The plan needs to address the four phases on an emergency: mitigation, preparedness, response and recovery, and hazard vulnerability analysis. The plan must be flexible and allow response to different situations involving both internal (institution-based) and external (community-based) disasters. The plan must also be scalable: it must have the ability to respond to emergencies as diverse as a heat wave or a terrorist attack. Plans must clearly describe areas of responsibility, circumstances under which the plan is to be activated, who is in charge, and who is authorized to activate the plan. It is required that the organization have an incident command structure for emergency management that is consistent with that used by the local community.
JCAHO advocates taking an all-hazards approach to emergency preparedness. Hazard Vulnerability Analysis (HVA) is an essential first step in the planning process. HVA is defined as the identification of potential emergencies and the direct and indirect effects these emergencies have on the healthcare organization's operations and the demand for its services. HVA is a formal assessment of hazards that might affect the organization or the surrounding community. External threats could involve hazardous weather, power outages, civil disturbances, terrorism, hazardous material release, or transportation accidents. Internal threats could involve fire or explosion, fumes, loss of environmental services (heat, water, power), loss of medical gases, or a hazardous material release. Once an organization has identified the potential threats, an attempt should be made to assess the likelihood of each of these possibilities occurring. Preparatory sessions, which involve brainstorming and a review of historical data, will assist in this process. The local community planning board may be able to provide the needed historical information. Once a list of vulnerabilities is established, it should be rank-ordered in terms of probability and severity. Finally, the organization must determine its level of preparedness and that of community for each of these possibilities. Performing a "gap analysis" will help organizations understand toward what areas it needs to direct future resources. Sample HVA tools are available from Joint Commission Resources.
Once the HVA analysis is complete, the issues of mitigation, preparedness, response, and recovery can be addressed. Mitigation is defined as the activities undertaken to lessen the severity and impact of a disaster or emergency. Some mitigation activities involve improving structural elements of the hospital, such as fireproofing or providing uninterrupted power through standby generators. A number of hospitals have recently built or purchased decontamination facilities in response to the threat of biologic and chemical terrorism. Other activities may involve a series of steps to respond to and lessen the impact to the institution or community of an unpreventable event (i.e., sandbags during a flood). One approach to mitigation is to utilize a cost-benefit analysis. In this way, scarce resources can be allocated to areas most likely to provide the greatest protection.
Preparedness is defined as activities an organization undertakes to build capacity and identify resources that may be used should a disaster or emergency occur. Organizations must plan to be self-sufficient for a period of 72 to 96 hours. Some activities that will assure preparedness include an inventory of resources and creating a system for procuring additional resources. This can be accomplished through pre arranged agreements with vendors and other healthcare organizations. A system should also be in place for credentialing of licensed personnel who may assist during an emergency. Plans should also be in place for utilization of hospital volunteers during an emergency. Mutual aid agreements with other organizations should be in place. Preparedness is an ongoing process, and the organization must have a system in place to constantly assess its state of preparedness and needs.
Response is the actual emergency management. It defines how an organization treats victims as well as how it reduces the secondary impact on the organization.
Recovery is the process by which an organization deescalates after an emergency. It is essential that an organization have a plan to get back to normal functioning. This plan should include specific steps and stages. Financial, staffing, and service needs all should be incorporated into this portion of the plan.
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