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)