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.

The Great Snow Plan Debate

Every winter the same conversation I am sure happens at various hospitals that are south of the Mason Dixon but north enough to get a little snow.  ‘Do we provide rides via four wheel drive vehicles to employees or not?  At my system we call it the Snow Plan.  So let’s talk about the struggles that face a Health Care EM guy during this:

Community

Now I am sure colleagues and individuals that live in areas that a white Christmas is the norm think we are nuts, but this is an issue in some of these areas like central North Carolina where snow is not a way of life.  When it snows an inch and the roads are covered here is what happens in the public:

Schools close Businesses close Churches delay services Meals on wheels stop delivering 24 hour news crawler about closing and weather on the TV

Stop lights don’t work right People forget basic physics Groceries store run out of milk and bread

Public Works Infrastructure / Resources

Some of that is in jest but seriously it is honestly a culture change here.  I understand this is foreign to so many folks.  I have spent time in the NE during winter and they all think this is crazy but the fact of the matter is that a lot of places do not have the infrastructure or resources to handle snow.  Most public works in these areas do not have enough snow plows and snow removal equipment to clear anything more than primary roads.  So it can be days before secondary and tertiary roads are even addressed.  If it is late in the winter season some agencies can even run out of funding and supplies like salt/brine before the winter is over.

Impact on a Hospital

Even though most Health Care Emergency Managers do not necessarily list snow storm at the top their HVA (Hazard and Vulnerability Analysis) it is an event that can impact almost every facet of operations.  It is one of the few events that can affect:

• The community by impacting transportation and basic service provision
• Logistics by stopping deliveries and shutting down transportation networking.
• Operations by impeding staff ability to get to work if public transportation shuts down and the streets are impassable.
• Casualty Creation one wreck or power outage in a key area can create individuals needing care or shelter.

A good example of this is the snow storm that hit the Midwest a few years back when supplies had to be airlifted to facilities and staff were living at hospitals.

The reason for the Snow Plan is driven hugely by staffing but is also a big morale boost.  Last year we activated the snow plan two times with total accumulations greater than 6 inches both times.  A command system was put in place and a process is implemented for ride requests and then dispatching of drivers to get key staff.  A story that sticks out in my mind is not how we got in a key member to save a life but happened when I snuck out of the coordination center and drove to pick up employees. 

I was dispatched to get a food service worker.  When I arrived he hopped through the snow to get in the truck and greeted me with a small and a thank you.  He looked at me and I think he was a little disappointed though.  He told me ‘Yesterday our CEO picked me up, what is your role at the hospital?’  I explained that I was the “Disaster Guy” and he nodded his head understandingly.  He was so thrilled yesterday that the CEO too the time to come and get him.  He explained to me that ‘normally he rides the bus to work but our public transit service had been on snow route and the closest stop was over a mile away.’

Before the experience I was fairly well decided that we needed to revisit the Snow Plan and turn it into a plan of last resort but after my time with our dietary employee I was reminded that it is not all about the staffing matrix and provision of care but about the service you need to provide to your employees.