Hurricane Irma After Action Report / Improvement Plan September 6 September 17, 2017

Transcription

1 Hurricane Irma After Actin Reprt / Imprvement Plan September 6 September 17, 2017 Submitted by: Flrida Hspital Assciatin 307 Park Lake Circle Orland, FL Nvember 30, 2017

2 FOUO Fr Official Use Only FHA Hurricane Irma After Actin Reprt / Imprvement Plan Handling Instructins 1. The title f this dcument is the FHA Hurricane Irma After Actin Reprt / Imprvement Plan. 2. The infrmatin gathered in this AAR/IP is classified as Fr Official Use Only (FOUO) and shuld be handled as sensitive infrmatin nt t be disclsed. This dcument shuld be safeguarded, handled, transmitted, and stred in accrdance with apprpriate security directives. Reprductin f this dcument, in whle r in part, withut prir apprval frm [agency] is prhibited. 3. At a minimum, the attached materials will be disseminated nly n a need-t-knw basis and when unattended, will be stred in a lcked cntainer r area ffering sufficient prtectin against theft, cmprmise, inadvertent access, and unauthrized disclsure. 4. Pints f Cntact: a. Jhn Wilgis Directr Emergency Management Services Flrida Hspital Assciatin 307 Park Lake Circle Orland, FL Office Cell Fax jhn@fha.rg b. Richard H. Rasmussen Vice President fr Membership Relatins Flrida Hspital Assciatin 306 E. Cllege Avenue Tallahassee, FL Office Cell Fax rich@fha.rg Page 2 f 16

3 FOUO Fr Official Use Only FHA Hurricane Irma After Actin Reprt / Imprvement Plan Cntents Administrative Handling Instructins... 2 Cntents... 3 Executive Summary... 4 Overview... 5 FHA Incident Management Team... 5 FHA Rles and Respnsibilities as Supprt Organizatin t State ESF Partner Organizatins... 6 Analysis f Capabilities... 7 Fundatin fr Health Care and Medical Readiness... 7 Health Care and Medical Respnse Crdinatin... 8 Cntinuity f Health Care Service Delivery... 8 Medical Surge... 9 FHA Lessns Learned Cnclusin Page 3 f 16

4 FOUO Fr Official Use Only FHA Hurricane Irma After Actin Reprt / Imprvement Plan Executive Summary FHA is required t prvide an after-actin reprt t the Flrida Department f Health f the lessns learned and recmmendatins fr imprvement. Belw is a timeline f declaratins and events fr Hurricane Irma: An Executive Order was signed n September 4 by Gvernr Sctt declaring a state f emergency in every cunty in the State f Flrida. The state emergency peratins center activated t a level 1, full activatin n September 5. FHA was activated t the state emergency peratins center n September 6. A public health emergency was declared by the U.S. Department f Health and Human Services n September 7 and a presidential declaratin was apprved n September 10. The state emergency peratins center returned t a Level 3 (mnitring) n Octber 8. State ESF8 requested input fr the ESF8 after-actin reprt n Octber 23. This reprt utlines infrmatin btained by FHA based n the active invlvement with hspitals and health systems in Flrida impacted by Hurricane Irma. FHA identified several areas where hspitals respnded successfully. Specific areas included: Hspital leadership respnded efficiently and effectively; Hspitals managed patient surge regardless f the challenges; The fcus was n life safety; Hspitals supprted the cmmunity s health and medical needs; and, Unmet needs were managed withut significant difficulty. Certainly, fllwing any event r incident, there are areas f imprvement. Hurricane Irma psed challenges t Flrida health and medical system and there is a need fr enhancements in different areas acrss the cntinuum f care. These include: Nn-acute prvider preparedness; Utility restratin priritizatin fr licensed health care facilities; At-risk ppulatin supprt; Imprved individual and cmmunity preparedness; Better lcal / state crdinatin; Access t transprtatin; Medical staff and emplyee augmentatin; Supprting the cntinuum f care; Cmmunity pharmacy clsure; Cmmunity dialysis prvider clsure; and, Hme health agency clsure. FHA used the lessns learned frm the 2016 hurricane seasn in respnding t the needs f hspitals and ther health care prviders during Hurricane Irma. The hurricane seasn f 2017 has demnstrated there is always a time t celebrate success stries and a time t rethink the respnse framewrk within the health care cmmunity. The infrmatin in this reprt is designed t prvide insight int what wrked and where there remains rm fr grwth and develpment. FHA is pleased t prvide infrmatin that may help imprve the cllective preparedness, respnse and recvery actins f the health and medical system in Flrida. Page 4 f 16

5 FHA Incident Management Team FOUO Fr Official Use Only FHA Hurricane Irma After Actin Reprt / Imprvement Plan Overview FHA s Incident Management Team fr Hurricane Irma included: Bruce Rueben, President Jhn Mines, Senir Vice President Crystal Stickle, Vice President f Gvernment Affairs Sarah McBrearty, Vice President f Cmmunicatins Mnica Crbett, Vice President f Public Affairs Martha DeCastr, Vice President fr Nursing and Clinical Care Plicy Rich Rasmussen, Vice President fr Member Relatins Kathy Reep, Vice President f Financial Services Kim Streit, Vice President fr Healthcare Research and Infrmatin Jhn Wilgis, Directr f Emergency Management Services Steve Thrntn, Directr f Cmputer Services FHA s Incident Cmmand Structure is utlined belw: Incident Cmmand Bruce Rueben Safety Officer Sarah McBrearty Liaisn Crystal Stickle Planning Rich Rasmussen Operatins Jhn Wilgis Finance Kathy Reep Lgistics Jhn Mines Public Infrmatin Mnica Crbett Medical - Technical Specialists Kim Streit and Martha DeCastr FHA Rles and Respnsibilities as Supprt Organizatin t State ESF-8 The primary rles and respnsibilities f FHA s Incident Management Team are: Serve as a supprt agency t the State Emergency Respnse Team and ur activities are crdinated at the State Emergency Operatins Center in Tallahassee, Flrida. Crdinate hspital respnse activities ensuring hspitals needs are met and t cmmunicate essential infrmatin t hspitals and health systems. Assist hspitals with cmmunicatins amng respnse partners, validating requests and fllwing up n request fr unmet needs. Wrk t identify the status f hspitals (i.e., evacuatin, bed availability, majr structural damage impeding the delivery f care and/r services r frcing an evacuatin, etc.) and t disseminate infrmatin t hspitals n a timely basis. Facilitate cnference calls with hspitals, as needed. Page 5 f 16

6 FOUO Fr Official Use Only FHA Hurricane Irma After Actin Reprt / Imprvement Plan Assist hspitals with reimbursement infrmatin and knwledge f prcesses fr accessing available relief funds. Partner Organizatins FHA s Incident Management Team wrked with the fllwing partner agencies and rganizatins during the respnse t Hurricane Irma: U.S. Senatr Bill Nelsn U.S. Senatr Marc Rubi Flrida Gvernr Richard Sctt Flrida Divisin f Emergency Management (FDEM) Agency fr Health Care Administratin (AHCA) Flrida Department f Health (FDOH) Flrida Department f Law Enfrcement (FDLE) Flrida Public Service Cmmissin (PSC) Flrida Department f Children and Families (DCF) Flrida Department f Elder Affairs (FDEA) Flrida Fire Chiefs Assciatin (FFCA) Flrida Emergency Prfessinal Assciatin (FEPA) Kidney Cmmunity Emergency Respnse (KCER) Flrida Health Care Administratin (FHCA) Leading Age Flrida Argentum Flrida Assisted Living Assciatin (FALA) American Hspital Assciatin (AHA) Page 6 f 16

7 FOUO Fr Official Use Only FHA Hurricane Irma After Actin Reprt / Imprvement Plan Analysis f Capabilities It is imprtant t align Flrida s health and medical prvider cmmunity s preparedness, respnse and recvery actins with the U.S. Department f Health and Human Services (HHS), Office f the Assistant Secretary fr Preparedness and Respnse (ASPR) Health Care Preparedness and Respnse Capabilities guidance, which is part f the Hspital Preparedness Prgram (HPP) 1. ASPR s guidance describes, what the health care delivery system have t d t effectively prepare fr and respnd t emergencies that impact the public s health. 2 Fllwing the September 11 attacks in New Yrk City and Washingtn, D.C., Flrida has participated in the HPP which has prvided funding fr health and medical preparedness fr Flrida s health and medical cmmunity prviders. Since 2011, Flrida has been fcusing HPP funding n building and sustaining health care calitins (HCCs) which is simply a grup f individual healthcare rganizatins in a specified gegraphic area wh wrk tgether t enhance their respnse t emergencies r disasters. 3 The cmments belw utline the Health Care Preparedness and Respnse Capabilities and FHA s bservatin s n hw thse capabilities were met, r nt met, during the run-up, respnse and recvery t Hurricane Irma. Fundatin fr Health Care and Medical Readiness The gal f this capability essentially lays the building blcks f a HCC. Flrida s HPP funding currently supprts 10 HCCs. A map f Flrida s HCCs utlines the gegraphic lcatin f these HCCs, as well as lists the names f each HCC and the dmestic security regin the HCC is lcated in. This includes the day-t-day peratin f the HCC s business functins. Establishing a HCC s readiness als invlves identifying the hazards a HCC and its members face within their cmmunity and establishing a plan t address thse risks. Readiness capability entails training fr the health care wrkfrce. And finally, this capability area prmtes peratinal sustainment in the face f shrinking federal funding supprt. Observatin(s): FHA is prviding the fllwing bservatins with the intent f explring strategies and methds f imprving a HCC s ability t prvide effective supprt t a lcal cmmunity and its health and medical prviders. Please cnsider the fllwing bservatins: Flrida s 10 HCCs are well frmed as federally recgnized nn-prfit rganizatins [501(c)3]. Each HCC has established a system f gvernance that allws them t cnduct business as a sub-grantee f Flrida s HPP accrding t Flrida statutes and federal law. HCCs have been cnducting hazard vulnerability analysis and cmmunity risk assessments with their members and lcal partners invlved in disaster preparedness, respnse and recvery. HCCs have develped plans t address the gaps and the greatest risks identified and have wrked t share this infrmatin with their members in a reasnable fashin. HCCs have been prviding several types f training (clinical and nn-clinical) that enhance the HCC member s wrkfrce capability t respnd mre effectively t any hazard event r incident. The HCCs have been examining hw they can perate mre independently f federal funds s they are mre self-sufficient. Flrida has been wrking t cnslidate the HCCs t better align with the state s seven (7) 1 Hspital Preparedness Prgram infrmatin available at: 2 HHS ASPR (2017) Health Care Preparedness and Respnse Capabilities. Available at: 3 The Health Care Calitin in Emergency Respnse and Recvery. Available at: Page 7 f 16

8 FOUO Fr Official Use Only FHA Hurricane Irma After Actin Reprt / Imprvement Plan dmestic security regins with nminal success. This is being dne t maximize the impact f federal grant funds fr HCC develpment and sustainment. Sme HCCs are resistant t cnslidatin and this may limit the impact HCC dmestic security regin alignment and federal funds n reginal preparedness. Health Care and Medical Respnse Crdinatin This capability is centered n a HCC their jurisdictinal partners, and the ESF-8 lead agency planning and cllabratin t share and analyze infrmatin, manage and share resurces, and crdinate strategies t deliver medical care t all ppulatins during emergencies and planned events. Observatin: FHA is prviding the fllwing bservatins with the intent f explring strategies and methds f imprving a HCC s ability t prvide effective crdinate the health and medical respnse within a given cmmunity, regin, r as part f the state s respnse. Please cnsider the fllwing bservatins: There is variability acrss Flrida s HCCs n hw they crdinate plans with their members, share situatinal infrmatin, respnd with their ESF-8 lead (lcal and state), share r make available resurces t their members, r ther HCCs based n a request fr resurces, and cmmunicate relevant infrmatin based n the event. Many calitins believe there are statutry limitatins n their ability t respnd t a declared incident r emergency event. HCCs d assist their members in develping r imprving their emergency management plans. HCCs attempt t share infrmatin in a variety f ways (e.g., meetings, telecnferences, newsletters); but, there is pr visibility and awareness at the state ESF-8 level n what infrmatin a HCC is sharing r cllecting with and frm its members, r what means they are using t cmmunicate that infrmatin. FHA is aware f reprts f HCCs cmmunicating and sharing infrmatin with their members in crdinatin with their lcal ESF-8 lead agency during Hurricane Irma. FHA is als aware f that many hspital executives have limited awareness f HCCs and are nt regular recipients f situatinal infrmatin r cmmunicatins frm HCCs. There is rm fr HCCs t imprve sharing situatinal infrmatin with members, state ESF-8 and hspital executives. Cntinuity f Health Care Service Delivery This capability is aimed at ensuring the HCC, tgether with their ESF-8 lead agency prvide uninterrupted, ptimal medical care t all ppulatins in the face f damaged r disabled health care infrastructure. Observatin: FHA is prviding the fllwing bservatins with the intent f explring strategies and methds f imprving a HCC s ability supprt health care delivery within a cmmunity r acrss a regin in respnse t Hurricane Irma. Please cnsider the fllwing bservatins: Per ASPR s guidance, the HCC may assist in supprting and maintaining the missin essential functins that include: Pre-hspital care Inpatient services Outpatient care Skilled nursing facilities and lng-term care facilities Hme care Labratry Radilgy Pharmacy Supply chain management (leasing, purchasing, and delivery f critical equipment and supplies such as medical Page 8 f 16

9 FOUO Fr Official Use Only FHA Hurricane Irma After Actin Reprt / Imprvement Plan devices, bld prducts, persnal prtective equipment (PPE), and pharmaceuticals) Facility infrastructure Utilities (water, electricity, gas, sewer, and fuel) Medical gases Air handling systems (heating, ventilatin, and air cnditining [HVAC]) Telecmmunicatins and internet services Infrmatin technlgy (e.g., sftware and hardware fr EHRs and patient billing) Central supply Transprtatin services Nutritin and dietary services Security Laundry Human resurces FHA is nt aware f any activities by HCCs during Hurricane Irma that supprted these essential functins. While HCCs have been develping cntinuity f peratins plans fr themselves and their members, FHA is nt aware f any activity where HCCs wrked with their members t sustain peratins, per the HCC r facility s plans during Hurricane Irma. Sme HCCs maintain and manage a cache f nn-persnnel resurces. FHA had n awareness f the use f these resurces by HCCs in supprt f their member s respnse r maintenance f peratins during recvery. HCCs culd imprve infrming state ESF-8 n hw they are making resurces available t lcal prviders t maximize the use f state resurces and reduce the time spent by state ESF-8, and their supprting agencies and rganizatins, in managing a request fr resurces fr a health r medical prvider. FHA had n visibility as t hw a HCC may have assisted in prtecting infrmatin systems and netwrks f a lcal prvider. FHA had n visibility hw HCCs supprted respnder safety and health. FHA is aware that reginal emergency respnse advisrs and ther frward perating team members crdinated with HCC partners during Hurricane Irma fr initial damage assessment and recvery peratins. FHA has n knwledge f HCC supprt r crdinatin fr facility evacuatin an relcatin. In assisting hspitals with mving patients befre the strm s impact, FHA experienced sme lcal push-back and resistance with missin requests fr transprtatin assets r identifying available beds fr patient mvement that delayed respnse. FHA was nt aware f any HCC invlvement with patient mvement, hspital evacuatin r relcatin. FHA is nt aware f any HCC invlvement with facility recvery and the repening f clsed r evacuated hspitals fllwing Hurricane Irma s impact. There is rm fr HCCs t be mre invlved in the delivery f health and medical services t a lcal cmmunity r regin; and, t share thse activities and actins with State ESF-8 and their supprt agencies and rganizatins. Such imprvements wuld better prepare their members fr respnse and wuld better crdinate resurces with State ESF-8 fr missin supprt. Medical Surge This capability guides HCCs, including hspitals, EMS, and ut-f-hspital prviders, t have the ability t deliver timely and efficient care t patients even when the demand fr health care services exceeds available supply. The HCC, in cllabratin with the ESF-8 lead agency, shuld wrk t crdinate infrmatin and available resurces fr its members t maintain cnventinal surge respnse. Observatin: FHA is prviding the fllwing bservatins with the intent f explring strategies and methds f imprving a HCC s ability t supprt a medical surge event f any magnitude within a lcal cmmunity and its health and medical prviders. Please cnsider the fllwing bservatins: Page 9 f 16

10 FOUO Fr Official Use Only FHA Hurricane Irma After Actin Reprt / Imprvement Plan Medical surge was a significant prblem fr hspitals with Hurricane Irma, befre, during and after the strm. FHA received n reprts frm hspitals f HCC activity t reduce the impact f medical surge within their facility. Cmmunity preparedness cmplicated the prblem. The state s sheltering system failed t adequately meet the needs and demand f peple in bth general ppulatin and Special Needs shelters primarily due t insufficient resurces, bth material and persnnel. Because f this, hspitals absrbed mre peple frm the cmmunity adding t the surge f patients hspitals were already explring. HCCs can imprve hw they crdinate medical surge within their cmmunities and their members; hw they cmmunicate thse activities lcally and with state ESF-8. Over the years, FHA has wrked well with the department and supprted the HPP prjects and prgrams within Flrida. FHA remains cncerned abut the inactivity f sme HCCs and the impact it may pse n hspitals, first respnders and ther nn-acute prviders. FHA is als cncerned abut the pr cmmunicatin between lcal ESF-8 lead agencies and the HCCs and their cmmunicatin with State ESF-8. If infrmatin is being shared vertically t State ESF-8, it is nt being shared hrizntally amng all State ESF-8 supprt agencies and rganizatins. FHA recmmends the sharing f infrmatin is imprved at all levels thrugh a simplified reprt n lcal prvider and HCC actins and activities. FHA recmmends that State ESF-8 cnduct rutine cnference calls with HCC leads during an incident like Hurricane Irma t imprve crdinatin and cmmunicatin, as well as resurce supprt. FHA supprts the effective and efficient use f federal grant funds t imprve the health and medical respnse at the lcal, reginal and state level. Since 2016, FHA, alng with ther supprt agencies and rganizatins has had n specific infrmatin related t the use and allcatin f HPP funds at any level. FHA recmmends the department re-establish a statewide versight grup t imprve transparency t the use f such funds and t slicit feedback and input n hw t best structure the use f preparedness funding. Page 10 f 16

11 FOUO Fr Official Use Only FHA Hurricane Irma After Actin Reprt / Imprvement Plan FHA Lessns Learned FHA s respnse t Hurricane Irma fllwed ur natinal invlvement with the respnse t Hurricane Harvey. We als experienced an verlap in respnse due t the impact t Puert Ric frm Hurricane Maria. FHA respnded t the state emergency peratins center n Octber 6 and dembilized n Octber 17. FHA s activities during Hurricane Irma were enhanced frm the lessns learned during the 2016 hurricane seasn (i.e., Hurricanes Hermine and Matthew). Belw is a summary f FHA s lessns learned: FHA Incident Cmmand Cmmand: Safety: Liaisn: Public Infrmatin: Planning Operatins FHA s cmmand structure is limited but effective. FHA is versatile in its ability t scale its respnse, and cmmand structure t effectively respnse t ESF-8 s needs. Internally, FHA will wrk t train all emplyees n specific rles within the rganizatin s plan. FHA encurages staff have persnal preparedness plans and prvides infrmatin n hw an individual/family plan can be develped. FHA staff safety was paramunt with regards t the internal peratins f the rganizatin. FHA s team members respnding t the state emergency peratins center tk persnal safety in mind with their respnse and wrked virtually during the peak impact f the strm. FHA augmented its respnse capability by maximizing ur use f a liaisn fficer t facilitate infrmatin between hspitals, state agencies, private rganizatins and Flrida s elected delegatin (state and federal). FHA can better refine the functinal rle f this psitin. FHA experienced sme challenges with managing hspital calls due t state agency leaders schedules. FHA fund daily calls with hspitals t be effective and infrmatinal. FHA respnded t the usual amunt f media requests fr infrmatin and respnded in an apprpriate and timely manner. FHA will wrk t develp cnsistent times fr reprting tls and updates in alignment with ther data and infrmatin shared by the state emergency respnse team and state ESF-8. FHA revises it s plan regularly but nt annually. FHA will begin reviewing and updating its plan n an annual basis. FHA will infrm staff f changes t the plan, their individual rle in the plan s peratin, and the effects t their specific wrk-related duties. Page 11 f 16

12 Lgistics Finance State ESF-8 HCCs FOUO Fr Official Use Only FHA Hurricane Irma After Actin Reprt / Imprvement Plan FHA respnded t the state emergency respnse team effectively within the 6-hur threshld as cntracted by the Flrida Department f Health. FHA rtated staff effectively thrugh the state emergency peratins center and within the rganizatin. FHA will wrk t capture the hurs wrked by each team member when activated t serve the state emergency respnse team. FHA daily hspital calls were well received by the hspital cmmunity. FHA had n interruptins in supplies fr the missin-critical peratins f the rganizatin. FHA wrked with several hspitals and nn-acute prviders t infrm them f lgistic ptins and services available within the FHA Management Crpratin. FHA will wrk t better mnitr the expenses f the rganizatin as it relates t any given respnse with State ESF-8. FHA s rle with State ESF-8 is best served with the patient mvement branch and situatin unit. FHA and State ESF-8 shuld wrk t better crdinate hspital calls fr a cnsistent apprach and assurance f the Department f Health s representatin availability. State ESF-8 prvided adequate time fr FHA s respnse t the state emergency peratins center. State ESF-8 shuld ensure wrk area access (fr buildings/rms and internet) are prvided ahead f time and made available upn supprt rganizatin s arrival. State ESF-8 shuld prvide pint-f-cntact infrmatin fr all persnnel at the state emergency peratins center, fr reginal emergency respnse advisrs and cunty ESF-8 pints f cntact (primary phne number, secndary phne number and ) t all supprt rganizatins. State ESF-8 culd imprve its cntingency planning fr anticipated events resulting frm a hurricane s impact given lessns learned frm past events and advise / cunsel frm the supprt agencies and rganizatins. FHA had n visibility f hw HCCs were assisting lcal health and medical prviders respnd t Hurricane Irma, either thrugh infrmatin sharing r resurce allcatin. HCCs shuld define their rle and share it with State ESF-8 and prvide regular updates f their activities thrugh a declared event / incident. Hspitals Hspital perfrmed exceptinally well, given the widespread impact f Hurricane Irma. 36 hspitals evacuated. While there were requests t State ESF-8 and FHA fr supprt, there were n unmet needs fr hspitals that were nt addressed. Hspitals acrss Flrida wrked t prvide shelter and medical care t nn-acute prviders, cmmunity special needs shelter evacuees, individuals frm the cmmunity at risk r with special needs fr extended perids f time. Page 12 f 16

13 FOUO Fr Official Use Only FHA Hurricane Irma After Actin Reprt / Imprvement Plan Hspitals expressed a need fr husing / sheltering fr staff and family members f essential medical persnnel. Prviding hspitals with cell phne numbers f state leadership and agency leads bypasses the lcal EM structure and cmplicates the respnse prcess. Hspitals wh lst utility prvisin (e.g., water, sewage r pwer) did nt have thse utilities restred in a unifrm manner as critical infrastructure. Nn-Acute Prviders Nn-acute prviders planning needs imprvement t better align with the new requirements by the Center fr Medicare and Medicaid Services. Nn-acute prviders struggled with evacuatin fr many reasns (e.g., ineffective planning, failure t activate their plans within a timely manner, inadequate resurce supprt, pr integratin with lcal partners, etc.). Nn-acute prviders sent patients t hspitals and special needs shelters as a respnse t inadequate plans and respnse. Pwer interruptin and inadequate alternate pwer resurces caused many nn-acute prviders t evacuate their facilities and mve patients after the strm passed. Prviding nn-acute prviders with cell phne numbers f state leadership and agency leads bypasses the lcal EM structure and cmplicates the respnse prcess. Utility Prviders and Pwer Utility prviders, primarily at the lcal level, struggle t categrize hspitals as critical infrastructure and respnd apprpriately t restre utilities (e.g., water, sewage and pwer) in a timely manner befre ther business and residential areas within a given cmmunity. Public and private utility prviders shuld immediately act t restre pwer and prvide generatr refueling fr acute care hspitals, critical access hspitals, lng-term acute care hspitals, skilled nursing facilities, assisted living facilities and Special Needs Shelters as a pririty alng with ther critical infrastructure cmpnents; and d s at their wn expense. State ESF-8 shuld have direct cntact infrmatin fr lcal utility prviders, in cllabratin with ESF-12. Patient Mvement The patient mvement branch perfrmed effectively. Having the federal ambulance strike team crdinatin persnnel in the rm with the patent mvement branch was very helpful. Re-entry and re-pening prcedures fr licensed, residential health care prviders were prvided by the Agency fr Health Care Administratin in a timely manner. 36 hspitals evacuated. Resurce Allcatin State ESF-8 and the Department f Health shuld cnsider prgrams and prcedures that are autmated fr effect given specific hazards t imprve lcal respnse. Specific examples include: Placard prgram fr essential medical resurce transprtatin assets allwing access int evacuated / impacted areas where there is a hspital within the cmmunity needing re-supply; Establishing multiple vendr relatinships fr critical supply needs (e.g., xygen, generatrs, fuel, etc.); and, Page 13 f 16

14 Medical Vlunteers FOUO Fr Official Use Only FHA Hurricane Irma After Actin Reprt / Imprvement Plan Augmenting the State Lgistics Resurce Center and ther Department f Health strage facilities t utilize a health care supply chain management cmpany t prvide vendrmanaged inventry f health and medical supplies fr emergency respnse fr acute care hspitals, critical access hspitals, lng-term acute care hspitals, skilled nursing facilities, assisted living facilities, EMS agencies, and Special Needs Shelters. It cntinues t be evident the state des nt have a wrking system t rster functinal teams f medical vlunteers f any size r t serve. The Flrida Department f Health shuld cnsider alternative mechanisms t develp, train, sustain, rster and activate vlunteer medical teams. At-Risk Ppulatins and Special Needs Shelters Special Needs Shelters within many cunties were unable t meet the demand f the citizens they serve. The Department f Health shuld cnsider prpsals t imprve the existing sheltering system fr the general ppulatin and individuals with special needs t ensure the resurces, bth material and persnnel, are adequate t meet the needs f all individuals seeking safe harbr within a lcal, shelter envirnment. FHA supprts achieving a fully functinal, sheltering system. FHA encurages nn-acute prviders t regularly enrll medically fragile clients with the state s Special Needs Registry system t better identify the health and medical needs f the mst at-risk individuals within a licensed, nn-acute health care facility. FLHealthSTAT FLHealthSTAT (FHS) wrked well withut majr difficulties. FHA has prvided the supprt team develping FHS with specific recmmendatins fr imprvement. Recmmendatins included: Prviding mre training t end users; Develping a simpler reprting tls that prvides critical infrmatin in a shrt frmat; and, Prviding grup access fr hspital systems. FHS still des nt address patient tracking. Cmmunity Preparedness There is a need fr mre cmmunity preparedness (e.g., persnal preparedness planning). Mre prmtin and marketing f the Special Needs Registry shuld be prvided t the public t reduce the number f unregistered peple reprting t shelters with n prir knwledge r resurces t supprt their needs. Recvery Operatins The Divisin f Emergency Management was mre frthcming with infrmatin abut the recvery prcess with hspitals and ther licensed health facilities. Key pints f cntact were shared early in the recvery prcess. The Divisin f Emergency Management was respnsive t questins frm hspitals and prvided fllw-up in a timely manner. There is n single, easy t use, reference dcument r guidelines fr licensed health care facilities instructing them n the recvery prcess. Page 14 f 16

15 FOUO Fr Official Use Only FHA Hurricane Irma After Actin Reprt / Imprvement Plan Cnclusin FHA is pleased t prvide feedback and infrmatin t the Department and State ESF8 n hspital and health and medical system respnse t Hurricane Irma. As stated, this infrmatin is designed t prvide insight int strengths and weaknesses that may help drive imprvement at all levels f preparedness, respnse and recvery actins. FHA encurages all agencies and grups t wrk tgether t imprve the emergency management f incidents like Hurricane Irma fr health care facilities and prviders, public agencies and the cmmunities acrss Flrida deserving f a resilient health and medical system. FHA will wrk t prvide infrmatin, supprt, guidance and resurces fr imprvement t hspital emergency management. The lessns learned frm Hurricane Irma will be reflected in thse activities, publicatins and infrmatin. Page 15 f 16

16 FOUO Fr Official Use Only FHA Hurricane Irma After Actin Reprt / Imprvement Plan End f Dcument Page 16 f 16