All-Hazards Disaster Preparedness

Chapter 25


All-Hazards Disaster Preparedness


Elizabeth T. Dugan, Karen Drenkard and Gene S. Rigotti



Photo used with permission from Photos.com.


imagehttp://evolve.elsevier.com/Huber/leadership/



TRANSITIONING THEORY INTO PRACTICE FOR ALL-HAZARDS PREPAREDNESS


September 11, 2001, was a tragic day that touched everyone’s lives and changed Americans’ perception of a “safe” world forever. As a result, people of all backgrounds have given thought to preparing themselves, their homes, and their work environments for the eventuality of a disaster. Most people are knowledgeable on how to prepare for potential natural disasters within their local regions; however, many have not had to consider the devastation that can be caused by terrorism. A list of terrorism possibilities is endless: biological exposures, chemical spills, radiological exposures, nuclear blasts, conventional bombings, agricultural contamination, cyber viruses, and other unforeseen cataclysmic events. Thus developing a contingency plan for most types of disasters, including bioterrorism, is most appropriately termed all-hazards disaster preparedness.


Since the occurrence of major disasters such as the attack on the World Trade Center, Hurricane Katrina, and the devastating tornado in Joplin, MO, in 2011, key community stakeholders, such as local government, fire and rescue workers, and hospitals, have been focused on gathering information from a variety of resources, developing collaborative response plans, and preparing for a probable disaster. The Joint Commission (TJC) has advanced hospital efforts through the development of six crucial areas for emergency preparedness: communication, safety and security, resources and assets, staff responsibilities, utilities management, and patient clinical and support activities (The Joint Commission Resources, 2008). These crucial areas create a framework for all-hazards disaster preparedness planning in hospitals. So how does one go about preparing for an event in the workplace, and more specifically, the hospital environment? Traditionally the community hospital is a place of refuge for the sick and wounded. How is all of this impacted in the event of a disaster?


Health care executives across the country understand the need to dedicate resources to support effective all-hazards preparedness. The Health Insurance Portability and Accountability Act (HIPAA) and TJC require all health care facilities to have detailed all- hazard preparedness plans. Nursing leaders are an integral part of the planning process and should have knowledge of the national response plan (NRP) and state and local disaster response plans (Danna et al., 2009). Effective planning skills, for all-hazards preparedness is an essential management competency for nurse executives.


This chapter describes how to orchestrate a multilevel plan for a health care facility. A comprehensive all-hazards preparedness plan will assist in establishing the following: (1) an organized hospital-based plan for both internal and external disasters at the department/unit level, (2) an inter-hospital plan for effectively collaborating with other hospitals within a health care system and within the vicinity, (3) a community plan that will integrate the hospital plan with other external community plans, and (4) a national plan that will guide nurse leaders in accessing financial assistance from federal and state all-hazards preparedness resources.



DEFINITIONS


From a health care perspective, a disaster is an unforeseen and often sudden event of sufficient magnitude that causes great destruction, human suffering and most often requires external assistance (World Health Organization, 2005). There are a wide variety of types and causes of disasters. Although often triggered by nature, disasters can be caused by human acts; these can include biological, chemical, radiological, nuclear, cyber, or conventional terrorist events. Wars and civil disturbances that destroy homelands and displace people are included among man-made disasters. Causes of natural disasters include blizzards, wildfires, floods, tsunamis, volcanic eruptions, earthquakes, tornadoes, and hurricanes such as the devastation caused by Hurricane Katrina in 2005 or the earthquake and resulting tsunami in Japan in 2011. Disasters can be internal, such as a catastrophic event that occurs within a facility, making it difficult to maintain operations (TJC, 2012); or external, a catastrophic event that affects the community, which may or may not affect the facility.


Other disaster-related definitions are as follows:



• All-hazards: A general term that is descriptive of all types of natural and/or human terrorist events.


• All-hazards disaster preparedness: Multifaceted internal and external disaster preparedness that establishes flexible and scalable action plans for every type of disaster or combination of disaster events (TJC, 2008).


• Altered standards of care: The definition of the term “altered standards” has not reached national consensus but generally is assumed to mean a shift to providing care and allocating scarce equipment, supplies, and personnel in a way that saves the largest number of lives, in contrast to the traditional focus on saving individuals (Agency for Healthcare Research and Quality [AHRQ], 2005a).


• Biological disaster: An incident occurring as a result of the deliberate or unintentional release of biological materials that may adversely affect the health of those exposed (U.S. Department of Defense, 2007).


• Chemical disaster: An incident occurring as a result of the deliberate or unintentional release of toxic chemical materials that may adversely affect the health of those exposed (U.S. Department of Defense, 2007).


• Conventional disaster: A catastrophic event caused by the use of weapons such as guns, bombs, missiles, or grenades.


• Cyber disaster: A catastrophic event that results from the use of information technology systems to control or disrupt critical infrastructure systems (U.S. Department of Veterans Affairs, 2005).


• Hazard Vulnerability Analysis: An exercise that identifies an organization’s potential emergencies, the likelihood of the event occurring, and the impact it would have on the organization (California Hospital Association, 2009).


• Mass casualty event (MCE): A catastrophic public health or terrorism-related event that results in the community’s health care system being overwhelmed by the needs of victims (AHRQ, 2005a. MCEs can be organized into two categories: (1) immediate or sudden impact; and (2) events resulting in ongoing or sustained impact (AHRQ, 2007).


• Radiological/nuclear disaster: A radiological or nuclear emergency that may result from accidents occurring within a facility (e.g., the departments of nuclear medicine and radiation oncology) or from external sources involving vehicles transporting radioactive materials (RAM) or caused by terrorism events (U.S. Department of Defense, 2007).



GETTING STARTED: FIRST STEPS


Starting any complex systems project can be confusing and difficult. Beginning the work of establishing a comprehensive all-hazards preparedness plan is no exception. Historically, most hospitals have had some type of disaster plan in place. Being the leader in the evaluation of the hospital’s existing emergency operations plan (EOP), in light of a focus on maintaining a state of constant readiness, can be a complicated process. One of the first steps to gaining participation from appropriate stakeholders and moving the evaluation process forward is the creation of an oversight committee, or an all-hazards preparedness task force (AHPTF, referred to as Task Force). The nursing executive, often called the chief nursing officer (CNO), will play a pivotal role in facilitating the initial Task Force.



Creating an All-Hazards Preparedness Task Force


As nurses know, effective projects that create lasting change start with the basic nursing process: assessment, planning, implementation, evaluation, and modification. The AHPTF will similarly follow this process. It is essential to get administrative support regarding the need for an all-hazards preparedness plan. This is best accomplished by establishing a high-level administrative Task Force whose purpose will be oversight of the multilevel all-hazards preparedness plan development. Whether the hospital is part of a larger health care system or is a freestanding, independent hospital, the Task Force will function similarly.


Health care systems with multiple facilities are very familiar with the complexity and intricacies of trying to establish a standardized system-wide approach to care needs. In organizations such as these, system-wide executive administrators need to be part of the Task Force. Having a senior executive administrator of the health care system serve as the chairperson of the Task Force will provide the leadership needed to communicate the importance of all-hazards preparedness as a system priority. A representative CNO and emergency medicine physician, serving as co-chairs with the senior executive administrator, will create a dynamic team that is uniquely prepared to tackle any issues that arise. A project facilitator is helpful in getting the Task Force started and operational. The project facilitator can also serve in a pivotal maintenance role, keeping the all-hazards preparedness plan current and in the forefront of the administration’s strategic planning over time.


Establishing the Task Force requires that all departments be committed to the tasks at hand and cognizant of the need for consensus building and standardization of processes. Bidirectional communication is imperative. The standing membership should be composed of stakeholders representing all areas of the organization. Because not all departments can logistically be on the Task Force, the members will have large areas of oversight and communication. The Task Force membership might typically look like that outlined in Table 25-1.



TABLE 25-1


All-Hazards Preparedness Task Force Membership Responsibilities
















































































Responsibility Area(S) Position Title Detail of Area Covered
Executive owner (chair) Executive administrator Leads the all-hazards preparedness task force as chair. If the hospital is part of a health care system, this person will be a system-wide senior administrator. If the hospital is a freestanding, independent facility, this person will be the hospital’s chief operating officer.
Clinical operations (co-chair) Chief nurse officer Represents all nursing and clinical departments. Co-chairs the Task Force.
Chemical/radiological/conventional threats (co-chair) Emergency department/ air care medical director Represents all aspects of emergency medicine and physician needs related to all-hazards preparedness. This person also will co-chair the Task Force.
Physician liaison(s) Department chiefs Serve as spokespersons for physician needs with regard to disaster preparedness. Facilitate communication of timely information should an event occur. Have oversight for physician credentialing in times of a disaster. Assist in approval of medical standards established for various types of disasters.
Chief operating officers (COOs) from health care system facilities Chief operating officer(s) Represent the needs of their facilities in establishing an effective all-hazards preparedness plan. Facilitate system-wide collaboration in standardizing practices and communicate essential information to employees.
Security Safety and security director Serves as liaison for system-wide safety and security departments in the system. Coordinates and synchronizes efforts of all departments as related to all-hazards preparedness. Responsible for rapid “lockdown” of all entrances and flow of people in the event of a disaster.
Communications Chief information technology officer Oversees successful operation of the integrated information system, including telephones, radios, and computers and satellite technology, during times of instability. Creates and maintains redundant systems to ensure an ability to communicate within facilities, outside to other hospitals, and partners with community.
Messages/media Marketing director Plays an active role in communicating the “All-Hazards Preparedness” message to all employees, patients, and community. Acts on behalf of the health care system or hospital in speaking with press about impending or actual disaster situations.
Human resources Human resources director Serves as the staff’s voice in meeting the needs of employees during a disaster. Creates manuals to guide staff in preparing for and responding to a disaster.
Financial reimbursement Chief financial officer Leads efforts in monitoring financial expenses related to establishing an effective all-hazards preparedness plan. Seeks out state/federal reimbursement opportunities for planning.
Government funding Government affairs director Serves as a vital link to local, state, and federal boards representing the system financial and operational needs regarding all-hazards preparedness. Advocates for funding related to all-hazards preparedness.
Biological threats Infectious disease medical director Serves as the liaison for all infection control (IC) departments in the system.
Infection control Infection prevention and control practitioner Coordinates and synchronizes efforts of all IC departments as related to all-hazards preparedness. Responsible for development, dissemination, and understanding of procedures related to biological events.
Legal Executive attorney Advises all-hazards preparedness task force in legal matters related to establishing an effective all-hazards preparedness plan.
Education planning Education director Has oversight for planning and implementing educational efforts for staff and patients. As needed, coordinates “just in time” training for any arising incident. Is an integral partner in planning and implementing internal and external disaster drills.
Logistics Pharmacy director Serves as the liaison for all system pharmacies. Has oversight for stockpiling medications for use in a disaster. Establishes par levels of drugs for use in “patient surge” situations. Establishes contracts with pharmaceutical vendors to ensure adequate supply of medications in the event of a disaster. Has oversight for any medical supply trucks ready for deployment in times of a disaster (e.g., stocking par level of drugs used in a chemical disaster).
Logistics Materials management director Serves as an active participant on the task force. This liaison is the system representative for all materials management departments. Is very involved in setting par levels for supplies and equipment on the units at the time of a disaster. Establishes contracts with materials management vendors to ensure adequate supply of medications in the event of a disaster (e.g., stocking a supplemental supply truck for use in a disaster).
Logistics Engineering Directs any operational building redesign needed to prepare hospital for handling a disaster (e.g., decontamination showers).

note: This assessment tool was developed by Inova Health System based on a bioterrorism preparedness survey created by a committee consisting of representatives from Baylor University’s Graduate Program in Healthcare Administration, the U.S. Army Center for Healthcare Education and Studies, and the University of Texas Health Science Center at San Antonio. (For more information, see Drenkard et al., 2002.)


Courtesy Inova Health System, Falls Church, VA.


As the team evolves in its work, ad hoc members can be added as needed. Internal ad hoc members might include radiology, facility engineering, telecommunications, volunteer support, chaplain services, physician chairs, social work, case management, and dietary, respiratory, and laboratory services. External ad hoc members might include representatives from the local public health department, government liaison, police, fire and rescue, public school system, representatives from the faith community, community physicians, and even vendor representatives, who can be contracted to provide such things as oxygen, ice, food, cots, and linens in the event of a disaster.


During the start up, the system-wide Task Force will need to meet frequently. To begin, the Task Force should perform a hazard vulnerability analysis (HVA). The HVA will be used as a starting point to create an EOP that addresses potential hazards that are identified specific to the organization (Joint Commission Resources, 2008). For specific details on the HVA process, there are several resources available including the Federal Emergency Management Agency (FEMA) and Joint Commission Resources websites.



Performing an Effective Gap Analysis


There are many ways to perform an all-hazards preparedness gap analysis and a multitude of online reference websites exist, including, but not limited to, the following examples:



The guiding principle for creating a hospital-specific all-hazards gap analysis is to “keep it simple!” One example of a simple way to assess the current state is to create an emergency preparedness survey that is easy to read and requires the department directors to answer in simple checklists one of two ways: (1) “Yes, we have it,” or (2) “No, we don’t have it.” Survey questions need to be concise and clear. The goal is to begin by identifying the areas where there are gaps in the facility’s preparedness plans. Questions should be addressed to appropriate departments, who then assess the items and determine the current state. A review of the literature and online searches will assist the team in identifying the areas of assessment (Joint Commission Resources, 2008; Mangeri, 2006). Examples of questions to ask in the survey might include those listed in Box 25-1.



BOX 25-1


Hospital Gap Analysis Survey: Sample Questions



General




• Has your organization conducted a thorough hazard vulnerability analysis (HVA)?


• Does your organization have an emergency operations plan (EOP) that specifically addresses the four disaster phases?


• Does your EOP identify how to activate an emergency response and who is in charge of the command center in a disaster?


• Are those in charge identified by a vest or have some other sort of physical distinction?


• Does your facility have an operational command center to coordinate the hospital’s response to a disaster?


• Does your department staff know the chain of command in an emergency?


• Does your department know their role in a disaster?


• Does your hospital know their role in the community in an emergency situation?


• Are there specific plans for biological, chemical, nuclear, and conventional emergencies? Do all staff in your department know their roles in each type of emergency?


• Is there a bed and staffing plan for surge capacity for 50 patients? 100 patients? 250 patients? Do you have portable cots contracted for use in a surge situation?





Communication




• Does your hospital have emergency-powered phones in case of a disaster?


• Does your facility have a backup radio system and volunteer staff to run it?


• Does your facility have a tiered paging system that can reach multiple staff simultaneously?


• Does your department know the central command center telephone number (if there is one)?


• Is there an on-call procedure for notifying the administrator on-call and opening the command center in the event of a disaster?


• Are there established linkages to the external community (e.g., other hospitals in the region, fire department, police, emergency medical system, public schools, public health)?


• Do the telephone operators know how to link patients and families both in your facility and in the community should a disaster occur?


• Is there an on-call list for administrative coverage of the command center? If so, do the telephone operators know how to contact the administrator on-call for the command center?


• Is there a plan for contacting essential employees and administrators in a disaster?



Logistics




• Does your facility have:



• Is there an established written psychosocial role for social work, chaplains, psychiatry, employee health, and case management in the event of a disaster?


• Are there contingency plans for 4 to 5 days for no power, no water, no computers, and/or no food?


• Are there contingency plans for staff to report to nearest facility to work?


• Are there contingency plans for childcare during an emergency so that parents can work?


• Is there common nomenclature used during an emergency so that everyone understands what is happening and who has what responsibility?



Clinical Operations




• Does your facility have:



• Does your facility have procedures for how to:


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Aug 7, 2016 | Posted by in NURSING | Comments Off on All-Hazards Disaster Preparedness

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