Emergency Management
EMERGENCY
Disaster Planning Strategies
Gary D. Slack, PE, CCE
Healthcare Engineering Consultants
Springfield, Ohio
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Approved Changes for 2009
EMERGENCY
The organization of the standards :
 EM.01.01.01: Plans for managing emergencies
 EM.02.01.01: Develops an emergency operations plan
 EM.02.02.01: Establishes emergency communication strategies
 EM.02.02.03: Establishes strategies for managing resources/ assets
 EM.02.02.05: Establishes strategies for managing safety and security
 EM.02.02.07: Defines and manages staff roles and responsibilities
 EM.02.02.09: Identifies an alternative means providing utilities
 EM.02.02.11: Identifies strategies for patient activities
 EM.02.02.13, 15: Emergency privileges to LIP’s and volunteers
 EM.03.01.01: Annual review of HVA, S-O-P-E of EOP, and inventory
 EM.03.01.03: The organization conducts drills to evaluate the EOP
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Emergency Management
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EM.01.01.01: The organization plans for managing the
consequences of emergencies
 Medical and clinical staff participate in planning
 A Hazard Vulnerability Analysis (HVA) is performed and documented
 The hazards are prioritized
 Communication of emergency plan with community responders
 Mitigation, Preparedness, Response, Recovery
 Assets and resources are inventoried and documented
 Asset and resource inventories are monitored during emergencies
 The emergency management program is evaluated annually (S,O,P,E)
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Emergency Management
EMERGENCY
Tips for Compliance with EM.01.01.01:
 Appoint a physician and administrative representative to actively
participate on the emergency management planning committee
 Perform and document the Hazard Vulnerability Analysis (HVA) for all
geographically separate facilities – review annually!
 Be ready to describe the Mitigation, Preparedness, Response and
Recovery procedures in the EOP
 Ensure that emergency resources are inventoried (PPE, utility and
medical supplies and pharmaceuticals) and monitored
 Verify that the hospital incident command system is integrated into and
consistent with the community command structure (NIMS compliance?)
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Emergency Management
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EM.02.01.01: The organization develops and maintains
an Emergency Operations Plan (EOP)
 Written EOP includes an “all hazards” command structure
 An incident command structure (ICS) is established and is consistent
with the community plan
 The ICS identifies a reporting structure
 Activation of ICS is identified
 Activation of ICS phases is identified
 The EOP identifies the organization response when community nonsupport may occur for up to 96 hours
 Alternative care sites are identified
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Emergency Management
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Tips for Compliance with EM.02.01.01
 Create a written emergency operations plan (EOP) that describes the
incident command structure and process that is in use (HICS 4?) as well
as how ICS integrates into the six critical core areas:
1. Emergency communications
2. Resources and assets
3. Safety and security
4. Staff roles and responsibilities
5. Management of utilities
6. Clinical and support activities
 The EOP can either describe the ICS and core area integration in
detail or reference existing documents
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Emergency Management
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HICS Organizational Chart
Incident
Commander
Operations
Section Chief
Public Info
Officer
Safety
Officer
Liaison
Officer
Med/ Tech
Specialist(s)
Planning
Section Chief
Logistics
Section Chief
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Finance/ Admin
Section Chief
Emergency Management
EMERGENCY
Tips for Compliance with EM.02.01.01
 Create two color-coded timeline charts the indicate how long utilities
will be operational and how long consumable supplies will be available in
the event of an emergency in which no re-supply is possible
 Ensure that decisions are made to determine whether any utility or
supply changes will be implemented to extend “green zones”
 Create two 96-hour plans that assume the following scenarios:
PLAN A: Supplies are available and are ordered and received
PLAN B: Internal supply shortages or utility failures require partial or
total patient evacuation
PLAN C: Shortages and/ or utilities are not sufficient to continue
normal patient care, although evacuation is not possible!
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Emergency Management
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Critical Utilities and Supplies Timeline
 Assume external help is not available
 Create timeline for utilities and critical
supplies, such as food and medications
 Determine time-dependent status:
- Green: Continue all services as usual
- Yellow: Transition to conservation mode
- Red: Discontinue patient treatment, evacuate
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Emergency Management
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Utility Failure Operational Impact Chart
Hours after utility failure
Normal power failure
0
8
16
24
32
40
48
56
Emergency power failure
Water pressure low
Entire loss of water pressure
Loss of steam generation (winter)
Loss of steam generation (summer)
Loss of natural gas
Loss of propane
Chiller failure (winter)
Chiller failure (summer)
Major air handler failure
Failure of sewage system
Sump pump failure
Loss of bulk oxygen
Loss of medical air
Loss of bulk nitrous oxide
Loss of medical vacuum
Computer server failure
Telephone switch failure
Failure of elevators
Pneumatic tube system failure
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64
72
80
88
96
Emergency Management
EMERGENCY
Consumable Supply Operational Impact Chart
Hours after emergency occurs
Fuel oil (winter)
0
8
16
24
32
40
48
56
Fuel oil (summer)
Gasoline
Propane fuel
Natural gas
Potable water
Non-potable water
Oxygen
Medical air
Nitrous Oxide
Nitrogen
Nutrition supplies
Pharmaceutical supplies
IV solutions
Pharmaceutical medications
General patient supplies
Surgical supplies
Environmental cleaning supplies
Central sterile supplies
General office supplies
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64
72
80
88
96
Emergency Management
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EM.02.02.01: The organization establishes emergency
communications strategies
 Staff notification procedures are created
 Provisions for ongoing staff communication during the emergency
 Process to notify external authorities
 Communication with patients and their families
 Communication with the community and media
 Communication with vendors and suppliers
 Sharing information with other health care providers
 Providing information about patients to third-parties (FEMA, CDC, etc.)
 Communication with alternative care sites
 Establishment of back-up communication systems and technologies
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Emergency Management
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Tips for Compliance with EM.02.02.01
 Create notification charts with phone numbers, email addresses, etc.
 Include for staff, external authorities, community, media, vendors
 Determine what information will be shared with other health care
providers in the area
 Ensure that liaisons are established with government agencies
 Verify that MOU’s for alternative care sites are updated
 Establish and check operation of back-up communication systems,
such as the internet, cell phones, two-way radios, emergency land lines,
and amateur radio operators
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EM.02.02.03: The organization establishes strategies for managing
resources and assets during emergencies
 Plans for obtaining medications and non-clinical supplies
 Replenishing medical supplies and equipment during the emergency
 Replenishing pharmaceutical supplies
 Replenishing non-medical supplies (food, water, fuel, linens, etc.)
 Managing staff and family support activities
 Sharing of resources with other health care organizations in and outside of the
local community
 Horizontal, vertical and total evacuation, including transportation of patients,
medications, equipment, staff and medical record information
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Tips for Complying with EM.02.02.03
 Plans should be in place to stockpile and reorder critical clinical and
non-clinical supplies
 Written procedures should describe how the needs of staff and
families of staff will be met during an emergency
 A plan to share community resources and assets should be in place
 A practical patient evacuation plan that includes horizontal and vertical
movement within the facility as well as partial or total evacuation outside
of the facility is required
 Logistics for evacuation should include: 1) transportation; 2) staffing;
3) medications; 4) equipment, and; 5) the medical record
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Emergency Management
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EM.02.02.05: The organization establishes strategies for managing
safety and security during emergencies
 Internal safety and security measures are established
 Role of community security agencies is established with the healthcare
organization and means of coordination is identified
 Processes for handling hazardous materials and waste are developed
 Plans are developed for radioactive, biological, chemical decontamination
 Patients susceptible to wandering are identified
 Access into and out of the facility are controlled
 Movement of staff and patients is controlled within the facility
 Traffic accessing the facility is controlled
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Emergency Management
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Tips for Complying with EM.02.02.05
 Security staffing plans during emergencies must be established
 Expectations with outside police agencies should be identified
 Plans to dispose of infectious and hazardous waste must be created
 Procedures to treat contaminated patients must be written
(radioactive, biological and chemical)
 Methods to lock down the facility to prevent entry must be provided
 Methods to minimize staff and patients from leaving the facility must
be planned
 Plans must be in place to control traffic accessing the facility
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Emergency Management
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EM.02.02.07: The organization defines and manages staff
roles and responsibilities
 Staff roles and responsibilities are defined for the critical areas
(communications, resources and assets, safety and security, utilities,
clinical activities)
 Management of staff support needs (housing, transportation, etc.)
 Staff are trained relative to their responsibilities
 Roles of LIP’s are specifically defined
 Care providers and command center staff are identified (ID badges,
vests, caps, etc.)
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Tips for Complying with EM.02.02.07
 Review and update as necessary, the ICS organizational chart and job
action sheets (check after each drill)
 Ensure that hospital staff have participated in NIMS training
 Discuss emergency expectations with the independent physicians
who have privileges at the hospital
 Select the primary and back-up command center locations
 Have a method to identify incident command staff (ID badges, vests,
caps, etc.)
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Emergency Management
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EM.02.02.09: The organization establishes strategies for
managing utilities during emergencies, such as:
 Electricity
 Potable and non-potable water
 Fuel for building operations or transport vehicles
 Other essential utility needs, such as:
- HVAC equipment
- Medical gas and vacuum systems
- Fire systems
- Sewer
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Tips for Complying with EM.02.02.09
 Complete the utility 96-hour timeline chart
 Determine which utilities require additional supplies, especially water
and fuel
 Determine the feasibility of redundant systems or supplies
Examples: Water – on-site well, water tower or nearby lake
Electricity – additional generators installed
Boilers – portable boiler “on a truck”
Medical gas – low pressure external connection, manifold
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EM.02.02.11: The organization establishes strategies for managing
patients during emergencies, including:
 Patient scheduling, triage, assessment, treatment admission, transfer,
discharge and evacuation
 Clinical services for vulnerable patients, such as: pediatric, geriatric,
disabled or serious chronic conditions or addictions
 Personal hygiene and sanitation
 Mental health needs
 Mortuary services
 Tracking and documenting patient information
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Tips for Complying with EM.02.02.11
 Identify which patients in the hospital are considered “vulnerable”
(neonatal intensive, pediatric, geriatric, dementia, behavioral health)
 Plan for patient and staff hygiene and sanitation without water or sewer
 Determine mortuary needs in the event of a pandemic
 Evaluate back-up methods to track patient information in the event that
the electronic information system fails
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EM.02.02.13: During disasters, the organization may grant privileges
to licensed independent practitioners
 Privileges granted only when EOP has been activated
 Medical staff bylaws indicate to who and how to grant privileges, and
policies will indicate how performance will be evaluated
 Minimum privileging requirements include:
1. Current picture ID and license to practice
2. Must be a member of a recognized disaster response group
3. Proof of government authority to provide services during a disaster
 Hospital determines within 72 hours if privileges should continue
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EM.02.02.15: During disasters, the organization may assign disaster
responsibilities to volunteer practitioners
 Hospital assigns responsibilities only when EOP has been activated
 Hospital identifies in writing who is eligible and how to assign disaster
responsibilities to non-LIP’s
 Minimum requirements to assist during disasters include:
1. Current picture ID and license to practice professional specialty
2. Must be a member of a recognized disaster response group
3. Confirmation by hospital staff the individual is qualified
 Hospital determines a method to evaluate performance and decide
within 72 hours if responsibilities should continue
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EM.03.01.01: The organization evaluates the effectiveness of its
emergency management planning activities
 The Hazard Vulnerability Analysis (HVA) is evaluated annually to
determine if revisions are necessary
 The Emergency Operations Plan (EOP) is evaluated annually with
regard to the Scope, Objectives, Performance and Effectiveness of
the program
 The hospital conducts an annual review of the inventory process with
regard to emergency supplies, and documents the results
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EM.03.01.03: The organization evaluates the effectiveness of the
Emergency Operations Plan
 Twice over 12 months, either as a drill or actual emergency, based on
the HVA results
 Once per year in a free-standing business occupancy
 One “influx of patient” drill per year (cannot be tabletop)
 One escalation per year to test community “non-support” (can be
tabletop)
 One “community-wide” drill per year (can be tabletop)
 Drills are realistic and based on the HVA
 A dedicated, trained individual must evaluate the drill
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EM.03.01.03: The organization regularly tests its emergency
operation plan (continued)
 The six critical areas are monitored: 1) Communication; 2) Resource
mobilization; 3) Safety and security; 4) Staff roles and responsibilities; 5)
Utility systems, and; 6) Patient clinical and support activities
 Exercises are critiqued with a multi-disciplinary group, including
leadership, physician and support staff to evaluate deficiencies
 The operations plan is revised based on the drill findings
 Subsequent exercises evaluate the improvements to the EOP
 Drill evaluations are reported to the hospital safety committee
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Tips for Compliance with EM.03.01.03
 Two drills per rolling 12-month period should be performed, based on
the HVA
 At least one drill per 12 months in a business occupancy
 At least one “influx” drill for a disaster receiving station
 Community-wide and influx drills can be performed concurrently
 The community 96-hour “non-support” drill can be a tabletop
 Trained staff, including a physician and leadership, must evaluate the
drill and must document the six core areas in the evaluation
 Infant abduction (EC.2.10) and patient surge (IC.6.10) drills are highly
recommended
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Simulating Plan A:
“An internal or external disaster occurs, but
adequate resources exist within the organization
and community to provide for continuity of patient
care and hospital operation”
Exercise:
A tornado that affects the community only
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Simulating Plan B:
“An internal or external disaster occurs that requires
movement of patients, either within or external to the
hospital. Internal and external resources are available, but
the healthcare facility is compromised so that partial or total
patient movement and/ or evacuation is required”
Exercise:
A tornado that affects the community and the
hospital facility
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Simulating Plan C:
“A disaster of such magnitude occurs that partial or total
evacuation from the facility is desired, but the surrounding
community is unable to accommodate the patients. Also,
physical movement of people and supplies to and from the
facility is not possible for up to four days”
Exercise:
An avian flu pandemic
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Questions?
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