PREPARING THE HEALTHCARE FACILITY: COMMUNITY ISSUES

Internal preparedness must be accomplished while strengthening community and external ties. The adage that “all disasters are local” is true in every case, as the initial response will be performed at the local level.

The GAO identified the following nine critical entities required for planning to ensure a coordinated response:

1. Emergency medical services

2. Fire services

3. Hazardous materials teams

4. Law enforcement

5. Hospitals

6. Laboratories

7. State and local government agencies

8. Public and private utilities

9. Public health

However, as of summer 2003, only 40 percent of hospitals reported contacting all nine entity types in developing their plans (U.S. GAO 2003a).

Despite this alarming statistic, the U.S. emergency management systems are becoming recognized as among the best in the world. Some efforts that facilitated this trend are the following:

• Emphasis on building partnerships among disciplines and across sectors, including the private sector and media

• Development and application of new technologies to provide the tools needed to be successful

• Emphasis on communication to partners, the public, and the media

• Focus on prevention as the cornerstone of emergency management

These same approaches are the cornerstone of excellence in healthcare facility preparedness and community interoperability.

Building Critical Partnerships

Healthcare facilities have only recently concerned themselves with building partnerships among disciplines, across sectors, or with the private sector and media in relation to disaster preparedness. Nor have they often addressed the barriers to communication with partners, the public, or the media in disasters. This changed dramatically following the events of 9/11, which ushered in strong programs at the federal and state level to address preparedness.

One of the most important changes proposed to the nation’s healthcare system, and one that is long overdue, is the critical benchmarking established in the Centers for Disease Control and Prevention (CDC 2003) grant process. This mandates development of regional plans for responding to bioterrorism, other infectious diseases, and other public health threats and emergencies.

Hospitals and other healthcare facilities have long formed mutual-aid agreements (although most are informal “handshake” agreements) with surrounding facilities and services to cover potential disasters. However, the sharing of knowledge, agreements to mutually plan, and agreements to share resources in case of disaster were rarely practiced prior to 2002.

State emergency management agencies encourage the development of mutual-aid agreements to enhance overall emergency preparedness, response, and recovery capabilities. The key to regional planning and mutual-aid agreements is centralizing specialized assets, equipment, and overall response capabilities to provide maximum accessibility to all local government within the region at the time they are needed. Regional planning also includes outreach to bordering states that may share similar threats (NEMA 2002).

Having formal mutual-aid agreements in place prior to a disaster ensures a quicker and more efficient response (NEMA 2002). Verbal agreements of the past may work for small businesses where resources are not critical nor delivery imperative. However, for large vendors with many clients, the informal agreement may actually harm the healthcare facility.

State preparedness surveys have revealed that many healthcare facilities—in some cases, entire regions—are depending on support from a single vendor for a critical item. In one case, the primary vendor for the area was found to be the sole provider for certain services or materials to more than 40 facilities (Missouri Hospital Association 2002). In a disaster, the loyalty and service delivery will go first to clients with whom the vendor holds formal agreements. Those who conduct business on a handshake have exactly that left, because the vendor has no binding agreement to produce.

It is imperative that healthcare administrators seek information on the number of additional facilities to which a single vendor is contracted to provide materials or services in disasters. If you perceive they are overloaded, they are. Seek agreements with additional providers.

Multistate Planning

As important as regionalized planning is among intrastate facilities, so too is multistate planning among contiguous states. The federal Emergency Management Assistance Compact (EMAC), initiated in 1992, facilitated the first efforts at interstate assistance among emergency management organizations, a process that also benefits the delivery of healthcare services.

EMAC is a national interstate mutual-aid agreement that allows states to share resources during times of disaster. Signatories include 47 states, 2 territories, and the District of Columbia. Components include training, standardized response protocols, and activation review. Legally binding agreements are signed that address the critical issues of liability, workers’ compensation coverage, and reimbursement of expenses. Intrastate mutual-aid agreements, whereby all local jurisdictions would have established agreements to provide resources and assistance in time of need, are also being encouraged. If adopted, this would cease the practice of handshake agreements and move the industry toward improved preparedness. These may even become a future prerequisite for eligibility to receive federal homeland-security funding (NEMA 2002).

Applying New Technologies

A plethora of new technologies has flooded the emergency management market. New and improved personal protective equipment (PPE) for responders and the mass population, early warning devices for the detection of chemical agents or notification of the public, computerized and wireless alert notices, and sophisticated computer models to estimate the plume projection of hazardous materials are only a few of the new refinements and items available. The current emphasis being placed on homeland security will bring future benefits for the healthcare delivery system as new items for responder information and protection emerge.

Emphasizing Communication

One of the most difficult and frustrating aspects in the movement toward interoperability at the federal, state, and local levels has been information sharing. A recent report of the U.S. GAO (2003b) states that “no level of government perceived the process [of information sharing] as effective, particularly when sharing information with federal agencies. Information on threats, methods, and techniques of terrorists is not routinely shared; and the information that is shared is not perceived as timely, accurate, or relevant.” Federal officials have not yet established comprehensive processes and procedures to promote sharing with state and local agencies.

With the lack of a centralized national communications system, an aging telecommunications infrastructure, cellular networks, and crashes from viruses attacking primary computer components, the communication among local providers and responders—which is supported by basic technology and processes—is that much more critical. A fax broadcast service for emergency mass communication, emergency e-mail, or wireless network notification services are increasing in popularity; redundant systems, manual work-arounds, or other basic alternatives are imperative. Having a telephone that does not plug into the wall is crucial when power fails, as is maintaining batteries and updated emergency contact lists, including numbers for cell or mobile phones, beepers, and wireless contact information.

Focusing on Prevention

According to K.O.Sundnes and M.L.Birnbaum (TFQCDM/WADEM 2003, 39), “prevention is the aggregate of approaches and measures taken to ensure that human actions, or natural phenomenon, do not cause or result in the occurrence of an event related to the identified or unidentified hazard.” It has no relationship to decreasing the amplitude, intensity, scale, and/or magnitude of an event. Although many natural disasters are impossible to prevent, some man-made events could be eliminated, and the effects of all these events could be decreased with preparedness.

Aspects of preparedness the healthcare community must address include the following:

• Risk analysis and hazards vulnerability analysis

• Incident management

• Surge capacity

• Protection of direct caregivers

• Provision for continuity of the daily (standard) levels of care

• Management of mental health and special-population needs

• Public education and involvement

• Redundant communications and process capabilities

• Periodic testing through communitywide drills and exercises

• Types and quantities of PPE and other protective items to be stocked

• Decontamination capabilities

• Regulations and standards that direct or mandate action

Progressive improvement in our ability to respond effectively and efficiently to disasters is imperative. Many factors have a profound influence on the occurrence of events and their effects. Because of the challenges and barriers we face, healthcare managers must be knowledgeable, flexible, and eager to engage in their community-preparedness efforts. With internal and external efforts, disaster readiness and service to our communities will be improved.