Hospital Disaster Planning for the Real World

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Hospital Disaster Planningfor the Real World

• John E. Prescott, MD,FACEP
• Dean, WVU School of Medicine

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• Disasters are unimaginable.

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• Disasters are sudden and
• come-as-you-are.

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Hospital Disaster Planning

• We have a plan for every contingency.

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Hospital Disaster Planning

• We have a plan for every contingency.
• We exercise according to our plan.

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Hospital Disaster Planning

• We have a plan for every contingency.
• We exercise according to our plan.
• Disasters never go according to the plan.

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Take home message

• Learn the principles of disaster planning so that
  they can be used in any situation.

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Objectives for today

• Realize the importance of hospital disaster
  planning.
• Know how to assess the key components of a
  hospital disaster plan.
• Understand phased disaster responses.
• Know how and why disaster responses fail.
• Understand after action reviews.

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Disaster

• Any emergency that disrupts normal community
  function causing concern for the safety of its
  citizens including their lives and property.

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Mass Casualty Incident (MCI)

• Any event that leads to the generation of a large
  number of casualties.

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Disaster Medicine

• The study of how humans cope with events (both
  man-made and natural) that seriously disrupt
  normal community function and cause concern for
  the safety of people.

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Disaster Planning

• Prime function is to minimize the resulting loss
  of property, injuries, suffering and death that
  accompanies a disaster.

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Hospital Disaster Planning

• The goal is to minimize the resulting injuries,
  suffering, and death that accompanies a disaster
  (same as above)
  and
• Provide continued quality care to those patients
  in the hospital.

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George Patton key concept

• Plans must be simple and flexible. They should
  be made by the people who are going to execute
  them.

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Public health personnel

• Must understand the basic concepts of disaster
  medicine and should be able to lead their
  hospitals and communities in disaster
  preparedness and response.

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Phases of the disaster response

• Activation phase
• Notification and initial response
• Organization of command and control

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Phases of the disaster response

• Implementation phase
• Search and rescue
• Triage, initial stabilization and transport
• Definitive management of patients/hazards

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Phases of the disaster response

• Recovery phase
• Scene withdrawal
• Return to normal operations
• Debriefing

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Key Factors in a Successful Plan

• Simplicity
• Flexibility
• Coordination
• Leadership
• Communication

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Simplicity

• Keep the disaster routine as close as possible
  to the everyday actions of hospital personnel.
• Confusion reigns when the plan strays from the
  norm.
• People do best what they do everyday.

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Flexibility

• Allows for adjusting the response to the
  situation.
• Use the plan as a framework for decision making.

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Coordination

• Knowing what you are supposed to do during a
  crisis, as well as having a basic understanding
  of how others are responding.
• Requires advanced knowledge of capabilities and
  resources internal and external.
• Prevents waste and bickering.

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Leadership

• The personal element built into every plan and
  often the deciding factor in its success or
  failure.
• The position has authority not the individual.

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Leaders

• Must remain calm.
• Must provide clear and concise orders
  (direction) especially when dealing with
  individuals they do not know.
• Must constantly reevaluate priorities based on
  need and the greatest good.

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Communication

• Internal and external it is often confused or
  compromised.
• Effective communication is frequently mentioned
  as the response element most likely to fail.
• Poor communication Inefficiency (and sometimes,
  panic).

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Effective Communication

• The delivery of the right information to the
  right people at the right time in an
  understandable and effective form.
• Do you have a need to know?
• At least 50 of the information you first receive
  will be wrong.

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Hospital disaster planning

• Requires a high degree of motivation.
• First step, find and review your current plan.
• Question whether it is a workable tool or
  obsolete bookend.
• Do not work in a vacuum.
• Who is in charge?
• Prepare for the worst.

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Key components of a hospital disaster plan

• The flow of patients into the hospital must be
  direct and open.
• Patient flow must be quick and direct throughout
  the hospital.
• Triage area near disembarkation point.
• Treatment areas must be pre-determined and marked.

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Key components of a hospital disaster plan

• Patients must be identified and logged in quickly
  and accurately.
• A command post must be operational in a timely
  manner.
• A command structure must be in place.
• Once notified, beds must be found in the ED, OR,
  and ICU.

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Key components of a hospital disaster plan

• Security for all of the areas must be maintained.
• A system for the rapid recall of staff must be in
  place.
• Effective communication from the site to the
  hospital must be maintained.
• Effective communication in the hospital must be
  maintained.

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Key components of a hospital disaster plan

• Information areas for families and media must be
  established.
• There must be rapid access to critical hospital
  supplies.
• Provision for the serious psychological impact on
  victims and staff must be made.
• Contingency plans for water, electricity and
  transportation must be made.

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Key components of a hospital disaster plan

• Evacuation plans for hospital patients and staff
  must be established.
• Mutual aid agreements with other hospitals and
  surrounding communities must be defined.
• Recognition, isolation and treatment of
  contaminated/infected patients must be addressed.
• Practice. Practice. Practice.

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Phased Disaster Plans

• The hospital response is tailored to the specific
  elements of the disaster scope, of patients,
  type of patients, etc.
  and
• the capabilities (depth) of the hospital.

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Phased Disaster Plans

• Phased rather than all or none.
• Typically in place at larger community hospitals
  or teaching hospitals.
• Phase I On-call staff
• Phase II On-call staff and select groups
• Phase III Total staff mobilization

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After Action Review

• An absolute requisite for improving the
  hospitals response.
• Should be conducted at every unit and results
  written down.
• Should lead to modifications of the plan.
• Leadership and Communication

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AAR General Considerations

• People and what they did.
• Equipment and how it functioned.
• Time management.
• The plan and how it worked.
• Order and how it was maintained.

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Summary

• Realize the importance of hospital disaster
  planning.
• Know how to assess the key components of a
  hospital disaster plan.
• Understand phased disaster responses.
• Know how and why disaster responses fail.
• Understand after action reviews.

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Summary

• It can happen here
• Planning is the most important element in any
  effective disaster response.
• You can play a critical role in disaster planning.

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• Please complete the survey for todays
  presentation at the link below.
• http//tinyurl.com/9bthk
• Once youve completed the survey, follow the
  prompt to the CE credit form.