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Center for Public Health Preparedness

Transcriptions

University at Albany Center for Public health Preparedness

Expanding Health Care Preparedness

Original Satellite Broadcast: 01/25/07

Moderator: Good morning and welcome to the University at Albany Center for Public Health Preparedness Grand Rounds Series. I’m Kris Smith, and I’ll be your moderator today. Before we start we would like to ask you to please fill out your evaluations online. Your feedback is always helpful to the development of our programs, and continuing education credits are available. We will be taking your calls later in the hour. The toll- free number is 1-800-452-0662. You may also send your questions by fax or e-mail at any time during the program. The fax number is 518-426-0696, or you can send your questions to the e-mail address on your screen. This program will run for an extra 15 minutes so we do encourage you to send us your questions. We hope to hear from you. Today's program is Expanding Health Care Preparedness. Our guest today is Ms. Bonnie Kaido, Director of Emergency Preparedness at Bassett Healthcare in Cooperstown, New York. Welcome to the program, Bonnie.

Ms. Kaido: Thank you, Kris.

Moderator: Really good to have you with us. Your topic is very important. To begin with, tell us about how Bassett Healthcare System is organized, and especially your health care response.

Ms. Kaido: Certainly. Bassett is a health care system located in Upstate New York. We're in eight counties. We have four hospitals within the system, 23 health centers, a research institute, a physician group of over 230 members. We also have the New York State Center for Agricultural Health and Medicine based in Cooperstown. The Mary Imogene Bassett hospital is a teaching hospital at Columbia, physicians and surgeons and also five other medical schools within the state and outside the state as well. We're also a member of the New York Presbyterian Health Care System.

Moderator: So you have a whole lot going on. When it comes to emergency responses, there have to be some key elements. What are those key elements of managing an emergency?

Ms. Kaido: Kris, sharing your emergency response plan with all of your staff members and assigning the responsibility for training to your management staff. That's very important. And they have to really understand the overall plan so that they can bring that knowledge to the level of staff that they're working with. What is your individual role in an emergency and how does our department fit into the overall emergency response plan? That's very important.

Moderator: You know, let's look at the breadth of your health care system, if you would, because you touched on it, how extensive it is, and certainly, just the geographic distribution of your facilities, must be enormous.

Ms. Kaido: It is. Within the eight counties, we really touch a lot of different lives. There are over 500,000 outpatient visits a year at Bassett within the health centers and in the clinic in Cooperstown. And as you can see from the map, we really do touch on a great deal of Upstate New York, and most of our territory is rural. And so that brings some special challenges to emergency preparedness.

Moderator: So what are some of those challenges? And how do you get it all together? Do you-- I know-- is there an incident command system for hospitals?

Ms. Kaido: There is absolutely one and it's a national system that Bassett adopted back in 1998. It was recently redone at the national level and we're in the process now of retraining people in the new system. It's really the foundation of all our preparedness activities, and we think that staff understanding that-- how the incident command system works is a key element in our response to emergencies. We have an emergency operation center, in some cases the hospitals in other areas may call it the hospital community center, and it's really the nerve center, not different from what a County would have or a local municipality during a time of an emergency. We want to make sure that people know how they can access us for quick answers for things. So communication is an important part of that.

Moderator: Just to make sure we're communicating, everybody on the same page, is the acronym HICS?

Ms. Kaido: It is HICS.

Moderator: Okay. Because when we talk about HICS later on. I want to make sure everybody knows what we're talking about.  What features of the HICS system make it most useful to responding for emergency?

Ms. Kaido: Well, as I said, it’s a national system, it's designed after the fire scope activities in California. It's predictable. It's a responsibility-oriented chain of command. It's a clear set of roles and responsibilities. We have job action sheets that people have that tell them what to do during each operational period. It’s a flexible response system, you can open up as many HICS positions or as few as you need to depending on the size and extent of the emergency. It's a standard vocabulary. So that if I’m out in the field as a EMS provider, I’m using the same words that I would use in the hospital as the incident commander to that emergency. The same thing with fire and law enforcement. We're all on the same page. And there are predefined functional roles so that you can train people to take those roles. In an emergency they have the information in front of them, but they also have the experience, so I think that it really pulls that together and it allows us to integrate with the community.

Moderator: And I would imagine that that's essential when time is of the essence, that everybody's speaking the same language and they know what to do, when to do it and with whom to partner.

Ms. Kaido: Absolutely. That’s no time for training.

Moderator: Exactly. Who exactly should be involved in planning for health care emergencies? Certainly clinicians, but who else?

Ms. Kaido: We think that it's important to get everyone involved, because in a real emergency, think about who's going to respond. We're going to need everyone's help. And so we believe that every hospital department needs to have a role in emergency preparedness. I think there are a lot of times when people forget certain areas. Business office or finance, research, administrative support. Sometimes it's very easy to overlook these less obvious areas of support. We always think of housekeeping and we always think of the maintenance personnel and we always think of the clinicians, because they have such key roles. But we can use other folks as well.

Moderator: What would these HICS teams be?

Ms. Kaido: You can have administration as part of it. They certainly know how to get resources quickly. Security, gaining access to the facility or limiting access to the facility. Maintenance staff as stretcher bearers, folks to supplement security. We use ours because we have a security force but it's a small security force, and so we need to supplement that group. So they get just-in-time training as to how to do that. And office and front desk staff make wonderful runners, communicators. They can record information for us, answering telephones. All of those things are very necessary in an emergency.

Moderator: Bonnie, take us through some of how you would identify what a cross-functional position would be; for instance that person who normally is involved in maintenance. How do you know what other emergency job he or she would be best at? How do you identify the skill sets?

Ms. Kaido: When you work with the departments and talk about some of the tasks that might be needed during an emergency. So we know, for example, that one of the things that we have to do very quickly is to get stretchers if it's going to be a mass casualty incident. We need all the stretchers and wheelchairs that we can find. And so these folks usually are out throughout the hospital, doing their regular jobs, and they know where these are located, so they will bring them to the triage area, with front office staff or registration staff. They're used to working with patients and gaining information. So what better group than to be escorts with the clinicians for those patients as they move through the system? They can then give us that information and tell us who these patients are and get them registered in the system if they're not already a Bassett patient.

Moderator: So do you ask for volunteers for this emergency duty or do you identify the staff that you think would be most relevant in the additional tasks?

Ms. Kaido: Well, we expect that everyone will have a role in emergency preparedness, and so as we work with departmental managers, they each have a departmental response plan that covers each type of emergency that we plan for. And so they bring that down. They discuss it with their staff and they look at what the individual roles are and how they might be used. But in an emergency, all things are open, and so we use people in whatever way we need to.

Moderator: All hands on deck.

Ms. Kaido: Absolutely.

Moderator: Well, certainly training has got to play a large role in this.

Ms. Kaido: It does. We need to train people. We need to make sure that it's appropriate training, and so we bring it down in different ways, and so many people learn by doing, and so by doing drills and exercises, that's how they learn to do things. We also do it in terms of making sure that we're speaking the right language with the right group and finding out what the point is where they will understand what their role is. And so we have to look at it in many different ways. People learn differently and so we need to respond to that. Sometimes they learn best by using video. Sometimes it might be an on-line program for training, and sometimes it might be just a conversation where you explain and you run through personally with them how they're going to react in an emergency. We test that all the time.

Moderator: I think that it's really important what you're saying about the non-traditional staff getting involved in emergency preparedness and responses. Maybe you could give us some specifics as to how these various staff can play a role; for instance the business office or research staff.

Ms. Kaido: I think business office folks are wonderful escorts for children involved in a school bus accident, for example. We try to make sure that the kids are comfortable and that they're not afraid. And so you're going to assign someone to be with them during the process of their being evaluated.

Moderator: Why business office?

Ms. Kaido: Because most of them are moms. They're in there. They're doing accounting work. They're billing, and a lot of these folks are moms who are used to being with their children, and so they're very comforting when this type of thing happens. Our research staff, they're used to tracking things so patients and staff and costs.  Administrative support, they're used to dealing with the public and they're used to taking questions by phone, and so they make wonderful folks to support in the emergency operations center and to troubleshoot as well. And then food services staff. We have to be fed. We need to be kept hydrated. We need to make sure that our patients currently in the hospital are still being fed, that our visitors are still being taken care of, but now we have an influx of folks that need also to be sustained, and so they're key people in an emergency.

Moderator: So you're not really asking that someone reinvents the wheel, but to take what they're good at and do it in a very challenging situation.

Ms. Kaido: Absolutely.

Moderator: And that's probably the best idea. You don't want to have to learn new things when, you know, the disaster is occurring.

Ms. Kaido: That's right.

Moderator: Well, certainly you have a little bit of experience with drills and exercises. Why do you think it's important to involve all staff in the drills and exercises and not just those you might normally think of as the usual suspects?

Ms. Kaido: Well, as I said before, it's no time when you have an emergency to have to, for the first time, alert someone as to how they're going to respond to that emergency. So we really need to know this and everyone needs to know what the plan is. If we look at evacuation drills, for example, it's important to me to have nurses actually be patients who get evacuated because they need to know how that's going to feel, and they need to know how they're going to do it so we have them work on both ends. I think giving them the opportunity to act in that way gives them that sense of, gee, now if I do it this way, my patient may feel uncomfortable, but if I do it a different way, they're going to feel a lot more comfortable. So we work. We have a lot of different tools that we can use in evacuations. We also bring in the fire department, and they learn how to evacuate patients with us as well. And they give us tips and we give them tips back. So it's very integrated with the community as well. Family members of staff make great victims, and so we get them involved, too. If something-- they know that their family member is going to be responding to the hospital to work during an emergency, but if they come in and they actually work the drill with us, they get a sense of what it's going to be like. And so maybe they have a little deeper understanding of what their person is going through.

Moderator: And actually that would contribute to the buy-in on every level from the staff member, who hates to leave their family when things are looking pretty dire, and for family members who hate to have, you know, their loved one go but know their job is so important.

Ms. Kaido: Absolutely.

Moderator: They've played a part in it. Now, how can you-- maybe you could just talk about specific strategies that planners can use to engage support members.

Ms. Kaido: I think it's important to engage in a wide variety of staff, and we recently put out a request for information to our staff saying “Would you like to be involved in a drill and exercise team?”  And in fact I have a number of people being trained today in exercise design. I think bringing it into the organization helps more people to understand what it is we're trying to do and how we're going to do it. So we try to involve all levels of staff. And again when we talk about using family members or we may use other staff and say, gee, would you like to be the patient that's going to be decontaminated so that they get a sense of what we're doing. I think when you know what's happening, you're less fearful of it and you understand it better and so you're more willing to do these things.

Moderator: Now, do you have to recruit these folks by yourself or do you go to their supervisors? Specifically how does it work?

Ms. Kaido: We pretty much put out the call through the managers and say, look, we're going to be doing some things and would you ask your staff if they're interested in being involved? And people like to do this. They like to feel like they're part of it because they are in an emergency. And so we find that we have good response from folks.

Moderator: So we have plans in place and systems exercised, and we're all set to go and then what happens in a real emergency?

Ms. Kaido: Well, you know, in the past we never had to worry about that, but since 9/11, we are living in a different world and we have different concerns and we have different issues. And so we think that, you know, the need for practice with all staff and for information helps in making people feel that they need to come in and respond; but what we're finding is that all staff may decide not to respond in an event. And so there was actually a study done in 2005, and they asked people about two things: Were they willing to respond, and were they able to respond? And they really had some interesting things come back from the study that I think mirrors how unsettled we are as a society now from 9/11. What they found in terms of ability to respond was that people thought that they were most able to respond to a mass casualty incident, the school bus accident, the charter bus, the airplane accident, an environmental disaster or a chemical event; but they were least able to respond to a smallpox epidemic, to a radiological event, to a sudden acute respiratory distress system or SARS. I might think that pandemic flu might also come in that area, or to a severe snowstorm. So that's the ability. What about the willingness? They found that most are willing to report during that snowstorm, the mass casualty incident or the MCI and the environmental disaster. But they were less willing to respond to SARS or flu, to the radiological event, to the smallpox or to the chemical event. And I think that that shows us that there are some barriers that we need to work on. And if you think about that, there's really an emotional response here since 9/11, and it really-- we looked at SARS. We saw all the people that were becoming ill as close as Toronto, and people really looked at that and said, gee, do I want to bring that home? So I think there are things that we can do about that.

Moderator: Well, take us through some of those barriers to both the ability to respond and the willingness to respond during an emergency.

Ms. Kaido: I think the ability looks towards transportation problems. In the snowstorm, the roads might be closed. You might not be able to get out of your driveway. Child care issues. If the schools are closed, who's going to take care of the kids? Many people have elders at home now that they take care of, and who's going to do that? And I think pets are a real problem. You know, we found in Katrina that people wouldn't leave their houses because they couldn't take their pets along. Pets are parts of people's families and many people feel strongly about that, and so that's also a barrier, I think. In the willingness area, it's much more emotional I think. The fear and concern for their family. Will they be in a situation where they could get exposed to something that they would want-- not want to bring home to their family or not get themselves? So I think some of this relates directly to a lack of knowledge, and some of this relates to personal preparedness.

Moderator: Well, okay. We should probably get into that a little more. You talk about a number of very valid concerns, and I think any of us would relate to that. We would want with all our hearts to be able to do our job, but our family and their issues have to come into play, and we do have an emotional response. So what do you do to address these concerns, Bonnie? What can be done? What should be done in the planning stages?

Ms. Kaido: I think education and training are very, very important, and certainly that's what we're focusing on right now. How diseases are spread, and what are the good hygiene practices that we can follow? Hand washing. There's a huge push to do something that mom told you to do a long time ago, but you know it's how you do it and it's not necessarily the soap that you're using but it's the length of time that you wash and the friction that's created in the washing that gets rid of the germs.

Moderator: I know. It sounds so simple. It's a message that we really need to get out there.

Ms. Kaido: And we need to get it out not only to the hospital staff but to the members of our community, to our children, so that it gets into the schools as well and out into the community. Respiratory etiquette or cough in your sleeve. It sounds kind of silly, but really if you're coughing straight on, the germs are spreading; even though mom told you to cover your mouth with that tissue, a lot of people do that and then they don't dispose of the tissue or they don't wash their hands. So we encourage people to cough in their sleeve. And by doing that, the germs are trapped in that fabric and will die.

 Moderator: Some say we should stop the practice of shaking hands.

Ms. Kaido: Well, you know when we get to the point that there is a pandemic flu, I wonder if that will happen. You think of some of the practices that you have in church, you know, with the shaking of hands. That may have to be adjusted accordingly. They talk about a personal space of three feet that's a safe space, and so we may be waving at people and blowing them that kiss instead of shaking their hands. I think also institutional emergency response plans need to be very clearly delineated with all staff. They need to know what exactly their individual role will be in that emergency. Knowledge is power. And so the more we know about things, the less fearful we are about them. And so I think doing that, letting them know how the hospital incident command system works and how it's integrated with the community, all of these things in the planning in the training stage hopefully will decrease those barriers.

Moderator: Are you really clear with employees about when the incident command system will commence?

Ms. Kaido: Absolutely. In every plan, we have what's the activation? And we announce that activation. We announce the code and they know that the emergency operations center will be operational at that point. We communicate, communicate, communicate. We have broadcast e-mails. We have meetings where we bring people together, briefings and we say: This is what the situation is. This is what we're doing. And we schedule them frequently. We schedule the e-mails to go out at least every 30 minutes so that people are always knowing what's going on. Our call center has prerecorded messages that people can call in and get the information that they need, and they can always call the incident command center as well. So we find that by giving information again, knowledge is power, people are less fearful and understand what's going on and actually contribute ideas as to how we can do things better.

Moderator: Of course you have to be prepared to do things better, and what role does personal preparedness play in breaking down these barriers, do you think?

Ms. Kaido: I think it's huge, and I think that what we're finding is that, if you're not prepared at home, that's when you're less likely to come in for an emergency, because once you're at the hospital, what are you going to do? You're going to worry about what's happening with your family. So I think developing personal preparedness plans are key to any type of encouragement of staff to come in for an emergency. Arrangements for child care, for elder care and for pet care. Family communication plans are so important. We saw this in Katrina. Again, we've learned so many lessons from that tragedy. Fire escape plans. You know, we teach kids to stop, drop and roll. We teach them to use EDITH, but have you practiced that fire escape plan in your own home? Do your kids know where the meeting place is? And do you do that regularly? So people don't forget. In an emergency, people are scared. They're excited. They forget their own names sometimes. So we encourage people to put next to their telephone their name and their address, because people forget what it is when they call 911, and dispatchers are sitting there and all they're hearing is "oh, my god, my house is on fire," and no other information, and unless you have enhanced 911, they may be stuck not knowing where that call is coming from.

Moderator: That may be a little hard for people to understand unless they've been through it, but certainly with all the adrenaline rushing through you, you just don't operate as you would in a normal situation.

Ms. Kaido: Absolutely.

Moderator: But if you’re prepared to go, what do you need to take with you?

Ms. Kaido: Well, again, make sure you have an out of state relative that is the contact and everyone knows that's the contact. Have someone in another town or even someone in your town because the emergency maybe just very localized. Develop a go bag.

Moderator: What's a go bag?

Ms. Kaido: Well, the go bag is something that, at a moment's notice you can pick up and you can leave your house. It may have medications; it may have water, weather radio that is a crank type so you don't need batteries, a crank flashlight. There are any number of items that you can keep in your go bag. For a hospital worker, that change of clothes is very important. Because once you get to the hospital, if it's a severe storm, if it's an emergency where we have roads closed, you may not get back. And so you may be there for a day or two.

Moderator: So what should a hospital worker have in his or her go bag?

Ms. Kaido: I think--

Moderator: Change of clothes you said.

Ms. Kaido: The change of clothes, the medications if they can, flashlights, radio, water, meals ready to eat, although we'll try very hard to provide meals, but, you know, things that you think that you would need. Medications are huge. A list of your medications if you can't actually-- there's certainly a question about whether or not we can get third party payers to pay for extra medication, and that's being addressed I think at the federal level right now. Certainly the idea is a good idea, but will it actually happen? We're not sure. But these are some of the things that I think you need to keep in that go bag, so we're encouraging people to make those up.

Moderator: We talked about some other barriers. Just remembering that map that was shown previously, your system covers such a huge geographic area and most of it is rural, isn't it?

Ms. Kaido: It is, absolutely.

Moderator: Transportation has to be a huge barrier to getting the responders to the hospital to care for the patients.

Ms. Kaido: It is. And in rural areas, you don't have the same kind of public transportation available that you do today in Albany. So we do have bus systems, but the schedules are not the same. If there's bad weather, things are going to get delayed. When they close roads, that brings up other issues. So we have to work on that. And again that's part of being prepared, making sure that you have the snow tires on, making sure that you have the de-icer and you have the snow brush and that you have your driveway plowed and ready so that you can get out to get to work.  Making that bus.  But if the buses aren't running, people carpool. On occasion, a rare occasion, but on rare occasions if we needed to get staff in, we've made arrangements to get them there. It's not-- it's certainly the exception to the rule but in an emergency we do what we need to do. And so, you know, patient care is paramount. You can have all the emergencies that happen but you still have patients that need your care, and they're already there. We have to have people able to come in to do that.

Moderator: You know, even as you're carpooling which is a great idea to know who you can count on to take you to work if you can't get there; that person needs to have gas in the car so that's probably something we should mention as well.

Ms. Kaido: Absolutely.

Moderator: No electricity, the gas pumps aren't working.

Ms. Kaido: I’m obsessive about that. My car is usually between three quarters and a full tank because I’ve seen it. I’ve been through those gas lines and I think that leaves a lasting impression on you. You're right. If the power is down you're not going to be pumping gas.

Moderator: I’m thinking about if the cellular phone service is out, you may want to be able to have a hard copy of your phone address book.

Ms. Kaido: Absolutely.

Moderator: Redundancy I guess is what you're talking about, isn't it?

Ms. Kaido: It is. That's a great term, and it's really the idea. You need backup plans for your plans. And I think cell phones-- you know, people depend on cell phones at home. If that goes out, you really need to have a hardwired land line phone at home so that people can get in touch with you. If you have digital phone service, they tell you that when the digital cable goes down that your phone will probably go down, too. So having some sort of backup, and in my case at my house we have another cellular phone. So we have two different companies running so that we again have the redundancy.

Moderator: I think we're talking probably about weather emergencies, you know, in terms of the power being out, et cetera. I think we may have a video that would dramatically illustrate what we've been talking about in terms of some of the challenges that people may face.

Video: We begin with some videotape of water rushing over flood walls in the city of Binghamton. This video was recorded about half an hour ago. You can see the water from the Susquehanna River pouring out onto the street. The National Guard is now evacuating houses on the south side, on Conklin Avenue, between South Washington and Tremont. Water also pouring onto North Shore D rive. Much of the area on both sides of the Washington Street Bridge is now flooded. Roads in the area, all blocked off. To get an idea just how much acreage is actually under water, we went up with a New York State Police helicopter, and this is the view from there. I believe that this was a house out in Conklin where some people were stranded, the house turned into a virtual island. This looks like Owego to me. Maybe that was Binghamton actually. Here’s what we did.  We took off from BCC., flew the Susquehanna River to the west to Owego, took a look at Tri-cities Airport on the way, Underwater. Route 17-c, under water. And you can just kind of pick out exactly what's going on here. All low areas, many of them never flooded before or not in recent memory, under water once again. Reporter: It was two feet of water that could end up costing Lourdes hospital up to $20 million, a crisis 36-year employee John Collins thought he'd never see. John: We've talked about the 100-year flood since the day I walked in, but I never expected I would be here to see that kind of water. Reporter: But as the ground floor flooded and the hospital shut down, many employees, like Collins, never stopped working. Nurses traveled with patients who were evacuated to UHS hospitals. Couriers continued to delivering to other Lourdes's locations. Even former Lourdes' employees called to see what they could do to help. Lourdes CEO John O'Neill says the collaborative effort helped the hospital to get state approval to reopen faster than expected.  O’Neill: They didn't think that we could put this together and be ready to go, but they are absolutely convinced that everything is safe and that we're basically as safe as we ever were.  Reporter: Water destroyed the hospital's laboratory, pharmacy, cafeteria, all which included expensive equipment. O'Neill says some of the construction will be finished in two weeks. Other projects could take up to a few months. The departments housed on the ground floor have been relocated to other areas throughout the hospital. This room here is actually a large lecture hall, but right now it's acting as the hospital's main pharmacy. You can see behind me people are working to fill prescriptions for patients who are now back at Lourdes. All services are again available at Lourdes and employees say, while they're happy to be back, returning to business as usual does not come without challenges.  Employee: It's a little confusing but, yeah, that's to be expected, you know. You can't have your answers for everything. You know, but we're getting there.

Moderator: Almost impossible to believe that that happened, you know, very close to our area. I think that was Broome County. Just those pictures and hearing about the former employees volunteering to come to work. It really shows you that that matters.

Ms. Kaido: It does. And, you know, as we talked previously about whether people would come, that's always been our experience, that in a real emergency, people come from out of the woodwork, and their whole goal is what can I do to help?  And so we haven't had to worry about that, at least in our rural area, and the same was true in Binghamton. The patients from Lourdes hospital were evacuated to United Health Services hospitals and it went flawlessly, and it makes you so proud of all the hospitals in the region for the job that they did during this unexpected flooding.

Moderator: You talk about the evacuation going flawlessly. You remember the video, just the flooding everywhere and the bridges out and the highways out. How did that even happen? That had to be attributed to a lot of good planning and a lot dedication.

Ms. Kaido: Absolutely. That's why we plan and that's why we drill and exercise. And so when this happens, we're ready. And I think every hospital in the country is at that point. The joint commission certainly demands this-- demands it of us and we respond to that. The federal government, the state government and local governments. We're integrating more and more every day with our local agencies so that it's a combined effort. That evacuation didn't just happen to those hospitals. The state was very much involved. The County was very much involved. The state activated their EMS mobilization plan to get additional ambulances there. They also activated the HERDS system, which is the Health care Emergency Response Data System that New York State has. And when they respond to these things-- or sent out the response, they were looking to see who could take patients. And it was wonderful that UHS hospitals were able to do that. The relationships that you design with the hospitals in your area or in your region really are the ones that come to the forefront in a crisis like this.

Moderator: And it's so important, because in an emergency, the hospital's often the first place people think to go to for help. Even if they're not truly sick, you know, simply someplace that might have power and just be able to take care of them. And I don't want to diminish the experience that you recently had as well with the flooding. You had your own real-life emergency to deal with, did you not?

Ms. Kaido: We did, and our four hospitals each had challenges. Our system works very well together, and so we worked on these together. We were in contact all the time. Little Falls hospital called me at one point and said, well, we have a swimming pool in front of the hospital at this point and we just lost power. And we said okay, what can we do to help? Well, they said National Grid is on the way and we think we're going to be fine but we're going to be in touch. O’Conner hospital in Delhi helped; Delaware Valley hospital in Walton taking some of their patients, Bassett Hospital in Schoharie County now Cobleskill Regional hospital was also there ready to help. All of our health centers, we had to look at all of them and be impacted by that. So several upstate counties were in fact part of this flooding. It tested all of our plans and it tested very importantly the community response and the integration with the community. And people suffered devastating losses.

Moderator: I think we had some photos that would also illustrate this-- I don't know if we had a chance to show them or not.  There it is.  Look at that.

Ms. Kaido: People were under water. We got calls from providers saying, okay, how do I get to the health center? Could the health center open? We were sending people-- we had a map in our emergency operations center, a laminated map of our region, and we were getting information from the County emergency managers as to which roads were closed, drawing them on the map and then sending out travel information. So we had cars under water. This is I believe I-88, where the road just went away. It washed away and two lives were lost there. A significant impact on the people involved, certainly those who lost their lives but on the community as well. The first responders in that community who responded to that emergency, very affected by that. People used any method that they could to get transport around, you know. The canoes were out and there was an awful lot of basement pumping going on. People lost their homes. Some of our staff lost homes, and so that was in Southern Otsego County, Delaware County, the same thing and certainly Broome County. But up in Herkimer and Montgomery County and Fulton County, they also had losses, and our Canajoharie Health Center for example was located high up on a hill. Their staff actually went to shelters to try to help people, because the rest of the village was under water. And so they had very critical situations all over this region that was hard to believe. This was our 100-year flood, I think. I live in a 33-year-old house that had never flooded before but I had water in my basement as well. So I think there were a lot of lives that were affected by this.

Moderator: Tell us about your personal experience. You had water in your basement. You're having-- you make it seem like it was minimal, but surely you were worried about people you care about, and yet as director of emergency preparedness you have this huge job to do. How were you able to do your job?

Ms. Kaido: Well, I’m a member of a local volunteer fire department and so I made a call down to the station and said, look, I’ve got to get to the hospital. Just keep checking on the house for me, would you please and check the basement and let me know what I have to do. So my colleagues there were very good and they took care of us. As long as, you know, they were also taking care of the rest of the people in our district, pumping a lot of basements for the next few days. But the impact I think to us was that we had this great opportunity to see if all this planning had worked. And so it really tested the integration between the hospital, the health centers and the community. And so we found that that was exceedingly important. And as I said, the state tested the HERDS system and it wasn't a test. This was not a drill. This is the real thing, and it worked very well for them. We ended up using ground, air and water transportation to get our dialysis patients to dialysis care, because we were concerned about them. I think within ten minutes of opening up our emergency operations center, our director of dialysis and the manager for that department were in that center saying, look, we've got dialysis patients that we're concerned about. We need to start to try to locate them and find out how we can get them to care. That was so important, and so we worked very hard on that.

Moderator: How did you make that happen?

Ms. Kaido: Well, you know those County emergency managers, fire departments and EMS squads were invaluable, because we were talking to them, and it wasn't the first time, and that's key. We knew who we were talking to. So when I called Schoharie County, I knew the person on the other end of the line and the same thing with the other eight counties. We had already had conversations. We had worked together in planning. We're about to embark again on another hazard vulnerability analysis for each of our health centers in each of those eight counties. And so you sit down at the table with the managers from the health centers and the County managers, and together you identify the hazards and make the plans. So this wasn't new to us. I think the other thing is that, when you're in a situation like this, you have to make sure that your patients are taken care of. And so they are your primary responsibility. And you look for the best way to do things. And so it takes a lot of people working together as a team, using the hospital incident command system, to do this. In logistics, for example. The transportation person was the one who was making these arrangements and our Liaison person was making some phone calls to set that up and then he could get to the right person at the right time to arrange for this transportation.

Moderator: Did you actually move the patients? You had staff who probably weren't traditionally patient transport staff, moving patients from one facility to another?

Ms. Kaido: Well, we had patients that were in shelters. We identified the shelters that they were in and we got them from the shelters to the dialysis centers. We were able to send out vans with our shuttle bus drivers to go through some pretty rough conditions. Actually we would give them roads and they would find out that they were the wrong roads because they had closed from the time we had given them to them.

Moderator: From one minute to the next.

Ms. Kaido: They did. And that was true for three days. And so they went down and they picked up patients and got them to dialysis. We also worked with dialysis units in Binghamton and we got two patients in there because they were closer to that area, and so we were able to do that. Even in the midst of all of the trouble down in that area. So everyone pulls together. Patient care, again, is the first thing that we look at and so we make sure that we do whatever we possibly can to make sure our patients are taken care of.

Moderator: Well, it sounded like you took a lot of steps to make sure that your staff were able to come to work, and it also sounded like they were very willing. To what do you attribute that?

Ms. Kaido:  I think that we have a situation-- and I think most hospitals are like this. People know that we care about them. We care about them in the good times; we care about them in the bad times. And we had people who lost their houses. We had people that lost their furnace, whatever. We have an emergency fund at Bassett for staff issues, emergency issues, and so we immediately put out the call and said we need to supplement this. And so the hospital kicked in more money and we had contributions from staff. We worry about our employees and so we work together with them to support them. And if we had people that wanted to come to work and couldn't get there, we try to work with them to get them there. I think that's important. Our call lists are done by proximity to the place that they work, and so you can look at where the emergency is and then you can call in staffing that are able to get there. Again, out of that incident command center, you're able to look at the map and see where people are and say, okay, well, this person should be able to get here so let's work on this. And that's one way that we do the staffing.

Moderator: So real-life solutions to real-life problems, and you made it work.

Ms. Kaido: Emergency preparedness, Kris, is common sense.

Moderator: Common sense and a little bit of luck probably.

Ms. Kaido: And some creativity.

Moderator: You make your own luck, as well.  So we had talked before, and I think it's important, because much of upstate is rural, and how did your rural location affect your ability to respond to this? We saw obviously all the transportation barriers. Did you have all of the resources that you needed?

Ms. Kaido: Well, if you look at where we are all located, it's not like being in a city where there's a store on every corner. And so we had some limitations. There's limited public transportation. We don't have the depth of the work force, the reserves. In a city you might have a per diem group that is huge. In a rural area, many of our per diems may be working at other hospitals and so we don't have that. Community resources. There's not the grocery store on every corner, and so if you need to get bottled water, you know, you have places that you go and you have plans that you make. But I think when you have limited resources, that's when we call in the County emergency management system. And many of our plans are integrated with the County to the points where we say, okay: When we hit this point, that's when we call for help. And in some cases we did that to gain extra resources. And that's their role.

Moderator: How long can you be self-sufficient, Bonnie?

Ms. Kaido: We can be self-sufficient for quite a long time. We have a lot of stock. We have vendors that we have agreements with that, if they can get the stuff there, we know that they will come. And so all hospitals have to have that in place or plans in place. And certainly, again, the state is asking us to do this. The federal government and the joint commission. So there's a lot of work that goes into making sure that you have these agreements in place and that you have backup resources. And that's very important, I think. We have to be self-sufficient just as you need to be self-sufficient at home. You need to start thinking about-- you know, when you go to the grocery store the next time, get some canned food. Add a couple of cans and put it away in a pantry and start doing that every week. And it's very painless to do that.

Moderator: I actually have that because we live in a rural area and the power goes out a lot.

Ms. Kaido: So you know the importance of that, of having some backup resources. The other thing that we find is that, when something happens, power outages are key ones, people know the hospital will have water; they will have food; they will have, you know, lights and it will be a comfortable place, and so they tend to come over. One of the first things that happens when we have a power outage is that our food services director knows, okay, it's time to up the production, because we'll probably have extra people here.

Moderator: People are coming because they've got no other place to stay warm or in the summer to stay cool. Of course you have the generator power. You are it. You are the refuge.

Ms. Kaido: We are.

Moderator: You had an enormous, shall we say, real-life exercise in emergency preparedness. Could you take us through some of the lessons that you might have learned?

Ms. Kaido: Sure.

Moderator: I’m sure there were many.

Ms. Kaido: There were many. I think all in all, I don't think there's a hospital that was involved or a health center that was involved in this real- life emergency that didn't do a wonderful job. And I think we all, though, have learned lessons from it. After every incident that we have, even if it's a drill or an exercise, we do an after-action report. We review the incident. We look at the things that we did well and the things that maybe we could do better, and then start making plans for correcting those items. What did we learn this time? We learned that it's good to plan. There's a huge need for both hospital and personal preparedness planning. We are increasing the emphasis on staff planning and developing their own plans at home and developing those go bags. We understand now that personal preparedness at home will support hospital preparedness, because if they feel comfortable about leaving home, they’ll get to work. And we did recognize, too, that people should consider having someone on their staff work on emergency preparedness perhaps full time. The mandate from the joint commission in the state are increasing, as well they should. Emergency preparedness at this point in time in our world is very important, and I think the recognition of that, Bassett recognized that in November of 2005 when I came into this position and I had had a lot of experience at the hospital prior to that and I’ve been a pre-hospital provider for over 30 years so I’ve had the experience. But we recognize that we are at the point where we had a large system. We had a lot of demands on people's time and that we really needed to focus on this area. So I think that's very important. Because of that, we were able to do things. We had developed a web site, an internal web site, that we immediately had information on what to do with your flood area, what to do with mold, how to get a hold of FEMA and the state, that people had those links immediately. We were able to give out the information about road closures because we had close working relationships with those County emergency managers and we were able to respond quickly to our employees in need.

Moderator: I think health care preparedness so often focuses on those things that we hope never, ever will happen but we absolutely have to be ready for if they do, but in this instance we are talking about things we know will happen. Floods happen, power outages happen, ice storms happen, and having someone in a position like you that focuses on that full time really gave you a leg up, didn't it?

Ms. Kaido: I think it did. I think, from an organizational standpoint, we had always done an excellent job at planning, and so I had worked on emergency response plans for years at the hospital. But I think it's that coordinated aspect of it, that we worked hard to develop our incident command team. Unlike most hospitals we don't use senior management. We use director level folks as incident commanders. And so we train and we have a monthly meeting and a quarterly dinner meeting where we do tabletop exercises and we talk about how we're going to respond to emergencies. It's really the preparedness. There's a saying in EMS and in fire and emergency preparedness that "failure to plan is planning to fail." and it's really true. I think as of this, one of our huge lessons learned is that we really need to focus on encouraging employees to plan at home.

Moderator: Yeah. Because you just can't do your job if you're worried about your family.

Ms. Kaido: That's right.

Moderator: You really have to have that peace of mind. We talked earlier about the hospital incident command system, HICS, the acronym. Did you learn some lessons about HICS and how well it works or where it needs to be bolstered?

Ms. Kaido: We did. We learned that it works and it works well.

Moderator: Good.

Ms. Kaido: And we learned that communication within that command structure is very important. Our emergency operations center got a little busy at times, and so we've taken some steps to separate out some areas, because when you have people excited and everybody's talking at once, you have to reduce that to a sense of calm and get people back into their roles. We actually have a plasma screen in the emergency operations center, and we were able to log into the Daily Star, the Oneonta newspaper, and they were posting digital photos that people were actually taking at the time. In fact that's how we learned that one road that we had recently sent one of our physicians on to get to our health center had closed before he got there. And so we had to get in touch with him and say, gee, no, we just saw this photo that says this road is no longer there. And so it was up-to-date information. The other thing we do is we keep a weather service up there. We keep Intellicasts up there with a looping radar so we can see what's happening with the weather as it's really happening. In a severe storm, that's a wonderful thing to have, a resource to have at our fingertips.

Moderator: Not just real life but real-time.

Ms. Kaido: Real time is right. I think the other thing we have, what we've always known, but this has shown clearly, is that not every emergency follows a linear plan. You know, we branch off, and as things-- action, reaction, action again. And so you try to be proactive. You try to be flexible and you try to be creative. And I think those are really strong keys to making this work. The emergency operations center is hugely important; recognizing when people are tired. You know, we all get into this hero syndrome where we're there; we're working; we know that we're important to the operation. We don't want to go home. Sometimes you have to say, okay, it's time for us to have these folks go home, get some rest. This group's going to stay for this period of time. We tend to operate in operational periods of 8 to 12 hours, and so we went into that mode and said it's time for you to go home. Come back at such and such a time.

Moderator: I suspect people were reluctant to do that.

Ms. Kaido: They are because they're in the thick of things. Home may not be the place that they're able to go. So you have to arrange for housing, which we were able to do. You use any resource you can get in a situation like this, and people were very cooperative.

Moderator: I suppose it's also hard to focus your mind around the fact that these emergencies aren't going to be solved in the space of the time of a drill or exercise but it's going on for days or perhaps weeks and you do need to save your strength. You are important and you need to continue to take care of yourself to take care of your patients.

Ms. Kaido: That's very true. And the other part of that-- you're right. These things don't end, you know, in a few hours. They are sustainable incidents and they continue to go on. On the weekend the Department of Health called and asked us to help with supplies for Delaware County and so we marshaled the forces again and got the supplies to where they needed to be. We found that communication handoff from one incident commander to another, from one logistics chief to another, is key to that situation so that you're always up to date with information.

Moderator: You know, I was curious because you had said that it was so important to incorporate all levels of staff into emergency planning and response, not just the clinicians, but all of the staff that helped to take care of patients. So were there any lessons learned about how those different types of staff reacted to this emergency?

Ms. Kaido: I think that, you know, clinicians are just so important to every emergency, and we focus a lot on their training. Staff react in different ways because we're all individuals. We all come from different backgrounds. We're all diverse in our backgrounds, and people react to emergencies in different ways, too. A lot of it depends on how closely affected you are. The farther away from the event, you know, the less reactive you may be. But one of the things that you have to do, you've got to acknowledge the differences, the cultural differences, social and educational differences within the staff and then target your messages appropriately. Target your training as well to the groups, and communicate and communicate again. We found that probably the biggest key to our success during that real-life incident was that people knew what was going on. We had those briefings whether we had a lot of information that was new or not. We sent out those updates as soon as we knew things. We changed the call center message frequently. People could access us and ask us questions, and that was absolutely key. Supporting and information sharing is very important, I think.  And being creative, because I think welcoming creativity and recognizing that the staff needs comforting here just as much as the patients do.

Moderator: You had talked about-- you have many different health care centers and hospitals and many different types of facilities within your health care system. Now surely not all of them were up and running during the flooding. So how did you maintain patient care?

Ms. Kaido: Well, in some cases we moved providers and office staff over to a different health center and had the phones forwarded to that so that when a patient called for Bassett, they got an answer, and we were able to provide the care in a different location. Certainly we had a lot of people that did different things, but the primary thing of importance is that you do what's necessary to care for your patients. We identified and searched and found those dialysis patients in the shelters, arranged for transportation in some rather unique ways, to the nearest dialysis unit to keep them on schedule. I think arranging for that continuity of patient care was a major focus of our emergency operations center, and so we moved people as we needed to provide that care. And again keeping that connection, touching base. We had our director of regional operations was our medical technical specialist, and she was there and she was in touch with all of her folks all of the time. We were in touch with the other hospitals in our system getting information. They were able to tell us about road closures, for example, in Delaware County, that we didn't know about. We hadn't gotten the information. They had just been to a briefing at the emergency management office. So it helped us getting up-to-date information. So touching base was very important to us.

Moderator: I’m recalling that picture we saw earlier of the ambulance that was almost totally inundated. The challenges just had to be enormous. All the staff do their job and it sounds like another job as well. Do you have any specific examples that you can share with us of some of the unique jobs that people took on?

Ms. Kaido: I do. Our director of nursing at O'Connor hospital in Delhi. Delhi traditionally gets flooding. The Delaware County area has had flooding in the past few years as well. She assisted residents brought in by EMS set up cots and blankets, provided the reassurance; did a lot of hands-on reassurance, I think, and providing of updated information for both staff and for patients. Was helping find resources for the pharmacy. Transported one of the elderly women to her home to get some things and then over to a shelter and helped with a helicopter airlift. We ended up bringing patients from our affiliated hospitals into Cooperstown for care.

Moderator: This is someone who traditionally is an administrative?

Ms. Kaido: Yeah, she is.

Moderator: She didn't forget the hands-on, that's for sure.

Ms. Kaido: No, she didn't. I would say that all of our nurses are patient care folks. And so they automatically go into the patient care mode. That's why they're nurses.

Moderator: Were there other examples? I’m sure there were.

Ms. Kaido: Yeah. Again at O'Connor, one of the housekeeping supervisors, again went into a transportation role taking residents to the Red Cross shelter, helped doing the cots and the privacy screens there. They couldn't get him out of there. He stayed late and returned early and just was an overall person that they could count on to do almost anything, not necessarily things that were in his job description. You know, everybody in health care has a little section in their job description that says "other duties as assigned."

Moderator: Yes.

Ms. Kaido: I think it's especially appropriate in an emergency.

Moderator: This is a person normally in charge of making sure the facility is clean.

Ms. Kaido: Absolutely.

Moderator: Hands-on now with patients.

Ms. Kaido: Helping them. And so, you know, we do everything that we need to do. And I think people really step up in an emergency, and you find that people do things that you wouldn't expect that they would be normally doing, but in an emergency, we need every person we have and we need them to fill every role that needs to be filled. And so that's why we train so hard, and that's why this hospital incident command system has job action sheets. So even if you've never done that job before, you can take that job action sheet; you can follow it and you have your path. You have a functional job description of that role. And I think that's one of the major proponents of using this system.

Moderator: You know, this is just fascinating especially because of the real-life examples, and I do want to remind you that we'll be taking your calls soon. The toll-free number is 1-800-452-0662. You may also send your written questions by fax to 518-426-0696, or send them to the e-mail address that you'll see on your screen. The program will run for an extra 15 minutes. That's good news, Bonnie. So we encourage you to send us your questions. We have a lot more that we really want to talk about. Right now I wanted to ask you if you think it's important for hospital staff to develop relationships with other community responders, such as you said emergency management and local health departments. You said that it's important. Too often things get silent. Do you think that's true?

Ms. Kaido: I think that's true. I think we're especially fortunate in our region, because we have wonderful relationships with the emergency management offices, and mainly because the one in Oswego County, our County emergency manager has encouraged that. He's been a member of our emergency preparedness committee for many years and so we were integrating with the community long before it become, you know, mandated. We also work closely with the village of Cooperstown. We have the baseball hall of fame induction coming up this year with two very popular inductees and we're already doing planning for that. I think that knowing that voice on the other end of the telephone in an emergency, knowing that you can call that individual for help, bringing the fire department into your hospital and working with them on evacuation drills, showing them where things are located in the hospital, absolutely key. In a rural area, it's not just the home based fire department but it's mutual aid as well. By bringing in the area fire departments to work with the chief of the local fire department, and then valuing those relationships, it helps for us because I’m a member of the fire department and I actually do the emergency preparedness for the fire department. We're further integrated than probably a lot of folks.

Moderator: Renaissance women, Bonnie.

Ms. Kaido: There are a lot of hats. People are concerned about, in an emergency, which hat do you wear? Do you wear the EMS hat? Do you wear the fire department hat or do you wear the hospital hat? Or in some cases are you affected so you're wearing your own hat? And that's true, I think, especially in a rural area, because many of us play a lot of different roles, because there are limited resources. So we have to look at that as well.

Moderator: I want to get back to the personal preparedness that you talked about, because you seem to suggest-- and I believe it's really critical. Talk to us some more about, you know, what the lessons taught us from the floods about personal preparedness.

Ms. Kaido: I think what we learned is that we need to look at what's available in the community. We need to look at what you can do on a daily basis, on a weekly basis. I mentioned before, you know, the next time you go to the grocery store, pick up that extra can of whatever you could eat that's not going to have to be heated. But we are going to do a personal preparedness fair in February, February 28th, I believe, because we think it is so important to focus on this for our staff members. We may open this up to the community as well. It's going to be very information-based. We're going to give them the opportunity to learn about the available products, you know those crank flashlights and weather radios. And resources in the community and for community preparedness. The American Red Cross has wonderful resources for that. Our counties all have resources as well. Federal, state and local resources are available. The State Emergency Management office; the State Department of Health. The School of Public Health at the University of Albany has wonderful personal preparedness information on their web site that can be accessed.

Moderator: You've done some incentives, though, to gets your staff thinking about this, haven't you?

Ms. Kaido: We have. We're just rolling out a lot of this information, and what we're going to do is have a raffle and raffle off some things, probably a go bag and probably a car emergency kit. We want to make sure that, again, this is another way to get the message out that we're concerned about our staff in good times and in bad, and we want to help them prepare during a good time so they'll be ready during a bad time.

Moderator: Okay. When you talk about the go kit, and you had a nice picture that-- you know, we think about food and water, and you mentioned the prescription information if not your prescriptions but what else do we have to think about in terms of personal preparedness, individual readiness?

Ms. Kaido: I think there are things that are day-to-day activities that people don't think about, but there really are parts of personal preparedness. Certainly the go bag is an important part of that. There's information on the internet that you can find that will show you exactly how to set one of those up. What about your attorney? Do you have your will up to date? Because in an emergency, that's no time to have to think about that. Do you have advanced directives? Your health care practices and your living wills, are they up to date? Have you thought about what you would do for your pet in a disaster?

Moderator: You mentioned that several times so that's obviously really important.

Ms. Kaido: It is. Have you talked to your veterinarian? Have you talked to the SPCA? What plans do they have?

Moderator: Studies show that that’s a real barrier.

Ms. Kaido: It is a real barrier. What can we tap into? Do you have extra pet food? Do you have extra toys? Do you have their medicine if they have medicine? These are all things to think about. What about AAA and the other auto clubs out there? They have wonderful information on handling road emergencies, and they have car emergency kits that are available. So there are products out there. We want to make sure that people are aware of these products and they know that they're available and they know that they can access them.

Moderator: What about the community? What particular organization should we be looking at to partner with in the community in terms of health care preparedness?

Ms. Kaido: I think that I recently talked to rotary club in the local area, and it was about a different hospital program, but at the end I asked them how many of them were prepared for the recent flood, and I said think about that for a second and think about the things that can happen in our area. So every opportunity that I have, I add in personal preparedness. And so it's the rotary club and it's the lion's and it's the Kiwanis club, the local fire departments. We've done the personal preparedness presentation to our local fire department and EMS squad. So again doing that. We're working on a pandemic flu program with the regional EMS council to provide to EMS providers so that they start thinking about what impact a pandemic flu would have on them and how they can become both personally prepared and prepared as a squad. Faith-based organizations are great places to share this message. And in your outpatient care setting. Having information available when people are sitting there in the waiting room, having brochures available that talk about personal preparedness. There are many avenues that we can communicate this message in, and I think that it's so important. There are very few things in life we can control, and in an emergency, there's very much that we can’t control. But, you know, if you have a plan for taking care of your kids, if you have some food, if you have the water, your two gallons per person a day, if you have these things behind you and you know that they're there, then you're going to at least have some control over part of your life. And I think that's important, because it brings to you a sense of calm at the same time. Again knowledge is power and preparation is power, too.

Moderator: Bonnie, you said the magic words, pandemic flu. It's obviously something we've all been thinking about and planning for. How do you ensure that willingness to work in the face of such a contagious, you know, potentially lethal problem? How do you get staff to come to work when they're so desperately needed.

Ms. Kaido: I think again knowledge. Knowledge is absolutely key for this. So, you know, we have in place already a respiratory disease response plan. We have respiratory etiquette that we're teaching folks, you know, the sneezing, coughing in your sleeve, disposing of your tissues, washing your hands, using the alcohol gel. Getting vaccinated. What's the first and best thing that we can do? Get your flu shot. Having the personal preparedness. You know, having your plans at home so that you're not worried about that. And using personal protective equipment at work when it's indicated. You know, all health care workers get training in this, and so making sure that we practice good hygiene practices for the safety of our patients and our own safety as well. I think we've also worked a lot with our local health department, Oswego County health department as well as the health departments in the other counties we're in, and we work with our regional health centers to make sure that the same messages are going out to our regional staff. So I think knowledge is power in this. We've seen it with other diseases. Look at SARS. People were very afraid to go to work. People were afraid that they were going to get the disease. We've seen it in other diseases. When you know about how these things are spread, when you know how you can protect yourself, that's a measure of preparedness and personal confidence.

Moderator: Knowledge is power.

Ms. Kaido: It is.

Moderator: We want to give people a chance to ask some questions. We are ready to take your calls now. Again that toll-free number is 1-800-452-0662. And of course you may also e-mail your questions or fax them to 518-426-0696. And the e-mail address is on your screen. And while we're waiting for those questions, we certainly do hope that you will send some and because, Bonnie, you're just a wealth of information. We should talk about some web sites or other information resources that may be available. Which ones are you particularly fond of?

Ms. Kaido: Well, I’m a fan of the government resources. Ready.gov is a wonderful resource. It has resources for children. It has resources for adults. The pandemicflu.gov also has a lot of check lists for personal, for school planning, for family planning, for hospital planning. The American Red Cross I think does a wonderful job of providing information on personal preparedness, and there's another site that I like, and it's www.72hours.org where it helps you. It's an icon-based system where you click on the icon and it shows you what you need to be prepared for that specific area. So everything on that site is very good. I didn't think that the tsunami might hit Cooperstown so I didn't look at that one. But all the rest of them I think are very important.

Moderator: 72 hours is a good start. But you should probably be prepared for a little more.

Ms. Kaido: People are saying now at least 96 hours.

Moderator: We're actually getting some questions fast and furious. The first one is Can you discuss emergency preparedness in community health centers and how community health centers can assist hospitals in the overall emergency response?" very good question.

Ms. Kaido: Well, in our health center, certainly we have plans. They all have emergency response plans so that they're covered with anything that happens. In our pandemic flu planning, you know, we're looking at our health centers as areas where we might be doing triage and treatment there. In pandemic flu, you want only the most ill patients to come to the hospital. And you work with your County public health department because their pandemic flus are important, too. So integration, again, of community plans and hospital plans and health center plans I think are very important.

Moderator: We have another question actually, and that goes to the personal technology of the PDA., cell phone, laptop. How did that helped you in the flooding.

Ms. Kaido: Well, we have blackberries that are issued to our incidents commanders, and certainly we use those for e-mail updates. You can get on there, you can check the weather. The cellular phones in our emergency operations center, we have portable phones that we use, but we also use the cell phones to get out. In the emergency, it may be that it's the cell phone that's working because maybe in a severe weather emergency, it may be that the telephone pole is down. We get lots of trees and wires that go down in rural areas as part of electrical storms and snowstorms and wind storms, ice storms, and so cell phones can be very helpful in that regard. And we do use the PDAs quite a bit.

Moderator: Great. We're running out of time, believe it or not, but there's another question I wanted to get in. This comes from-- regarding the director of nursing: "during the flood, was the HICS role that the nursing supervisor was assigned to outside of their normal duties?" you talked about the director of nursing and what she did. Was that outside of her normal duties?

Ms. Kaido: Yes. I mean she was doing the nursing role I think, but she also was filling in. In a small hospital, and remember this is a small rural hospital, you pretty much take whatever role you need to take, but we do it within the HICS structure. But again, when you see something that needs to be done, you may not have the staff resources that a larger hospital in the city would have, and so everybody works together and we do things as teams. We use a lot of interdisciplinary teams in day-to-day operations, and that comes in handy during an emergency.

Moderator: And that was the expectation, not the surprise.

Ms. Kaido: Right.

Moderator: I did want to talk about some other resources that are really important, including one from the University of Albany Center for Public Health Preparedness. It's a personal preparedness on-line course, and you can look for it at the e-learning center in the next couple of weeks. There are also some emergency preparedness training for hospital clinicians, good resources available. You see them on your screen. New York consortium for emergency preparedness and continuing education, and I’m very fond of the flu planning, www.pandemicflu.gov. We talked about the additional resources, we talked about this study that is very important, and there is the reference for that study if you want to learn a little more. So we really do want to thank Bonnie very much for all that you've shared with us, and thank you so much for joining us today. Anything else you want to add real quickly?

Ms. Kaido: Again, personal preparedness is key to this effort, I think and, you know, encourage your employees to do that.

Moderator: All right. Well, again, thank you so much for joining us today. Bonnie and our viewers and the great questions, and we have more. You know, if you do have more, we're sure that Bonnie will be available. We do want to ask you to take a moment to fill out your evaluations. As we said your thoughts and comments are very valuable to us as we prepare our future programs. If you submitted a question for today's broadcast and we were unable to answer it, Bonnie will be glad to talk with you so please contact Bonnie Kaido. Continuing education credits, including nursing contact hours, CME and CHES credits are available free of charge to viewers who complete the on-line evaluation and a short post-test. Please visit our web site for more details. This program, as well as other previous programs, will be available via web streaming on-line within the week. Please see our web site for an archived collection of past broadcasts as well. We hope you'll join us next month on February 8th for the World Trade Center Evacuation Study with Dr. Robyn Gershon, professor at Columbia University Mailman School of Public Health. I’m Kris Smith. Thank you for watching the University at Albany Center for Public Health Preparedness Grand Rounds Series. Bonnie, thank you so much. It was a fascinating conversation. Great advice.

Ms. Kaido:  Thank you, Kris.

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