Health care organizations traditionally have had preparedness plans for many types of emergencies such as fires, infant abductions, tornadoes, and automobile and plane crashes. In response to the events of September 11, 2001, however, health care organizations have had to enhance their ability to respond to various types of emergencies.

A hazard vulnerability analysis (HVA) is a proactive process. First, all of the emergencies that could potentially occur within the organization and community are identified. Next, leaders and staff must determine the likelihood of each possible event and what effect it would have on the organization and on the community (such as structural damage, loss of homes, disruption of utilities and services, and loss of life). Determining the probabilities of occurrence and impact allows leaders to prioritize the emergency management plan and concentrate resources on the most likely and potentially serious events. Finally, leaders and staff must ascertain how prepared the organization is to manage each emergency. This process needs to be individualized because each organization’s potential emergencies and needs will differ by geographic location, type of services offered, and populations within the community served. The emergency management plan can then be tailored accordingly. For example, a large hospital in Chicago might list severe temperatures, snowstorms, fire, multivehicle or train crashes with mass casualties, flu
and pneumonia epidemics, bomb threats, and manmade disasters as possible incidents, whereas a long term care organization in the Florida Keys might choose to concentrate on plans for hurricanes, flooding, fire, severe heat, utility failures, and multivehicle or plane crashes

Many factors must be considered in planning for any emergency situation, including maintaining internal and external lines of communication, finding room for a large influx of patients, maintaining supply inventories, calling in extra staff, and providing transportation and food for patients and staff. In addition, some types of emergencies require special procedures and/or equipment. For example, decontamination necessitates
segregation of victims from the rest of the patient population (whether in the same building or in an outdoor facility), a separate ventilation system for quarantined areas, and provision of adequate personal protective equipment for staff.

Emergency planning often focuses on hospital emergency departments and trauma centers, but in a communitywide emergency, all health care organizations may be needed—whether to assist with triage and urgent care of victims, provide non urgent care to others, shelter community members or patients from other facilities that have been evacuated, or supply staff and/or supplies to other organizations. The need for cooperation also exists when an organization that normally houses patients, such as a hospital, long term care or rehabilitation facility, or 24-hour behavioral health care organization, has an internal emergency that forces evacuation. In such cases, other organizations within the community must be prepared to help. It is important to coordinate emergency management plans for individual organizations with those of the community and other local health care facilities.

In addition to emergency management plans, organizations need to establish an “all-hazards command structure,” also called an incident command system. When an emergency occurs, this structure goes into effect to provide organized response and overall site management for the facility. An all-hazards command structure designates responsibilities and reporting relationships for leaders and staff members during the emergency
and is usually divided into two branches: medical and administrative.

For the system to work effectively, it should have the following characteristics:

■ Flexibility— The structure must be adaptable to a wide variety of situations, including those that the organization may not have considered.

■ Clarity— Everyone within the organization, from clinical to clerical staff, must clearly understand his or her roles and responsibilities.

■ Community integration— The organization’s command structure must be coordinated with those of community response groups such as the police and fire departments; local, state, or federal emergency management agencies; and other local health care organizations.

The best way to tell whether an organization is ready to deal with potential emergencies is to conduct regularly scheduled emergency drills.* It is helpful to use a wide variety of scenarios that involve both internal and external emergencies.

Possible drill scenarios might include a fire that takes place during a citywide power outage or a boiler explosion that necessitates evacuation of a large number of pneumonia patients in the middle of winter. Equipment that will be used during an emergency, including battery-operated infusion pumps and emergency generators, should be tested and retested.

Participation in community disaster drills can help to prepare for all types of emergencies. The more often command centers are established, alternative communication lines are used, and volunteer or “paper” patients are transported or evacuated, the more comfortable staff members will be with the process in a real emergency.

Ten Weaknesses in Emergency Management Plans

1. Lack of critical information
2. Not flexible enough
3. Do not address communication issues broadly or in enough detail
4. Do not contain enough multidisciplinary input
5. Do not contain adaptable forms for managing information
6. Do not consider enough scenarios (or enough hazard vulnerabilities)
7. Poorly document incidents
8. Do not include troubleshooting tools
9. Lack alarm points signaling that critical supplies are running low
10. Have not undergone a detailed review with local agencies and do not consider community linkages or processes

Source: Bruce C.: Troubleshooting your top ten weaknesses in emergency preparedness plans.
Environment of Care® News 3(2):11, 2000.

Checklist for Creating an Emergency Management Plan
The following checklist provides some ideas for organizations that may be reviewing or developing emergency management plans. It is only a starting point and is not meant to be exhaustive.
Staff Issues
Staff have been trained and assessed for competency in emergency management issues (including triage and basic first aid, ability to access critical resources and reporting, familiarity with the all-hazards command structure, and knowledge of isolation/quarantine and decontamination procedures). ______
A staff member has been designated to manage and verify credentials of volunteer professional staff during an emergency. ______
Space Issues
There is a plan for making beds available, including the transfer/discharge of patients whose attending physicians are not on hand. ______
Alternative areas of the organization have been designated for expanded treatment and triage needs. ______
Mutual aid agreements exist with other health care organizations in the community to receive and transfer patients. ______
Morgue capabilities have been established at the organization or at nearby locations. ______
Outsourcing and Supply Issues
Alternative providers have been identified in case normal operations must be suspended. ______
Agreements with vendors include prearranged delivery of supplies without an order if communication lines are cut off. ______
An emergency stockpile of medications and supplies is maintained. ______
An adequate supply of water and emergency generator fuel can be maintained and replenished as needed. ______
Appropriate levels of personal protective equipment are available as necessary for staff. ______
Alternate routes of transportation have been identified in case normal routes are inaccessible. ______
Arrangements have been made for alternate ways of managing the disposal of infectious waste, sewage, and general trash. ______
Communication Issues
Alternative communication systems (such as two-way radios and cell phones) are available. ______
Communication networks exist with local emergency agencies and the media. ______
Organized messenger or runner services are in place. ______
A system is established to ensure that medical records remain with patients. ______
An on-call roster is maintained for staff who may be needed during an emergency. ______