Preparing Your Healthcare Facility for Disaster

CHECKLISTS

Checklist 1.1. A successful Emergency Planning Process

• Commitment and leadership from the top of the organization: The CEO, or equivalent, must be the champion for preparedness, setting an example for all employees and being the purveyor of the growth of a “disaster culture” in the organization.

• An organizational need and desire to “do the right things”: A mandated plan, for the sake of meeting mandated requirements, is a useless tool. It will not be followed, is rarely developed as a facilityspecific entity, and will fail to meet the needs of the facility. The desire for preparedness must be inherent within the organization.

• A facility-specific disaster plan: Plans that address appropriate responses to the needs of your facility are not transferable to your neighbor’s facility, nor to other types of healthcare facilities.

• Input from the organization as a whole: Management and staff must participate to create staff ownership and pride in the plan and to ensure that all areas of concern and need are appropriately addressed.

• Integration with the community: Coordination with and understanding of community resources and assistance are critical.

• Delineated support functions: Authority and coordination, roles and responsibilities, and the ability to find and access needed resources must be addressed in detail.

Source: Adapted from Anderson, B., J.Dilling, P.Mann, A.Moore. 1996. Emergency Planning for Assisted Living Facilities. Silverdale, WA: Emergency Training & Consulting, International. Used with permission.

Checklist 1.2. Facility Preparedness for Terrorism

I. Emergency Management Team and Planning

1. Designate an emergency management or disaster planning team in each facility and the community that

   • Consists of all disciplines that will respond to the disaster

   • Is represented by all standard and support departments (create an internal call list of team members, with all contact numbers)

   • Designates and understands the healthcare facility’s role in the community emergency management team and response

   • Understands the medical functions and their interconnectivity in a federalized response

2. Define the work of the emergency management team and the work to be accomplished.

   • Conduct an internal hazards vulnerability analysis (HVA)

   • Prioritize threats and risks, and establish a plan to address each

   • Conduct a community and area HVA

   • Develop production time lines for each HVA issue addressed

   • Assess community programs and processes for current disaster response, and identify weaknesses and gaps in service

   • Plan for alternative delivery methods and routes for delivery of supplies, personnel, or other needs

   • Review all relevant disaster-response plans, and ensure that appropriately designated staff are familiar with their content and strategies

   • Know the community’s local or regional emergency management plans, command structures, and contacts in each organization

   • Determine secondary and backup processes and programs, and identify need for redundant systems

3. Assess and test power and backup systems.

   • Identify all patient care needs in a power failure; prepare to use manual systems for a prolonged time

   • Develop a staffing support system for critical tasks during power or infrastructure failures

   • Understand the capabilities of the area emergency operations center (EOC) for communication and service should the area be without power for extended lengths of time

   • Preidentify special needs and services that the healthcare facility will require from the community or area services in a power failure; have a clear understanding of capabilities and limitations available in the local area

   • Assess strengths and vulnerabilities of internal technology, communications, information, and data systems

   • Ensure manual access to automated systems (e.g., medication dispensing) in power failures

4. Establish an internal command center in each healthcare facility.

   • Prepare staff and volunteers via incident command system standards and protocols for seamless response

   • Practice setting up and operating the center frequently

   • Involve ham or volunteer radio operators in EOC operations; you may elect to have an on-site HAM operator to ensure continual communications

II. Communications Systems

• Establish internal and external lines of communications (to medical staff, personnel, responding agencies, and public health authorities) with appropriate and redundant technology; develop a call list of external team members and contact numbers.

• Establish collaborative strategies for communicating with neighboring hospitals, civic leaders, law enforcement, public health authorities, and emergency response agencies.

• Assess routine staffing and emergency call-up plans, and ensure they are supported with communication and transportation strategies.

• Maintain ongoing primary and redundant communication systems.

• Inform staff of how you will communicate with them when off duty and what is expected of them in disasters; if a call chain is to be used for staff activation from home, make certain that alternate means of reaching each person are available.

• Communications systems for influx of large volumes of calls must be predetermined, tested often, and designed to meet the needs of all Emergency Support Functions of the National Response Plan.

• Ensure adequate internal communication systems and prepare for failures of vital equipment (e.g., cell phones and pagers); develop alternative delivery systems, including runners.

III. Communications, Alerts, and Warnings

• Coordinate all activities through the area command center, emergency management agency, or EOC.

• Know the alert systems and sources for alert information in your area.

• Incorporate the community warning system into your facility disaster planning.

• Link the community command center or EOC to each healthcare provider in your area.

IV. Community Integration

• Develop strong relationships with other healthcare organizations and providers.

• Develop personal and professional relationships with providers through a continual planning process.

• Plan and conduct communitywide drills often, taking into account input from all sectors of the community.

• Establish formal memoranda of understanding and agreements with critical providers of services.

• Establish ties with counterparts at other healthcare organizations (e.g., incident commanders, pharmacists, laboratory directors, administrators) to better know each other and understand the plans of respective facilities.

• Quantify pharmaceutical and antibiotic supplies, both at central and satellite facilities; routinely update this list.

• Participate in the development of a coalition of hospitals that are geographically close to share supplies, pharmaceuticals, and staff under a clear chain of command.

• Assess strengths and vulnerabilities of the community’s internal technology, communications, and information and data systems, and know how these interact with healthcare facility systems or providers.

• Ensure that appropriate healthcare professionals from all agencies are aware of the importance of reporting unusual disease presentations, clusters, and atypical patterns of hospital use, and know the mechanisms for reporting.

V. Disaster Preparedness

• Ensure preparedness to operate independently and be self-sufficient for up to 72 hours minimum.

• Assess routine staffing and emergency call-up plans, and ensure that these are supported with communication and transportation strategies; update the roster of essential personnel.

• Develop work-arounds or substitutions for any services and supplies you anticipate may not be available or may be inaccessible for delivery.

• Consider developing a volunteer safety service team to assist with safety, security, and crowd control if professional help is not available.

• Coordinate the preestablishment of an areawide licensure or certification approval system for local physicians, nurses, and other professional staff; establish a system to quickly evaluate essential credentials for temporary or volunteer professional staff; establish a community or area database to track and verify certification of medical personnel.

• Develop a community or area volunteer service (e.g., Citizens Corp), and provide training and education and determine tasks for these teams in disasters to strengthen the overall response.

• Ensure that the community is prepared to receive the Strategic National Stockpile in the event of a massive medical emergency; personnel needed for unloading, warehousing, security, and medication distribution should be preidentified; personnel should be trained and prepared in their roles and the processes tested in every drill event.

• Prepare for mass-fatality management of deaths occurring inside the facility and in the community; bodies or body parts must be identified, cataloged, and refrigerated, and contaminated remains must be identified and secured for proper disposal.

VI. Drills and Exercises

• Conduct both internal and external drills and exercises.

• Participate in all communitywide disaster drills and exercises when requested.

• Focus external drills on the role of the facility to respond to community needs in concert with emergency medical services and other emergency responders.

• Clearly define the roles of first-responder agencies in various types of disaster events (e.g., Which department takes the lead in decontamination of victims? Will this be done in the field or at the hospital only? Will there be assistance from outside agencies if decontamination capability is established outside the emergency department?).

• Conduct a communitywide tabletop exercise to include the most difficult tasks such as lockdown or quarantine of the town, a facility, or an area.

• Drill multiple aspects of the plan at a time to provide an opportunity for the healthcare facility to realistically test interoperability with other community responders.

• Include the establishment and operation of various shelters to provide care in a community; test medical overflow shelters or temporary structures.

• Plan with community providers to treat a large number of patients (hundreds to thousands).

• Test evacuation plans for the area, including the evacuation of the healthcare facilities.

• Test shelter-in-place provisions throughout the healthcare delivery system.

• Assess mutual-aid pacts and cooperative agreements for mass-casualty treatment capability.

Sources: This checklist was developed by K.J.McGlown, with additional information from the following: JCAHO. 2001. “The Power of Preparation.” Special issue, entitled “Emergency Management in the New Millennium.” Joint Commission Perspectives 21 (12):13–15; JCAHO. 2001. “Responding Effectively in the Midst of a Natural Emergency.” Special issue, entitled “Emergency Management in the New Millennium.” Joint Commission Perspectives 21 (12):22–23.

Checklist 1.3. Successful Drills and Exercises

• Involve employees from all departments in planning an exercise; incorporate their suggestions and ideas for specific actions to be tested and examined.

• Exercise emergency plans a minimum of twice a year, with a variety of internal and external events; various types of exercises can keep preparedness issues before staff year-round.

• Fully integrate exercises to involve all area healthcare facilities and providers.

• Test the communication and notification links within the organization and those from the organization to the external community at large.

• Test internal systems.

  1. Notifying key personnel

  2. Setting up the command post

  3. Assessing internal damage to the physical plant and the impact on patient care delivery

  4. Preparing the emergency department (ED) to identify, process, and care for large groups of patients (establish alternate emergenct care locations in case the ED is destroyed or contaminated)

  5. Testing capacity and ability to clear beds as needed

  6. Implementing victim tracking and documentation

  7. Determining equipment and supplies available for activation (test delivery of items to ED or central care points)

  8. Establishing a triage center outside the ED

  9. Securing all ED operations and access points into the department

  10. Securing all entrances to the facility

  11. Establishing media control and public relations procedures

  12. Activating secondary call and standby for patient care services (e.g., surgery, burn unit, pediatrics, etc.)

  13. Testing communications with the area emergency operations center and other external responding agencies; testing backup systems of various types

• Practice the stand-down of the exercise, testing the return to normalcy. These actions include adjustment of staff schedules and call coverage, communications required, and reporting processes.

• Critique the exercise. Have outside experts evaluate your effectiveness; request comments from all participating organizations.

• Conduct a “results oriented” evaluation process, and address (among others) the following major aspects of disaster preparedness:

  1. Alert systems

  2. Mobilization

  3. Direction and control

  4. Facilities

  5. Communications

  6. Exposure of responders

  7. Monitoring of environment

  8. Public information

  9. Media information and rumor control

  10. Special populations/schools

  11. Reception or mass-casualty receiving centers

  12. Traffic and access

  13. Medical services, transportation, facilities, and equipment

• Develop corrective action plans from the gaps between performance and expectations.

• Provide timely feedback to staff to reinforce lessons learned.

• Take corrective actions on gaps identified from the exercise; document all actions taken.

• Write the final “after action” report of the exercise, including findings and corrective action taken; share results with decision makers and those with a need to know.