s e c i d New York State Department of Health Community-Based Care Center n Toolkit e p p A C e n t e Nre wf oYorr kD Miseadisctael rC oMlleegde icine Funded and Supported Through the New York State Department of Health Office of Health Emergency Preparedness www.nymc.edu/CDM Note: This document is being provided to assist localities with planning for Community-Based Care centers. The final document is available at the above web site. Appendix: Table of Contents Appendix 1 – Job Action Sheets Appendix 2 – Community-Based Care Center Site Selection Checklist Appendix 3 – Medical Surveillance Appendix 4 –Liability Protection Memo - NYS DOH and NY SEMO Appendix 5 – Credentialing Appendix 6 - Partner Agency Memorandums of Understanding and Contracts Appendix 7 – Sample Equipment List Based on 50 Patients Appendix 8 – AHRQ Reopening Shuttered Hospitals to Expand Surge Capacity Staffing Excerpt Appendix 9 - Community Health Care Surge Capacity Appendix 10 – FEMA Assistance for Pandemic Influenza Appendix 11 – Reference List Appendix 1: Job Action Sheets Functional Roles Acute Care Area Boss‡ *Volunteer Coordinator *CBCC Group Supervisor *Clinical Staff (Level I, II, III) † ‡ Ψ *Communications Officer/PIO Cook Credentialing/Training Boss *Credentialor - Staff Check-in *Community Triage Point Supervisor Data Entry Boss † - Requires Level I Clinical Staff *Data Entry Clerk ‡ - Requires Level II Clinical Staff *Discharge Planner† Ψ - Requires Level III Clinical Staff Discharge Planning Boss† * - Essential Operational Personnel *Facilities Unit Leader Food Services Boss Holding Area Boss‡ Home Care Preparation Coordinator† *Housekeeping Intake Area Boss‡ *Inventory Controller IT Services Technician *Liaison Officer *Logistics Unit Leader Maintenance *Medical Care Branch Director Mental Health Boss Mental Health Worker Observation/Hydration Area Boss‡ Palliative Care Area Boss‡ *Patient Care Unit Leader‡ *Pharmacist Pharmacy Technician† *Physician Medical Director Ψ *Registrar Runner *Safety Officer Security Boss *Security Officer Staff Needs Coordinator *Support Services Unit Leader Translator *Transportation Coordinator *Triage Area Boss - Community‡ ACUTE CARE AREA BOSS Functional Role Overview: This individual is responsible for the supervision of clinical staff in the Acute Care Area of the CBCC. Essential: NO Required Clinical Level: LEVEL II Required Pre-event Training: ICS 100/200/300; NIMS 700; Fit Testing; Medical Protocol Orientation Date: _________________ Shift Start Time: _________________ Shift End Time: _________________ Position Reports to: Patient Care Unit Leader Direct Reports: Clinical Staff Assigned to Acute Care Area Assigned Work Area/Location: CBCC Acute Care Area Assigned Landline: ______________________________ Designated Fax: ___________________________ Assigned Cellular/Satelite Phone: _______________________________ Radio Number: _________________ Initial Operational Tasks Time Initial Read this entire Job Action Sheet Obtain briefing and situation status report from the Patient Care Unit Leader Recieve Just-in-time training Establish communications with Patient Care Unit Leader and Clinical Staff Obtain shift report, and patient census/status from off-going Acute Care Area Boss Meet with Clinical Staff assigned to Acute Care Area and assign patient care assignments Establish deficiencies of supplies in Acute Care Area Intermediate Operational Tasks Time Initial Organize and direct all Acute Care Area staff 1 Intermediate Operational Tasks (Continued) Time Initial Monitor and replenish all Acute Care Area supplies as needed Communicate directly with Patient Care Unit Leader for patient admissions & discharges Maintain contact with Level III providers Communicate hourly with Patient Care Unit Leader regarding status of Acure Care Area Authorize resources as needed for Clinical Staff Conduct routine briefings with clinical staff when appropriate Consult with Patient Care Unit Leader on the needs for equipment, supplies and staffing. Extended Operational Tasks Time Initial Observe all staff, volunteers and patients for signs of stress and fatigue. Provide rest periods and breaks regularly. Organize and direct briefings in Acute Care Area Demobilization/Operational Stand-down Time Initial Direct clinical staff to secure area for shift change and/or debriefing/demobilization Assist with breakdown of Acute Care Area upon deactivation of CBCC 2 Demobilization/Operational Stand-down (Continued) Time Initial Helpful Documents & Tools CBCC Operations Plan Medical Care Protocols CBCC Organization/ICS Chart CBCC telephone directory Radio/satellite phone Transportation plan Notes/Additional Information Signature _________________________________________Date ________________ 3 CBCC GROUP SUPERVISOR Functional Role Overview: Provide overall direction for the CBCC. Oversee the organization and operation of the CBCC, and supervise all unit leaders. Coordinate CBCC activities with Medical Care Branch Director. Essential: YES Required Clinical Level: NONE Required Pre-event Training: ICS 100/200/300/400; NIMS 700/800; Fit Testing; Facility-specific training Date: _________________ Shift Start Time: _________________ Shift End Time: _________________ Position Reports to: Medical Branch Director Direct Reports: CBCC: Patient Care Unit Leader; Logistics Unit Leader; Facilities Unit Leader; Support Services Unit Leader. Assigned Work Area/Location: CBCC Assigned Landline: ______________________________ Designated Fax: ___________________________ Assigned Cellular/Satelite Phone: _______________________________ Radio Number: _________________ Initial Operational Tasks Time Initial Read this entire Job Action Sheet Obtain briefing and situation status report from the Medical Care Branch Director Receive Just-in-time training Establish communications with Physician Medical Director for CBCC operational period Obtain shift report from off-going CBCC Group Supervisor Conduct Briefing with Unit Leaders on incident status, objectives and chain of command Establish command post and work area in CBCC Direct Unit Leaders to conduct just-in-time training with staff as needed. Assure hourly situation updates are provided by Unit Leaders Intermediate Operational Tasks Time Initial Oversee and resolve any CBCC problems 1 Intermediate Operational Tasks (Continued) Time Initial Perform CBCC walk-through every hour Communicate at least hourly with direct reports and Medical Care Branch Director every 1-2 hours Communicate operational period objectives to Unit Leaders Remain in facility at all times during operational period. If relief required contact Medical Care Branch Director and appoint interim replacement Extended Operational Tasks Time Initial Keep track of all damage to facility and communicate losses to Finance/Administration Section at Agency EOC Maintain logs and prepare reports as directed by Medical Care Branch Director Direct Unit Leaders to debrief employees in their area immediately after operational period Be informed of health status of personnel and when staff require medical treatment for illness Work closely with Safety Officer to monitor staff compliance with personal protection requirements and safe work practices Receive report on security status on regular basis by Facilities Unit Leader Demobilization/Operational Stand-down Time Initial Conduct end-of-shift debriefings with each functional area under supervision Participate in senior staff debriefing with Medical Care Branch Director Instruct Unit Leaders to demobilize staff as needed based on closure of functional areas Coordinate and direct breakdown of site upon deactivation of CTP/CBCC and facilitate return of facility to pre-incident condition. 2 Demobilization/Operational Stand-down (Continued) Time Initial Helpful Documents & Tools CBCC/CTP Operations Plan Agency ICS Structure CBCC/CTP Organization/ICS Chart CBCC/CTP Telephone Directory Radio/satellite phone ICS Forms Functional Roles and Job Action Sheets Site Security/Lockdown Plan Transportation Plan Equipment and Supply List Notes/Additional Information Signature _________________________________________Date ________________ 3 Intermediate Operational Tasks (Continued) Time Initial Monitor and replenish all Care Area supplies as needed Evaluate patients in accordance with Level I roles in medical care protocols Communicate hourly with Level II Clinical Staff regarding status of patients Consult with Care Area Boss on the needs for equipment and supplies Extended Operational Tasks Time Initial Observe all patients for signs of worsening condition Maintain contact with Level II/III providers Perform any additional tasks as assigned by Care Area Boss or Level II/III Clinical Staff Demobilization/Operational Stand-down Time Initial Assist with breakdown of Care Area and any other assigned tasks upon deactivation of CBCC/CTP 2