May 28 – June 3, 2018

Click the read more button to find out this week’s information from Centers for Disease Control and Prevention (CDC), Centers for Medicare and Medicaid Services (CMS), Homeland Security, Federal Emergency Management Agency (FEMA), Assistant Secretary for Preparedness and Response (ASPR), Hospital Preparedness Program (HPP), Assistant Secretary for Preparedness and Response Technical Resources, Assistance Center, and Information Exchange (ASPR TRACIE),  Virginia Hospital and Healthcare Association (VHHA), Virginia Department of Health (VDH), Virginia Department of Emergency Management (VDEM), and other miscellaneous sources.




Recovery Workshop – May 31st

The Northwest Region Healthcare Coalition (NWRHCC) is hosting a FREE Recovery Workshop May 31 at the Rockingham County Office Building. Lunch will be provided.

Registration can be found on the Event calendar on our website.

To access our website click here. Don’t forget to visit the Events calendar. There you will find training and education opportunities listed on it. 

Credit: Centers for Disease Control and Prevention

CDC: Outbreak Associated with Synthetic Cannabinoids Spreads to 9 States

More than 200 people in nine states have reported bleeding or other symptoms associated with exposure to synthetic cannabinoid products containing an anticoagulant agent, including five who died, the Centers for Disease Control and Prevention reported Friday in an update on an outbreak that began in March. Most of the cases were in Illinois, and the rest in Maryland, Florida, Indiana, Kentucky, Missouri, Pennsylvania, Virginia and Wisconsin. Nearly all of the patients have tested positive for brodifacoum, a vitamin K antagonist anticoagulant, which public health officials believe may have been mixed with synthetic cannabinoid products, commonly referred to as synthetic marijuana, K2 or Spice. CDC said health care providers should screen patients presenting with unexplained bleeding and a possible history of synthetic cannabinoid for vitamin K-dependent antagonist coagulopathy, and report possible cases to their local health department, among other recommendations.

Credit: Centers for Medicare and Medicaid Services

CMS Emergency Preparedness Rule Frequently Asked Questions

The Center for Medicare Services (CMS) has posted five rounds of Frequently Asked Questions pertaining to the Final Rule on Emergency Preparedness. Two previously posted rounds (two and three) were revised June 1, 2017.

CMS Emergency Preparedness Rule Update for Health Systems

CMS Emergency Preparedness Rule Round 1 (October 28, 2016) Frequently Asked Questions

CMS Emergency Preparedness Rule Round 2 (November 2016 – Revised June 1, 2017) Frequently Asked Questions

CMS Emergency Preparedness Rule Round 3 (December 2016 – Revised June 1, 2017) Frequently Asked Questions

CMS Emergency Preparedness Rule Round 4 (January 2017) Frequently Asked Questions

CMS Emergency Preparedness Rule Round 5 (September 2017) Frequently Asked Questions

       U.S. Department of Homeland Security 

Federal Emergency Management Agency


 Assistant Secretary for Preparedness and Response


Assistant Secretary for Preparedness and Response Technical Resource,                                                                                                                             Assistance Center, and Information Exchange

Hospital Preparedness Program

1. CDC Provides Update on 2018 Ebola Virus Disease Outbreak in Democratic Republic of Congo

On May 8, the Ministry of Public Health (MoHP) of Democratic Republic of the Congo (DRC) declared an outbreak of Ebola virus disease (EVD) in Bikoro Health Zone, Equateur Province, in Northwest DRC. The declaration was made after lab confirmation of two cases by Institut National de Recherche Biomedicale in Kinshasa, DRC. This is the ninth outbreak of EVD DRC since 1976, when the virus was discovered. The current outbreak is in a remote, forested area of DRC, which makes it difficult to access the region. On May 18, the World Health Organization (WHO) convened an Emergency Committee meeting under the authority of the International Health Regulations to assess the EVD outbreak in DRC and determine if conditions warrant declaring a Public Health Emergency of International Concern (PHEIC).

As of 21 May 2018, a cumulative total of 58 Ebola virus disease (EVD) cases, including 27 deaths (case fatality rate = 47%), have been reported from three health zones in Equateur Province. The total includes 28 confirmed, 21 probable and 9 suspected cases from the three health zones: Bikoro (n=29; ten confirmed and 19 probable), Iboko (n=22; fourteen confirmed, two probable and six suspected cases) and Wangata (n=7; four confirmed and three suspected case). Of the four confirmed cases in Wangata, two have an epidemiological link with a probable case in Bikoro from April 2018. As of 21 May, over 600 contacts have been identified and are being followed-up and monitored field investigations are ongoing to determine the index case. Three health care workers were among the 58 cases reported.

More information can be found here.

2. The U.S. Needs a Disaster Health Response System to Save Lives After an Emergency

Bombings, multi-country cyberattacks, severe natural disasters and deliberate chemical attacks reflect the real and complicated threats our nation faces in the 21st century. To save lives, the nation’s health care systems must be ready. Combating modern threats requires innovative solutions to train, equip, and organize our health care systems in ways that make our local communities more resilient.

The U.S. Department of Health and Human Services’ Assistant Secretary for Preparedness and Response – ASPR – advocates for using established investments in health care preparedness and trauma systems to serve as the foundation of a new, “regional disaster health response system.”

This approach builds on existing health care coalitions – more than 28,000 health care businesses, emergency medical services, state public health agencies and local health departments across the country that work together with funding and guidance from ASPR’s Hospital Preparedness Program. The regional disaster health response system will expand this public-private partnership, adding trauma centers, burn centers, pediatric hospitals, public health labs, outpatient services, and federal facilities like Veterans Affairs clinics to better meet the health care needs of the public in a disaster.

More information can be found here.

3. ASPR TRACIE Technical Assistance Spotlights: Primary Care Clinic Resources

ASPR TRACIE receives, on average, over 100 requests for technical assistance (TA) per month. Their redacted responses are summarized here and can be found in the Information Exchange to benefit other stakeholders. In these weekly reports, ASPR TRACIE will periodically highlight TAs that may be of particular interest to several stakeholders.

This Primary Care Clinic Resources TA response includes links to information on recommended supplies and equipment needed by primary care clinics during emergencies, both for staff (e.g., food, and water), and patients (e.g., equipment and clinical supplies).

 Virginia Hospital & Healthcare Association

Virginia Department of Health

Virginia Department of Health Announces Expanded Collaboration with Walgreens

For more than three years, the Virginia Department of Health (VDH) has collaborated with Walgreens to provide no-cost, rapid HIV testing at 30 of the company’s stores across Virginia. Today, this collaboration is expanding to provide no-cost, rapid Hepatitis C Virus (HCV) testing by Walgreens pharmacists in 10 of those locations. Appointments are not necessary and all testing will be done in private consultation rooms near the pharmacy.  Test results can be provided while you wait.1

“VDH is committed to chronic disease prevention, and this collaboration with Walgreens will allow us to do just that,” said Acting State Health Commissioner M. Norman Oliver, MD, MA. “First and foremost the Hepatitis C virus infection is completely preventable. If a patient tests negative, they can receive the information they need to make informed decisions so they remain healthy.  If a patient tests positive, we can link them to the treatment they need.”

Walgreens pharmacists are specially trained to provide counseling and support services to those who need assistance, and will help connect patients to local resources to confirm results and provide subsequent care.

Click here to learn more from the Virginia Department of Health.

Virginia Department of Emergency Management


1. OSHA Cites Another Healthcare Facility for not Protecting Staff From Workplace Violence

Be aware that OSHA is continuing to cite healthcare organizations for not protecting their staff from workplace violence.

In the latest announced penalty, an acute care inpatient behavioral health facility in Bradenton, Florida is facing more than $71,000 in fines for “failing to institute controls to prevent patients from verbal and physical threats of assault, including punches, kicks, and bites; and from using objects as weapons,” according to information released by the U.S. Department of Labor.

OSHA cited Premier Behavioral Health Solutions of Florida Inc. and UHS of Delaware Inc., which operates Suncoast Behavioral Health Center in Bradenton, after investigating a complaint that employees were “not adequately protected from violent mental health patients.” The citation, announced May 2, follows the OSHA citation of another UHS subsidiary in 2016 “for a deficient workplace violence program.”

“This citation reflects a failure to effectively address numerous incidents over the past two years resulting in serious injuries to employees of the facility,” said Les Grove, OSHA Tampa Area Office Director, in a published news release.

OSHA, CMS, The Joint Commission (TJC), and other regulators are cracking down on failures to protect workers from violence. TJC issued a Sentinel Event Alert in April and OSHA is considering proposing a new standard to deal just with workplace violence, which currently is cited under the General Duty clause requiring employers to protect workers from hazards “that are causing or are likely to cause death or serious harm.”

The OSHA citation report offered up a list of problems and potential solutions for Premier Behavioral Health Solutions and UHS to consider. Those solutions included:

  • evaluating the configuration of the nurses’ workstations to keep patients from jumping over desks or otherwise gaining access to personnel as well as weapons such as staplers, phones, cords, pens, and computers
  • develop a “disruptive behavior response team” and provide that team with “clear written procedures for how employees should respond to clients making threats, showing aggression, and assaults
  • evaluate intake procedures to better identify incoming patients with potential for violence
  • ensure security cameras are continuously monitored
  • provide panic alarms
  • discourage employees from wearing necklaces or lanyards that can be used for strangulation, and encourage staffers to secure “loose hair so that it is not accessible to patients, to minimize the risk of neck strains and hair pull injuries”
  • to regularly train staff in methods to protect themselves when patients become violent
  • conduct effective investigations and root cause analyses into violent events\
  • establish a comprehensive medical and psychological counseling and debriefing for employees experiencing or witnessing violent assaults or incidents

Premier Behavioral and UHS have 15 business days from when they were notified of the citations and penalties to pay the fines, request an informal conference with OSHA’s area director, or contest the findings before the independent Occupational Safety and Health Review Commission.

This OSHA citation follows a similar case last year in which a psychiatric treatment center in Massachusetts faced more than $207,000 in proposed penalties after OSHA accused the facility of failing to adequately protect employees from workplace violence, despite having promised specifically to do so. That center said it was contesting OSHA’s allegations.

In another case, a hospital in New Jersey was able to successfully defend itself against allegations that it had failed to protect workers from workplace violence.

2. EMTALA and Disasters

During recent meetings, questions regarding EMTALA during disasters has been discussed and questioned. Below is a document from the U.S. Department of Health and Human Services and Centers for Medicare and Medicaid Services providing frequently asked questions (FAQs) regarding EMTALA during a declared public health emergency. The FAQs have lots of great information including the 1135 waiver. The document provides information for all healthcare providers and some specific healthcare provider answers too. 

Click here to download the document.

3. New NFPA Standard Focuses on Responding to Active-Shooter Incidents (from Patient Safety & Quality Healthcare – PSQH)

Early this year, the NFPA promised to fast-track a new standard to help first responders, healthcare providers, facility managers, and others prepare for an active-shooter incident, and they have delivered, complete with its own acronym.

Designed as a roadmap for the multidisciplinary response needed in the aftermath of an active-shooter incident, there is a separate chapter for “Hospital Preparedness and Response for Out-of-Hospital ASHER Incidents.”

The chapter outlines minimum expectations for hospitals in preparing for, reacting to, and receiving patients from an active-shooter event in the area. Among other things, it says hospitals should:
• plan and drill regularly with other local authorities having jurisdiction (AHJ)
• have at least two ways to communicate with public safety officials about how patients are being distributed to health care sites, and to test communications at least once a month
• expect spontaneous arrivals of injured patients and those looking for them
• have a way to identify victims and reunite children with their families
• and have a security plan to restrict access as needed, and to search the facility for devices and weapons if that becomes a concern

Other chapters detail expectations for the variety of first responders, government agencies, and other organizations who might be involved in an ASHER response to prepare, plan, and recover from an incident.

NFPA 3000 can be purchased from the National Fire Protection Association’s website.