Planning for Health Systems

Overview Development of a hospital-based disaster and emergency preparedness plan Recognize the importance of communication with external agencies (County, State, Federal) Consider how a biological emergency (naturally occurring or terrorism-related) may pose different challenges to hospital disaster response

Hospital Disaster and Emergency Preparedness Basic principles Decision making structure (Incident Command) Parallel normal standard operating procedure (SOP) whenever possible Flexibility Protection of staff and patients Communication Coordination with community-wide plans Training and Exercises

Incident Command Structure HEICS (Hospital Emergency Incident Command System) Set of procedures which facilitate coordination and integration of disaster response Flexibility Accountability of all positions within organizational chart Job action sheets Common language facilitates integration with external partners http://www.emsa.cahwnet.gov/Dms2/heics3.htm

Disaster and Emergency Preparedness Normal SOP Familiarity Do what you do best Medical staff follow departmental plans except where individual assignments are published in hospital-wide (e.g HEICS-based) plan Suggest coordinating area for staff reporting for assignment (responders) not be ER (particularly in large hospitals)

Flexibility “All Hazards Response” Internal vs. external event Multiple casualties WMD/NBC vs naturally occurring disaster (e.g. weather) vs trauma Insult to infrastructure Limited resources

Biological vs Trauma (or Chemical or Radiological) No disaster scene Implications for field response / triage ER may not be the entry point to hospital for affected individuals Clinics Front door May already be inpatients! May be more difficult to contain, and pose greater risk to health care workers Issues of decontamination Personal Protective Equipment

Protection of staff and patients (before, during and after event) Facility security Exposure mitigation Decontamination…a community/public health response versus hospital responsibility Timely and accurate information Training and education

Communication Unified voice Internal and external Unified voice Coordination with County, State and Federal Use of multiple strategies Timely and accurate

Disaster and Emergency Preparedness Coordination Established triage and transport protocols Relocation and shelter plans Community decontamination plan County and State agencies National Medical Disaster System Discharge and admission planning

Surge Capacity It’s not just about beds, it’s about resources! Bed capacity Licensed hospital beds Staffed beds Bed mix (critical care, isolation etc.) Alternative sites Personnel Medical Nursing Ancillary (radiology, laboratory, PT, pharmacy) Security Housekeeping Dietary

Resources (contd.) Supplies/Equipment/Infrastructure Dressings Drugs i.v. fluids Oxygen Food Water Linen Power Telecommunications Heat

Resources Individual Facility Local (town, city, county) Regional State Federal

Integration of Disaster Planning examples: Metropolitan Medical Response System (MMRS) National Disaster Medical System (NDMS) Strategic National Stockpile (formerly known as the National Pharmaceutical Stockpile) Disaster Medical Assistance Teams (DMAT)

Disaster Exercises Identify weaknesses in plan Refine roles and responsibilities Assess adequacy of resources Improve coordination / communication both internally and externally

1961 Academy Award Nominee, Short Subject (Cartoon) Warner Brothers