capabilities to support medical services after a disaster, including directing individuals to

F.2 G.1.a G.1.b G.1.c G.1.d G.1.e G.1.f G.2 Response Required Within 90 Days Board of Supervisors • • • • • • • • • • • • Response Required Within 60 Days Office of the Mayor • • • • • • • • • • • • • • • • • • • • • • • OES/HS • • • • • • • • • • • • • • • • • • • • DPH • • • • • • • • • • • • • • • • • • • OPP • • • EMSA • • • • • • • • • • • • • • • • • • • Disaster Council • • • Health Commission • • CHN • • Community Clinics Consortium • • DTIS • SFFD • • • SFPD • • • SFUSD • Response Optional HCNCC • • • • • • • • • 38 VIII. APPENDICES A. Acronyms B. Hospital Utilization in San Francisco C. Disaster Council Members D. Hospital Council Emergency Preparedness Scorecard E. Department of Health Organizational Chart F. EMS Landing Sites G. Sources Consulted I APPENDIX A: ACRONYMS CDC – Centers for Disease Control and Prevention CHN – Community Health Network (San Francisco Department of Health) CPMC - California Pacific Medical Center DEIR - Draft-Environmental Impact Report DHHS - Department of Health & Human Services DHS - Department of Homeland Security DOC - Department Operating Center DPH - San Francisco Department of Public Health DHS - Department of Homeland Security DSW – Disaster Service Worker DTIS – Department of Technology and Information Services EDs – Emergency Departments (a term now used in lieu of Emergency Rooms) EMS - Emergency Medical Services (San Francisco) EMSA - Emergency Medical Services Agency EMT - Emergency Medical Technician Civil Grand Jury - San Francisco 2005-2006 Civil Grand Jury EOC – Emergency Operations Center HCNCC – Hospital Council of Northern and Central California HRSA - Health Resources & Services Administration ICS - Incident Command System JCAHO - Joint Commission on Accreditation of Healthcare Organizations MONS - Mayor's Office of Neighborhood Services MUNI - Municipal Railway System (San Francisco) NDMS – National Disaster Medical System NERT - San Francisco Neighborhood Emergency Response Team Training program NIMS - National Incident Management System OES/HS - San Francisco Office of Emergency Services & Homeland Security OES/HS - Office of Emergency Services / Homeland Security OPP - Office of Policy & Planning OSHPD - California Office of Statewide Health Planning & Development SFFD - San Francisco Fire Department SFGH - San Francisco General Hospital Medical Center SFPD - San Francisco Police Department SFUSD – San Francisco Unified School District UASI - Urban Area Security Initiative UCSF - University of California at San Francisco Medical Center VA – Veterans Affairs II APPENDIX B: HOSPITAL UTILIZATION IN SAN FRANCISCO General Acute Care Facility Name GAC Lic. Beds GAC Bed Days Total Lic. Beds Total Lic. Bed Days Total Hosp. Discharges Census Days Total CALIFORNIA PACIFIC-CALIF. EAST 95 34770 190 69540 1531 21556 CALIFORNIA PACIFIC-CALIF. WEST 382 139812 382 139812 8006 31708 CALIFORNIA PACIFIC-DAVIES 279 102114 341 124806 4577 40630 CALIFORNIA PACIFIC-PACIFIC 295 107970 325 118950 15549 82155 CHINESE HOSPITAL 54 19764 54 19764 2193 11100 KAISER FND HOSP - GEARY S F 247 90402 247 90402 13052 64976 SAN FRANCISCO GENERAL HOSP. 403 147498 639 242616 16816 143361 ST. FRANCIS MEMORIAL HOSPITAL 287 105042 356 130296 6784 43344 ST. LUKES HOSPITAL 150 54900 260 95160 6237 52474 ST. MARYS MEDICAL CENTER 336 123226 403 150873 7563 48305 UCSF MEDICAL CENTER 547 200202 547 200202 26588 155052 UCSF MEDICAL CENTER-MT. ZION 140 51331 140 51331 2460 9328 TOTALS: 3215 1177031 3884 1433752 111356 703989 SFGH as % of TOTALS: 12.5% 12.5% 16.5% 16.9% 15.1% 20.4% Source: California Office of Statewide Health Planning and Development, State Utilization Data File of Hospitals, Calendar Year 2004. Abbreviations: GAC = General Acute Care Lic. = Licensed Hosp. = Hospital III APPENDIX C: DISASTER COUNCIL MEMBERS64 Honorable Gavin Newsom, Chair Annemarie Conroy, Office of Emergency Services / Homeland Security, Executive Secretary Heather Fong, Chief of Police Joanne Hayes-White, Fire Chief Trent Rhorer, General Manager, DHS Dr. Mitchell Katz, Director, DPH Edwin Lee, Director, DPW Chris Vein, Director, DTIS Chris Cunnie, Executive Director, ECD Susan Leal, General Manager, SFPUC Honorable Michael Hennessey, Sheriff Arlene Ackerman, Superintendent of Schools Edwin Lee, City Administrator Edward Harrington, Controller Dennis Herrera, City Attorney Harold Brooks, CEO, American Red Cross, Bay Area Chapter Honorable Fiona Ma, Member, Board of Supervisors Honorable Ross Mirkarimi, Member, Board of Supervisors Honorable Michela Alioto-Pier, Member, Board of Supervisors Gloria Young, Clerk, Board of Supervisors Dr. Amy Hart, Medical Examiner Honorable Kamala Harris, District Attorney Nathaniel Ford, Executive Director, MTA Stuart Sunshine, MTA Bond Yee, Acting Director, Department of Parking and Traffic Monique Moyer, Executive Director, Port of San Francisco Yomi Agunbiade, General Manager, Recreation and Parks John Martin, Director, San Francisco Airport Phil Ginsburg. Human Resources Director Naomi Little, Director, Office of Contract Administration Amy Lee, Acting Director, Bureau of Building Inspection 64 OES & DHS Council Meeting CITY AND COUNTY OF SAN FRANCISCO DISASTER COUNCIL January 17, 2006, Video available at (accessed on March 28, 2006). IV APPENDIX D: HOSPITAL COUNCIL EMERGENCY PREPAREDNESS SCORECARD 65 TO: San Francisco Hospital Leaders FROM: Ron Smith RE: Emergency Preparedness and Scorecard At the request of the hospital leaders at the February 6th meeting, the Hospital Council Emergency Preparedness Taskforce has prepared the attached “San Francisco Hospitals – Emergency Preparedness Scorecard”. (Approved by the Taskforce representing all SF hospitals, the Scorecard was written by Debi Simon of CHW.) I have two major concerns about the City’s emergency planning process. As far as we know there is no surge plan for more casualties than those our hospitals can handle. The second concern is that there is no City plan to transport patients from our hospitals to other hospitals, helicopter landing sites, or SFO. The City has twenty-one sites where helicopters can land. However, the City reports that none of these sites could accommodate a military helicopter that could hold several patients. The City also said that it would be politically impossible for the City to identify sites for such activity. The City pointed out the difficulty they have in getting even one helicopter pad approved at SFGH. Cheryl Fama has suggested that perhaps now is the appropriate time to inform the Mayor of our progress and concerns. (Draft letter attached.) 65 Received by the 2005-2006 Civil Grand Jury on March 23, 2006 V SAN FRANCISCO HOSPITALS – EMERGENCY PREPAREDNESS SCORECARD ITEM ACTION NEEDED RESPONSIBLE PARTY(IES) COMPLETED ITEMS BELOW DUE TO BE COMPLETED BY 7/1/06 Surge Plan to 135% of ADC Write Surge Plan to include: Hospital EM Committee • Physical space • Facility based alternate care sites • surge tent • Beds/cots/gurneys • Staffing • Supplies/equipment Decontamination Identify Team members (disciplines, shifts, names); write Decontamination procedures Hospital Haz Mat/EM Coordinators Revise Disaster Plans to reflect • revised HEICS IV (if received) Hospital EM Coordinator • revised JCAHO EM Standards (major changes go into effect 7/1/2006) Hospital EM Coordinator MOU for Mutual Aid Approve draft; submit to Legal for approval Hospital EM Coordinator/ Materials Manager Communications Participation in all daily and weekly communications tests (800MHz, HEARNet, EMSystems) DPH/Hospital Pharmacist Assess needs for structural work to accommodate satellite phone, 800 megahertz and HAM radios Hospital Facilities Personnel with OES/ACS HAM Training: at least 2 per shift or minimum of 6 hospital staff trained Hospital EM Coordinator Identify all locations which need dedicated backup power supply - telephone switches, all radio systems, all critical computers Hospital Facilities Personnel Identify and establish working relationship with local SFPD and SFFD chiefs Mgr, Public Safety/Security; Chief Engineer Begin document detailing information flow, communication priorities, location and operating procedures for all communications equipment Hospital EM Coordinator Pharmaceutical Cache Cache cart located in all participating hospitals; prophylactics can be provided to all staff, family, and patients. DPH/Hospital Pharmacist VI Patient Tracking system Hardware selected/purchased DPH SFCC HRSA Coordinator Job description written and position approved DPH ITEMS BELOW DUE TO BE COMPLETED BY10/1/06* Surge Plan Plan and related policies and procedures finalized in preparation for 11/14/06 drill Hospital EM Committee MOU for Mutual Aid Finalized in preparation to drill 11/14/06 Hospital EM Coordinator/ Materials Manager Communications Requests for satellite phone, 800 megaherz and HAM radios submitted to OSHPD Hospital Facilities Personnel Install dedicated backup power for all radios and critical computer equipment (battery / Universal Power Supply) Hospital Facilities Personnel / Hospital IT Personnel Complete document detailing information flow, communication priorities, location and operating procedures for all communications equipment Hospital EM Coordinator Patient Tracking system Hardware distributed DPH Initial training complete DPH and Hospital ED staff Decontamination Train at least 3 potential Decon Team members per shift (no <9 per facility, by 8/31 per HRSA funding mandate* Hospital EM Committee/Education Dept SFCC HRSA Coordinator Hired DPH ITEMS BELOW DUE TO BE COMPLETED BY 1/1/07 Surge Plan Plan finalized based on drill findings Staff educated Hospital EM Committee MOU for Mutual Aid Finalized based on drill findings ? Materials Manager Patient Tracking system All hospitals trained to use system; website up DPH Decontamination Drill decontamination team 2 times Hospital Haz Mat/EM Coordinators SF HRSA Coordinator Trained and productive DPH/Hospital EM Coordinators VII APPENDIX E: DEPARTMENT OF HEALTH ORGANIZATIONAL CHART VIII APPENDIX F: EMS LANDING SITES IX EMS LANDING SITES. X APPENDIX G: SOURCES CONSULTED Interviews with Representatives from: City and County of San Francisco Office of Emergency Services and Homeland Security City and County of San Francisco Disaster Council City and County of San Francisco Board of Supervisors Budget Analyst’s Office City and County of San Francisco Department of Health City and County of San Francisco Office of Policy & Planning City and County of San Francisco Emergency Management Services Agency City and County of San Francisco Community Clinics Consortium City and County of San Francisco Office of Emergency Services and Homeland Security – Auxiliary Communications Service City and County of San Francisco Unified School District, Emergency Planning City and County of San Francisco Fire Department San Francisco VA Medical Center, Emergency Management Strategic Healthcare Group Hospital Council of Northern and Central California San Francisco General Hospital San Francisco General Hospital Foundation Various Private Hospitals in San Francisco State of California Office of Homeland Security XI Resources - City & County of San Francisco: 2002-2003 Civil Grand Jury for the City and County of San Francisco, It’s a Catastrophe: the State of Emergency Planning in San Francisco, June 19, 2003. City and County of San Francisco, Office of the Mayor, “3ll: Improved Customer Service and Public Safety of San Francisco,” September 2, 2004, . City and County of San Francisco Board of Supervisors, Resolution 0140-06, File # 060079, March 14, 2006. City and County of San Francisco, Emergency Operations Plan, Part I: Basic Plan, January 2005. City and County of San Francisco Administrative Code, Ordinance 275-05, Approved November 30, 2005. City and County of San Francisco Department of Public Health, Annual Report for Fiscal Year 2004-2005. City and County of San Francisco Department of Public Health, Health Commission Minutes, May 17, 2005. City and County of San Francisco Department of Public Health, Health Commission Meeting, October 18, 2005. City and County of San Francisco Department of Public Health, Health Commission Meeting, November 15, 2005. City and County of San Francisco Department of Public Health, Emergency Operations Plan, draft dated January 12, 2006. San Francisco Department of Public Health, Office of Policy and Planning, EMS Agency, and the Environmental Health Section, “Earthquake 2006 Disaster Exercise”, March 20, 2006 (1st Draft). City and County of San Francisco Emergency Medical Services Agency, The San Francisco Disaster Registry Program Information, April 12, 2006, < http://www.sfgov.org/site/uploadedfiles/dhr/intranet_memo/Memo_07-2006.pdf>. City and County of San Francisco Emergency Medical Services Agency, Policy and Procedure Manual, compiled Nov. 14, 2005. XII City and County of San Francisco Emergency Medical Services Agency Aircraft Utilization, September 1, 2005, pp.16–17, Policy Reference #4020, April 5, 2006, . City and County of San Francisco Emergency Medical Services Agency, March 20, 2006 City and County of San Francisco, Department of Human Resources, Memorandum DHR No. 01-2006, February 3, 2006. City and County of San Francisco Office of Emergency Services and Homeland Security, Disaster Council, Revised Meeting Agenda, January 11, 2005. City and County of San Francisco, Office of Emergency Services & Homeland Security, “After Action Report: Fast Track – Part II, Full Scale Exercise,” October 12, 2005. San Francisco Unified School District, “Emergency Plan Overview”, , (March 14, 2006). Disaster Service Worker Program: Executive Summary, as presented to the meeting of the City and County of San Francisco Disaster Council, January 17, 2006. Operation Safe Return (Interim Plan), Draft #1 6/17/2005 Fast Track Terrorist Simulation Press Release: from the Office of the Mayor of the City and County of San Francisco Tuesday, July 26, 2005. After Action Report Fast Track – Part II Full Scale Exercise, San Francisco Office of Emergency Services & Homeland Security. (Limited distribution, for official use only). Hospitals (of San Francisco) CEO meeting, Overview of Communications Capabilities and Gaps (PowerPoint presentation), February 6, 2006. Brown, John F. MD , Medical Director, EMS Section, San Francisco Department of Public Health, “How Would San Francisco Manage A Complex Emergency? Response to a Terrorist Attack “, Vol. 75, No. January 2002. Brown, John MD, “Ambulance Diversion, It’s Time for a Change”, San Francisco Medicine, Publication of the San Francisco Medical Society October, 2005. Brown, John F. MD , Medical Director, Emergency Medical Services Agency, San Francisco Department of Public Health,, Power Point Presentation, “EMS System Surge Capacity & Capability Assessment,” presented to the Health Commission, May 17, 2005. Cabanatuan, Michael, “San Francisco Area’s Infrastructure Graded a C-minus”, San Francisco Chronicle, October 18, 2005. XIII Campbell, Scott J. MD, MPH, Chairman Department of Emergency Medicine Kaiser Permanente Medical Center, San Francisco, “Rethinking San Francisco’s Ambulance Diversion Crisis”, Report to the San Francisco Board of Supervisors the “Emergency Room Diversion” Task Force, January 27th, 2003. Epstein, Edward, “House Panel Rips Administration on Katrina Response”, San Francisco Chronicle, February 16, 2006. Epstein, Edward, “Homeland Security Directive Shocks Local Governments, 12 Major Cities Must Single Grant Application”, San Francisco Chronicle, January 4, 2006 Fagan, Kevin, and Charlie Goodyear, “San Francisco’s Emergency Services Chief Blasted by Supes”, San Francisco Chronicle, September 21, 2005. Fagan, Kevin, “Bay Area Cities to Pool Disaster Resources, Homeland Security Will Fund Regional Emergency Plan”, San Francisco Chronicle, October 18, 2005.Noyes, Dan, “Flaws Found In SF's Emergency Warning System”, ABC I-Team, November 11, 2005. Fancher, Emily, “Helicopter Pad Fight Ready to Take Off Again,” San Francisco Chronicle, November 1, 2005. Gerson/Overstreet Architects, San Francisco General Hospital Medical Center: Air Medical Access Needs and Feasibility Study, Prepared for the San Francisco Health Commission, March 4, 2003. Gordon, Rachel, “State Sets February 24 Deadline to Review Anti-terror Request”, San Francisco Chronicle, January 18, 2006. Gordon, Rachel, “$320 Million Wish List for Homeland Security for Everything from Terrorist Attacks to Quakes,” San Francisco Chronicle, February 24, 2006. Greenwald, Alan MD, “Disaster Readiness”, San Francisco Medicine, Publication of the San Francisco Medical Society October, 2005. Hampton, Adriel, “S.F. Unveils Wide-ranging Alert System,” The San Francisco Examiner, March 9, 2005. Hayes-White, Joanne, Chief of San Francisco Fire Department, Letter to Civil Grand Jury dated April 12, 2006. Health Management Associates, The San Francisco Department of Public Health: Its Effectiveness as an Integrated Health Care Delivery System and Provider of a Continuum of Long Term Care Services, a Report submitted to the Office of the Controller, City and County of San Francisco, July 2005. XIV Holbrook, Karen, MD, PhD, “San Francisco Physician Guidance for Public Health Emergencies Due to Bioterrorism or Infections Disease Outbreaks,” San Francisco Medicine, Vol. 78, No.1, February 2005. Jouvenal, Justin, Bay Area Cities Laggin in Bid for Federal Anti-Terror Funds, San Francisco Chronicle, January 12, 2006. Lagos, Marisa, “Homeland Security Funding Proposal Goes Down to Wire”, San Francisco Chronicle, February 23, 2006. Noyes, Dan, “Is San Francisco Ready for a Major Disaster?”, ABC I-Team September 7, 2005. Noyes, Dan, “Official Wants Hearing on City Siren System”, ABC I-Team, November 15, 2005. Noyes, Dan, “Out of State SF Firefighters Face Investigation”, ABC I-Team, December 1, 2005 Rauber, Chris, “Deadline Looking Shaky,” San Francisco Business Times, January 23, 2006 Stannard, Matthew, “Mastering Homeland Security, Naval School Offers Anti-Terrorism Degree”, San Francisco Chronicle, July 6, 2004. Ross, Carol, SF Planning Department, Environmental Analysis of the Helipad at SFGH, , (March 10, 2006). Southers, Erroll, Deputy Director, California Office of Homeland Security quote from during conference on counter-terrorism in Israel,“U.S. Security Officials Train with the Pros”, San Francisco Chronicle, March 24, 2006. Vassar, Mary, Emergency Medical Services Agency,, November 2005 Ambulance Diversion Data, SFPD, December 7, 2005. Vassar, Mary and Kate Garay, “EMS System Surge Capacity & Capability Assessment,” as presented by John F. Brown, M.D. to the San Francisco Health Commission, May 17, 2005. Wachsmuth , Chris, SFGH Medical Helipad Project Timeline, December 5, 2005, March 29, 2006 . “URS Selected for Bay Area Regional Emergency Coordination Plan”, Business Wire, October 17, 2005. Resources - State of California: California Healthcare Foundation, California Healthline, “Two San Francisco Hospitals Might Miss Seismic Retrofit Deadline,” January 25, 2006. California Office of Statewide Health Planning and Development, 2004 Hospital Data File from Annual Utilization Report. XV California Office of Statewide Health Planning and Development, Summary of Hospital Seismic Performance Ratings, April 2001. California Office of Statewide Health Planning and Development, Facilities Development Division. Summary of Requests for Extensions to Seismic Safety Deadlines, February 2, 2006. Joint Commission on Accreditation of Healthcare Organizations, Health Care at the Crossroads: Strategies for Creating and Sustaining Community-wide Emergency Preparedness Systems, 2003. Hospital Council of Northern and Central California, communications from Ron Smith re Emergency Preparedness and Scorecard, received by the Civil Grand Jury March 23, 2006. Working Group on California Earthquake Probabilities, Executive Summary: Earthquake Probabilities in the San Francisco Bay Region: 2002-2031, U.S. Geological Survey, Open-File Report 03-214, March 13, 2006, . “The Role of Local EMS Agencies in California EMS System,” , (1/13/2006). Bamattre, William, Los Angeles Fire Department Chief, quoted by Jim Hahn, Mayor of Los Angeles, August 2, 2004 Press Release, April 3, 2006, http://www.laobserved.com/archive/002286.html. Sun, Benjamin C. et al., “Effects of Hospital Closures and Hospital Characteristics on Emergency Department Ambulance Diversion, Los Angeles County, 1998 to 2004,” Annals of Emergency Medicine 47:309-316, April 2006. Resources - Federal Government: U.S. Congress, Senate: Committee on Government Affairs, July 23, 2001 Testimony of Tara J. O’Toole, M.D., M.P.H., Johns Hopkins Center for Civilian Biodefense Studies, as quoted in Joint Commission on Accreditation of Healthcare Organizations, Surge Hospitals: Providing Safe Care in Emergencies, 2006. Office of the President of the United States, The Federal Response to Hurricane Katrina: Lessons Learned, February 2006, as prepared by Frances Fragos Townsend, Assistant to the President for Homeland Security and Counterterrorism, March 1, 2006, . U.S. House of Representatives, 109th Congress, 2nd Session, A Failure of Initiative: Final Report of the Select Bipartisan Committee to Investigate the Preparation for and Response to Hurricane Katrina, February 15, 2006, . Health and Social Services Committee Report and Recommendations to the Commission January 18, 2006, Failure of Initiative. XVI U.S. Department of Homeland Security, National Response Plan, December 2004 U.S. Department of Homeland Security, Office of Grants and Training, March 30, 2005, . U.S. General Accountability Office, GAO-06-365R, Enclosure I, “Statement by Comptroller General David M. Walker on GAO’s Preliminary Observations Regarding Preparedness and Responses to Hurricanes Katrina and Rita,” February 1, 2006. FEMA Position Paper, April 3, 2006, . Resources - Other “A Deadly Vacuum”, New York Times Editorial, February 16, 2006 American College of Surgeons, Statement on Disaster and Mass Casualty Management, Ad Hoc Committee on Disaster and Mass Casualty Management of the Committee on Trauma, June 2003. Lipton, Eric, “Handling of the Infirm During Katrina Assailed”, New York Times, February 1, 2006 Marcus, Leonard J., Barry C. Dorn, and Joseph M. Henderson, “Meta-Leadership and National Emergency Preparedness: Strategies to Build Government Connectivity,” Harvard University, John F. Kennedy School of Government, Center for Public Leadership, Working Papers, Spring 2005, p. 43. Montana Area Health Education Center, Strategic Planning for Healthcare Organizations, April 5, 2006 . Mullen, Sam, Critical Communications: An Operations Guide for Business, April 5, 2006, . New York City Department of Information Technology and Communications, April 5, 2006, . O’Malley, Ann S., Anneliese M. Gerland, Hoangmai H. Pham and Robert A. Berenson, “Rising Pressure: Hospital Emergency Departments as Barometers of the Health Care System” Center for Studying Health System Change, Issue Brief No. 101, Nov. 2005. Wolf, Gary, “Reinventing 911”, Wired Magazine, Issue 13-02. Testimony by Director Henry Renteria, Governor’s Office of Emergency Services, Little Hoover Commission Hearing May 26, 2005.