Hospital Disaster Planningfor the

Real World

John E. Prescott, MD,FACEP

Dean, WVU School of Medicine

Disasters are unimaginable.

Disasters are sudden and

come-as-you-are.

Hospital Disaster Planning

We have a plan for every contingency.

Hospital Disaster Planning

We have a plan for every contingency.

We exercise according to our plan.

Hospital Disaster Planning

We have a plan for every contingency.

We exercise according to our plan.

Disasters never go according to the plan.

Take home message

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

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.

Disaster

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

Mass Casualty Incident (MCI)

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

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.

Disaster Planning

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

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.

George Patton – key concept

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

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.

Phases of the disaster response

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

Phases of the disaster response

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

Phases of the disaster response

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

Key Factors in a Successful Plan***

Simplicity Flexibility Coordination Leadership Communication

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.

Flexibility

Allows for adjusting the response to the situation.

Use the plan as a framework for decision making.

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.

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.

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.

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).

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.

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.

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.

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.

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.

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.

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.

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.

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

After Action Review

An absolute requisite for improving the hospital’s response.

Should be conducted at every unit and results written down.

Should lead to modifications of the plan.

**Leadership and Communication**

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.

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.

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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