Northeast Florida Healthcare Coalition Multi-Year Strategic Plan ( )

Transcription

1 INTRODUCTION Northeast Florida Healthcare Coalition Multi-Year Strategic Plan ( ) The Northeast Florida Healthcare Coalition (NEFLHCC) was organized in early 2014 with six county and four discipline group partner members. The start-up requirements and deliverables that were addressed by the NEFLHCC Executive Committee were established through funding provided by the Assistant Secretary for Preparedness and Response Hospital Preparedness Program (ASPR/HPP) through the Florida Department of Health (FDOH) and FDOH in Duval County. Although a multi-year strategic plan was not a deliverable under this funding, it was a priority with the Executive Committee and components of various deliverables are integrated into this plan. It is acknowledged by the NEFLHCC Executive Committee that the grant period did not allow sufficient time to carry out some activities that would have typically been a part of the strategic planning process; however, this plan provides the foundation of the Coalition s mission and additional processes and procedures will be instituted in future years that will continue to build and enhance the organizational goals and objectives. The Strategic Plan brings together the various components of the NEFLHCC s founding tasks and efforts, and constructs a snapshot of the organization s current capabilities, resources and gaps. This document then informs the Coalition s future activities and initiatives. This plan is intended to be revised and built upon in future years, as the organization expands and matures, and the goals and objectives adapted to changing preparedness and response requirements and environments. Future activities related to the risk assessment and gap analysis should include workshops to include all Coalition partners to ensure that a comprehensive process is established. In addition, as new or revised data is identified the risk assessment process will include periodic updates to ensure that it will serve as timely guidance for project development. NEFLHCC Strategic Plan (Approved 6/26/14) Page 1

2 REFERENCES Northeast Florida Healthcare Coalition Charter (6/9/14, amended 6/26/14) Northeast Florida Healthcare Coalition Bylaws (6/9/14, amended 6/26/14) Northeast Florida Healthcare Coalition Executive Committee Meeting Minutes (3/14/14, 4/4/14, 5/27/14, 6/9/14, 6/26/14) County Comprehensive Emergency Management Plans (CEMP), various dates. (Baker, Clay, Duval, Flagler, Nassau and St. Johns) County Threat and Hazard Identification and Risk Assessments (THIRA) (Baker, Clay, Duval, Flagler, Nassau and St. Johns) County Health Department Vulnerable Populations Assessments (VPA), June (Baker, Clay, Duval, Flagler, Nassau and St. Johns) Jacksonville Urban Area Security Initiative (UASI) Gap Analysis (March 30, 2009) Regional Domestic Security Task Force 3 Capability Assessment, 2010 Healthcare System Preparedness Guidance (Department of Health and Human Services/Assistant Secretary for Preparedness and Response), January 2012) Incorporating Medical and Social Vulnerability into an All-Hazards Assessment for the State of Florida, Hazards and Vulnerability Research Institute Department of Geography University of South Carolina, August 3, Florida Healthcare Coalition Task Force Risk Assessment Tool NEFLHCC Strategic Plan (Approved 6/26/14) Page 2

3 HAZARD IDENTIFICATION Methodology The hazard identification process for this strategic plan began with the hazard identification and analysis sections of the Baker, Clay, Duval, Flagler, Nassau and St. Johns Counties Comprehensive Emergency Management Plans (CEMP). Because the CEMP serves as the local jurisdictions foundation for emergency planning, exercise design and resource allocation, the data and information presented in these documents was considered to be valid and current. In addition, specific hazard information in the CEMPs is obtained from a broad range of sources and has been validated through the planning process. The hazard listings, which included selected levels of probability, potential impact, and vulnerability were extracted from the CEMPs and placed into a single matrix. Also included were descriptions of potential impacts to the public health and medical systems, if described within the hazards analyses. Table 1: Identified Hazards (by county) and probability, impact and vulnerability ranking Hazard Tropical Cyclones Impacts/Consequences mass care; sheltering; shortto long-term housing; responder health and safety; infrastructure, economic and social disruption; widespread psychological impacts; Rank** County P I V B C D F N SJ H H H x x x x x x Severe Weather (tornado, wind, coastal storms) power outage; tornado; road closures; health/safety; water supply contamination; mass care; environmental contamination L-H MH M- H x x x x x x Flood road closures; responder health and safety; water supply contamination; evacuation; mass care; environmental contamination H Mn- M M- H x x x x x x Drought reduced water supply; reduced food supply; wildfires; infrastructure disruption M- MH Mn- Mj H x x x x x Extreme Temperatures power failure; heat stroke and exhaustion; cold weather sheltering; short-term economic and social disruption M Mn- Mj M x x x x x NEFLHCC Strategic Plan (Approved 6/26/14) Page 3

4 Hazard Mass Migration/Civil Disturbance Wildfire Dam/Levee Failure Agricultural (exotic pest, disease) Sinkholes/Landslides Earthquake Tsunami Biological Technological (communications, transportation, cyber, hazardous materials accidents, coastal oil spill, major power failure, critical infrastructure disruption, etc.) Terrorism Impacts/Consequences sheltering/shelter-in-place; mass care evacuation; large scale sheltering; air quality issues; temporary lack of access to medical services evacuation; mass care; psychological impacts; infrastructure damage or loss; responder health and safety mass casualty/fatality; infectious disease control measures; mass care; medical surge; quarantine; impact to food supply Minimal potential for environmental damage or loss; emergency medical Minimal potential for mass care, mass casualty/fatality, hazardous material accident, infrastructure disruption evacuation; large scale sheltering; mass casualty/fatality; water supply contamination; hazardous material accident Mass casualty/fatality; infectious disease outbreak; mass feeding; mass care; medical surge; quarantine; responder health and safety; alternate care sites; Mass casualty/fatality; responder health and safety; sheltering/shelter-in-place; large scale contamination/mass decontamination; mass feeding; mass care; contaminated land/water; psychological needs; medical surge Responder health and safety; Infectious disease outbreak; mass casualty/fatality; large scale contamination; psychological needs Rank** County P I V B C D F N SJ L M Mn- Min M- Mj L x x x L x x x x x N-L N N x x L L L x x L N L x N L N x L L L- ML L L Min- M L-M Min- M L- Min L- MH M- H x x x x x x x x x x H x x x x x NEFLHCC Strategic Plan (Approved 6/26/14) Page 4

5 Hazard Nuclear/Radiological Incident Impacts/Consequences sheltering/shelter-in-place; mass care; medical surge; mass casualty; responder health and safety; long-term public health issues; long-term environmental impact Rank** County P I V B C D F N SJ L M Mn x x x Special Events Mass casualty/fatality L L Mn x x * Sources: Baker, Clay, Duval, Flagler, Nassau and St. Johns Comprehensive Emergency Management Plans ** Ranks are composites of the individual ranks in each of the six county CEMPs. Table Labels P= Probability of hazard occurrence I= Type/Severity of impact V=Vulnerability level H= High MJ = Major MH = Moderately High M=Moderate ML= Moderately Low Min=Minor Mn=Minimal L= Low N=None or unlikely A second matrix was developed from the hazards listed in Table 1, and assigned numerical values in order to quantify the probability, impact, and vulnerability levels defined within the plans and provide a picture of overall risk. This process was used as a ranking system to identify the hazards that were considered to be the highest risk in that they had a high level of probability, the broadest potential impact, and/or created high or significant vulnerabilities for the populations at risk. The top ten (10) hazards were considered for the purpose of this risk assessment. Table 2: Hazard Ranking Scoring System Level Score H= High 8 MJ-Major 7 MH = Moderately 6 NEFLHCC Strategic Plan (Approved 6/26/14) Page 5

6 High M=Moderate 5 ML= Moderately Low 4 Min=Minor 3 Mn=Minimal 2 Using the numerical scoring system described above, total ranking scores for hazards ranged from 1 to 24, with the higher the number indicating the higher priority of the hazard. Table 3: Hazard Rankings by Probability, Impact, Vulnerability and Overall Risk Hazard Overall Probability* Overall Impact* Overall Vulnerability* Overall Risk Score Tropical Cyclones Flood Severe Weather (tornado, wind, coastal storms) Extreme Temperatures Terrorism Technological (communications, transportation, cyber, hazardous materials accidents, major power failure, critical infrastructure disruption, etc.) Drought Wildfire Biological Nuclear/Radiological Incident Mass Migration/Civil Disturbance Tsunami Special Events Agricultural (exotic pest, disease) Sinkholes/Landslides Dam/Levee Failure Earthquake *Approximate average of individual county rankings NEFLHCC Strategic Plan (Approved 6/26/14) Page 6

7 Tan-filled cells indicate the top ten (10) ranked hazards VULNERABILITY AND RISK ASSESSMENT Methodology The Northeast Florida Healthcare Coalition Risk Assessment Tool is included in this plan as Attachment 1. As background to the development of the Risk Assessment Tool, multiple sources of information were reviewed to obtain an understanding of the various levels of vulnerability and disparate distribution across the six-county NEFLHCC region. Additional sources of data and information will be identified and incorporated into future updates of this assessment. County Comprehensive Emergency Management Plans (CEMPs) Initially, the impact and vulnerability descriptions from the six county CEMPs provided the basis of determining the hazards with the highest potential for risk. The top ten hazards then became the focus of the vulnerability and risk assessment. The next level of assessment considered social vulnerability and medical vulnerability 1. This information was used as a point of consideration for each county to provide further understanding of potential vulnerabilities related to the healthcare system in general. While this data assisted in pointing out percentages and numbers of population potentially at risk within each county, it was not the sole basis of the risk assessment. Regional Threat and Hazard Identification and Risk Assessment (THIRAs) During the process to develop this risk assessment, it was noted that the Regional Threat and Hazard Identification and Risk Assessment (THIRA) would assist in defining risks and vulnerabilities; however, the time needed to acquire and analyze this data was not available during the initial risk assessment process. NEFLHCC will obtain this information for the next update process. Social and Medical Vulnerability Indices The concept of vulnerability provides a mechanism for understanding the interactions between social and ecological systems and how these interactions can result in hazards and disasters. The Social Vulnerability Index (SoVI) is based on characteristics of social groups that influence their capacity to prepare for and respond to environmental threats. The SoVI variables used for this assessment were based on the following 1 Incorporating Medical and Social Vulnerability into an All-Hazards Assessment for the State of Florida (SoVI), Hazards and Vulnerability Research Institute Department of Geography University of South Carolina, August 3, NEFLHCC Strategic Plan (Approved 6/26/14) Page 7

8 categories of population characteristics used in the 2010 Florida Department of Health report. 2 Population Characteristic and Specific Variables Race & Ethnicity Socioeconomic Status Gender Age Rural/Urban Renters Residential property Occupation Family Structure Employment Education Influence on Social Vulnerability Language and cultural barriers for disaster preparedness and response; affects access to preand post-disaster resources; minority group tendency to occupy high hazard areas Affects community ability to absorb losses; wealth enables communities to recover more quickly using insurance, personal resources; poverty makes communities less able to respond and recover quickly Women often have a more difficult time coping after disasters than men due to employment sector (personal services), lower wages, and family care responsibilities Age extremes (elderly and very young) increase vulnerability; parents must care for children when day care facilities are not available; elderly may have mobility or health problems Rural residents may be more vulnerable due to lower wealth and dependence on locally-based resource economy (farming); high density urban areas complicate evacuations and sheltering Renters are viewed as transient populations with limited ties to the community; they often lack shelter options when lodging becomes uninhabitable Value, quality, and density of residential construction affects disaster losses and recovery; expensive coastal homes are costly to replace; mobile homes are easily damaged Some occupations, especially those involved resource extraction (fishing, farming, forestry) can be affected by disasters; service sector jobs suffer as disposable income declines; infrastructure employment (transportation, communications, utilities) is subject to temporary disruptions postdisaster Families with large numbers of dependents or single parent households may be more vulnerable because of the need to rely on paid caregivers Communities with high numbers of unemployed workers (pre-disaster) are viewed as more vulnerable, because jobs are already difficult to obtain; this slows the post-disaster recovery Limited educational levels influence ability to understanding warning information, likely disaster impacts; access to post recovery resources 2 SoVI, page 4 NEFLHCC Strategic Plan (Approved 6/26/14) Page 8

9 Population Characteristic and Specific Variables Population Growth Social Dependency and Special Needs Populations *Source: Heinz Center 2002; Cutter et al (SoVI-FL2010) Influence on Social Vulnerability New immigrant populations lack language skills and are unfamiliar with state and federal bureaucracies in how to obtain disaster relief; may not be permanent or legal residents; unfamiliar with range of hazards in area Residents totally dependent on social services for survival are often economically marginalized and thus more vulnerable; special needs populations (infirmed) require more time for evacuation and recovery is often difficult. Using the SoVI-FL2010, social vulnerabilities in the six NEFLHCC member counties can be identified by percentages and total number of population. Table 4: Social Vulnerability Rank (% of county population by vulnerability class)* Ranking County Low Medium Low Medium Medium High High Baker 0.00% 19.85% 80.15% 0.00% 0.00% Clay 0.00% 51.66% 45.55% 2.78% 0.00% Duval 8.47% 34.26% 40.15% 10.73% 6.39% Flagler 0.00% 3.36% 80.04% 16.60% 0.00% Nassau 0.00% 55.76% 44.24% 0.00% 0.00% St. Johns 7.32% 67.19% 23.30% 2.19% 0.00% *Source: SoVI-FL2010 Gray-filled cells indicate highest percentage category by county Table 5: Social Vulnerability Rank (total county population by vulnerability class) County Low Medium Low Ranking Medium Medium High High Baker 5,381 21,734 Clay 98,608 86,946 5,311 Duval 73, , ,000 92,745 55,194 Flagler 3,217 76,595 15,884 Nassau 40,878 32,436 St. Johns 13, ,689 44,284 4,155 Gray-filled cells indicate highest percentage category by county NEFLHCC Strategic Plan (Approved 6/26/14) Page 9

10 Additional research makes a clear distinction between health risk and health need. While the Social Vulnerability Index (SoVI) assists in identifying sensitive populations, the indicators of health needs in the Medical Vulnerability Index (MedVI) identify individuals and communities with inherent medical vulnerability independent of other factors. Research in recent years has focused on characteristics that contribute to potential for harm, that include individual medical needs, community healthcare access and health system capability. These characteristics are derived not only from direct disaster impacts on the exposed population, but also impacts on the healthcare system that include the interruption of key medical services. For the purpose of this assessment, the following medical vulnerability concepts are considered: 3 Table 6: Medical Vulnerability Concepts and Descriptions Concept Physical health needs Psychological health needs Healthcare access Health System Equity Description Individuals dependent on the public healthcare system for medication, medical treatments, equipment, or supervision from skilled medical professionals to maintain quality of health and life. Examples include chronic illness, communicable diseases, physical disability or immobility. Individuals with psychological or psychosomatic disorders, or having mental ilimi8tations that often require medical consideration including medication, therapy, supervision, and in some acute cases institutionalization. Conditions include, but are not limited to depression and mental illness, dementia, and mental retardation. Individuals or communities with limited access to healthcare resources, either through direct local scarcity of healthcare providers, or through financial proxies such as insurance status. Resources maintained by the local healthcare system that prepare for emergencies and help to build medical surge capacity during disasters. Proxies include emergency medical vehicles and personnel, a diverse set of medical professionals, CERT capacity, and Home Health Agencies Increases (=), or Decreases (-) Vulnerability Extensive physical health needs of the individuals within a community (+) Extensive psychological health needs of the individuals within a community (+) Increased access (-), decreased access (+) Increased capability (-), decreased capability (+) The MedVI process identifies the potential number of vulnerable populations in each of the NEFLHCC counties. 3 SoVI, page 43. NEFLHCC Strategic Plan (Approved 6/26/14) Page 10

11 Table 7: Medical Vulnerability (total population within each MedVI classification by county) County Ranking Low Medium High Baker 0 6,684 20,431 Clay 190, Duval 565, ,174 34,821 Flagler 0 71,175 24,521 Nassau 73, St. Johns 164,184 18,182 7,673 County Health Department Vulnerable Populations Assessment 2013 The next step in the risk assessment process was to collect the vulnerable population data from each of the six County Health Departments. This data was developed with the assistance of the Northeast Florida Regional Council in early 2013 and built the picture of vulnerable populations based on the ten categories established by the Florida Department of Health. The Local Vulnerable Population Assessment for participating counties was a comprehensive project that assessed the status of the County s vulnerable population in ten defined categories. The assessment covered vulnerable populations data and accompanying statistics based on the 2010 census and estimated population for This informational assessment provided County Health Departments and County Emergency Preparedness with an additional tool in planning for potential vulnerability in specific populations. The table below provides the most recent data available for vulnerable populations. This information was taken into consideration during the risk assessment process for each of the high-ranking hazards. Table 8: Total population within vulnerability categories, by county Vulnerability Baker Clay Duval Flagler Nassau St. Johns Elderly 2,956 3,127 22,292 24,842 96, ,720 23,405 28,126 11,908 13,100 29,793 34,522 Disabled 3,383 3,579 27,621 30,781 99, ,210 14,052 16,887 10,635 11,699 21,031 24,369 Non-English 0 o 18,404 20,509 8,932 9,311 5,168 6, ,800 4,403 Population in shelters 2,344 2,480 1,251 1,394 6,311 6,579 4,492 5, ,798 3,242 Dialysis N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A N/A Developmentally Disabled 6,562 6,943 54,015 60, , ,617 21,053 25,300 17,375 19,114 43,899 50,866 Community-based 3,010 3,185 17,560 19,569 68,168 71,061 7,656 2,879 5,205 5,726 15,013 17,396 Specialty Care ,139 1,269 1,787 1, ,199 1,389 Migrant Populations 953 1,008 2,685 2,992-1,050-1, , ,468 7,495 Economically Disadvantaged 6,033 6,383 6,033 6, , ,132 25,902 7,734 20,025 22,039 52,589 60,936 TOTAL COUNTY POPULATION 27,115 28, , , , ,945 95, ,000 73,314 80, , ,201 Source: NEFRC, 2013 NEFLHCC Strategic Plan (Approved 6/26/14) Page 11

12 Healthcare Hazard Vulnerability Assessments Many healthcare facilities have conducted Hazard Vulnerability Assessments; however, there was insufficient time to acquire this data during the initial risk assessment. The healthcare facility assessments will be reviewed for future updates to the NEFLHCC risk assessment. Coalition Risk Assessment Tool Finally, the Coalition Risk Assessment Tool (Exhibit 3, Deliverable 5) was slightly modified to further identify associated risks, contingencies and gaps using an allhazards approach that is applicable to the top ten hazards. Data from the above sources was used to describe associated risks, contingencies, capability gaps and resource gaps. In addition, supporting evidence was identified, where it could be linked to a specific reference document. The Risk Assessment Tool is included in this document as Attachment A. NEFLHCC Strategic Plan (Approved 6/26/14) Page 12

13 GAP ANALYSIS Methodology Due to the limited timeframe available to perform the Coalition s initial risk assessment and gap analysis, potential gaps were identified from existing current capability assessments, gap analysis, and input from members. The Regional Domestic Security Task Force Capability Assessment, 2010 also served as a source of information for capability gaps. In addition, the After Action Report/Improvement Plan from the Coalition s full-scale exercise in May 2014 provided specific recommendations and corrective actions that were incorporated in the risk assessment and gap analysis. The process used to develop this assessment included participation from multiple counties and disciplines. Identified gaps are described in the Risk Assessment Tool, Attachment 1. NEFLHCC Strategic Plan (Approved 6/26/14) Page 13

14 NEXT STEPS Goals and objectives of the NEFLHCC are described in the organization s Charter, but are summarized below: Goal The goal of the Coalition is to promote and enhance the emergency preparedness and response capabilities of the healthcare systems in member Counties and the region in general. Objectives Improving community-based healthcare infrastructure by helping partners to prepare for disasters with public health impact. Capability-based planning which supports the National Health Security Strategy and builds upon the strong preparedness foundation already in place at the local level. The following eight capabilities serve as the basis for HCC preparedness: o Healthcare System Preparedness o Healthcare System Recovery o Emergency Operations Coordination o Fatality Management o Information Sharing o Medical Surge o Responder Safety and Health o Volunteer Management Community Risk Assessment that uses a capability-based approach to preparedness and response and includes jurisdictional risk assessments that identify potential hazards, vulnerability, and risks within the community that relate to the public health, medical, and mental/behavioral systems inclusive of at-risk individuals. Leveraging resources - partners enhance a community s response capability through shared planning, organizing, equipping, training, exercising and evaluating activities related to disaster operations Staged approach that builds on existing partnerships and their relationship to their regional domestic security structure and enhances the multi-jurisdictional and multi-agency coordination during response through capacity-building from exercises and real-life incidents. NEFLHCC Strategic Plan (Approved 6/26/14) Page 14

15 Multi-Year Strategic Work Plan This section of the Strategic Plan is a compilation of the goals, objectives, risk assessment and gap analysis that identifies specific activities, projects and initiatives developed to enhance the Coalition s level of preparedness and response in future years. Budget Period 2 is used as the baseline for FY planning, noting requirements are to be completed by the end of the project period in 2017, as well as additional objectives identified by the Coalition s member organizations. GOAL: On-going/Annually Maintain outreach to healthcare system providers and services to engage executives and clinical leaders in the Coalition. Monitor capability and resource gaps with Coalition members Coordinate development of a Coalition-based Multi-Year Training and Exercise Plan that incorporates county and discipline resources and needs. GOAL: FY (Budget Period 3 June 30, 2015) By End of September 2014 Obtain signatures of agency executives on the NEFLHCC Charter Seat all confirmed Executive Board representatives Elect Coalition Officers By End of December 2014 Complete coalition-wide hazard identification and risk assessment (HIRA) Conduct EMResource training for Coalition members By End of February 2015 Develop a list of projects, prioritized by most important to the HCC (this list should address items in the gap analysis and prioritized by the HIRA) Develop an information sharing protocol that addresses situational awareness and common operating picture, to support HCC response activities By End of April 2015 Conduct continuity of operations training for Coalition members and agency representatives; and monitor progress in developing and implementing a continuity program. NEFLHCC Strategic Plan (Approved 6/26/14) Page 15

16 Conduct EMResource training for Coalition members By End of June 2015 Develop a Coalition Communications Regional Coordination Plan/Procedure Develop a Coalition Resource Allocation and Management Regional Coordination Plan/Procedure Develop a Coalition Behavioral Health Plan/Procedure Plan a coalition-wide tabletop exercise to be conducted in FY GOAL: FY (Budget Period 4 June 30, 2016) Develop a Coalition Pandemic Influenza Regional Coordination Plan Develop a Coalition Mass Fatality Regional Coordination Plan Conduct a functional exercise with Coalition members GOAL: FY (Budget Period 5 June 30, 2017) Develop a Coalition Healthcare Recovery Regional Coordination Plan/Procedure Conduct a full-scale exercise with Coalition members NEFLHCC Strategic Plan (Approved 6/26/14) Page 16