Certified Hospital Emergency Coordinator (CHEC) Training Program Prerequisites for EOP Creation: Hazard Identification and Assessment

Objectives Describe an Emergency Operations Plan (EOP) Understand the use of the HVA in the development of the EOP Describe methods for completing hazard identification and threat analysis Identify components of a Hazard Vulnerability Analysis (HVA) An eerie picture from Joplin, lots of devastation and empty wheelchairs looking back on the hospital.

What is an Emergency Operations Plan? EOP Overview An EOP is the critical element of the Hospital Emergency Management Program (HEMP) Based on a well-considered HVA Is required by numerous regulatory bodies many facilities also refer to the EOP as an EMP…emergency management plan or Disaster Preparedness plan, although, in this class, the HEMP is the larger framework, in which the EOP sits.

EOP Overview, continued An EOP is a living document that: Assigns responsibilities to departments and individuals for carrying out specific actions when an emergency or disaster exceeds the capability or routine of an organization, facility, agency, or institution In doing so the EOP: Shows how actions will be coordinated Describes how people and property will be protected in emergencies and disasters

EOP Overview, continued Additionally, an EOP… Identifies personnel, equipment, facilities, supplies, and other resources available: Within the hospital and Among community partners

What’s in an Emergency Operations Plan? EOP elements & prerequisites Based on an Hazards Vulnerability Analysis (HVA) Compliance with standards and regulations Identification of hospital needs and resources Photo © Microsoft Corporation

EOP Prerequisite: Hazard Vulnerability Analysis (HVA) An HVA is an organized and formal approach to evaluating the probabilities and consequences of all hazards that might affect a facility Quote from Sun Tzu from the Art of War “Time spent in reconnaissance is seldom wasted” The time it takes to thoroughly evaluate each hazard is well worth it when it comes to defending choices to leadership, the committee, and/or regulators. “Time spent in reconnaissance is seldom wasted” -The Art of War by Sun Tzu

HVA, continued To create an HVA, these need to be assessed: Identifiable Hazards Probability/Risk of Hazard Vulnerability to Hazard Preparedness Efforts Hazard Identification All hazards Probability/ Risk of Hazard Likelihood of occurrence Vulnerability to Hazard Impact of incident Preparedness Efforts Mitigation A preliminary analysis should include: Identification of all potential hazards & risks (past, present, and anticipated) Vulnerabilities - areas effected by potential hazard (departments, wards, wings, etc.) Preparedness efforts

HVA, continued What are hazards? Include natural and/or man-made objects or events which provide for potential adverse effects on the health and safety of individuals, communities, and/or the environment, as well as the activity of business and other social, political, and economic considerations

Hazard Vulnerability Analysis (HVA): Types of Hazards CBRNE Attack Cyber Attack Active Shooters Other Terrorism Natural Flood Earthquake Tornado Hurricane Typhoon Landslide Tsunami Ice Storm Drought Wildfire Disease Epidemic Civil or Political Terrorist/Criminal Strike Protest Domestic Effects of War Public Demonstration Civil Disturbance Mass Migration Special Event or Special Security Event Accidental Use this slide to affirm and reiterate what people just discussed in the practical exercise. Each click will reveal the types of hazards. Order of appearance: Natural Terrorist Civil Accidental Special Chemical Spill Utility Outage Transportation Accident Industrial Accident Radiological Incident Nuclear Incident Explosion Inaugural State of the Union Olympics Major Sporting Event Summit Conference

Hazard Vulnerability Analysis (HVA): Take an All-Hazards Approach Be sure to think “outside the box” Include all types of hazards, man-made or natural Consider hazards within the hospital as well as in the surrounding community and environment Use historical data Look at other hospital EOPs and HVAs Consider various population types Reiterate that it is essential to consider the hazards not only for the hospital, but for all of the community. They all have an impact. USE HISTORICAL DATA where appropriate and using a reasonable timeline for measurement of that particular hazard Reiterate the importance of having external partners on the HEMC and actively involved, sharing their knowledge and expertise

Hazard Vulnerability Analysis Tool Just shown briefly as an example, like the next 3 slide.

Hazard Vulnerability Analysis Tool The previous tool does not include preparedness efforts, but this tool and the one on the following slide do include preparedness efforts which should be included appropriately when ranking hazards. Source: FEMA

Source: Screenshot of LiveProcess HVA Tool Source: Screenshot of LiveProcess

Hazard Vulnerability Analysis (HVA): Consult a variety of sources Consult your local county EOP and HVA AAP Website has Disaster Resources for peds Visit various state and federal websites to view hazard maps Consult www.FEMA.gov for flood maps View the National Weather Service’s history of storms For chemical hazards, visit: http://toxmap.nlm.nih.gov/toxmap/ Consult a variety of sources, including your local county EOP and HVA, to see what your local authorities found necessary to include in their plans and assessments Visit various state and federal websites to view hazard maps to see what natural disasters may pose a problem for your hospital New version of ToxMap now in Beta

HVA, continued Hazard Identification The source of the hazard Aims to determine the qualitative nature of: The source of the hazard Potential adverse consequences The strength of the hazard Effects The source Potential adverse consequences Social, biological, chemical, radiological, environmental, etc. The strength Damage caused by hazard Effects Duration of affect on people, environment, and business operations Specific results of hazard influence

HVA, continued Once hazards are identified, there needs to be a logical assignment of risk This allows for prioritization during plan development

HVA: Consider Probability/ Risk of Hazard Individual risk can be thought of as the probability that an incident or event will occur Overall risk is determined by taking into consideration the: Probability (risk) of an incident or event Vulnerability to impact of the incident or event Preparedness efforts Although the probability, or risk, of a given hazard may be high, the overall risk can vary depending on preparedness efforts to reduce or ameliorate the impact. Example: Pandemic influenza will likely occur Hospitals can chose to prepare, or not…however: Overall risk to the hospital depends on preparedness Impact will be dependent on preparedness Preparing for expected and likely hazards can help to reduce ones vulnerability to them. Risk of pan flu event occurring is high. Overall risk of the hospital being ravaged by flu DEPENDS on preparedness for pan flu Therefore, the impact on the hospital by pan flu depends on preparedness Vulnerability … in this context, is “susceptibility to the deleterious effects of a given incident or event.” Vulnerability is not a function of the probability of an individual incident, but rather a function of an institution’s ability to prevent, protect, or otherwise ameliorate the negative effects of an incident or event. Vulnerability is reduced or controlled through preparedness and mitigation. Talk about how first we discussed the risk of a given hazard affecting the hospital… This helps to determine what the hospital should prepare for…”do we really have to worry about an ice storm in Miami, or is it more likely that we will be affected by a hurricane?” And, once you’ve identified that you face a certain risk, how vulnerable are you to it? Do you have the proper windows/storm design of the architecture? How about vulnerability to the flooding that might occur, etc… Once you recognize where you are vulnerable, you can make changes to reduce that vulnerability

Risk=Probability x Impact HVA: Managing Risks Identify those risks that could cause an interruption or loss of a critical function or service Use a scoring tool that can help prioritize the risks such as: Risk=Probability x Impact The formula is for what the templates are doing in the background to calculate risk. We’re not teaching algebra, so don’t worry, the formula wont be on the test Addressing Vulnerability: Reducing Impact Priority hazards to consider should include: Risk to human life Threat to life & safety Property damage Power & system failures Legal ramifications Business continuity Prioritize these based on likelihood, severity, and impact to the hospital.

HVA: Managing Risks, continued Managing Risk: Impact & Probability Accept Plan Manage Reduce All delineated on the following slide.

HVA: Managing Risks, continued Risk Reduction Plan Accept the risk when impact and probability are low Transfer the risk using insurance when appropriate Avoid the risk by removing the source of the threat (prevention) Manage the risk if it is frequent but of low impact by monitoring and reduction efforts Reduce the risk through mitigation or outsourcing Preparedness: an organization’s ability to respond to, and recover from, an incident or event. Preparedness is measured on: An organization’s available resources The ability to utilize such resources when needed The organization’s ability to improvise when resources are exhausted An organizations available resources Internal - organizational personnel, and resources External - community partners Determined by drills and exercises The organizations ability to improvise when resources are exhausted To ensure preparedness, organizations should continuously: Evaluate their current level of preparedness Re-evaluate their emergency plans Be up-to-date with laws, standards, and regulations as they continuously evolve regarding recommendations and mandates

Hazard Vulnerability Analysis (HVA): Once it’s complete Use HVA results to: Determine areas that require the most attention and which are most important Identify unacceptable concentrations of risk or critical single points of failure Tailor sections of the EOP to address organizational/community-specific hazards Classify from greatest risk down to lowest level risk areas

Identify some hazards that your community and hospital may face? Practical Exercise Identify some hazards that your community and hospital may face? Discuss some mitigation and risk reduction strategies for each. Having already asked about their top hazards, focus on mitigation or preparedness in this practical exercise. Discuss things here like earthquakes, hurricanes, tornados, nuclear plants, ICU’s on high floors (creating difficulties with evacuation), special populations housed in hospitals creating logistical problems for evacuation (like prison units or psych wards)…

Prerequisites for an EOP Creation: Hazard Identification & Assessments Review An EOP is a living document outlining specifics for an emergency situation The EOP is an essential component of the Emergency Management Program The EOP is developed by the EM Committee An HVA is required by regulating bodies and needed for all EOPs An HVA assesses risks & vulnerability and defines needed preparedness measures

Certified Hospital Emergency Coordinator (CHEC) Training Program Prerequisites for an EOP Creation: Hazard Identification and Assessments Questions?

Practical Exercise Description of area/facility: The hospital is a medium sized hospital (175 beds) located approximately 60 miles from a major metro area. The local area is to be described as in central Alabama within a few hours of the coast, in a mostly farming community with a small community college in town. There is a river 5 miles and it is within a 50 mile radius of a nuclear facility.