CHAPTER 39 Disaster Preparedness and Response

A disaster is a catastrophic event that overwhelms available resources. Disasters can result from natural hazards such as tornados, earthquakes, hurricanes, ice storms, droughts, and floods, for example, or they can include technologic disasters to such as building collapses, hazardous materials releases, industrial accidents, and acts of terrorism including the use of weapons of mass destruction (WMDs) such as chemical, biologic, radiologic, nuclear, or explosive devices (see Chapter 40). To understand and plan for a disaster, it is important to review the stages of a disaster. Effective response to a disaster can be summarized in the traditional emergency management phases. Emergency nurses need to be familiar with their expected role in a disaster situation, including having a personal response plan. Disaster planning and response are cyclic processes that are ever evolving. Disasters are managed by recognizing and planning a series of predictable stages, and they are addressed in the classic emergency management stages of response, recovery, mitigation, and preparedness. Responding to a disaster should be accomplished within an incident management system (IMS), to coordinate command and control, communications, and allocation of resources. Recipients of federal preparedness funding are required to comply with guidelines developed by the presidentially directed National Incident Management System (NIMS), which is housed within the Federal Emergency Management Agency (FEMA). NIMS guidelines that affect hospital preparedness are developmental and can be viewed online at www.fema.gov/emergency/nims/index.shtm.

II. DISASTER MANAGEMENT STAGES

A. Preparedness

1. The goal of preparedness is to plan how to respond to, mitigate damage from, and recover from a disaster.

2. Actions can include:

a. EOPs

b. An EOP should address all hazards, instead of one plan per problem, have clear organization, and be flexible enough to deal with any contingency

c. Elements of an EOP

1) List of potential hazards and institution vulnerabilities to these hazards

2) Integration with community responders

3) Critical resources needed for 5 days of autonomous functioning

4) List of planning priorities (e.g., mitigating damage, preserving essential functions, life safety, rapid recovery)

5) Facility approach to a graduated response (e.g., scalable IMS)

6) Operational functions to include surge capacity

7) Legal basis for response to include quarantine order impact

8) Regulatory compliance

a) Emergency Medical Treatment and Active Labor Act (EMTALA)

b) The Joint Commission

c) Occupational Safety and Health Administration (OSHA)

d) Health Insurance and Portability Accountability Act (HIPAA)

9) Mutual aid agreements

10) Contracts for emergency support

a) Supplies

b) Evacuation assistance

c) Critical services

d) Patient transfers

e) Assessment of contract exclusivity in the event of multiple agency demands on the same resources

11) Mental health support

12) Mass casualty ethics to include a plan to address issues of scarce lifesaving resources

13) Mass casualty triage and plan for distribution of limited resources

14) Shelter-in-place plan

a) Supplies and equipment needs

b) Augmentation staffing plan

(1) Plan to provide or encourage staff to have a plan for child, pet, and elder care

(2) Staff lodging, meals, off-duty but onsite activities, and other needs

(3) Staff transportation

15) Emergency credentialing plan integrated with community emergency credentialing plans

16) Hazardous materials plan

a) Detection capabilities

b) Ongoing monitoring

c) Need for decontamination

d) Personal protective equipment

e) Environmental remediation

f) Lockdown procedures to protect core functions from contamination

g) Radiation detection, response, and remediation

17) Infectious disease plan

a) Increased surveillance

b) Recommendations for infection control levels of personal protective equipment

c) Plans for isolation, cohorting of patients as well as quarantine

18) Expectations of the hospital for acute care centers or other community-based surge capacity plans; identify nontraditional care areas for hidden capacity

19) Hospital as a primary or secondary target plan

20) Command and control

a) Establish lines of authority during an emergency, utilizing the common language of a national IMS (NIMS)

b) Contingencies should include a line of succession plan and delegations of authority in an emergency event

c) The hospital command and control structure should be linked to the community emergency management system

d) During an event, an EOC is established away from the front line

e) All functions are staffed using an IMS

f) Alternate sites should be established for the EOC and for any hospital essential functions (e.g., emergency services) in the event the primary site is rendered inoperable

21) Communications

a) Redundant, interoperable communications should exist to cover the possibility that main channels of communication may fail during an event

b) Should include a contingency plan for the loss of landlines, cellular phones, power, radios and electronic communications; possible use of amateur (e.g., ham, citizen band) radios, satellite phones, and other methods of communications

c) Needs to address how response decisions are communicated to management, staff, patients, family, visitors, vendors, and the community

d) Alert, notification and implementation process

22) Evacuation

a) Phased evacuation plan should include the ability to interface with potentially needed community assets

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