Disasters can hit like a bomb, causing injury and death, wiping out power, phone and water services and damaging buildings – the hospital itself. Without a plan of action, disaster can throw your facility into chaos, disrupting patient care. That’s why you have a plan to deal with such emergencies. A plan of action dispels the chaos so that patient care can continue as smoothly as possible. Think of this plan as a countdown to defuse a time bomb.
TEN – DISASTERS HIT FROM WITHIN OR WITHOUT
Forces that are either external or internal to your facility cause disasters. When disasters affect many people in the community, they are called external emergencies. Disasters are called internal emergencies when they originate from within your facility or directly affect the facility itself, threatening to injure patients and employees.
External emergencies include:
- Natural disasters such as floods, hurricanes, tornadoes and winter storms
- Mass-casualty disasters such as fires and explosions; multiple vehicular, plane or train crashes; accidents involving hazardous materials; epidemics, infectious outbreaks and food poisoning; riots and civil disturbances; and shortages of food or water
- National emergencies such as nuclear power accidents, terrorist attacks and acts of war
Internal emergencies include:
- Fires and explosions
- Radiation leaks or other hazardous-material exposures
- Severe weather damage
- Violence against the facility or its occupants
- Losses of power, resources or supplies needed to maintain life-support
Whatever the disaster, your hospital must be ready to save lives, treat casualties and maintain quality patient care.
NINE – WHAT COULD HAPPEN HERE?
What disasters could hit your area? Could they include hurricanes, tornadoes, earthquakes, floods, ice storms, power outages, airplane crashes or even a terrorist attack?
Your hospital has identified which disasters are more likely to occur in your area by conducting a hazard assessment. Your emergency preparedness plan was developed to deal with these specific disasters. Study your plan so you know what to do if one of these disasters occurs.
EIGHT – PREPAREDNESS GUIDELINES
Your hospital’s written emergency preparedness plan complies with standards set by JCAHO (the Joint Commission on Accreditation of Healthcare Organizations) and OSHA (the Occupational Safety and Health Administration). Your emergency response plan is also part of a broader community disaster plan developed by safety experts, including the Federal Emergency Management Agency (FEMA), the National Fire Protection Association (NFPA), the American Red Cross, and state and local emergency management agencies.
SEVEN – PRESCRIPTION FOR SURVIVAL
In a hospital disaster plan, nothing is left to chance.
- A chain of command is identified to set the disaster plan in motion and provide leadership
- A command center provides a central site for decision-making and communications
- An alert procedure spreads the word that the disaster plan is activated, extra staff may be called in to ensure continuous care until the crisis is over.
- Emergency communications, such as two-way radios or cellular phones, maintain contact in the hospital and with community emergency agencies when phone service is lost
- Contingency plans make sure enough food, water and medical resources are on hand
- Alternate power sources keep essential services running when electricity or fuel is lost
- Preplanned triage receives casualties, sorts them by severity and routes them to care, triage may be set up at the disaster site, the hospital or both
- To provide care needed by disaster victims, your facility may need to determine who can be discharged and which procedures can be postponed safely
- If patients must be evacuated from your hospital, the plan specifies where and how to transport them, their medical records, medications and equipment
- If patients are received from evacuating facilities, your hospital must provide their medical care, foodand water. Authorities must be notified if your hospital exceeds its licensed capacity to handle the emergency
- Patients who have been moved must be tracked and their families must be notified, after the crisis is over, your hospital conducts necessary safety inspections. When safe to do so, patients, records, equipment and supplies are returned to their original facility
SIX – WHO DOES WHAT? AND WHY?
Everyone in the hospital is part of the disaster-plan team.
- A special committee develops the plan, schedules drills and monitors outcome
- One person, often a safety officer, develops links with community agencies and the plan — during drills and actual emergencies.
- Department managers review procedures with the staff, participate in drills and keep the “communications pyramid” or phone tree updated.
- All employees’ addresses, phone and pager numbers are on file, so they can be located during disasters
When disaster strikes, your emergency plan comes to life and runs on people-power.
- Those in the chain of command direct the plan and make decisions. Members of the command center keep staff and patients informed, start up standby communications when needed, maintain contact with community emergency services and notify families if patients are moved.
- Teams swing into action to make sure food, water and medical supplies are adequate, start up alternative power sources, and call in extra staff to keep services going and give breaks to those on duty.
- Evacuation teams decide when and where to move patients along with necessary supplies and track all patient movement or discharges.
- Once the crisis is over, teams make safety inspections, get patients and equipment hack where they belong and restore services.
FIVE – KNOW THE DRILL
To make sure your disaster plan works, your hospital holds emergency preparedness drills as required by JCAHO . Prior to a drill, you will learn to:
- Carry out your responsibilities so you know where to go and what to do
- Report a fire, chemical spill, bomb threat or other emergencies
- Recognize various emergency alarm codes
- Find and use first-aid supplies, fire extinguishers and other emergency equipment
- Evacuate patients, staff and others following your assigned route.
Drills are held often enough to keep everyone’s skills strong and current. If your hospital provides emergency services or acts as a disaster-receiving station, you must have at least one drill per year that involves volunteers acting as patients from a disaster. This realistic exercise tests every department’s reaction times and performance levels.
During a drill, act as if an actual emergency were underway. Ask questions if directions are unclear. Afterward, you will evaluate the disaster drill, document results and suggest improvements. In fact, everyone who was involved will critique the drill, including public safety workers and workers from other healthcare facilities. If a weakness in your disaster plan is identified, your facility will revise the plan to correct the problem, and will then document that the correction was made within a reasonable amount of time.
There are many more parts to handling a disaster. Know your role.
FOUR – COMMUNITY WITHIN A COMMUNITY
Your hospital is part of a community-wide disaster plan that includes other healthcare facilities, public safety workers and other emergency support agencies. Everyone works together to prepare tor potential disaster. Police, fire and emergencymanagement officials raise awareness of possible disasters. Local news media keep people informed through first-aid and rescue bulletins. Local chapters of agencies such as the American Red Cross and FEMA provide emergency services. Healthcare facilities preplan how to receive patients from each other if a disaster requires one of them to evacuate.
Your community’s public safety workers, such as police officers, firefighters, emergency services crews, civil defense workers and others, also participate in your drills. These drills teach everyone how they should work together during a real disaster. After the drill, everyone’s evaluation further prepares your community to handle a disaster.
THREE – PREPARE. PREVENT. PROTECT.
When a disaster threatens, you need to be ready to act. The key is to prepare for the worst, prevent disaster whenever possible, and protect against the dangers a disaster can bring.
To prepare, your hospital does such things as:
- Arrange for emergency supplies of food, water, pharmaceuticals and other medical items
- Provide a backup strategy for saving computerized patient records and other data.
To prevent, you are trained to take safety precautions.
For instance, to prevent a disastrous fire, you are trained to inspect your work area for fire hazards, to identify flammable substances, to enforce
smoking rules and to use fire extinguishers. To prevent exposure to hazardous materials, you learn to identify and safely handle potentially hazardous
substances in your own work. You learn to read labels and Material Safety Data Sheets for first aid and other vital information in case of accidental spills.
To protect, your hospital establishes procedures to guard against certain dangers.
If potentially hazardous materials are manufactured, used or transported within a five-mile radius of your facility, your hospital cooperates with area police, fire and emergency services to handle accidental spills. For this type of disaster, your hospital provides:
- Quarantined treatment areas to care for contaminated victims
- Decontamination procedures, including special showers
- Personnel trained to handle or dispose of contaminated clothing, tools and other items.
You are trained to use personal protective equipment, or PPE, to protect against dangers in certain disasters. PPE can protect you from chemical splashes, airborne gases and fire or falling particles.
PPE may include safety glasses, goggles, face shields, respirators, hard hats, safety shoes and even whole-body coverings. Make sure you know how to use and dispose of PPE properly.
Develop a plan to protect your family and your home.
If disaster strikes, you will focus better at work when your own family is prepared to handle the emergency. Develop a plan of action at home to deal with area disasters as well as a method of communicating during emergencies.
Both at work and at home, remember to prepare, prevent and protect.
TWO – COUNTDOWN TO ACTION
Certain disasters can happen anywhere. Let’s look at three examples. You have detailed guidelines covering each of these potential disasters. In each case, the chain of command is mobilized, a command center is established, contingency supplies are organized and extra staffing is arranged as needed.
Afterward, the plan’s effectiveness is reviewed and documented.
A Bomb Threat
- Your aim is to prevent a disaster from occurring. Stay calm. Always take the caller seriously. Be polite and attentive.
- Follow your hospital’s procedure in asking questions. Find out where the bomb is located and when it is set to go off.
- Use your ears to identify the caller’s sex, approximate age and language accent. Listen for background sounds such as cars, planes, music and voices.
- Note whether the caller seems familiar with your hospital. Document this data.
- Notify your supervisor or security right away. Tell no one else about the call unless instructed to do so.
Both at work and at home, remember to prepare, prevent and protect.
A Major Electrical Outage Due to a Storm
Your hospital starts contingency plans for power loss as soon as storm warnings am received. Additional fuel s secured to operate backup generators. When power is lost:
- Utility companies are notified immediately. Certain areas of the hospital are monitored for the risk of fire.
- The backup system goes on within seconds. It supplies electricity to the ER and urgent care areas; operating rooms and special care units; obstetrics and newborn units; blood, hone and tissue storage areas; medical-surgical vacuum systems and medical air compressors; at least one elevator; alarm systems and lights that show exit and evacuation routes.
- Some areas may be in darkness. Be prepared to find supplies, reassure patients and move them to other rooms.
- Most of the phone and computer systems may be out. Runners may be used for communication.
- Life-support systems such as monitors and specialty beds may lose power temporarily. Battery backup systems must be checked for proper operation.
- Portable units of medical gases and oxygen may be needed if supplies to patient rooms are lost.
- Refrigerated food and medicine storage units must be kept closed to prevent spoilage.
- Be prepared to work where needed most. For instance, if telemetry is lost in CU, extra staff will be assigned to monitor patients.
- When power is restored, all systems must be restarted, checked and returned to working order.
A Mass Casualty Such as a School Bus Accident
- Pain, fear and grief can heighten such a crisis. Stay calm and focus on your tasks.
- Triage teams at the accident site and at the hospital ER prepare to treat the wounded. Emergency agencies and other hospitals may be involved.
- Hospital personnel prepare to receive victims from ambulances or other vehicles at various entrances. Admission procedures are altered as needed.
- Staffing is adjusted to meet the needs of victims as well as the ongoing needs of other patients. Some patients may be discharged to make room for critical admissions.
- Elective procedures may be postponed to allow for emergency surgeries.
- Special effort is made to track the status of ‘victims, communicate with families and provide the public with progress reports.
- Expert staff is assigned to help the wounded and their families deal with trauma and grief.
Make sure you know what you are supposed to do and do it.
ONE – IT ALL COMES DOWN TO YOU
It takes everyone to handle a disaster — that includes you. Learn about potential disasters that could hit your community. Keep your address and phone numbers up to date on the communications pyramid. Know your role in your disaster plan. Take your disaster training drills seriously. Look for ways your facility can do better next time and share these.
Remember, the key to coping with disaster both at work and at home is to prevent, prepare and protect. Prevent disaster whenever possible. Prepare yourself to handle a disaster. Protect your patients, yourself and your family during a disaster.