1. Ready for Disaster? A review of our status and
an Objective Assessment Tool
Dr. Daniel Kollek
Executive Director
Centre for Excellence in Emergency Preparedness

2. Overview Where is the handout? Are we ready in 2008 ?
The HERO study
If not who would know?
Changes to accreditation
How can we check and document readiness?
The CEEP tools for readiness (and risk) assessment

3. The handout

8. Are we ready in 2008?
The new survey has, to date, collated results from 38 hospitals across Canada.
Less than a quarter of hospitals had performed a risk analysis and of those more than half had not revisited this at all within five years.
About half the responders also coordinated with other organisations.
There was improvement in the recency of table top (65% vs. 40% in 2001) or full deployment exercises (30% vs. 4%).
88% of facilities had a reporting protocol for bio events such as a sentinel case of smallpox, (37% in 2001).
Only 38% of hospitals stocked PPE (6% in 2001) in the ED, 40% of those who stocked the equipment have not trained within the past year and 62%  have a chemical decontamination plan or team (18% in 2001). The prompt availability of chemical improved from 13-34% in 2001 to 100% today.
100% of respondents made N95 masks available and about half of the staff had been fit tested within the past year, 88% had access to supplies in an emergency and 74% had HEPA filtered rooms installed in their EDs.

9. Are we ready in 2008? The HERO Study 2001 2008
Plan reviewed within 3 years
Simulation within 3 years
Exercise within 3 years
Protocol for bio-events
PPE in the ED
Decontamination plan
Antidotes on site
N95 availability
HEPA filtered room

10. Are we ready in 2008? The HERO Study 2001 2008
Plan reviewed within 3 years
81%
80%
Simulation within 3 years
Exercise within 3 years
Protocol for bio-events
PPE in the ED
Decontamination plan
Antidotes on site
N95 availability
HEPA filtered room

11. Are we ready in 2008? The HERO Study 2001 2008
Plan reviewed within 3 years
81%
80%
Simulation within 3 years
40% (paper trial)
65% (tabletop)
Exercise within 3 years
Protocol for bio-events
PPE in the ED
Decontamination plan
Antidotes on site
N95 availability
HEPA filtered room

12. Are we ready in 2008? The HERO Study 2001 2008
Plan reviewed within 3 years
81%
80%
Simulation within 3 years
40% (paper trial)
65% (tabletop)
Exercise within 3 years 4%
30%
Protocol for bio-events
PPE in the ED
Decontamination plan
Antidotes on site
N95 availability
HEPA filtered room

13. Are we ready in 2008? The HERO Study 2001 2008
Plan reviewed within 3 years
81%
80%
Simulation within 3 years
40% (paper trial)
65% (tabletop)
Exercise within 3 years 4%
30%
Protocol for bio-events
37%
88%
PPE in the ED
Decontamination plan
Antidotes on site
N95 availability
HEPA filtered room

14. Are we ready in 2008? The HERO Study 2001 2008
Plan reviewed within 3 years
81%
80%
Simulation within 3 years
40% (paper trial)
65% (tabletop)
Exercise within 3 years 4%
30%
Protocol for bio-events
37%
88%
PPE in the ED 6%
38%
Decontamination plan
Antidotes on site
N95 availability
HEPA filtered room

15. Are we ready in 2008? The HERO Study 2001 2008
Plan reviewed within 3 years
81%
80%
Simulation within 3 years
40% (paper trial)
65% (tabletop)
Exercise within 3 years 4%
30%
Protocol for bio-events
37%
88%
PPE in the ED 6%
38%
Decontamination plan
18%
62%
Antidotes on site
N95 availability
HEPA filtered room

16. Are we ready in 2008? The HERO Study 2001 2008
Plan reviewed within 3 years
81%
80%
Simulation within 3 years
40% (paper trial)
65% (tabletop)
Exercise within 3 years 4%
30%
Protocol for bio-events
37%
88%
PPE in the ED 6%
38%
Decontamination plan
18%
62%
Antidotes on site
13-34%
100%
N95 availability
HEPA filtered room

17. Are we ready in 2008? The HERO Study 2001 2008
Plan reviewed within 3 years
81%
80%
Simulation within 3 years
40% (paper trial)
65% (tabletop)
Exercise within 3 years 4%
30%
Protocol for bio-events
37%
88%
PPE in the ED 6%
38%
Decontamination plan
18%
62%
Antidotes on site
13-34%
100%
N95 availability NA
HEPA filtered room

18. Are we ready in 2008? The HERO Study 2001 2008
The new survey has, to date, collated results from 38 hospitals across Canada.
Less than a quarter of hospitals had performed a risk analysis and of those more than half had not revisited this at all within five years.
About half the responders also coordinated with other organisations.
There was improvement in the recency of table top (65% vs. 40% in 2001) or full deployment exercises (30% vs. 4%).
88% of facilities had a reporting protocol for bio events such as a sentinel case of smallpox, (37% in 2001).
Only 38% of hospitals stocked PPE (6% in 2001) in the ED, 40% of those who stocked the equipment have not trained within the past year and 62%  have a chemical decontamination plan or team (18% in 2001). The prompt availability of chemical improved from 13-34% in 2001 to 100% today.
100% of respondents made N95 masks available and about half of the staff had been fit tested within the past year, 88% had access to supplies in an emergency and 74% had HEPA filtered rooms installed in their EDs.
2001
2008
Plan reviewed within 3 years
81%
80%
Simulation within 3 years
40% (paper trial)
65% (tabletop)
Exercise within 3 years 4%
30%
Protocol for bio-events
37%
88%
PPE in the ED 6%
38%
Decontamination plan
18%
62%
Antidotes on site
13-34%
100%
N95 availability NA
HEPA filtered room
74%

19. Is anyone (else) checking?

20. Accreditation Canada might….

21. But, of course, YOU are ready!
(aren’t you?)

22. How do you know?
These are Gap Analysis tools, you will see how they assist you in defining your areas of weakness, identifying the action plan to remedy this and documenting that it has been resolved (remember the Qmentum process?).

23. Covers all aspects of readiness except CBRN (separate document)
The preamble and plan checklist outline how to use the tool – I will go through some of that now.
Note that no one person does all of this. The tool is modular such that the workload can (and should!) be spread across the organisation. This is a first step towards silo breaking and as such the tool is both diagnostic and therapeutic – if used correctly it forces cooperation across the organisation.

24. Start with an inventory (foundational considerations) because every facility is different

25. Foundational considerations are not just bed inventory but also planning to date
Lets look at the for of the questionnaire now.
Note the three columns on the right:
N/A: not applicable – every facility is different so, for example, questions related to ICU or pediatric inpatients may not apply to your environment
U: unsure – it is anticipated that there will be questions you will not be able to answer. This is, in fact part of the therapeutic benefit of going through the process – identifying what you do not know
Required actions: this can be “nothing” or anything dependent on the answers to the previous columns
Person Responsible: this is the person who signs off on the item as ready or N/A or who is responsible for remedying the gap.
KEEP THE DATED DOCUMENTATION since comparing iterations allows you to show that you have implemented an action plan and reassessed to check its effectiveness. Let’s look at come specific areas in the tool.

26. This page is from the top of a section
This page is from the top of a section. Note that each section has a person responsible for filling it in – as mentioned earlier this not only spreads the load but also promotes teamwork.
Also note that the questionnaire suggests process for those facilities that do not have one. Here it defines levels of activation of the disaster plan – teaching the user that plans activation is – ideally and if time allows – graduated.

27. Here it provides a list of services that may be required on a 24/7 basis in a disaster. The idea is to stimulate thought in your facility about what services you should, can and cannot deliver in a disaster.

28. Here the tool promotes incident management (or Incident command systems) and, in case you do not know what this is, sends you to the reference section. In addition to the document itself there is a slew of references on the CEEP website and these are frequently updated, last update being September 08.

29. The topic covered are very broad and include staff wellness as well as….

30. ….post disaster recovery.

31. The CBRN document follows the same format but with CBRN specific guidance, Note that a facility does not have to accept the guidance blindly – for example I purposely chose this page with antibiotics on it – you can choose to say No and leave it that way (no action required) as long as you went through the process and discussed why you did it that way. The document is not proscriptive but designed to stimulate discussion.

32. Summary
The HERO study shows we are more prepared than eight years ago but still not ready
Accreditation Canada’s new process looks at gap analysis including for disasters
The CEEP tools for readiness (and risk) assessment are at your disposal at

33. Questions?