Preparedness & Disaster Mgmt

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Instructions


	Hospital Preparedness Program		Hospital Preparedness Program
INSTRUCTIONS:		Issues to consider for preparedness include, but are not limited to:
		1	Status of current plans
Evaluate potential for event and response among the following categories using		2	Frequency of drills
the hazard specific scale. Assume each event incident occurs at the worst		3	Training status
possible time (e.g. during peak patient loads).		4	Insurance
		5	Availability of alternate sources for critical supplies/services
Please note specific score criteria on each work sheet to ensure accurate recording.
Issues to consider for probability include, but are not limited to:		Issues to consider for internal resources include, but are not limited to:
1	Known risk	1	Types of supplies on hand/will they meet need?
2	Historical data	2	Volume of supplies on hand/will they meet need?
3	Manufacturer/vendor statistics	3	Staff availability
		4	Coordination with MOB's
Issues to consider for response include, but are not limited to:		5	Availability of back-up systems
1	Time to marshal an on-scene response	6	Internal resources ability to withstand disasters/survivability
2	Scope of response capability
3	Historical evaluation of response success	Issues to consider for external resources include, but are not limited to:
		1	Types of agreements with community agencies/drills?
Issues to consider for human impact include, but are not limited to:		2	Coordination with local and state agencies
1	Potential for staff death or injury	3	Coordination with proximal health care facilities
2	Potential for patient death or injury	4	Coordination with treatment specific facilities
		5	Community resources
Issues to consider for property impact include, but are not limited to:
1	Cost to replace	Complete all worksheets including Natural, Technological, Human and Hazmat.
2	Cost to set up temporary replacement	The summary section will automatically provide our specific and overall relative threat.
3	Cost to repair
4	Time to recover
Issues to consider for business impact include, but are not limited to:
1	Business interruption
2	Employees unable to report to work
3	Customers unable to reach facility
4	Company in violation of contractual agreements
5	Imposition of fines and penalties or legal costs
6	Interruption of critical supplies
7	Interruption of product distribution
8	Reputation and public image
9	Financial impact/burden

Natural Hazards

HAZARD AND VULNERABILITY ASSESSMENT TOOL
NATURALLY OCCURRING EVENTS
		SEVERITY = (MAGNITUDE - MITIGATION)
EVENT	PROBABILITY	HUMAN IMPACT	PROPERTY IMPACT	BUSINESS IMPACT	PREPARED-NESS	INTERNAL RESPONSE	EXTERNAL RESPONSE	RISK
	Likelihood this will occur	Possibility of death or injury	Physical losses and damages	Interuption of services	Preplanning	Time, effectivness, resouces	Community/ Mutual Aid staff and supplies	Relative threat*
SCORE	0 = N/A 1 = Low 2 = Moderate 3 = High	0 = N/A 1 = Low 2 = Moderate 3 = High	0 = N/A 1 = Low 2 = Moderate 3 = High	0 = N/A 1 = Low 2 = Moderate 3 = High	0 = N/A 1 = High 2 = Moderate 3 = Low or none	0 = N/A 1 = High 2 = Moderate 3 = Low or none	0 = N/A 1 = High 2 = Moderate 3 = Low or none	0 - 100%
Hurricane								0%
Tornado								0%
Severe Thunderstorm								0%
Snow Fall								0%
Blizzard
Ice Storm								0%
Earthquake
Tidal Wave
Temperature Extremes								0%
Drought								0%
Flood, External								0%
Wild Fire								0%
Landslide
Volcano
Epidemic								0%
AVERAGE SCORE	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0%
*Threat increases with percentage.
0		RISK = PROBABILITY * SEVERITY
0		0.00	0.00	0.00

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Technological Hazards

HAZARD AND VULNERABILITY ASSESSMENT TOOL
TECHNOLOGIC EVENTS
		SEVERITY = (MAGNITUDE - MITIGATION)
EVENT	PROBABILITY	HUMAN IMPACT	PROPERTY IMPACT	BUSINESS IMPACT	PREPARED-NESS	INTERNAL RESPONSE	EXTERNAL RESPONSE	RISK
	Likelihood this will occur	Possibility of death or injury	Physical losses and damages	Interuption of services	Preplanning	Time, effectivness, resouces	Community/ Mutual Aid staff and supplies	Relative threat*
SCORE	0 = N/A 1 = Low 2 = Moderate 3 = High	0 = N/A 1 = Low 2 = Moderate 3 = High	0 = N/A 1 = Low 2 = Moderate 3 = High	0 = N/A 1 = Low 2 = Moderate 3 = High	0 = N/A 1 = High 2 = Moderate 3 = Low or none	0 = N/A 1 = High 2 = Moderate 3 = Low or none	0 = N/A 1 = High 2 = Moderate 3 = Low or none	0 - 100%
Electrical Failure								0%
Generator Failure								0%
Transportation Failure								0%
Fuel Shortage								0%
Natural Gas Failure								0%
Water Failure								0%
Sewer Failure								0%
Steam Failure								0%
Fire Alarm Failure								0%
Communications Failure								0%
Medical Gas Failure								0%
Medical Vacuum Failure								0%
HVAC Failure								0%
Information Systems Failure								0%
Fire, Internal								0%
Flood, Internal								0%
Hazmat Exposure, Internal								0%
Supply Shortage								0%
Structural Damage								0%
AVERAGE SCORE	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0%
*Threat increases with percentage.
0		RISK = PROBABILITY * SEVERITY
0		0.00	0.00	0.00

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Human Hazards

HAZARD AND VULNERABILITY ASSESSMENT TOOL
HUMAN RELATED EVENTS
		SEVERITY = (MAGNITUDE - MITIGATION)
EVENT	PROBABILITY	HUMAN IMPACT	PROPERTY IMPACT	BUSINESS IMPACT	PREPARED-NESS	INTERNAL RESPONSE	EXTERNAL RESPONSE	RISK
	Likelihood this will occur	Possibility of death or injury	Physical losses and damages	Interuption of services	Preplanning	Time, effectivness, resouces	Community/ Mutual Aid staff and supplies	Relative threat*
SCORE	0 = N/A 1 = Low 2 = Moderate 3 = High	0 = N/A 1 = Low 2 = Moderate 3 = High	0 = N/A 1 = Low 2 = Moderate 3 = High	0 = N/A 1 = Low 2 = Moderate 3 = High	0 = N/A 1 = High 2 = Moderate 3 = Low or none	0 = N/A 1 = High 2 = Moderate 3 = Low or none	0 = N/A 1 = High 2 = Moderate 3 = Low or none	0 - 100%
Mass Casualty Incident (trauma)								0%
Mass Casualty Incident (medical/infectious)								0%
Terrorism, Biological								0%
VIP Situation								0%
Infant Abduction								0%
Hostage Situation								0%
Civil Disturbance								0%
Labor Action								0%
Forensic Admission								0%
Bomb Threat								0%
AVERAGE	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0%
*Threat increases with percentage.
0		RISK = PROBABILITY * SEVERITY
0		0.00	0.00	0.00

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Hazardous Materials

HAZARD AND VULNERABILITY ASSESSMENT TOOL
EVENTS INVOLVING HAZARDOUS MATERIALS
		SEVERITY = (MAGNITUDE - MITIGATION)
EVENT	PROBABILITY	HUMAN IMPACT	PROPERTY IMPACT	BUSINESS IMPACT	PREPARED-NESS	INTERNAL RESPONSE	EXTERNAL RESPONSE	RISK
	Likelihood this will occur	Possibility of death or injury	Physical losses and damages	Interuption of services	Preplanning	Time, effectivness, resouces	Community/ Mutual Aid staff and supplies	Relative threat*
SCORE	0 = N/A 1 = Low 2 = Moderate 3 = High	0 = N/A 1 = Low 2 = Moderate 3 = High	0 = N/A 1 = Low 2 = Moderate 3 = High	0 = N/A 1 = Low 2 = Moderate 3 = High	0 = N/A 1 = High 2 = Moderate 3 = Low or none	0 = N/A 1 = High 2 = Moderate 3 = Low or none	0 = N/A 1 = High 2 = Moderate 3 = Low or none	0 - 100%
Mass Casualty Hazmat Incident (>= 5 victims)								0%
Small Casualty Hazmat Incident (with < 5 victims)								0%
Chemical Exposure, External								0%
Small-Medium Sized Internal Spill								0%
Large Internal Spill								0%
Terrorism, Chemical								0%
Radiologic Exposure, Internal								0%
Radiologic Exposure, External								0%
Terrorism, Radiologic								0%
AVERAGE	0.00	0.00	0.00	0.00	0.00	0.00	0.00	0%
*Threat increases with percentage.
0		RISK = PROBABILITY * SEVERITY
0		0.00	0.00	0.00

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Summary

SUMMARY OF HAZARDS ANALYSIS
	Natural	Technological	Human	Hazmat	Total for Facility
Probability	0.00	0.00	0.00	0.00	0.00
Severity	0.00	0.00	0.00	0.00	0.00
Hazard Specific Relative Risk:	0.00	0.00	0.00	0.00	0.00
Copy to OEM	Date

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Summary

Hazard Specific Relative Risk

Priorities & Measures

Relative Impact on Facility

Probability and Severity of Hazards to East Texas Gulf Coast Region

Priorities
	Epidemic	Hurricanes/Floods w/associated utility failure	chemical/hazmat
Mitigation	handwashing and cough hygeine at healthcare facilities staff education, work with public health officials to educate public, develop strategies for surge capacity	Generators, fuel contracts, facility hardening, staffing plans, utility redundancy	All facilities have decon equipment and trained personnel. Early notification systems and relationships with local refineries.
Preparedness	Education, signage, development of RACS system for surge capacity. Facilities to have redundant supply vendors and initial stockpile of supplies/medications. Develop staff plans for decreased workforce/increase patient demand	Redundant vendors, evacuation/shelter in place plans, regional coordination, identification of resources to include transportation assets.	Regular decon training and exercises. Meetings with local LEPC and refinery officials
Response	Work with public health, OEM and CMOC for surge capacity, alternate care sites, and patient load sharing	Work with local OEM, EMS and regional jurisdictions to coordinate response and resources/requests	Preserve facility and staff from contamination, provide rapid and effective decontamination capabilities to prevent death and further injury.
Recovery	Return to normal operating procedures	Return to normal operating procedures	Return to normal operating procedures
Measures

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