Planning for Hospital Emergency Preparedness, Response and Recovery

INTRODUCTION

Role of Hospitals in Emergency Management (AO 6-B s. 1999) Hospital shares the goal: “To promote health emergency preparedness among general public and to strengthen the health sector’s capability to respond to emergencies, disasters or calamities”

Role of Hospitals in Emergency Management (AO 168 s, 2004) The hospital shares the DOH mission: “To lead in the formulation of comprehensive, integrated, and coordinated health sector response to emergencies and disasters”

Hyogo Framework for Action (2005-2015) World Conference on Disaster Reduction in in Kobe, Japan in 2005 One of the key priorities for action “Promote the goal of “hospitals safe from disasters” Inter-agency Task Force of the ISDR made “Safe Hospital” as the focus of the global risk reduction campaign (2008 – 2009)

Significant Roles of a Hospital in Emergency or Disaster Receiving end of victims Responders to emergencies/disasters Direct life saving roles Symbol of social progress Prerequisite for social stability and economic development

Role of Hospital in Management of Emergencies To protect public safety and public health, a hospital and its emergency services need: Capacity to reduce vulnerabilities Capacity to respond Capacity to recover From: WHO – PHEMAP Course

Bureau of Licensing and Regulation “Submission of “Hospital Emergency Preparedness, Response, and Recovery Plan” is a requirement prior to the issuance of new hospital licenses to operate and renewal of existing licenses”

Risk Management in Hospital Planning

Disaster Management Cycle Disaster Impact Response Preparedness Recovery Development Mitigation Prevention

HEM Planning ? Protect life, property, Mitigate loss environment of services HEM Planning ? Promote Cooperation Among sectors And agencies Use efficiently Available resources Create systems and networks for responding To and recovering from emergencies “Hospital Emergency Preparedness, Response and Recovery Plan Development ‘08”

Preparedness Capacity measures to build capacities to respond to, and recover from emergencies Capacity ability to manage risks by: reducing hazards reducing vulnerabilities reducing consequences by responding to, and recovering from emergencies In terms of: Organization; systems; resources and partnership

Emergency Management Plan An agreed set of arrangements for: responding to, and recovering from emergencies

Emergency Management Plan A plan containing description of: Responsibilities Command & coordination mechanism Management structures Resource management Information management and communication Training and exercises

Risk Management is a comprehensive strategy for reducing threats and consequences to public health and safety of communities by: preventing exposure to hazards (target = hazards) reducing vulnerabilities (target group = community) developing response and recovery capacities (target group = response agencies)

Hospital emergency Preparedness, Response and Recovery Plan Emergency Preparedness Plan or A risk reduction plan includes: A hazard prevention plan A vulnerability reduction plan An emergency preparedness plan (or capacity development plan)

Hazard Prevention Plan plan to prevent exposure to hazards not all hazards are predictable or preventable Strategies/activities to prevent exposure to hazard

Vulnerability Reduction Plan Plan to reduce consequences of exposure to hazards Identify vulnerabilities specific to the five elements of the community Strategies/activities to reduce the vulnerabilities Building resilience of the hospital to withstand impact and consequences of hazard

Emergency Preparedness Plan Plan to build response capacity of the hospital Policies, Protocols, Guidelines and Procedures Plans People Promotion and Advocacy Partnership Building Physical (Facility Enhancement) Program Development Practices Peso and Logistics Package of Services

2. Emergency Response Plan to use existing response capacity, includes : Policies for direction and plans to be activated Systems and Procedures to be activated/implemented Organized team to respond to emergencies Available logistics and funds for the operation Established networks for emergency management

Emergency Response Plan use existing capacities to deliver relief or response mobilization of resources use of developed systems for emergency management actual implementation of guidelines/proedures for the developed systems

3. Recovery and Reconstruction Plan A plan to restore services and replace damaged elements of hospital for the better

Vulnerability Analysis Develop Strategies and Problems/Gaps Analysis Emergency Planning Process Analyze resources Define the plan Describe Roles and Responsibilities Form Planning Group Hazard Analysis Describe Management Structure Vulnerability Analysis Risk Analysis Develop Strategies and Systems Problems/Gaps Analysis “Hospital Emergency Preparedness, Response and Recovery Plan Development ‘08”

Elements of Hospital Preparedness, Response and Recovery Plan I. Background II. Plan description III. Goals and objectives IV. Planning Group V. Emergency Preparedness Plan Hazards prevention Vulnerabilities reduction Risk reduction VI. Management Structures VII. Roles and responsibilities

Elements of Hospital Preparedness, Response and Recovery Plan VIII. Hospital Response Plan Policies, guidelines, protocols for the developed systems IX. Recovery and Reconstruction Plan X. Annexes Glossary Abbreviations Directory of contact persons Inventory of resources of hospital and partner agencies Hospital policies, guidelines, protocols, and other issuances relevant to emergency or disaster management

Hospital Emergency Planning Process I. Background Write in narrative form the background of your region or agency including the provinces, municipalities/communities within your area of jurisdiction. Some data are better presented in tabular or graph forms for faster and easier comprehension of the reader or user.

Background Name of the Hospital and address (narrative) Geographic description (location: Low lying area? Etc.) Demographic profile of catchments communities Hospital Profile Health statistics of the hospital (IMR, MMR, etc.) Health facilities found in the municipality/city (tabular) Health services areas/departments of the hospital Manpower complementation of the hospital Disasters responded/managed Legal issuances establishing its authority in HEM 1. Geographic description Description of hospital in the city/municipality/community Location in relation to the West Valley fault line Low lying area Location in relation to other hazardous elements like oil depot, industrial establishments, military camps, etc. Distribution and concentration of vulnerable population (i.e, squatters area, etc.) (narrative, tables, etc) Where the hospital is built (on a hill, along river banks, along the railroad, etc.) (narrative) 2. Demographic profile (narrative, tabular) of the catchments community Population Population density Number of households Number of barangay Number and names of health emergency related agencies in the municipality/city (Ex. BFP, Private EMS, DSWD, other Government agencies and non-government agencies 3.Hospital Profile of the hospital Category of the hospital (primary, secondary, tertiary) Authorized bed capacity Government or private Services delivered Other relevant information to reflect the capacity of the hospital to manage emergencies 4. Health statistics of the hospital (tabular) Leading causes of morbidity and mortality Leading causes of consultation Leading causes of discharge Infant Mortality Rate Maternal Mortality Rate Malnutrition Rate Vaccination coverage Indicators for basic health services and preventive health program 5. Health facilities found in the municipality/city (tabular) Hospitals (private, LGU, category whether primary, secondary or tertiary) Lying in clinics, birthing places halfway houses Laboratories Dialysis clinics Etc.

Significance: Picture of the site and location of the hospital Catchments areas provided with hospital services Health resources in and around the hospital Existing capacity and capability of the hospital Partner agencies around the hospital Anticipated hazards as basis for hospitals’ capacity and capability building

II. Plan Definition Aim, objectives, and scope Tasks to be performed Resources to be needed Framework which emergencies will be managed

Plan Definition Brief description of the content of the plan Specific intentions relevant to set goals and objectives. Include the coverage, scope and limitations. Include the legal basis whereby the hospital is authorized to act in disaster situations Legal issuances detailing the roles and functions of hospitals in managing all phases of emergencies or disasters

Example: PLAN DEFINITION The JRMH Health Emergency Preparedness and Response Plan defines the direction of the hospital in preparing for an effective and efficient response in any event of emergency or disaster. This embodies a set of strategies and activities based on the hazards and vulnerabilities or risk analysis of the hospital.

Example: Context of JRMH HEPRRP The JRMH Preparedness Plan contains strategies & activities that the hospital will carry out to build and enhance hospital capacity to respond to emergency or disaster, whereas its Response Plan includes strategies and activities in utilizing hospital resources for effective and efficient response during emergency or disaster. Likewise, this Response Plan includes policies, protocols, guidelines and procedures pertaining to various emergency management systems for more efficient response. The third set is the Regional Recovery or Rehabilitation Plan which entails strategies and activities in mainstreaming the hospital back to its prepared position for any forthcoming eventuality. The JRMH Emergency Preparedness and Response Plan includes the inventory of its internal and external resources, in terms of inventory lists and directories, in the context of human resources, logistics, financial sources, existing systems and services. These are all found in the annexes of the plan.

Scope of the Plan This Plan shall be implemented, by the JRMH together, (but not limited) with all other members of the regional hospital network concerned with emergency or disaster management. Significance: Who will implement the plan Extent of implementation including limitations

III. Goals and Objectives Gives the purpose of the plan from a broader to more specific perspectives. Example : Goal: To build the hospital capacity for effective and efficient response to and recovery from emergency Objectives: To strengthen the hospital HEPRRP To develop systems and guidelines for emergencies To develop human resource competencies To upgrade hospital facility for better services To ensure availability of funds and logistics in times of emergency or disaster

IV. Planning Committee Hospital Planning Committee include major stakeholders Permanent or “AD HOC Group” which convenes only for hospital emergency planning purposes. This group shall be created through a hospital order. Roles and functions of the planning group/committee Develops, reviews and updates the HEPRRP Gathers required information and gain commitment of key people and organizations Initiates testing of the plan for its functionality and adaptability to current situation

Example: Planning Committee Structure Hospital Director/CMPS/HEMS Coordinator Representative from Planning Division Representative from Administrative Division (especially finance and logistics officers) Representative from areas of hospital operation Representative from the community

Hospital Planning Committee Structure Hospital Director/CMPS/ HEM Coordinator Representative from areas of hospital operation Representative from Administrative Division Representative from Planning Division Representative from the community

V. Emergency Preparedness Plan Development 1. Hazard assessment Identifying all the possible hazards that have the potential to affect the hospital Identify the possible areas to be affected Hazards Areas commonly affected Translate into a Hospital Hazard Map

Example of Hospital Hazard Map Legend: Fire Earthquake OPD ER Flood Laboratory Radiology Admitting Sect. Billing Sect. OB Ward EENT Ward Ortho Ward OR Urology Ward Delivery Rm. Pedia Ward Medicine Ward Surgery Ward OR

Recovery/Rehabilitation Plan Emergency Risks People Property Environment Services Livelihood (Damages Needs) Hospital People Property Environment Services Livelihood (Vulnerable) Hazard Disaster Recovery/ Rehabilitation Capacities used To manage Risks

Hazard Reduction/Prevention Plan Strategies/ Activities Time Frame Resource Requirement Person Resp. Indi cators Req’d. Avail. Source

Risk Analysis Identified Hazards Impact to hospital (Risks) 1. Property: Structural; Non-structural; Funtional Components 2. People 3. Services 4. Environment 5. Livelihood

Risk Assessment People Properties Services Environment Livelihood Hazards Vulnerabilities Risks People Properties Services Environment Livelihood Probability of death Probability of spread of the disease Prob. Of disease or injury (mental, physical) Prob. Of contamination Prob. Of displacement Prob. Of loss of income or property Prob. Of breakdown in security Prob. Of breakdown in essential services

Preparedness Plan Capacity (10P’s) Hospital weaknesses Strategies/ Activities Time Frame Resource Req’t. Person Resp. Indi cators Req’d Avail Source From the results of the self assessment of the hospital, list down all the weaknesses based on the expected hospital capacities. List down all the strategies and activities to be done for capacity development.

Recovery/Rehabilitation Plan Emergency Risks People Property Environment Services Livelihood (Damages Needs) Hospital People Property Environment Services Livelihood (Vulnerable) Hazard Disaster Recovery/ Rehabilitation Capacities used To manage Risks

Vulnerability Assessment Impact to hospital (Risks) Why did Risks happen? (Vulnerabilities) 1. Property: Structural; Non-structural; Funtional Components 2. People 3. Services 4. Environment 5. Livelihood

Vulnerability Reduction Plan Hazard Vulne rability Strategies/ Activities Time Frame Resource Req’t. Person Resp. Indi cators Req’d Avail Source

Activities during Response Phase Utilization of capacities built Activation of plans and systems developed Activation of OPCEN Mobilization of resources Management of emergency cases Validation and constant monitoring of the event

Hospital Emergency Management Policies, Guidelines, Procedures and Protocols Available procedures, protocols, for emergency management Security system Public Information System Incident Command System Information Management System MHPSS Blood and blood products mobilization

Hospital Emergency Management Policies, Guidelines, Procedures and Protocols Available procedures, protocols, for emergency management Code Alert System Infection Control System to expand services, spaces and beds in case of surge of patients System on drills/simulation exercises Stockpiling of emergency medicines and supplies

Hospital Emergency Management Policies, Guidelines, Procedures and Protocols Available procedures, protocols, for emergency management SOP on Operation Center Referral System Procedures Logistics management system Decontamination procedures

Hospital Emergency Management Policies, Guidelines, Procedures and Protocols Manual for the operation, preventive maintenance, and restoration of critical services Electrical supply and back-up generators Drinking water supply and alternate sources Fuel reserves Medical gases Back-up communication system Wastewater and solid waste water treatment Fire suppression

Hospital Emergency Management Policies, Guidelines, Procedures and Protocols Hospital policies on emergency/disaster management Hospital policies related to disaster management Policy on managing volunteers during emergency

VI. Response Plan A. Management Structures Incident Commander Safety Officer Public Info. Officer Liaison Officer Administrative/ Finance Operations Logistics Planning “Hospital Emergency Preparedness, Response and Recovery Plan Development ‘08”

Response Plan Activation of Code Alert System Activation of the Plan Activation of the ICS Activation of the Operation Center Implementation of the RESPONSE Standard Operating Procedures/ Protocols Emergencies Implementation of existing Standard Operating Procedures/Guidelines for systems developed Initiation and Maintenance of Coordination and networking for referrals of cases

Response Plan h. Initiation and Maintenance of Mental Health and Psychosocial Support Services for casualties, patients, hospital staff and other responders, bereaved i Management of Information j. Activation of plan in the event of complete isolation of hospital/CHD/community for auxiliary power, water and food rationing, medication/ dressing rationing, waste and garbage disposal, staff and patient morale k. Provision of the Public Health Services l. Management of the Dead

Recovery/Rehabilitation Plan Emergency Hospital People Property Environment Services Livelihood (Vulnerable) Risks People Property Environment Services Livelihood (Damages Needs) Hazard Disaster Capacities Utilized, Damaged Capacities used to manage Risks Recovery/ Rehabilitation

Recovery/Rehabilitation Plan Damages/ utilized Resource Req’t. Resp. Person Time Frame Indicators

Next Actions 1. Write the Plan and have it approved by the head of the agency. The Plan is not a plan until written and approved by the head of agency 2. Disseminate the plan to all the stakeholders and staff. Everyone needs to know the plan so that in emergency no one would ever say, “he does nothing cause he knows nothing”. 3. Test the plan. The plan is believed to be effective only when it is tested, be able to know its functionality, acceptability, and doability in the hands of the implementers.Update the plan Implement the plan. 5. Monitor and evaluate the implementation of the plan 6. Review and update the plan regularly.

Thank You!