1. Planning for Health Systems

2. 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

3. 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

4. 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

5. 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)

6. 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

7. 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

8. 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

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

10. 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

11. 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

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

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

14. 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)

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

16. 1961 Academy Award Nominee, Short Subject (Cartoon)
Warner Brothers