Medical Center Hazard and Vulnerability Analysis

This document is a sample Hazard Vulnerability Analysis tool. It is not a Issues to consider for
substitute for a comprehensive emergency preparedness program. Individuals or 1
organizations using this tool are solely responsible for any hazard assessment and 2
compliance with applicable laws and regulations. 3
4
INSTRUCTIONS: 5
Evaluate potential for event and response among the following categories using
the hazard specific scale. Assume each event incident occurs at the worst Issues to consider for
possible time (e.g. during peak patient loads). 1
2
Please note specific score criteria on each work sheet to ensure accurate recording. 3
4
Issues to consider for probability include, but are not limited to: 5
1 Known risk 6
2 Historical data
3 Manufacturer/vendor statistics Issues to consider for
1
Issues to consider for response include, but are not limited to: 2
1 Time to marshal an on-scene response 3
2 Scope of response capability 4
3 Historical evaluation of response success 5
Issues to consider for human impact include, but are not limited to: Complete all worksheet
1 Potential for staff death or injury The summary section w
2 Potential for patient death or injury
Issues to consider for property impact include, but are not limited to:
1 Cost to replace
2 Cost to set up temporary replacement
3 Cost to repair
4 Time to recover
Issues to consider for business impact include, but are not limited to:
1 Business i
2 Employees unable to report to work
3 Customers unable to reach facility
4 Company in violation of contractual agreements
5 Imposition of fines and penalties or legal costs
6 Interruption of critical supplies
7 Interruption of product distribution
8 Reputation and public image
9 Financial impact/burden

© 2001 Kaiser Foundation Health Plan, Inc. 406225484.xls

DEFINITIONS
Internal Emergency
An Internal Emergency involves an incident within the hospital that disrupts normal hospital operations. These type

External Emergency
An External Emergency involves an incident beyond the immediate boundaries of the LSUHSC-S campus. This typ
Mass Causality Emergency
A Mass Causality Emergency involves a large influx of victims from an internal or external event requiring treatmen
Any series of events which creates an overload situation in the Emergency Department may necessitate the use of

The Safety Committee has developed appropriate specific emergency response plans based on priorities establish

MITIGATION - Activities designed to reduce the risk of and potential damage due to an emergency (i. e., the installation of sta

PREPAREDNESS - Activities that organize and mobilize essential resources (i. e., plan-writing, employee education, preparati

RESPONSE - Activities the hospital undertakes to respond to disruptive events. The actions are designed with strategies and

RECOVERY - Activities the hospital undertakes to return the facility to complete business operations. Short-term actions asse

© 2001 Kaiser Foundation Health Plan, Inc. 406225484.xls

 Medical Center Hazard and Vulnerability Analysis

Issues to consider for preparedness include, but are not limited to:
Status of current plans
Frequency of drills
Training status
Insurance
Availability of alternate sources for critical supplies/services

Issues to consider for internal resources include, but are not limited to:
Types of supplies on hand/will they meet need?
Volume of supplies on hand/will they meet need?
Staff availability
Coordination with MOB's
Availability of back-up systems
Internal resources ability to withstand disasters/survivability

Issues to consider for external resources include, but are not limited to:
Types of agreements with community agencies/drills?
Coordination with local and state agencies
Coordination with proximal health care facilities
Coordination with treatment specific facilities
Community resources
Complete all worksheets including Natural, Technological, Human and Hazmat.
The summary section will automatically provide your specific and overall relative threat.

© 2001 Kaiser Foundation Health Plan, Inc. 406225484.xls

 al operations. These types of incidents include, but are not limited to fire, bomb threats, utility failures, hostage situations, and i

UHSC-S campus. This type of incident can result in arrival of multiple casualties, including contaminated or contagious victims,

event requiring treatment, such as the result of a fire, explosion, train wreck, or bioterrorism event that directly affect hospital o
may necessitate the use of the emergency procedures described in the Mass Casualty Discharge Plan. The mass casualty emer

sed on priorities established as part of the Hazard Vulnerability Analysis. Each Emergency Response Plan will address the four

y (i. e., the installation of stand by or redundant equipment, training).

mployee education, preparation with outside agencies, acquiring and maintaining critical supplies).

esigned with strategies and actions to be activated during the emergency (i. e., control, warnings, and evacuations).

ons. Short-term actions assess damage and return vital life-support operations to minimum operating standards. Long-term actions focus on

© 2001 Kaiser Foundation Health Plan, Inc. 406225484.xls

hostage situations, and infant/pediatric abductions.

ed or contagious victims, which involve the Emergency Department. These type of external emergencies include; utility outages

t directly affect hospital operations. The victims may arrive at the Emergency Department via ambulance or other emergency s
The mass casualty emergency may be combined with other response plans used to protect the facility, such as in the event of

Plan will address the four phases of emergency management activities:

Long-term actions focus on returning all hospital operations back to normal or an improved state of affairs.

© 2001 Kaiser Foundation Health Plan, Inc. 406225484.xls

ergencies include; utility outages, tornadoes, hurricanes, chemical incidents, biological, and radiation. These may not impact th

ambulance or other emergency service vehicle.

e facility, such as in the event of an approaching hurricane or ice storm.

© 2001 Kaiser Foundation Health Plan, Inc. 406225484.xls

diation. These may not impact the hospital directly, but could require a status alert for the facility.

© 2001 Kaiser Foundation Health Plan, Inc. 406225484.xls

 HAZARD AND VULNERABILITY ASSESSMENT TOOL
KEJADIAN BENCANA ALAM TAHUN 2015

DAMPAK = (LUAS KEJADIAN - MITIGASI)

PROBABILITAS DAMPAK DAMPAK DAMPAK RESPON RESPON
KESIAPAN
KEJADIAN MANUSIA PROPERTI BISNIS INTERNAL EXTERNAL

Kemungkian
Probabilitas akan Kehilangan dan Gangguan Waktu, efektifitas, Masyarakat/Bantua
meninggal atau Praperencanaan
terjadi kerusakan fisik pelayanan sumberdaya n umum dan supli
cedera

0 = N/A 0 = N/A 0 = N/A 0 = N/A 0 = N/A

0 = N/A 1 0 = N/A 1
1 = Rendah 1 = Low 1 = Tinggi 1 = Tinggi 1 = Tinggi
= Low 2 = Rendah
NILAI = Moderate
2=
2 = Moderat 3
2 = Moderate 2 = Moderat 2 = Moderat 2 = Moderat
Moderat 3 3 = High 3 = Rendah atau 3 = Rendah atau 3 = Rendah atau tidak
3 = High = Tinggi
= Tinggi tidak ada tidak ada ada
Gempa bumi 3 3 3 3 3 3 3
Gelombang air pasang 2 1 2 2 1 1 2
Suhu meningkat 3 3 1 2 2 1 1
Kemarau 3 1 1 2 0 0 0
Banjir, External 3 3 3 3 3 1 1
Angin Putting Beliung 3 2 2 3 3 3 1
Kebakaran 1 3 3 3 2 1 1
Bendungan rusak 3 3 3 3 1 1 1
Epidemi 3 2 0 0 1 2 2

NILAI RATA-RATA 1.50 1.31 1.13 1.31 1.00 0.81 0.75

* Makin besar persentase makin tinggi ancaman
24 RISIK) = PROBABILITITAS * DAMPAK
101 0.18 0.50 0.35

© 2001 Kaiser Foundation Health Plan, Inc. Natural Hazards : 406225484.xls

 RISIKO

Ancaman relatif*

0 - 100%

100%
33%
56%
22%
78%
78%
24%
67%
39%

18%

© 2001 Kaiser Foundation Health Plan, Inc. Natural Hazards : 406225484.xls

 HAZARD AND VULNERABILITY ASSESSMENT TOOL
KEJADIAN TERKAIT TEKNOLOGI RUMAH SAKIT TAHUN 2015
DAMPAK = (LUAS KEJADIAN - MITIGASI)
PROBABILITAS DAMPAK DAMPAK DAMPAK RESPON RESPON RISIKO
KESIAPAN
KEJADIAN MANUSIA PROPERTI BISNIS INTERNAL EXTERNAL
Kemungkinan Masyarakat/
Kemungkinan harus Kehilangan dan Gangguan Pra- waktu, efektifitas,
Meninggal atau staf pendukung Ancaman Relatif*
terjadi kerusakan fisik Pelayanan perencanaan sumberdaya
cedera dan bantuan

0 = N/A 0 = N/A 0 = N/A 0 = N/A 0 = N/A

0 = N/A 1 0 = N/A
1 = Rendah 1 = Rendah 1 = Tinggi 1 = Tinggi 1 = Tinggi
= Rendah 1 = Rendah
NILAI 2 = Moderat
2= 2=
2 = Moderat
2 = Moderat 2 = Moderat 2 = Moderat 0 - 100%
Moderat Moderat 3 3 = Rendah 3 = Rendah atau 3 = Rendah
3 = Tinggi 3 = Tinggi
3 = Tinggi = Tinggi atau tidak ada atidak ada atau tidak ada

Gangguan listrik 3 2 1 3 3 3 3 83%

Gangguan Generator
1 3 3 3 2 2 2 28%
Zet (Gen-Zet)

Gangguan
Transportasi 2 3 2 3 1 2 1 44%
Ambulans
Kehabisan Bahan
2 3 3 3 1 1 2 48%
Bakar
Gangguan suply air 1 3 3 3 1 1 3 26%

Gangguan saluran air 1 0 2 3 2 2 2 20%

Gangguan Steam
1 3 2 3 2 2 2 26%
boiler

Gangguan Fire Alarm 1 3 2 3 3 2 1 26%

Gangguan Komunikasi 1 2 1 1 2 2 2 19%

Gangguan Gas Medis 2 3 2 3 1 1 2 44%

Gangguan Vakum
2 3 2 2 1 1 2 41%
Medis

Gangguan pada HVAC 1 2 2 2 2 2 2 22%

Compress air 1 0 2 1 2 1 3 17%

Gagal Sistem
3 1 1 3 1 1 2 50%
Informasi Rumah Sakit
Fire, Internal 3 3 3 3 2 2 1 78%
Terpapar Hazmat,
1 3 2 2 2 2 3 26%
Internal
Gangguan pada Alat
1 3 1 3 2 2 2 24%
Medis
Gangguan Suply O2 1 2 3 1 1 1 1 17%
© 2001 Kaiser Foundation Health Plan, Inc. Technological Hazards : 406225484.xls
 Kekurangan suply 0 0 0 0 0 0 0 0%

Kerusakan struktur
2 3 3 3 1 2 2 52%
Bangunan

1.58 2.37 2.11 2.53 1.68 1.68 2.00 36%

* Makin besar persentase makin tinggi ancaman
30 RISIKO = PROBABILITITAS * DAMPAK
235 0.36 0.53 0.69

© 2001 Kaiser Foundation Health Plan, Inc. Technological Hazards : 406225484.xls

 HAZARD AND VULNERABILITY ASSESSMENT TOOL
KEJADIAN TERKAIT MANUSIA TAHUN 2015

DAMPAK = (LUAS KEJADIAN - MITIGASI)

PROBABILITAS DAMPAK DAMPAK DAMPAK RESPON RESPON RISIKO
KESIAPAN
KEJADIAN MANUSIA PROPERTI BISNIS INTERNAL EXTERNAL

Kemungkinan Community/
Probabilitas akan Kehilangan dan Gangguan Waktu, efektifitas,
meninggal atau Pra-perencanaan Mutual Aid staff Ancaman relatif*
terjadi kerusakan fisik pelayanan sumberdaya
cedera and supplies
0 = N/A
0 = N/A 0 = N/A 0 = N/A 0 = N/A
0 = N/A 1= 0 = N/A
1 = Rendah 1 = Tinggi 1 = Tinggi 1 = Tinggi
1 = Rendah Rendah 1 = Rendah
NILAI 2 = Moderat
2=
2= 2 = Moderat
2 = Moderat 2 = Moderat 2 = Moderat 0 - 100%
Moderat 3 = Rendah atau 3 = Rendah atau 3 = Rendah
3 = Tinggi Moderat 3 = Tinggi
3 = Tinggi tidak ada tidak ada atau tidak ada
3 = Tinggi
Insiden Masal/kecelakaan
1 3 3 2 2 1 2 24%
lalu lintas (Trauma)
Insiden Masal
1 3 0 3 1 1 2 19%
(medis/infeksius)

Situasi VIP 2 1 1 1 2 2 2 33%

Penculikan Bayi 3 2 1 2 3 2 2 67%

Penyanderaan 1 3 0 1 2 2 2 19%

Tawuran/huru hara 3 2 2 2 3 2 3 78%

Aksi Tenaga Kerja 2 2 1 3 2 2 3 48%

Kasus Forensik 3 0 0 2 2 2 1 39%

Ancaman Bom 3 2 2 2 3 2 3 78%

NILAI RATA-RATA 1.90 1.80 1.00 1.80 2.00 1.60 2.00 36%

* Makin besar persentase makin tinggi ancaman

19 RISIKO = PROBABILITITAS * DAMPAK
102 0.36 0.63 0.57

© 2001 Kaiser Foundation Health Plan, Inc. Human Hazards : 406225484.xls

 HAZARD AND VULNERABILITY ASSESSMENT TOOL
KEJADIAN TERKAIT HAZMAT TAHUN 2014
DAMPAK = (LUAS - MITIGASI)
PROBABILITAS DAMPAK DAMPAK DAMPAK RESPON RESPON RISIKO
KESIAPAN
KEJADIAN MANUSIA PROPERTI BISNIS INTERNAL EXTERNAL
Kemungkinan Masyarakat/
Probabilitas akan Kehilangan dan Gangguan Waktu, efektifitas,
meninggal atau Pra-perencanaan Bantuan umum dan Ancaman relatif*
terjadi kerusakan fisik pelayanan sumberdaya
cedera supli

0 = N/A 0 = N/A 0 = N/A 0 = N/A 0 = N/A

0 = N/A 1 0 = N/A
1 = Rendah 1 = Rendah 1 = Tinggi 1 = Tin ggi 1 = Tinggi
= Rendah 1 = Rendah
NILAI 2 = Moderat
2=
2 = Moderat
2= 2 = Moderat 2 = Moderat 2 = Moderat 0 - 100%
Moderat Moderat 3 3 = Rendah atau 3 = Rendah atau 3 = Rendah atau
3 = Tinggi 3 = Tinggi
3 = Tinggi = Tinggi tidak ada tidak ada tidak ada

Petugas terpapar B3
(medis, Non, Medis, 3 2 1 3 2 2 2 67%
dan Tajam)
Penyimpanan Bahan
2 3 1 1 2 2 2 41%
B3

2 1 1 2 2 2 2 37%
Pelabelan Bahan B3
Penangan Tumpahan
2 3 2 2 2 2 2 48%
B3
NILAI RATA-RATA 1.00 1.00 0.56 0.89 0.89 0.89 0.89 9%

* Makin besar persentase makin tinggi ancaman

9 RISIKO = PROBABILITAS * DAMPAK

46 0.09 0.33 0.28

© 2001 Kaiser Foundation Health Plan, Inc. Hazardous Materials : 406225484.xls

 SUMMARY OF MEDICAL CENTER HAZARDS ANALYSIS

Total for Facility

Technological

Hazmat
Natural

Human
Probability 0.50 0.53 0.63 0.33 0.51

Severity 0.35 0.69 0.57 0.28 0.50

Hazard Specific Relative Risk:
0.18 0.36 0.36 0.09 0.25
R e la tiv e Thre a t to Fa c ility

Hazard Specific Relative Risk to Medical Center

1.00
0.90
0.80
0.70
0.60
0.50
0.40
0.30
0.20
0.10
0.00
R e la tiv e Im pa c t on Fa c ility

Natural Technological Human Hazmat

Probability and Severity of Hazards to Medical Center

1.00
0.90
0.80
0.70
0.60
0.50
0.40
0.30
0.20
0.10
0.00
Probability Severity

This document is a sample Hazard Vulnerability Analysis tool. It is not asubstitute for a comprehensive emergency preparedness program.
Individuals or organizations using this tool are solely responsible for any hazard assessment and compliance with applicable laws and regulations.

© 2001 Kaiser Foundation Health Plan, Inc. 406225484.xls Summary