Assessing Risk: Shifting Focus from Hazards to Capabilities. Jane Coolidge Kara Walker CMRHCC April 2017

Transcription

1 Assessing Risk: Shifting Focus from Hazards to Capabilities Jane Coolidge Kara Walker CMRHCC April 2017

2 Hazards Vulnerability Analysis (HVA): Overview To identify jurisdictional hazards To assess hazard related impacts (the extent of damage/response needs/consequences/ severity) on people, property and community services. To determine the shortfall between impact damage/response needs and the current ability to respond to each hazard (vulnerability). 2

3 Current Model modified Kaiser Permanente EVENT SCORE 1. PROBABILITY Likelihood this will occur 0 = N/A 1 = Low 2 = Moderate 3 = High SEVERITY = (MAGNITUDE - MITIGATION) 2. HUMAN IMPACT Possibility of death or injury 0 = N/A 1 = Low 2 = Moderate 3 = High 3. PROPERTY IMPACT Physical losses and damages 0 = N/A 1 = Low 2 = Moderate 3 = High 4. COMMUNITY IMPACT Interuption of services 0 = N/A 1 = Low 2 = Moderate 3 = High 5. REGIONAL PREPARED- NESS Preplanning 0 = N/A 1 = High 2 = Moderate 3 = Low or none 6. REGIONAL RESPONSE Time, effectivness, resouces 0 = N/A 1 = High 2 = Moderate 3 = Low or none 7. EXTERNAL RESPONSE Community/ Mutual Aid staff and supplies 0 = N/A 1 = High 2 = Moderate 3 = Low or none RISK Relative threat* 0-100% Ice Storm % Heavy Snow, Blizzard % Flood % Lightning % Severe Thunderstorm % Drought % Hurricane % Urban Fires % Heat Wave % Tornado % Pandemic/Epidemic % Wild Fire % Dam Inundation % Landslide % Damaging Earthquake % Tsumani % AVERAGE SCORE % *Threat increases with percentage. 20 RISK = PROBABILITY * SEVERITY Apr-16 3

4 HVA as Gap Analysis The outcome of the HVA is a list of jurisdictional hazards rated from most vulnerable to least vulnerable based on current jurisdictional preparedness to respond. The hazards that are identified as the most probable to occur and having the greatest impact (consequence) which also have a low preparedness (mitigation score) become the hazards of most concern (vulnerability). These hazards require further jurisdictional response planning, training and exercising to increase the level of preparedness to therefore decrease the vulnerability to that hazard. 4

5 Hazards Vulnerability Analysis (HVA) CMRHCC HVA Results 2016 (Partial Listing) Naturally Occurring Events 1. Ice Storm 78% 2. Heavy snow, Blizzard 67% 3. Flood 56% 4. Lightning 50% 5. Severe Thunderstorm 50% 6. Drought 48% 7. Hurricane 48% 8. Urban Fires 44% 9. Heat Wave 39% 10. Tornado 39% 11. Pandemic/Epidemic 37% Technological Hazards Human Hazards Hazardous Materials 5

6 Reframing the HVA: Conceptual Framework Hazards Public Health Consequences Response Capabilities 6

7 Reframing the HVA: Capability Based Planning The Assistant Secretary for Preparedness and Response (ASPR) has determined that all public health emergency preparedness and response functions can be condensed into 4 broadly defined Hospital Preparedness Program (HPP) Capabilities. The HPP Capabilities are not hazard specific They have broad application to a wide variety of hazards 7

8 Capabilities vs Hazards It is suggested here that it is not as much the hazard that makes us vulnerable but the lack of preparedness relative to the Capabilities. Therefore it is suggested that the focus for preparedness should be on mastering performance of the Capabilities rather than responding to specific hazards. Actual All Hazard Planning 8

9 The 4 HPP Capabilities: Capability 1: Foundation for Health Care and Medical Readiness Goal of Capability 1: The community s health care organizations and other stakeholders coordinated through a sustainable HCC have strong relationships, identify hazards and risks, and prioritize and address gaps through planning, training, exercising, and managing resources. Capability 2: Health Care and Medical Response Coordination Goal of Capability 2: Health care organizations, the HCC, their jurisdiction(s), and the ESF-8 lead agency plan and collaborate to share and analyze information, manage and share resources, and coordinate strategies to deliver medical care to all populations during emergencies and planned events. Capability 3: Continuity of Health Care Service Delivery Goal of Capability 3: Health care organizations, with support from the HCC and the ESF-8 lead agency, provide uninterrupted, optimal medical care to all populations in the face of damaged or disabled health care infrastructure. Health care workers are well-trained, welleducated, and well-equipped to care for patients during emergencies. Simultaneous response and recovery operations result in a return to normal or, ideally, improved operations. 9

10 The 4 HPP Capabilities: Capability 4: Medical Surge Goal of Capability 4: Health care organizations including hospitals, EMS, and out-ofhospital providers deliver timely and efficient care to their patients even when the demand for health care services exceeds available supply. The HCC, in collaboration with the ESF-8 lead agency, coordinates information and available resources for its members to maintain conventional surge response. When an emergency overwhelms the HCC s collective resources, the HCC supports the health care delivery system s transition to contingency and crisis surge response and promotes a timely return to conventional standards of care as soon as possible. Associated with each Capability and stated goal is a set of objectives with associated activities. Together these more specifically define the intent and expectations for each of the Capabilities. 10

11 Capability Based Planning Annually assess ability to perform the Capabilities and their associated critical activities Identify gaps in ability to perform the various Capabilities The goal: to fully develop the ability to perform each Capability as defined by the critical activities through preparedness planning, training and exercising The lesser developed Capabilities provide the foundation for further preparedness planning and testing; and for the development of exercise objectives The purpose of an exercise would be to test, measure and validate performance of chosen (least developed) capabilities and their associated critical activities 11

12 Capability Based Planning: Hazards List However, still need to complete an annual jurisdictional hazards list The identification of jurisdictional hazards and their severity (defined by public health consequences) remain central to preparedness planning List the jurisdictional hazards in order of most likely/ most severe (consequences) to the least likely/least severe The hazards list is then used to choose jurisdictional specific hazard scenarios (most likely and severe) within which to test and exercise the all hazards Capabilities in most need of further development. 12

13 Consequences or Impacts of Hazards The anticipated severity of each hazard is estimated to include the anticipated impact (consequences) of each hazard on people, property and community services (severity). However, consequences are not specific to specific hazards: water source contamination can occur from a variety of hazards from flooding to terrorism mass casualties can occur from a train wreck or an active shooter medical surge due to illness can generate from influenza to exposure to toxic substances public distress occurs to some extent with all hazards. 13

14 Consequences or Impacts of Hazards: Listing Prolonged power outage/ power grid failure; summer heat; winter cold: widespread Major infrastructure damage; roads, homes, businesses, schools, public buildings: widespread Major communications disruption: widespread Information systems failure: widespread Transportation disruption; roads, rail, planes: widespread Supply disruption/ shortages: food, and other necessary commodities: widespread Fuel shortage: widespread Food contamination/spoilage: widespread Water supply contamination: widespread Water shortage: widespread Mold growth: widespread occurrence Carbon monoxide poisonings: numerous occurrences with some deaths 14

15 Consequences or Impacts of Hazards: Listing cont. Major hazmat exposure/contamination; chemical, radiological, biological, nuclear: widespread/significant numbers Public displacement: evacuation to shelters: significant numbers Shelter in place: significant numbers Security issues: civil disturbance, disobedience: riots/ looting; protection of scarce resources/assets Medical Surge: trauma (MCI); illness (due to food, water, or toxic exposures) Medical Surge, infectious disease: Influenza, widespread; Ebola (due to the intensity of the resources needed to care for one patient); Mass Fatalities: overwhelms local/regional capacity Public distress: from stress and anxiety to fear and panic 15

16 Crosswalks Two crosswalks were completed o Hazards were cross walked with Public Health Consequences o Public Health Consequences were cross walked with Capabilities These crosswalks are subjective and not intended to be set in stone The crosswalks are offered in order to demonstrate: o Very different hazards can result in similar Public Health Consequences o The set of response Capabilities can be used to respond to a variety of Public Health Consequences 16

17 Hazards Public Health Consequences Power outage/ power grid failure: summer heat; winter cold: widespread Major infrastructure damage; roads, homes, businesses, public buildings: widespread Major communications disruption Information systems failure: widespread Transportation disruption: widespread Supply disruption/ shortages: widespread Fuel shortage: widespread Food contamination/spoilage Water supply contamination: widespread Water shortage: widespread Mold growth Carbon monoxide poisoning Major hazmat exposure/contamination; chemical, radiological, biological, nuclear: widespread or significant numbers Public displacement: evacuation; shelters: significant numbers Shelter in place: significant numbers Security issues; civil disturbance, disobedience: riots/ looting; protection of scarce resources/assets Medical Surge; trauma (MCI); illness (due to food, water, or toxic exposures) Medical Surge; infectious disease: Influenza, Ebola (due to the intensity of the resources needed to care for one patient) Mass Fatalities Public distress: from stress and anxiety to fear and panic Hazards to Consequences Information Systems Failure Supply Disruption / Shortage Food Contamination Mass Casualty Incident Mass Fatality Situation Flood X X X X X X X X X X X X X Hurricane X X X X X X X X X X X X X X X X X 17

18 Utilize Communications Systems and Platforms Identify and Coordinate Resource Needs during an Emergency Coordinate Incident Action Planning During an Emergency Communicate with Health Care Providers, Non- Clinical Staff, Patients, and Visitors during an Emergency Communicate with the Public during an Emergency Consequences to Capabilities CAPABILITY 2 OBJECTIVES Utilize Information Sharing Procedures and Platforms Health Care and Medical Response Coordination Coordinate Response Strategy, Resources, and Communications ACTIVITIES Power outage/ power grid failure: summer heat; winter cold: widespread X X X X X Supply disruption/ shortages: widespread X X X Major hazmat exposure/contamination; chemical, radiological, biological, nuclear X X X X X Public displacement: evacuation X X X X X Shelter in place X X X X X Medical Surge; trauma (MCI) X X X X X Medical Surge; infectious disease X X X X X Mass Fatalities X X X X X Public distress; range from stress to panic X X X X X Public Health Consequences 18

19 Continue Administrative and Finance Functions Assess and Address Equipment, Supply, and Pharmaceutical Requirements Distribute Resources Required to Protect the Health Care Workforce Develop and Implement Evacuation and Relocation Plans Develop and Implement Evacuation Transportation Plans Facilitate Recovery Assistance and Implementation Consequences to Capabilities CAPABILITY 3 Continuity of Health Care Service Delivery OBJECTIVES Plan for Continuity of Operations Maintain Access to Non-Personnel Resources during an Emergency Protect Responders Safety and Health Plan for and Coordinate Health Care Evacuation and Relocation Coordinate Health Care Delivery System Recovery ACTIVITIES Power outage/ power grid failure: summer heat; winter cold: widespread X X X X Supply disruption/ shortages: widespread X X Major hazmat exposure/contamination; chemical, radiological, biological, nuclear X Public displacement: evacuation X X Shelter in place Medical Surge; trauma (MCI) X X Medical Surge; infectious disease X X Mass Fatalities X Public distress; range from stress to panic Public Health Consequences 19

20 Implement Emergency Department and Inpatient Medical Surge Response Implement Out-of- Hospital Medical Surge Response Provide Pediatric Care during a Medical Surge Response Provide Surge Management during a Chemical or Radiation Emergency Event Provide Burn Care during a Medical Surge Response Provide Trauma Care during a Medical Surge Response Respond to Behavioral Health Needs during a Medical Surge Response Distribute Medical Countermeasures during Medical Surge Response Manage Mass Fatalities Consequences to Capabilities CAPABILITY 4 Medical Surge OBJECTIVES Respond to a Medical Surge ACTIVITIES Power outage/ power grid failure: summer heat; winter cold: widespread Supply disruption/ shortages: widespread Major hazmat exposure/contamination; chemical, radiological, biological, nuclear X X X X Public displacement: evacuation X Shelter in place X Medical Surge; trauma (MCI) X X X X X X X Medical Surge; infectious disease X X X X X X Mass Fatalities X X Public distress; range from stress to panic Public Health Consequences X 20

21 Capability Vulnerability Analysis: Part I Identify most probable hazards with severity (as defined by public health consequences); list in order of high to low probability/severity 0 = not happening 1 = will happen, low severity 2 = will happen, high severity Jurisdictional Hazards SCORE Pan/Epidemic Disease Outbreak Extreme Heat Zoonotic Disease Outbreak Tornado Earthquake Flood Drought Hurricane Severe Thunderstorm Heavy Snow, Blizzard Ice Storm Landslide Dam Inundation Tsunami Likelihood this will occur to what severity 0 - won't happen 1 - will happen, low impact/severity 2 - will happen, high severity/impact 21

22 Capability Vulnerability Analysis: Part II Assess the current ability or readiness to perform each of the HPP Capabilities 0 = no ability 1 = some ability 2 = significant ability 3 = full ability Foundation for Health Care and Medical Readiness Establish and Operationalize a Health Care Coalition Define Health Care Coalition Boundaries Identify Health Care Coalition Members Establish Health Care Coalition Governance Identify Risk and Needs Assess Hazard Vulnerabilities and Risks Assess Regional Health Care Resources Prioritize Resource Gaps and Mitigation Strategies Assess Community Planning for Children, Pregnant Women, Seniors, Individuals with Access and Functional Needs, Including People with Disabilities, and Others with Unique Needs Assess and Identify Regulatory Compliance Requirements Develop a Health Care Coalition Preparedness Plan Train and Prepare the Health Care and Medical Workforce Promote Role-Appropriate National Incident Management System Implementation Educate and Train on Identified Preparedness and Response Gaps Plan and Conduct Coordinated Exercises with Health Care Coalition Members and Other Response Organizations 22

23 Capability Vulnerability Analysis HPP CAPABILITIES CONSEQUENCES HAZARDS List low to high relative to ability to respond Foundation for Health Care and Medical Readiness Health Care and Medical Response Coordination Continuity of Health Care Service Delivery Medical Surge List of possible impacts of hazards Power outage: summer heat or winter cold: widespread; prolonged Major infrastructure damage: roads, homes, businesses, public buildings: widespread Major communications disruption: widespread Information systems failure: widespread List high to low relative to probability and severity (impact) score Pandemic/ Epidemic Disease Outbreak Extreme Heat Zoonotic Disease Outbreak Tornado Transportation disruption; roads, rail, air: Earthquake widespread Supply disruption/ shortages: widespread Flood Nuclear Detonation Major Radiological Exposure/ Terrorism 23

24 Capability Vulnerability Analysis Goal is to develop all capabilities to full ability: Train and exercise using highly likely hazard threat scenario with expected associated public health consequences Test those capabilities that are: rated low relative to current ability to perform the critical tasks required to respond those expected consequences of the likely hazard scenario 24

25 Capability Vulnerability Analysis Health Care and Medical Response Coordination Develop and Coordinate Health Care Organization and Health Care Coalition Response Plans Develop a Health Care Organization Emergency Operations Plan 2 Develop a Health Care Coalition Response Plan 3 Utilize Information Sharing Procedures and Platforms Develop Information Sharing Procedures 1 Identify Information Access and Data Protection Procedures 0 Utilize Communications Systems and Platforms 1 You completed your assessment and you selfrated a very low score in the Health Care and Medical Response Capability Coordinate Response Strategy, Resources, and Communications Identify and Coordinate Resource Needs during an Emergency 2 Coordinate Incident Action Planning During an Emergency 1 Communicate with Health Care Providers, Non- Clinical Staff, Patients, and Visitors during an Emergency 1 Communicate with the Public during an Emergency 1 25

26 So, you need to build an exercise Exercise Name [Insert the formal name of exercise, which should match the name in the document header] Exercise Dates Scope Mission Area(s) Capabilities Objectives Threat or Hazard Scenario Sponsor [Indicate the start and end dates of the exercise] This exercise is a [exercise type], planned for [exercise duration] at [exercise location]. Exercise play is limited to [exercise parameters]. [Prevention, Protection, Mitigation, Response, and/or Recovery] Health Care and Medical Response Coordination [List the core capabilities being exercised] [List Communicate exercise objectives] with the public by conducting a press briefing by the Public Information Officer during the first operational period of the incident. [List the threat or hazard (e.g. natural/hurricane, technological/radiological release)] [Insert a brief overview of the exercise scenario, including scenario impacts (2-3 sentences)] Participating Organizations [Insert a brief summary of the total number of participants and participation level (i.e., Federal, State, local, Tribal, non-governmental organizations (NGOs), and/or international agencies). Consider including the full list of participating agencies in Appendix B. Delete Appendix B if not required.] Point of Contact [Insert the name, title, agency, address, phone number, and address of the primary exercise POC (e.g., exercise director or exercise sponsor)] 26

27 So, you need to build an exercise. Utilize Communications Systems and Platforms Identify and Coordinate Resource Needs during an Emergency Coordinate Incident Action Planning During an Emergency Communicate with Health Care Providers, Non- Clinical Staff, Patients, and Visitors during an Emergency Communicate with the Public during an Emergency CAPABILITIES Health Care and Medical Response Coordination Scenario [Insert a brief overview of the exercise scenario, including scenario impacts (2-3 sentences)] OBJECTIVES Utilize Information Sharing Procedures and Platforms Coordinate Response Strategy, Resources, and Communications ACTIVITIES Mold growth X X X Carbon monoxide poisoning X X X Public displacement: evacuation X X X X X Security issues; civil disturbance, disobedience: riots/ looting X X X X X Medical Surge; trauma (MCI) X X X X X Mass Fatalities X X X X X Public distress; range from stress to panic X X X X X 27

28 So, you need to build an exercise Power outage/ power grid failure: summer heat; winter cold: widespread Major infrastructure damage; roads, homes, businesses, public buildings: widespread Major communications disruption Information systems failure: widespread Transportation disruption: widespread Supply disruption/ shortages: widespread Fuel shortage: widespread Food contamination/spoilage Water supply contamination: widespread Water shortage: widespread Mold growth Carbon monoxide poisoning Major hazmat exposure/contamination; chemical, radiological, biological, nuclear: widespread or significant numbers Public displacement: evacuation; shelters: significant numbers Shelter in place: significant numbers Security issues; civil disturbance, disobedience: riots/ looting; protection of scarce resources/assets Medical Surge; trauma (MCI); illness (due to food, water, or toxic exposures) Medical Surge; infectious disease: Influenza, Ebola (due to the intensity of the resources needed to care for one patient) Mass Fatalities Public distress: from stress and anxiety to fear and panic Threat or Hazard [List the threat or hazard (e.g. natural/hurricane, technological/radiological release)] Pan/Epidemic Disease Outbreak Zoonotic Disease Outbreak X X X X X X X X X X Tornado X X X X X X X Flood X X X X X X X X X X X X X Drought X X Hurricane X X X X X X X X X X X X X X X X X Severe Thunderstorm Heavy Snow, Blizzard X X 28

29 So, you need to build an exercise Threat or Hazard [List the threat or hazard (e.g. natural/hurricane, technological/radiological release)] Jurisdictional Hazards Likelihood this will occur to what severity SCORE 0 - won't happen 1 - will happen, low impact/severity 2 - will happen, high severity/impact Pan/Epidemic Disease Outbreak 2 Extreme Heat 1 Zoonotic Disease Outbreak 2 Tornado 1 Earthquake 1 Flood 2 29

30 So, you need to build an exercise Exercise Name [Insert the formal name of exercise, which should match the name in the document header] Exercise Dates Scope Mission Area(s) Capabilities Objectives Threat or Hazard [Indicate the start and end dates of the exercise] This exercise is a [exercise type], planned for [exercise duration] at [exercise location]. Exercise play is limited to [exercise parameters]. [Prevention, Protection, Mitigation, Response, and/or Recovery] [List Health the Care core and capabilities Medical being Response exercised] Coordination Communicate with the public by conducting a press briefing by the Public Information Officer during [List exercise objectives] the first hour of the incident. [List Zoonotic the threat Disease or hazard Outbreak (e.g. natural/hurricane, technological/radiological release)] Scenario Sponsor [Insert Zoonotic a brief Disease overview Outbreak of the causing exercise public scenario, panic including requiring scenario the organization impacts (2-3 to communicate sentences)] to the public regarding response actions, etc. Participating Organizations [Insert a brief summary of the total number of participants and participation level (i.e., Federal, State, local, Tribal, non-governmental organizations (NGOs), and/or international agencies). Consider including the full list of participating agencies in Appendix B. Delete Appendix B if not required.] Point of Contact [Insert the name, title, agency, address, phone number, and address of the primary exercise POC (e.g., exercise director or exercise sponsor)] 30

31 Capability Vulnerability Analysis The Hazards are not the focus; the Consequences are not the focus. The ability to perform the all hazards capabilities in response to the consequences of the likely jurisdictional hazards is the rightful focus regarding vulnerability assessment. The likely hazards and associated consequences provide the context; the ability to perform the capabilities are the essence of the vulnerability. 31

32 Questions? Jane Coolidge PhD Maine CDC, PHEP Planner Kara Walker Central Maine Regional Health Care Coalition Director Thank you! 32