Introduction

Healthcare facilities and their staff play a key role in emergency preparedness and response efforts for all types of events, including natural or man-made disasters, pandemic outbreaks, or terrorist attacks. Because the availability of healthcare is essential to accommodate the surge in demand for providing care related to a public health emergency, this website is intended to assist healthcare facilities in with all aspects of emergency planning, including mitigation, preparedness, response, and recovery.

This web site is intended to provide basic tools and resources from federal governmental agencies, professional organizations, universities, and state and local public health agencies. We have chosen some selected resources to highlight on this page, including resources for education and training, key documents, products and equipment and sample procedures and lessons learned.

Level of readiness

Planning

With growing awareness of the significance of healthcare facilities’ response to emergencies, many are reassessing and upgrading their existing emergency preparedness plans. General elements of emergency management for healthcare facilities include mitigation, preparedness, response, and recovery.

Although hospitals have general emergency management plans in place, they may not have planned for a large-scale incident until federal and state public health groups developed communication plans and networks to address such incidents. Such planning better prepares staff to manage smaller hazardous materials situations, such as industrial accidents – in which both staff and facility may be contaminated unless such incidents are anticipated beforehand. Planning should address the concerns of caregivers and the potential for distribution of a contaminant throughout the emergency department or even the hospital.

Key planning resources

  • CDC’s Healthcare Preparedness Activity website features healthcare preparedness tools and resources to help communities plan for public health emergencies. Resources for clinicians can be found under both the “Clinical Resources and Tools” and “Planning Resources” sections.
  • CDC Public Health Preparedness and Response Partner Resources
  • U.S. Dept. of Health & Human Services
    HHS Response and Recovery Resources Compendium Project is an easy to navigate, comprehensive web-based repository of HHS resources and capabilities available to Federal, State, local, territorial and tribal stakeholders before, during, and after public health and medical incidents. The resources in this repository may also be useful for public health and medical emergency management officials. Each topic contains a list of the major HHS capabilities, products and services that support that function, a brief description of each and information on accessing them.
    HHS Response and Recovery Resources Compendium

Links to numerous tools, resources, and situational awareness portals published by non-governmental and governmental partners.

Facility risk assessment: The facility risk assessment should be a multidisciplinary process, with representatives from all services involved in an emergency situation. This includes infectious disease, infection control and safety staff to assist in differentiating biological from chemical agent exposures and in follow-up management.
Hazard vulnerability analysis: The Joint Commission has, since 2001, required member hospitals to complete an annual hazard vulnerability analysis (HVA), which is expected to provide a foundation for emergency planning efforts.

Facilities should conduct or review existing HVAs. The process includes assessing the probability of each type of event, the risk it would pose, and the organization’s current level of preparedness. This HVA should also take into account nearby community resources likely to be affected or called upon for assistance – including schools, churches, public transportation, news media, telephone and communication systems, voluntary organizations (such as the Red Cross and the Salvation Army), restaurants, and food suppliers.

Training

Agencies of the U.S. government (specifically the CDC, FDA and FEMA) offer considerable number of resources for emergency management preparedness and response. Public health professionals and clinicians can find training assistance for virtually all disciplines and levels of responsibility.

Command and Coordination

Confusion and chaos are commonly experienced by the hospital at the onset of a medical disaster. However, these negative effects can be minimized if management responds quickly with structure and a focused direction of activities. In addition, emergency plans need to be coordinated at the local community level based on the individual needs of the community.

The Hospital Emergency Incident Command System (HEICS) is an emergency management system which employs a logical management structure, defined responsibilities, clear reporting channels, and a common nomenclature to help unify hospitals with other emergency responders. There are clear advantages to all hospitals using this particular emergency management system, which is fast becoming the standard for healthcare disaster response.

HEICS provides guidance for hospital/healthcare settings to improve their emergency planning and response capabilities.

Evacuation

When the situation escalates to a level that endangers the health and/or safety of the facilities patents, staff, and visitors’ evacuation of the endangered areas is necessary. Safety and continuity of care among evacuees during a disaster depend on planning, preparedness, and mitigation activities performed before the event occurs.

Security: Facility security needs include planning for facility lockdown to prevent access by unauthorized individuals. As an event progresses, the procedure must also consider traffic and crowd control as more individuals are identified as victims. Family members, the “worried well,” and the media are likely to converge on the facility. Planning should include determining staff resources that can be deployed to support hospital security staff.

Communication: Communication between news media and hospital media relations can support the healthcare organization by conveying important and realistic information to the public.

The Emergency Risk Communication Branch (ERCB) Clinician Communication Team works to enhance partners’ knowledge of emerging threats and their effects on human populations, and to provide relevant, timely information to help manage these threats by developing and maintaining mechanisms for communication. The Clinician Communication Team is responsible for the management of all COCA products and offers a variety of free tools and resources to help you enhance your knowledge of emergency preparedness and response:

Updating readiness

Facilities should continuously reassess their emergency readiness plans. All facets of planning must be re-examined; most importantly, coordination with local emergency planning agencies in surrounding communities as well as communications with local and state public health should be enhanced.

  • The American Hospital Association provides a number of tools and resources that are both timely and useful in assessing and reassessing emergency readiness plans.

Types of emergencies

  • The Centers for Disease Control and Prevention (CDC) maintains a comprehensive website with information for emergency preparedness and response and recovery from disasters, including hurricanes, tornadoes, floods, earthquakes, and extreme heat.

Terrorism, including bioterrorism

Events resulting from terrorism can include virtually any non-weather-related event, including mass casualty and transportation events, chemical incidents, and those resulting from biological and chemical agents.

Biological and chemical agents

Biological agents: Bioterrorism is quite different from a chemical incident. An incident of bioterrorism may be recognized as such only after a number of victims displaying similar symptoms arrive at the emergency department, following an incubation period of unknown length. Diagnosis may be difficult: it may be hard to distinguish biological from chemical exposures (or the possibility of both, immediately after an event like an explosion). Deployment of a biological agent in a public place would impact everyone and everything in the area, including the healthcare facility. Rapid assessment and infection control management are critical.

Identification of chemical or biological agents: When a recognized incident occurs in a community, the key to treating the exposed individuals is identification of the agent. In the case of an industrial, agricultural or transportation accident, that identification may be made early in the event. In the case of a covert action, the hospital must rely on detection equipment used by emergency responders at the site in response to presentation of symptoms. Understanding the decontamination process becomes critical in these “unknown” exposures. Some chemical and biological agents of greatest concern are listed on the CDC Web site.

Chemical agents: CDC provides detailed information on treating exposure to representative chemical agents

Anthrax: Increased media attention to Anthrax contamination following incidents around the nation raises questions about managing potentially contaminated personnel and the environment.

Clinical assessment: The hospital depends on clinicians in the emergency department to make the initial diagnosis until other information becomes available. Clinicians must remain alert for unusual diseases that could result from an act of bioterrorism. As an event progresses, the public health department will work closely with healthcare organizations to identify patterns and exposed victims. See resources for training programs on learning to identify and treat critical agents.

Chemical incidents

Local industries and traffic patterns may be more important than size or urban/rural location in assessing impact on the facility. Weather conditions may redirect contaminants into the facility’s vicinity. A transportation accident may be the initiating event; agricultural, industrial, and even home garage accidents are not infrequent. In the aftermath of such accidents, contaminated victims may be transported to the nearest facility, rather than to a major trauma center. Chemicals used in the healthcare facility should be considered as potential sources of accidental spills.