Helping Health-Care Facilities Prepare to Meet the Needs of the Communities They Serve
Communities are vulnerable to a full spectrum of risks. These range from natural hazards (hurricanes, tornadoes, flooding,earthquakes, etc.) to technological risks (hazardous materials incidents, nuclear power plant incidents, etc.) to other man-made perils (terrorism, cyber incidents, mass shootings, etc.).
With all of these hazards, health-care facilities have a critical role in ensuring that they remain operational so they can provide care to their existing patients at both the time of the emergency or disaster, and in the days that follow. In addition, many facilities, particularly hospitals, also play a key role in responding to a mass casualty event (MCI). This dual mandate requires health-care facilities to be able to accommodate an unexpected surge of patients, many of whom may need critical care, while continuing to handle existing patients. And while every disaster will present a unique set of challenges, preplanning for these challenges and adopting an allhazards approach to planning enables health-care facilities to be better prepared to meet the needs of the communities they serve.
THE PLANNING PROCESS
Creation of an operational and comprehensive disaster plan begins with establishing the plan’s goals and objectives.
These are the three major areas of focus—or the “Three Cs”—for health-care-facility disaster planning:
- Continuity of Care – Continuing the physical care of those currently seeking medical attention, while ensuring the full continuity of operations for the facility and the ability to serve a disaster-response role.
- Communication Channels – Managing internal and external communications channels as both become more crucial and more complicated than on a typical day.
- Coordinated Response Protocol – Developing a protocol for response within an organization, while also looking outward to integrate into a community-wide response.
These critical aspects set the basis for plan development and form the crux of what health-care facilities need to achieve in order to fulfill their special dual mandate during a disaster. The health-care industry is no stranger to these concepts. The Joint Commission, a United-States-based nonprofit organization that accredits health-care facilities—and with which many, if not most, health-care providers are familiar—has established standards for hospital emergency preparedness. In addition, federal efforts, such as the Hospital Preparedness Program and Public Health Emergency Preparedness Program, have been actively facilitating the establishment of local health-care coalitions. Each of these local coalitions can potentially serve as an invaluable knowledge resource for any health-care entity interested in furthering its disaster planning.
THE STARTING LINE – CONDUCTING A VULNERABILITY AND RISK ANALYSIS
Once goals are set and the need to plan for more than just one hazard is understood, conducting a vulnerability and risk analysis for each facility will set the focal points of the planning process. This four-part process involves the following steps:
- Considering the possible effect a hazard could have on a facility
- Assessing the likeliness of the hazard to occur, and the overall risk that the hazard poses to the facility
- Creating the plan to address the findings of the analysis
- Updating the plan to reflect lessons learned from realworld events
As an example of this process, a facility along the East Coast will most likely experience hurricanes, but it may also be brought into the response of a mass casualty event, such as the recent nightclub shooting in Orlando, Florida, or the Boston Marathon bombing. Identifying these hazards at the beginning of the planning process ensures the creation of a full-spectrum plan that can be customized to each specific facility and community.
During this process, it is crucial to identify all infrastructure capabilities, such as the availability and functionality of a backup power source. As Hurricane Sandy highlighted, loss of power for a health-care facility—a hospital in this case—can force emergency evacuations of patients at an incredibly inopportune time. Walking through an analysis of the facility’s vulnerabilities and risks creates the baseline from which all planning can begin.
TAKING AN ALL-HAZARDS APPROACH TO DISASTER
PREPAREDNESS PLANNING
As noted earlier, health-care facilities need to take what emergency management professionals refer to as an all-hazards approach to planning. Simply put, a disaster plan needs to achieve these goals and objectives in a way that is not specific to just one hazard (i.e., a plan applicable only to hurricanes), but rather one that provides the facility with the ability to cope with an emergency of any size, duration, and type. In many ways, this is intuitive. Preparing a healthcare facility for a water-disruption event is applicable to earthquakes, severe weather, and even cyber incidents. We can see how critical this is when we look at recent events that affected health-care facilities around the country.
Hurricane Sandy in New York and New Jersey; the 2011 tornadoes in Joplin, Missouri; the 2013 West Fertilizer Company explosion in Texas; and the Boston Marathon bombing in Boston, Massachusetts, are key examples of the dual mandate health-care facilities have to continue to provide care to existing patients while dealing with an influx of casualties.
APPLYING THE THREE Cs
The criticality of disaster planning can make the task seem daunting. However, disaster planning involves breaking down the three broad goals (Continuity of Care, Communication Channels, and a Coordinated Response Protocol) into manageable planning components, keeping in mind the all-hazards approach.
Continuity of Care – Continuing care applies not only to the physical care of those currently seeking medical attention, but also to the full continuity of the facility’s operations. This includes establishing plans to obtain medical supplies, equipment, and other resources; planning for a possible overall greater demand for these resources;and the possibility of established supply channels experiencing delays or not being operational at all. It also includes planning for the protection of medical and other vital records and equipment to ensure these assets are not lost in the event of damage to structures or systems. Federal law underlines the importance of having this component built into disaster plans. Health Insurance Portability and Accountability Act (HIPAA) covered entities are required to have a contingency plan to ensure all electronic protected health information is available during disasters. However, in a disaster, not just patients’ records are at risk. During Hurricane Sandy, NYU Hospital’s generators failed, causing an immediate evacuation of the facility and resulting in the loss of years of innovative research. Prior planning for the use of redundant systems may have been able to prevent this loss.
An additional layer of continuity of care is integrating into a disaster plan the use of alternate care sites (ACS). These are community-based locations that may provide additional treatment area(s) with a minimum specific level of care for patients. A major disaster could result not only in an increased demand for medical care, but it could also significantly impact a community’s ability to meet the health and medical needs of the impacted population. In these situations, it may be necessary to identify, convert, and activate a location that is not currently providing health-care services. Additionally, a medical facility, where the usual scope of medical services does not normally include large-scale urgent care or traditional inpatient services, could be used as an ACS.
A best practice in ACS selection is to use existing infrastructure that is already within health-care facilities, such as attached gyms, physical therapy offices, outpatient surgery centers, or cafeterias.
Communication Channels – During a disaster, communications channels become more crucial and more complicated than they are on a typical day. Internally, facilities need to create and communicate notification procedures to leadership and staff. This may include establishing phone trees, call lists, or other forms of reaching staff to report on the status of the facility and the need for staffing. In larger facilities, staff members will need a way to easily communicate with each other that accounts for the possibility of a surge of patients or the possibility of normal communication channels being unavailable. Externally, facilities will need a way to communicate with first responders, other facilities, and other response agencies. (Planning ahead for redundancy in communications will help to prevent any facility from being left without an effective way to communicate.)
Coordinated Response Protocol – Building a coordinated response structure involves health-care facilities not only looking within their own organizations, but also looking outward to integrate into a community-wide response. (Health-care facilities need to be prepared to work with government agencies, first responders, and other health-care providers, depending on the needs created by the disaster.) These entities can interact with health-care facilities during disasters, either as support for the facility, as seekers of support themselves, or as seekers of
information. For instance, if a hospital were to lose power during a hurricane, it would most likely seek external support so it could tend to the issue or so it could relocate thosecurrently in the hospital’s care. However, there could also be instances, such as a large sheltering event, when external entities may be seeking patient information about people residing in a shelter. The U.S. Department of Health and Human Services provides a decision making tool to help facilities navigate requests for patient information, while also avoiding any HIPAA or other regulatory violations. Working with external entities (such as health-care coalitions) during the planning process and sharing response procedures during blue-sky days helps to ensure internal confidence and improve response efficiency as staff members carry out these operations.
Building a response structure internally involves identifying staff members’ roles and responsibilities, educating staff members on those roles and responsibilities, and practicing to make sure they understand their roles and responsibilities. It involves identifying key staff and leadership to be available during business and non-business hours and establishing whom to call, when to call, and how to call in the event of an emergency.
One of the more challenging situations a health-care facility may face is an unexpected evacuation. If a hospital loses power and generators fail, the hospital is left with no choice but to get patients to a facility that has the resources to care for those patients. This involves planning how to physically move patients and determining where they will be sent. Working with other healthcare facilities before a disaster to establish agreements and procedures for emergency patient acceptance can greatly reduce the challenges presented by this scenario. Some patients may be able to be discharged instead of evacuated, depending on the current status of the situation. Establishing patient discharge procedures for pre- and post-disaster can greatly reduce the strain on resources in the event of an evacuation.
IT’S TIME TO PLAN!
Adopting an all-hazards approach to disaster planning is an essential component of health-care-facility preparedness. Healthcare facilities and their staffs are uniquely positioned in a disaster to be called on to fulfill a response role while continuing to deliver vital services to the existing patient population. Taking the time to assess the facility’s level of preparedness and undertaking the disaster planning process not only leaves the facility better able to respond to a disaster, but ultimately can save money, resources, and most importantly, lives.