the book

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Much of the material on this website is based on the Functional Emergency Preparedness book.  However, it is easier to update and expand further on the concepts from the book utilizing the site.  Below are some highlights from each chapter of the book.  If you would like more information on purchasing options scroll to the bottom of the page.

INTRODUCTION 

Much of the material in this book is specific to LTCFs.  However, other provider types or healthcare organizations could also benefit from the material covered in the book as well.  At the beginning or end of several chapters, I include specific information about the CMS requirements as they relate to LTCFs.  In addition, I have utilized the emergency preparedness interpretive guidance provided by CMS throughout the book.  I also cover a few things independently towards the end of the book.  For example, there is a chapter on Hurricane Katrina as a natural disaster.  A chapter on Cyberattacks as a facility-based disaster. A chapter on COVID-19 as an emerging infectious disease (EID). And I also included a chapter on Active Shooter as a man-made disaster and a security threat.  Hopefully, this allows the reader a chance to see how the teachings from the beginning of the book can be utilized in an actual scenario instead of just reading about the CMS requirements or emergency preparedness in general.   

Key Takeaways from Introduction Chapter

Immediate Responders, Continuous Improvement, Vulnerability, Smart and Healthy 

CHAPTER 1.  COOPERATION and COLLABORATION 

Leaders cannot assume what worked for an LTCF in the past is good enough for all future emergency events and disasters. In the OIG study mentioned at the beginning of this chapter, there was a lack of cooperation between LCTFs and outside emergency management agencies. In addition, emergency plans were not being developed and utilized appropriately.  So, the OIG recommended that CMS expand its emergency preparedness requirements for LTCFs and other provider types. 

Key Takeaways from Chapter 1

The Office of the Inspector General (OIG) Study, Selecting the Emergency Preparedness Coordinator, Incident Command System 

CHAPTER 2.  THE BRAIN, STRESS, and FEAR 

In an emergency response, we make assumptions based on our training and experience for quicker decision-making and to fill in the gaps when there is a lack of information available.  In addition, we have billions of neurons in our brain trying to make connections to what is taking place during an emergency event and attempting to compare it to another situation we dealt with in the past.  However, when the brain is required to “drill down” repeatedly for specific information it takes additional effort and energy to retrieve the information required for an important decision.  So, in our emergency response, we are often trying to figure out if there is a pattern to the event.  We are looking for things that are similar or different from past events.  By discovering these patterns, we can make quicker decisions.  However, I caution that this ability to make assumptions and seek out patterns based on past experience does not replace the need for a comprehensive emergency operations plan (EOP).  In addition, there should be more than one person at a facility that has received the emergency preparedness training that is essential for utilizing these decision-making methods. 

Key Takeaways from Chapter 2

The Triune Brain, Conscious versus Unconscious Mind, Stress, and Fear 

CHAPTER 3.  EMERGENCY PREPAREDNESS 

Humans were built for preparing and responding to emergency events, and I highlight this point frequently in the book.  We could be the only living things on the planet that are capable of thinking about the future.  So, that means we are the only ones capable of planning and preparing for future emergency events. The good news is that we are capable of thinking and planning for the future.  The bad news is that we tend to be overly optimistic about the future and therefore we do not properly plan.   

      The emergency preparedness program should be based on four core elements.  First, the program must have an emergency plan that was developed using a risk assessment.  Second, the program must have policies and procedures in place that were created using a risk assessment.  Third, the program must have a communication plan in place for both internal and external contacts.  The communication plan must also provide for alternate means of communication.  Lastly, there must be training and testing of the emergency preparedness program.  To be sure, a comprehensive program is considered superior to those emergency programs only focusing on a few natural disaster scenarios.  So, when a facility implements an “all-hazards” approach to emergency preparedness it will include the ability to respond to emerging infectious disease (EID) outbreaks like that of COVID-19. 

     Preparedness, mitigation, response, and recovery are typically the four phases considered for effective emergency management. An LTCF should take all four into consideration when developing the emergency preparedness program.  When this can be accomplished, it will allow the facility to be more self-sufficient and less dependent on others in the community. In addition, if we are heading in the right direction with the emergency preparedness program we can deal with some setbacks along the way.  But we must avoid the pitfall of becoming complacent in our efforts. Whether we are taking small steps or large steps the goal is to keep moving forward with our emergency preparedness program.  Progress is achieved when an LTCF or any organization demonstrates the commitment to keep improving.     

Key Takeaways from Chapter 3

Subsistence Needs, Communications Plan, Policy and Procedures, and Resources. (Resources include raw materials, people, equipment, and technology) 

CHAPTER 4.  EMERGENCY OPERATIONS PLAN 

The EOP will include information on preparedness, formulated responses, and the recovery from an emergency event. The EOP provides us a “hint” for what direction we need to take in the emergency response. In addition, the EOP allows us to make small adjustments and avoid the pitfall of thinking we need the perfect plan from scratch in each response. Instead of worrying about having the perfect plan our efforts are better spent trying to perfectly implement the plan we have. The completed EOP provides us with a script and offers some guidance, so we do not freeze from too many decisions. The EOP is not a perfect tool. However, it beats the alternative of having nothing and therefore, not being prepared at all. The EOP is our map to make our journey easier and to make sure we get off to a good start when responding to an emergency event. Ultimately, a quality EOP makes poor decisions less likely and provides an LTCF with some consistency when responding to an emergency. 

Key Takeaways from Chapter 4

Hazard Vulnerability Assessment or Analysis (HVA), Facility-based Risk Assessment, Community-based Risk Assessment, “All-Hazards” Approach, Transfer Agreements, Memorandums of Understanding (MOUs), Continuity Plan or Continuity of Operations Plan (COOP) 

CHAPTER 5.  INCIDENT COMMANDER 

The Incident Commander (IC) or designated leader is the single person in charge of an emergency event at a long-term care facility (LTCF) and they are responsible for creating the overall incident objectives for the event. The IC would also be responsible for activating the emergency operations plan (EOP) and the overall strategic direction for the emergency response and recovery. The Incident Commander needs to create an environment where interactions and communication can take place while responding to an emergency event. The IC should believe in their people often and early during an emergency. In some cases, their people might not even believe in themselves yet while responding to an emergency. The IC should be able to deal with multiple opposing ideas and still facilitate necessary operations. Mistakes will be made in every emergency response, but we should strive to make better mistakes than we did in the past. To be sure, if we can resume normal operations after an emergency event, we should be grateful that there will be an opportunity to make better mistakes tomorrow. 

Key Takeaways from Chapter 5

Selection of Incident Commander, Frictionless Information Gathering, Prioritization, Multitasking and Toggling, Decision Making, Asking Questions, Communication, Dissenting Opinions, Transparency, Praise, Strengths and Weaknesses 

CHAPTER 6.  TRAINING, TESTING, and PREPARATION 

Time and resources are typically in short supply during an emergency response, and this causes added stress to the decision-making process. We need the ability to process information quickly in an emergency response to make the appropriate decisions. For this decision-making process to occur almost automatically there needs to be training on a continual basis. This emergency preparedness training should include the opportunity for testing the skills obtained and for feedback. Both can be beneficial for improving our emergency preparedness programs. The training we provide should be challenging to the participants. Training can still be fun and engaging without being too easy for the learner. There is still risk even after we think we have planned and trained for everything. Thankfully, humans can plan for future emergency events, and we have the capability to be flexible when responding to the event. Our knowledge will always have limits. But by putting in the time and training necessary our emergency preparedness program will be repeatable and sustainable. We should never settle for feeling like we are finished with emergency preparedness. 

Key Takeaways from Chapter 6

Tiered Ruggedness, After-Action Review/Report (AAR), Shelter-In-Place (SIP), Emergency and Standby Power 

CHAPTER 7.  HURRICANE KATRINA (Natural Disaster) 

Hurricane Katrina is one of several events that may have prompted the CMS requirements for emergency preparedness. As a result of what could only be perceived as a poor performance during the Hurricane Katrina response, many LTCFs have improved their ability to prepare for and respond to an emergency event like a hurricane.  An LTCF must have the ability to be self-sufficient for at least a short period of time during an emergency event. However, this time frame might extend to longer periods than projected. One of the reasons I have focused on Hurricane Katrina and the levee problem that caused much of the flooding for this chapter is because the risk assessment or hazardous vulnerability assessment (HVA) completed at an LTCF should include threats for specific geographic locations. Ultimately, Hurricane Katrina created a situation that local, state, and federal officials were not prepared for. 

Key Takeaways from Chapter 7

Hurricane Katrina Compared to Other Disasters, Immediate Responders, Volunteers, Non-governmental Aid, The Levees, Personal Safety, Facilities for Staging, Supplies, and Shelter 

CHAPTER 8.  COVID-19 (Emerging Infectious Disease) 

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is the coronavirus that causes the coronavirus disease 2019 (COVID-19), and there will be plenty of books written about the pandemic in the years to come that deal mainly with the science or possibly a book about “Operation Warp Speed”. However, the objective of this chapter is not to give the reader a scientific overview of COVID-19, but rather some innovative technologies available and lessons learned during the first two years of the pandemic. In addition, supply chain disruptions are thoroughly covered in this chapter as well. I hope this chapter demonstrates the need for an all-hazards approach to our emergency preparedness that includes the ability to respond to future pandemics.   The risk assessment we complete at LTCFs should include emerging infectious diseases like COVID-19 and the possible staff shortages we might face as a result. To be sure, in this risk assessment there will need to be an assessment completed of our physical environment. A review of the physical environment at an LTCF should include the ventilation system and the ability of the facility to increase outdoor air usage or purify the air using a filtration system. 

Key Takeaways from Chapter 8 

Innovative Technologies, Global Human Tragedy, Psychology of Pandemics, Supply Chain Shortages and Stockpiling 

CHAPTER 9.  CYBERATTACKS (Facility-Based Disaster) 

During the COVID-19 pandemic, many companies allowed remote work, and these same companies increasingly migrated to the cloud. There will be an increased need for cybersecurity going forward because of the new working environment created during the pandemic. In addition, during the pandemic, we experienced supply chain disruptions and ransomware attacks can exacerbate these supply chain problems. Severe supply chain disruptions could possibly require an LTCF to activate its emergency operation plan. To be sure, healthcare organizations can be high-value targets for cyberattacks and ransomware attacks. So, my recommendation is that an LTCF include IT personnel in the emergency preparedness program and planning at the facility. In addition, cyberattacks should be considered when completing the risk assessment at an LTCF. If a crime is carried out using a computer or the internet it is considered a cybercrime. There are many things that make up a cybercrime besides cyberattacks and ransomware attacks. Internet fraud and identity theft would be among those other things. Cybercrime is vicious and is not without victims and cyberattacks have become something comparable to a digital plague.   

Key Takeaways from Chapter 9 

Cybersecurity Threats, Ransomware Attacks, Cybersecurity Agencies, Phishing and Digital Scams 

CHAPTER 10.  ACTIVE SHOOTER (Man-Made Disaster) 

I think we can all agree there have been too many active shooter incidents that have occurred in the United States over the last twenty years. And senior living communities and long-term care facilities are not immune to these hideous acts of violence. There have not been many active shooter events in senior living or long-term care facilities (LTCFs), but they have happened. Because active shooter events do not happen that often in LTCFs my biggest fear is that the staff do not quickly recognize and respond to an actual active shooter. My recommendation is that in addition to providing active shooter training an LTCF should incorporate these scenarios into their emergency operations plan (EOP), including planned responses and recovery from an active shooter event. In addition, I recommend that an LTCF develop a policy and procedure for active shooter/armed intruder events. The response to an armed intruder would be the same as the response an LTCF would utilize in an active shooter event. Every active shooter situation is unique, but most take place quickly. So quickly, there is a good chance the shooter could be gone by the time first responders arrive. First responders would include law enforcement, fire service, and emergency medical personnel. There is no perfect response to an active shooter, the protection of life is our goal, and everyone will need to decide for themselves how to best accomplish this based on the circumstances of the event. However, in an ideal situation, we would prevent the shooting incident altogether. 

Key Takeaways from Chapter 10 

Profile of an Active Shooter, Alert Systems, Run, Hide, Fight®, Rapid Intervention (Tactics and Responses) 

CONCLUSION 

To be a successful investor I cannot invest for the present or for the past. I need to be optimistic and invest for the future. In a similar fashion, an LTCF should be investing in emergency preparedness for the future. With emergency preparedness, we are continually trying to be better prepared for tomorrow than we were today. Implementing and maintaining an emergency preparedness program at an LTCF is not only achievable it can be extremely satisfying as well if we care enough to make it great. The emergency preparedness program and plan at an LTCF should be comprehensive. To be sure, a comprehensive program is considered superior to those emergency programs only focusing on a few natural disaster scenarios. However, “comprehensive” does not necessarily mean complicated. An emergency preparedness program and plan can be comprehensive and remain functional at the same time. 

Key Takeaways from Conclusion Chapter

The Wright Brothers, Areas of Improvement, Community Resource, Goals of the Book 

APPENDIX (Resources for Emergency Preparedness) 

In this “Appendix” I have listed resources that I think the reader should be familiar with for emergency preparedness. In my opinion, these resources should help an LTCF achieve compliance with the CMS emergency preparedness requirements. I have provided a brief description and website information/link for each of the resources.