Download Multiple-site Ambulatory Organization Performs

Reprinted from Environment of Care News, March 2003
CASE
Study
Multiple-site Ambulatory Organization
Performs Hazard Vulnerability Analysis
AltaMed Health Services Corporation discovers new emergency vulnerabilities
hen AltaMed Health
Services Corporation set
out to make sure it had
covered all potential emergency bases by conducting its first
hazard vulnerability analysis (HVA),
it had some surprises in store.
AltaMed provides integrated health
care services to 43,000 families every
year at 19 sites in the East Los Angeles
area. Brian Smouse, corporate safety
officer for the 33-year-old non-profit
agency, took the lead, along with
compliance coordinator Isaac Garcia.
The HVA team included site safety
coordinators and alternates from each
site.
W
Creating a tool
The team’s first step was to do its
homework. “We studied the accreditation standards,” Smouse says, “as
well as finding out what other organizations had done.”
Early on Smouse and Garcia
reviewed an assessment tool that had
been presented to the American
Society for Healthcare Engineering.
“This tool was designed for one facility, and we have many,” Smouse says.
“We had to develop something tailored to our facilities and programs.”
AltaMed ended up with a five-page
worksheet consisting of instructions
for determining probability, risk, and
preparedness scores; three pages of
human, natural, or technological
An HVA is “the identification
of potential emergencies and
the direct and indirect effects
these emergencies may have
on the health care
organization’s operations and
the demand for its services”
(EC.1.4).
events; and a general glossary of
events.
The list of nine human emergency
events that AltaMed chose to analyze
included, among others, mass casualties (trauma, medical, and hazardous
materials), chemical and biological
terrorism, and hostage situations.
Natural events included earthquake,
wildfire, tidal wave, epidemic, and 10
others. Technological events, the
longest list, included 18 events, such
as generator failure, fuel shortage,
information systems failure, and
internal fire.
An important step in creating the
HVA tool involved standardizing the
definitions of emergency events so
that everyone was speaking the same
language. “It might be clear what is
meant by power failure,” explained
Garcia, “but assaultive behavior or
civil disturbance, for example, might
not mean the same thing to everybody. When you have as many locations as we do, you want to be sure
the definition is the same at every
facility.”
Smouse added, “Emergency codes
often mean something different from
one organization to another. For
example, code blue might represent a
respiratory arrest at one organization,
but at another it might be a computer
failure. We standardized these defini(continued on next page ➤)
Case at a glance
Main challenge: Identify and analyze potential hazards, catastrophic events, and
emergency situations that would affect the operations of the organization.
Issues: Develop an assessment tool; communicate the importance and value of the
hazard vulnerability analysis (HVA) to participating staff; complete analyses for multiple
sites.
Joint Commission standards: EC.1.4—Conduct an HVA.
Solutions: Standardize terminology; develop an HVA instrument; train key staff in
completing the HVA.
Outcome: Completed HVA and discovered new areas of vulnerability.
March 2003 Environment of Care® News
9
Case Study
➤
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continued from previous page)
tions and codes.”
Part of the impetus for standardizing the codes for events came from
the Hospital Association of Southern
California (HASC), which has established standard emergency codes so
that each facility has a procedure to
approach an emergency in the same
way. “This avoids the confusion of
what to respond to if a physician or
an RN or any health care worker were
to transfer to another facility,” says
Smouse. “We have even established a
particular code and response for
power outages or rolling brownouts.”
When the team completed the tool,
it started the assessment process.
Site safety coordinators
(SSCs) rank potential
emergency situations
The foresight of AltaMed’s leadership
in appointing an SSC at each site
facilitated the performance of the
HVA. Chosen based on their experience and background, the SSCs went
through an initial training process in
environment of care standards and
will receive ongoing training.
The SSCs assessed the risk of each
emergency situation listed in the HVA
based on three criteria, and they
assigned each situation a score:
■ Probability (score 0–3),
■ Risk (score 1–5); and
■ Preparedness (score 1–3).
Events were scored for risk and
preparedness only if they scored
above 0 for probability. The sum of
the three scores represented the site’s
vulnerability to that particular hazard.
Events that received a total score of 5
or higher (either across the organization or at a specific site) were the
ones AltaMed considered to be in
10 Environment of Care® News
March 2003
Community Health Clinic
need of attention and/or resources for
Bioterrorism Preparedness Survey of
emergency planning.
the California Emergency Medical
One potential situation that meritServices Authority. This survey will
ed attention was chemical or biologihelp in determining funding for traincal terrorism. This event scored an
ing, equipment, and supplies based
average of 8 from 18 sites surveyed.
on AltaMed’s needs and capabilities.
“Some results we expected, such as
Smouse and Garcia emphasize that
the high terrorism or earthquake
conducting the HVA was a worthscores,” says Garcia. “But some came
while process. “The HVA gave us a
out of left field—like the high score
good assessment of our vulnerability,”
of 6 for civil disturbance.”
Garcia says.
It’s been more than ten years since
the city of Los
Angeles had a major AltaMed’s Emergency Events
riot. But the
Upon analysis, these
These are the events that AltaMed
thought of a civil
events were determined
analyzed at all 17 sites. If the event
disturbance is still
to be not applicable to
average score is above a (5), AltaMed
AltaMed’s survey.
schedules drills.
there, based on the
Human
Events:
Human
Events:
observations, histo1.
Labor
Action
1.
Mass
Casualty
(5)
ry, and experience
2. Forensic Admission
(Trauma/Medical/HAZMAT)
of AltaMed’s SSCs
2. Terrorism/Chemical/Biological (8)
and site administra3. VIP Situation (3)
tors, explains
4. Infant Abduction (3)
Garcia.
5. Hostage Situation (6)
The team com6. Civil Disturbance (6)
piled results from
7. Bomb Threat (8)
the individual surNatural Events:
Natural Events:
veys and forwarded
1. Hurricane
1. Earth Quake (10)
the results to
2. Tornado
2. Drought (3)
AltaMed’s environ3. Severe Thunderstorm
3. Landslide (0)
4. Snowfall
4. Epidemic (6)
ment of care com5. Blizzard
mittee, where safety
6. Ice Storm
representatives from
7. Tidal Wave
all sites and pro8. Temperature Extremes
grams will prioritize
9. Wild Fire
and develop appro10. Volcano
priate interventions
Technological Events:
Technological Events:
for emergency
1. Fuel Shortage
1. Electrical/Generator Failure (5)
events.
2. Natural Gas Failure
2. Transportation Failure (1)
For example, as a 3. Water Failure (5)
3. Steam Failure
result of scoring 8
4. Medical Gas Failure
4. Sewer Failure (5)
for chemical or bio- 5. Fire Alarm Failure (5)
5. Unavailability of
logical terrorism,
Supplies
6. Communication Failure (3)
AltaMed is in the
7. HVAC Failure (4)
8. Information Systems Failure (3)
process of develop9. Fire Internal (7)
ing a response for
10. Flood Internal (3)
staff at all sites.
AltaMed is currently 11. HazMat Exposure (4)
12. Structural Damage (4)
participating in the
13. Engine/Mechanical Failure (1)