Chapter 23 Preparing for emergencies

Emergency preparedness is the focus of national efforts and promises to increase in the coming decade.
Every healthcare organization must prepare for both natural and man-made disasters and the resulting mass casualty events (MCE).
Emergencies include natural disasters, man-made accidents, mass shootings, and acts of terrorism.
Natural disasters include any disaster that is not man-made (floods, hurricanes, tornadoes, volcanoes, heat waves, and blizzards).
- Location is a key element in preparing for natural disasters.
- Health disasters are also natural disasters. Epidemics of diseases that spread rapidly through the population and pandemics that spread disease around the globe are health disasters (e.g., SARS, AIDS, antibiotic resistant bacteria, Ebola, H1N1 influenza, and the Zika virus).
Man-made disasters can be accidental or intentional.
- Industrial hazards, structural collapses of buildings or bridges, and power outages are examples of accidental hazards.
- Subways, sports stadiums, and airplanes may be attacked.
- Chemical, physical, biological, radiological, or nuclear toxins may spread to the population, causing illness and death.
- Cyber security is an increasing threat, and infiltration of the health organizations’ systems can cause disruption to individuals as well as the computer infrastructure.
Disasters may be further categorized by levels of disaster:
- Level I: Local level response and containment suffices.
  - Example:
    - A small creek has flooded, requiring the rescue of one person from a stranded automobile. Electrical service was interrupted for a short period, and traffic will be diverted around flooded roads for several hours. Local law enforcement and fire departments have been well equipped to manage the disaster.***
  - Level II: Regional level response is necessary.
    - Example:
      - Fire departments from a three county area have responded to a wildfire that has threatened several homes and a hospital in a wooded area. The fire is now under control, and the fire chief is completing paperwork on the response. **
    - Level III: Statewide or national assistance is needed.
      - Example:
        
        A tornado that destroyed the majority of the businesses and homes in a small Midwestern city.***
      - Plans for emergency management are required of all hospitals.
      - An “All Hazards Approach” consists of planning for various disasters based on an analysis of the community’s vulnerability to specific threats.
        
        The Institute of Medicine’s report, Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response, recommends that:
        
        Hospitals, emergency services, and local government agencies integrate their plans to respond to disastrous events.
        
        Local community members become involved in the planning and that nurses play a key role in developing the community’s response to crises.
        
        A hospital emergency operations plan (EOP) includes preparation, education and training, and implementation of the hospital’s response to emergency situations.
        
        The hospital’s EOP includes the following components:
        
        Activation response
        
        Communication plan
        
        Client care coordination plan
        
        Security plan
        
        Traffic flow plan
        
        Data management strategy
        
        Resources availability
        
        EOP must also include plans to deactivate the response and follow up with a postincident review and a schedule for practice drills.
        
        Implementation of the EOP includes three components: planning, preparing, and practicing.
        
        Planning involves determining the hospital’s top three to five vulnerabilities based on its geographic location.
        
        Preparation includes staff education and training.
        
        Practicing requirements include testing their EOP twice a year. One practice can be a tabletop event, but one must involve realistic situations and simulated clients.
        
        Surge capacity describes an institution’s ability to mobilize when suddenly confronted with a vast increase in client demand.
        
        A surge system includes:
        
        Supplies
        
        Personnel
        
        Physical space
        
        Management infrastructure
        
        At the onset of a disaster and the impending arrival of mass casualties, a hospital incident command structure can be implemented, a rapid needs assessment conducted, and appropriate activities mobilized.
        
        Preparation drills ensure that the components (“stuff, staff, structure, and systems”) are in place.
        
        Post incident follow-up is essential to continually evaluate performance and initiate improvements.
        
        Triage in a mass casualty incident is the reverse of normal standards:
        
        The goal is to treat the most people in the shortest time with the resources available.
        
        Inundated with mass casualties, precious time must be directed to the least seriously injured first, then the more seriously injured, and so on.
        
        Example triage:
        
        A client with a minor forearm laceration that will require a simple bandage and tetanus immunization will be seen first because most likely to survive!**
        
        Complicating emergency preparedness is the need to provide for continuation of services during an emergency. The EOP must address these issues.
        
        Resources such as electricity and resupply of food, water, and medication may be disrupted.
        
        Assessment of capabilities, resources, and education and training needs must be assessed must be carried out in preparation for disasters.
        
        Staff utilization may be drastically altered in emergencies.
        
        Employee fatigue and exhaustion, including mental fatigue, must be addressed.
        
        Personal protective equipment must be available, and staff must be trained to use the equipment and know how to access it in an emergency.
        
        Key to maintaining operational readiness is the staff’s willingness to come to work during a disaster through callback systems.
        
        Factors that determine staff members’ decisions to come to work include vulnerability of family, personal safety concerns, professional accountability, past experience with disasters, caring connection with the organization, and the desire to help.
        
        Developing a caring relationship with staff members and a compassionate response during and after a disaster may slightly help mitigate staff concerns about family vulnerability and personal safety.
        
        Additional factors to consider for emergency planning include the fact that the organization may not be reimbursed for care provided, standards of care may not be established or able to be maintained, and the hospital may incur liability for volunteers’ safety or their performance.