Hello, my name is Alice Bonner and I'm adjunct faculty at the Johns Hopkins University, School of Nursing, and director of strategic partnerships for the capable program. I also work at the Institute for Healthcare Improvement or IHI. I'm delighted to be here today to speak with all of you who've joined this course to learn about, specifically today, emergency preparedness and disaster planning, and some of the related topics that come up as people who are working in Assisted Living Residences around the country. Many of you who have decided to take this class, are in that role, and so we've prepared an interview today and we're glad to talk about some of these related topics and then you may have some follow-up questions as well. With that, I'd like to introduce our guest for today, Mr. Ali Shah, who is with us from Texas. I'm up here in Massachusetts today, so we have some geographic diversity. Ali is going to tell you a little bit about himself and about his role, and the different perspectives he brings to this work, but he and I met on a national panel and we shared a lot of really great stories from the field, so I know he has a lot to contribute that will be helpful today. Ali, I'll just turn it over to you and say, maybe you could talk a little bit about some of your experiences and some of the thoughts that you have in working with Assisted Living Residences, and the teams of experts in those settings. Just tell us a little bit about yourself to start. It's a pleasure being here, Dr. Bonner. My name is Ali Shah. I currently serve as the Emergency Manager for San Jacinto College. It's a small community college in Texas. My experiences in public safety, I've been a firefighter paramedic for a little over 20 years now, and within that time, I've responded to multiple large-scale incidents, some of which you may remember from recent memory like Hurricane Harvey or the current COVID-19 pandemic. To bring things into perspective, the incident response on a national scale, is driven by the federal government through specific guidance called the National Response Framework. That document guides how, not only the federal government, but also lower levels of government, all the way down to individual municipalities or political jurisdictions, manage incidents, how they communicate, how they interact with each other. Within this document is a specific section and specific emphasis on Public Private Partnership. That's where the interaction between agencies at the federal level like health and human services, and within them, the assistant secretary for preparedness and response, ASPR office, the public health emergencies office, can interact with public or private Assisted Care Living Facilities, in addition to the ongoing communication pathways that are created between the local jurisdiction that a facility may reside in, so the city, county, or even at the state level. That's how that response framework is created, crafted. Everyone aspires to speak the same language, aspires to follow the same standard, so as an incident grows, maybe from a local level to a state or even a federal level, everyone is still following the same playbook, everyone still has access to the same resources and the same personnel. Great information. Thank you. I think you made a terrific point about the importance of both the local, municipal, and then state and then federal authorities. Because really it's important to know about all of those different, either regulations or standards for responding in an emergency when time is of the essence and people really need to be able to communicate with one another through that public-private partnership which you described. Is there anything else you would want to add about the incident command structure? You mentioned about the document, and I'll just mention for our listeners here that at the end of this presentation, we do have a slide that has that information that you've shared with us and they might want to check some of these documents, but anything else about incident command structure that you would also add? Absolutely. Excellent question. One of the primary drivers for when we find ourselves in a large-scale incident or even a small-scale incident that may be large for us internally, is who's in charge. The response framework through the National Incident Management System has a standardized process for how authority is delegated throughout an incident. We call that the incident command structure. That can be utilized at a very low level, maybe internal disasters, but it's the same process that's utilized all the way up to large national level incidence. Within that framework, there is a command structure. You may have an incident commander or unified command that's multiple people with specific area expertise that oversee the entire incident itself. Then you have several specialty areas that take care of different areas within that incident response. Where that public-private partnership comes in, it's something we call liaison officer. Say for example, there's a large-scale incident, you have your state which is running the incident for that state. They usually do that through something called the state operations center. Within that operations center, you have liaisons from different agencies that are present. It's important to know that the decision-making is happening at the command level, but your voice is not unheard. Your voice is heard through the liaison officer process. That liaison officer, that liaison between the agency and the operations center can be done pre-plan that happened before the incident. You make those connections here, you find out who that is, so during times of incident, you know exactly who to call, to forward your request to the right person. Right. That's great. That's so important because as we said earlier, time is often of the essence, and having all of this planned out ahead of time and knowing who the incident commander and other liaison officers are is critical. One of the other areas that comes up with assisted living residents' colleagues is individuals living there who may have some cognitive impairment or challenges. Some of these individuals are living with Alzheimer's disease or different types of dementia and other conditions. So could you just talk a little bit about training for EMS, firefighters, police around older people who may need some special assistance related to their thinking and processing. Absolutely. Training for public safety professionals is really varied depending on what they're there to do. Police officers have very limited training, but they do have at least some first aid or first response level training where they can handle some very gross emergencies, but not something that deals with cognitive disabilities other than the fact that they may be able to recognize it. But when you start getting into your EMS folks, your EMP is your paramedics, they spend significant amount of time studying about special needs population that maybe pediatrics, geriatrics, old people with cognitive disabilities. So they do spend a fair amount of time studying that there are even some continuing medical education requirements so they have to keep up with that study and keep up with evidence-based interventions that are current for managing patients with those kinds of difficulties. What's important to remember is that you may not know what level a responder you get, so it's important to understand what each level can do. An EMT may be able to do certain things where a paramedic may not. When you're requesting for assistance, you have to be specific in what the needs are. When the resources are sent to you, the properly trained personnel are sent to you. For example, if you just ask for an escort from facility A to facility B, in a large-scale incident, you may get a police officer who's just there to shuttle the patient from one facility to another. If that patient has or their resident has specific cognitive disabilities that require specialty care. That officer may not be able to provide that level of care. You need to be specific in your request and be specific in what your needs are so that maybe a paramedic can be sent out, who can manage that at a much better level, with better background education than a police officer would be able to. Yeah, that's great, and I think that that idea of requesting the person who's got the right skills and training to interact with an older adult makes a lot of sense to interact with anybody. Just one other point before we close, could you talk a little bit about care transitions? Again, people going from one place to another. You really just addressed it largely in your comments just now. But anything else that comes to mind in terms of the types of folks who might be able to respond or advice you have for our listeners about making a request that's specific enough, that they're going to get somebody who can best meet the needs of all of the people who are having to move sometimes at the same time. Absolutely. This is an issue that we deal with on a routine basis, not just with folks who are outside of this incident response framework. We deal with this issue even internally, where requests aren't specific enough. When you are requesting, you have to understand that under normal operations, you may be communicating from your facility to the receiving facility directly, and you're giving them a whole lot of information that they're going to use to manage this resident or patient when they get to that facility. You need to be able to be that specific when you request as well. In a large-scale incident, there's a lot of resources that are made available, but they have to be used as they're needed. If your request isn't specific enough, if you're not asking specifically for an ambulance that has cardiac monitoring capabilities, that has the expertise to manage a cognitively impaired person or mobility impaired person, if you're looking at a bariatric patient or a geriatric patient, you have to be very specific in your request. You have to give all those details within your request so that the right people and the right resources are re-directed to you. It's essential when you're making that request to be able to include that information, and there's no amount of information that's too much, be sure to include as much as you can so that information can be handled and re-direct the resources to the appropriate thing. Yeah, that's great. I wanted to say thank you so much for joining us today and bringing your tremendous expertise, all those years in emergency services and firefighting, and so forth. We thank you for your service, first of all, and thanks for the nice emphasis on the partnership, and I think that a key takeaway here for our listeners is, when there's an emergency, it's all hands on deck, and everybody's go to chip in and work together very collaboratively. It's one team, it's not the emergency services team and the [inaudible] team. It's one team, everybody out for the same thing, which is helping all of the staff, all of the residences, all of the visitors, the residents, to be able to be as safe as possible, and to ensure that the process is as smooth as it can be. Again, I want to thank Ali Shah, who joined us today from Texas, and on our last slide that we have here at the end of the presentation, there are some resources for you that have a little description of what's in each one, and then you can put these links in and click on them and look up the resources that are most useful for you in your state, in your county, and you're assisted living residents. Thanks to everyone who called in today. Thanks for all the work that you all do every day, at the point of care, we are truly grateful, and we wish you well, and we hope you'll join us for another one of these sessions in the course. Thank you very much.
