Faculty & Clinical Affairs

Alan P. Marco, M.D., M.M.M., Associate Dean
Albert F. Painter Jr., Psy.D., Assistant Dean

Wright State University Boonshoft School of Medicine
Sponsored Graduate Medical Education Programs
Resident Manual

Item 508
Disaster Policy

Adopted: July 2008

Purpose
This Disaster Planning Policy and Procedure is intended to protect the well being, safety, and educational experiences of the residents/fellows, hereby referred to as trainees, enrolled in Wright State University Graduate Medical Education (GME) training programs.

It provides guidelines for communication with trainees and program leadership to assist in reconstituting or restructuring the trainee's educational experiences as quickly as possible after the disaster, or determining need for transfer or closure in the event of being unable to reconstitute normal program activity.

It provides general information and procedures to support Wright State University GME training programs and trainees in the event of a disaster or interruption in their educational experience.

Definitions
A disaster is defined herein as an event or set of events causing significant alteration to the trainees' experience of a Wright State University GME training program.

This policy and procedure document acknowledges that there are multiple types of disaster including but not limited to acute disaster with little or no warning (e.g. tornado, bombing), and the insidious disruption or disaster (e.g. pandemic event). This policy and procedure will address disaster and disruption in the broadest terms.

Scope
This policy applies to all GME training programs sponsored by Wright State University Boonshoft School of Medicine.

 

POLICY

Following declaration of a disaster by the ACGME, the Designated Institution Official (DIO), Graduate Medical Education Committee (GMEC), hospital leadership, and other sponsoring institution leadership will strive to restructure or reconstitute the educational experience as quickly as possible following the disaster. The overall objective is the continuity of training.

In order to maximize the likelihood that trainees will be able to complete program requirements within the standard time required for certification in that specialty, steps will be taken to transfer the affected trainees to other local sites, if necessary. If leadership determines that the sponsoring institution can no longer provide adequate educational experience for its trainees, the sponsoring institution will, to the best of its ability, arrange for temporary transfer of trainees to programs at other sponsoring institutions until such time as the sponsoring institution is able to resume providing the educational experience. Preference will be given to the closest geographic location with the most appropriate training required for trainees.

The Program Director will give the trainees, who temporarily transfer to other programs as a result of a disaster, an estimated time that relocation to another program will be necessary. Should that initial time need to be extended, the Program Director will notify the trainees by written or electronic means identifying the estimated time of the extension.

If the disaster prevents the sponsoring institution from re-establishing an adequate educational experience within a reasonable amount of time following the disaster, then permanent transfers will be arranged.

The Wright State University DIO will be the primary institutional contact with the ACGME, program specific RRC's, and the Institutional Review Committee Executive Director regarding disaster plan implementation and needs within the sponsoring institution.

 

PRE-DISASTER ORGANIZATION

Communications
Communication between the DIO, the GME Office, the program directors, and the trainees is critical in the event of a disaster to assess the impact of that disaster on education and the health and well-being of the trainees.

The DIO will identify an institutional designee to act in the DIO's absence or in case the DIO is incapacitated. If neither the DIO nor the designee is available, the Executive Associate Dean of the SOM will appoint an interim DIO.

The GME office will routinely maintain updated contact information to include home phone numbers, cell phone numbers, pager numbers, and WSU email addresses for its program directors. The program directors will gather and maintain current contact information to include the home phone numbers, cell phone numbers, pager numbers, and email addresses for trainees and faculty. GME Administration will maintain an email list-serve and list of phone and pager numbers for core residency Program Directors, program coordinators, and key faculty (associate program directors) which will be transferred to a memory stick and kept in a separate geographic location.

Data and Document Recovery
Trainee's demographic documentation is stored in Residency Management Suite (RMS) by New Innovations, which is a web-based relational database management system. Data and documents stored in RMS are stored on two IIS servers and two SQL servers at each data center in separate cities. Data from each server is copied to the other server every hour. The servers also have full backups run every night and the backups are located on a backup sub-system own and operated by another company.

Programs are responsible for establishing procedures to protect the academic and personnel files of all trainees from loss or destruction by disaster. This should include at least a plan for storage of data in a separate geographic location away from the sponsoring institution.

A disaster recovery plan which includes management and maintenance of information systems will be critical to maintaining a business continuity plan for GME. Protection of data is paramount to maintaining operations. Therefore, the GME Office, affiliated hospitals, and programs should employ a data protection system that includes electronic capture and storage of all data. Previous data that is still being maintained and stored, whether paper or microfilm, will be protected in an off-site and climate controlled space in order to maintain access to this information after a disaster.

Finance
During and/or immediately following a disaster, Wright State University and the employing institutions will make every effort to ensure that the trainees continue to receive their salary and fringe benefits during any disaster event recovery period, and/or accumulate salary and benefits until such time as utility restoration allows for fund transfer.

Longer term funding will be determined on the basis of the expected operations of the teaching sites, Centers for Medicare and Medicaid Services (CMS) and governmental regulations, and the damage to the infrastructure of the finance and hospital operations.

Legal and Medical-Legal Aspects of Disaster Response Activity
Trainees serving under the direction of their program in disaster response efforts will be covered by their employing institution's liability insurance company. Trainees who act as emergency responders under an executive order issued by the governor of Ohio are immune from damages for their good faith acts/omissions in rendering emergency care, advice or assistance under emergency plans.

 

PROCEDURE

1. Disaster Response: 0-72 hours after occurrence

Designated Institutional Official (DIO)
The DIO is the primary institutional contact with the ACGME, RRCs, and Institutional Review Committee (IRD) Executive Director regarding disaster plan implementation and needs within the sponsoring institution. The DIO is responsible for maintaining communications between the various Program Directors, the hospital Directors of Medical Education, and the Office of Graduate Medical Education to assess the impact of a disaster on any and all areas of GME and maintaining business and educational continuity. The DIO consults with hospital leadership as needed and may decide to convene a planning meeting to work through important details in managing the situation. The DIO assessment will include the following:

  • Immediate contact and discussion with program directors to determine the availability of trainees and faculty to aid in disaster response.
  • The feasibility of continuing on-site training within the training site(s).

The immediate email communication to all parties will go out through Graduate Medical Education Administration, hereby referred to as GME Administration.

If email communication is not possible, then GME Administration will contact the core residency Program Directors by phone or pager. Fellowship Directors should contact the Program Directors of their core residency program with fellowships to determine next steps.

The DIO will notify the ACGME Executive Director of the disaster and, if appropriate, request a declaration of disaster. The ACGME will post a notice on its website, www.acgme.org.

Program Director
First point of contact. The Program Directors will immediately assess the impact of a disaster on their own programs and on the health and well-being of the trainees within that program. This will be done by the following:

  • Contacting trainees in the program to gather information
  • Referring affected trainees to available resources for care
  • Assessing the functionality of the facilities and operations in the institution that supports that particular educational program
  • Identifying and arranging for alternative clinical/training sites for residents as may be needed

If necessary, the Program Directors will develop a recovery strategy and timetable and a written plan to address response, recovery, and resumption of education and services. They are responsible for getting communications out to their trainees and if necessary to their fellowship directors.

Residents/Fellows (Trainees)
Initially they are expected to report to their originally assigned hospital/clinic location. In the event the hospital/clinic is affected by the disaster and unable to operate in the usual fashion or if the patient load is skewed by the disaster, some or all of the trainees may need to be reassigned by the DIO after discussion with the Program Director and approval of the DIO with the hospital officials.

2. Disaster Response: 3-30 days after occurrence
Institutional Assessment and Decision-making on Program and Institution Status
Resident Transfer

DIO (GME Administration)
The DIO will communicate in writing a formal initial report with the ACGME regarding the nature, extent, and impact of the disaster.

Within ten days after the declaration of a disaster by the ACGME, the DIO will contact the ACGME to discuss the timeframe and dates pertinent to maintaining the education of the trainees within affected programs, including

  • To submit program reconfigurations to the ACGME, and
  • To inform trainees of any transfer decisions. The due dates for submission shall be no later than 30 days after the disaster unless other due dates are approved by the ACGME.

The DIO will monitor progress of both healthcare delivery and functional status of GME training programs for their educational mission during and following a disaster. They (or their designees) will work with the ACGME to determine the appropriate timing and action of the options for disaster impacted institution and/or programs:

  1. Maintain function and integrity of program(s),
  2. Transfer trainees temporarily until program(s) reinstated, or
  3. Transfer trainees permanently, as necessitated by program or institution closure.

Information and decision communications will be maintained with Program Directors and trainees, as appropriate to circumstances of the individual disaster event.

Program Director
The Program Director(s) will communicate with their appropriate Review Committee(s) (RRC) regarding the impact of the disaster and, if necessary, with the specialty board(s) regarding any break in resident training and ensuring compliance as directed by the board. The ACGME website provides instructions for changing trainee email information in the ACGME Web Accreditation Data System.

The Program Director is responsible for:

  • Providing direction and working with others as appropriate to locate and arrange for office space for residency faculty and staff, supplies and equipment, etc. as may be needed.
  • Informing hospital affiliates, volunteer faculty and others associated with the program in a timely manner.
  • Providing oversight, direction and assistance to residents to ensure a quality educational experience throughout the duration.
  • Informing and providing updates as appropriate for the Department Chair about the alternative arrangements, quality of training experiences, issues, progress, etc.

Trainees
The trainees should call or email the appropriate Review Committee Executive Director with information and/or requests for information. On its website, the ACGME will provide instructions for changing trainee email information on the ACGME Web Accreditation Data System.

ACGME (from ACGME Policies and Procedures)
When warranted, the ACGME Chief Executive Officer, with consultation of the ACGME Executive Committee and the Chair of the Institutional Review Committee, will make a declaration of a disaster. A notice of such will be posted on the ACGME website with information relating to ACGME response to the disaster.

If within the ten days the ACGME has not received communication from the DIO or designee, the ACGME will attempt to establish contact with the DIO(s) to determine the severity of the disaster, its impact on training, and next steps.

The ACGME will assist with communications during any declared disaster. The ACGME will maintain phone numbers and email addresses for emergency communications with disaster-affected institutions.

  • The DIO will call or email the IRC Executive Director with information or requests for information.
  • The program directors will call or email the appropriate RRC Executive Director with information and requests for information.
  • Trainees will call or email the appropriate RRC Executive Director with information and requests for information.

The ACGME will provide and periodically update its website with information relating to the disaster. The ACGME will provide instructions on its website so that a trainee can change his/her information on the Web Accreditation Data System. In the event of a disaster, the Graduate Medical Education Office will communicate directly with program directors and trainees via all available communication techniques to provide guidance for the affected trainees. These communications will include the Graduate Medical Education Office website, the DAGMEC website, and the ACGME website.

The ACGME will establish a fast track process for reviewing (and approving or not approving) submissions by programs relating to program changes to address disaster effects, including, without limitation, (a) the addition or deletion of a participating institution, (b) change in the format of the educational program, and (c) change in the approved trainee complement.

Once information concerning a disaster-affected program's condition is received, the ACGME may determine that one or more site visits is required. Prior to the visits, the DIO will receive notification of the information that will be required. This information, as well as information received by the ACGME during these site visits, may be used for accreditation purposes. Site visits that were scheduled prior to a disaster may be postponed.

New ACGME policy will supersede these current policies as they become enacted.

Resident/Fellow (Trainee) Transfer
As soon as feasible and to the extent that it is possible, the DIO, the GME Office, and the program directors will determine whether the disruption of each program's ability to maintain the educational experience is temporary or permanent.

At the outset of a temporary transfer, a program must inform each transferred trainee of the minimum duration and the estimated actual duration of the temporary transfer and continue to keep each trainee informed of such durations. In the event that the transfer will continue, the program must inform the trainee who has transferred.

In the event that the DIO in conjunction with the program directors determines that a program can no longer provide an adequate educational experience for the trainees, the program directors and the DIO will do the following:

  • Arrange for temporary transfers to available programs to complete the educational experience on an interim basis, or
  • Assist the trainees to achieve permanent transfers to other programs or institutions, if necessary

If more than one program/institution is available for temporary or permanent transfer of a particular trainee, the preferences of each trainee must be considered by WSU. Programs must make the keep/transfer decision expeditiously so as to maximize the likelihood that each trainee will complete training in a timely fashion.

Offering to Accept Transfers
If offering to accept temporary or permanent transfers from programs affected by a disaster, the DIO will complete the form found on the ACGME website. Upon request, the ACGME will give information from the form to affected programs and trainees, and post the information on its website, upon authorization.

The ACGME will expedite the processing of requests for increases in trainee complement from non-disaster affected programs to accommodate trainee transfers from disaster affected programs. The RRC will expeditiously review applications and make and communicate decisions.

3. Post-Disaster

Plans will be made with the participating institutions to which trainees have been transferred for trainees to resume training at Wright State University.

Appropriate credit for training will be coordinated with the ACGME and the applicable Residency Review Committees and

Decisions as to other matters related to the impact of the disaster on training will be made.

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