HOSPITAL DISASTERS
WEEK 10
TOPICS
• How hospitals define “Internal disaster”
• Types and Impact of Internal disasters in hospitals
• Combined Internal/external disasters
• The HICS structure, its roles and responsibilities
• Internal Emergency Response Plan
• Communication during types of internal disaster
• Adapting care to the context
• Evaluation and follow through
Internal disaster
• “Internal” disasters refer to incidents that disrupt the everyday,
routine services of a medical facility and may or may not occur
simultaneously with an external event.
• Any event that threatens the smooth functioning of the
hospital, medical center, or healthcare facility, equipment or
that presents a potential danger to patients or hospital
personnel.
Common Types Internal Disasters
• Power outage
• Fire
• Workplace violence
• HazMat leaks/spills
Types and Impact
of
Healthcare Internal Disasters
Types of internal disasters:
•
Power outrage
•
Communications within & outside hospital disrupted.
•
Loss of HVAC systems that rely on electricity for heating,
cooling, and ventilation.
•
Loss of respiratory devices and other critical equipment for
patients in intensive care, neonatal, or cardiac units.
•
Loss of lighting for high-risk surgical procedures and potential
black out of rooms with no emergency lighting
Types of internal disasters:
•
Power outage
•
Loss of pressure in water distribution systems.
•
Inability to access electronic patient medical records and other
hospital data.
•
Loss of patient signaling system for assistance by medical and
hospital staff.
•
Potential loss of access to medication, vaccines, and other
medical supplies requiring keyless entry.
Types of internal disasters:
• Power outage
•
Laboratory and Radiological procedures disrupted.
•
Sterilization of instruments disrupted
•
Kitchen operations disrupted
•
Non-operational elevators – transporting of supplies to other
floors disrupted
Types of internal disasters:
•
Power outage
•
ICU patient care compromised
•
Increase staffing needs
•
Business hospital operation stopped/disrupted
•
Others e.g. equipment failure
Types of internal disasters:
• Fire
•
Damage to the hospital structure
•
•
smoke and soot may carry out through hospital ventilation
Damage patients’ rooms
•
reduces ability to receive and care for patients if the blaze is
serious enough
•
Hospital facilities like administration office may damage
•
Important documents and computer files may be lost forever.
Types of internal disasters:
• Fire
•
Injuries or even fatalities may occur as the result of a hospital fire.
•
Patients are unable to move under their own power, or may not be
able to move rapidly.
•
If there is not an evacuation plan in place, more injuries &
fatalities can happen
•
Damaged location may not be able to utilize until repaired, severely
curtailing doctors & nurses ability to provide for their patients' needs
Types of internal disasters:
• Bomb threats
Types of internal disasters:
•
Workplace violence - Active shooter
•
Can have a devastating occurrence on patients and employees
in the hospital
•
Vulnerable areas of concern:
•
Laboratories – chemical spills & exposure to a
microorganism may occur
•
Radiological dept – MRI rooms – with high powered
machine magnets – may cause missile effect to
guns/weapons
Types of internal disasters:
•
Workplace violence - Active shooter
•
Vulnerable areas of concern:
•
ICUs – where critically ill patients are hooked to machines
and ventilators – difficult to evacuate
•
Emergency room – many patients are waiting to be seen
or admitted – difficult to manage injuries if disruption of
activities/operation takes place.
Types of internal disasters:
• HazMat leaks
Kinds of hazardous materials in hospitals:
• Chemicals – like cleaning materials
• Drugs - like chemotherapy to treat cancer
• Radioactive material that is used for x-rays or radiation treatments
• Human or animal tissue, blood, or other substances from the body
that may carry harmful germs
• Gases that induces patients to sleep during surgery
Hazardous materials can harm individual if they:
•
Touch the skin
•
Splash into the eyes
•
Get into the airways or lungs when breathe
•
Cause fires or explosions
Types of internal disasters:
• Emergency Evacuation
Emergency evacuation may be difficult in the event of power
outage.
• No elevators
• Dark hallways
• Patients with contraptions
• High rise hospital buildings
Combined
Internal/External Disasters
Combined Internal/external disaster in healthcare
• MCI
• Extended power outage
• Large infectious disease outbreak/ Pandemic
• Earthquakes
• Severe storms and flooding
• others
The HICS Structure
Its Roles and Responsibilities
HICS achieves command and control during disaster response
through its chain of command.
• As the disaster response evolves, sections are activated or deactivated.
• The only position that is always required for incident command is the IC.
Specific HICS functional roles
Incident Commander:
• The mission of the IC is to organize and direct the operations of the incident.
The highest-ranking executive in the organization appoints the IC
• directs the disaster response
• immediately appointing the command staff (e.g., safety, liaison, and
PIOs) and activates the sections (planning, operations, logistics, and
finance) required by the event.
• The IC establishes an emergency operations center (EOC) and holds a
meeting to develop the initial IAP.
• The IC manages on a macro level rather than a micro level.
Specific HICS functional roles
Safety and Security Officer:
The mission of the safety officer is to ensure the safety of the staff, facility, and
the environment during the disaster operation.
• Has the final authority to make decisions as they relate to safety and
hazardous conditions, and can overrule portions of an IAP if deemed
too hazardous.
• A key goal is to ensure that no responding personnel become part of
the injured needing care!
• With the threat of bioterrorism and chemical warfare, the role of the
safety officer has taken on added importance
Specific HICS functional roles
Liaison Officer:
The mission of the liaison officer is to function as a contact for external
agencies:
• protecting the IC from requests from outside the organization.
• As any health facility is likely to interface with multiple local, state, or
federal agencies.
• All communication from the hospital to these external agencies
should go through the liaison officer to prevent duplicate
requests or conflicting information.
Specific HICS functional roles
Public Information Officer:
As the title indicates, the individual in this role is responsible for providing
information to the news media.
• When the media are handled appropriately, they can be an asset to
the disaster response.
• The PIO is key to this process, and this position should be activated
for any response that has the potential to involve the media.
• This individual would also be responsible for coordination with the
interagency information process for any large event
Specific HICS functional roles
Medical/Technical Specialists:
These positions are activated as needed to provide guidance in the facility’s
EOC in a variety of special situations. Positions may include:
• specialists in biological and infectious diseases
• legal affairs
• chemical exposure
• radiological exposure
• risk management
• medical staff
• pediatric care
• clinic administration, hospital administration, and medical ethic
THE EOC
In addition to the command positions, the EOC includes four sections, each
headed by a staff chief.
• Through these four sections that the remainder of the response participants
receives information and directions.
1. Planning Section Chief:
The mission - to collect and distribute any information available within the
organization required for planning and the development of an IAP.
• Ensures that the appropriate reports are being generated.
• Ensure that the IAP is communicated to the other section chiefs.
• Ensure adequate staffing, including oversight of any labor resource pools.
2. Operations Section Chief:
The mission - to direct all patient care activities during disaster response. The
largest of the sections and engages the most personnel, with multiple branches
and units within the section. This section includes:
• clinical (medical and nursing)
• ancillary services
One branch within this section may be responsible for ongoing care of patients in
the facility prior to the arrival of the casualty surge associated with the disaster.
Logistics Section Chief:
The logistics section chief has a mission to ensure that all resources and
support required by the other sections are readily available. Responsibilities
Include:
• maintenance of the environment
• procurement supplies, equipment, and food.
• Ensures that the operations staff can focus on delivering services.
For that to happen, the operations section chief must ensure that information
about needed resources is directed to the Logistics Section in a timely
manner.
Finance/Administrative Section Chief:
The mission - to monitor the utilization of assets and authorize the acquisition
of resources essential for the emergency response.
• This position is also frequently charged with ensuring that human
resources policy and procedure consultation is available to the IC.
Response Plan
to Internal Disasters
Power outage
• Recommendation to consider in the Response Plan:
• the use of an uninterruptible power supply or UPS (12, 16,
18,20), a standard in ICUs today that is followed by very few in
some places (limited time only)./or electrical back-up.
• Loss of ventilation – portable ventilator or hand ventilation
• Suctioning – have a ready 60 cc syringe for manual suctioning.
Power outage
• Recommendation to consider in the Response Plan:
• Communications – use of personal cellular phones, or should
have an internal-external battery operated communication
systems.
• Transporting patients – shutdown elevators – evacu-trac/
impassable roadways - helicopters
• Documentation – manual logging
• Foods – outside sources may be of help
Other Recommendations:
1. Coordination of human response.
2. Crisis training that includes such elements as communication, coordination
with other healthcare professionals.
3. Strong leadership is essential during a crisis
4. Community volunteer involvement - Human response. Without the help of
volunteers, it would be impossible to carry patients down the stairs of the
hospital in darkness.
5. Communications - . Cellular telephones are useful but may be limited by
weather conditions and battery life. A regionalized communications center
and network should be considered
Other Recommendations:
6. Protection of essential services. Areas at risk of flooding, or areas of high
seismic activity or other threats including terrorism – should be in safer
place to continue operation even in times of crisis/emergency.
Critical services such:
•
Pharmacy
these services should
•
laboratories
be prepared for challenging
•
Radiology
situations
•
blood bank
•
central supply rooms
Other Recommendations:
7. Water and other essential supplies. Maintenance of protected
•
water supply;
•
water purifiers;
•
emergency food supplies;
•
emergency kits with batteries, flashlights, battery-operated lamps, and
two-way radios;
•
Reflecting devices or emergency lights in stairwells and corridors;
telephones in elevators
•
lists of telephone numbers of personnel, essential internal services, and
outside facility emergency services
Other Recommendations:
8. Patient-logging system. A nonelectronic emergency system for the
identification of incoming or outgoing patients should be readily available.
9. Evacuation plan. Effective design and system for vertical evacuation of
patients could help to reduce evacuation time, personnel requirements,
potential injuries, or deaths. This includes:
• updated engineering and architectural design of stairwells
• Special evacuation equipment, such as the Evacu-Trac or Evacuchair
Adapting
care to the context
Contextual changes may include:
• shortages of staff or supplies
• provision of care in settings other than the usual patient care rooms
• numbers of patients far in excess of the usual capacity.
• Expected standards of care may not be possible
• The management have to clarify expectations within the
existing situation.
• The management is required to have thoughtful
anticipation and planning.
SOPC (standards of Patient Care) during Internal emergency/disaster
A key to the change is the shift to an approach that ensures the greatest
good for the largest possible number of patients.
AHRQ 4 levels of medical standards:
1. Normal medical standard
2. Near-normal medical standards (expanded scope of practice for some
practitioners, use of alternate sites of care, and use of atypical devices,
such as reusing disposable equipment after cleaning)
SOPC (standards of Patient Care) during Internal emergency/disaster
AHRQ 4 levels of medical standards:
3. key lifesaving care (many will receive only key lifesaving care and
nonessential services will be delayed or eliminated)
4. total systems/standards alteration (severe rationing of care, with no
treatment and only pain relief for some persons)
The guidelines are based on the following five principles:
1. During disaster planning, the goal should be to keep the system
functioning to deliver the highest level of care possible to save as many
lives as possible.
2. The planning must be comprehensive, community-based, include all
types of agencies, and coordinated at the regional level.
3. There must be an adequate legal framework for providing care during a
catastrophic event that has many casualties.
The guidelines are based on the following five principles:
4. The rights of patients must be protected to the extent possible
considering the circumstances.
5. Clear, effective communication with all is essential during all phases of a
disaster, including before, during, and after an event.
American Nurses Association
The mutual responsibilities of every health organization to
maintain a state of readiness for emergency or disaster
response, and every health professional to maintain personal
readiness for response.
Respond to Active shooter
Respond to Bomb threat
Bomb threat, is usually announced by phone or SMS.
• stay calm
• try to get as much information as possible.
(Although this might be difficult, try to note any unique features about
the voice and any background sounds you hear over the telephone).
• Keep the caller on the line as long as possible and take detailed notes
about what is said.
Respond to Bomb threat
Try to note the following:
• If the speaker is male or female
• If the speaker has a distinctive accent
• If the voice is disguised, muffled or strange-sounding
• If the voice is shrill or deep
• Any background noises (e.g. traffic, bus passing, bell ringing, fax or printer
sounds)
• Any indoor vs. outdoor sounds
• Call the police and building management immediately after you hang up.
• Do not touch any suspiscious objects
Communication
during types of internal disaster
Hospital code meanings
These codes are used to communicate emergencies and
circumstances among healthcare workers within the hospital.
• To respond immediately
•
Prevent concern or panic by visitors and patients
• Healthcare personnel will know exactly what is going on
without any further explanation.
• There is no universal standardization of emergency color codes. Each hospital
or country may have different meanings per color.
• The most widely used color codes with the same meaning universally are: code
blue, code red and code black.
Code Alert Levels (White, Blue, and Red)
Code White
1. Conditions for adopting Code White:
• Strong possibility of a military operation within the area/region, e.g., coup attempt
• Any planned mass action or demonstration within the catchment area
• Forecast typhoons (Signal No. 2 up) the path of which will affect the area
• National or local elections and other political exercises
• National events, holidays, or celebrations in the area with potential for MCI
• Any emergency with potentially 10-50 casualties (deaths, injuries)
• Any other hazard that may result in emergency
• Unconfirmed report of reemerging diseases, e.g., bird flu, SARS
Code Blue
1. Conditions for Adopting Code Blue:
■ Any of the following conditions:
• When 20-50 casualties (red tags) are suddenly brought to the hospital.
• Any internal emergency/ disaster in the hospital which brings down their
operating capacity (i.e., vital areas) to 50% or which would require evacuation of
patients and setting up of a Field Hospital.
• For conditions other than MCI, the influx of patients is beyond the capacity of
the hospital to handle.
• Confirmed/documented report of reemerging diseases (SARS, human to
human avian flu) within the catchment area.
Code Red
1.Conditions for Adopting Code Red:
Any of the following is present:
• When more than 50 (red tag) casualties are suddenly brought to the hospital.
• An emergency wherein the services of the hospital is paralyzed since 50% of the
manpower are themselves victims of the disaster.
• Hospital is structurally damaged requiring evacuation and/or transfer of
patients.
• Conditions requiring mandatory quarantine of hospital and its personnel (e.g.,
SARS, avian fl u); uncontrolled human to human transmission of SARS/avian flu
within the catchment area.
Recovery, Evaluation
& Follow through
• The timing and speed of recovery will be related to the overall scope of the
disaster, and the degree to which it involved not only the specific health facility,
but other resources in the community.
• As part of the disaster continuum, Recovery Plans should be in place:
• To provide debriefing
• To provide documentation if there are external resources from which to
recover some of the unusual costs.
• Any needed support for those staff members who were exposed to
traumatic experiences or worked for prolonged periods of time and may
be simply exhausted.
• Restocking of supplies
Evaluation & Follow through
A drill or true disaster response, an evaluation must be done.
• Each unit or division should examine its own performance,
making a list of what went well and what proved to be
problematic
• The final step, the organization should convene an evaluation
meeting with all of the collaborating agencies to evaluate
interagency performance.
• The documentation from each should then be forwarded to the
senior management and to the individual or committee responsible
for the emergency plan, so that a list of recommendations for
change can be developed.
• This list should take the form of an improvement plan, including
who, what, and when as well as what resources are required to
implement the changes.
• A final report that includes the critique and the improvement plan
should be
made available to all staff, as their continued
investment
in
preparedness and
continuous
improvement
of
emergency
response is key to the organization’s
performance.
• Following through with the changes identified demonstrates to
the staff that emergency preparedness is valued and important.
END OF TOPIC
Planning for power Outages: A Guide for Hospitals & healthcare Facilities
https://www.phe.gov/preparedness/planning/cip/documents/healthcareenergy.pdf
Consequences of Fire Damage in Hospitals
https://www.restorationsos.com/education/commercial/fire-damage-inhospitals/consequences-of-fire-damage-in-hospitals
PH-DOH HEMS Guidelines on Early Warning and Alert Systems
https://hospitalsafetypromotionanddisasterpreparedness.wordpress.com/20
12/03/29/ph-doh-hems-guidelines-on-early-warning-and-alert-systems-fordoh-hospitals/