Emergency Management Preparing for Internal and External Emergencies and Disasters.
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Transcript of Emergency Management Preparing for Internal and External Emergencies and Disasters.
Emergency Management
Preparing for Internal and External Emergencies and Disasters
Definition of an Emergency
• A sudden, unexpected event requiring immediate action due to a potential threat to health and safety.
• Joint Commission on Accreditation of Healthcare Organizations (JCAHO) defines an emergency as a natural or man-made event that suddenly or significantly:
Disrupts the environment of care
Disrupts care and treatment of patients
Changes or increases the demand for services
Definition of a Disaster• A sudden, unplanned event that makes it difficult, or
impossible for a facility to carry out essential activities. During a disaster, the needed resources are greater than those available
• A facility disaster is an event in which the demand for health services from the event or existing patients, exceeds the ability of the to provide those services.
• A disaster can occur at any level – local, state, regional, country or multiple countries.
Classification of Facility Disasters
• Internal Disasters- events that result in loss of resources used for regular activities.Examples: fire, smoke, fumes, loss of utilities, worker strikes, release of chemicals or radiation, hostage situations, or bomb threats
• External Disasters – events that occur in the community outside the hospital that may effect the facility’s ability to carry out regular activities.Examples: hurricanes, tornados, floods, storms, earthquakes, train derailments, plane crashes, power outages, terrorist attacks, and riots.
Facility Emergency Preparedness
Facilities must be prepared to respond to a wide range of emergencies. These events may include natural disasters, terrorist attacks or any other situation that dramatically increases the number of patients who come to the facility needing treatment.
Facility emergency preparedness helps to reduce the impact of emergencies and disasters while continuing to provide essential day-to-day services.
Preparedness phases include:– Prevention– Response– Recovery– Mitigation
Emergency Management Activities• Prevention – activities aimed at avoiding or intervening
to stop an emergency from occurring
ex. Examining the facility for potential dangers and correcting
• Mitigation – lesson or eliminate the impactex. Back-up generator, Planning for likely events
• Response – address the immediate effects of the emergency
ex. Transferring of Patients to Alternate Site
• Recovery – actions taken to restore normal operations
ex. Clean-up operations
Goals and Objectives
• Ensure safety of employees, staff, visitors
• Assure availability of dialysis care
• Protect PHI
• Mitigate DamagePlanning, Sharing of Resources, Building/Equipment/System Changes
• Expedite return to normal operations
• Comply with laws and regulations
Emergency Management Plans
• Easy to understand• Functional, flexible and adaptive• Consider various views• Written and updated annually• Comprehensive, All-Hazard• Education and Training• Adhere to existing standards, requirements• Include outside agencies
Creating a Plan• Planning
• Administrative
• Communications
• Preparation
• Record Keeping
• Security
• Supplies
• Transportation
• Power
• Water Systems
• Waste Disposal
• Recovery
Assumptions when Creating a Plan
• Dialysis facilities are not usually included in state or local disaster plans
• Disasters burden outside resources• Disasters may interrupt utilities services• Communications may be impacted• Staffing Shortages• Impractical to plan for all emergency types and sizes• Acute renal services may be in need
Risk Based Approach to Planning
• Hazard Vulnerability Analysis
1) Identify Potential Risks/Hazards
Internal/External
2) Identify Possible Causes
3) Assign Risk Level (Probability)
Hazard Vulnerability AnalysisNatural
DisastersCriminal
Terrorist ActionCivil
DisastersAccident Internal Disasters
snowstorms hailstorms ice storms tornadoes floods earthquake
bomb threat/incident nuclear, chemical or biological attack hostage incident with multiple victims
demonstrations riots strikes
buses planes multiple vehicle accidents explosions bridge collapse hazardous material spills/events
Fire physical damage from natural disasters such as snow storms, ice storms etc utilities failure broken water mains explosions hazardous material spills workplace violence hostage taking infant abduction acts of terrorism
All Hazard Planning
All-hazard planning, the foundation of preparedness, is a process that makes certain that each individual, each department and the entire facility is always ready for any type of emergency that might occur.
Although each event has specific needs, many of the functions performed remain the same during any type of event.
Plan Activation - Event LevelsAlert Phase Minor Impact Moderate Impact Major Impact
Pre-disaster activation for alerting necessary staff to “stand by” in the event they are needed.
Administration is immediately notified.
Example:Storm Warning
Delay in providing daily hemodialysis services.
Administration is immediately notified.
Example:Storm
Suspension of services requiring temporary facility closer.
Administration is immediately notified.
Coordination with the Orleans/Genesee County Emergency Management Office is immediately enacted.
NYS DOH and ESRD Network are immediately notified.
Example:Loss of Water, Power
This would be an overwhelming disaster requiring immediate facility evacuation and indefinite suspension of services.
911 call initiated
Hospital Administration is immediately notified.
Coordination with the Orleans/Genesee County Emergency Management Office is immediately enacted.
NYS DOH and ESRD Network are immediately notified.
Example:Fire, Chemical, Radiological, Biological Event
Problems in Disasters
During disasters, problems often occur because hospital and management systems that work well on a day-to-day basis cannot effectively meet the additional needs of the disaster.
– Lack of clearly defined leadership and chain of command
– Lack of accurate facts and information– Lack of, miscommunication, right amount
Incident Command System
Incident commander
Logistics SectionChief
Planning SectionChief
Finance SectionChief
Operations SectionChief
Liaison OfficerSafety/Security
Officer
Public InformationOfficer Incident Command
Possible Emergencies and Associated Components
• Contaminated Water Supply• Loss of Utilities• Fire/Water Damage• Loss of Communications• Supply Shortages• Increase in Census/Surge• Staffing• Financial Concerns
Contaminated Water Supply
- May or May Not be Informed- Indicated by water system monitoring.
• Contact the municipal water supplier/County Health Department for present status of water supply
• Adjustments may have to be made to your water treatment system
• Contact water system vendor or manufacturer • Water meets EPA requirements or pre-existing quality
prior to use• Increased Monitoring
Loss of Utilities• Generator
Calculate Power RequirementsExisting transfer switchPower Plan – full or partial loadFuel PlanMonitoringTest Emergency Power (Hospital Based)
• Bulk Water (could delay recovery phase)
Calculate ConsumptionConnectionsSuspend ReuseShorten TreatmentsTesting/Monitoring
Bulk/Tanker Water at the Facility
Typical Water Treatment Systems designs based on EPA MCL’s.
• NYSDOH Certification of Approval for Distribution of Bottle or Bulk Water
• Verification of compliance with EPA standards for drinking water
• Testing Records for MCL’s• Disinfection Records• Approved Transportation Container
Fire/Water DamageDamage Assessment Check List (Two Types)
Survey Assessment – quick, briefWhat you Have What you NeedWhat you Lost
- Detailed Assessment• Physical/Equipment/Supplies• Current Condition and Safety Risk• Certified for use or service
Communications
Loss of Landline• Cell Phones – Machine Interference• Internet – HAN/HPN• Two Way Radio• Runners• TV/Media• Battery Powered Radio
Supply Shortages
• Days on Hand
• Dialysis Specific
• What is required Per/Treatment
• Emergency Purchase Orders/Cash on hand
Increase in Census/Surge• Limited to C of O• Rationing of Treatments/Alternate Schedules• Supplies, Utilities Consumption• PHI• Transportation• Staffing
• NYS DOH Waivers?
Staffing• Availability
Reserves and National Guard staff may be calledTravel – Driving BansTypes Needed – Professional, SupportWho can do what?
• Cross Credentialing• Providing for staff in sustained operations
Nutrition, Health, Rotation, Housekeeping, Family Issues, Incentives, Communication
• Educate Staff on Home Preparedness
Financial Concerns• Obtaining Supplies• Emergency Payroll• Billing• Personnel Policies• Inventory Control• Insurance Review• Documentation
Summary
• Develop Emergency Management Plans
• Keep Plan readily available
• Train, Review, Update Plans to Changing Environment
• Be active with your local Emergency Management agency (EMO)
• Mutual Aid Agreements (MOU’s)
• List of local vendors/suppliers/labs for assistance
• Preventative Maintenance
• Establish a Decision Making Tree/Center (EOC)Incident Command System
Emergencies Stop Being One
When You are Prepared for It
References
http://www.cms.hhs.gov/ESRDNetworkOrganizations/Downloads/EmergencyPreparednessforFacilities2.pdf
http://www.bt.cdc.gov/disasters/hurricanes/katrina/watersystems.asp
http://www.bt.cdc.gov/disasters/hurricanes/katrina/reopen_healthfacilities.asp
http://www.bt.cdc.gov/disasters/watersystemrepair.asp
http://www.nyhealth.gov/nysdoh/water/main.htm
http://www.fda.gov/cdrh/emergency/dialysis.html#1
References
http://www.cdc.gov/ncidod/dhqp/dpac_dialysis_boilwater.html#
http://www.aami.org/publications/HH/Katrina.pdf
http://www.aami.org/publications/HH/Water.quality.Payne.pdf
http://www.aami.org/publications/HH/Practical.Concepcion.pdf
http://www.aami.org/publications/HH/Dialysate.Hoenich.pdf
http://www.bt.cdc.gov/disasters/hurricanes/katrina/pdf/watersystems.pdf