster sits in all of our minds, but it was especially important to me as my first ever response to a true Type I Catastrophic incident.  I am not recollecting that time in 2005 because of comparisons of NOLA and NYC or because of the storm of the century titling’s but because I can’t help but wonder if we have learned from the many lessons Katrina taught us.  

Now, I am not calling to question government response because I have a tremendous amount of respect of Craig Fugate and his team.  I am concerned by those that did not heed the warnings of true experts that did not evacuate or take the appropriate actions.  James Lee Witt did a good job of placing the focus on the individual to prepare for disasters and Craig Fugate has returned to that mantra.  I am just not sure if it has worked.

As an emergency manager it is a struggle to convince individuals to invest the time and resources to prepare.  People truly believe that it will not happen to them.  Katrina served as a wake-up call for our nation but the blessing that was a problem in disguise was that we have not had a catastrophic incident since.  The nation has fallen back asleep and it looks like Sandy is our new wake-up call. 

My thoughts and prayers are with those that are in the path of Sandy and my colleagues that will serve them.   I hope Sandy will silence the critics that want to eliminate disaster response funding or those that think their local emergency manager is nicety not a necessity.

I would love to hear your thoughts, so leave me a comment.

An Emergency Manager's Impression of China

If you are like me, you have heard a lot about China in the news lately in the political discourse or the production of hot new tech items like the iPhone 5. It got me thinking about my immersion trip to China a few years ago and what would happen if I was doing business in Asia.  Ok, I know this seems like a bit of non sequitir when compared to my normal posts but hang on, there is a connection.

The media mostly focus on China’s manufacturing and how it affects the jobs front but in all actuality my impression of China was an area wanting for partnership and further development.   My time in China was just days after the Sichuan Earthquake where over 69,000 individuals perished and I arrived a day before the 3 day period of mourning.  I saw country’s population that had a similar response to US Citizens’ response to Katrina.  The compassion and the desire for response is no different.  The citizenry and government want to rapidly improve it’s relatively young governmental Emergency Management program and be a resource to do good works rather than nation that is perceived is a victim.

One of my biggest take-aways from my time in China is how well the emergency manager’s mindset lends itself to Chinese business and culture. A good emergency manager knows the importance of building relationships and will dedicate time to developing those relationships.  In Asia in general, the development of a relationship is a key investment in developing business and it is more than just simple networking.  An entity’s success in China can very easily be tied to how it maintains relationships.

If you are interested in work in China or Asia in general I would take a few minutes to check out US AID, they have some cool humanitarian missions throughout Asia.

Do you have a comment or thought about EM oversees?  Lets here it, please leave me a comment I would love to discuss.

PS- I did get to do some touristy stuff while I was there:

The Great Wall of China

The Summer Palace

A Debate Can Teach Us Something....

During last night’s Presidential Debate I realized that I was not watching the debate as a voter but as an Emergency Manager and Crisis Communicator.  (In all actuality debates rarely help me decide).  I realized that a debate, albeit good or bad, can teach us a lot about how to communicate during high stress events.  

Here are a few things to take away.

• If you cannot make a point in two minutes or less you are already behind.

The structure of the presidential debates limits answers to two minutes, and the candidates have to set-up and sell their respective messages in that 2 minutes of their 90 minute debate.  When you think about the rest of us, 2-3 minutes is the average length of time of an average segment on the local news.  When designing your communication that goes out through local media make sure you can make your point in less than 2-3 minutes that way it fits into a nice neat segment.

• If you find yourself going back to re-explain a point or clarify you didn’t make a point.

This actually applies to when you review your performance.  If possible it is always good to constructively review (not obsess over) your actions / performance.  If you notice that you had to re-explain yourself you message was not concise and to the point.

• The sound bite is king.

No matter how great you did in your debate or interview if there was one juicy sound bite it has the potential to resonate and dominate your message regardless of whether or not it was message.   To mitigate the risk of a negative sound bite formulate your message as much as possible and rehearse, rehearse, rehearse.   Now some would argue that you couldn’t rehearse enough but sometimes coming off too scripted can hurt too.

So if you are like me and are a little sick of all the politics and still feel compelled to watch the debates next watch through the lens of an emergency manager or crisis communicator.   If you are looking for a good analysis of last night’s debate through the eyes of a media trainer let me recommend Brad Phillips Blog – Mr Media Training .

If you other suggestions or tips feel free to leave them in the comments.

Multi-Patient Disasters and the Need for Analysis: As influenced by the Aurora Theater Shooting

First, along with the rest of the nation and the entire public safety and health care community, my thoughts and prayers are with the survivors and victims of the shooting in Aurora.  I also send support and praise to all of the PD, EMS, Fire, and Hospital personnel that were affected and will continue to be affected.

Posting on my original planned topic (SCOTUS Health Care Ruling) would be disrespectful. Instead I provide this short post on two topics; one a health care disaster response to something like this and two why we start to analyze the next day.

Health Care Response

I saw a post on Twitter the other day that said hospitals throughout the United States have disaster plans.   For those of you not familiar, hospitals are obligated by regulators to have disaster plans.  They are required to test their plans twice a year.  Watching the information coming from Aurora you can see that they have been preparing for worse case scenarios.  When hospital staff members were interviewed they all said something similar to ‘We were notified of multiple patients and we activated our disaster plan.’  These plans are what allowed those hospitals to respond capably to this disaster.  The regulatory standards around EM have supported organizations that have to be very cost conscious to focus on disaster preparedness.  Friday morning, that level of focus paid dividends as Incident Command was initiated and staff were called in to augment the response.  Dr. Sasson at UCH actually said they were able to open virtually every OR needed, a true testament to planning and preparedness.

Now, as the focus rightly shifts to the victims, there are additional survivors that weren’t in the theater when the shooting occurred.  All of the public safety workers involved and hospital staff are indirect survivors are strongly affected.  In the first day of a hospital stay victims of a multiple shooting at a trauma center can interact with 100+ staff members.  Those indiviuals are impacted by their experience and suffer an extension of the trauma and their exposure will not end when the crime scene tape comes down or the news cycle fades.  It is up to their employer to ensure that they have the plans in place for a delayed recovery.  Critical Incident Stress Management (CISM) must be a core part of it so that they support the indirect survivor.

The Need for Immediate Analysis

When something like this happens there is always someone that becomes a Monday morning quarterback.  That is not what I am advocating.  To use another analogy I encourage individuals to strike while the iron is hot.  As any seasoned Emergency Manager will tell you, you get more buy-in to an initiative such as Active Shooter response planning or the need for a disaster drill when there is desire for change generated from an event such as the Aurora Theater Shooting.  The ultimate goal is to protect and/or save lives in the future.

If you agree or disagree, please comment and let me know below.

I will blog more in the coming weeks on the concept of indirect survivors and CISM in the hospital setting.

Why hospitals use generators when there is no power outage?

So during heat waves some hospitals either elect to or are asked by local utilities to “sell back” electricity to the grid.  This serves several purposes.  First it allows a major 24/7 consumer of electricity to mitigate its draw during high use times. This can help the utility companies to prevent brown outs and maintain quality of service.  It also allows the hospital to test their generators under load in an environmentally stressful situation.

Hospitals do this in a planned manner and it is done with no interruption of power to the facility.  Some hospitals use the power directly from the generator and some provide the electricity to the grid.  If the generators have any problems the hospital staff returns the systems to normal operations.

What can we learn from the Costa Concordia incident?

Image from www.cruisecritic.com

I am not an 'avid cruiser', I have not even been on a cruise but I have been fascinated with the tragic event unfolding off the Tuscan coast of Italy.  If you have been living under a rock or been drowning in the US GOP Primary coverage, the Costa Concordia is a cruise liner that ran aground and partially capsized Friday night causing a complete evacuation.  At post time there were 5 fatalities and 17 souls still missing.  A more detailed account of the event can be found at http://www.cruisecritic.com/news/news.cfm?ID=4710.
My fascination has had me surfing the web for information about the event and I realized that emergency managers, risk managers, and crisis professionals could learn a tremendous amount from this event.

Crisis Communication

Web Presence:

The company’s voice in this event has been amazingly silent.  The company’s website has been over loaded and unable to respond.  This shows the perfect opportunity for ‘Thin Sites.’  Thin sites are websites that replaces a company’s graphically and media intense landing page with a page that is mainly text based and a platform for a message about the crisis.  Costa should want to be the source of truth for this event as to maintain customer trust if at all possible, if customers don’t hear from them or can’t get to the material then the void will be filled else where.

The Message:

One of the first thing most of mentors in Crisis Communications have always said decide on a message and get it out there.  Even though it sounds cliché the sentiment of compassion is what the public and customers want to here followed quickly by a sense of urgency to discover and fix whatever is wrong.  We are seeing very little of this from Costa.  A matter of fact this event is getting worse if you read posts of passengers that say Costa has not been able to assist them and won’t even help them secure a change of clothes.  An ideal response to this event would be ‘The safety of Costa’s passengers is at the forefront of the Costa’s mission while begin an exhaustive investigation to understand the events on the Costa Concordia our primary focus is to support and provide for welfare of our passengers.’ That statement should be followed up by assigning a slew of employees to the evacuated passengers and make sure they have the essentials:

·        Food

·        Clothing

·        A nice place to stay

·        Access to their Embassy

·        Transportation Home

Furthermore the family of the fatalities should each get a personal liaison to help them with what ever arrangements they need.  These actions are not only the right thing to do but they are the first step at restoring the Costa’s image in a service industry.

Rumor Control:

Finally, there has been a lot of speculation about several things ranging from the ship’s course to the evacuation drill schedule and we still continue to hear very little concerning the events from Costa.  A key part in the intermediate and extended phase of a crisis is rumor control.  If the major player is not speaking then the rumors will abound, like they are in the Costa Concordia event.  If the message was 'We are investigating the event in full cooperation with the authorities' that at least dispels or delays some rumors.  Finally, with out infuriating too many attorneys, if the facts are bad and obvious, acknowledge them and then fix what ever caused so it won’t happen again.

The Victim’s Message

We are all used to seeing the traditional victim’s story as they describe what happened to them to a reporter and we only heard it at the discretion of the media outlet.  Well those were the simple times, today’s victim will share their story on YouTube as the video they take in the life boat.

As we define how we message and how we respond we must take into account that the victim’s voice is much louder and I personally believe that is a great thing.  We will learn more from these individuals to better our response in the future.

Risk Management

Now, Italian laws surrounding negligence probably differ slightly from US but some core tenants exist.  First, were there policies and procedures in place that should prevent some if not all of the chaos.  Companies should walk a fine line between empowering the employees and protecting the customers.  The ship’s course is coming under such scrutiny to the point that staff are speaking about being too close to shore, policies should be in place saying courses should be followed as planned, this is no different than in a hospital that a patient should be treated according to the standard of care.  It also seems that safety was an after thought as to when the evacuation drill was scheduled, 5 pm Saturday a full 24 hours from embarkation.  Most American Cruise Ships conduct the “muster drill” in the first hours of the cruise.  If it is policy to schedule drills when it is convenient that creates an environment that doesn’t make safety a priority.

Reading the comments and reviews on line one comment sticks out from an avid cruiser “Don’t rush to blame the cruise company.  I agree it was not the CEO or policies that steered this 4,000 passenger mega-ship into a reef, it was a man.  This man is now in the custody of the Italian Carbinieri on charges of manslaughter, among other things.  Where the criticism of a company like Costa can come to play in a disaster that resulted from errant decision making, is how they responded and prepared for a disaster. This company has a 150+ year history and it’s operation and market share are in dire jeopardy because of a human error.  We don’t know if Costa has a crisis or disaster response plan but if they don’t they will in the near future.