By Don Sadler
Sometimes it can be easy to grow numb to the wave of disasters that seems to occur in our world on a regular basis. These include natural disasters like hurricanes, tornados and earthquakes as well as terrorist attacks, mass shootings and violent intruders.
Communities depend on hospitals and ambulatory surgical centers (ASCs) to be prepared to provide emergency services in the aftermath of a disaster. So, these health care facilities can’t afford to be numb or complacent about disaster threats.
A Key Role
According to Roslyne Schulman, the director of policy at the American Hospital Association (AHA), hospitals play a key role in the nation’s emergency preparedness and response as part of America’s health care infrastructure.
“Hospitals are pivotal to disaster-response activities, whether they are rural or critical access hospitals or Level 1 trauma centers,” says Schulman.
Schulman notes that emergency preparedness for health care facilities requires a significant investment in staff and resources.
“In times of disaster, communities look to hospitals not only to care for the ill and injured, but also to provide food and shelter and help coordinate recovery,” she says.
Preparedness isn’t a one-time investment, Schulman adds. Rather, it is a dynamic process that changes over time.
“Hospitals and health systems need to learn from each emergency situation and incorporate new technology into their emergency readiness plans that gives them the ability to care for their communities when a disaster or terrorist attack occurs,” she says.
“ASCs should prepare for an influx of patients by working in advance with community safety and emergency networks, including area hospitals, ambulance services and the police and fire departments,” says Jan Davidson, MSN, RN, CNOR, CASC, the director of the Ambulatory Surgery Center Division of the Association of periOperative Registered Nurses (AORN).
“When there is a large influx of patients, this network of providers needs real-time communications to ensure proper triage,” Davidson adds.
Final Rule from the CMS
To help health care facilities make emergency preparations for natural and manmade disasters, the Centers for Medicare & Medicaid Services (CMS) published a final rule last fall establishing new emergency preparedness requirements for hospitals and ASCs.
In a Regulatory Advisory, the AHA stated that it believes the new requirements “reflect a commonsense approach to help hospitals protect patients and communities during disasters.”
Along with creating a consistent set of emergency planning regulations across provider-types, “the CMS has provided flexibility in meeting the new standards,” stated the AHA in the Regulatory Advisory.
The new emergency preparedness requirements will be implemented on November 15, 2017. They will require health care facilities to:
• Conduct risk assessments using an all-hazards approach.
• Develop emergency preparedness plans, policies and procedures.
• Create distinct communications plans.
• Establish training and testing programs.
The standards stipulate that health care facilities must conduct a thorough evaluation of their existing emergency preparedness programs to determine necessary changes and additions needed to comply with the final rule. Facilities also must review and update their emergency preparedness plans on an annual basis if they do not do so already.
There are six key aspects of the final rule for health care facilities:
1. Generator location and testing – Generators must be located in accordance with National Fire Protection Association (NFPA) standards when a new structure is built or an existing structure is renovated.
2. Community involvement – Health care facilities are strongly encouraged to engage in community collaboration in their disaster planning efforts.
3. Integrated, system-wide planning – Integrated health systems have the option to maintain one coordinated emergency plan in cases where a single plan improves preparedness.
4. Development of a communications plan – Health care facilities must have a detailed communications plan that includes contact information for staff, physicians, other hospitals, entities providing services under arrangement, volunteers and relevant emergency preparedness officials.
5. Development of policies and procedures for various provisions – Health care facilities must develop policies and procedures based on the risk assessment, emergency plan and communications plan.
6. Testing of the emergency plan – Health care facilities must conduct two exercises annually to test the emergency plan, monitor and document these tests, analyze the results, and update the plan as needed.
Part of the Environment
Jeff Solheim, MSN, RN, CEN, TCRN, CFRN, FAEN, the president of Solheim Enterprises, has been involved in a number of health care facility disaster scenarios throughout his career.
“As an emergency department nurse and emergency department director, disasters are part of our environment,” he says.
Among the disaster scenarios Solheim has been involved in were several chemical incidents in which patients required decontamination and care, as well as a number of motor vehicle collisions in which large numbers of critically injured patients were transported simultaneously.
“My main advice to every health care system out there is to pour adequate resources into the mitigation and preparation phases of disaster management,” he says.
“A well- designed and well-rehearsed disaster plan equates to saved lives and reduced staff stress during a disaster.”
Mitigation and preparation are the two main steps that should be taken before a disaster occurs, Solheim explains.
“Mitigation requires performing a hazards vulnerability analysis, or an HVA,” he says. “Here, the staff will try to determine all potential man-made or natural disasters that could possibly affect the facility.”
Once potential disasters are identified, the facility should develop steps to minimize their potential negative effects.
“This includes devising an alternate communication plan in case landline phone lines, cell towers and other electronic forms of communication are impaired,” says Solheim.
The preparation step recognizes the fact that, regardless of how thorough a facility’s HVA is, it could still be severely impacted by a disaster.
“Preparation involves creating an incident command structure, drafting a formal disaster response plan, training all facility staff on the plan, and conducting drills to test the plan,” says Solheim.
Preparing for Direct Impact
In addition to preparing for a large influx of patients due to a disaster in the area, health care facilities also must make preparations in case they are directly impacted by a disaster themselves.
“Emergency preparedness is a required exercise for accredited facilities of any kind,” says Davidson. “Conducting emergency management drills at least once per calendar quarter is mandatory.”
“The first step in emergency preparedness is to determine if you can remain fully operational or if you’ll need to reduce services or transfer patients to another facility,” says Jonathan Flannery, the senior associate director of advocacy at the American Society for Healthcare Engineering (ASHE).
“Health care facilities need to understand the memorandums of understanding (MOUs) that are in place with other facilities with regard to transferring patients,” adds Flannery. “Are these facilities across the street or hours away? You don’t want to be too dependent on a facility across the street because they could be affected by the disaster, too.”
Facilities also need to make plans for how to mange patients who are in surgery or pre-op at the time of the disaster, as well as how to reschedule surgeries.
“Patient tracking and handling of patient records is critical here because you don’t want to lose track of a patient during a disaster,” says Flannery.
Active Engagement is Crucial
Flannery believes it’s critical that the OR staff actively engage with the facility’s disaster and emergency planning.
“Communication is especially critical,” he says. “Active surgical patients are among the most at-risk patients in the facility when a disaster occurs, so the OR department must be diligent in its disaster preparations.”