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DISASTER READINESS
Connections Matter
When Disaster Hits
By COLETTA C. BARRETT, RN, FACHE, and ALLYN T. WHALEY-MARTIN, M.A.
As a net is made up of a series of ties, so everything in this world is connected by a
series of ties. If anyone thinks that the mesh of a net is an independent, isolated thing,
he is mistaken. It is called a net because it is made up of a series of interconnected
meshes, and each mesh has its place and responsibility in relation to other meshes.
— Buddha
D
isasters are the great equalizers, they do not discriminate. All who live in a community that experiences a disaster become “those most in need.” It is during these times
that Catholic health care and its commitment to the community have the opportunity to differentiate themselves.
Our Lady of the Lake Regional Medical Center in Baton Rouge, La., and other hospitals in the
region, face challenges from natural disasters as
well as man-made emergencies. In addition to the
devastating fallout of hurricanes Katrina and Rita
over the past decade, we have contended with prolonged loss of electricity, chemical plant explosions, total closure of the interstate and potential evacuation of the hospital due to an accident
involving a tanker truck transporting hazardous
chemicals. Our preparedness in these situations
has been critical to our ability to respond to the
community and continue to take care of patients.
This culture of preparedness does not happen
by chance. It takes organizational commitment,
continuous training, community collaboration
and coordination to be successful in the everchanging health care environment. Louisiana’s
HEALTH PROGRESS
approach to emergency preparedness is grounded
in the belief that our community is stronger when
we stand as one and act for the common good. For
more than a decade, under the leadership of the
Louisiana Hospital Association and the Louisiana
Department of Health and Hospitals’ emergency
preparedness division, hospitals in the state have
worked together.1, 2 Our regional response efforts
to build, maintain and expand networks of health
care services have focused on communication
and resource coordination during communitywide emergency and disaster events. The primary
objective is to sustain health care, to keep our
doors open and to be present to all those affected.
Our shared mission lives in times of disaster.
As part of this regional network, each hospital defines its capabilities and works with other
health care providers in a coordinated response.
www.chausa.org
NOVEMBER – DECEMBER 2013
37
BUILDING A CULTURE OF PREPAREDNESS
E
nsuring a hospital’s preparedness is
both an operational necessity and
a regulatory expectation. Regulatory
agencies including the Joint Commission and Centers for Medicare
and Medicaid Services have defined
standards to ensure accredited facilities actively prepare for emergencies
which affect that facility and their role
in a communitywide response.1,2 Regulatory standards focus on issues common to disaster events, such as communication and coordination, both
within the facility and with community
agencies, facility safety and security,
staff roles and responsibilities, patient
management, patient care resources
and support for building systems.
Regulatory agencies expect plans
to be living documents that are tested
frequently and revised as often as
necessary to address changes in the
organization’s services and capabilities. Planning should focus on defining
procedures and securing resources to
sustain operations during an event, as
well as on how the organization will
recover from the disaster.
Funds and resources to support
emergency preparedness are available
through federal grant programs such
as the Hospital Preparedness Program
(HPP) to support planning for public
health threats and the Cities Readiness Initiative, funded by the Centers
for Disease Control, for preparedness in large cities and metropolitan
areas.3,4 Hospitals participating in
these programs not only gain access
to programs that will help prepare
their facility, but they also may find
the programs offer an opportunity
to network with key community
stakeholders and build support for the
community as a whole. In Louisiana,
the HPP grant is an integral part of the
structure used to create our unique
regional coordination plan.
38
Here is a checklist that can help
build a culture of preparedness:
BUILD RELATIONSHIPS
Identify key stakeholders in your
community. Consider hospitals, nursing homes, outpatient service providers for dialysis or diagnostic testing
and ambulance services, as well as
individual practitioners.
Meet with local governmental
agencies such as the county Office of
Emergency Management/Homeland
Security and Office of Public Health.
Participate in planning meetings hosted by the Local Emergency
Planning Committee, Department of
Health or other community agency.
CREATE PROCESSES THAT SUPPORT
EFFECTIVE COMMUNICATION
Require leaders and staff to learn
the Incident Command System so it
becomes hardwired into your organization. (See sidebar, page 30.)
Establish an internal report telephone line for staff so they can hear
current operational status information
during an extended disaster.
Create templates for internal
alerts and messages for team members, patients and guests.
Consider electronic tools such as
mass notification systems to support
timely communication.
UNDERSTAND THE HAZARDS
IN YOUR COMMUNITY
Learn about what kind of industry operates in your area. Ask to work
with them to plan for an emergency
involving their business.
Talk with the state law enforcement agency about hazardous materials that may be transported through
your community via interstate highway or railways.
Contact the Local Emergency
NOVEMBER – DECEMBER 2013
www.chausa.org
Planning Committee about its assessment of hazards for the community.
Complete a hazard vulnerability
analysis for your hospital and share
the results with other hospitals and
community agencies.
PRACTICE YOUR PLAN
AND EVALUATE THE RESULTS
Seek opportunities to test your
emergency operations plan throughout the year. Contact your local airport
to ask about participating in FAA (Federal Aviation Administration) drills.
Invite community partners,
including other hospitals, to participate in emergency plan drills whenever possible. If a practice scenario
does not involve community coordination, invite a partner to be an exercise
evaluator.
Take time to methodically evaluate each exercise or plan implementation.
Use the lessons learned to refine
detailed action plans
— Allyn T. Whaley-Martin
NOTES
1. The Joint Commission’s Emergency Management Standards, www.jointcommission.org/new_revised_reqs_emergency_
management_oversight/.
2. Centers for Medicare and Medicaid Services, Condition of Participation: Disaster
Preparedness, Title 42 CFR 485.727.
3. U.S. Department of Health and Human
Services, Office of the Assistant Secretary
for Preparedness and Response, Hospital
Preparedness Program, www.phe.gov/
Preparedness/planning/hpp.
4. Centers for Disease Control, Cities Readiness Initiative, http://emergency.cdc.gov/
cri/.
HEALTH PROGRESS
DISASTER READINESS
For example, a large, academic medical center large and small. The Federal Emergency Managesuch as Our Lady of the Lake is expected to pro- ment Agency (FEMA) offers courses in incident
vide acute medical care and a fully functioning command through the FEMA independent study
emergency department, while a surgical specialty program that will provide a solid foundation for
hospital or a long-term acute care hospital pro- anyone in health care.3 Once they learn the convides refuge or space for sheltering the medically cepts of incident command, leaders should be
needy and patients dependent upon electric- required to practice using it in drills.
ity. Each institution brings a different resource
It also is important to focus on processes and
and capability to the response table, and all are tools to provide accurate, up-to-date information
equally important to supporting the whole com- to team members, patients and guests throughmunity in times of disaster.
out a disaster situation. During early stages of any
In our area, the group got its start by simply emergency, rumors abound, and it can be hard to
asking hospitals to communicate more effec- refocus efforts as the situation evolves. Accurate
tively during times of disasters and to work more information can quell anxiety over the unknown
closely with public health officials to
respond to community need. It now Each institution brings a different
has grown to a collaborative statewide
network that includes nursing homes, resource and capability to the
emergency medical services, dialysis
response table, and all are equally
and home health providers.
Each entity has committed to com- important to supporting the whole
municate, collaborate and coordinate
resources toward sustaining the com- community in times of disaster.
munity. The expanding network allows
individual providers greater flexibility and pro- and allow teams to focus on their responsibility
vides a depth of support for one another and the to provide care to those affected by the event.
community.
Both in planning as well as during a response, be
Creating a culture of preparedness involves vigilant for instances of miscommunication and
four components: Strong relationships, effective resolve them quickly. Small miscommunications
communication, clear understanding of potential can work silently to erode vital trust and support.
hazards and the testing of response plans.
1. Build strong relationships around a single
mission: to provide care for those most vulnerable, those most in need.
Developing a collaborative network within a
competitive health care community is not easy, so
it’s important to establish why preparing together
for disasters should be an important priority. The
ministry of Catholic health care calls us to serve
the whole of our communities, paying special
attention to those most vulnerable, those most in
need. Communitywide disasters highlight community needs and the fact that no one hospital or
provider can meet those needs alone. By working
together, the community can make itself whole.
2. Invest time and energy into processes that
support effective communication.
An “Incident Command System” sets up a management structure that applies to any emergency
or disaster and gives community leaders a common language and method of dealing with events
HEALTH PROGRESS
3. Understand the potential hazards in the
community.
Although it’s impossible to anticipate every
disaster scenario, understanding the hazards
present in the community can provide a foundation for developing an organizational structure for
response. Hospitals accredited by the Joint Commission are required to complete a hazard vulnerability analysis annually and to use the information gleaned from the assessment to guide their
planning efforts.4
The hazard analysis should be a living document, developed through assessment of hazards
specific to a facility and community. Consider
vulnerabilities linked to industry and transportation, technological interdependencies, as well as
natural threats from severe weather or geography.
Learning about local industry and its emergency
planning efforts can help the hospital not only to
gain a more thorough understanding of the risks,
but it also creates the opportunity to develop a
relationship potentially critical to an emergency
www.chausa.org
NOVEMBER – DECEMBER 2013
39
response in the future.
Another resource to consider is the state’s
National Guard civil support team. The mission
of these teams includes advising civilian responders about weapons of mass destruction hazards
and how to respond to them. For us, the Louisiana
National Guard 62nd Civil Support Team has been
a committed partner, supporting hazard identification, training and response support for several
years.
4. Practice the plan and evaluate the results.
Plans for responding in an emergency are
effective only when the team knows how to use
them. Training to ensure awareness of hazards
is often the first step to securing an effective
response. Will the emergency department staff
recognize the signs of a chemical exposure? Are
physicians alert to symptoms that may signal an
emerging biological threat? Subtle signs may be
missed in many emergencies because of a lack of
experience or awareness that the hazard exists.
Following training, invest in exercises, whether
a tabletop discussion or full-scale drill, to test the
plan and response procedures thoroughly in a safe
setting. These exercises allow team members to
learn their roles, as well as how to interact with
each other. Drills give an opportunity to develop
organizational memory that makes responding in
an actual event more familiar.
It’s also important to practice responding with
partners outside the organization whenever possible. Not only will it help establish lines of communication before an event occurs, it also helps
clarify what resources do or do not exist in the
community. Transparency and humility are very
important in these exercises, and all players
should feel comfortable to speak openly about
their capabilities and needs.
Finally, take time to thoroughly evaluate both
drills and responses to actual events. Be candid,
and use a critical eye to ensure opportunities for
improvement are captured. Online tools available through the Homeland Security Exercise and
Evaluation Program include detailed guides and
forms for planning and evaluation.5
In Louisiana, experience with both natural and man-made disasters has taught us that
40
NOVEMBER – DECEMBER 2013
through collaboration, we gain the strength to
face adversity. The relationships established to
guide communication have become the foundation of our culture of preparedness, and they are
key to our resilience as a health care community.
Maintaining them is a top priority to ensure that
we can continue our mission of service and care
for the vulnerable and those most in need in our
community.
Many colleagues have asked, “What is the
secret to creating a culture of preparedness?”
There is no secret. It takes hard work, leadership,
commitment to being prepared and a willingness
to be a part of a larger response effort (which may
mean giving up control and some decision-making). Most importantly, it requires a belief that
strength is drawn from being connected and committed to each other.
COLETTA C. BARRETT is vice president, mission,
Our Lady of the Lake Regional Medical Center,
Baton Rouge, La.
ALLYN T. WHALEY-MARTIN is director, safety, Our
Lady of the Lake Regional Medical Center, Baton
Rouge, La.
NOTES
1. The Louisiana Hospital Association Emergency
Preparedness Program, www.lhaonline.org/display
common.cfm?an=1&subarticlenbr=138.
2. Louisiana Department of Health and Hospitals, Emergency Preparedness Program, www.dhh.louisiana.gov/
index.cfm/subhome/17/n/173.
3. Federal Emergency Management Agency Independent
Study program, https://training.fema.gov/IS/crslist.
aspx.
4. The Joint Commission requires the hospital to conduct a hazard vulnerability analysis to identify potential
emergencies that could affect demand for the hospital’s
services or its ability to provide those services; the likelihood of those events occurring; and the consequences
of those events. The findings of this analysis are
documented. www.jointcommission.org/standards_
information/standards.aspx.
5. Homeland Security Exercise and Evaluation Program,
https://www.llis.dhs.gov/hseep.
www.chausa.org
HEALTH PROGRESS
JOURNAL OF THE CATHOLIC HEALTH ASSOCIATION OF THE UNITED STATES
www.chausa.org
HEALTH PROGRESS
®
Reprinted from Health Progress, November – December 2013
Copyright © 2013 by The Catholic Health Association of the United States
BUILDING A CULTURE OF PREPAREDNESS
E
nsuring a hospital’s preparedness is
both an operational necessity and
a regulatory expectation. Regulatory
agencies including the Joint Commission and Centers for Medicare
and Medicaid Services have defined
standards to ensure accredited facilities actively prepare for emergencies
which affect that facility and their role
in a communitywide response.1,2 Regulatory standards focus on issues common to disaster events, such as communication and coordination, both
within the facility and with community
agencies, facility safety and security,
staff roles and responsibilities, patient
management, patient care resources
and support for building systems.
Regulatory agencies expect plans
to be living documents that are tested
frequently and revised as often as
necessary to address changes in the
organization’s services and capabilities. Planning should focus on defining
procedures and securing resources to
sustain operations during an event, as
well as on how the organization will
recover from the disaster.
Funds and resources to support
emergency preparedness are available
through federal grant programs such
as the Hospital Preparedness Program
(HPP) to support planning for public
health threats and the Cities Readiness Initiative, funded by the Centers
for Disease Control, for preparedness in large cities and metropolitan
areas.3,4 Hospitals participating in
these programs not only gain access
to programs that will help prepare
their facility, but they also may find
the programs offer an opportunity
to network with key community
stakeholders and build support for the
community as a whole. In Louisiana,
the HPP grant is an integral part of the
structure used to create our unique
regional coordination plan.
38
Here is a checklist that can help
build a culture of preparedness:
BUILD RELATIONSHIPS
Identify key stakeholders in your
community. Consider hospitals, nursing homes, outpatient service providers for dialysis or diagnostic testing
and ambulance services, as well as
individual practitioners.
Meet with local governmental
agencies such as the county Office of
Emergency Management/Homeland
Security and Office of Public Health.
Participate in planning meetings hosted by the Local Emergency
Planning Committee, Department of
Health or other community agency.
CREATE PROCESSES THAT SUPPORT
EFFECTIVE COMMUNICATION
Require leaders and staff to learn
the Incident Command System so it
becomes hardwired into your organization. (See sidebar, page 30.)
Establish an internal report telephone line for staff so they can hear
current operational status information
during an extended disaster.
Create templates for internal
alerts and messages for team members, patients and guests.
Consider electronic tools such as
mass notification systems to support
timely communication.
UNDERSTAND THE HAZARDS
IN YOUR COMMUNITY
Learn about what kind of industry operates in your area. Ask to work
with them to plan for an emergency
involving their business.
Talk with the state law enforcement agency about hazardous materials that may be transported through
your community via interstate highway or railways.
Contact the Local Emergency
NOVEMBER – DECEMBER 2013
www.chausa.org
Planning Committee about its assessment of hazards for the community.
Complete a hazard vulnerability
analysis for your hospital and share
the results with other hospitals and
community agencies.
PRACTICE YOUR PLAN
AND EVALUATE THE RESULTS
Seek opportunities to test your
emergency operations plan throughout the year. Contact your local airport
to ask about participating in FAA (Federal Aviation Administration) drills.
Invite community partners,
including other hospitals, to participate in emergency plan drills whenever possible. If a practice scenario
does not involve community coordination, invite a partner to be an exercise
evaluator.
Take time to methodically evaluate each exercise or plan implementation.
Use the lessons learned to refine
detailed action plans
— Allyn T. Whaley-Martin
NOTES
1. The Joint Commission’s Emerge …
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