Hospitals and Disaster Preparedness: How Ready Are We?
By Debra Wood, RN, contributor
In a world plagued by earthquakes, hurricanes, tsunamis and terrorism, hospitals across the country have studied the risks for their locales and prepared their clinicians to work with first responders, other facilities and each other to provide optimal care regardless of the circumstances.
“Planning is everything, because it makes people think about what could happen and how to lesson the impact,” said Martin Klett, RN, BSN, emergency preparedness manager for Memorial Healthcare System in Hollywood, Fla.
Michael Wargo, RN, BSN, MBA, PHRN, director of the offices of emergency preparedness and emergency management at Lehigh Valley Health Network in Allentown, Penn., added that it’s imperative for hospitals and health systems to prepare, because they are key to any disaster response. People will continue to seek care from hospitals, so they must maintain normal operations and scale up to handle the emergency.
“The more prepared you are, the more prepared the community is and the more resources; it offsets the impact, the scale [of the disaster],” Wargo said.
The Joint Commission requires accredited hospitals have a plan that covers all natural and man-made disasters, and the Centers for Medicare and Medicaid Services mandates that participating hospitals develop and implement a comprehensive plan to ensure patient safety during emergency situations, such as natural disasters, bioterrorism threats and nuclear accidents.
“Hospitals don’t really have a choice about whether they comply with having an emergency preparedness plan,” said Roberta Carroll, RN, MBA, senior vice president of Aon Risk Solution’s health care practice in Tampa, Fla. “How thorough and appropriate for their locale depends on how much they do in the planning stage.”
Not all facilities prepare as extensively as others, according to a March 2011 paper from the Centers for Disease Control and Prevention’s National Center for Health Statistics, which reports that nearly all hospitals have response plans for chemical releases, natural disasters, epidemics and biological incidents, but only 81.3 percent had plans for a nuclear accident and 79.6 percent had plans for explosive or incendiary accidents. About 67.9 percent had all-hazard plans.
“Our program is all hazard, meaning we prepare for all different types of emergencies, from natural disasters, such as tornadoes and hurricanes, to technological accidents like hazmat spills, as well as intentional or manmade incidents, like terrorist attacks,” said Eric Alberts, manager of emergency preparedness at Orlando Health in Orlando, Fla. “The occurrence and frequency of emergencies is on the upswing. The things we plan for are likely and could happen in the Central Florida area. We do the best we can to prepare for ourselves, our patients and our team members.”
Mercy Medical Center in Baltimore also takes an all-hazards approach. Annually, the hospital conducts a risk assessment, said Chip Hatchell, RN, BSN, CPHRM, director of patient safety at Mercy.
As with the majority of hospitals the National Center for Health Statistics studied, Orlando Health, Memorial Healthcare, Lehigh Valley and Mercy Medical coordinate with public health officials, law enforcement, fire rescue and other hospitals.
“We reach out to other neighboring hospitals that every day might be competitors, but during a disaster or crisis, there should be no competition,” Wargo said.
Not only must hospitals plan, drills and exercises help ensure that the preparations work. Orlando Health participated in a full-scale community exercise in January, with 26 other entities including four area hospitals.
As part of an April citywide readiness drill, Memorial Healthcare accepted about 30 “victims” of a terrorist attack, exposing them to pneumonic plague.
“The more we exercise and drill, the more we can identify what works and what doesn’t work and how to improve,” Klett said.
Memorial stockpiles antibiotics and plans for how to handle the dead, if the morgue reaches capacity.
The federal report found more than half of hospitals staged epidemic drills but only one-third included mass vaccination or medication distribution. Mercy Medical Center conducts annual influenza clinics that serve as drills if the hospital had to dispense antibiotics for anthrax or some other emergency in mass quantities.
“Testing things like that is to see how well prepared we are for a major disaster,” Hatchell said. “We look at turnaround time, how quickly we can get people in and out.”
The National Center for Health Statistics found that only one-half of hospitals have plans that accommodate the needs of children, people who speak a different language or persons with disabilities.
“We include them in all of our emergency exercises,” Alberts said. “Every day we have patients with special needs and language barriers, so it only makes sense to plan that way.”
Nationally, the federal study found that most hospitals would cancel elective procedures and admissions in the event of a disaster. But only half of the facilities had plans to place beds and other equipment in areas not traditionally used for patient care or to convert medical-surgical units to critical care beds. And about half of the hospitals had developed adjustments to standards of care for allocation of mechanical ventilators during mass casualties.
“You have to change the available resources to do the greater good for the most, and that’s part of the triage,” Wargo said.
Lehigh Valley keeps additional equipment, including ventilators, on hand to deal with surges, but Wargo said that not having enough staff limits the ability to serve higher volumes.
About half the hospitals responding to the national survey had planned for advance registration of health care professionals who could assist during an event.
“We’re always looking for nurses to step out and help out during disasters,” said Klett, who indicated nurses can volunteer through the Medical Reserve Corps Network. He also encourages all health care professionals to develop a home plan.
Carroll and Albert urge nurses to participate in their hospitals’ disaster planning and to learn more about emergency preparedness. The Department of Homeland Security offers free online courses so clinicians can learn more.
“Nurses are one of the keys to responding to an emergency in a hospital, and without them, the response will fail,” Alberts said. “Getting their involvement and feedback in how to develop plans within the hospital is very important. They are critical to the response.”
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