Hospital Response to Hospital Response to DisastersDisasters

HARRT 2004HARRT 2004

Hospital PreparednessHospital Preparedness

9/11 had placed hospital preparedness under 9/11 had placed hospital preparedness under the microscope at the local, state, and federal the microscope at the local, state, and federal levelslevels

Although the “All Hazards” approach is the norm, Although the “All Hazards” approach is the norm, hospitals have entered a new era in hospitals have entered a new era in preparednesspreparedness

At this point hospitals are amongst the last At this point hospitals are amongst the last players to join the community efforts, prior to players to join the community efforts, prior to 9/11, hospitals had not viewed themselves as 9/11, hospitals had not viewed themselves as part of the local response systempart of the local response system

Hospital Preparedness:Hospital Preparedness:

Clarification for HIPPA, EMATALA, and Clarification for HIPPA, EMATALA, and EPA regulatory requirements and their EPA regulatory requirements and their applications in emergency situations is applications in emergency situations is vitalvital

Relationship building amongst the Relationship building amongst the stakeholders takes time and truststakeholders takes time and trust

Large scale events don’t just happen in Large scale events don’t just happen in major metropolitan areas---all hospitals major metropolitan areas---all hospitals are potential respondersare potential responders

Hospital Preparedness for large Hospital Preparedness for large scale events:scale events:

Hospitals have always planned for disasters, but Hospitals have always planned for disasters, but not large scale eventsnot large scale events

Since 9/11, hospitals have begun to focus on Since 9/11, hospitals have begun to focus on readiness for large scale terrorism events as readiness for large scale terrorism events as wellwell

Community involvement Community involvement is necessary in large scale is necessary in large scale planning---something planning---something that hospitals have little that hospitals have little experience withexperience with

Hospital Surge Capacity: Hospital Surge Capacity: InventoriesInventories

Just-in-time inventory models have Just-in-time inventory models have become the normbecome the norm Pharmaceuticals Pharmaceuticals (antibiotics, vaccines, anti-viral medications)(antibiotics, vaccines, anti-viral medications)

Food storesFood stores PPE to handle large volumes PPE to handle large volumes

Hospitals lack ventilatorsHospitals lack ventilators A recent GAO report revealed that most A recent GAO report revealed that most

hospitals have <10 ventilators per 100 staffed hospitals have <10 ventilators per 100 staffed bedsbeds

Hospital Surge Capacity: Hospital Surge Capacity: InventoriesInventories

A 48-72 “stand alone” capability is A 48-72 “stand alone” capability is essential essential

Hospitals also lack the space necessary to Hospitals also lack the space necessary to accomodate enhanced caches, create accomodate enhanced caches, create additional triage, patient care, and morgue additional triage, patient care, and morgue areasareas

Hospital Planning:Hospital Planning:

Planning is a dynamic processPlanning is a dynamic process A plan is NEVER completeA plan is NEVER complete The best plans are based on predictable The best plans are based on predictable

behaviorsbehaviors Plans must be practicedPlans must be practiced

Disaster drills are not punitive activitiesDisaster drills are not punitive activities Disaster drills are learning laboratoriesDisaster drills are learning laboratories Disaster drills provide opportunitiesDisaster drills provide opportunities

HEICS and the ClinicianHEICS and the Clinician

Do you know what your role is in a Do you know what your role is in a disaster?disaster?

Have you ever been part of a disaster Have you ever been part of a disaster drill?drill?

Have you been educated on the disaster Have you been educated on the disaster plan at your facility?plan at your facility?

What would you do in the event of a What would you do in the event of a disaster?disaster?

HEICS:HEICS:Hospital Emergency Incident Hospital Emergency Incident

Command SystemCommand System Incident Command System or Incident Incident Command System or Incident

Management System characteristicsManagement System characteristics Universal language for all clinicians to useUniversal language for all clinicians to use Small span of controlSmall span of control Small span of controlSmall span of control Delineation of authorityDelineation of authority

Delayed Treatment UnitDelayed Treatment Unit

ActionsActions Identification of Delayed Treatment Unit LeaderIdentification of Delayed Treatment Unit Leader

• Assignment of roles and responsibilitiesAssignment of roles and responsibilities• Increased responsibilities of care providersIncreased responsibilities of care providers

Disaster Medical CareDisaster Medical Care• A, B, C’sA, B, C’s• Pain ManagementPain Management• ↑ ↑ Resource limitation utilizationResource limitation utilization

Secondary TriageSecondary Triage• Triage of patients in DTUTriage of patients in DTU• Triage of incomingTriage of incoming

Emergency Operations Center:Emergency Operations Center:HospitalHospital

Purpose----Under the direction of the EICPurpose----Under the direction of the EIC To maintain overall command of the overall To maintain overall command of the overall

hospital operationshospital operations Oversight of the Emergency Operations Oversight of the Emergency Operations

CenterCenter To maintain communications both internal and To maintain communications both internal and

externalexternal Data gathering both internal and externalData gathering both internal and external

• Magnitude of eventMagnitude of event• Resource availabilityResource availability