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Biggest Pitfalls and Best Practices
in Emergency Management
EMERGENCY
Strategies for the 2011 Emergency
Management Standards
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Emergency Management
EMERGENCY
The organization of the standards :
 EM.01.01.01: Plans for managing emergencies, including HVA
 EM.02.01.01: Emergency operations plan (EOP) developed – Direct Impact!
 EM.02.02.01: Establishes emergency communication strategies
 EM.02.02.03: Establishes strategies for managing resources
 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 for providing utilities
 EM.02.02.11: Identifies strategies for patient management
 EM.02.02.13: Privileges to LIP’s – Direct Impact!
 EM.02.02.15: Privileges to volunteer staff – Direct Impact!
 EM.03.01.01: Annual effectiveness review
 EM.03.01.03: Regularly tests the emergency operations plan
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Issue: Emergency Management Committee
Best Practice:
 Dedicated EM committee not required, but suggested
 Leadership and physicians should be committee members and
participate in planning
 The committee should perform the following functions:
- Review the HVA annually
- Plan for emergency drills
- Evaluate actual emergencies and drills
 Plan for other emergency activities
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Emergency Management
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Issue: Hazard Vulnerability Analysis (HVA)
Best Practice:
 A Hazard Vulnerability Analysis (HVA) is performed and documented,
for each geographically separate location
 The HVA includes a numerical score
 The hazards are prioritized
 The HVA is used to define Mitigation and Preparedness
 The HVA includes the “disaster level” to determine how long the
resource timeline charts must be for specific emergencies
 The HVA is reviewed and revised, as necessary, annually
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Hazard Vulnerability Analysis (HVA) for Emergency Management
Event Description
Occurrence
Probability (OP)
3
Human
Impact (HI)
3
Property
Impact (PI)
5
Operational
Impact (OI)
4
Total
Score (TS)
36
Procedure
Required?
Yes
Disaster
Level
1-2
Severe Thunderstorm
4
2
3
2
28
Yes
1
Severe Winter Storm
4
2
2
2
24
Yes
1-2-3
Severe Ice
4
2
3
3
32
Yes
1-2-3
Earthquake
3
1
3
2
18
No
N/A
Hurricane
0
4
4
4
0
No
N/A
Flooding
2
1
4
4
18
Yes
1-2
Pandemic
2
5
1
5
22
Yes
1-2-3
Hazmat Spill (internal)
3
3
2
3
24
Yes
1-2
Hazmat Spill (external)
2
2
1
3
12
Yes
1-2
Electrical Failure
4
1
1
5
28
Yes
1-2
Medical Gas Failure
2
4
1
5
20
Yes
1-2
Bomb Threat
2
4
4
4
24
Yes
1-2
Biological Terrorism
1
5
1
5
11
Yes
1-2-3
Nuclear Terrorism
1
5
5
5
15
No
N/A
Tornado
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Issue: Create an Emergency Operations Plan (EOP)
Best Practice:
 Written EOP developed with participation by leadership and physicians
 EOP describes response procedures for HVA determined events
 EOP describes procedures for 96-hour community non-support
 EOP describes the recovery phase of disasters based on HVA
 EOP identifies the individual(s) who have the authority to activate the incident
command function and phases
 EOP includes descriptions of the six critical core areas: 1) communications; 2)
resources and assets; 3) safety and security; 4) staff roles; 5) utility management,
and; 6) patient management
 EOP “crosswalk” is completed to locate required elements
 EOP is reviewed and revised, as necessary, annually
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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
Issue: 96-hour Timeline Charts
EMERGENCY
Biggest Pitfall: Stocking supplies for 96-hours
Best Practice:
 Create color-coded timeline charts that 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” or “yellow” zones
 Create timeline charts for all of the Level 3 scenarios from the HVA; the
timeline is dependent upon the Level 3 duration (how many hours?)
Level 1: Supplies are available and are ordered and received
Level 2: Internal supply shortages or utility failures require partial or total patient evacuation
from the facility
Level 3: Shortages and/ or utilities are not sufficient to continue normal patient care,
although evacuation is not possible and outside assistance is not available
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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
EMERGENCY
Based on the duration of the Level 3 scenario, the timeline
may only extend to 24 or 48 hours, rather than 96
24 hours
48 hours
Utility Failure Operational Impact Chart
Hours after utility failure
Normal power failure
0
8
16
24
32
40
48
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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56
64
72
80
88
96
Emergency Management
EMERGENCY
Issue: Emergency Communication Strategies
Best Practices:
 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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Issue: Resource and Asset Strategies
Best Practice:
 Plans should be in place to stockpile and reorder critical clinical and
non-clinical supplies (supply inventory should be checked routinely)
 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 partial or total
evacuation outside of the facility is required
 Logistics for evacuation must include: 1) transportation; 2) staffing; 3)
medications; 4) equipment, and; 5) the medical record
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Issue: Safety and Security
Best Practices:
 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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Issue: Staff Roles and Responsibilities
Best Practices:
 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.)
 Make sure that decisions regarding staff and family support needs
(house and feed family and pets?) have been determined and are in
writing
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Issue: Utility Back-up Strategies
Best Practices:
 Complete the utility timeline chart for the Level 3’s on the HVA
 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
Fuel – additional on-site storage
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Issue: Patient Management
Best Practices:
 Identify which patients in the hospital are considered “vulnerable”
(neonatal intensive, pediatric, geriatric, dementia, behavioral health,
bariatric)
 Consider plans to move vulnerable patients vertically without elevators
 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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Issue: Privileges to LIP’s During Disasters
Best Practices:
 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
 Mentor must be provided to oversee LIP
 Hospital determines within 72 hours if privileges should continue
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Issue: Privileges to Volunteer Practitioners During Disasters
Best practices:
 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
 Mentor must be provided to oversee volunteer
 Hospital determines a method to evaluate performance and decide within 72
hours if responsibilities should continue
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Issue: Emergency Drills
Best Practices:
 Two drills per rolling 12-month period should be performed, based on the HVA
 At least one drill per 12 months for each business occupancy
 At least one “influx” drill for a disaster receiving station
 Community-wide and influx drills can be performed concurrently
 Don’t forget about patient “surge” drills (IC.01.06.01) and infant/ pediatric
abduction drills (EC.02.01.01)
 The community “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
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Issue: Emergency Drills (continued)
Best Practices:
 To count, drills and actual disasters must:
1) initiate the incident command system (ICS)
2) require additional internal or external resources, beyond what is normally
available
3) the drill or actual disaster must be documented and include an evaluation
of the six critical core areas
 Tabletop simulations are permitted for the community and community nonsupport drills only
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Questions?
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