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

2. 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.

3. 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.

4. 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

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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

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

13. 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

14. Source: Screenshot of LiveProcess
HVA Tool
Source: Screenshot of LiveProcess

15. 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 for flood maps
View the National Weather Service’s
history of storms
For chemical hazards, visit:
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

16. 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

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

18. 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

19. 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.

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

21. 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

22. 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

23. 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)…

24. 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

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

26. 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.