Hospital Emergency Management: The Anatomy of Growth

The following link was from the most recent Domestic Preparedness Journal Weekly Brief.  It is amazing how much has changed, and how much has not changed.

I could be wrong, but I would be willing to bet that a lot of our hospitals out there have someone who has hospital emergency management as one of many responsibilities.  We need to focus the energies of those who fulfill that responsibility to just hospital EM, for the protection of the patients, their families, the staff, and the community.

I welcome the thoughts of those who follow me.



Hospital Emergency Management: The Anatomy of Growth: Prior to 11 September 2001 the term "emergency management" was more an abstract theory than an operational mandate. Today it is a full fledged…

Hospital Emergency Management exercises

Communication

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

Call to Action

I had just received the January issue of American Nurse Today this week.  Within it was an article authored by David Benton titled "Is nursing prepared for the next disaster?  Are we?

Do we have a plan B in place to cover other systems that will be affected by the disaster (schools, child-care, elder-care, transportation, etc.)?  Do we have a game plan in place for our families so that we can effectively respond to the disaster?  Have we read after-action reports from previous disasters that dramatically affected the delivery of healthcare to learn the lessons learned?  Or are we doomed to repeat the same mistakes and shortcomings that occurred in previous events?

Are we becoming advocates for increased availability for disaster training in our workplace or advanced degree programs?  Are we prepared for the realities of a major incident?

How many of our workplaces offer disaster training through simulation, community disaster exercises, hospital exercises, or tabletop exercises?  How many of us are ready for the mental health challenges that we will face during a disaster; in our patients and ourselves?  What resources are available to our patients and us?  Is our behavioral health
or employee health resources actively involved in the planning phase?

How many of us truly understand that when we talk about triage during a disaster we are talking about the fact that we will not be able to save everyone?  Inherent in a disaster is an event that so totally overwhelms the healthcare system that simple issues become major hurdles.  This will be mentally taxing for many of us.  How many of us are so self-aware of our triggers and are okay to ask for help?

These and many more questions need to be asked.  If you identify a gap or shortcoming, are you willing to take action no matter your role in your institution?

Thank you David Benton for your timely article.

References

Benton, D. (2018). Is nursing prepared for the next disaster? American Nurse Today. 13(1), 32-33.

Veenema, T. G., Lavin, R. P., Griffin, A., Gable, A. R., Couig, M. P., & Dobalian, A. (2017). Call to Action: The Case for Advancing Disaster Nursing Education in the United States. Journal of Nursing Scholarship. 49(6), 688-696.

National Healthcare Disaster Certification

For a while now, I have been discussing the need for a better foundation for healthcare professionals regarding what to expect and how to respond during an emergency or a disaster.  If this past hurricane season has taught us anything, interagency and interdepartmental cooperation is paramount to a successful response to a large scale incident.

To that end, the American Nurse Credentialing Center (ANCC) last year created an interprofessional certification that offers to provide a valid and reliable assessment of the competencies required to respond to a large-scale healthcare crisis.  The National Healthcare Disaster Professional certification (http://nursecredentialing.org/Certification/NurseSpecialties/National-Healthcare-Disaster-Certification) has done a great job in ensuring the foundation of what is required to interact with the myriad of agencies that will respond.

This is not just designed for nurses. This is designed for every profession that plays a role in the effective response to a disaster.  Public health, emergency management, fire, police, EMS, governmental, public/private, and healthcare.....all are included.

From my perspective, this is not to replace any existing certification.  This is intended as a means to plug the gaps that are present in between disciplines.  Yet again, in my humble opinion, well worth the time and money necessary to complete!

Healthcare Emergency Management responsibilities

In their work on healthcare emergency management, Reilly and Markenson (2011) make the follow conclusion regarding the roles of healthcare emergency managers:

Typical positions within healthcare organizations that also perform emergency preparedness activities include nursing managers, educators, administrators, security managers, environmental health and safety administrators, facilities or physical plant directors, or emergency medical services coordinators (p. 16).

How many of the people, who deal with healthcare emergency management, have roles similar to the above listed?  Or do you have different primary/ancillary responsibilities?  How many of you out there have healthcare EM as your sole role?

Should this responsibility be given to an individual whose sole responsibility is to manage or coordinate the following:

• communications
• surge capacity
• volunteer management
• security issues
• hazmat/CBRNE preparedness
• collaboration and integration with public health
• education and training
• equipment and supplies
• worker safety
• drills and exercises
• emergency department disaster operations
• trauma centers (Reilly and Markenson, 2011, p. 6)

Thank you for your responses.

Reilly, M. & Markenson, D. (Eds.) (2011). Health Care Emergency Management: Principles and practice. Burlington, MA: Jones & Bartlett Learning

When the "routine" incident becomes not so routine.

For today's discussion, I'm going to pull a quote from an article published in Fire Rescue Magazine in March 2016.

Most of us in the fire service are used to handling a car fire, a house fire, maybe a fuel spill, or a car accident with two or three victims. This is what we do, what we practice, and the kinds of things that we have responded to and have some confidence that we can handle well. It becomes a completely different story when multiple incidents happen, and they can happen in communities of almost any size. For this reason, every fire officer or individual who could be placed in a situation where he needs to take control of an incident, or a portion of an incident, needs to understand the incident command system (ICS) and how to implement it at both simple and complicated incidents (Jakubowski, 2016).

Throughout the years that I worked in the fire service, I was always advised to avoid being casual about "routine" incidents.  I was trained to know what every position on the fire apparatus was expected to know.  Even early in my career, my officers would give me "what-if" scenarios to prepare me for the day when I might lead.

Why doesn't healthcare do the same?  Can we guarantee that our administration will be available within the facility?  Can our management and supervisors guarantee that they will be available to respond to the affected area of the hospital?

At emergency drills and exercises, excluding the Emergency Room staff, who is present?  Based on an informal poll that I took among local emergency managers, it was upper management of hospitals.  Very few staff members were present at these drills/tabletop exercises.

Because of their role, emergency room staff regularly train on disasters or surge events.  What if it is the Emergency Room that is needing the emergency response?  Without adequate training, can the rest of the hospital be in a position to respond timely and effectively?

Following the model within the fire service, what if everyone within the hospital was familiar with the hospital incident command system (HICS)?  What if everyone within the facility knew the appropriate steps to be taken to initiate a response, whether management and administration was present or not?  What if we drilled on these steps much like we do for a code blue, a missing child, or a fire drill?

It is time hospitals took a more progressive and forward leaning attitude towards non-routine events.

Jakubowski, G. (2016, March 1). Are you prepared to handle more than the "routine" incident? FireRescue Magazine, 11(3).  Retrieved from http://www.firerescuemagazine.com/articles/print/volume-11/issue-3/firefighting-operations/are-you-prepared-to-handle-more-than-the-routine-incident.html

Welcome to all visitors

This is intended as a forum for all of you interested in hospital emergency management.  Since the early 90s, I have worked as an EMT, paramedic, firefighter, and as a nurse.

I would like to see hospitals be more proactive regarding preparedness training for all bedside staff.  Courses that allow staff to think outside the box during a crisis would create a more forward-leaning, as opposed to reactionary, preparatory stance.  My goal is to develop a training program to achieve that goal.