it could happen to you, are you ready?

When Disaster Strikes: It could happen to you, are you ready?

Panel

• Patricia Burchett, CHAM• Director – Patient Access, Bronson Methodist Hospital

• Stacy Collins, MHIM, RHIA• Director – Patient Access, East Jefferson General Hospital

• Jeffrey Brossard, BSHA, CHAM• Director – Patient Access, Mercy Hospital Springfield• President - NAHAM

• Brenda Sauer, RN, MA, CHAM• Director – Patient Access, New York Presbyterian Hospital• Vice President, NAHAM

GOALS

• Participants will be able to discuss the differences between a natural disaster and a criminal attack (foreign and domestic)

• Participants will be able to identify elements needed to create a plan for a mass casualty incident

• Participants will be able to discuss what to do when a disaster strikes their area

What doesn’t kill you makes you stronger

Kanye West -

BRONSON METHODIST HOSPITAL

Why Prepare When it has not happened to you

•No major incidents•Bronson's commitment to quality, safety and community•Not a matter of if but when•It’s simply the right thing to do

PLAN

Current Structure

• Executive Support

• State of the Art Command Center

• Investment in Redundant Systems

• Investment in training time and education

• Staff Support Systems

Bronson Incident Command Center

Patient Access Plan

Practice PracticeDrill Drill

Practice Practice

Train

Elements

Components

• Located in the ED Emergency Manual

• Hard copies with all managers

• Call in sheet for all Registrars in System

• Job Action Sheet

• Flow Chart

• Patient Access To Go Bags

• Supplies

• Keep it simple

Development

• Front line staff via Table Tops

• Drill Report Outs

• Off site Training

• List Serves

• Networking with other organizations

Training & Drills

Drills

• Test as if “no” systems are available

• Backup hardware & equipment

• Hardcopy documentation

• Supplies

• Types

• Frequency

• PDCA

• Safety Fair

• Toolbox Classes

• Mandatory CBL’s

• Alabama

• Leadership 3 deep

• Drills

Training

Communication Tools

• Department Web Page

• Safety Bus

• Town Hall's

• Employee Badges

• Internal Publications

• Videos

All Staff

• Do not self deploy

• Go to your One-Up

• Refer to the “Red Book”

• Clarify and Verify

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Current Initiatives

• Incident Command Center Training

• New Employee Orientation

• Alabama training

• Community Registration Network

• Home Land Security Assessment

Three questions to ask…

• Am I safe?

• Are my family and friends (two and four legged) safe?

• Is where I am working safe?

Ready.gov

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New Orleans, Louisiana

Pre-Katrina

• Paper based records and registrations• Manual processes• Print schedules for Surgeries and Opt Procedures to perform pre-

registration when systems went down and Census to know who was in the house

• Prepare to go on down time• Make sure we have enough downtime forms• Downtime MRN’s – assign to ED and Main registration• Prepare work schedules for staff to cover ED and Bed Control

Hours before Katrina

• Report to EJ on Sunday August 28, 2005 at 7:00 a.m.• Bring clothes, air mattress, supplies, food & water for 3

days.• Photo albums in trunk of car• Send loved ones to North Louisiana• Slept on air mattress for 13 days

In Preparation for Katrina

• Go-live of Cerner postponed (original go-live Oct. 2005)

• Print X-ray file MRN’s• IT moved the large (4,000 lb.) Cerner chart servers to

the 8th floor.• Registration, Scheduling, Bed Control located on the

2nd floor (Didn’t have to worry about flooding)

During Katrina

• All systems were still running, at first.• Communication was our # 1 issue. Phones were working for a

while (approx. 3 days after Katrina).• Bell South’s battery back-up only lasted 3 days at the hub in

Metairie.• Out of phone service for about 4 days. We had someone in Baton

Rouge as our life line. They provided letters to our vendors allowing them to enter New Orleans to assist us in bringing up our systems.

• Spotty cell phone service• Everyone learned how to text message during this time.

During Katrina

• We could communicate to most of our vendors only through the internet.

• Hospital searching for diesel to run the generators.• Registration was on downtime processes for weeks until the main

IT system came up.• Bed Control was down for days and we utilized runners to bring

bed assignments and armbands to the nursing units.• Runners were our only mode of communication due phone and

elevators not working.

During Katrina

• National Guard around the perimeter of the hospital to protect us. There was a lot of looting going on in the surrounding areas.

• All the doors chained down and locked• Jefferson Parish was under Marshall Law.• EJ was the 1st hospital to bring up all major IT systems

out of the hospitals that remained opened.• All systems were up by Thursday.

During Katrina

• We were receiving calls from insurance companies all over the country. The Insurance companies told us all services would be covered until further notice.

• We would ask them if they knew about a little hurricane named “ Katrina”.

• We told them we were in partial darkness and trying to “survive”.

• Callers began to ask if they could do anything to help us.

Post-K (After Katrina)….

• Staff were located all over the country• We had a quarter of our staff lose all their belongings• EJ worked with a camp ground and Coca Cola to set

up trailors for team members. We also had staff on cruise ships docked in New Orleans.

• Some staff lived in the trailors or with a family member for over a year.

Challenges

• Since we had staff all over the country, this posed many challenges• The first month (September) we had 15 FTE’s (normally had 95

FTE’s) working 12 hr shifts. We had to cover a 24/7 department. • Many TM’s were evacuated and/or living in surrounding areas and

had to travel several hours to work each day.• Staff began to trickle in each day. By November we were up to about

half our staff.• Management worked 12 hr. shifts as well to help support our team

members.• We had families living in our main registration lobby and finally had

find them shelter so we could open for business.

Lessons Learned

• Better communication with our vendors (getting phone #’s of key staff).

• Print 2 armbands for pt’s, MD’s, visitors and TM’s in case there is a need for evacuation. We need 2 armband printers instead of one. Working with Medical Staff and other depts to share the armband printing process.

• Bring supplies for 7 days.• Downtime procedures worked but since the systems were

down for so long manually register all the patients. We are on electronic systems now since Hurricane Isaac and have a redundant system which is located in Kansas City, MO.

• As a hospital, we reviewed the entire evacuation process (dialysis & NICU patients, etc.)

Joplin, Missouri

We were ready… or so we thought…

Joplin, MO

May 22, 2011

Joplin, MO

May 23, 2011

My Story

• On my way to NAHAM• Passed through Joplin 20 minutes prior• Couldn’t get back

• Roads closed

We Thought We Were Prepared

• Never enough preparation• Less than 10 minutes warning• 5:34pm• EF5 Tornado

Disaster Facts

• 158 killed• 183 patients in the hospital• 5 deaths

Lessons Learned

• Shoes• Broken Glass

• Track evacuations• 2 weeks to find all patients

New York City, New York

NewYork-PresbyterianThe University Hospital of Columbia and Cornell

September 11, 2001

NewYork-PresbyterianThe University Hospital of Columbia and Cornell

NewYork-PresbyterianThe University Hospital of Columbia and Cornell

One plane is an accident…

Two planes is an attack

NewYork-PresbyterianThe University Hospital of Columbia and Cornell

NewYork-PresbyterianThe University Hospital of Columbia and Cornell

What could we expect?

• Regional Burn Unit• Level 1 Trauma Center

NewYork-PresbyterianThe University Hospital of Columbia and Cornell

NewYork-PresbyterianThe University Hospital of Columbia and Cornell

NewYork-PresbyterianThe University Hospital of Columbia and Cornell

NewYork-PresbyterianThe University Hospital of Columbia and Cornell

NewYork-PresbyterianThe University Hospital of Columbia and Cornell

What did we learn?

NewYork-PresbyterianThe University Hospital of Columbia and Cornell

Questions