FAQs

The Emergency Management Program (EMP) implements the mission, vision, goals and objectives of the organization as related to Emergency Management. The EMP utilizes organized analysis, planning, decision making and assignment of available resources to mitigate, prepare for, respond to, and recover from all-hazards. (Emergency Management Principals and Practices for Healthcare Systems, Department of Veterans Affairs, 2006) link

The Emergency Operations Plan (EOP) provides the structure and processes that the organization utilizes to respond to and initially recover from an event. The EOP is therefore the response and recovery component of the EMP. (Emergency Management Principals and Practices for Healthcare Systems, Department of Veterans Affairs, 2006) link. The Joint Commission Emergency Management Standards (link?) are very specific to the requirements of the hospital EOP, however it should be noted that some of these requirements cross over to mitigation and preparedness activities.

For a suggested outline of the EMP and for further guidance, see the following:

• CHA Key Components of a Hospital Emergency Management Program (link)
• CHA Hospital Emergency Management Program Checklist (link)

The CHA Hospital Preparedness Program is a federal grant-funded program. The program includes 10 staff - One executive director, one administrative assistant and 8 hospital preparedness coordinators (HPCs). Program activities include but are not limited to: providing technical assistance, conducting site visits and support to hospitals; emergency management program review; identification of hospital needs and priorities; assistance with meeting HPP deliverables; facilitation and liaison with local jurisdictions and community partners.

Additionally, program staff research best practices develop tools to assist hospitals with strengthening their Emergency Management Program and their Emergency Operations Plans. This program also provides various local training opportunities. There is no cost for the CHA program services and tools.

• More about the program

The After Action Report (AAR) captures observations of an exercise and makes recommendations for post-exercise improvements. The AAR then is used to develop Improvement Plans (IP). HSEEP AAR examples can be found on the HSEEP website.

The Joint Commission requires a hospital designee whose sole responsibility during emergency response exercises is to monitor performance and document opportunities for improvement in EM.03.01.03 and specifies that all emergency response exercises include the identification of deficiencies and opportunities for improvement. Developing an AAR meets the criteria.
 

The Recovery phase begins when hospital incident command determines that the event is de-escalating or over and that some or all de-mobilization and recovery activities can be initiated.
Activities involved in recovery phase will be dependent on the event and its impact on the hospital; these include assessing the six critical elements of operation and taking the steps necessary to ensure safe, normal operations (communications, resources and assets, safety and security, staff responsibilities, utilities, and [patient] clinical and support activities).

 Event response checklists and/or HICS Response Guides include recovery phase activities; recovery activities should include preparation of documentation for submission of claims for federal reimbursement as appropriate to the event.

If the hospital has facility damage or has evacuated the facility, then review and approval by appropriate regulatory agencies (e.g., state licensing, OSHPD, Fire Marshall) may be required before repatriating facilities or operations. Preparations for recovery should be initiated during the Mitigation, Planning and Response phases to minimize event impacts and optimize timely resumption of normal operations and recuperation of expenses. For example, mitigation activities may include information technology (IT) systems secure back-up to allow for recovery after an event involving loss of IT, planning may include the establishing procedures and appropriate documentation to account for event related expenses to maximize federal funding, and response may include de-escalation plans that allow for gradual resumption of normal operations.

The hospital should have a business continuity plan (BCP), or continuity of operations plan (COOP), that identifies non-critical functions and resources that may be reassigned during an emergency, as well as critical functions, services and their redundancy to support both response and recovery
 

Comfort care is a synonym for palliative care, supportive care, or austere care. It is care given to improve the quality of life of patients who have a serious or life-threatening condition. In some event scenarios in which the entire healthcare system is overwhelmed by mass catastrophe or pandemic, patients who are not expected to survive may be given comfort care in the form of pain control, hydration, and psychological support.
 

Several statutes provide qualified immunity to persons rendering aid and healthcare facilities providing care during an emergency and address the need to provide liability protection to healthcare providers during an emergency. (Pages 110-114 of the California Department of Public Health Standards and Guidelines for Healthcare Surge During Emergencies Volume I: Hospitals is available here.

A summary of these statues is below.

California Civil Code Section 1714.5: Provides immunity from liability for disaster service workers as well as an owner or operator including a public agency that owns or maintains any building or premises which is used as a mass care center, first-aid station, temporary hospital annex or other necessary facility for mitigating the effects of an emergency.

California Health and Safety Code Section 1317: Provides immunity from liability for upon the health facility, the officers, members of the staff, nurses, or employees of the health facility who may be at risk for loss of life.

California Emergency Services Act, Government Code Section 8659: Any physician or surgeon (whether licensed in this state or any other state), hospital, pharmacist, nurse or dentist who renders services during a state of war emergency, a state of emergency or local emergency at the express or implied request of any responsible state or local official or agency shall have no liability for any injury sustained by any person by reason of such services, regardless of how or under what circumstances or by what cause such injuries are sustained; provided.

California Business and Professions Code Section 1627.5: Same as above for dentists.

California Business and Professions Code Section 2395; California Business and Professions Code Section 2727.5; California Business and Professions Code Section 2861.5; California Business and Professions Code Section 3503.5: No licensee (physician, registered nurse, licensed vocational nurse or physicians’ assistant) who in good faith renders emergency care at the scene of an emergency or during a medical disaster, shall be liable for any civil damages as a result of any acts or omissions by such person in rendering the emergency care.

Government Code Section 178, Article 5: This section addresses the liability of health professionals providing service outside the state by which they are licensed.


 

Federal statutes and regulations cannot be waived or suspended by the Governor. However, during a catastrophic disaster, the Governor may make a request to the federal Secretary of Health and Human Services requesting waiver of specific federal statutes and regulations. The following provisions could be waived.

• Requirement to Obtain Patient Consent to Speak with Family or Friends - 45 CFR 164.510
• Requirement to Honor Opt-Out Request Obtain for Facility Directory - 45 CFR 164.510
• Requirement to Distribute Notice - 45 CFR 164.520; 42 USC Section 1320b-5(b)(7)(B)
• Patients Right to Request Privacy Restrictions and Confidential Communications - 45 CFR 164.522; 42 USC Section 1320b-5(b)(7)(C)
 

The EMTALA requirement is based on federal law and cannot be waived by the Governor. However, the Governor may request that the Health and Human Services Secretary waive the EMTALA requirements under 42 USC Section 1320b-5.
 

The Homeland Security Exercise and Evaluation Program (HSEEP) is a capabilities and performance-based exercise program which provides a standardized policy, methodology, and terminology for exercise design, development, conduct, evaluation, and improvement planning. Using HSEEP helps ensures that exercise programs conform to established best practices, and helps provide unity and consistency of effort for exercises at the hospital level and for all levels of government. 

Hospitals are required by The Joint Commission to monitor performance and evaluate each exercise or actual event using a multidisciplinary process that involves licensed independent practitioners. During an exercise, individuals are to be designated to observe performance and document opportunities for improvement. That evaluation process is to result in:

• Documented identification of deficiencies and opportunities for improvement
• Documented assignment and monitoring of improvement activities, including the hospital team/committee responsible for emergency management
• Modification of the hospital Emergency Operations Plan or supporting policies and procedures based on the evaluation; if modifications require substantive resources and cannot be accomplished by the next exercise, interim measures should be implemented
• Incorporation of modified or interim measures in subsequent emergency response exercises.
  The hospital should maintain clear and timely documentation of each step in after action evaluation, improvement planning and monitoring, resulting modifications to Plans policies and procedures, and exercising of modifications or areas identified for improvement.

Hospital Preparedness Program (HPP) participating hospitals are required to participate in community-wide after action evaluation and improvement planning meetings and to submit an exercise summary report form to the Local HPP Entity following each community-wide exercise in which the hospital participates.