Transitioning from public sector emergency management for a large city to emergency management for a private sector hospital is not easy. The fundamentals of emergency preparedness are the same, but the hospital setting has unique challenges. Each day, there are different numbers of people within the hospital. Some days, the occupants exceed hospital capacity during normal operating conditions. There is no set vulnerable population as the demographics of the population changes hourly. Having a large turnover of people in the hospital because of appointments, outpatient surgeries, visitors, and vendors makes preparedness efforts more challenging.
As performed in the public sector, hospitals must identify their hazards by conducting a hazard vulnerability analysis (HVA), which is like a threat and hazard identification and risk assessment (THIRA). Hospitals need to identify hazards, provide context, and prioritize which hazards make them most vulnerable. The THIRA from the public-sector agencies should be taken into consideration when preparing the HVA as some of the threat to the community will affect hospitals as well. The whole community is needed to prepare for any disaster within a hospital setting.
After identifying hazards and vulnerabilities, the next step is to update the emergency operations plan (EOP). This must be updated annually as local hazards and vulnerabilities may have changed. This is where hospital preparedness gets challenging. Once the EOP is up to date, staff must be trained on the updates and exercise the EOP.
Training can be much more difficult than in the private sector due to budgetary concerns that most hospital emergency managers have to manage in an active hospital. All the services provided at the hospital are revenue generating, which is important for the hospital budget. As such, it is difficult to interrupt surgeries, appointments, laboratory work, and administrative duties to conduct exercises on the EOP. Technology has assisted with this process by having online learning requirements within a health care system. However, online learning only does so much.
Exercising, Resourcing & Informing
Exercising the plan is the difficult part of preparedness. Continuing active patient care complicates conducting exercises in the hospital setting. Patient safety must be considered when planning the exercises and having post-op patients, non-ambulatory patients, and mental health patients requires significant additional resources especially with regard to evacuations. The public information component is also very important especially if conducting a security threat exercise. It is essential that outside agencies are included in the exercise process. Sometimes it is easy to live in the bubble of the hospital building, but there is a community outside the front doors that needs to be included in the preparedness efforts.
Establishing and maintaining quality relationships with the community facilitates conversations about including them in exercise programs. Involving the community on a regular basis will start to build those relationship and build their trust in the hospital. This should be done through community outreach events, public forums, involving them in developing the HVA, or having their input on EOP development. Once the community understands what the hospital is doing, they will be more willing to exercise the plans and ensure the hospital and the community are resilient to any threat or hazard.
The priority should be ensuring the hospital staff is always prepared. Having them understanding the EOP and exercising the EOP is essential for hospital resilience. Hospital emergency managers will need to enhance or change the culture of leadership to focus on preparedness efforts. Some executives do not need any convincing, but others still need to understand why preparedness is so important. In general, leadership wants to see qualitative and quantitative data that supports why preparedness is so important. By demonstrating that actions can save lives and provide continuity of operations, hospitals can build support for the preparedness program. The type of data presented is important. Ensure that the data represents a hospital of comparable size and services to make the exercise realistic and less likely for the results to be questioned.
In addition, the hospital staff should be prepared at home and the emergency manager at the hospital should take considerable time to make sure they are. During significant local incidents or disasters, it is natural for people to protect their homes and family. If emergency managers work with hospital staff to be prepared at home, then it is more likely that the staff will report to work because they feel that their families are taken care of. Hospitals need their staff during times of disaster to provide essential services to the community. A couple of ways to assist with home preparedness efforts is to attend department huddles. This offers face-to-face time with all department members to express the importance of the program and discuss which preparedness items and plans they should have in their homes. Wall readers with colorful creative designs in areas where staff may sit frequently (break rooms, bathrooms, and staff cafeterias) will grab attention and offer significant exposure. However, wall readers should be changed monthly to avoid becoming “invisible” over time.
Ensuring a Resilient Community
Hospitals have an obligation to provide emergency and essential services to the community regardless of what is happening inside or outside the hospital setting. Hospitals need to ensure their facilities and staff are prepared for all types of hazards they may face. Safety, budget, logistical, and legal concerns are necessary for meeting preparedness goals, but emergency managers must also exhaust all efforts to ensure a prepared and resilient facility.