biggest pitfalls and best practices in emergency management healthcare engineering consultants...

Biggest Pitfalls and Best Practices in Emergency Management

Healthcare Engineering Consultants

Strategies for the 2011 Emergency Management Standards

EMERGENCY

Emergency Management

EMERGENCY


The organization of the standards :

EM.01.01.01: Plans for managing emergencies, including HVA

EM.02.01.01: Emergency operations plan (EOP) developed – Direct Impact!

EM.02.02.01: Establishes emergency communication strategies

EM.02.02.03: Establishes strategies for managing resources

EM.02.02.05: Establishes strategies for managing safety and security

EM.02.02.07: Defines and manages staff roles and responsibilities

EM.02.02.09: Identifies an alternative means for providing utilities

EM.02.02.11: Identifies strategies for patient management

EM.02.02.13: Privileges to LIP’s – Direct Impact!

EM.02.02.15: Privileges to volunteer staff – Direct Impact!

EM.03.01.01: Annual effectiveness review

EM.03.01.03: Regularly tests the emergency operations plan

Emergency ManagementEMERGENCY


Issue: Emergency Management Committee

Best Practice:

Dedicated EM committee not required, but suggested

Leadership and physicians should be committee members and participate in planning

The committee should perform the following functions:

- Review the HVA annually

- Plan for emergency drills

- Evaluate actual emergencies and drills

Plan for other emergency activities



Issue: Hazard Vulnerability Analysis (HVA)

Best Practice:

A Hazard Vulnerability Analysis (HVA) is performed and documented, for each geographically separate location

The HVA includes a numerical score

The hazards are prioritized

The HVA is used to define Mitigation and Preparedness

The HVA includes the “disaster level” to determine how long the resource timeline charts must be for specific emergencies

The HVA is reviewed and revised, as necessary, annually


EMERGENCY


Hazard Vulnerability Analysis (HVA) for Emergency Management

Event Description Occurrence Probability (OP)

Human Impact (HI)

Property Impact (PI)

Operational Impact (OI)

Total Score (TS)

Procedure Required?

Disaster Level

Tornado

3 3 5 4 36 Yes 1-2

Severe Thunderstorm

4 2 3 2 28 Yes 1

Severe Winter Storm

4 2 2 2 24 Yes 1-2-3

Severe Ice

4 2 3 3 32 Yes 1-2-3

Earthquake

3 1 3 2 18 No N/A

Hurricane

0 4 4 4 0 No N/A

Flooding

2 1 4 4 18 Yes 1-2

Pandemic

2 5 1 5 22 Yes 1-2-3

Hazmat Spill (internal)

3 3 2 3 24 Yes 1-2

Hazmat Spill (external)

2 2 1 3 12 Yes 1-2

Electrical Failure

4 1 1 5 28 Yes 1-2

Medical Gas Failure

2 4 1 5 20 Yes 1-2

Bomb Threat

2 4 4 4 24 Yes 1-2

Biological Terrorism

1 5 1 5 11 Yes 1-2-3

Nuclear Terrorism

1 5 5 5 15 No N/A



Issue: Create an Emergency Operations Plan (EOP)

Best Practice:

Written EOP developed with participation by leadership and physicians

EOP describes response procedures for HVA determined events

EOP describes procedures for 96-hour community non-support

EOP describes the recovery phase of disasters based on HVA

EOP identifies the individual(s) who have the authority to activate the incident command function and phases

EOP includes descriptions of the six critical core areas: 1) communications; 2) resources and assets; 3) safety and security; 4) staff roles; 5) utility management, and; 6) patient management

EOP “crosswalk” is completed to locate required elements

EOP is reviewed and revised, as necessary, annually


EMERGENCY


Incident Commander

Public Info Officer

Liaison Officer

Safety Officer

Med/ Tech Specialist(s)

Operations Section Chief

Planning Section Chief

Logistics Section Chief

Finance/ Admin Section Chief

HICS Organizational Chart


EMERGENCY


Issue: 96-hour Timeline Charts

Biggest Pitfall: Stocking supplies for 96-hours

Best Practice:

Create color-coded timeline charts that indicate how long utilities will be operational and how long consumable supplies will be available in the event of an emergency in which no re-supply is possible

Ensure that decisions are made to determine whether any utility or supply changes will be implemented to extend “green” or “yellow” zones

Create timeline charts for all of the Level 3 scenarios from the HVA; the timeline is dependent upon the Level 3 duration (how many hours?)

Level 1: Supplies are available and are ordered and received

Level 2: Internal supply shortages or utility failures require partial or total patient evacuation from the facility

Level 3: Shortages and/ or utilities are not sufficient to continue normal patient care, although evacuation is not possible and outside assistance is not available


EMERGENCY


Utility Failure Operational Impact Chart

Hours after utility failure 0 8 16 24 32 40 48 56 64 72 80 88 96 Normal power failure Emergency power failure Water pressure low Entire loss of water pressure Loss of steam generation (winter) Loss of steam generation (summer) Loss of natural gas Loss of propane Chiller failure (winter) Chiller failure (summer) Major air handler failure Failure of sewage system Sump pump failure Loss of bulk oxygen Loss of medical air Loss of bulk nitrous oxide Loss of medical vacuum Computer server failure Telephone switch failure Failure of elevators Pneumatic tube system failure


EMERGENCY


Consumable Supply Operational Impact Chart

Hours after emergency occurs 0 8 16 24 32 40 48 56 64 72 80 88 96 Fuel oil (winter) Fuel oil (summer) Gasoline Propane fuel Natural gas Potable water Non-potable water Oxygen Medical air Nitrous Oxide Nitrogen Nutrition supplies Pharmaceutical supplies IV solutions Pharmaceutical medications General patient supplies Surgical supplies Environmental cleaning supplies Central sterile supplies General office supplies


EMERGENCY


Utility Failure Operational Impact Chart

Hours after utility failure 0 8 16 24 32 40 48 56 64 72 80 88 96 Normal power failure Emergency power failure Water pressure low Entire loss of water pressure Loss of steam generation (winter) Loss of steam generation (summer) Loss of natural gas Loss of propane Chiller failure (winter) Chiller failure (summer) Major air handler failure Failure of sewage system Sump pump failure Loss of bulk oxygen Loss of medical air Loss of bulk nitrous oxide Loss of medical vacuum Computer server failure Telephone switch failure Failure of elevators Pneumatic tube system failure

Based on the duration of the Level 3 scenario, the timeline may only extend to 24 or 48 hours, rather than 96

24 hours

48 hours


EMERGENCY


Issue: Emergency Communication Strategies

Best Practices:

Create notification charts with phone numbers, email addresses, etc.

Include for staff, external authorities, community, media, vendors

Determine what information will be shared with other health care providers in the area

Ensure that liaisons are established with government agencies

Verify that MOU’s for alternative care sites are updated

Establish and check operation of back-up communication systems, such as the internet, cell phones, two-way radios, emergency land lines, and amateur radio operators


EMERGENCY


Issue: Resource and Asset Strategies

Best Practice:

Plans should be in place to stockpile and reorder critical clinical and non-clinical supplies (supply inventory should be checked routinely)

Written procedures should describe how the needs of staff and families of staff will be met during an emergency

A plan to share community resources and assets should be in place

A practical patient evacuation plan that includes partial or total evacuation outside of the facility is required

Logistics for evacuation must include: 1) transportation; 2) staffing; 3) medications; 4) equipment, and; 5) the medical record


EMERGENCY


Issue: Safety and Security

Best Practices:

Security staffing plans during emergencies must be established

Expectations with outside police agencies should be identified

Plans to dispose of infectious and hazardous waste must be created

Procedures to treat contaminated patients must be written (radioactive, biological and chemical)

Methods to lock down the facility to prevent entry must be provided

Methods to minimize staff and patients from leaving the facility must be planned

Plans must be in place to control traffic accessing the facility


EMERGENCY


Issue: Staff Roles and Responsibilities

Best Practices:

Review and update as necessary, the ICS organizational chart and job action sheets (check after each drill)

Ensure that hospital staff have participated in NIMS training

Discuss emergency expectations with the independent physicians who have privileges at the hospital

Select the primary and back-up command center locations

Have a method to identify incident command staff (ID badges, vests, caps, etc.)

Make sure that decisions regarding staff and family support needs (house and feed family and pets?) have been determined and are in writing


EMERGENCY


Issue: Utility Back-up Strategies

Best Practices:

Complete the utility timeline chart for the Level 3’s on the HVA

Determine which utilities require additional supplies, especially water and fuel

Determine the feasibility of redundant systems or supplies

Examples: Water – on-site well, water tower or nearby lake

Electricity – additional generators installed

Boilers – portable boiler “on a truck”

Medical gas – low pressure external connection, manifold

Fuel – additional on-site storage


EMERGENCY


Issue: Patient Management

Best Practices:

Identify which patients in the hospital are considered “vulnerable”

(neonatal intensive, pediatric, geriatric, dementia, behavioral health,

bariatric)

Consider plans to move vulnerable patients vertically without elevators

Plan for patient and staff hygiene and sanitation without water or sewer

Determine mortuary needs in the event of a pandemic

Evaluate back-up methods to track patient information in the event that

the electronic information system fails


EMERGENCY


Issue: Privileges to LIP’s During Disasters

Best Practices: Privileges granted only when EOP has been activated

Medical staff bylaws indicate to who and how to grant privileges, and policies will indicate how performance will be evaluated

Minimum privileging requirements include:

1. Current picture ID and license to practice

2. Must be a member of a recognized disaster response group

3. Proof of government authority to provide services during a disaster

Mentor must be provided to oversee LIP

Hospital determines within 72 hours if privileges should continue


EMERGENCY


Issue: Privileges to Volunteer Practitioners During Disasters

Best practices: Hospital assigns responsibilities only when EOP has been activated

Hospital identifies in writing who is eligible and how to assign disaster responsibilities to non-LIP’s

Minimum requirements to assist during disasters include:

1. Current picture ID and license to practice professional specialty

2. Must be a member of a recognized disaster response group

3. Confirmation by hospital staff the individual is qualified

Mentor must be provided to oversee volunteer

Hospital determines a method to evaluate performance and decide within 72 hours if responsibilities should continue


EMERGENCY


Issue: Emergency Drills

Best Practices: Two drills per rolling 12-month period should be performed, based on the HVA

At least one drill per 12 months for each business occupancy

At least one “influx” drill for a disaster receiving station

Community-wide and influx drills can be performed concurrently

Don’t forget about patient “surge” drills (IC.01.06.01) and infant/ pediatric abduction drills (EC.02.01.01)

The community “non-support” drill can be a tabletop

Trained staff, including a physician and leadership, must evaluate the drill and must document the six core areas in the evaluation


EMERGENCY


Issue: Emergency Drills (continued)

Best Practices: To count, drills and actual disasters must:

1) initiate the incident command system (ICS)

2) require additional internal or external resources, beyond what is normally

available

3) the drill or actual disaster must be documented and include an evaluation

of the six critical core areas

Tabletop simulations are permitted for the community and community non-

support drills only


EMERGENCY


Questions?

biggest pitfalls and best practices in emergency management healthcare engineering consultants...

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emergency management

hva eop

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emergency drills

emergency activities

security em

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