Contact a disaster preparedness person at either a local hospital, or local city or county emergency services agency.
Interview your contact, asking the following questions:
1) “What do you consider to be the top three disasters for which you prepare?”
2) “What would you say are your top three lessons learned about managing a disaster?”
Write a paper of 1,000–1,200 words that summarizes your findings from the interview as well as from your readings.
Refer to the assigned readings to incorporate specific examples and details into your paper.
Prepare this assignment according to the APA guidelines found in the APA Style Guide, located in the Student Success Center. An abstract is not required.
This assignment uses a grading rubric. Instructors will be using the rubric to grade the assignment; therefore, students should review the rubric prior to beginning the assignment to become familiar with the assignment criteria and expectations for successful completion of the assignment.
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The New Reality: Bioterror and Disaster Management
Introduction
Preparing for a disaster of any kind is one of the more stressful and difficult things a health care leader must do. There are so many different types of events that it is almost impossible to plan in advance for any specific one. However, almost all health care entities have plans based on basic concepts for managing a disaster event, with some specific twists for more likely events. This module will review the basic elements of a strong disaster plan and discuss some specific events that require special planning.
Types of Disasters
While some disasters may be specific to a given area, others may happen to anyone. Fires, hostile situations, community illnesses or pandemics, and possible terror attacks can occur anywhere. Hurricanes, earthquakes, and weather-specific disasters are more dependent on the location. Internal disasters can also occur to any facility, such as water line breakage, loss of heat or air conditioning, loss of power, and loss of total water supply.
Fires are one of the more feared disasters, since there are opportunities for fires to grow quickly in the oxygen-enriched environments that exist in some hospital areas. All staff are regularly trained and drilled in quick identification of fires and speedy reactions to control or extinguish any fire that occurs. Smoking in bed used to be one of the more common fires, but the ban of smoking in hospitals has helped to reduce that problem. The biggest issue with fires in hospitals, in particular, is the need to speedily evacuate patients if the fire grows out of control. This may be a horizontal evacuation to another unit on the same floor or a vertical evacuation to another floor. The most feared option is the total evacuation of the hospital. Since critical patients, patients in surgery, and patients in active labor are difficult to move, it becomes an extreme challenge to get everyone out safely. Such a mass evacuation also requires transfers of patients to other facilities, along with their medical records and staff to care for them. This is a huge endeavor and is difficult to do quickly. So the need to find fires quickly and respond to extinguish them without delay is very important.
Hostile situations are becoming unfortunately more common, particularly in hospitals. The events that can occur in a hospital are stressful and emotional at best and can become a dangerous trigger to someone with rage/anger management problems or a pre-existing mental disorder. When this is coupled with relatively easy access to firearms, the possible danger is exacerbated. There have been numerous media reports of individuals who shot patients, staff, physicians, and themselves for a variety of reasons. In one hospital in the 1980s, a man brought a shotgun into the intensive care unit (ICU) where his brother lay paralyzed and comatose after a motor vehicle accident. His goal was to discontinue the patient’s life support, since he felt that his brother would not want to live in that condition. He took the entire ICU by storm, although some patients were able to be moved out by the nursing staff. A physician and nurse were held by the hostage taker in the patient’s room. The police SWAT (Special Weapons And Tactics) team was called and the hospital went into disaster mode and was locked down to outsiders. The ending was a good one, as the hostage negotiators were able to talk the hostage taker out of any violent action and he surrendered with no injury to anyone. Unfortunately, it does not always end that way. During this period, however, families were escorted out of the building, patients had to be moved, and the fear and terror of all involved were very high.
A community pandemic is a less terrifying but more resource-draining disaster, and they last longer. The most commonly seen version of this is the flu. While many flu seasons pass with no more than predictable levels of illness, every so often a new strain with a high transmission factor and severe illness can devastate the health care system. Community fears can cause the “walking ill” to flood into emergency departments (EDs), hindering the provision of care to those who really need it. Such fears are intensified with media reports of high death rates from the illness, as seen in the flu epidemic from H1N1, or swine flu, several years ago. The most significant issues here are complex, due to the extraordinarily high demand for services from a frightened public, coupled with an illness that infects staff and physicians as well as the community. When hospitals and EDs are full of patients and short on staff and physicians due to their own illnesses or their families’ problems, it is very difficult to manage resources to meet the demands. A particularly contagious strand of flu can also complicate hospital status, since flu patients cannot be mixed with other types of patients due to the contagion. In such a situation, communities and the public health system may have to make decisions about how to provide care for those who need it while reducing the care demands of the walking ill or just the “worried with a sniffle.”
Floods can provide their own challenges. Generally, the community as a whole is affected, as seen in the situations that arose in New Orleans after Hurricane Katrina and in south Florida after any number of hurricanes that produced a flooding surge. When a hospital floods, the management of patient safety must become the first priority. If several floors are flooded, it may be impossible to evacuate patients safely, as at Charity Hospital in New Orleans, where patients had to be airlifted from the roof or taken out in boats. In addition, in such situations, the power is also usually out or had to be shut down for safety purposes, making it impossible to operate the facility. In Indiana, after a river flooded a hospital basement, the emergency generators were destroyed, since that was where they were located, and the hospital was shut down and required patient evacuation. Internal flooding can also cause a disaster. In one hospital, a sprinkler head popped off in the laboratory and water poured out of it. In the time it took to find the shutoff valves, a significant portion of the floor was flooded and water moved through it into the basement, shutting down the sterile supply area and almost flooding the hospital computer system in the basement. While this affected only a portion of the hospital and did not necessitate any movement of patients, it illustrates that disasters can come in many sizes, big and small.
Earthquakes are not common in most of the United States, but where they are, they can destroy a hospital. In California, both the Loma Prieta earthquake in San Francisco and the Northridge earthquake in Los Angeles posed serious problems for area hospitals. At a time when injured patients may be pouring into local EDs and trauma centers, those facilities may themselves be affected by structural damage, water problems, and power issues. The building codes in earthquake-prone areas are being changed to help the buildings withstand the shocks and the swaying effects, but the secondary problems of power and water interruption can still make the disaster more intense.
There are several aspects of weather that can cause a disaster in a health care facility. The most easily understood are the hurricanes and tornadoes that wrack different parts of the country almost every year. Both cause structural damage from high winds and can cause issues with flooding and interruption of community services. They also produce injuries and illnesses that require higher levels of health care access at a time when it can be very difficult to provide such services. However, there are other types of weather that can cause disaster conditions. In the Midwest and North, blizzard conditions in the winter and extreme cold can have very detrimental effects, as ice storms and high winds can cause power interruptions for prolonged periods. While all hospitals have emergency generators, they require a supply of fuel that may become more difficult to sustain or obtain in these circumstances. In the Southwest, the problem is different. Extreme heat in the summer is not a problem, until the air conditioning fails. At that point, there must be an alternative or patients must be evacuated within 24 hours. Also, with extremely high heat, aeromedical helicopters experience more difficulty with lift, especially with patients on board. In Phoenix, on days when temperatures exceed 120 degrees, planes and helicopters can be grounded until the temperatures drop below 120 degrees.
Threat Analysis
Health care facilities are all required to have disaster management plans in place, along with threat analysis. A threat analysis looks at several things:
·The type of disaster (weather, fire, flood, etc.)
·The likelihood of such a disaster occurring
·The expected frequency of such a disaster occurring
·The expected impact on the facility and the community
Based on the threat analysis, the facility can plan more specifically for its more likely or frequently occurring disaster threats and spend less time on the ones not as likely to occur.
Key Elements of Disaster Planning
Every facility should have plans for both internal and external disasters, and they can have similar elements. Plans should be reviewed and updated at least yearly and after any major event that triggers the use of the disaster plan, so as to learn key lessons. Every disaster plan should have timed components, including a plan section for the initial response to a disaster, what to consider and manage in the first 12 hours, what to plan for in the second 12 hours, and sections that deal with 48 hour periods, 72 hour periods, 96 hour periods, and longer. Disasters may be resolved in a period of hours for most internal problems but they may go to weeks in the case of natural disasters that affect entire communities. Health care entities need to be flexible in their responses.
Key elements of any effective disaster plan need to include the following:
A Defined Leadership Structure: When attempting to manage a disaster response, it is absolutely critical to have a defined chain of command, with one leader at the top. This individual, which in many plans is called the incident commander, may be one of several people in the entity’s organizational structure, depending on time of day and day of week. It may also change as the disaster situation evolves and changes. For example, in an initial hostile event during the night, the administrative supervisor or house supervisor may be the initial incident commander but may pass the role on to a hospital administrator if the situation demands it. The incident commander needs to be someone with recognized authority to make decisions, allocate staff to different areas of the hospital, and direct physician responses to the disaster. Depending on the situation, the incident commander may also need to work collegially with commanders of outside agencies responding to the situation, such as fire or police. The incident commander needs to stay in the command area, which is a defined space with computer, phones, a television, and adequate desk and office space for multiple people to function. This is likely to be the administrative offices in a hospital setting. Several subcommanders will be needed to take more focused responsibilities as the disaster progresses. In a natural disaster where the hospital’s functioning is at risk, an operations commander will be in charge of staff and the activities of providing care to patients. A logistics commander will be responsible to monitor and ensure that supplies, equipment, and services such as power, water, and air conditioning or heat are operational and functioning appropriately. A financial commander may be needed to ensure that medical records, admissions processes, and activities that affect the ability to be paid for services provided and to pay for additional resources to respond to the disaster are all being tracked and accounted for. A security commander will need to be responsible to maintain physical security of the facility, since it may be in lockdown. Crowd control is also a responsibility of the security commander, who may need to have the incident commander approve a request for more support from local law enforcement. A public relations liaison is essential, since any disaster situation will likely draw media attention, and the hospital’s responses need to be carefully designed and managed.
A Communcations System: One of the most critical functions the disaster management group must have access to is an effective communications system. Most people who have led through disasters will tell you that communications flow is always a problem in some way. There are several aspects of communication that have to be effectively planned:
·Hardware: It is common for teams creating and revising a disaster plan to focus their communication strategies on cell phones, since most people carry them. However, in a communitywide disaster, cell phone towers will quickly become overloaded with traffic and the cell calls will not go through or they will drop. Internal telephone coverage is problematic, since it will be difficult to tell where various people are in the facility, and landline phones may be disrupted by the disaster event. Wireless communications may also be disrupted. Hand held radios can work, although if multiple people are on them at once, the channels will become overloaded with communications. If radio discipline can be enforced, this technique can work well for immediate communications. However, people who are not used to working with the radios may find this difficult and cumbersome. Some hospitals have invested in a small number of satellite phones, although the problem of being unfamiliar with how to use them continues. In a communitywide disaster, having local amateur, or ham, radio operators stationed at the hospital is very valuable, especially if cell and landline phone service is out.
·Process: It is inevitable in almost every disaster that people will come to the command center for information. It can quickly be overwhelmed by the sheer number of people who come, and thus it is important to ensure that the command center has security that can control the number of people trying to access it. Only those on the approved list should come to the command center. However, it is also important to get information on the disaster, the response to it, and the latest updates and bulletins out to staff in various areas. Different entities have planned for this in various ways: runners with updates and information who go out on a regular route to take new information to staff; printed update bulletins to be posted on each unit and department for staff; phone calls if the systems are functional; etc. This is especially important if the disaster is one that will take 24 hours or longer to resolve.
·Accuracy: Most people who have experienced a disaster will be quick to relate that accurate communications and information is one of the biggest challenges of the leadership team. Rumors develop and fly quickly, and people in a hurry do not always stop to confirm accuracy before acting on the information. It is essential that accurate information on the disaster, its impacts on the facility, and how resources are being allocated and used, be gotten to the incident commander. Unfortunately, that is frequently not the case, especially in the initial stages of the disaster. The incident commander may succumb to the need to go look for him or herself, but that takes them out of the command center at a time where data are flowing into it at a high rate and decisions must be made. Some teams have appointed a person to be the eyes and ears of the incident commander and who has no other role other than to see what the situation looks like and report back directly to the incident commander. In terms of accuracy of information and managing the rumor mill, the public relations liaison can be invaluable in sorting out rumors from fact and finding methods to disseminate accurate information throughout the facility.
Resource Management: Here is where active advanced planning can really pay off. If a disaster is going to be one of the ones that are days in duration, staff will need to be rotated home for rest periods or sent to a respite location on campus for sleep, food, and showers. A plan to manage and rotate available staff can be constructed in advance and applied by the incident commander as soon as the duration of the disaster is appreciated. Supplies will also need to be carefully managed and inventories restocked. In a community disaster, this requires advanced planning with vendors to have adequate stock delivered when requested. Such stock is not always medical care supplies. A source of clean drinking water and food supplies would be essential in a community disaster from flooding or weather, where public water may be contaminated. In one hurricane in Virginia, the local sewer system was flooded out and water was shut off. Residents flocked to local hospitals in order to have a place to use the toilet, necessitating the quick delivery of portable toilets to the parking lots. In Hurricane Katrina, the hospitals in New Orleans did their best, but it quickly became apparent that patients would need to be evacuated out of the city, including transfers to hospitals in other states. There were no resources available for prolonged periods, and evacuation was the only sensible answer. This created mini internal disasters in other hospitals elsewhere in the state, since they received large patient loads that stretched their own resources. In any major disaster where community resources are overwhelmed, the states and the federal government will respond, but it may take days for the aid to arrive. Careful planning is not guaranteed to make it all smooth, but it helps.
Terror Events
When considering disaster preparedness, the level of preparation moved to a new high after September 11, 2001. When the nation began to realize the need to prepare for a variety of terrorist activities, a new language, understanding of threats, and need for training emerged. Terms such as “dirty bomb” and “mass casualty event” took on new meanings. The federal government has committed billions of dollars to help communities around the nation prepare to respond to terrorist events, should some occur. These can vary from attacks from passenger planes, to bioterror organisms in the water or food supply, to dispersal of radioactive substances, and events we cannot yet foresee. As an example, after September 11, in the following month the final game of the World Series was scheduled to be played in Phoenix. Hospitals in the region were told to be on the alert for terrorist activities and to be prepared to receive up to 1,000 patients per hospital if a mass casualty event occurred at the ballpark. The planning to be ready for such a traumatic and major event was very stressful, but the hospitals were ready. Fortunately, no such event occurred, but there is no doubt that terrorist-inspired events continue around the world, and that health care facilities need to be in a constant state of readiness if their community is a victim.
Conclusion
Disaster preparedness is an essential part of providing for the health and well-being of patients and members of the community. It is important for every health care facility to have a plan for the management of internal disasters and community disasters of a wide variety of types. The plan must be created, updated on a regular basis, and drilled multiple times per year for several types of disasters, just to keep people in training and a mindset of preparedness. Readiness, flexibility, adaptability to changing circumstances, and careful management of resources are keys to successfully surviving disasters.
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Electronic Resource
1. Emergency Preparedness and Response
Explore the Emergency Preparedness and Response page from the Centers for Disease Control and Prevention website.
https://emergency.cdc.gov/planning/index.aspe-Library Resource
1. Boston Strong: Raising a Voice Against Hospital Violence
Read “Boston Strong: Raising a Voice Against Hospital Violence,” by Evans, from Hospital Employee Health (2017).
https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=120130623&site=ehost-live&scope=site
2. Managing Security and Safety During Disasters
Read “Managing Security and Safety During Disasters,” by Huser, from Briefings on Hospital Safety (2015).
https://lopes.idm.oclc.org/login?url=http://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=111832630&site=ehost-live&scope=site
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