Due August 21
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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Top of Form Disaster Preparedness
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Materials
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.
Copyright 2011.
Grand Canyon University. All Rights Reserved.
.gcu.edu/learningPlatform/externalLinks/externalLinks.html?operation=redirectToExternalLink&externalLink=http%3A%2F%2Fwww.cdc.gov%2Fphpr%2Fhealthcare%2Fplanning.htm”>http://www.cdc.gov/phpr/healthcare/planning.htm
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Due August 28
1) Use your critical
thinking skills to write a paper of 1,000–1,200 words that responds to the
question, “Is the PPACA legislation an improvement or a liability to our
health care delivery system?” Use examples to illustrate your points and
include pros and cons of the changes.
2) Refer to the assigned
readings to incorporate specific examples and details into your paper.
3) 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.
4) 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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Top of Form PPACA Paper
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