SWFLHCC COVID-19 Briefing Was Developed and Disseminated to All Members and Partners

COVID-19 After Action Report/ Improvement Plan

March – October 2020

Volume 1. March 2021

Real World Event Overview: COVID-19

Event Name COVID-19 Response (Real World Event)

The Southwest Florida Healthcare Coalition began monitoring the COVID-19 outbreak in January 2020. Increased information gathering efforts began in early March. The Coalition activated its Operations Plan on March 11th, 2020, in alignment with the declaration of a pandemic by the World Health Organization, in order to provide enhanced communication and critical resource coordination to Coalition members and partners. Florida began to report cases of COVID-19 in March 2020, and both the Coalition and the health care system has been responding to COVID-19 since that time.

Significant dates that initiated statewide response to COVID-19: Real World Event Information & • State: Florida Public Health Emergency declared on 03/01/2020 Important Dates [Executive Order Number 20-51]

• State: Florida State of Emergency declared on 03/09/2020 [Executive Order Number 20-52]

• Presidential Declaration: President Trump issued a federal disaster declaration pursuant to Section 501(b) of the Stafford Act for Florida Covid-19 (EM-3432) on 3/13/2020. The incident period is January 20, 2020 and continuing.

• A Major Disaster Declaration (FEMA-4486-DR) was approved for Florida on March 25, 2020.

This After Action Report covers the response by the Southwest Florida Healthcare Coalition to the COVID-19 Pandemic from March 2020 through

October 2020. The pandemic response continued after that date and Scope of AAR subsequent reports will document and analyze the ongoing response including vaccinations.

Mission Area Response

Healthcare Capability 1: Foundation for Health Care and Medical Readiness Preparedness & Capability 2: Health Care and Medical Response Coordination Response Capability 3: Continuity of Health Care Service Delivery Capabilities Capability 4: Medical Surge

Event Name COVID-19 Response (Real World Event)

1. Health care organizations, the HCC, their jurisdictions, and the ESF-8 lead agency plan and collaborate to share and analyze information, manage and share resources, including volunteer management support, and coordinate strategies to deliver medical care to all populations during emergencies and planned events. 2. In conjunction with or through ESF-8, local coalition partners can Objectives (for demonstrate the ability to enhance situational awareness by sharing Healthcare Essential Elements of Information (EEIs). Coalition 3. HCCs, in conjunction with ESF-8, demonstrate use of communication Qualifying systems and platforms to assist in the collection and dissemination of Exercise) timely, relevant, and actionable information. 4. Health care organizations, and the HCC, in conjunction with ESF-8, will need to respond to a surge in demand for health care services as a result of an emergency. This will require a coordinated approach to share information and resources, including staff, and ensure the stewardship of beds, medical equipment, supplies, pharmaceuticals, and other key items to provide the best possible care under such conditions.

Hazard Infectious Disease Pandemic – Coronavirus (COVID-19)

Participating Reference Appendix B for a list of agencies/organizations who participated in Organizations the development of this after-action report and improvement plan (AAR-IP)

Points of Contact Kevin Gingras Project Manager Southwest Florida Healthcare Coalition Email: [email protected] Cell: 239-270-1041

Peggy Brown Director Southwest Florida Healthcare Coalition Email: [email protected] Cell: 239-223-4447

Executive Summary

The Southwest Florida Healthcare Coalition (SWFLHCC) leadership and staff began monitoring activities regarding the 2019 novel coronavirus (now known as COVID-19) in January 2020, and continued monitoring media and government communications through February and early March. In mid-March, following the declaration of a pandemic by the World Health Organization, SWFLHCC staff started gathering critical information from many sources, including county, regional and state conference calls regarding response planning and potential operations.

On March 12th, the SWFLHCC activated its Operations Plan to uphold its mission to provide information and resource coordination in support of Emergency Support Function-8 (ESF-8). On the same day, the first SWFLHCC COVID-19 Briefing was developed and disseminated to all members and partners. Coalition staff continued to monitor conference calls, collect current information and feedback from members, and send out informational messages throughout 2020. These briefings included up-to-date case counts, current information on emergency response efforts at the county, regional and state levels, upcoming trainings and webinars on COVID-19, test site information, notes from statewide conference call, and resources and links to a variety of COVID-19 related topics. While originally disseminated daily, once information flow slowed to a more predictable speed, they were created and sent out less frequently. Feedback on the briefings was overwhelmingly positive from our members and partners, as they were deemed a credible source of current information on the COVID- 19 pandemic response.

Logistical support for response activities is a component of SWFLHCC’s Operations Plan. This component was activated early on in our response to COVID-19. In early February 2020, SWFLHCC began to acquire infectious disease prevention equipment to support our healthcare system. The coalition was able to purchase decontamination tents, swamp coolers, electrostatic sprayers, air scrubbers, and aeroclaves. SWFLHCC quickly developed a resource acquisition list outlining the preferred method for their perspective county emergency operation management’s protocols to obtain PPE and other materials.

The SWFLHCC also provided an opportunity for members and partners to attend a combined webinar on COVID-19 and hurricane preparedness that had several panelists from various agencies such as AHCA, FDOH, and EM. These webinars focused on how healthcare agencies can prepare for the upcoming hurricane season during the COVID-19 pandemic and included general question and answer period related to COVID-19.

Throughout the pandemic, one area that SWFLHCC has been consistent in is the support of County Standing Committee/Coalition Meetings. These meetings serve as invaluable opportunities for collaboration and information sharing, and our regional staff has offered support to all county standing committee leadership. We have provided a virtual meeting platform and consistent administrative support for these meetings.

This report covers the SWFLHCC COVID-19 Response from March through October of 2020. The COVID-19 pandemic is far from over. To allow for interim learning and improvement the coalition choose to divide the report on the response to the pandemic into phases. The next phase will include the introduction and dissemination of the vaccines. We recognize that there will be many more strengths and areas for improvement in our response before the end of the pandemic, and we will document those in subsequent report.

Analysis of Healthcare Preparedness & Response Capabilities Aligning objectives and capabilities provides a consistent taxonomy for evaluation that transcends individual exercises or events to support preparedness reporting and trend analysis. Table 1 includes the event objectives, aligned capabilities, and performance ratings for each capability as observed during the event. Healthcare Performed Performed Performed Unable to Preparedness & without with Some with Major be Objective Response Challenges Challenges Challenges Performed Capabilities (P) (S) (M) (U) Health care organizations, the HCC, 1: Foundation for their jurisdictions, and the ESF-8 Health Care & S lead agency plan and collaborate to Medical share and analyze information, Readiness manage and share resources, 2: Health Care & including volunteer management Medical Response support, and coordinate strategies Coordination S to deliver medical care to all populations during emergencies and planned events. In conjunction with or through ESF- 2: Health Care & 8, local coalition partners can Medical Response demonstrate the ability to enhance Coordination situational awareness by sharing S Essential Elements of Information (EEIs). HCCs, in conjunction with ESF-8, 2: Health Care & demonstrate use of communication Medical Response systems and platforms to assist in Coordination S the collection and dissemination of timely, relevant, and actionable information.

Health care organizations, and the 3: Continuity of HCC, in conjunction with ESF-8, Health Care Service S will need to respond to a surge in Delivery demand for health care services as a result of an emergency. This will require a coordinated approach to share information and resources, 4: Medical Surge including staff, and ensure the stewardship of beds, medical equipment, supplies, pharmaceuticals, and other key items to provide the best possible M care under such conditions.

Table 1. Summary of Capability Performance

Ratings Definitions:

Performed without Challenges (P): The targets and critical tasks associated with the capability were completed in a manner that achieved the objective(s) and did not negatively impact the performance of other activities. Performance of this activity did not contribute to additional health and/or safety risks for the public or for emergency workers, and it was conducted in accordance with applicable plans, policies, procedures, regulations, and laws.

Performed with Some Challenges (S): The targets and critical tasks associated with the capability were completed in a manner that achieved the objective(s) and did not negatively impact the performance of other activities. Performance of this activity did not contribute to additional health and/or safety risks for the public or for emergency workers, and it was conducted in accordance with applicable plans, policies, procedures, regulations, and laws. However, opportunities to enhance effectiveness and/or efficiency were identified.

Performed with Major Challenges (M): The targets and critical tasks associated with the capability were completed in a manner that achieved the objective(s), but some or all of the following were observed: demonstrated performance had a negative impact on the performance of other activities; contributed to additional health and/or safety risks for the public or for emergency workers; and/or was not conducted in accordance with applicable plans, policies, procedures, regulations, and laws.

Unable to be Performed (U): The targets and critical tasks associated with the capability were not performed in a manner that achieved the objective(s). The following sections provide an overview of the performance related to each objective and associated healthcare preparedness & response capability, highlighting strengths and areas for improvement.

Analysis of Healthcare Coalition Capabilities, Strengths, and Areas for Improvement

Objective 1: Health care organizations, the HCC, their jurisdictions, and the ESF-8 lead agency plan and collaborate to share and analyze information, manage and share resources, including volunteer management support, and coordinate strategies to deliver medical care to all populations during emergencies and planned events. The strengths and areas for improvement for each healthcare preparedness & response capability aligned to this objective are described in this section.

Capability 1: Foundation for Health Care & Medical Readiness The community’s health care organizations and other stakeholders—coordinated through a sustainable HCC—have strong relationships, identify hazards and risks, and prioritize and address gaps through planning, training, exercising, and managing resources.

Strengths The partial capability level can be attributed to the following strengths:

Strength 1: Robust membership list and structure

Due to recruitment by the SWFLHCC staff, leadership, and other partners the coalition membership list was robust and included all hospitals, emergency management, department of health and healthcare agencies within the region. These existing lists and relationships made communication and coordination effective and efficient. The structure of the Coalition included members of the leadership from each of the core four agency- types (hospital, emergency management, emergency medical services, and public health) as well as representatives from other major partners such as long-term care, federally-qualified health centers and hospice. The leadership also included representatives from all counties in the region. The combination of an Executive Council that covered the whole region and leadership committees that focused on smaller areas of the region allowed for flexibility in decision-making whether it was regional or local.

Strength 2: Hazards Vulnerability & Gaps Analysis

The SWFLHCC holds yearly surveys to determine the most likely hazards to occur in order to prepare for their eventuality. Epidemic was highlighted as one of the potential hazards. In addition, members are annually asked which of the Coalition capabilities and objectives the Coalition should prioritize. Preparing for medical surge, communication, and coordination, and protecting healthcare workers safety were all prioritized by the membership as a focus for Coalition efforts. This focus allowed the Coalition to spend its time and money where it was most needed.

Strength 3: Operations Plan and Preparedness Plan

November 2020 the SWFLHCC created a preparedness plan the plan is an all-hazards and integrated approach to the healthcare coalition. The plan focuses on abilities of the SWFLHCC that are critical for emergencies or disasters a pandemic or natural disaster. Another plan created was the operation plan created on November 2020. These plans were implemented as intended and prepared the Coalition for activation.

Strength 4: Training offerings

The Southwest Florida Healthcare Coalition has provided ample training with regards to preventing preparing and responding to an infectious disease situation. For example, the SWFLHCC has provided Infectious

Disease Training: Prevention of Reportable Infectious Diseases, HEP A training, Infectious Disease Training- Vibrio and COVID-19 training. This was done to enhance the preparation and response to infectious diseases emergencies and the role of healthcare facilities and providers play on prevention, treatment and reporting.

Strength 5: Coordination of efforts resulted in new relationship and agreements.

Success for a multi-agency process involving agencies from all levels of government along with private entities involves a concentrated effort and a willingness to do things differently. The initial coordination and collaboration between entities was key to successfully coming together to manage in this public health emergency. There was a renewed emphasis on working together and many relationships were developed that did not exist before March 2020 that proved to be beneficial not just to the entities but more importantly to the public served in the region. It is worth noting that involvement of local emergency management was referenced as a key component in the effectiveness of response. Members in Sarasota, and Charlotte specifically mentioned the benefit of their relationships between Emergency Management, Department of Health, and providers.

Areas for Improvement: The following areas require improvement to achieve the full capability level:

Area for Improvement 1: Gaps in membership The SWFLHCC has gaps in certain membership types. As an example, not all nursing homes and assisted living facilities are active members in the Coalition. While some emergency medical services agencies are strong and involved partners there is still a need for recruitment among these agencies. The Coalition could also benefit from more involvement from non-traditional members such as medical suppliers and pharmacies.

Reference: CMS Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers Final Rule, 11/16/19. The SWFLHCC preparedness plan 2.4 Organizational Structure/ Governance Paragraph 5

Analysis: The SWFLHCC is aware that there are gaps within membership and has created a marketing plan designed to help alleviate those gaps. Efforts to enact much of the plan was delayed due to the pandemic. For example, the Coalition created new marketing materials meant to be distributed at in-person meetings and events. The Coalition could better enact the Marketing Plan including recruiting additional core and non-traditional members.

Capability 2: Health Care & Medical Response Coordination Health care organizations, the HCC, their jurisdiction(s), and the ESF-8 lead agency plan and collaborate to share and analyze information, manage and share resources, and coordinate strategies to deliver medical care to all populations during emergencies and planned events.

Strengths The partial capability level can be attributed to the following strengths

Strength 1: Utilization of local talent and resources was effective.

This was a resource scare environment almost from the onset. Personal protective equipment (PPE) and cleaning supplies quickly became in short supply and what could be found or purchased was at a premium price. Based on member feedback from surveys and focus groups, some challenges were met locally when resources were not available and local vendors were able to adapt and provide substitutions that worked well

and accomplished the mission. Utilizing local talent kept dollars in the local economy which was important and as well as being able to accomplish the mission in a timely manner. Additionally, there was a good spirit of teamwork and staff response to changes. With new information and changes coming regularly, staff worked extremely well together and responded to the changes with good attitudes and a willingness to get the job done.

Strength 2: Health Planning Council staff was available after hours and weekends to support Coalition members.

In surveys and focus groups, several members shared that they were pleased by the availability of staff and support offered after hours and on weekends. The “all hands-on deck” and “stronger together” approach from the Coalition to the membership was appreciated and valued in the response efforts. As this response has remained fluid and rapidly changing, knowing that staff was monitoring the situation and prepared to response to needs identified by membership was a valued-added benefit.

Strength 3: Situation Reports

March 12th 2020 began the implementation of the SWFLHCC preparedness plan, the strength of the SWFLHCC is the ability to communicate across the region. Information sharing was invaluable; it reduced the regions reliance on having to search for important information themselves. In surveys and focus groups, local agencies lauded the SWFLHCC for their material and timeliness. An example of information sharing by the Coalition was related to the state testing sites. Early on during the COVID-19 pandemic there was confusion on the ever changing locations of the testing, types of testing and hours of testing operations. The SWFLHCC was created a hyperlinked message during their sitrep notifications to allow for the most centralized and comprehensive test site information. It was also advised within the sitrep that if there was any knowledge of a location change or new knowledge of testing sites to contact the coalition as soon as possible.

Strength 4: Resource requisition information

It was quickly determined early on during the pandemic that many of the agencies across the region were unaware of the proper method to ask for personal protective equipment through the local emergency operations center. The concern was quickly alleviated as the SWFLHCC worked with Emergency Operations Centers across Region 6 to gather their requested step by step methods and disseminate the information in a region-wide message using ReadyOp.

Strength 5: Sharing of local needs and resources

The Coalition worked with members to share their needs and connect them with local resources. For example, the pandemic was proving to be mentally taxing on healthcare workers across the spectrum of agencies. Due to working prolonged hours and having very little time for breaks it was clear very early on that there was going to be a need for mental health resources. The SWFLHCC reached out to the local behavioral health members and tasked them with creating a spreadsheet of available resources whether it be professional or peer to peer. The information was quickly obtained and delivered to all agencies.

In another example, local hospitals were making public via their social media accounts as well as through email that there was an urgent need for blood donations. There was also an urgent request for fit test equipment after hours. The SWFLHCC reached out in a late night message to the local healthcare agencies in an attempt to get the information out.

Areas for Improvement The following areas require improvement to achieve the full capability level:

Area for Improvement 1: Lack of coordination and staff sharing resulted in confusion.

There was a lack of coordination amongst related agencies. A few examples were noted by members in surveys and focus groups: for example, some EMS units were not allowed to enter long-term care facilities to drop off or pick up patients due to concerns about whether the personnel staffing the units had been tested or not. In another example, some facilities allowed ancillary staff in while others only allowed clinical staff. It should be noted that even those that did not allow the ancillary staff to visit did provide for virtual visits.

Reference: SWFL Healthcare Coalition Preparedness Plan Section 3.2 Engagement of Partners and Stakeholders Analysis: Although the Coalition provided forums for communication during chapter meetings and focused webinars, there could have been more done to foster communication. The Coalition could work to develop additional methods of communication and coordination among related agency types throughout the region to help mitigate confusion and share best practices.

Area for Improvement 2: Shortages highlighted gaps in the supply chain.

Many members highlighted serious gaps in the supply chain particularly during the early phases of the pandemic. The development of relationships with local suppliers could help mitigate those challenges. While the Coalition had accessed gaps in the supply chain, planning was largely focused on events such as hurricanes and fires. The Coalition had not yet created a supply chain mitigation plan. An update to the supply chain analysis and creation and implementation of a supply chain mitigation plan could be beneficial. Reference: Supply Chain Integrity Assessment June 2019, FDOH Coalition Contract COPAM Task 19

Analysis: While the Coalition had accessed gaps in the supply chain, planning was largely focused on events such as hurricanes and fires. The Coalition had not yet created a supply chain mitigation plan. An update to the supply chain analysis and the creation and implementation of a supply chain mitigation plan could be beneficial and is planned as a part of the Coalition’s tasks and deliverables for 2021.

Objective 2: In conjunction with or through ESF-8, local coalition partners can demonstrate the ability to enhance situational awareness by sharing Essential Elements of Information (EEIs).

Capability 2: Health Care & Medical Response Coordination

Strengths The partial capability level can be attributed to the following strengths:

Strength 1: Pandemic Training, discussion and preparation.

During the beginning phases of the pandemic the SWFLHCC collaborated with all chapters of the coalition by hosting webinars with panelists ranging from the Agency for Healthcare Administration (AHCA), Department of Health epidemiologists, Emergency Management and local hospitals. There were discussions on updates, best practices & looking forward on how to prevent the next pandemic.

Strength 2: Information sharing prior and during the event.

The SWFLHCC utilized information gathering by reaching out to all area healthcare coalition members and requesting needs, best practices and/or excess resources that could be made available to other organizations. This was advertised as an as needed method using ReadyOp by creating a briefing that would be sent to all members. This was useful as most healthcare agencies utilized this method to make their own information known to others.

Strength 3: Communicating State, Regional and County-level information requests to members

The Coalition shared requests for information from state, regional and county-level entities with its members. For instance, members were encouraged to update the Web-EOC and ESS databases with their information to allow for better coordination and planning by state, regional and county officials.

Areas for Improvement The following areas require improvement to achieve the full capability level:

Area for Improvement 1: Too much information was received, some repetitive and sometime conflicting. It is not uncommon for a strength to also have an aspect that is an area of improvement. The amount of information coming to members was intense; there was a large amount of information sharing occurring over many conference calls and virtual meetings. Members stated in surveys and focus groups that is was difficult to know which information to prioritize.

Reference: Operations Plan Concept of Operations and SWFL Healthcare Coalition Preparedness Plan Section 3.2 Engagement of Partners and Stakeholders

Analysis: While the Coalition shared a lot of information, it could have been easier to review and prioritize. The Coalition could update its operations plan to include a communication plan with a system which allows members to identify which messages include critical or essential information.

Area for Improvement 2: Some groups felt they were left out of the calls and information sharing. In any response that has multiple moving parts it is expected that something will fall through the cracks. In this case, the home health agencies were not as represented in the calls and planning efforts as they would have liked. This led to some decision making and implementation that did not consider or address their unique situations. This group referenced using the media as their information source which is concerning.

Reference: Operations Plan Concept of Operations and SWFL Healthcare Coalition Preparedness Plan Section 3.2 Engagement of Partners and Stakeholders

Analysis: The Coalition provided a lot of information that was specific to particular agency types, however they were generally included as a part of longer messages with a variety of topics. It would have been easy for the information to be missed. The Coalition could update its marketing plan to assure that all of member-types are included in the Coalition membership. It can also consider creating communication that is specific to particular agency types. This would be reflected in the communications plan.

Area for Improvement 3: Information sharing from facility to facility or between related entities was not effective.

Members reported that they felt that information sharing between facilities of like-types, i.e., ALF to ALF, etc. was not as effective as they should have been. Policies made by one facility may have affected another and they were unaware of those situations until it created an issue at their doorstep.

When some facilities stopped taking in new patients due to COVID, home health agencies were overrun without an effective plan in place. Had some communication occurred earlier, the home health agencies would have been better prepared to respond. Home health also had to call each different facility they serviced to get information on how to gain access to the facilities. Rules and guidance changed frequently, was not consistent, and was implemented immediately without time to process.

There also seemed to be some confusion and lack of sharing between facilities and their transport providers. This resulted in issues in transporting patients to and from the facilities.

Reference: Operations Plan Concept of Operations and SWFL Healthcare Coalition Preparedness Plan Section 3.2 Engagement of Partners and Stakeholders

Analysis: The Coalition is currently strongest at sharing information from federal, state and county sources and less strong at sharing information between local agencies. The Coalition could work to develop additional methods of communication and coordination among related agency types throughout the region to help mitigate confusion and share best practices. These plans should be included in the communications plan.

Area for Improvement 4: Sharing of Essential Elements of Information

While the Coalition shared state, regional and county requests for information, the Coalition Operations plan did not designate what the essential elements of information are for its members. Also, while the Coalition shared the need to enter information, it did not have access to that information or the ability to share it with its members.

Reference: Operations Plan Concept of Operations and SWFL Healthcare Coalition Preparedness Plan Section 3.2 Engagement of Partners and Stakeholders. The Emergency Status System (ESS) is the Agency for Health Care Administration's (AHCA) online database for reporting provider emergency status, planning or operations information, as required in Florida Statute 408.821.

Analysis: The Coalition should identify the Essential Elements of Information in the Communications Plan as a part of the Operations Plan. The Coalition should also work with state, regional and county partners to determine what information would be valuable to share with Coalition members and how the Coalition can best access that information

Objective 3: HCCs, in conjunction with ESF-8, demonstrate use of communication systems and platforms to assist in the collection and dissemination of timely, relevant, and actionable information. Capability 2: Health Care & Medical Response Coordination

Strengths The partial capability level can be attributed to the following strengths:

Strength 1: Virtual meeting platform use was beneficial.

The availability and use of virtual meeting platforms were vitally important in the response. The Coalition did a good job of implementing and utilizing Zoom meetings for information sharing and situational awareness and made sure to include all members in the opportunity. It was commented several times that the use of the Zoom meetings by the Coalition became comfortable and easy as a means to communicate.

Strength 2: Transition to virtual

The SWFLHCC had the fortunate capability to move to 100% virtual meetings with very little issue. This due to the executive council approving the funding for virtual meetings pre-pandemic. The SWFLHCC hosted emergency meetings, webinars and scheduled meetings entirely virtual using the Zoom platform

Strength 3: ReadyOp ReadyOp is a secure web-based application that integrates multiple databases and a communications platform to help with planning, response, command and communications for single agencies. ReadyOp was utilized on a daily basis by the SWFLHCC for routine communications ranging from messaging directly to Hospital, Department of Health, Emergency Management or any other healthcare agency within the membership. The communications using this system were rarely reported as being caught in firewalls or otherwise blocked, an improvement from the system used in the last implementation. The system also allowed for communication via text, e-mail and phone call as needed. Strength 4: Bi-weekly Health Care Coalition Task Force (HCCTF) Conference Calls During the pandemic the quarterly task force meeting were rescheduled to be held on a biweekly basis. This was paramount to the success of the state health care coalition achievements as the ramped up information sharing of experiences, best practices and areas for improvement became front and center during the COVID- 19 pandemic. The Health Care Coalition Task Force meetings continue to be the foundation of the group's continuous growth. The meeting is the basis for relationship structure, exercises and trainings, exchange of ideas, problem solving, resolving conflicts, innovation, recovering from shortfalls, and celebrating successes.

Areas for Improvement The following areas require improvement to achieve the full capability level:

Areas for Improvement 1: Correct Contact Information

Often the contact information held by the Coalition is the day-to-day office contact information. It is also often to contact most likely to attend Coalition meetings. That may not always be the best contact information in the case of an emergency. The Coalition should work to expand the contact information to include multiple methods of contact and additional agency contacts to ensure that information is received by the individuals who need it most. This can be tested during the regular communication tests.

Reference: none

Analysis: The Coalition should work to expand the contact information to include multiple methods of contact and additional agency contacts to ensure that information is received by the individuals who need it most. This can be tested during the regular communication tests.

Objective 4: Health care organizations, and the HCC, in conjunction with ESF-8, will need to respond to a surge in demand for health care services as a result of an emergency. This will require a coordinated approach to share information and resources, including staff, and ensure the stewardship of beds, medical equipment, supplies, pharmaceuticals, and other key items to provide the best possible care under such conditions.

Capability 3: Continuity of Health Care Service Delivery

Health care organizations, with support from the HCC and the Emergency Support Function - 8 (ESF-8) lead agency, provide uninterrupted, optimal medical care to all populations in the face of damaged or disabled health care infrastructure. Health care workers are well-trained, well- educated, and well- equipped to care for patients during emergencies. Simultaneous response and recovery result in a return to normal or, ideally, improved operations.

Strengths The partial capability level can be attributed to the following strengths: Strength 1: Resource Requisition A critical component in executing PPE conservation tactics is determining the appropriate level of PPE for use. Because of the increase in usage and the changing federal policies by the Center for Disease Control that were occurring early on during the COVID-19 pandemic, there were internal reviews of agency wide stockpiles. Once it was determined that there was a need for more PPE, the SWFLHCC enacted a document that would be sent to all agencies through ReadyOp stating how each Emergency Operations Center would like for the request to take place.

Strength 2: Resource Sharing/Requisition during the event

Resource sharing/requisition was instantly a high priority for the SWFLHCC. Each Emergency Management agency throughout Region 6 acted as a point of contact as it dealt with resource requisition. Each county had a different methodology of making those requests. The SWFLHCC was tasked with relaying the resource requisition procedures and relaying that information to the members to help streamline the processes. A second means of resource sharing method was handled by the SWFLHCC as some agencies had some items or resources available to others with no means of letting others know. The SWFLHCC was asked to notify agencies that there are available items that could be beneficial to other agencies. In other cases, there was the need for the purchase of items to help to aid in the continuity of operations. Infectious disease control item purchases made by the SWFLHCC aided in the continuation of operations for healthcare officials throughout Region 6. One item that became a high demand item was the Aeroclave. The HCC purchased Aeroclaves that were shared among multiple member agencies. The Aeroclave was used for both manual hand-application and remote fogging. The machine was used to disinfect ambulances, patrol cars, buses, training rooms, exam rooms, bunkrooms and much more. In another example, local hospitals had deployed their healthcare agents to remote locations outdoors to follow through with the Covid-19 testing. A need for a cooling machine developed that would help keep the healthcare agents cool during their work outdoors/ A purchase was made for an evaporative cooler or also known as a swamp cooler. The operation of an evaporative cooler is to bring down the temperature by allowing

fresh water to disperse into dry air. As the water evaporates, it naturally lowers the temperature in that area, and this cold air is then blown where you need it by the system's fan.

Areas for Improvement The following areas require improvement to achieve the full capability level:

Area for Improvement 1: Awareness of Available Items

Members reported that they were not always aware of the items that were available to share. Members would find the available items would valuable if there knew how to access them in times of need.

Reference: SWFL Healthcare Coalition Task 7 IRMS Provider Assets

Analysis: The Coalition should ensure that the inventory list is publicly available, that the members are aware of the existence of the inventory list and that sharing protocols are clear and easy to follow.

Capability 4: Medical Surge

Health care organizations - including hospitals, emergency medical services (EMS), and out-of- hospital providers - deliver timely and efficient care to their patients even when the demand for health care services exceeds available supply. The HCC, in collaboration with the Emergency Support Function-8 (ESF-8) lead agency, coordinates information and available resources for its members to maintain conventional surge response. When an emergency overwhelms the HCC’s collective resources, the HCC supports the health care delivery system’s transition to contingency and crisis surge response and promotes a timely return to conventional standards of care as soon as possible.

Strengths The partial capability level can be attributed to the following strengths:

Strength 1: Surge Training and Exercises

In 2017, 2018 and 2019 The SWFLHCC worked with community partners to simulate a potential surge of patients. The Coalition Surge Test was designed to help identify gaps in the surge planning through a no notice exercise. The exercise is a planning tool to prepare for real-world possibilities of a massive patient surge through evacuation. Each surge exercise includes a lessons-learned analysis to be utilized for preparation for emergencies and were a foundation for the COVID-19 pandemic.

Strength 2: Coalition-purchased Items assisted with medical surge

Prior to the pandemic, the Coalition had purchased some member-requested items that were available throughout the community to help facilitate care during the medical surge. Examples of these items included decon tents, to-go kits, radios, and others.

Areas for Improvement The following areas require improvement to achieve the full capability level:

Area for Improvement 1: Awareness of Available Items

Members reported that they were not always aware of the items that were available to share. Members would find the available items would valuable if there knew how to access them in times of need.

Reference: SWFL Healthcare Coalition Task 7 IRMS Provider Assets

Appendix A: Improvement PLAN

Healthcare Primary Preparedness Issue/Area for Capability Organization Completion Corrective Action 1 Responsible Start & Response Improvement Element POC Date Organization Date Capability 1. Gaps in Marketing SWFLHCC Project Manager June 2021 Ongoing 1. The Coalition will better membership Capability 1: enact the Marketing Plan Foundation for including recruiting Health Care & additional core and non- Medical traditional members. Readiness

Planning SWFLHCC Project Manager March Ongoing 1. Lack of coordination 1. The Coalition will 2021 Capability 2: develop additional Health Care & and staff sharing resulted in confusion. methods of Medical communication and Response coordination among Coordination related agency types

throughout the region to

help mitigate confusion and share best practices.

Planning SWFLHCC Project Manager March Ongoing 2. Shortages 2.The Coalition will 2021 highlighted gaps in the create a supply chain supply chain mitigation plan. 3. Too much 3. The Coalition will Planning SWFLHCC Project Manager March September 2021 information was update its operations 2021 received, some plan to include a repetitive and communication plan with sometime conflicting. a system which allows members to identify

which messages include critical or essential information.

4. Some groups felt 4. The Coalition will Planning SWFLHCC Project Manager May 2021 Ongoing they were left out of update and implement the calls and its marketing plan to information sharing. assure that all of member-types are included in the Coalition membership. 5. Information 5. The Coalition will work to Communication SWFLHCC Project Manager March Ongoing sharing from facility develop additional methods 2021 to facility or of communication and between related coordination related to entities was not agency types thought the effective region to help mitigate confusion and share best practices 6. Sharing of The Coalition will work with Communication SWFLHCC Project Manager March Ongoing essential elements the county, state, and 2021 of information regional county partners to determine what information would be valuable to share with Coalition members and how the Coalition can best access that information. 7. Correct contact 7. The Coalition will work to Organization SWFLHCC Project Manager July October 2021 information expand the contact 2021 information to include multiple methods of contact and additional agency contacts to ensure that information is received by the individuals who need it most. 1. Awareness of 1. The Coalition will ensure Communication SWFLHCC Project Manager June October 2021 Capability 3: available items that the inventory list is 2021 Continuity of publicly available, that the Health Care members are aware of the

Service Delivery existence of the inventory list and that sharing protocols are clear and easy to follow. Capability 4: 1. Awareness of 1. The Coalition will ensure Planning SWFLHCC Project June October 2021 Medical Surge available items that the inventory list is Manager 2021 publicly available, that the members are aware of the existence of the inventory list and that sharing protocols are clear and easy to follow.

1 Capability Elements are: Planning, Organization, Equipment, Training, or Exercise. This IP has been developed specifically for the Southwest Florida Healthcare Coalition as a result of the COVID-19 Pandemic real world event that began to impact Florida in March 2020.

APPENDIX B: AAR/IP PARTICIPANTS

Participating Agencies & Organizations A Little Help Nurse Registry, LLC Center for Endoscopy A1 America Home Healthcare Central Florida Regional Planning Council Acadia Healthcare Charlotte County EM Adult & Children's Surgery Center of Southwest Florida Chelsea Place Advanced Physical Therapy Choices In Living Adult Day Care Cape Coral, Fl. Advanced Physical Therapy & Rehabilitation City of North Port Advent Health City of Punta Gorda Advent Health Wauchula & Sebring City of Sanibel Agency for Healthcare Administration Coastal Behavioral Health Alderman Oaks Collier County Emergency Management Amavida Senior Living Collier County EMS Amedisys Home Healthcare Collier County Sheriff's Office Amedisys Inc. Cape Coral Collier Endoscopy and Surgery Center American House Assisted Living Comfort Keepers American Red Cross Consulate Health Care Angel Works Mgt Coral Trace Healthcare Arbor at Shell Point Cypress Cove Arden Courts Cypress Living Area Agency on Aging Cypress Point Senior Living Arlington of Naples David Lawrence Center Autumn Leaves DaVita Dialysis Avalon Manor DeSoto County Emergency Management Avidity Home Health Desoto Health & Rehab Avow Hospice Desoto Memorial Hospital Barkley Place DeSoto Psychiatric Services Barrington Terrace ALF Discovery Village at The Forum Bayfront Health Doctors Choice Home Care Sarasota Bayfront Health Pt Charlotte Doctors Hospital Sarasota Bayfront Health Punta Gorda Doctors Same Day Surgery Center Big Lake Kidney Center Okeechobee Dornoch Place Blue Sky Therapy Douglas Jacobson Veterans Nursing Home Bonita Community Health Center Encompass Medical, LLC Braden Clinic Englewood Community Hospital BriovaRX Infusion Services Evans Health Care Brookdale Eye Specialist Laser and Surgery Center Calusa Harbor Fairway Pines Sebring, Fl. Cape Coral Emergency Management Family Community Health Centers Cape Coral Fire Department Family First Homecare Cape Coral Police Department Family Health Centers of SWFL Cape Villa ALF Fawcett Memorial Hospital Center for Digestive Health FDOH (Regional)

Participating Agencies & Organizations FDOH Charlotte County Healthcare Network of Southwest Florida FDOH Collier County Heartland Healthcare & Rehab Sarasota FDOH DeSoto County Heartland Healthcare Center FDOH Hendry and Glades Counties Heartland North Sarasota FDOH Highlands County Helgemo and Liou Pediatrics FDOH Lee County Hendry Co. EMS FDOH Okeechobee County Hendry County Emergency Management FDOH Sarasota County Hendry County Emergency Medical Services Florida Gulf Coast University Hendry Public Safety Florida Gulf Coast Physical Therapy Hendry Regional Medical Center Florida Gulf Coast University Heritage Healthcare & Rehabilitation Florida Health Care Association Heritage Healthcare and Rehab Florida Hospital Highlands County Emergency Management Florida Hospital - Lake Placid Highlands County Emergency Medical Services Fort Myers Eye Surgery Center Highlands County Veteran Services Fort Myers Police Department Highlands Regional Medical Center Fort Myers Rehab & Nursing Center Home Helpers of Sarasota Fort Myers Rehab and Manatee Springs Home Sweet Homes Fort Myers Surgery Center Hope Healthcare Frantz Eye Care Hospice of Okeechobee Fresenius Kidney Care Hospice of Okeechobee, Inc Friendship Centers Inn at Sarasota Bay Club Fruitville Physical Therapy Intercoastal Surgery Center Genesis Healthcare Jacaranda Trace Glades County Emergency Management Joyful Life Assisted Living Inc. Glades County Emergency Medical Services King Crown at Shell Point Gladiolus Surgery Center King's Crown Assisted Living at Shell Point Golden Care Home Health LA Colonia Grainger Lake Placid Health and Rehabilitation Center Greystone Health Lakeshore Medical Center Gulf Coast Endoscopy Lamplight Fort Myers Assisted Living Gulf Coast Medical Center / Lee Health Landmark Hospital Gulf Coast Village Larsen Pavilion at Shellpoint Retirement Community Ham Operator Lee Control 911 Harbor Health Southport Square Lee County EM Harmony Homes Lee County Emergency Management Hawthorne Village Lee County EMS Hawthorne Village of Sarasota Lee County Government HCR Manor Care Lee County Medical Society Health and Human Services Lee County Port Authority Health Planning Council of Southwest Florida, Inc. Lee County Public Safety

Participating Agencies & Organizations Lee County Sheriff's Department Oak Brook of LaBelle Lee County VA Healthcare Clinic Oaks at Avon Lee Health Home Services Okeechobee Fire Rescue Lee Health OB Okeechobee Community Emergency Response Team Lee Memorial Health Systems Okeechobee County Emergency Management Legend Senior Living Okeechobee Fire Rescue Lehigh & Ft Myers Kidney Care Center Orchid Cove at Naples Lehigh Acres Place Organization Lehigh Health Pacifica Senior Living Lehigh Health & Rehab Center Page Rehab Lehigh Regional Medical Center Palmer Ranch Senior Care Community Life Care Center Palms of Fort Myers Life Care Center of Estero PAM Specialty Hospital of Sarasota Life Care Center of Punta Gorda Paradise Love ALF Lolita's Hispanic Family Center Park Center for Procedures Louetta Muller Emergency Planning Services LLC Park Royal Behavioral Health Services Loving Care Home Health Parkside Assisted Living and Memory Care Magnolia Health & Rehab Physicians Regional Maintenance at Winkler Court Plymouth Harbor on Sarasota Bay Manor Care Lely Pondella Residential Care LLC Manor Care of Fort Myers Preferred Care Home Health Services ManorCare at Lely Palms Premier Surgery Center of Sarasota Manor care Fort Myers Preserve in Ft Myers Marco Island Fire Rescue Preserve Senior Living Marco Island Fire Rescue, HazMat (District Response Priority Life Care Fort Myers Team) Marshall Family Dentistry Project Help McGregor Clinic Providence Family Life Center McKenney Home Care Quality Healthcare Mederi Care Tenders Radiology Regional Center Medical Reserve Corp Rai Dialysis Center Medical Reserve Corp Sarasota Raulerson Hospital Millennium Home Care Rehabilitation and Healthcare Center of Cape Coral Montgomery Eye Center Renaissance at the Terraces Naples Day Surgery Right at Home Naples Police Department Riverwalk Surgery Naples Suncoast Surgery Center Royalty Home Health Services NCH Healthcare System Saber Healthcare Group Fort Myers Nokomis Physical Therapy SalusCare North Collier Fire Control and Rescue San Carlos Park Fire Nurse On Call Home Health Sandy Park Dev Ctr Oakbrook Health & Rehab Sandy Park Development Center

Participating Agencies & Organizations Sarasota Bay Club The Arbor Company - Senior Living Sarasota County EM The Carlisle Sarasota County EMS The Center for Endoscopy Sarasota Emergency Management The Center for Progress & Excellence Sarasota Health and Rehab Center The Center for Specialized Surgery at Fort Myers Sarasota Interventional Radiology The Crossings at Hancock Creek Sarasota Medical Reserve Corps The Ebenezer ALF Sarasota Memorial Health Care System The Glenridge on Palmer Ranch Sarasota Physicians The LSH Group/Omega Home Sarasota Point Rehabilitation Center The Opal Senior Living Fort Myers Seminole Tribe Fire Rescue The Palms at Barkley Place Seminole Tribe of Florida The Palms of Fort Myers Senior & Retired Physicians Assoc. The Palms of Punta Gorda Senior Friendship Centers The Preserve Shell Point The Springs at Lake Pointe Woods Signature Healthcare The Springs at Shell Point Signature Healthcare at College Park The Terraces Bonita Springs Sims Lodge The Village ALF & LaColonia III Solaris Charlotte Harbor Thrive at Beachwalk Solaris Healthcare Tidewell Hospice Solaris Healthcare Charlotte Harbor Tuscan Gardens of Venetian Bay Solaris Rehab TUSCANY VILLA OF NAPLES Southport Square Harbor Ter. Tyson Eye Southwest Florida Home Care, Inc. Tzuriel Assisted Living Facility Inc. Springwood Court United Surgical Partners St Lucy Eye Surgery Center University of Miami EM BASCOM Palmer Eye Institute University of Miami Health System & Miller School of St. Vincent DePaul Medicine Stratum Health System / Tidewell Hospice US Renal Care Suncoast Endoscopy of Sarasota Venice Regional Bayfront Health Suncoast Surgery Center Venice Regional Medical Center Sunnyside Village Vi at Bentley Village Sunrise Community Vi Living Sunshine ALF Village on the Isle Surgery Center of Naples Village Place Health and Rehab Surgery Centre of SWFL Vitas Surgicare Center Vitas Healthcare SWFL Health Coalition Vitas Hospice SWFL Healthcare Coalition Windsor of Cape Coral Tarpon Point Nursing and Rehabilitation Winkler Court The Anthurium Assisted Living Facility

Appendix C: AAR/IP Survey

Southwest Florida Healthcare Coalition Regional After Action Report Survey The Region 6 Southwest Florida Healthcare Coalition monitored the COVID-19 outbreak since it was reported in China in December 2019. In response, the SWFL healthcare coalition member organizations began to implement preparedness measures for the eventual impacts to the immediate healthcare sector in Florida. Florida began to report cases of COVID-19 in March 2020, and the healthcare system has been responding to COVID-19 since that time. The Region 6 Healthcare Coalition activated their Operational Plan in response to COVID-19 beginning on March 13, 2020.

Significant dates that initiated statewide response to COVID-19.

· State: Florida Public Health Emergency declared on 03/01/2020 [Executive Order Number 20-51]

· State: Florida State of Emergency declared on 03/09/2020 [Executive Order Number 20-52]

· Presidential Declaration: President Trump issued a federal disaster declaration pursuant to Section 501(b) of the Stafford Act for Florida Covid-19 (EM-3432) on 3/13/2020. The incident period is January 20, 2020 and continuing.

· A Major Disaster Declaration (FEMA-4486-DR) was approved for Florida on March 25, 2020.

1. Agency Type

2. Organizational Type For Profit Not for Profit/Nonprofit Government 3. Which SWFHCC Chapter are you a member of? (select all that apply) CHEPC (Collier) Heartland (DeSoto, Hendry, Glades, Highlands, Okeechobee) Lee County Suncoast (Charlotte and Sarasota) 4. Which county(ies) does your agency serve? (select all that apply) Charlotte Collier DeSoto Glades Hendry Highlands Lee Okeechobee

Sarasota 5. List up to three things that went well during the response to COVID-19.

Within your agency:

Locally (County DOH/EM, partner agencies):

State (state DOH/EM, associations, governor):

Federal (federal government, agencies):

Provide additional feedback List up to three things that could be improved during the response to COVID-19.

Within your agency:

Locally (County DOH/EM, partner agencies):

State (State DOH/EM, associations, governor):

Federal (federal government, agencies):

Provide additional feedback

7. Please share any best practices or lessons learned during the response to COVID-19.

8. During the response to COVID-19, list three suggestions that could be implemented to improve infection prevention activities within your agency. Suggestion 1:

Suggestion 2:

Suggestion 3: 9. During the response to COVID-19, list three suggestions that could be implemented to improve infection prevention activities within the healthcare community locally. Suggestion 1:

Suggestion 2:

Suggestion 3: 10. During the response to COVID-19, list three suggestions that could be implemented to improve infection prevention activities within the healthcare community at the state level. Suggestion 1:

Suggestion 2:

Suggestion 3:

11. During the response to COVID-19, list three suggestions that could be implemented to improve infection prevention activities within the healthcare community at the federal level. Suggestion 1:

Suggestion 2:

Suggestion 3: 12. During the response to COVID-19, the Healthcare Coalition was beneficial to our agency and/or the community. Strongly agree Agree Neither agree nor disagree Disagree Strongly disagree

Provide additional feedback 13. Please share a strength the Healthcare Coalition brought to the healthcare community during the response to COVID-19.

14. Please provide any areas of improvement for the Healthcare Coalition during the response to COVID-19.

15. Please provide any suggestions on how the coalition could be more helpful in future events.

16. Please share any additional feedback or comments that we may not have covered:

17. If you are interested in participating in a ZOOM focus group, please enter your email here or send a message to [email protected]

Appendix D: AAR/IP Survey Results Related to Coalition

46 agencies responded to the survey in the fall of 2020.

Which SWFHCC Chapter are you a member of? (select all that apply) 50.00% 45.00% 40.00% 35.00% 30.00% 25.00% 20.00% 15.00% 10.00% Responses 5.00% 0.00% CHEPC (Collier) Heartland Lee County Suncoast (DeSoto, Hendry, (Charlotte and Glades, Sarasota) Highlands, Okeechobee)

Please share a strength the Healthcare Coalition brought to the healthcare community during the response to COVID-19.

Respondents Responses 1 communication 2 county updates (emails) were very beneficial and much appreciated Except for one zoom meeting and some briefs sent out, I don't believe there was much 3 other assistance from the coalition. 4 Assisting the LTC communities with procuring PPE through the local EOCs. Linked the various aspects of local and regional healthcare services, thus providing 5 greater visibility. Provided factual information. The email communication with information, executive orders, important links, testing sites, mental health and other resources were extremely helpful especially as 6 information was changing and being released often in the beginning of the pandemic. 7 They showed us strength and resilience in their daily operation Daily up to date information on COVID-19. Where to go for resources like PPE's. 8 Broadcasting information from DOH, CDC, and other resource information. I think the coalition did a great job of distributing information. A more frequent schedule 9 of that would have been good. 10 Communication 11 Was not directly in contact with them so I do not have any input 12 Served as a central repository of information dissemination Opened lines for communication via email and zoom calls.

13 Provided wonderful resources to front line and staff and for patients as well. Kept us connected and communicating during a time of great demand. Allowed for 14 purchase of cleaning/disinfection devices for facilities. 15 available PPE for struggling businesses 16 available PPE for struggling businesses Provides information to us for the surrounding counties, because if it affects them it 17 could possibly have an affect on our county. 18 Provided surveys and liaison between FHA and local healthcare 19 Good Communication 20 frequent updates providing resources 21 Updates regarding numbers and testing 22 Weather radios, and information I was able to disseminate 23 they worked even after hours and weekends to meet needs brought to the coalition 24 Daily emails 25 They kept us informed of outside resources. 26 Frequent written communication. 27 assistance, information, supplies 28 distribution of information 29 Knowledge

It seems to be the best forum for developing consensus and the community approach to 30 events like these 31 The sharing of information 32 I just joined so I can not provide any feedback. The Coalition was very reliable, and provided information accurately and quickly. I am 33 excited to see the AAR to bring back and expand upon for our agency AAR. 34 The weekly communications were extremely helpful 35 Kept members up to date and provided needed supplies

Please provide any areas of improvement for the Healthcare Coalition during the response to COVID-19.

Respondents Responses 1 communicate to SNF folks the outcomes of task force meetings 2 offer more zoom-type coalition meetings to health care providers It would have been helpful to have biweekly zoom meetings with members to 3 exchange ideas, best practices, etc. 4 Recommend weekly meeting/phone calls with group to discuss overall needs 5 Provide signage if you cannot provide supplies. This pandemic has tested everyone's resilience. I have no significant suggestions for improvement. Proud of all the work that has been done. 6 7 I reached out to members of the coalition and they were helpful. 8 Communication was good but it could have been better 9 N/A 10 Become more aware of/involved with ALF/SNF providers. 11 N/A Should serve as a PPE staging area.

Need to reach out in a proactive way to the "mom & Pop" AKA smaller Healthcare facilities (i.e. Home Health agencies, Nurse registries, Hospice and 12 Home Medical Equipment) to make sure they are more involved in the coalition. 13 NA 14 Move unused funds sooner for better utilization 15 none 16 none 17 None Make you newsletters facebook loadable so we can load them on our facebook 18 pages Emailed updates/communication were quite delayed. I ended up using FHA, 19 Lee DOH updates which were more reliable and timely. 20 none 21 none 22 Increase communication earlier in the process. 23 none 24 NA

Smaller Coalitions seemed to struggle more so maybe sending them staff to 25 assist 26 none 27 none 28 I just joined so I can not provide any feedback.

29 I thought they did a very remarkable job.

Please provide any suggestions on how the coalition could be more helpful in future events. Respondents Responses 1 increase communication and training provided 2 See #14. Could the Healthcare Coalition partner with Contract healthcare Worker 3 agencies in an effort to direct help to communities with workforce shortages? Continue this trend of looking for opportunities and creating the space to help 4 the region and communities e serve. The email communication was great with resources, testing sites. NOt sure if we received the daily communication or if it was actual daily or different frequency. 5 Would have liked to seen more specific info for Collier. 6 The Coalition did a superb job, however, maybe better contact information 7 N/A 8 N/A 9 See above pushing more healthcare outreach. It would be beneficial to invite HCAF (Home Care Association of Florida) to be an active member of the Coalition. Not only are they an expert and are key players for analyzing rulings, they address needs and concerns of both private 10 duty and home health agencies. 11 Good communication always. 12 none 13 none 14 More frequent telephone meetings 15 expand on the communication briefs started for this event. 16 Doing a great job! 17 Additional ZOOM meetings to increase communication. 18 none 19 NA 20 Same as above-more staff helps everyone do a better job 21 Keep moving forward with this model 22 no suggestions Not sure why there are not more ALF, SNF type facilities that are part of this 23 organization. I like that someone from AHCA is always involved, but please try to have someone that knows all areas of AHCA. It seems there is a lack of Home Health 24 knowledge or resources available. 25 Continue as your are. The frequent communication is the best.

Appendix E: Acronyms

Acronym/Abbreviation Definition

AAR After Action Report

AHCA Agency for Health Care Administration

COVID-19 2019 Novel Coronavirus Disease ESS Emergency Status System

FDOH Florida Department of Health

HSEEP Homeland Security Exercise Evaluation Program IP Improvement Plan

MOA Memorandum of Agreement

POC Point of Contact SWFLHCC Southwest Florida Healthcare Coalition

Appendix F: AAR Template for Member Use

After Action Report – Improvement Plan Form (AAR / IP) Evaluation of Drill / Exercise OR Actual (Real-Life) Event

The following After-Action Report / Improvement Plan (AAR/IP) template incorporates the required CMS Emergency Preparedness Rule elements described below and includes other valuable features. The template format is designed to effectively integrate the required AAR/IP elements into a facility’s overall emergency program and emergency operations plan.

CMS EP Rule Requirements for After Action Reports A. The CMS Emergency Preparedness Rule (EP Rule) requires facilities to analyze their response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the facility’s emergency plan accordingly. The Interpretive Guidance states that facilities should “document the lessons learned following their tabletop and full-scale exercises and real-life emergencies and demonstrate that they have incorporated any necessary improvements in their emergency preparedness program. Facilities may complete an after action review process to help them develop an actionable after action report (AAR). The process includes a round-table discussion that includes leadership, department leads and critical staff who can identify and document lessons learned and necessary improvements in an official AAR. The AAR, at a minimum, should determine 1) what was supposed to happen; 2) what occurred; 3) what went well; 4) what the facility can do differently or improve upon; and 5) a plan with timelines for incorporating necessary improvement.” [IG, Tag #0039].

B. Actual (Real-Life) Events: The EP Rule states that if the facility experiences an actual natural or man-made emergency that requires activation of the emergency plan, the facility is exempt from engaging in a community-based or individual, facility-based full-scale exercise for 1 year following the onset of the actual event. The After-Action Report for the actual (real-life) event is also required.

C. AAR / IP Format: The EP Rule does not dictate a specific format. It states that the facility must analyze the facility’s response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the facility’s emergency plan.

After-Action / Improvement Plan Documentation A. For all facility-based drills and exercises (full scale, functional, tabletop, etc.): Document on sign-in sheets all attendees by name, title, department, and organization (especially important if external partners also participated). B. For community-based exercises sponsored by another entity, but in which your facility participates: Request a copy of the sign-in sheets from the sponsoring agency/organization and assemble in a folder with other exercise handouts/materials. C. For actual (real-life) events: Maintain a folder containing shift rosters, staff schedules and assignments, communications from your Emergency Manager and other authorities and community partners, situation status reports, and any other supporting materials used during the actual event. D. Assemble in a folder for access upon request by the licensing authority: All drill / exercise planning documents: For example, planning meeting agendas, meeting announcements, scenario descriptions, or other materials that document the drill / exercise or actual (real-life) event.

After Action Report – Improvement Plan Form (AAR / IP) Evaluation of Drill / Exercise or Actual (Real-Life) Event

Name of Organization/Facility:

Point of Contact & Title:

Drill / Exercise or Actual (real-life) Event Date(s): Duration: AAR / IP Meeting Date: Location:

1. Type of Drill / Exercise or Actual (real-life) event being evaluated (see REFERENCES for definitions): Check one box in each section below (a through c) to describe the drill / exercise or actual (real-life) event. a) Type of Event: b) Facility-Based or Community- c) Internal or External Event or ☐ Tabletop Exercise (TTX) Based: Scenario ☐ Workshop/ Discussion ☐ Facility-Based Drill / ☐ Internal Drill / Exercise ☐ Full Scale/Functional Exercise Scenario Exercise ☐ Community-Based Drill / ☐ External Drill / Exercise ☐ Actual (Real-Life) Event Exercise Scenario ☐ Actual (Real-Life) Event

2. Type of Hazard: Referencing your Hazard Vulnerability Assessment (HVA), identify the hazard(s) involved in the drill / exercise or actual (real-life) event.

3. Provide a brief description of the Drill / Exercise Scenario or Actual (real-life) Event. Use additional page(s) if needed.

Drill / Exercise or Actual (Real-Life) Event Objective(s) Describe the distinct objectives (outcomes that you wanted to achieve) for the drill / exercise or actual (real-life) event. The objectives should relate to a specific performance expectation described in your Emergency Operations Plan (EOP). • Objectives should be SMART: Simple, Measurable, Achievable, Relevant, and Time-bound. • Typically, 3 to 5 concisely stated objectives will adequately address a drill / exercise or actual (real-life) event. Increase or decrease the number to meet your needs). • Example: “Test evacuation policies and procedures for moving patients to an external site or an internal safe "shelter-in-place" location.”

OBJECTIVE 1: ______

Plan Reference(s): Identify the section(s) of your Emergency Operations Plan (EOP) which relate to this Objective.

Expected Performance: Describe (list) the specific performance expected to achieve/meet the objective (what was supposed to happen?).

Actual Performance Observed/Executed: Describe (list) the actual performance observed or executed (what actually occurred?).

Major Strengths: Describe (list) the performance strengths observed (what went well?) which contributed to achieving the objective. Strength 1: Strength 2: Strength 3: Areas for Improvement: Describe the observed performance problems or gaps, and the performance improvements necessary to address them; list each area of improvement separately (what can be done differently or improved upon?). Improvement Area 1: Improvement Area 2: Improvement Area 3:

Analysis: Provide an analysis of why the objective was not achieved (e.g., root cause analysis). OBJECTIVE 2: ______Plan Reference(s): Identify the section(s) of your Emergency Operations Plan (EOP) which relate to this Objective.

Expected Performance: Describe (list) the specific performance expected to achieve/meet the objective (what was supposed to happen?).

Actual Performance Observed/Executed: Describe (list) the actual performance observed or executed (what actually occurred?).

Major Strengths: Describe (list) the performance strengths observed (what went well?) which contributed to achieving the objective. Strength 1: Strength 2: Strength 3:

Areas for Improvement: Describe the observed performance problems or gaps, and the performance improvements necessary to address them; list each area of improvement separately (what can be done differently or improved upon?). Improvement Area 1: Improvement Area 2: Improvement Area 3:

Analysis: Provide an analysis of why the objective was not achieved (e.g., root cause analysis).

OBJECTIVE 3: ______

Plan Reference(s): Identify the section(s) of your Emergency Operations Plan (EOP) which relate to this Objective.

Expected Performance: Describe (list) the specific performance expected to achieve/meet the objective (what was supposed to happen?).

Actual Performance Observed/Executed: Describe (list) the actual performance observed or executed (what actually occurred?).

Major Strengths: Describe (list) the performance strengths observed (what went well?) which contributed to achieving the objective. Strength 1: Strength 2: Strength 3:

Analysis: Provide an analysis of why the objective was not achieved (e.g., root cause analysis).

OBJECTIVE 4: ______

Plan Reference(s): Identify the section(s) of your Emergency Operations Plan (EOP) which relate to this Objective.

Expected Performance: Describe (list) the specific performance expected to achieve/meet the objective (what was supposed to happen?).

Actual Performance Observed/Executed: Describe (list) the actual performance observed or executed (what actually occurred?).

Major Strengths: Describe (list) the performance strengths observed (what went well?) which contributed to achieving the objective. Strength 1: Strength 2: Strength 3:

Analysis: Provide an analysis of why the objective was not achieved (e.g., root cause analysis).

OBJECTIVE 5: ______

Plan Reference(s): Identify the section(s) of your Emergency Operations Plan (EOP) which relate to this Objective.

Expected Performance: Describe (list) the specific performance expected to achieve/meet the objective

(what was supposed to happen?).

Actual Performance Observed/Executed: Describe (list) the actual performance observed or executed (what actually occurred?).

Major Strengths: Describe (list) the performance strengths observed (what went well?) which contributed to achieving the objective. Strength 1: Strength 2: Strength 3:

Analysis: Provide an analysis of why the objective was not achieved (e.g., root cause analysis).

AAR / IP MEETING DOCUMENTATION ~~ Sign-in Sheet for Participating Staff and External Partners The below chart documents the attendance at the AAR / IP Meeting. Included are key leaders with the authority to approve and implement improvement plans. Attendees include organizational leaders; department heads; additional key staff; and external partners.

Name Title Organization Telephone & Email

Print additional sheets as needed.

After-Action Report (AAR) and Improvement Plan (IP)

DIRECTIONS: Use the below format to outline a specific improvement plan for each objective. From the previous Objective pages, list each objective number, the corresponding EOP plan reference(s), the areas for improvement, the person responsible for the improvement plan action, and the projected completion date. Expand to additional pages as needed.

AREAS FOR IMPROVEMENT RESPONSIBLE OBJECTI EOP PLAN PARTY VE (Include all items identified for IMPROVEMENT PLAN – ACTION Completi Reference each objective – see previous STEPS (name, position, on Date Number pages) title)

After-Action Report Primary Point of Contact:

Name (printed): Telephone: Email:

Title: Organization:

Signature: Date:

Checklist for After-Action / Improvement Plan Documentation  For all facility-based drills and exercises (full scale, functional, tabletop, etc.): Document on sign-in sheets all attendees by name, title, department, and organization (especially important if external partners also participated).

 For community-based exercises sponsored by another entity, but in which your facility participates: Request a copy of the sign-in sheets from the sponsoring agency/organization and assemble in a folder with other exercise handouts/materials.  For actual (real-life) events: Maintain a folder containing shift rosters, staff schedules and assignments, communications from your Emergency Manager and other authorities and community partners, situation status reports, and any other supporting materials used during the actual event.  Assemble in a folder for access upon request by the licensing authority: All drill / exercise planning documents: For example, planning meeting agendas, meeting announcements, scenario descriptions, or other materials that document the drill / exercise or actual (real-life) event. Links to Regulatory References and Guidance  CMS Emergency Preparedness Rule – webpage dedicated to the EP Rule, including FAQs and links to other regulatory and guidance tools.  CMS FAQ webpage: Note that there are six sets of FAQs (some with revised versions). FAQ Round 4 Definitions is specifically referenced in the CMS Surveyor Web-Based Training (see #D below).  CMS Interpretive Guidance for the EP Rule  CMS Emergency Preparedness Basic Surveyor Training Online Course: Released by CMS on September 1st (Administrative Memo 14-24-ALL), this web-based training is now available to providers. To access the training, go to the Surveyor Training Website and select “I AM A PROVIDER”, then “Course Catalog.” In the Search Courses field, type Emergency Preparedness Basic Surveyor Training, then click the Launch the Course button.

Appendix G: Additional Meetings Where Information was Gathered

Virtual Coalition Member Meetings Date

Collier Chapter May 20, 2020

Suncoast Chapter May 27,2020

Virtual Coalition Focus Groups Date

Long Term Care Facilities October 14, 2020

Hospitals October 16,2020

Government Agencies October 16, 2020