One of the keys to an effective response to an internal or external emergency is communication. The healthcare staff must be aware of the altered expectations that will be in place in the event of a major incident.
What contingency plan is in place to accommodate staff that must remain at the facility beyond their regularly scheduled shift? What understanding does the staff have regarding mandatory callbacks? When might mandatory callbacks be implemented? Which staff members will be required to make every possible effort to report to duty on a scheduled day off? Is the staff even aware that a major emergency might trigger such extraordinary callbacks?
When is the last time that the employee's contact information had been updated in the system? A simple exercise might involve a simulation where staff are asked to respond back when a "callback order" is given. This should involve minimal time and minimal interruption of one's day. However, the lessons learned from this simple exercise could be a good foundation upon which to build.
Altered Standards of Care
The occurrence of an emergency alters the context in which care is given. Contextual changes may include shortages of staff or supplies, provision of care in settings other than the usual patient care rooms, or numbers of patients far in excess of the usual capacity. Expected standards of care that can be followed during usual times may not be possible, requiring the facility to clarify expectations within the existing situation. This is another area in which management during the disasterous event requires thoughful anticipation and planning. A key to the change is the shift from what is typical in any United States care setting, that of providing maximum care possible to each presenting patient before moving on to the next one, to an approach that ensures the greatest good for the largest possible number of patients (Veenema, 2012, p 195).Emergency standards of care would involve a massive contextual shift in the minds of those who respond. Much of our "normal" environment at work might be altered in a major event. Staff must be prepared to adapt quickly to this altered environment in order to effectively provide care. To achieve this goal, staff must practice under simulated conditions.
The goal here is not to act like a bunch of robots. The goal is for staff to anticipate restrictions and limitations and be able to respond accordingly. The anticipation of the possible conditions is the key. To achieve this, the staff must be provided with possible context.
References
American College of Emergency Physicians. "Guidelines for Crisis Standards of Care during Disasters." ACEP Disaster Preparedness and Response Committee; 2013.
Veenema, T. Disaster Nursing and Emergency Preparedness for Chemical, Biological, and Radiological Terrorism and other Hazards. 3rd. Ed. New York, NY: Springer Publishing Co. 2012
