Hospital Emergency Management

The safety officer wrote the disaster plan! What am I supposed to do?

Hospital emergency management has changed over the past few years...
Until recently, hospitals planned response to mass casualty disasters (Alert 1), fire, and a few natural disasters (tornado, earthquake) that could impact the facility.

U K H o s p ita l H a z a r d V u ln e ra b ility A n a ly s is

Now hospitals conduct an annual hazard vulnerability analysis and come up with a list of emergencies that looks like this
This list takes into account probability impact on institution institutional preparedness

E vent M a ss C asu alty In c id en t (H az m at) H os t ag e S itu ation C iv il D istu rb an c e B om b T h reat E arth q u ak e H az m at E xp o s u re, In tern al M a ss C asu alty In c id en t (T rau m a) T erroris m , B iolog ic al T erroris m , C h em ic al H V A C F ailu re In form ation S y s tem s F ailu re C om m u n ic ation s F ailu re T orn ad o U n av ail ab ility of S u p p lies M a s s C as u alty In cid en t (M ed ic al) In fan t A b d u ction F ire, In tern al Ic e S torm T em p eratu re E xtrem es E p id em ic H az m at E xp o su re, E xtern al G en erato r F ailu re E lec tric al F ailu re M ed ic al G as F ailu re L ab or A c tion S ev ere T h u n d erst orm D rou g h t M ed ic al V ac u u m F ailu re F lood , In tern al B lizz ard S ew er F ailu re F u el S h ortag e S team F ailu re V IP S itu ation S truc tu ral D am ag e W ater F ailu re S n ow F all F oren s ic A dm is sion F ire A larm F ailu re W ild Fire F lood , E xt ern al T ran s p ort ation F ailu re

2 0 0 2 R a tin g 30 30 30 30 30 30 30 30 30 30 28 20 20 20 20 20 20 18 16 15 15 10 10 10 9 9 8 8 8 6 4 4 4 4 4 4 3 3 2 1 1 1

Emergency Management has evolved beyond response planning. It includes:

Mitigation Preparedness Response and Recovery

Because of the numbers and kinds of emergencies that can impact a hospital, most begin planning with a basic infrastructure...
Incident Commander

Safety Officer

Security Officer

Public Information Officer

Liaison Officer

Logistics Chief

Planning Chief

Finance Chief

Operations Chief

JCAHO and NFPA 99 require an all-hazards incident command structure that...

Can be coordinated with the command system in the community Uses the same terminology as the community ICS Is flexible enough to allow activation and deactivation of components, based on the specific event

Both JCAHO and NFPA also require a structure that explicitly allows for the management of...
Patient care Staff/family support Logistics of critical supplies Media Security

Hospital Emergency Incident Command System HEICS

Incident Commander

Public Information Officer

Safety and Security Officer

Liaison Officer

Logistics Chief Facilities Unit Leader

Planning Chief Situation-Status Unit Leader

Labor Pool Unit Leader

Finance Chief Time Unit Leader

Procurement Unit Leader Medical Staff Director

Operations Chief Medical Care Director Ancillary Services Director Human Services Director

Damage Assessment and Control Officer Sanitation Systems Officer

Laboratory Unit Leader Treatment Areas Supervisor Radiology Unit Leader

Staff Support Unit Leader Psychological Support Unit Leader

Medical Staff Unit Leader Nursing Unit Leader

Claims Unit Leader Cost Unit Leader

In-Patient Areas Supervisor

Communications Unit Leader

Transportation Unit Leader Materials Supply Unit Leader

Surgical Services Unit Leader Patient Tracking Officer Patient Information Officer

Triage Unit Leader

Pharmacy Unit Leader

Cardiopulomonary Unit Leader

Dependent Care Unit Leader

Maternal Child Unit Leader

Critical Care Unit Leader General Nursing Care Unit Leader

Immediate Treatment Unit Leader

Delayed Treatment Unit Leader Minor Treatment Unit Leader

Nutritional Supply Unit Leader

Out Patient Services Unit Leader

Discharge Unit Leader

Morgue Unit Leader

What is HEICS?
An all-hazards command structure A universal link with outside resources

HEICS provides...
A dependable chain of command Improved communication through common language Flexibility Prioritization of tasks Organized documentation system Effective mutual aid planning
The Fayette County Healthcare Emergency Planning Committee has adopted HEICS. As a result, all acute care hospitals will begin using the HEICS structure.

HEICS Tools
Organization chart Job Action Sheets Forms

Basic Units of HEICS Organization

Incident Commander Section Chiefs Directors Unit Leaders Officers

PI Officer Safety Officer Security Officer Liaison = Command Center

Each situation is unique and requires a different implementation strategy.

Some positions will need to be filled immediately. Others may not be needed for hours or days. Some may not be needed at all.

Five sections one mission...

To respond to the emergency at hand.

Command Center Logistics Planning Finance Operations

Command Center
Defines the mission and ensures its completion.

Logistics
Provides for a working environment and adequate materials to meet the overall medical objective.

Planning
Determines and provides for the continuance of each medical objective. Prompts and drives all HEICS officers to develop short- and long-range action plans.

Finance
Provides funding for present medical objective and stresses facility-wide documentation to maximize financial recovery and reduction of liability.

Operations
Carries out the medical objective to the best of the hospital s ability.

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Job Action Sheets

Your disaster response job descriptions Tell you
What you are going to do When you are going to do it To whom you are going to report it after you have done it.
Universal titles and missions allow emergency responders from a variety of agencies to communicate.

HEICS Forms
Used with job assignments Can be altered in any way necessary Documentation = $$$

The Language of Emergency Management

To specific disaster plans

(to reflect HEICS structure)

Emergency code names

(to make consistent with other hospitals and emergency responders)

JCAHO Emergency Management standards

Advance planning for

Medical Care Director

The Operations Chief will require written plans for:
Establishing an Operations Section Center, including locations and staffing Assessing staffing, supply, equipment needs in patient care settings. Emergency inpatient discharge. (See Nursing Unit Leader.) Communicating with patient care areas. (See Communications Unit Leader.)

Advance planning for

Medical Staff Director

The Operations Chief will require written plans for: Establishing a physician labor pool. (See Medical Staff Unit Leader.) Credentialing volunteer medical staff. (See Medical Staff Unit Leader.) Assessing physician staffing needs and assigning physicians.

Advance planning for

InIn-Patient Areas
The Operations Chief will require written plans for: Assessing inpatients for early discharge. (See Nursing Staff Unit Leader.) Establishing alternate inpatient care sites within the facility. Assessing staffing, supply, equipment needs in patient care settings.

Advance planning for

Treatment Areas
The Operations Chief will require written plans for:
Establishing emergency treatment areas, including location and staffing. Assessing staffing, supply, and equipment needs in treatment areas. (See Medical Care Director.) Assessing security needs in treatment areas. Moving patients through treatment areas to discharge or admission.(See Transportation Leader.)

Advance planning for

Ancillary Services
The Operations Chief will require written plans for:
Inventorying available blood supply. Evaluating ancillary services capacity to perform services required by emergency. Tracking patients to ensure results reporting. (See Patient Tracking Officer.) Assessing staffing, supply, and equipment needs.)

Advance planning for

Human Services
The Operations Chief will require written plans for:
Establishing Human Services Center, including location and staffing. Implementing emergency discharge procedures. (See Nursing Staff Unit Leader.) Establishing staff rest, nutrition, and sleeping areas, including location and staffing. Keeping staff updated regarding emergency status. (See Situation-Status Unit Leader.) Establishing staff psychological support and debriefing areas, including location and staffing. Establishing a dependent care area, including location and staffing. Identifying dependents. Assessing materials and supply needs.

Advance planning for

SituationSituation-Status Unit
The Planning Chief will require written plans: Maintenance and recovery of computer systems Security of medical records

Advance planning for

Labor Pool
The Planning Chief will require written plans for:

Establishing the labor pool, including location and staffing Registration and credentialing of volunteer staff

Advance Planning for

Logistics of

Critical Supplies
The logistics section chief will require a written plan and procedures for procuring, handling, and distributing...

Pharmaceuticals Medical supplies Food supplies Linen Water Critical Equipment

Advance planning for

Communications
Logistics
The logistics section chief will require a written plan and procedures for communicating with In addition, the chief will require an... Other areas/departments within hospital Other facilities External agencies Alternative communications plan for all major communication systems

Advance planning for

Transportation
Logistics
The logistics section chief will require a written plan and procedures for transportation of... Patients Staff Equipment to or from other facilities Staff to and from hospital during bad weather Critical supplies

Advance planning for

Medical Staff Unit

The Planning Chief will require written plans for:

Establishing a physician labor pool, including location and staffing Registration and credentialing of volunteer medical staff

Advance planning for

Nursing Unit
The Planning Chief will require written plans for:

Emergency Inpatient discharge Patient Tracking Release of Patient Information Recalling Nursing Staff