Brandon Bond - Emergency Management in a Complex Environment Bond... · the process of care. We are...

Emergency Management In A Complex Environment

Brandon Bond, MS, CBCP Administrative Director, Office of Emergency Management Stanford Health Care | Stanford Children s Health

Confidential – For Discussion Purposes Only

A little bit about us…

  Stanford Hospital

−  Level 1 Adult & Pediatric Trauma Center

−  Life Flight

−  613 Licensed Beds

−  37 Operating Rooms

  Lucile Packard Children’s Hospital Stanford

−  311 Licensed Beds

−  10 Operating Rooms

  Expanding Network of Specialty & Primary Care Clinics

  Office of Emergency Management

−  4 Full Time Staff, 2 Part Time

−  2 Part Time Medical Directors


First let me state why we believe health care is the most complex operating environment there is

  We are capital intensive with expensive buildings and expensive equipment.

  We are labor intensive. Unlike other industries that deploy a lot of capital, we don’t use it to reduce down the size of our labor force, and in fact it often goes up with additional capital being deployed.

  We are in the service business, delivering our “product” with our “customer” being along side of us, and, if we are doing it right, they are highly involved in the process of care.

  We are in the knowledge management business, working in a network of information flow, with complex information development and communication as a key predictor of our ability to deliver high quality care. Related to that, unlike many industries, the people with the highest level of training and expertise are at the point of service, not in management.

  Ours is a highly regulated and litigious environment at the local, state and federal level.

  Our mistakes can have immediate life and death consequences.

3


Our Standard: Zero Downtime with a Recovery Time Objective of Zero minutes

Emergency Management

Resources and Assets

Staff Responsibilities

Safety & Security Communications

Utilities Management

Patient Clinical & Support Activities

Emergency Management

Mitigation

Planning

Training Response

Recovery


LPCH Hospital Board SHC Hospital Board

LPCH Medical Executive Committee

SHC Medical Executive Committee

SHC Quality Improvement Patient

Safety Committee

LPCH Quality Improvement

Committee

Emergency Management Steering Committee

Operations Finance

Sub-Committees

BCP Technology

COMMUNITY INTERFACE

City of Palo Alto

SCC Hospital Council SMC Hospital Council

SU EM Committee SU IC Committee

Unv, SoM, Hosp (USHER) SFO Emerg Mgt Group

Hospital Incident Management Team

Logistics PIO

Mitigation

Planning

Contingency ERT Leads

Senior Physicians

Disaster Management Committee

Emerging Infectious

Diseases & Bioterrorism

Sub-Committee

Emergency Management Governance Structure

Response to Asiana Flight 214, 6 July 2013


•  21 miles from SFO by ground •  10 minute flight time


Response to Asiana 214

  SHC received 55 patients transported patients

−  2 Immediate

−  11 Delayed

−  42 Minor

−  26% were pediatric

  18 patients admitted to SHC

  7 pediatric patients admitted to LPCH

  150 + personnel responded to the incident

  ED remained open to both San Mateo and Santa Clara EMS


Initial Timeline of Events

1127 1140 1149 1205 1206 1240 1246 1827 2012

Asiana Flight 214 Boeing 777 crashes at

SFO

San Mateo County

EMSystems ED MCI query

San Mateo County

EMSystems ED MCI query

Initial Code Triage

Standby Page

•  ED Rapid Admission Plan Initiated

•  Initial Staff Call Back •  Establish Direct

Communications with EMS & PA OES

First two patients

arrived by Coast Guard helicopter

Code Triage Major

Hospital Command

Center Activated

•  San Mateo EMS reported 290 patients being triaged

•  1st Ambulance with Four patients

ED RN In Lobby See’s

Breaking News

Reports

Last Patients Arrive by

Bus

ALL CLEAR


1246 hrs. First Ambulance Arrive with Four Immediate Patients


1300 hrs. Mass Casualty Triage Established


Expanded Staging and Patient Waiting Areas


1315 hrs 6 Operating Rooms & Trauma Teams Mobilized


1315 hrs Hospital Command Center Fully Established


Waves of Ambulances Continued


1827 hrs. Last Patients Arrive by Bus


Many patients arrived with no documentation…


Unique aspects of the incident…

  Mechanism of Injury

  International Diplomatic & Security Issues

  Patients without passports and who had not cleared customs

  Language barriers & confusion with names

  High number of Unaccompanied Minors

  San Francisco incident within San Mateo County transporting to outside county hospitals

  This was a worst “best” case scenario for and MCI


Patient Coordination Challenges

  Patient Tracking

  Manifest Reconciliation with DHS-HSI

  Family Re-Unification

  Unaccompanied Minors

  Discharge Planning

  Food & Comfort

  Counseling

  Transportation

We did well, but we can do better!

“Do nothing which is of no use”

– Miyamoto Musashi

Confidential – For Discussion Purposes Only cussion Purposes Only

People

Infrastructure

Technology

Systems Approach to C3:


Principles of the Stanford Operating System

  Continuous Improvement −  Challenge - We form a long-term vision, meeting challenges with courage and creativity to realize our

dreams. −  Kaizen – We improve our business operations continuously, always driving for innovation and evolution. −  Gemba – We go to the source to find facts, understand how the work is done, and make correct

decisions.

  Respect for People −  Respect - We respect others, making every effort to understand each other, and taking responsibility to

do our best and to build mutual trust. −  Teamwork - We stimulate personal and professional growth, share the opportunities of development and

maximize individual and team performance.

Confidential – For Discussion Purposes Only The facility and utility infrastructure is the foundation of the patient experience.

The technology enables interoperability and access.

Understand the Patient Value Stream. Identify key touch points of technology and infrastructure. Develop contingencies for the people around them.

Disaster Planning by Following the Patient Value Stream


Kaizen – We improve our business operations continuously, always driving for innovation and evolution.

The Challenge:

  Improve the mass casualty patient registration process

−  Role clarity

−  Arrival process logistics

−  Naming convention

−  Access to equipment −  Patient identification and accountability

−  Reporting on patients

AND… be ready to test the process in six weeks!


The Kaizen Process


Current State


Future State


The Outcome

  Registration at triage

  Leveraging technology

  One touch registration

  Picture uploaded to record

  Tracking board in Command Center

  Daily standard work

It was difficult for our team to keep track of all the patients who came in during the disaster, Now we will be able to put a patient s actual picture in the chart, how they

look at that moment, so every doctor and nurse will be able to know who they are and make sure they are identified before being treated

- Ian Brown, M.D. Medical Informatics


Planning for a long term deployment

  Mobilization Thoughts

  Family Considerations

  Household Considerations

  Personal Equipment

  In Theater Logistics


Top 10 Things an Emergency Manager Doesn’t Want to Hear!

1.  Is this real?

2.  What’s an HCC? (Hospital Command Center)

3.  You mean you didn’t just make up these HICS forms?

4.  What am I supposed to wear to a disaster?

5.  I just walked through the water!

6.  I hope you’re not planning an earthquake drill.

7.  Seriously do I have to be here?

8.  Sandwiches again?

9.  Do I have to? I’ve got blisters.

10.  I’ve got big problems, we have water up to our knees!


Mobilization thoughts

You

 What is the mission?

 What should I bring?

 How should I prepare myself?

 Where are my boots?

  I’m late; I better hurry

Your family

  Is it safe? (Don’t go!)

 Will we need anything from you while you’re gone?

 How do we handle...?

 Slow down; spend some time with us; say goodbye


While you are away...

  Your paycheck arrives, and only you can cash it. How can your family buy groceries?

  Your partner needs to know if you paid the mortgage before you left. Did you?

  Your water heater breaks and floods the living room.

  Your spouse locks him/herself out of the car.


Inaccurate information

 News flashes on TV: inaccurate, incomplete

 News media interviews your family: what can (should) they say about you?

  Inconsistent information from team members

− people react differently to stress


When you return, your family...

  Is stressed: −  they’ve been worried about you; they dealt with problems you

usually handle

  Is anxious: −  they prepared for your return

  Is excited: −  Tell us all about it − Don’t tell us all about it − Want to tell you all about their experiences while you were away

  Is tired: −  from being stressed, anxious and excited


When you return, you are ...

  Distressed/withdrawn: − Don’t want to talk about it − Only want to talk with other

team members

  Excited: − You want to talk (will they

listen)? −  They want to get back to

normal

  Exhausted from the mission: −  let me sleep


Aftermath

 Unfinished business is still unfinished

 Problems don’t seem as important (to you!) as before

  “I’ve had it worse”

  “You’ve changed”


Talk with your family

  Explain Your Role

  Emotional impact of disaster response −  Separation anxiety:

  Anticipation of loss

  Detachment (immediately before departure)

  Emotional disorganization

−  Disinformation, conflicting information, lack of information, media impact


Talk with your family

  Handling stress while you’re away

−  Take care of yourself: eat, sleep

−  Keep regular patterns

−  Be unhappy or try to make the best of it!

  Homecoming

−  Anticipation of return −  Emotions: exhaustion, excitement

−  Give each other some space for a few days


Tips for you

  Your family may have changed, learned new skills, done different activities. Don’t be threatened by independence.

  Ease back into your normal life. Don’t try to resume your normal routine right away.

  Be positive about decisions your family made while you were gone, even if you would have done things differently.


Talk with your children

 Meet as a family, discuss possible problems

− Separation anxiety

− Lifestyle changes

− Re-divide chores

 Notify teachers, baby-sitter, day care

− They’ll be more attuned to possible problems if they know what’s happening at home


Plan ahead (financial)

 How to handle everyday issues (e.g. pay bills)

 List (name, address, phone): −  Job

−  Landlord −  Insurance agents

− Plumber, electrician, heating/air conditioning, mechanic, etc.

− Pets: boarding, daycare, vet


Plan Ahead (checklist)

  Deployment Check List

  Tuesday 9-05-07

  Call Alyssa

  Call Mom

  Call Dad

  Cancel Karen Green CA CSS 916-000-000

  Cancel Lt. Christensen

  Cancel CTC Training

  Auto reply work email

  Change work-personal voicemail


In Theater - Sleeping


In Theater - Sanitation


In Theater - Transportation


In Closing

1.  The strength of our program starts in the C-Suite

2.  Become a part of the corporate culture

3.  Understand your value streams

4.  Work to eliminate waste

5.  Remember it is the constant pursuit of perfection


Thank You!

Brandon Bond

Administrative Director, OEM

[email protected]

650-723-0592

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