Operations Under Fire

Ray Barishansky is a featured speaker at EMS World Expo 2014, scheduled for November 9–13 in Nashville, TN. For more, visit EMSWorldExpo.com.

You are the director for All-City EMS, a third-service EMS agency handling BLS and ALS for a large urban area. One day, the director of your health department calls to say he has been informed by the Centers for Disease Control and Prevention that some Southeast Asian areas are seeing an increase in avian flu. The World Health Organization has categorized this as a phase 4 pandemic, and he advises you that the city manager has requested that all department heads break out their continuity of operations plans (COOP). He also tells you there will be a mandatory meeting the next day with the city manager to discuss COOP. "COOP," you think to yourself. "I haven't even looked at that plan since they made us write it three years ago."

What Is COOP?

   For the uninitiated, a continuity of operations plan, commonly referred to as a COOP plan, can be intimidating to understand, develop and operationalize. The process may seem daunting, but having a solid understanding of what it entails and who needs to be at the proverbial table can make the process easier.

   Continuity of operations planning allows for the continuation of essential functions of government departments or agencies during any incident or emergency that may disrupt normal operations. COOP addresses the recovery of critical and essential government operations in the event of an emergency. This can be on a short-term basis, like a power failure, where having backup capability (systems, personnel, processes, files, etc.) can quickly resolve the situation. It can also be longer term, such as in a natural disaster, when services are impacted for several days or even weeks. Most recently, certain public health and EMS agencies found themselves dusting off, and even implementing, components of their COOPs for the 2009-2010 H1N1 pandemic.

   As critical components in the healthcare system and emergency response entities, EMS agencies need to understand who needs to be involved in the COOP process, the various components that make up a COOP, the transition from day-to-day emergency operations to COOP activation and other elements.

   The initial development and subsequent retention of adequate COOP capabilities requires substantial effort. For that reason alone, COOPs should be developed and maintained using a multi-year attitude and process, which should, among other things:

• Outline the progression the agency will follow to designate essential functions and resources
• Define both short- and long-term COOP goals and objectives
• Forecast budgetary requirements
• Anticipate and address possible problem areas and potential obstacles
• Establish planning milestones.

The Planning Process

   A good plan can utilize the following general template, with minor modifications based on your EMS agency specifics:

Section I: Statement of purpose

   This statement need not be long, but it should summarize concisely the intent of your agency's COOP. A statement such as "This Continuity of Operations Plan (COOP) is intended to help preserve and restore essential functions of the Regional Emergency Medical Services Agency (REMS) if its headquarters is subject to a crisis, an actual or threatened loss of administrative and/or operational capacity" is more than sufficient. This statement should be able to make the uninitiated aware of who you are, what the essential functions of your agency are and why you are developing a COOP.

Section II: Risks/hazards identified

   This section of your plan will detail any known or expected community risks and/or hazards that have the potential to imperil your agency's operations and cause activation of your COOP efforts. Obviously, these risks are variable and dependent on your specific geographic location, as well as additional considerations. This particular section should be done in cooperation with your local emergency management officials, with input from your public health authorities and hospitals, who will all have a good idea of what the area has seen before and how it will likely impact your EMS agency. Keep in mind that the aforementioned risks/hazards might be caused by any natural disaster, accident or terrorist act that significantly damages your facilities, equipment and/or vehicles.

Section III: Plan objectives

   This section will spell out the major objectives of your COOP. For anyone looking at the COOP for the first time, this is an opportunity to understand why your EMS agency needs a COOP, why the COOP is being written and what it hopes to accomplish. An example is as follows:

   The key objectives of this continuity plan are:

• Continue critical business operations
• Minimize the duration of a serious disruption to operations and resources
• Minimize immediate damage and losses
• Identify critical lines of business and supporting functions
• Establish management succession and emergency powers
• Work with additional entities toward continuation of effective emergency response
• Facilitate effective coordination of recovery tasks
• Reduce the complexity of the recovery effort.

Section IV: Authority

   This section should include on whose authority this COOP is being written, its overall compliance with standards (these can be state or federal), as well as who has authority to activate the COOP.

Section V: Essential functions

   As previously stated, your COOP is based on your EMS agency's essential functions. Ask yourself: What do we do? What is expected of us by code, charter, governmental or citizen expectation, or other?

   This element consists of:

• Identifying the services your EMS agency provides on a regular basis, in a specific branch or division within the overarching entity (e.g., fire department, health department, etc.)
• Categorization of each of the aforementioned services, usually under one of the so-called "4 Rs"--reinforce, run, reduce and remove--in order to reduce or remove as many nonessential services as possible
• Ranking and prioritizing the order of importance of the services needed in each distinct program during times of emergency.

   This section also serves as an operational guide to facilitate relocation of essential staff and/or equipment and vehicles, as well as backup of critical systems and vital records so essential functions may continue. This can include, but should not be limited to, any call-taking and dispatch services you provide, your 9-1-1 and even nonemergency transport responsibilities, an operations center, and even necessary administrative tasks. The level and manner of support needed to continue essential functions depends on the nature of an event.

Section VI: Identifying key personnel and orders of succession

   This section asks, "Who is in charge if it is not the traditional boss? What if your top management is not available? Who is at the next level?" This entails clearly outlining who will respond during one of the aforementioned emergencies and what role that person (or persons) will play. A critical element here is to ensure the correct persons are chosen and that they have a thorough understanding of the strengths, weaknesses and overall capabilities of your EMS agency.

   This section will also contain a plan for succession and delegation of authorities for the key leadership and decision-making/authority positions within the organization, and will select the minimum number of EMS agency staff needed to carry out the services needed to continue in an emergency. You should identify 2-3 successors for the key leadership positions to ensure coverage for illness and absenteeism (some projections say to expect up to 40% of the workforce to be absent during a severe pandemic). These key positions may include:

• EMS medical director
• EMS director
• Shift supervisors/team leaders

   Additional points to consider include informing employees of the plan, ensuring that those employees have been properly trained, and planning for high employee absenteeism, as well as determining the feasibility of having at least some staff working from home.

Section VII: Activating the COOP

   What triggers or events will cause you to actually activate the COOP? These should be considerations that will impact your EMS agency's operations to some degree. For instance, in the case of pandemic, this could include a significant number of absent employees and its impact on your staffing levels; in a natural disaster, it could include damage to your physical facilities and/or vehicles. Remember that this activation section should cover any incident or emergency that has the potential to disrupt normal operations, whether on a short-term basis or even longer term, when services are impacted for several days or weeks.

Section VIII: Recovery

   How will you get things back to the way they were before? There should be someone to coordinate replacement of equipment; reestablish/purchase office equipment; reestablish mail delivery, Internet and telephone service; reorganize records; repair facilities, etc. This section should also discuss working from home and e-meeting alternatives, as well as short- and long-term office relocation. The recovery section also addresses when employees can return to work and any additional assignments they might have when they return.

Section IX: Testing and exercising your COOP

   It's just not enough to have a well- written, researched COOP based on your EMS agency's needs. Remember, after developing a plan, you must be able to test it, train your employees to use it effectively and exercise your agency's ability to utilize it in an emergency. Your COOP must include schedules and planning for these tasks, including, at minimum, the full spectrum of emergency exercises (discussion-based and operation-based). It should also include all of the other "players" in your community (law enforcement, fire department, health department, emergency management personnel, elected officials, etc.) who have the potential to interact with your EMS agency during a time when the COOP will be activated. Although testing, training and exercising do not seem to be part of a working plan at first glance, they are vitally important in preparing you to work within the other plan elements.

Additional Elements

   In addition to these sections, there will be annexes, which should include an annex for key business contacts (your accountant, bank of record, landlord, insurance agent/company, public works entity, media outlets, telephone company and others), an overall inventory list (all assets including date of purchase, initial cost and identification/serial number), and a current list of employee contact information (including home phone, cell phone and physical address).

Deconflicting COOP

   It is important to remember that all of your community's emergency response entities, as well as many other service-based governmental entities, will have engaged in COOP planning, and there is a good chance they may have identified the same physical locations in your area where they can relocate their operations. Getting all entities (municipal, county and even regional) together to discuss COOPs in advance and ensure that the resource situation is understood is paramount to success during an actual COOP activation.

Conclusion

   These are some, but by no means all, of the factors that must be taken into consideration when establishing an effective and workable COOP. The most important factor, though, is to ensure that the departmental leadership fully understands the need for and purpose of a COOP, and makes development and implementation of the plan a high priority.

   Your EMS agency's COOP must be a living document. Be sure to review the COOP at least annually and update it as needed. Equally important as writing and updating the plan is distribution to all of your supervisory and management level employees and your board of directors.

BIBLIOGRAPHY

   FEMA Continuity of Operations. www.fema.gov/government/coop/index.shtm.

   Harford County (MD) COOP Workbook. www.harfordcountymd.gov/Health/Download/924-243.pdf.

   National Fire Protection Association. NFPA 1600 Standard on Disaster/Emergency Management and Business Continuity Programs. www.nfpa.org/assets/files/pdf/nfpa1600.pdf.

Raphael M. Barishansky, MPH, MS, CPM, is director of EMS for the Connecticut Department of Public Health. A frequent contributor to and editorial advisory board member for EMS World, he can be reached at rbarishansky@gmail.com.