May 08, 2021
It's not unusual for personnel at some trauma centers to wear many hats. Your facility may not have a full-time, certified emergency management professional and, therefore, may need to assign one or more people who fill other trauma roles to handle emergency preparedness.
Nevertheless, any day a massive car pileup may occur just 10 miles from your hospital, so preparation for emergencies in your region is essential.
Emergencies requiring response preparation
The definition of emergency varies among medical sites, says Deborah O. Teske, C.E.M., Mayo Clinic business continuity and emergency management coordinator. Mayo Clinic defines emergency and disaster as follows:
Emergency
This is an unexpected or sudden incident significantly disrupting a work area's ability to perform its primary mission, or the care environment itself, while manageable with routinely, readily available resources. Examples include a missing person, limited severe weather, bomb threat, or short-term or small-scale utility failures. The affected area can respond to the event, recovering in about an hour.
Disaster
This is an incident where its complexity, scope or duration threatens a work area or an organization's capabilities and requires assistance beyond what's typically available to sustain patient care, safety, security or other essential functions. Disasters require Hospital Incident Command System (HICS) activation to coordinate response or recovery. Examples include multiple or mass casualty incidents, widespread information technology outages, major infectious disease outbreaks, or long-term or large-scale utilities outages.
Emergency management and community resource interaction
The emergency manager — as a primary or part-time job — doesn't assume the roles of the professionals at an emergency response organization such as the fire department, says Teske. Rather, this role is to coordinate networking with internal and community resources and develop plans before an actual emergency.
A local hospital can be inundated with patients quickly if a multicar crash or other incident occurs nearby. Patients may arrive in reverse priority order. In mass casualty incidents, the more minimally injured often reach the hospital first, as they can hop in a car and good Samaritans may drive them to the emergency department.
Although important, evaluation of patients with less severe traumatic injuries can deplete all hospital resources before more seriously affected patients arrive if the hospital isn't briefed on the scope of the situation. First responders to hospital communication, often through public safety dispatch, can alert the hospital to the extent of the situation and ensure the medical center is prepared to have the resources available to match or exceed the need. Preplanning triage and other aspects of response before an incident occurs is critical.
"When a disaster occurs, it's not time to hand out business cards and get to know each other," says Teske. "Rather, it's important to identify response roles and expectations pre-disaster. Through writing, reviewing and updating plans together, partners learn capabilities and establish communication pathways and response protocols."
At smaller hospitals where the individual who is assigned emergency management likely performs other tasks, it may feel like there's insufficient time to establish community connections. Teske recommends, at minimum, getting acquainted with the local emergency manager, leaders of emergency medical service agencies, fire chief and emergency personnel with local utility companies. Knowing each resource's capabilities, establishing relationships and coordinating plans are essential to effective response. Emergency management planning involves a continual preparation cycle that's similar to continuous improvement's Plan-Do-Study-Act process.
Teske also recommends cross-training and establishing mutual aid agreements, since disasters can overwhelm local resources. For example, if a worker involved with a facility's hazardous material spill leaves the scene without being decontaminated and goes to a medical center's emergency department, that locale becomes the incident's secondary contamination site. Fire departments may not have personnel to manage both sites; hospital staff, therefore, need training and plans — ideally with local fire department expertise — for patient decontamination.
Emergency preparedness exercises
Emergency drills, conducted regularly, are invaluable, says Teske, explaining that a plan that worked four years ago may not work now.
"You can have all the plans in the world, but if you never implement them, you don't know if they'll work," Teske says. "If you don't call phone numbers in your plan, you won't know if those numbers changed."
Testing response plans ranges from simple discussion with appropriate responders to full-scale exercises with actors playing patients. Teske suggests regional coalitions, such as the Southeast Minnesota Disaster Health Coalition, as disaster exercise resources. To share the load, she suggests establishing exercise planning partnerships with other facilities.
An exercise may address issues such as:
- Managing less injured patients who may drain resources when higher acuity patients need attention
- Transporting patients to higher level trauma centers
- Coordinating family reunification
Regulatory considerations
Beyond establishing communication to facilitate incident resource use, hospitals must make these preparations to fulfill accreditation requirements. The Joint Commission, Centers for Medicare & Medicaid Services, and other regulatory bodies require plans for events such as a missing person or fire, as outlined in The Joint Commission's Hospital Compliance Assessment Checklist. An after-action report should evaluate and document plan exercises.
Emergency preparation steps
Teske shares several emergency preparedness tips for trauma centers:
Learn about emergency planning
The Trauma Center Association of America and the Technical Resources, Assistance Center, and Information Exchange websites include useful informational materials, sample plans, exercises, conferences and webinars.
Shadow a pro
Find another professional developing an emergency exercise and ask to shadow the professional during planning and execution.
Join a coalition
Affiliating with groups beyond your medical center and pooling emergency management preparation resources can be invaluable. Groups such as the Southern Minnesota Regional Trauma Advisory Committee and Southeast Minnesota Disaster Health Coalition provide online resources, training and networking opportunities.
Leverage others' plans
If you're feeling strapped for time, creating emergency preparedness plans from scratch is probably unnecessary. Ask other emergency managers for plan copies to compare and improve yours.
Divide and conquer
Partner with other medical centers or community organizations to share emergency plan creation. You don't have to develop plans solo.
Participate in other facilities' exercises, starting small
Incident tabletop drill exercises where all parties potentially involved sit together in a room to discuss scenario strategies provide building blocks for full-scale emergency preparedness exercises.
Empower your manager
Enable your hospital's emergency management designee. He or she needs authority for incident planning responsibility and enacting plans.
Get hospital leadership on board
Hospital leadership must prioritize emergency planning to make it effective. "Disasters often happen when you don't have bandwidth to deal with them; so it is with disaster planning," says Teske.
While believing written plans are important references, she views planning processes as more crucial. "It's establishing coordination and collaboration pieces — just as important as the plan document itself," she says. "In fact, the framing process is probably more valuable than the written plan."
Emergency preparedness planning isn't a one-and-done event, says Teske. It's an iterative process, where plans are activated or exercised every 1 to 2 years and evaluated for strengths and weaknesses. She explains that these recommendations need a process to be completed; improvements then require retesting to ensure changes don't disrupt other response components.
For more information
Hospital Compliance Assistance Checklist. Joint Commission Resources.
Trauma Center Association of America.
Exercises. Southeast Minnesota Disaster Health Coalition.
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