The Commonwealth of Massachusetts

Executive Office of Health and Human Services
Department of Public Health
Bureau of Health Care Safety and Quality
99 Chauncy Street, 2nd Floor, Boston, MA 02111
617-753-8000 

DEVAL L. PATRICK
GOVERNOR
TIMOTHY P. MURRAY
LIEUTENANT GOVERNOR
JUDYANN BIGBY, MD
SECRETARY
JOHN AUERBACH
COMMISSIONER	
Circular Letter:  DHCQ:  08-04-485

TO:         Long-Term Care Facilities
FROM:   Paul Dreyer, Bureau Director 
RE:	   LTCF Communications During an Emergency: Government Emergency Telecommunications
               Service Program Calling Cards, Health and Homeland Alert Network and Mutual Aid 
               Evacuation and Supply Plans.                                    
DATE:    April 4, 2008

Following the events of September 11, 2001 and Hurricane Katrina, it is evident that healthcare facilities need the tools to be better prepared to respond to disasters.  The purpose of this circular letter is to advise long-term care facilities that the Massachusetts Department of Public Health, in cooperation with MassAging, the Massachusetts Extended Care Federation and the Massachusetts Assisted Living Facilities Association, is addressing long-term care emergency preparedness and communications in the event of a disaster.  

MDPH can immediately address three initial elements of emergency preparedness of long-term care facilities:  the inclusion of LTCFs in the Government Emergency Technology Services (GETS) Program, addition of LTCFs to the Health and Homeland Alert Network (HHAN) and LTCF participation in the Health Care Mutual Aid Evacuation and Supply Plan.  

1.  	GETS Program 
	GETS provides healthcare facilities a high probability of completion for phone calls when normal calling methods via a landline phone are unsuccessful.  The federal government designed GETS for periods of severe network congestion or disruption.  Included with this circular letter is a GETS calling card to access priority service during this type of network congestion. MDPH obtained this card for your facility.  The card is activated and ready to use.  Its use, during an emergency, is free of charge.  MDPH does monitor usage on a monthly basis.  This simple calling card provides access phone numbers, a PIN number and concise dialing instructions. MDPH encourages LTCFs to place clearly marked GETS cards and accompanying informational packets at a main switchboard for use during an emergency.  Please see Attachment A for further information on the GETS Program.

2.	Health and Homeland Alert Network (HHAN) 
The HHAN project is intended to ensure that each community has rapid and timely access to emergent health information for health preparedness and response on a 24/7/365 basis.  The HHAN is a web-based messaging system that is used to transmit health alerts, advisories and updates over modes of communication selected by each user; for example, text messaging to a cellular device, voice activated messages via work and home landline and cellular and email notification.  MDPH groups users by specific topic area in order to target pertinent alerts to the appropriate audience.  Currently, the MDPH actively uses and conducts monthly proficiency drills with the hospital emergency preparedness HHAN group.  Our goal is to create a Long-Term Care group that MDPH would use in a similar manner. 

 	In order to create the LTCF HHAN group, MDPH must generate an email invitation to appropriate LTCF staff to join the HHAN.  Please email Dana Ohannessian, Office of the Assistant Secretary for Preparedness and Response (ASPR) Communications Coordinator, at dana.ohannessian@state.ma.us with the email addresses of all facility staff who should receive high-level health alerts.  You may provide as many contacts as you deem appropriate for your facility.  Once the HHAN generates the email invitation, staff can login to the system and set up their accounts as they wish for the various levels of alerts (see Attachment B).  The system will attempt to alert users by consecutive contact methods specified in the account.  

3.  	Evacuation and Supply Mutual Aid Planning

All licensed long-term care facilities in Massachusetts are required to have written emergency preparedness plans.  As stated in regulations at 105 CMR 150.015(E)(1):  “Every facility shall have a written plan and procedures to be followed in case of fire, or other emergency, developed with the assistance of local and state fire and safety experts, and posted at all nurses' and attendants' stations and in conspicuous locations throughout the facility.”   Such emergency preparedness plans should include a section on facility evacuation.

As part of the efforts of MDPH, Mass Aging, the Massachusetts Extended Care Federation and the Massachusetts Assisted Living Facilities Association to address long-term care and assisted living emergency preparedness and communications in the event of a disaster, an evacuation/mutual aid task force has been established.  This task force is working with a vendor that has expertise in healthcare facility evacuation procedures and planning to develop and coordinate the formation of regional facility evacuation mutual aid plans.  The Supply portion of the plan is designed to provide the resources to a long-term care facility to do everything possible to provide supplies and other resources (e.g., generators, AC Units) to prevent an evacuation.  During 2008, there will be a series of regional seminars regarding such planning that all licensed facilities will be invited to and are strongly encouraged to attend.  At the seminars, topics including the formation of regional inter-facility mutual aid memoranda of agreement and integration of communications and alerting systems such as the HHAN will be featured.

 Attachment A

Emergency Preparedness and the GETS Priority Landline Phone Access Program - FAQ
What is GETS? 
The Government Emergency Telecommunications Service (GETS) is an emergency phone service provided by the Office of the Manager, National Communications System (OMNCS) in the Department of Homeland Security. GETS supports federal, state, and local government, industry, and non-governmental organization (NGO) personnel in performing their National Security and Emergency Preparedness (NS/EP) missions. GETS provides emergency access and priority processing in the local and long distance segments of the landline phone system - the Public Switched Telephone Network (PSTN). It is intended to be used in an emergency or crisis when the probability of completing a call over normal or other alternate telecommunication means has significantly decreased.
How does GETS work? 

GETS is accessed through a universal access number 1-710-NCS-GETS 
(1-710-627-4387), using common telephone equipment such as a standard desk set, STU-III, facsimile, modem, or cordless phone. A prompt will direct the entry of your PIN and the telephone number. Once you have been authenticated as a valid user, your call is identified as an NS/EP calls and receives special treatment.

Why does my organization need GETS cards?
GETS cards are part of a redundant communications system in the event of an emergency or disaster. GETS is necessary because of the increasing reliance on telecommunications. This growth has been accompanied by an increased vulnerability to system failures. Although backup systems are in place, disruptions in service can still occur. Recent events have shown that natural disasters, power outages, fiber cable cuts, and software problems can cripple the telephone services of entire regions. Additionally, congestion in the public switched telephone network (PSTN) can prevent access to circuits. However, during times of emergency, crisis, or war, personnel with NS/EP missions need to know that their calls will go through. GETS addresses this need. Using enhancements based on existing commercial technology, GETS allows the NS/EP community to communicate over existing public switched telephone network with a high likelihood of call completion during the most severe conditions of high-traffic congestion and disruption. The result is a cost-effective, easy-to-use telephone service that is accessed through a simple dialing plan and Personal Identification Number (PIN) card verification methodology. It is maintained in a constant state of readiness and provides a cost-effective means to overcome network outages through such methods as enhanced routing and priority treatment. 
Does my organization qualify for GETS cards?
YES.  MDPH has obtained GETS cards for each Massachusetts LTCF. 
How much does a GETS card cost? 

There is no cost to obtain or use the MDPH cards in an emergency. 

How do I obtain additional GETS cards for my organization? Please contact Dana Ohannessian, dana.ohannessian@state.ma.us, should your organization need additional GETS cards. 

What about wireless/cellular phones and priority access?
Wireless Priority Service (WPS) is a White House-directed National Security/Emergency Preparedness (NS/EP) National Communications System (NCS) program for priority cellular network access. 
LTCFs are encouraged to register for wireless priority service.  As that service is tied to the cellular provider and user account, WPS must be obtained independently.  
Please visit http://wps.ncs.gov/ for more information regarding the Wireless Priority System or contact Dana Ohannessian, dana.ohannessian@state.ma.us, for more information about this program.  

Attachment B

Screen shot that demonstrates how a user would set up alerting preferences in their HHAN account for the various levels of alerts (minor to extreme).