Management of Health Care Organizations
Chapter 5: Preparing for Emergencies
Chapter Objectives
• Appreciate the importance of planning for emergencies.
• Be familiar with the elements and use of the National Response Framework and the National Incident Management System.
• Appreciate the necessity for maintaining communication channels during an emergency.
Chapter Objectives
• Understand the importance of educating members of the general public regarding emergencies.
• Know the impact of emergencies on mental health.
• Appreciate the importance of volunteers.
• Understand the importance of after-action reports and other post-event activities.
Outline • Preparedness Planning
• The National Response Framework
• The National Incident Management System
• Using the National Incident Management System
• Communications
• Involvement of Hospitals
• Population Education
Outline
• Mental Health
• Shelters
• Volunteers
• Surveillance
• Post-Event Activities
• After-Action Reports
• Documentation
Preparedness Planning
• Health practitioners are vital components of the large system of emergency response.
• Responses to natural or human-made disasters must be made in a timely manner.
• Responders must be trained in advance.
• Health practitioners can ensure preparedness by applying the principles of assessment, policy development, and assurance.
Components of Preparedness
• Identify essential stakeholders
– Include firefighters, police, hospitals, volunteer agencies, health directors, and many others
– Trust, open channels of communication, and a common plan must be built
Components of Preparedness
• Identify available resources and establish formal agreements for their use in an emergency
• Train staff using information and exercises to prepare them for response
National Response Framework (NRF)
• The NRF specifies best practices and responsible authorities for incidents ranging from local weather emergencies to large-scale terrorist attacks
• Five key principles underlie the nation’s response to emergencies:
– Engaged partnership
– Tiered response
– Scalable, flexible, and adaptable operational capabilities
– Unity of effort through unified command
– Readiness to act
The National Incident Managing System (NIMS)
• Formal structure for coordinating and controlling resources and activities during emergencies
• Based on the Incident Command Structure
• Led by an Incident Manager/Commander, in charge of operations, logistics, planning, and finance sections.
• Uses common terminology and standard operating procedures
Roles in NIMS
• Incident Manager/Commander: coordinates the overall response
• Operations Section Leader: assumes direct control of all actions focused on resolving an emergency situation
• Logistics Section Leader: ensures that resources, supplies, and personnel are available for operations
• Planning Section Leader: develops guidelines to be implemented by operations
• Finance Section Leader: establishes financial guidelines and allocates funds
Using the NIMS • Activated in an emergency
• Three primary goals:
1. Save and preserve life
2. Stabilize the environment
3. Protect property
• Action must be aligned with existing emergency preparations and follow standard operating procedures
• Decision making is a critically important skill for incident commanders and section chiefs
Communications • Critical in an emergency
• Multiple channels must be maintained throughout a response
• Emergencies that disrupt infrastructure also disrupt conventional communication techniques such as telephones, fax, and e-mail
• Backups include: amateur radio, battery power, and runners
• Preparing different modes of communication before an emergency will improve response capabilities
Involvement of Hospitals
• Integral components of the public health system during emergencies
• Hospital capacity and occupancy data influences evacuation, containment, quarantine, treatment, and other decisions
• All emergency planning should include hospitals and other care providing institutions
• An early warning system should be developed that uses the information obtained from hospitals and other sources
Population Education
• An integral component of any preparedness planning
• Before an emergency occurs, messages must be developed and transmitted to educate the population
• A variety of methods, approaches, and information are needed for different communities, population subgroups, and types of emergencies
• Delivery channels for a response should be established and regularly reviewed
Mental Health
• Stress and problems related to mental health are present in all emergencies
• Mental health is important for both responders and members of the public during and after a crisis
• Mental health professionals must be involved in the planning and response. They should continually adjust their methods and messages as an emergency evolves or continues
Shelters
• Providing shelter for affected people is a need in most emergencies
• Shelters provide temporary housing, food, water, clothing, sanitary services, and may dispense antibiotics or immunizations or providing clinical care
• Personnel, resources, and coordination are essential
• Alternative strategy: “sheltering in place” (bringing resources to people who stay put in their homes)
Volunteers
• Trained volunteers can provide the additional help when professionals are unavailable or limited
• Must be identified, organized, trained, credentialed, engaged, and evaluated before an event
• The role of volunteers should be recognized during and after a response
Surveillance
• An important component of the warning system for a natural disaster or terrorist attack
• Vulnerable populations and potential targets should be identified and followed
• Systems should be tested and evaluated prior to an emergency
• Provides essential data regarding the size and scope of the event during and after the response
Types of Surveillance
• Syndromic Data Collection – Uses specific codes for different symptoms related
to the nature of an emergency
– Approach currently used by hospitals, laboratories, responders, and other organizations
• Sentinel Site Surveillance – Routine data are automatically compared using
pre-established thresholds for diseases or conditions of interest
– When the thresholds are exceeded, situation is investigated
Post-Event Activities
• Concluding is almost as important as undertaking a disaster response
• Planning should include objective criteria for the decision to demobilize
• Demobilization: formal conclusion of a response, but recovery operations may continue long after
• All activities should be reviewed and evaluated
• Documentation should be collected, reviewed, and filed
After-Action Reports
• Standardized forms or formats that contain a debriefing, an analysis, and a critique of the plan for the response
• Essential component of all emergency responses
• Enable organizations to identify and improve their deficiencies
Documentation
• Gathering data, records, and assessments concerning an incident is important and should be ongoing
• If not done during the incident, should be addressed as soon as possible after
• Essential from a legal perspective (can influence future rights to compensation for workers, volunteers, and members of the public harmed in or by the crisis)