Hospital Response to Disasters HARRT 2004

Hospital Preparedness  9/11 had placed hospital preparedness under the microscope at the local, state, and federal levels  Although the “All Hazards” approach is the norm, hospitals have entered a new era in preparedness  At this point hospitals are amongst the last players to join the community efforts, prior to 9/11, hospitals had not viewed themselves as part of the local response system

Hospital Preparedness:  Clarification for HIPPA, EMATALA, and EPA regulatory requirements and their applications in emergency situations is vital  Relationship building amongst the stakeholders takes time and trust  Large scale events don’t just happen in major metropolitan areas---all hospitals are potential responders

Hospital Preparedness for large scale events:  Hospitals have always planned for disasters, but not large scale events  Since 9/11, hospitals have begun to focus on readiness for large scale terrorism events as well  Community involvement is necessary in large scale planning---something that hospitals have little experience with

Hospital Surge Capacity: Inventories  Just-in-time inventory models have become the norm Pharmaceuticals (antibiotics, vaccines, anti-viral medications) Pharmaceuticals (antibiotics, vaccines, anti-viral medications) Food stores Food stores PPE to handle large volumes PPE to handle large volumes  Hospitals lack ventilators A recent GAO report revealed that most hospitals have <10 ventilators per 100 staffed beds A recent GAO report revealed that most hospitals have <10 ventilators per 100 staffed beds

Hospital Surge Capacity: Inventories  A “stand alone” capability is essential  Hospitals also lack the space necessary to accomodate enhanced caches, create additional triage, patient care, and morgue areas

Hospital Planning:  Planning is a dynamic process  A plan is NEVER complete  The best plans are based on predictable behaviors  Plans must be practiced Disaster drills are not punitive activities Disaster drills are not punitive activities Disaster drills are learning laboratories Disaster drills are learning laboratories Disaster drills provide opportunities Disaster drills provide opportunities

HEICS and the Clinician  Do you know what your role is in a disaster?  Have you ever been part of a disaster drill?  Have you been educated on the disaster plan at your facility?  What would you do in the event of a disaster?

HEICS: Hospital Emergency Incident Command System  Incident Command System or Incident Management System characteristics Universal language for all clinicians to use Universal language for all clinicians to use Small span of control Small span of control Delineation of authority Delineation of authority

Delayed Treatment Unit  Actions Identification of Delayed Treatment Unit Leader Identification of Delayed Treatment Unit Leader Assignment of roles and responsibilitiesAssignment of roles and responsibilities Increased responsibilities of care providersIncreased responsibilities of care providers Disaster Medical Care Disaster Medical Care A, B, C’sA, B, C’s Pain ManagementPain Management ↑ Resource limitation utilization↑ Resource limitation utilization Secondary Triage Secondary Triage Triage of patients in DTUTriage of patients in DTU Triage of incomingTriage of incoming

Emergency Operations Center: Hospital  Purpose----Under the direction of the EIC To maintain overall command of the overall hospital operations To maintain overall command of the overall hospital operations Oversight of the Emergency Operations Center Oversight of the Emergency Operations Center To maintain communications both internal and external To maintain communications both internal and external Data gathering both internal and external Data gathering both internal and external Magnitude of eventMagnitude of event Resource availabilityResource availability