Healthcare Emergency Manager Core Competencies discussion

EDITORIAL Disaster Medicine and Public Health Preparedness: A Discipline for All Health Professionals James J. James, MD, DrPH, MHA; Georges C. Benjamin, MD, FACP; Frederick M. Burkle Jr, MD, MPH, DTM, FAAP, FACEP; Kristine M. Gebbie, DrPH, RN; Gabor Kelen, MD; Italo Subbarao, DO, MBA I ndividuals and populations exposed to natural and humancaused disasters confront myriad social, physical, psychological, environmental, and economic conditions that affect health. Lessons learned from Hurricane Katrina (2005), the Haitian earthquake (2010), and other large-scale disasters consistently demonstrate that such events disproportionately affect the most vulnerable members of society, including children, elderly people, and minority populations. Minimizing adverse health outcomes requires cooperative efforts that cross traditional boundaries of heal

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th specialties, professions, and nationalities. Health professionals are on the front lines when dealing with injury and disease every day, whether natural or man made. vide a foundation for doctrine, education, training, and research within the public health and health care sectors. (DMPHP includes all health professions and specialties, including but not limited to allied health, dentistry, emergency medical services, environmental health, epidemiology, hazardous materials response, medicine, mental health, nursing, pharmacology, public health, toxicology, and veterinary medicine.) Previous definitions have been proposed, but despite their relevance, they have not achieved widespread consensus. To distinguish DMPHP from other health disciplines and professions, a modified definition is proposed that recognizes the essential integration of clinical and public health science and practice into the emergency response system: There are a wide variety of disasters ranging from localized events to large-scale public health emergencies. To respond effectively, health professionals, regardless of specialty or area of expertise, require a fundamental understanding of the disaster management system and the ways in which various healthrelated roles are integrated to protect health and respond to disease or injury. In a disaster or public health emergency (PHE), health professionals have an obligation to protect and preserve the health, safety, and security of their patients, families, and communities, as well as themselves. All health disciplines should be knowledgeable about the range of illnesses and injuries that may arise and how their particular expertise facilitates effective response. In addition, all must be able to recognize the general features of disasters and PHEs and be knowledgeable about their impact on the population, how to report a potential public health event, and where to access pertinent information as required. Most disaster events are on a scale that communities, whether in the developed or developing world, can manage well. Consequences are usually limited to direct injuries and deaths. In particular, large-scale PHEs place unprecedented demands on the existing public health infrastructure and system that may increase overall morbidity and mortality. PHEs require an added degree of coordination, cooperation, and collaboration between the clinical workforce and public health authorities. DMPHP is defined as the study and collaborative application of sound scientific principles, practices, and standards by multiple health professions for the prevention, mitigation, management, and rehabilitation of injuries, illnesses, and other problems that affect the health, safety, and well-being of individuals and communities in disasters and public health emergencies. DEFINING THE KNOWLEDGE BASE FOR DISASTER MEDICINE AND PUBLIC HEALTH PREPAREDNESS It is recognized within the discipline of disaster medicine and public health preparedness (DMPHP) that there are distinct principles and practices across the health and social sciences that pro102 (Reprinted) Disaster Medicine and Public Health Preparedness Strong impetus for more focused attention to education, training, and research in DMPHP was provided by Homeland Security Presidential Directive 21 (HSPD-21)3 and 3 recent consensus reports.4-6 HSPD-21 specifically calls for the establishment of a discipline that recognizes the unique principles in disasterrelated medicine and public health; provides a foundation for the development and dissemination of doctrine, education, training, and research in this field; and better integrates private and public entities into the disaster health system. As precedent for this new discipline, HSPD-21 cites the evolution of the specialty of emergency medicine due to recognition of the special considerations of emergency patient care. HSPD-21 endorses similar action directed to disaster-related public health and medicine, which merits the establishment of a separate formal discipline. Although DMPHP draws from multiple other fields, to be recognized and embraced as a distinct academic discipline, it must be differentiated by its own unique and distinctive essentials. This can be accomplished through description of an identifiable philosophy for the discipline, a sound conceptual framework, a unique core body of knowledge, and acceptable methodological approaches for the pursuit and development of knowledge in the field.7 Just as the discipline of biochemistry and its accompanying journals once evolved from the interests of individual exVOL. 4/NO. 2 ©2010 American Medical Association. All rights reserved. Editorial perts in organic chemistry, zoology, botany, and other fields, and the discipline of genomics evolved from the interests of individual biochemists, geneticists, pharmacologists, and others, it is envisioned that the discipline of DMPHP will evolve similarly, in response to proper input and nurturing from experts with diverse clinical and public health backgrounds.8 DMPHP can be seen as a “composite” discipline requiring integrated multidisciplinary study and research to meet its goals. Proficiency in DMPHP requires knowledge and skills beyond those typically acquired in clinical and public health training and practice, and must encompass unique competencies. The delivery of optimal care in a disaster relies on both clinical and public health expertise, and depends on a common understanding of each health professional’s role in the broader emergency management system. To be considered proficient in DMPHP, individuals must demonstrate common mastery of defined essentials in this field. Certain backgrounds (such as may be found in subspecialties within medicine, public health, and nursing, among others) may have further differentiated skills that can be applied effectively in specific disaster events. EMERGENCY MANAGEMENT ASPECTS OF DMPHP To prepare for a disaster or PHE, health professionals should learn the essential elements of community and institutional disaster plans, as well as federal and local incident command. Plans should include assessment and characterization of surge capacity assets in the public and private health response sectors, and the extent of their potential assistance in an emergency. Health responders must be knowledgeable about institutional, community, and regional response systems and their respective roles within those structures, including policies and procedures for mobilizing and integrating civilian, military, and other response resources and assets. Health responders also require knowledge of administrative regulations, safety and security issues, systems engineering, decontamination protocols, forensics, use of personal protective equipment, evacuation procedures, continuity planning, and utilization of public information and communication networks. CLINICAL ASPECTS OF DMPHP In a disaster, clinicians should be prepared to apply and adapt their usual practices and behaviors, as appropriate, to the recognition, diagnosis, triage, and treatment of seriously injured or ill people, with limited situational awareness and resources. They may be required to apply their accustomed clinical skill set to the assessment and management of people of all ages under a variety of scenarios. At times, they may be called upon to fill nonclinical response functions such as moving patients during a hospital evacuation. Although clinicians specializing in DMPHP should have a universal core knowledge and skill set, understanding the limitations of one’s individual clinical capabilities is equally important. Clinicians and other health responders need to be familiar with medical and mental health implications of the spectrum of diDisaster Medicine and Public Health Preparedness (Reprinted) sasters and PHEs and recognize that people may have been exposed to nonconventional agents as the source of unusual presentations. This requires competence in identifying the health consequences and treatment of exposure to biological, chemical, radiological, nuclear, and incendiary agents. In a mass casualty situation, health system responders may need to take personal histories, conduct physical examinations, and manage injured or ill people in potentially hazardous environments with limited medical supplies and equipment while maintaining situational awareness. They should be prepared to follow appropriate diagnostic procedures to confirm or refute possible etiologies, and in some cases begin treatment based solely on symptoms and signs. Implementation of safety and protection principles to prevent harm to themselves and others is critical, as is sensitivity to the diagnostic and treatment plans for psychological and behavioral as well as physical trauma. All health responders should know the ethical and legal structures that govern response to disasters and PHEs, while maintaining the highest possible standards of care under extreme conditions. This encompasses their rights and responsibilities to protect themselves and treat others (including those with potentially contagious diseases), with consideration of issues such as professional liability, worker protection and compensation, licensure, and privacy. PUBLIC HEALTH ASPECTS OF DMPHP There are many health system responders who are not clinicians that need to demonstrate proficiency in public health preparedness and response. Although they may not be involved directly in casualty assessment and treatment, the work of these responders is critical to meeting the health needs of affected populations. Actions and interventions that must be considered following the onset of a disaster or PHE include health monitoring and surveillance; outbreak investigation; isolation and quarantine; population-based triage; mass sheltering and feeding; vector control; environmental monitoring; ensuring the safety of food and water supplies; responder and health care worker protection; basic sanitation and hygiene; countermeasure stockpiling, distribution, and dispensing; and management of mass fatalities. This requires basic knowledge of descriptive and analytical epidemiology, laboratory science, environmental and occupational health, infection control, nutrition, effective communication practices and the social sciences. Health professionals who have direct roles in disaster response should be able to support surveillance efforts and explain the rationale and procedures for case reporting. The basics of risk communication and health messaging will be essential for communicating with affected individuals, their families, and the media regarding exposure risks and potential preventive measures. Finally, just like clinicians, public health responders should know the moral, ethical, and legal issues that are relevant to the management of affected populations and communities and the basic legal framework for public health. They should be fa103 ©2010 American Medical Association. All rights reserved. Editorial miliar with ethical principles that underlie decision making in disasters, such as those impacting allocation of scarce resources. DEVELOPING CORE CURRICULA AND TRAINING PROGRAMS IN DMPHP Recent disasters and terrorist events have increased federal interest and attention for the integration of DMPHP into clinical and public health education. In 2006, passage of the Pandemic and All-Hazards Preparedness Act (PAHPA; PL 109417) created important opportunities to build upon and standardize disaster preparedness education through various programs at the federal, state, and local levels.9 PAPHA called for the development of integrated, interdisciplinary, and consistent public health and medical disaster response curricula, which would be available to health professionals and health professional schools. Section 304 of the Act states that “the Secretary of Health and Human Services (HHS), in collaboration with the Secretary of Defense, and in consultation with relevant public and private entities, shall develop core health and medical response curricula and training by adapting applicable existing curricula and training programs to improve responses to public health emergencies.” In 2007, HSPD-21 called for federal interagency action and cooperation to ensure that core public health and medical curricula and training developed pursuant to PAHPA address the needs to improve individual, family, and institutional public health and medical preparedness and to develop a mechanism to coordinate public health and medical disaster preparedness and response core curricula and training across executive departments and agencies, to ensure standardization and commonality of knowledge, procedures, and terms of reference within the federal government that also can be communicated to state and local government entities, academia, and the private sector. To lead federal efforts for the development and delivery of core curricula and training related to medicine and public health in disasters, HSPD-21 specifically calls for the establishment of an academic joint program for disaster medicine and public health, housed at a National Center for Disaster Medicine and Public Health, at the Uniformed Services University of the Health Sciences. The HHS and Department of Defense are required to carry out respective civilian and military missions within this program. In 2009, federal directives aimed at education and training in disaster medicine and public health began to be addressed by the Federal Education and Training Interagency Group. The Group, as authorized under PAHPA, serves as a coordinating body for the delineation of core competencies and education and training standards across federal departments and agencies, as well as state and local government entities, academia, and the private sector in relation to public health emergency and disaster response. The primary charge of this group is to identify and implement a national strategy for the education and training of health professionals in disaster-related medicine and public health. The recently re104 (Reprinted) Disaster Medicine and Public Health Preparedness leased National Health Security Strategy further emphasizes the importance of professional training, competencies, and standards to help ensure the attainment and maintenance of proficiency by the disaster response workforce.10 In 2009, the American Medical Association (AMA) House of Delegates adopted policy calling for formal education and training in DMPHP to be incorporated in all medical school and residency programs.11 This initiative includes integration of core curricula and training programs to provide a consistent learning experience for physicians-in-training and other students in the health professions. Such training requires consensus on competencies and learning objectives to ensure that course content is based on a well-defined and testable body of knowledge, skill set, and methodology. To prepare health professionals to respond appropriately and to assist professional schools and continuing education programs to meet this challenge, various organizations and universities have developed competencies for health professionals and other emergency responders.12-20 To date, many of these efforts have been limited primarily to individual specialties or targeted professionals. This has resulted in a lack of definitional uniformity across professions with respect to education, training, and best practices, thus limiting the establishment of DMPHP at an operational level. To better integrate competencies across all health specialties and professions, a consensusbased educational framework and competency set was published from which educators could devise learning objectives and curricula in DMPHP that are tailored to the needs of all health professionals.21 The framework includes the delineation of 7 core learning domains and 19 core competencies (Table), as well as 73 specific subcompetencies targeted at 3 broad health personnel categories. A learning matrix also was developed to allow disaster health educators and accreditation entities to incorporate the competencies at any desired proficiency level. The DMPHP educational framework identifies 3 broad, yet distinct, personnel categories to encompass all health professionals: informed workers/students, practitioners, and leaders. Personnel are expected to perform at different levels of proficiency depending on their experience, professional role, level of education, or job function across the core competencies and subcompetencies. The framework allows for all health professions to be represented in each category, and recognizes the diversity of expected job functions and educational requirements for each health profession involved in disaster prevention, mitigation, response, and recovery. The health personnel categories establish increasing standards for each core competency. The proposed competency set and educational framework were endorsed by the National Disaster Life Support Education Consortium in May 2008. (The Consortium is an unincorporated association jointly sponsored by the AMA and National Disaster Life Support Foundation, Inc, convened by the AMA. It consists of 75 professional organizations and distinguished individuals with interest and expertise in diVOL. 4/NO. 2 ©2010 American Medical Association. All rights reserved. Editorial saster medicine and public health preparedness, as well as experts in professional education and curriculum development, all of whom participate on a voluntary basis.) Although this vision has been endorsed by many, the implementation is not clear. Decisions about exactly which competencies form the common core for all members of all professions considered to be health professions have not been made. Work that is under way to meet the PAHPA mandate for public health education, for example, does not presume that all public health workers will possess the skills to diagnose individual patient conditions or initiate individual therapies. Similarly, it is unlikely that all licensed physicians and nurses will be expected to have the skills to diagnose and mitigate contamination of a municipal water supply. All of these need a common base that is respectful of all contributions to health and maximizes the efficiency of the health contribution to community readiness, response, and recovery. The DMPHP educational framework provides the best effort to date to facilitate decisions about how best to proceed. If DMPHP is to be a recognized discipline, then a core standard curriculum must be defined and mastery demonstrated by all who wish to be acknowledged as proficient or “specialist” in this field. Anything less perpetuates the insular “silo” approach that continues today. Specific subcompetencies appropriate for public health practitioners, or certain medical and nursing practitioners, must be considered in addition to the core competencies, however they are defined. BUILDING THE DMPHP RESEARCH BASE The effects of conventional disasters and PHEs can be studied through well-established clinical and epidemiological research methods. Such information is critical for adaptation of preparedness, response, and recovery plans. To ensure a sound evidence base for DMPHP, continued research is needed to elu- TABLE Core Competencies for All Health Professionals in DMPHP21 Competency Domain Core Competencies 1.0 Preparation and Planning 1.1 Demonstrate proficiency in the use of an all-hazards framework for disaster planning and mitigation. 1.2 Demonstrate proficiency in addressing the health-related needs, values, and perspectives of all ages and populations in regional, community, and institutional disaster plans. 2.0 Detection and Communication 2.1 Demonstrate proficiency in the detection of and immediate response to a disaster or public health emergency. 2.2 Demonstrate proficiency in the use of information and communication systems in a disaster or public health emergency. 2.3 Demonstrate proficiency in addressing cultural, ethnic, religious, linguistic, socioeconomic, and special health-related needs of all ages and populations in regional, community, and institutional emergency communication systems. 3.0 Incident Management and Support Systems 3.1 Demonstrate proficiency in the initiation, deployment, and coordination of national, regional, state, local, and institutional incident command and emergency operations systems. 3.2 Demonstrate proficiency in the mobilization and coordination of disaster support services. 3.3 Demonstrate proficiency in the provision of health system surge capacity for the management of mass casualties in a disaster or public health emergency. 4.0 Safety and Security 4.1 Demonstrate proficiency in the prevention and mitigation of health, safety, and security risks to yourself and others in a disaster or public health emergency. 4.2 Demonstrate proficiency in the selection and use of personal protective equipment at a disaster scene or receiving facility. 4.3 Demonstrate proficiency in victim decontamination at a disaster scene or receiving facility. 5.0 Clinical/Public Health Assessment and Intervention 5.1 Demonstrate proficiency in the use of triage systems in a disaster or public health emergency. 5.2 Demonstrate proficiency in the clinical assessment and management of injuries, illnesses, and mental health conditions manifested by all ages and populations in a disaster or public health emergency. 5.3 Demonstrate proficiency in the management of mass fatalities in a disaster or public health emergency. 5.4 Demonstrate proficiency in public health interventions to protect the health of all ages, populations, and communities affected by a disaster or public health emergency. 6.0 Contingency, Continuity, and Recovery 6.1 Demonstrate proficiency in the application of contingency interventions for all ages, populations, institutions, and communities affected by a disaster or public health emergency. 6.2 Demonstrate proficiency in the application of recovery solutions for all ages, populations, institutions, and communities affected by a disaster or public health emergency. 7.0 Public Health Law and Ethics 7.1 Demonstrate proficiency in the application of moral and ethical principles and policies for ensuring access to and availability of health services for all ages, populations, and communities affected by a disaster or public health emergency. 7.2 Demonstrate proficiency in the application of laws and regulations to protect the health and safety of all ages, populations, and communities affected by a disaster or public health emergency. Disaster Medicine and Public Health Preparedness (Reprinted) 105 ©2010 American Medical Association. All rights reserved. Editorial cidate the clinical and public health effects of specific disasters; analyze risk factors for adverse social and health effects; and provide for investigation of the effectiveness of clinical and public health interventions and various types of disaster assistance, and the long-term influence of relief operations on the restoration of predisaster conditions. New or modified research tools may be needed to facilitate discoveries in DMPHP. Dedicated textbooks and peer-reviewed journals, such as Disaster Medicine and Public Health Preparedness, are being published to provide the scientific basis and framework for research, education, and training in this field. Additional venues for scholarly discourse in DMPHP include numerous conferences and symposia that have been convened in the United States and abroad. In December 2009, the AMA, in conjunction with the HHS Office of the Assistant Secretary for Preparedness and Response, sponsored the Third National Congress on Health System Readiness. The conference was attended by more than 500 public and private sector health professionals. In February 2010, the National Association of County and City Health Officials held the Fourth Annual Public Health Preparedness Summit, which was attended by approximately 2000 health professionals. In May 2010, the annual Integrated Medical, Public Health, Preparedness and Response Training Summit, sponsored by HHS, was convened as a forum for conducting training, sharing information, and networking among various national organizations involved in preparing for and responding to disasters and public health emergencies. International conferences include the Asia-Pacific Conference on Disaster Medicine as well as meetings sponsored by the World Association for Disaster and Emergency Medicine, the International Society for Disaster Medicine, and the World Health Organization. Continued validation of principles and practices in DMPHP through sound scientific methods and evidence is fundamental, urgently needed, and essential. Research is needed for the design and evaluation of process and performance measures, educational modalities (eg, lectures, simulations, drills, exercises), and clinical and public health interventions, as well as for the translation of research into improvements in disaster medicine and public health practice. To be meaningful, best practices and performance benchmarks must be evaluated in the context of where these will really be required, in realistic scenarios that involve a community’s entire emergency management system, operating as required under the National Response Framework and compliant with the National Incident Management System. ESTABLISHING THE DISCIPLINE OF DMPHP— THE TIME IS NOW DMPHP seeks to engage all health professions in efforts to prepare for, respond to, and recover from disasters and PHEs. Because DMPHP relies on the amalgamation of knowledge about health issues affecting individuals and populations in a disaster or public health emergency, it does not belong to any single specialty, profession, or discipline—it belongs to all. It is not simply 106 (Reprinted) Disaster Medicine and Public Health Preparedness an extension of dentistry, medicine, nursing, mental health, pharmacy, or a branch of public health. Rather, the discipline extends to all health care and public health professionals whose expertise supports the health-related capacity of emergency response systems. DMPHP is unique in that it can be considered a secondary discipline of all health professionals, as they seek to fulfill professional and societal obligations to patients, populations, and communities in a disaster or public health emergency. Education and training in DMPHP should be integrated as a basic element of lifelong learning for all clinical and public health professionals. Considering the relevance of this field for all health professionals, schools and entities responsible for the training, continuing education, credentialing, and certification of health professionalsshouldincorporatecross-cuttingcompetenciesinDMPHP into curricula at the undergraduate, graduate, and postgraduate levels. Mechanisms must be developed to coordinate public health and clinical disaster preparedness and response education in the public and private sectors to ensure standardization and commonality of knowledge, procedures, and terms of reference. Core curricula and training programs are needed to provide a consistent learning experience for all health professionals. Developing such curricula presents a daunting challenge— disasters, terrorism, and public health emergencies can occur in multiple scenarios, with diverse clinical and public health outcomes, many of which are not addressed in current health professional education. Certainly, DMPHP topic areas must be relevant to the roles they will play and be reasonably attainable, considering time and financial resources. Despite the challenges of integrating new content into existing health professional curricula, the risk of not doing so can no longer be ignored. DMPHP is more than just clinical care and public health. There are also major elements of politics, economics, social sciences, and logistics that must exist to plan and respond effectively. DMPHP professionals provide care, leadership, and community guidance throughout all phases of a disaster. They serve to interface with public safety and emergency management personnel, government agency officials, legislators, and the media, and facilitate coordination of private and public sector disaster response assets. As colleagues of a formally recognized discipline, DMPHP professionals can provide the essential expertise and leadership to facilitate the integration of the clinical and public health sectors as well as civilian-military coordination that forms a resilient national disaster health system. A new organizational entity that has the committed resources to provide comprehensive, dedicated leadership and support for the promotion and advancement of this field is needed to provide the structure and means for sustaining multiprofessional interaction and discourse in DMPHP, with a broad membership. As the umbrella organization for DMPHP, this entity could develop and foster mechanisms to coordinate public health and clinical disaster preparedness and response core curricula and training across professions. As envisioned, the mission of this VOL. 4/NO. 2 ©2010 American Medical Association. All rights reserved. Editorial organization would be to achieve and promote excellence in education, training, and research related to DMPHP for all health professionals based on sound educational principles, scientific evidence, and best clinical and public health practices. To fulfill this mission and realize its desired impact, this new organization would support a membership dedicated to formalized, lifelong learning in DMPHP with a shared vision to create a network of personnel who are ready, willing, and able to meet the health and safety needs of all ages and populations affected by disasters and public health emergencies. This editorial was unanimously endorsed by all DMPHP Board members in attendance at the annual Editorial Board meeting on April 28, 2010. 11. 12. 13. 14. Acknowledgments The authors gratefully acknowledge James Lyznicki, MS, MPH, and Edbert Hsu, MD, MPH, for their contributions to this commentary. 1. Brown RKB. Disaster medicine. What is it? Can it be taught? JAMA. 1966; 197:133-136. 2. Gunn SWA, Masellis M. The scientific basis of disaster medicine. Ann MBC. 1992;5:51-55 http://www.medbc.com/annals/review/vol_5/num_1 /text/vol5n1p51.htm. Accessed March 12, 2010. 3. Homeland Security Presidential Directive 21 (HSPD-21). Public Health and Medical Preparedness. Washington, DC: The White House. October 18, 2007. http://fas.org/irp/offdocs/nspd/hspd-21.htm. Accessed March 12, 2010. 4. Institute of Medicine Report Series on the Future of Emergency Care in the U.S. Health System: (a) Emergency Care for Children: Growing Pains. (b) Emergency Medical Services at the Crossroads. (c) Hospital-Based Emergency Care: At the Breaking Point. Washington, DC: National Academies Press; 2006. 5. American Medical Association, American Public Health Association. Improving Health System Preparedness for Terrorism and Mass Casualty Events: Recommendations for Action. A Consensus Report of the AMA/APHA Linkages Leadership Summit. Chicago: American Medical Association; 2007. http://www.ama-assn.org/ama1/pub/upload/mm/415/final_summit_report .pdf. Accessed March 12, 2010. 6. Institute of Medicine. Research Priorities in Emergency Preparedness and Response for Public Health Systems: A Letter Report. Washington, DC: National Academies Press; 2008. http://www.nap.edu/catalog.php?record_id =12136. Accessed March 12, 2010. 7. Cameron-Traub E. An evolving discipline. In Gray C, Pratt R, eds. Towards a Discipline of Nursing. Melbourne, Australia: Churchill Livingstone; 1991. 8. James JJ, Subbarao I, Lanier WL. Improving the art and science of disaster medicine and public health preparedness. Mayo Clin Proc. 2008;83: 559-562. 9. Pandemic and All-Hazards Preparedness Act (PAHPA); 2006. http://www .hhs.gov/aspr/opsp/pahpa/index.html. Accessed March 12, 2010. 10. US Department of Health and Human Services (HHS). National Health Disaster Medicine and Public Health Preparedness (Reprinted) 15. 16. 17. 18. 19. 20. 21. Security Strategy of the United States of America. Washington, DC: HHS; 2009. http://www.hhs.gov/aspr/opsp/nhss/nhss0912.pdf. Accessed March 12, 2010. Policy H-295.868; AMA Policy Database. As cited in Report 15 of the Council on Medical Education. Education in Disaster Medicine and Public Health Preparedness During Medical School and Residency Training. CME Report 15 (A-09). Chicago: American Medical Association; 2009. Association of Schools of Public Health. Public Health Preparedness and Response Core Competency Development Project. http://www.asph.org/document .cfm?page=1081. Accessed March 12, 2010. Medical Reserve Corps. MRC Core Competencies Matrix. Washington, DC: Office of the Surgeon General; 2007. http://www.medicalreservecorps.gov /File/MRC%20TRAIN/Core%20Competency%20Resources/Core _Competencies_Matrix_April_2007.pdf. Accessed March 12, 2010. Hsu EB, Thomas TL, Bass EB, et al. Healthcare worker competencies for disaster training. BMC Med Educ. 2006;6:1-9 http://www.biomedcentral .com/1472-6920/6/19. Accessed March 12, 2010. Barbara JA, Macintyre AG, Shaw G, et al. VHA-EMA Emergency Response and Recovery Competencies: Competency Survey, Analysis, and Report. Washington, DC: Institute for Crisis, Disaster, and Risk Management, The George Washington University; 2005. Hospital Core Competency Sub Committee and Health, Medical, Hospital, and EMS Committee Florida State Working Group. State of Florida Recommended Core Competencies & Planning/Mitigation Strategies for Hospital Personnel; 2004. http://www.emlrc.org/pdfs/disaster2005presentations /HospitalDisasterMgmtCoreCompetencies.pdf. Accessed March 12, 2010. Educational Competencies for Registered Nurses Responding to Mass Casualty Incidents. Nashville: International Nursing Coalition for Mass Casualty Education; 2003. http://www.aacn.nche.edu/Education/pdf /INCMCECompetencies.pdf. Accessed March 12, 2010. Center for Public Health Preparedness, Columbia University Mailman School of Public Health and the Center for Health Policy, Columbia University School of Nursing, Greater New York Hospital Association, The Commonwealth Fund. Emergency Preparedness and Response Competencies for Hospital Workers. New York: Center for Health Policy, Columbia University School of Nursing; 2003. http://www.ncdp.mailman.columbia.edu /files/hospcomps.pdf. Accessed March 12, 2010. Center for Health Policy, Columbia University School of Nursing. Bioterrorism and Emergency Readiness: Competencies for All Public Health Workers. New York: Center for Health Policy, Columbia University School of Nursing; 2002. https://www.train.org/Competencies/btcomps.pdf. Accessed March 12, 2010. American College of Emergency Physicians NBC Task Force. Developing Objectives, Content, and Competencies for the Training of Emergency Medical Technicians, Emergency Physicians, and Emergency Nurses to Care for Casualties from Nuclear, Biological, or Chemical (NBC) Incidents: Final Report. Washington, DC: Department of Health and Human Services, Office of Emergency Preparedness; 2001. Subbarao I, Lyznicki JM, Hsu EB, et al. A consensus-based educational framework and competency set for the discipline of disaster medicine and public health preparedness. Disaster Med Public Health Preparedness. 2008; 2:57-68. 107 ©2010 American Medical Association. All rights reserved. Appendix C – Healthcare Emergency Management Competencies Appendix C Healthcare Emergency Management Competencies: Competency Framework Final Report 1 Joseph A. Barbera, MD, Anthony G. Macintyre, MD, Greg Shaw, DSc, Valerie Seefried, MPH, Lissa Westerman, RN, Sergio de Cosmo, MS Institute for Crisis, Disaster, and Risk Management The George Washington University October 11, 2007 Introduction In December 2004, the Veterans Health Administration (VHA) Emergency Management Strategic Healthcare Group awarded the Institute for Crisis Disaster & Risk Management (ICDRM) a contract to participate in establishing innovative training and personal development curricula for the VHA Emergency Management Academy (VHA-EMA). The objective of the project was to develop a nationally peer-reviewed, National Incident Management System (NIMS) compliant, competency-based instructional outline and curriculum content upon which to base education and training courses. The curriculum is intended to educate VHA personnel for response and recovery in healthcare emergencies and disasters, to provide a resource for future VHA training programs, and to be placed in the public domain for use by other healthcare personnel. The initial phase of the EMA project consisted of developing a competency framework (competency definition, structure and format, and critical elements) followed by development of peer-reviewed emergency response and recovery competencies for VHAselected healthcare system job groups. The competencies describe knowledge, skills, and abilities essential for adequate job performance during the emergency response and recovery phases of an incident. Peer review was accomplished through a web-based survey of the proposed competencies, which was distributed to a select, nationwide sampling of emergency management personnel who were identified as having extensive experience or advanced expertise in healthcare emergency response. The survey process was designed to obtain a balanced expert opinion as to whether the project team’s written competencies were valid, and to assess the appropriate level of proficiency for each primary competency (i.e., awareness, operations, or expert). The competencies developed during this initial phase were then used to guide the development of learning objectives for the instructional curriculum. 1 This report was supported by Department of Veterans Affairs, Veterans Health Administration contract “Emergency Management Academy Development,” CCN20350A. The report is the work of the authors and does not represent the views of the Department of Veterans Affairs or any of its employees. Institute for Crisis, Disaster and Risk Management The George Washington University 33 Appendix C – Healthcare Emergency Management Competencies An extensive research effort was conducted to understand the historical use of competencies, and to establish objective criteria for competency development. Historical development of competencies Competency modeling originated in business management research, and has evolved extensively over the past 25 years as other disciplines began adopting the practice. 2 The original intent of competency development was to enhance the then common “job analysis” by relating a position’s requisite knowledge, skills and abilities to the overall objectives of the organization in which the position existed. This approach aligns the objectives (i.e., desired outputs) of individual jobs with the overall objectives of the organization, such that organizational objectives are achieved through effective individual job performance. While this was the original intent of competencies, their definition varied widely as time progressed. Competency definitions range from emphasizing underlying characteristics of an employee (e.g., a motive, trait, skill, aspects of one’s self-image, social role, or a body of knowledge) that produce effective and/or superior performance 3 to performance characteristics (i.e., how an employee conducted their job in relation to the organization’s objectives). 4 The application of competencies across the many organizations that use them has also varied widely. The private sector has commonly employed competencies to define “superior performers” 5 and therefore, as a selection tool for hiring, promotion, and/or salary enhancement. In other organizations, competencies have been used for job-specific performance feedback and improvement. Still others have used competencies to guide future program training and development. Because of this variation in definition and application, it becomes critically important to address these vagaries at the outset of any competency development project. This concept was well-described by one competency research team: “The first step in the implementation of any competency-based management framework must be the organizational consensus on how to define ‘competency.’ This agreed upon definition will drive the methodology used to identify and assess the competencies within the organization.” 6 The GWU-ICDRM project team strongly agreed with this concept, and started the project by defining how the competencies within this initiative would be applied: 2 Newsome, Shaun, Victor M Catano, and Arla L. Day. Leader Competencies: Proposing a Research Framework. 2003. available at http://www.cleleadership.ca/paper/leader_competenciesproposing_a_research_framework.pdf 3 Boyatzis, Richard. The Competent Manager: A Model for Effective Performance New York: Wiley, 1982. 4 US Office of Personnel Management. Executive Core Qualifications (ECQ’s), accessed at http://www.opm.gov/ses/ecq.asp 5 Klein AL. Validity and Reliability for Competency-based Systems: Reducing Litigation Risks. Compensation Benefits and Review, 28, 31-37, 1996. cited in “Newsome, Shaun, Victor M Catano, and Arla L. Day. Leader Competencies: Proposing a Research Framework. 2003. 6 Newsome, Shaun, Victor M Catano, and Arla L. Day. Leader Competencies: Proposing a Research Framework. 2003. available at http://www.cleleadership.ca/paper/leader_competenciesproposing_a_research_framework.pdf Institute for Crisis, Disaster and Risk Management The George Washington University 34 Appendix C – Healthcare Emergency Management Competencies The project competencies are intended to serve as formative tools to guide healthcare system personnel in developing knowledge, skills and abilities for effective performance during emergency response and recovery. These competencies are also intended to serve as a guide for developing preparedness education and training, and therefore, to serve as a basis for the healthcare emergency management curriculum. Finally, the competencies may be employed as a tool for assessing the performance of individual healthcare personnel performance during emergency response and recovery operations. Defining a competency framework Despite an extensive search of published articles related to competencies, the GWUICDRM project team determined that no single authoritative source presented a consistent competency definition and competency framework to adequately support the VHA-EMA project needs. A framework was therefore developed, analyzed through pilot competency development, refined and completed before establishing the individual emergency response and recovery competencies for this project. The competency framework was therefore used to impose a strict methodological consistency when developing and defining all competencies developed in this program. Central to this framework is the critical importance of competencies being objective and measurable, internally and externally consistent, and tightly described within the context of the organization’s specific objectives. Within this framework, the project team defined a “competency” as a specific knowledge element, skill, and/or ability that is objective and measurable (i.e., demonstrable) on the job. It is required for effective performance within the context of a job’s responsibilities, and leads to achieving the objectives of the organization. Competencies are ideally qualified by an accompanying proficiency level. 7 The GWU-ICDRM project team recognized the need to adapt the methods for competency development, since the usual business approach to establishing competencies is problematic for emergency management. Business management models establish competencies by observing performance and relating it to individual and organizational outputs. Because emergencies are rare events, and therefore emergency response and recovery outputs occur very infrequently, the related competency framework and definitions for this project are based less upon observed outputs. Instead, the basis is a healthcare system’s emergency response and recovery objectives, together with the NIMS-consistent incident command system 8 structure and processes mandated for use by all emergency response organizations in the U.S. 9,10 7 GWU Institute for Crisis, Disaster and Risk Management. Emergency Management Glossary of Terms (October 2007) available at www.gwu.edu/~icdrm/ 8 Fedral Emergency Management Agency. National Incident Management System (NIMS) (March 1, 2004), available at: http://www.fema.gov/emergency/nims/index.shtm. 9 Bush GW. Homeland Security Presidential Directive (HSPD) -5: Management of Domestic Incidents (February 28, 2003) accessed at http://www.whitehouse.gov/news/releases/2003/02/20030228-9.html Institute for Crisis, Disaster and Risk Management The George Washington University 35 Appendix C – Healthcare Emergency Management Competencies Response competencies in systems using the Incident Command System (ICS), therefore, should be based upon the general incident objectives an organization has during incident response, and upon the organizational structures, processes, and relationships with other organizations that are used during response rather than those used during everyday experience. Emergency competencies are commonly developed without this relationship to a defined response system, 11 making it difficult to define how scientific or medical knowledge is to be implemented in an emergency response. In contrast, the GWUICDRM project team specifically incorporated the NIMS mandate to use ICS by including reference to the NIMS/Incident Command System structure and processes throughout the project’s emergency response and recovery project competencies. Because of the anticipated large number of competencies, the project team also established a “primary versus supporting competency” hierarchy to categorize the individual competencies as they were developed. Designating “primary” and “supporting” competencies helps to maintain a priority in the framework when listing a large number of individual competencies. Supporting competencies are also a means to more fully define and clarify the primary competencies. Preparedness versus response and recovery competencies Published articles describing emergency management competencies commonly do not differentiate between preparedness and response competencies, and list them in an intermixed fashion. 12,13 The GWU-ICDRM project team sought to maintain a separation between these categories. Preparedness competencies are commonly based upon everyday organizational objectives, structure, processes, and relationships to other organizations. Preparedness is unquestionably important, but for it to be accurate, comprehensive and successful in establishing an effective emergency response capability, a thorough understanding of the response system must be established first, and preparedness guided by this. It was therefore reasoned by the project team that specific competencies for emergency response should be established and validated first, and then used as the “end state” to guide the development of valid preparedness competencies. 10 Barbera JA, Macintyre AG, et al. Emergency Management Principles and Practices for Healthcare Systems, Unit 3, Lesson 3.1.1, accessed at http://www1.va.gov/emshg/page.cfm?pg=122 11 ATPM (Association of Teachers of Preventive Medicine) in collaboration with Center for Health policy, Columbia University School of Nursing. Emergency Response Clinician Competencies in Initial Assessment and Management, 2003, accessed at http://www.atpm.org/education/Clinical_Compt.html 12 INCMCE (International Nursing Coalition for Mass Casualty Education). Educational Competencies for Registered Nurses Responding to Mass Casualty Incidents, 2003. Available at: http://www.nursing.hs.columbia.edu/institutes-centers/chphsr/hospcomps.pdf 13 ACEP (American College of Emergency Physicians) and the U.S Department of Health & Human Services, Office of Emergency Preparedness. Developing Objectives, Content, and Competencies for the Training of Emergency Medical Technicians, Emergency Physicians, and Emergency Nurses to Care for Casualties Resulting From Nuclear, Biological, or Chemical (NBC) Incidents, Final Report April 23, 2001. American College of Emergency Physicians, Irving, Texas. Institute for Crisis, Disaster and Risk Management The George Washington University 36 Appendix C – Healthcare Emergency Management Competencies Because of these considerations, the initial project focus was response and recovery competencies. Emergency management program competencies related to mitigation and preparedness were developed later for the two job groups that are the initial focus of the certification project. Establishing appropriate levels of proficiency Concurring with other authors that “competency” is not an all-or-none phenomenon, the GWU-ICDRM project team established “proficiency levels” to address this issue in a graduated fashion. Proficiency levels delineate the “The degree of understanding of the subject matter and its practical application through training and performance…” 14 In emergency management, proficiency indicates the level of mastery of knowledge, skills and abilities (i.e., competencies) that are demonstrable on the job and lead to the organization achieving its objectives. Levels of proficiency may therefore also be used to describe the level of mastery that is the objective of and specific training or education program. The final proficiency levels defined for this project are presented in Table 1. Table 1. Definition of the Levels of Proficiency Represents an understanding of the knowledge/skills/abilities Awareness encompassed by the competency, but not to a level of capability to adequately perform the competency actions within the organization’s system. Operations Expert Represents the knowledge/skills/abilities to safely and effectively perform the assigned tasks and activities, including equipment use as necessary Represents operations-level proficiency plus the additional knowledge/skills/abilities to apply expert judgment to solve problems and make complex decisions. As core and job group competencies were developed, the project team qualified each primary competency with an indicated level of proficiency (awareness, operations, expert). 14 EMA. Urban Search & Rescue Incident Support Team Training: Student Manual. Module 1, Unit 4, Page 6: Planning Process Overview. n/a:40. 4/16/2004, accessed at: http://www.fema.gov/emergency/usr/usrist2.shtm Institute for Crisis, Disaster and Risk Management The George Washington University 37 Appendix C – Healthcare Emergency Management Competencies Developing emergency response and recovery competencies Using the competency framework established in this project, response and recovery “core” competencies were developed for all personnel within a healthcare system that may have a role in the emergency response, regardless of their specific emergency response and recovery function. Additional competencies were then established for three functionally based job groups within a healthcare. The original designation for these job groups were (1) healthcare facility leaders, (2) patient care providers, and (3) emergency management program managers. The titles and definitions evolved with outside input as the project tasks were accomplished (see Table 2 for final titles and descriptions). Initial competency identification and development was accomplished through an analysis of ICS as presented in NIMS, an extensive literature review, and an evaluation of the VHA system and processes for emergency response. 15 Additionally, the GWU-ICDRM project team relied upon their extensive emergency management and disaster response experience, and upon related previous research efforts. 16,17,18 The emergency response and recovery competencies for the initially designated three job groups were then fully developed, studied through a web-based survey, revised based upon input and completed. 19 Identification of additional job groups and their associated competencies Early in the competency development process, it became apparent that there were additional important healthcare emergency management job groups beyond the three that were initially described. These groups have distinct response and recovery responsibilities (and therefore associated competencies) for the healthcare organization’s resiliency and medical surge. After extensive research during the latest phase of the project, the additional groups were identified as: Facilities and Engineering Services (FES), Police and Security Services (PSS), and Clinical Support Services (CSS). Their descriptions are presented in Table 2. Using the previously defined methodology (including web-based peer review), the follow-on project allowed for the development of emergency response and recovery competencies for these remaining job groups. 15 Veterans Health Administration. VHA Emergency Management Program Guidebook, 2005, accessed at: http://www1.va.gov/emshg/page.cfm?pg=114 16 Barbera, Joseph A and Anthony G. Macintyre. Medical and Health Incident Management System: A Comprehensive Functional Description for Mass Casualty Medical and Health Incident Management. Institute for Crisis, Disaster & Risk Management. The George Washington University, Washington DC, October 2002, accessed at www.gwu.edu/~icdrm/ 17 Barbera, Joseph A and Anthony G. Macintyre. Mass Casualty Handbook: Hospital Emergency Preparedness and Response, First Edition. Jane’s Information Group, 2003. 18 CNA Corporation. Medical Surge Capacity & Capability: The Management System for Integrating Medical and Health Resources During large-Scale Emergencies. August 2004, accessed at: http://www.hhs.gov/ophep/mscc_handbook.html 19 Barbera JA, Macintyre AG, et al. VHA-EMA Emergency Response and Recovery Competencies: Competency Survey, Analysis, and Report (June 16, 2005), available at www.gwu.edu/~icdrm/ Institute for Crisis, Disaster and Risk Management The George Washington University 38 Appendix C – Healthcare Emergency Management Competencies Development of preparedness and mitigation (program) competencies for Emergency Management Program Managers and Healthcare System Leaders The methodology utilized in this project focused first on the development and validation of response and recovery competencies as an “end state” for healthcare system personnel in their emergency management activities. The second phase of the project allowed for the development of program competencies for Emergency Program Managers and Healthcare System Leaders, which focused upon preparedness and mitigation activities necessary to reach this “end state.” These two job groups maintain primary responsibility for the emergency management program within a healthcare system, and thus have extensive primary competencies that relate to program development and maintenance required for successful response to emergencies and disasters. The program competencies were developed using the earlier methods, with identical criteria that the competencies be objective and measurable, maintain internal and external consistency, and be described within the context of an organization’s specific emergency management program objectives. Program competencies may more closely align with business management models during day-to-to day operations. Hence, organizational and individual outputs for these groups can be expected to be more frequent. This concept was included in the development of the program competencies. While no formal survey was conducted following the development of these program competencies, peer review was accomplished by providing draft competencies to experts for comment. Only minor changes resulted. The final job group titles and their descriptions are listed below. The competencies follow. Table 2. Healthcare System Job Group Definitions All Personnel (AP) All personnel are defined as any healthcare system administrator, employee, professional staff, licensed independent practitioners or others with a specified role in the healthcare systems emergency operations plan (EOP). Patient Care Providers (PCP) Physicians, physician assistants, registered nurses, licensed practical nurses, nurses working within expanded roles (CRNA, RNP, and others), emergency medical technicians, paramedics, and respiratory therapists and others who provide direct clinical patient care. Not included are clinical support staff that provide patient care services under the direct supervision of patient care providers: e.g., nurse’s aides, procedure technicians, orderlies, and others. Institute for Crisis, Disaster and Risk Management The George Washington University 39 Appendix C – Healthcare Emergency Management Competencies Hospital and/or healthcare system-wide senior executives (CEO, COO, CFO), hospital-wide managers, department heads, nursing executives, chief of the medical staff, and/or senior managers in Healthcare System Leaders large departments or key operating units. It is assumed that members of this job group, due to their everyday organizational (HSL) positions, would be assigned to serve in the command and general staff positions of an ICS structure during a healthcare system’s emergency response. Emergency Management Program Managers (EPM) Personnel primarily responsible for developing, implementing and maintaining healthcare facility and system-wide emergency management (EM) programs that include the Emergency Operations Plan (EOP). System level emergency program managers, above the level of individual facilities, (such as VHA Area Emergency Managers or program managers at the level of the VA Emergency Management Strategic Healthcare Group) are also included in this job group. It is assumed that the individuals in this job group will be assigned to a command & general staff ICS position (usually planning section chief) during response, and so are expected to possess the response and recovery competencies listed under Healthcare System Leaders as well. In some healthcare systems, an EM Program Manager may oversee a more limited position (e.g. program coordinator) with a narrower range of competencies. Clinical Support Services (CSS) Personnel that perform tasks related to the medical care of patients without direct patient interface (e.g. pharmacists, lab technicians, etc.) or provide patient services that aren’t primarily medical care (social services, physical and occupational therapy, pastoral care, patient educators, and others) or provide patient care services under the direct supervision of patient care providers (such as nurse’s aides, procedure technicians, orderlies, transporters). Police & Security Services (PSS) Personnel whose day to day job in the healthcare system involves security and the full range of law enforcement activities. Day-today duties may or may not put these individuals into direct contact with patients. Institute for Crisis, Disaster and Risk Management The George Washington University 40 Appendix C – Healthcare Emergency Management Competencies Facilities and Engineering Services (FES) Personnel whose day to day job involves maintaining the physical plant and its various systems. Included in this group are facilities and physical plant personnel, engineers, grounds personnel, biomedical engineers, food services, communications and IT personnel. It also usually includes administrative safety positions below the level of the healthcare system leaders. Day to day duties rarely put these personnel in direct patient contact. Institute for Crisis, Disaster and Risk Management The George Washington University 41 Appendix C – Healthcare Emergency Management Competencies Emergency Response and Recovery Competencies All Personnel (AP) All personnel are defined as any healthcare system administrator, employee, professional staff, licensed independent practitioners or others with a specified role in the healthcare systems emergency operations plan (EOP). x AP-R1: Utilize general Incident Command System (ICS) principles during incident response and recovery. Recommended proficiency for Primary Competency: operations level Knowledge o AP-R1.1: Describe ICS as an emergency response and recovery operating system and its application to healthcare system incident response and recovery, management structure, concept of operations, and planning cycle. o AP-R1.2: Describe your potential role(s) and responsibilities within the healthcare system response and recovery in terms of ICS principles. o AP-R1.3: Describe the ICS-delineated expectations of individual responders in relation to the healthcare system response and recovery to include: attendance at briefings, reporting requirements, and use of rolerelated documents such as Operational Checklists (Job Action Sheets). Skills o AP-R1.4: Demonstrate an operations level of proficiency in ICS principles by utilizing appropriate forms, attending indicated meetings, and adhering to appropriate reporting requirements. x AP-R2: Recognize situations that suggest indications for full or partial activation of the healthcare system’s Emergency Operations Plan (EOP), and report them appropriately and promptly. Recommended proficiency for Primary Competency: operations level Knowledge o AP-R2.1: Describe the general characteristics of emergency situations that may indicate the need for full or partial EOP activation. o AP-R2.2: Describe the reporting requirements and methodology for situations that may require full or partial EOP activation. Skills o AP-R2.3: Identify situations within your areas of regular duty that should be reported for consideration for full or partial activation of the healthcare system’s EOP. Institute for Crisis, Disaster and Risk Management The George Washington University 42 Appendix C – Healthcare Emergency Management Competencies o AP-R2.4: Report situations within your areas of regular duty by following EOP notification procedures and contacting the appropriate person as indicated by your specific role and by the situation at hand (e.g., page operator, supervisor, etc.). x AP-R3: Participate in healthcare system mobilization to rapidly transition from day-to-day operations to incident response organization and processes Recommended proficiency for Primary Competency: operations level Knowledge o AP-R3.1: Describe the procedures necessary to receive notification of EOP activation and to prepare your work area, as indicated, for EOP response and recovery. o AP-R3.2: Describe the initial reporting requirements for your expected role or position. o AP-R3.3: Describe the location and format of the system EOP. Skills o AP-R3.4: Follow your functional areas mobilization plan as outlined in the EOP to prepare your work area for EOP response and recovery. o AP-R3.5: Confirm notification receipt and report to the appropriate EOP position your initial situation, resource status, and any special problems encountered for your specific role or functional area. o AP-R3.6: Locate the facility EOP and access portions applicable to your role and responsibilities. x AP-R4: Apply the healthcare system’s core mission statement to your actions during emergency response and recovery. Recommended proficiency for Primary Competency: operations level Knowledge o AP-R4.1: Describe how your emergency operations role and responsibilities support the healthcare system mission during emergency response and recovery. Skills o AP-R4.2: Demonstrate your understanding of the healthcare system’s mission during emergency response and recovery by ensuring your actions continually contribute to 1) continuity of patient care operations, 2) the safety of patients, families, and staff, 3) the conservation of property, and 4) the healthcare system support to the community to ensure the nation’s safety. x AP-R5: Apply the healthcare system code of ethics to your actions during emergency operations. Institute for Crisis, Disaster and Risk Management The George Washington University 43 Appendix C – Healthcare Emergency Management Competencies Recommended proficiency for Primary Competency: operations level Knowledge o AP-R5.1: Describe how the healthcare system’s and other codes of ethics (such as Federal codes of ethics for Federal facilities), as applicable, apply to your role and responsibilities during emergency response and recovery. Skills o AP-R5.2: Demonstrate your understanding of the healthcare system’s and Federal codes (as applicable) of ethics by applying them to your individual response actions during emergency response and recovery. x AP-R6: Execute your personal/family preparedness plans to maximize your availability to participate in the healthcare system’s emergency response and recovery. Recommended proficiency for Primary Competency: expert level Knowledge o AP-R6.1: Describe the importance of both a personal and a family preparedness plan to allow you to perform your healthcare system emergency response and recovery role. o AP-R6.2: Describe your responsibility as an employee to maintain a personal and family preparedness plan. o AP-R6.3: Describe your responsibility as a supervisor (if applicable) to promote employee maintenance of a personal and family preparedness plan. o AP-R6-4: Identify the personal/family specific requirements and details that must be addressed in your personal/family preparedness plan that allow you to perform your healthcare system response role in a potentially changed work schedule and environment. Skills o AP-R6.5: Demonstrate your availability to work in your assigned role during healthcare system response and recovery by executing your personal/family preparedness plan. o AP-R6.6: Demonstrate an expert level of proficiency in personal and family preparedness planning by executing your personal/family preparedness plan and meeting your personal and family needs across any circumstances. x AP-R7: Respond with your previously prepared and maintained personal “go-kit” to maximize your ability to perform your assigned role during healthcare system response and recovery. Recommended proficiency for Primary Competency: expert level Knowledge Institute for Crisis, Disaster and Risk Management The George Washington University 44 Appendix C – Healthcare Emergency Management Competencies o AP-R7.1: Describe the importance of your personal “go kit” for selfprotection and to allow you to perform your healthcare system response and recovery role and responsibilities (A “go kit” contains personal supplies that an employee would need to work their emergency response and recovery role beyond a usual work shift, potentially not returning home for 72 hours). o AP-R7.2: Describe your responsibility as an employee to maintain a personal “go-kit.” o AP-R7.3: Describe your responsibility (if applicable) as a supervisor to promote employee maintenance of a personal “go kit.” o AP-R7.4: Describe how the EOP components and related policies and procedures, (evacuation, shelter in place, lock down, etc.) of the healthcare system Emergency Operations Plans impact your decisions on what should be included in your personal “go kit.” o AP-R7.5: Identify your personal situation (physical ability/constraints, medical needs, personal/family preparedness plan, etc.) and how it impacts on your decisions on what should be included in your personal “go kit.” Skills o APC-7.6: Demonstrate your availability to work in your assigned role and operational periods during response and recovery through the use of your personal “go kit.” x AP-R8: Follow the general response procedures for all personnel in the Occupant Emergency Procedures (OEP) and assist others (healthcare system personnel, patients, and visitors) as necessary to accomplish the OEP directives. [Footnote: More specific response procedures are addressed under respective job groups.] Recommended proficiency for Primary Competency: operations level Knowledge o AP-R8.1: Describe the component parts of the OEP and your responsibilities and actions under each. o AP-R8.2: Describe circumstances that could lead to OEP activation and your responsibilities during OEP activation. o AP-R8.3: Describe the reporting procedures for your job position that would activate the OEP. Skills o AP-R8.4: Execute your roles and responsibilities for the facility OEP by conducting the OEP directives for your job position in evacuation, shelter in place, or other actions during emergency operations. x AP-R9: Perform your specific roles and responsibilities as assigned in the healthcare system’s Emergency Operations Plan (EOP) and the appropriate Incident Action Plan (IAP) in order to support the system’s objectives. Institute for Crisis, Disaster and Risk Management The George Washington University 45 Appendix C – Healthcare Emergency Management Competencies Recommended proficiency for Primary Competency: operations level Knowledge o AP-R9.1: Describe the ICS framework as applied specifically to the healthcare system emergency response and recovery. o AP-R9.2: Describe your role and responsibility as assigned in the healthcare system’s EOP. o AP-R9.3: Describe how potential changes in event parameters may necessitate changes in the facility IAP objectives and strategies, and hence changes in your job area’s tactics and assignments (Management by objectives). o AE-R9.4: Describe the urgent issues that could potentially require a change in your job or job area’s response strategies and tactics. o AP-R9.5: Describe your personal accountability requirements during emergency response and recovery. o AP-R9.6: Describe the equipment and technologies for your specific role and responsibilities within the healthcare facility EOP. o AP-R9.7: Describe the facility policy applicable to your role for engaging the media. Skills o AP-R9.8: Demonstrate appropriate EOP-designated reactive actions in response to potential/actual events that have activated the EOP. o AP-R9.9: Demonstrate your specific role and responsibilities as assigned in the healthcare facility’s EOP by following your operational checklist (job action sheet), completing assignments, filling out appropriate forms, and fulfilling reporting requirements. o AP-R9.10: Ensure organizational objectives are met by formulating and/or implementing specific tactics consistent with the objectives and strategies delineated in the controlling IAP for the current operational period. o AP-R9.11: Report data to supervisors, as indicated, to contribute to measuring effectiveness of your EOP functional area and its contributions to achieving the organization’s designated incident objectives. o AP-R9.12: Operate all equipment and technologies for your specific role and responsibilities within the healthcare system’s EOP. x AP-R10: Follow the Communication Plan and reporting requirements as outlined in the healthcare system’s EOP and the specific Incident Action Plan for an emergency event. Recommended proficiency for Primary Competency: operations level Knowledge o AP-R10.1: Describe the policy and methods for communication and reporting during emergency response and recovery. Institute for Crisis, Disaster and Risk Management The George Washington University 46 Appendix C – Healthcare Emergency Management Competencies o AP-R10.2: Describe the process for rapidly communicating urgent issues that could require a change in response strategies or tactics for your job area, and the appropriate party to receive your communication. o AP-R10.3: Describe the process for reporting significant hazard or response impacts that you or your job area encounter to the appropriate party as indicated by the EOP. o AP-R10.4: Describe the general content of the communication plan component of the Incident Action Plan as it relates to your emergency response and recovery role. o AP-R10.5: Describe the procedures applicable to your role for interaction with the media. Skills o AP-R10.6: Demonstrate the reporting requirements within your functional area as delineated in the healthcare system EOP. o AP-R10.7: Maintain communications with appropriate parties for your role/functional area despite changing requirements and event parameters. o AP-R10.8: Demonstrate an understanding of media interactions by referring requests to appropriate personnel (as applicable), and when interacting with the media, follow designated interview procedures and protocols. x AP-R11: Follow and enforce healthcare system’s safety rules, regulations, and policies during emergency response and recovery. Recommended proficiency for Primary Competency: operations level Knowledge o AP-R11.1: Describe the healthcare system’s safety rules, regulations, and policies during emergency response and recovery that maintain personal safety and a safe work environment. o AP-R11.2: Describe how to apply the Safety Plan component of the facility Incident Action Plan. o AP-R11.3: Describe the safety specific actions and procedures to be followed when unsafe situations/events are encountered. o AP-R11.4: Describe incident parameters that may serve as stressors for response personnel, how stress may be manifested, and appropriate interventions for your specific role. Skills o AP-R11.5: Demonstrate your adherence to and enforcement of healthcare system safety rules, regulations, and policies during emergency response and recovery by wearing appropriate PPE, following pre-defined safety procedures, identifying and addressing unsafe practices, and following the IAP Safety Plan as briefed by your immediate supervisor. o AP-R11.6: Recognize and address incident stress for yourself and others in your functional area by identifying manifestations of stress and, in a fashion appropriate to your specific role, decreasing the stressors, limiting Institute for Crisis, Disaster and Risk Management The George Washington University 47 Appendix C – Healthcare Emergency Management Competencies the negative impact of the stressors, or ensuring appropriate assistance in recovering from negative stressors. x AP-R12: Follow and enforce police and security measures consistent with the nature of the incident that has prompted the EOP activation. Recommended proficiency for Primary Competency: operations level Knowledge o AP-R12.1: Describe healthcare system security rules, regulations, and policies that apply to your assigned role and responsibilities in the EOP. o AP-R12.2: Describe the security specific actions and procedures to be followed when a suspicious event or security breach is detected. Skills o AP-R12.3: Demonstrate your adherence to and enforcement of security measures during emergency response and recovery by following security briefings, instruction from individual security personnel, and badge procedures. x AP-R13: Utilize or request (as appropriate) and integrate equipment, supplies, and personnel for your specific role or functional area during emergency response and recovery. Recommended proficiency for Primary Competency: operations level Knowledge o AP-R13.1: Describe procedures for requesting equipment, supplies, and personnel for your functional area and the integration of these resources during emergency response and recovery. Skills o AP-R13.2: Demonstrate your ability to request and integrate additional resources by following EOP procedures outlined for these activities. o AP-R13.3: Demonstrate the ability to assess the adequacy of equipment, supplies and personnel to carry out your job assignments during each operational period. x AP-R14: Follow demobilization procedures that facilitate rapid and efficient incident disengagement and out-processing of individual resources and/or the overall healthcare organization. Recommended proficiency for Primary Competency: operations level Knowledge o AP-R14.1: Describe demobilization policies and procedures for your work area, including procedures to “catch up” on regular staffing and other activities that were suspended or revised during emergency operations. Institute for Crisis, Disaster and Risk Management The George Washington University 48 Appendix C – Healthcare Emergency Management Competencies o AP-R14.2: Describe the policy and procedures for out-processing of personnel during demobilization. o AP-R14.3: Describe the policy and procedures for conducting an initial Incident Review (commonly known as a “hot wash”) for your work area. o AP-R14.4: Describe the policy and procedures for documenting and reporting incident-related issues for inclusion in After Action Report process, analysis, and corrective measures. Skills o AP-R14.5: Demonstrate demobilization procedures for the incident by following the demobilization plan specific to your functional area. o AP-R14.6: Prioritize, initiate or participate in delayed activities (relevant to your position) that were suspended or revised during emergency response. o AP-R14.7: Participate in out-processing, to include a performance evaluation and any indicated physical exam. o AP-R14.8: Provide input into the Incident Review as appropriate for your position during emergency response. x AP-R15: Follow recovery procedures that ensure facility return to baseline activity. Recommended proficiency for Primary Competency: operations level Knowledge o AP-R15.1: Describe policies and procedures for rehabilitation of personnel. o AP-R15.2: Describe policies and procedures for rehabilitation of equipment (including recertification for use), reordering of supplies specific to your functional area, and rehabilitating your workspace. o AP-R15.3: Describe policies and procedures specific to your role and responsibilities for rehabilitation of the facility. o AP-R15.4: Describe the policies and procedures for a formal After-Action Report. Skills o AP-R15.5: Demonstrate an understanding of the importance of personnel rehabilitation activities by participating in personnel rehabilitation as instructed. o AP-R15.6: Demonstrate an understanding of facility and equipment rehabilitation by participating in these procedures to ensure your functional area readiness for day-to-day activities and future EOP activations. o AP-R15.7: Demonstrate an understanding of After Action-Reports by submitting items in the required format. Institute for Crisis, Disaster and Risk Management The George Washington University 49 Appendix C – Healthcare Emergency Management Competencies Emergency Management Program Manager (EPM) Personnel primarily responsible for developing, implementing and maintaining healthcare facility and system-wide emergency management (EM) programs that include the Emergency Operations Plan (EOP). System level emergency program managers, above the level of individual facilities, (such as VHA Area Emergency Managers or program managers at the level of the VA Emergency Management Strategic Healthcare Group) are also included in this job group. It is assumed that the individuals in this job group will be assigned to a command & general staff ICS position (usually planning section chief) during response, and so are expected to possess the response and recovery competencies listed under Healthcare System Leaders as well. 20 x EPM-R1: Recognize circumstances and/or actions, across the program manager’s jurisdiction if appropriate, that indicate a potential incident and report the situation to facility leadership and appropriate authorities. Recommended proficiency for Primary Competency: expert level Knowledge o EPM-R1.1: Describe the conditions across representative hazard types that indicate a potential incident requiring healthcare system response and recovery capabilities. o EPM-R1.2: List the healthcare system leadership positions that should be notified in the event of a potential incident and describe the formal notification process. o EPM-R1.3: List the outside authorities and resources that can be queried to rapidly obtain information about an evolving event, and describe the communication methods for this purpose. Skills o EPM-R1.4: Identify and obtain information from all non-healthcare system sources that could indicate the occurrence of an incident and need for healthcare system response. o EPM-R1.5: Report the circumstances of the potential incident to the relevant facility leader(s) and notify outside authorities as appropriate. x EPM-R2: Provide assistance and guidance to healthcare system Incident Managers, and other authorities as requested, on the decision to fully or partially activate Emergency Operations Plans (EOP). Recommended proficiency for Primary Competency: expert level Knowledge 20 In some healthcare systems, an EM Program Manager may oversee a more limited position (e.g. program coordinator) with a narrower range of competencies. Institute for Crisis, Disaster and Risk Management The George Washington University 50 Appendix C – Healthcare Emergency Management Competencies o EPM-R2.1: Describe the criteria that indicate the need for a partial or full healthcare system EOP activation. o EPM-R2.2: Describe the impact of EOP activation (full or partial) upon day-to-day facility operations. o EPM-R2.3: Describe the process for healthcare system EOP activation. Skills o EPM-R2.4: Assist facility leaders with the decision to activate emergency medical response plans and procedures by communicating relevant information about the nature and consequences of an incident and by explaining the benefits of activating the EOP. o EPM-R2.5: Provide Incident Managers with a list of all facility personnel positions with the authority to activate the EOP, as requested, and outline the methods for activation. x EPM-R3: Assist in the rapid mobilization of activated healthcare systems to transition from day-to-day activities to response and recovery operations. Recommended proficiency for Primary Competency: operations level Knowledge o EPM-R3.1: Describe processes and procedures used to mobilize the healthcare system and/or its individual facilities for emergency response and recovery. o EPM-R3.2: List all the external agencies relevant to your position that should be notified of the healthcare system’s EOP activation and determine their level of response. o EPM-R3.3: List all the internal healthcare system resources and facilities (ICP/EOC and others) that must be mobilized as the EOP is activated. Skills o EPM-R3.4: As requested by facility or healthcare system leadership, assist in facility mobilization by ensuring appropriate external liaisons are established and ensuring the facility management structure for response is clearly communicated externally. o EPM-R3.5: Provide the Healthcare System Incident Manager with briefings on the mobilization status of healthcare system facilities and/or internal resources (such as the EOC or the Decontamination Area) as indicated by the type and scope of the incident activation. x EPM-R4: Ensure full and proper execution of the appropriate emergency operations plan (EOP) for your healthcare system or designated healthcare system facilities during emergency response and recovery. Recommended proficiency for Primary Competency: expert level Knowledge Institute for Crisis, Disaster and Risk Management The George Washington University 51 Appendix C – Healthcare Emergency Management Competencies o EPM-R4.1: Describe the facility-specific as well as the larger, overarching healthcare system incident management organizational structure and response roles of all functional areas and key positions and how the incident management team (IMT) functions in parallel with continued enterprise management and operations.. o EPM-R4.2: Describe the healthcare enterprise’s organizational requirements as well as the relevant laws, regulations, policies and precedents that affect emergency operations and principles of emergency management. Skills o EPM-R4.3: Provide the healthcare system Incident Command Post with an initial projection of the supplies and resources needed for response and recovery as requested and as appropriate. o EPM-R4.4: At the outset of the incident, provide a briefing to the healthcare system incident manager on the response actions undertaken by external incident response agencies, or assure this is accomplished by the healthcare system senior liaison. o EPM-R4.5: Verify that the healthcare system’s personnel have adopted incident management roles and responsibilities according to the response structure and functional roles delineated in the relevant EOPs. o EPM-R4.6: Verify compliance of EOP response actions with applicable rules and regulations, and advise the facility Incident Commander as indicated. o EPM-R4.7: Provide assistance by monitoring the emergency response system assessing the adequacy and effectiveness of the incident management system in place at activated facilities within the healthcare system, as appropriate for the Program Manager’s jurisdiction. o EPM-R4.8: Address any apparent deficiencies noted in the incident management system during response and recovery by notifying the Incident Commander of the facility within the healthcare system and recommending solutions. x EPM-R5: Demonstrate the ability to function as a healthcare system’s Plans Chief within the ICS structure as indicated by the Emergency Operations Plan (EOP). Recommended proficiency for Primary Competency: expert level Knowledge o EPM-R5.1: Describe the healthcare system response roles and responsibilities ascribed to the chief of the Planning Section in the EOP. o EPM-R5.2: Describe the facility Incident Planning Cycle and the key components for which the Plans Chief is responsible. o EPM-R5.3: Describe the methods for functional area reporting and for the collation, processing, and dissemination of this information. Institute for Crisis, Disaster and Risk Management The George Washington University 52 Appendix C – Healthcare Emergency Management Competencies o EPM-R5.4: Describe methods for monitoring response and recovery actions in order to assist the Incident Commander in determining progress towards achieving the incident objectives. Skills o EPM-R5.5: Establish an effective Incident Planning Cycle by defining operational periods (approved by the system Incident Commander), coordinating the Planning Cycle timing with non-healthcare system response agencies, and disseminating the schedule for essential planning activities (management and planning meetings, operational briefings, and others). o EPM-R5.6: Ensure adequate functional area reporting by establishing the time schedule for reporting and verifying reports are received, to include situation, resource status, specific tactics utilized, progress accomplished, and unusual problems encountered; include patient tracking as necessary. o EPM-R5.7: Include information originating internal and external to the system in the planning process by monitoring internal and external sources for information, including the level of response by external organizations, and considering the information in the planning process. o EPM-R5.8: Ensure awareness of event parameters within the healthcare system by providing continual updates to the leader of functional areas and external agencies as appropriate. o EPM-R5.9: Provide rapid contingency response by monitoring for sudden changes in event parameters that necessitate revision of response strategies and tactics, and disseminate appropriate notification to relevant internal and external parties. o EPM-R5.10: Manage orderly and concise planning activities (management and planning meetings, operational briefings) by limiting distractions, providing agendas, and ensuring documentation of all relevant information discussed in the meetings. x EPM-R6: Perform or assist with the senior healthcare system liaison function and ensure that relevant response and recovery information is exchanged with senior healthcare system management levels beyond the immediate agency executive, if indicated. Recommended proficiency for Primary Competency: operations level Knowledge o EPM-R6.1: Describe the purpose and structure of the enterprise’s overarching healthcare system administrative hierarchy (such as the Veterans Integrated Service Network and Headquarters for the VHA) and its potential role during facility emergency response and recovery. o EPM-R6.2: Describe essential components of facility planning that should be disseminated to senior healthcare system management levels. o EPM-R6.3: Describe any assigned healthcare enterprise responsibilities to the community, State, or Federal governments or other entities established Institute for Crisis, Disaster and Risk Management The George Washington University 53 Appendix C – Healthcare Emergency Management Competencies through contracts, statutes or other authorities (for example, the VHADoD Contingency Plan) where the healthcare organization should establish a formal liaison function. Skills o EPM-R6.4: If part of a larger healthcare system (such as a VA Medical Center within a Veterans Integrated Service Network (VISN)), fulfill the region-wide emergency operations (response) plan and liaison function if it is activated. o EPM-R6.5: Ensure that senior healthcare system officials are receiving accurate information from the facility (usually through the facility’s agency executive) by providing the current facility IAP and/or situation reports in formats that are understandable to them. o EPM-R6.6: Ensure that the facility Agency Executive and Incident Manager receive appropriate communications from senior healthcare system officials above the level of the incident management structure. o EPM-R6.7: Assure that established responsibilities to the community, State, or Federal governments or other entities addressed and required actions communicated to appropriate Agency Executives and Incident Management Teams. x EPM-R7: If Program Manager of a larger healthcare system (such as a VA Medical Center within a Veterans Integrated Service Network (VISN)) with activated IMTs within individual healthcare facilities within your network, establish senior liaison with appropriate external healthcare organizations within the healthcare system in your area, conduct information exchange, and coordinate incident response strategies and tactics. Recommended proficiency for Primary Competency: operations level Knowledge o EPM-R7.1: List relevant external healthcare organizations that exist within the emergency response network in your area and methods for contacting them. o EPM-R7.2: Describe how the emergency response and recovery actions of healthcare facilities within your network and in your area impact one another. o EPM-R7.3: Describe how healthcare facilities within your network and external agencies in the same impact area may support one another during emergency response and recovery. Skills o EPM-R7.4: Ensure the IMT contact information for activated IMTs in your network is disseminated to appropriate external emergency response agencies. o EPM-R7.5: Facilitate the process for healthcare facilities within your network to gain access to appropriate external emergency response Institute for Crisis, Disaster and Risk Management The George Washington University 54 Appendix C – Healthcare Emergency Management Competencies agencies by establishing liaison or providing contact methods (as indicated). o EPM-R7.6: Facilitate coordination of response strategies and tactics by ensuring regular exchange of Incident Action Plans (or summaries contained in Situation Reports) between IMTs in your network and the appropriate external emergency response agencies. EPM-R7.7: Facilitate the use of mutual aid agreements between facilities within your network, and with external organizations when indicated. x EPM-R8: Participate in demobilization processes within the activated healthcare organization (such as a VHA Medical Center and/or within its overarching Veterans Integrated Service Network) to disengage resources from incident response and allow return to normal operations or back to stand-by status. Recommended proficiency for Primary Competency: operations level Knowledge o EPM-R8.1: Describe both the general objectives of the demobilization process and the specific management issues associated with demobilization, rehabilitation of response elements, and preparation to return to routine professional roles. Skills o EPM-R8.2: Assist in the demobilization of the healthcare organization and its resources by verifying that operational objectives have been met (or are reassigned to continuing units) and that appropriate internal and external notification is made regarding demobilization. o EPM-R8.3: Participate in any initial incident review (commonly known as a “hot wash”) and assist organizational leadership with ensuring appropriate procedures are followed for maintaining/preserving information for the After Action Report process. o EPM-R8.4: Assist with the debriefing and performance assessments of response personnel under your supervision, and others as requested by the organization’s incident manager. x EPM-R9: Assist, as indicated by assigned position in recovery management, with healthcare organization recovery to full pre-incident function, including return to routine facility management and medical care activities. Recommended proficiency for Primary Competency: operations level Knowledge o EPM-R9.1: Describe the incident planning and management processes for transitioning from response to recovery. Institute for Crisis, Disaster and Risk Management The George Washington University 55 Appendix C – Healthcare Emergency Management Competencies o EPM-R9.2: Describe the procedures and priorities for returning response resources and the overall organization to pre-incident operations and management. o EPM-R9.3: Describe the process required to re-evaluate the healthcare organization’s patient population and post-incident patient care activities, which includes addressing the backlog of regular work. Skills o EPM-R9.4: Assist, as requested, with personnel rehabilitation by providing advice on procedures for addressing physical or psychological concerns. o EPM-R9.5: Assist, as requested, with facility and equipment rehabilitation by establishing priority of recovery activities and identifying additional resources that may be required. o EPM-R9.6: Assist, as requested, with addressing backlogs of regular work by providing advice to facility leaders on surge capacity methods and the prioritization of backlogged services. x EPM-R10: Fulfill emergency management program requirements for a formal incident After-Action Report (AAR) process that captures and processes recommended changes to achieve organizational learning. Recommended proficiency for Primary Competency: expert level Knowledge o EPM-R10.1: Describe the policies and procedures as well as other considerations for completing the formal After Action Report on healthcare system response. o EPM-R10.2: Describe procedures for capturing information, analysis and acceptance or recommendations, and implementation of changes to a healthcare system EOP and overarching emergency management program. Skills o EPM-R10.3: Conduct efficient After Action Reports by utilizing incident response procedures for conducting a meeting and by ensuring After Action Report items are documented in the required format (i.e., issue, background, recommended action, responsible party and recommended timeframe). o EPM-R10.4: Ensure organizational learning by conducting appropriate analysis of recommendations, obtaining formal administration approval of accepted recommendations, and incorporating the recommended changes into the healthcare system EOP and other components of the emergency management program. Institute for Crisis, Disaster and Risk Management The George Washington University 56 Appendix C – Healthcare Emergency Management Competencies Healthcare System Leaders (HSL) Hospital and/or healthcare system-wide senior executives (CEO, COO, CFO), hospitalwide managers, department heads, nursing executives, chief of the medical staff, and/or senior managers in large departments or key operating units. It is assumed that members of this job group, due to their everyday organizational positions, would be assigned to serve in the command and general staff positions of an ICS structure during a healthcare system’s emergency response. x HSL-R1: Identify specific criteria of potential events that require the full or partial activation of the system’s Emergency Operations Plan (EOP). Recommended proficiency for Primary Competency: expert level Knowledge o HSL-R1.1: Describe the specific characteristics of potential events that would require EOP full or partial activation. o HSL-R1.2: Describe the impact of EOP activation (full or partial) upon day-to-day facility operations. o HSL-R1.3: Describe potential sources of information that may assist with incident recognition. Skills o HSL-R1.4: Demonstrate understanding of criteria for EOP full or partial activation by initiating appropriate levels of EOP activation rapidly during specific events. o HSL-R1.5: Ensure appropriate decisions are made about EOP activation by considering the impact of EOP activation (full or partial) upon day-today facility operations including the provision of essential services to existing patient populations. o HSL-R1.6: Ensure appropriate information is included in the decision to activate the EOP (as necessary) by coordinating with facility personnel who have relevant information or who have expertise relevant to the incident type. o HSL-R1.7: Ensure appropriate information from external sources is considered in the decision to activate the EOP by coordinating with external agencies that may provide incident-related information. x HSL-R2: Activate or support activation of the Emergency Operations Plan (EOP) to manage emergency response. Recommended proficiency for Primary Competency: operations level Knowledge o HSL-R2.1: Describe the EOP activation and notification process. Institute for Crisis, Disaster and Risk Management The George Washington University 57 Appendix C – Healthcare Emergency Management Competencies o HSL-R2.2: List the types of notification for the facility and specific functional areas. o HSL-R2.3: List relevant external agencies that should be notified of the system’s EOP activa…
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