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Jeff Rubin I was just told to cut a minute off. Actually I'm going to cut a minute and a half off. I want to do something that I need your cooperation on. I don't want anyone to say a word. I just want you to stand and stretch for 30 seconds. (Applause.) Okay. You've been very good. You can sit down now. You just practiced the first principle in disaster planning, response, and recovery. That's flexibility. (Laughter.) This afternoon in the remaining time what I'd like to do is talk to you a bit about California's experience and the approach that we're talking in working to develop regional and state wide response networks to disaster, particularly in regard to cooperative strategies with hospitals. I ask you to set it within the framework of the overall disaster, medical and public health, environmental health planning, response and recovery system. That system, I think, is important in that it's an all hazard system. What we're talking about today, bioterrorism, pandemic influenza, are unique portions of a particular kind of disaster or hazard that we must face where the public health community comes into the fore, and we need to learn how to work better to integrate them into that overall system. The system begins at the local level, the hospitals, the physicians, public, environmental health, fire, law enforcement, and emergency management. I'd like to focus, again, specifically now on the hospital side of the picture. This is my vision and that of our office. To get there, we believe it's our role to promote disaster medical preparedness and response planning and exercising and training and development within the State of California with the industry so we can forge better regional, state-wide, and at the local level community-wide partnerships. On the next two slides, you're going to hear some of the same information that you heard from the previous two speakers, and I ask you not to think that that's redundant. Actually I think it's important. It shows the other side of the coin, the provider side of the coin, from the hospitals' and physicians' perspective, as well as the fact that on the government side we have to understand what they're going through. If we do not, we're doomed to failure. It also shows that we as bureaucrats can actually learn over time. I think the last point here, and it was made by Jim earlier, and the previous speaker also regarding physicians, is that we really haven't done a good job in reaching out to hospitals and selling our idea of the importance of preparing for a terrorism event here in the United States. We really haven't done a good job in selling emergency preparedness to hospitals and the health care industry, and I think we have a lot to learn and a lot to work with with our partners in the health care industry to make strides in this area. The results have not always been optimal, and I can use our state as an example, but I know unfortunately there are others around the country. In the Loma Prieta earthquake, we had a hospital pick up in the air a couple of inches and sit back down again. That cause simultaneous internal and external disaster. They had written plans to deal with that, and they had written plans on how to manage that kind of a response. So in the intervening years before the Northridge earthquake, rather, we helped them by working with a group of hospitals and county governments in developing an incident command system for hospitals to help manage a disaster response. In the Northridge earthquake, our seismic safety commission documented those hospitals that did use the hospital emergency incident command system, had an easier time and did a better job in managing the response. Unfortunately, some hospitals weren't using it, and there were more difficulties that they experienced. We had hoped that we had really worked out a lot of the issues in planning and response for the hospitals in an emergency, but a couple of years later when we had 165,000 people evacuate due to flooding, we found that two hospitals refused to leave. As a matter of fact, they went and took in extra patients and moved them all up to a higher floor. If the levies had broken, I have no idea how we would have gotten them out of there. A year later we had the influenza season, and what happened there essentially is that we had hospitals, again, not working within the system that we had all tried to put together. They were calling the National Guard asking for nurses. They were asking county governments to declare local emergencies. So obviously we have a long way to go. There's three different approaches, and I think the two previous speakers mentioned them. You can throw money at the issue. You can mandate it. Again, the carrot and stick, or you can look at shared goals that we buy into collaboratively. In California, being Left Coasters and being all inclusive, we have to take a holistic approach. Let me call it that. (Laughter.) We do believe there is some need for additional funding, whether it's in the planning and preparedness end of things, whether it's in the response in. You know, we cut a deal with FEMA following the Northridge earthquake to reimburse hospitals for some of the -- and clinics for the extra services and staff that they brought in, supplies, and unfortunately the hospitals were never reimbursed. We can't continue to do that. We have to figure out a way to reimburse them for the activities and the services they provide. We need to figure out what the proper role is of this whole weapons of mass destruction arena and how hospitals relate to it and how we can utilize some of that monies to better prepare them. There is a role for mandates. Because of our experience in past disasters, we are working with our Department of Health Services, which licenses health care facilities, to upgrade our requirements of health care facility disaster plans. We also have a new Seismic Safety Act. Actually it's a couple of years old. It's just been extended as far as implementation date to build better and stronger and safer buildings. And the new JCAHO guidelines which most of you are aware of regarding environmental care, we think they're absolutely critical because for the first time they move the hospital industry and health care industry closer to the emergency management industry, and we talk the same language, which I think is very important. But I think we're going to see much better results if we have shared goals. We've tried in California over the last couple of years to hold annual medical and health disaster conferences focusing on hospitals in the northern and southern part of the state. They have almost 500 people attending. Last year, the first year we did our annual state-wide exercise, 400-plus hospitals, 56 out of 58 counties, 100 ambulance providers. We just finished the exercise a week ago, and we're counting up the numbers, but it looks like it will be pretty close again, again bringing the hospitals into concert with the government's need to plan for and train for disaster response. We're very proud of a subcommittee we have developed for the California Health care Association, our state hospital association. In working on developing model HAZMAT protocols, in model bioterrorism annex plans for hospitals, they're the ones developing it. We don't mandate it. There's an ownership there. There's three or four major hospital systems representing almost 200 hospitals on this group, and we think if it comes out of the industry itself we have a much better chance of selling it within the rest of the health care industry and the state. We're also continuing to promote the hospital emergency incident command system. We think it has a lot of benefits. It's available for free from our Web site. We'll send you a free video. We believe that regional, community-wide, cooperative agreements are important. In Portland, Oregon, in Reno, Nevada, here in the Washington, D.C. area, they've made these kinds of approaches to dealing with how the hospitals can together work to share resources in time of need, and I think that that's absolutely critical. In a typical hospital in Sacramento, you may find a nurse who works in three different and separate health care systems. We've got to train the staff in a common way because they'll be in different places. We have to have shared communications systems. That was talked about earlier. We have a system we're using in eight counties serving 18 million people, the Ready Net system. It comes from the Health Care Association of Southern California. It's used daily for EMS diversion, multi-casualty incident, hospital status, ED availability. They used it during the Democratic National Convention to do surveillance. I think this is a step in the right direction. And also the Health Care Association has developed a model for standardization of emergency codes. Again, nurses and staff working in different facilities; we need to have standardization wherever possible. We think if some of these efforts pay off that we're going to be better prepared. There will be better awareness, more widespread awareness, improved planning, improved training, and staff preparedness. That will benefit all of us. And we firmly believe this cannot be done by an individual, an individual organization, an individual health care provider or government entity. We have to work together. We don't have all the answers. We're not even sure if we have some, but we have some thoughts on it based on our experiences, and we'd be very glad to share them with you in detail. Thank you for your attention today. (Applause.)
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