Emergency Management for Healthcare: Describing Emergency Management

By Norman Ferrier

This series of books focuses on highly specialized Emergency Management arrangements for healthcare facilities and organizations. It is designed to assist any healthcare executive with a body of knowledge which permits a transition into the application of emergency management planning and procedures for healthcare facilities and organizations.

This series is intended for both experienced practitioners of both healthcare management and emergency management, and also for students of these two disciplines.

• Language: English
• Publisher: Business Expert Press
• Release date: Jul 13, 2022
• ISBN: 9781637421789

Norman Ferrier

Norm Ferrier is an award-winning practitioner, educator, and author who has worked in various aspects of Canadian healthcare for more than forty-two years, and for thirty-two of those years has focused increasingly on emergency planning for all types of health care settings. Norm was the 2013 winner of the Canadian Emergency Management Award and continues to write and lecture on the subject of emergency management for all types of healthcare settings.

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Introduction

This series of books is intended to teach the skills which have been traditionally associated with the practice of emergency management. This includes all of the skills involved in the assessment of risk, selection of Command-and-Control models, the writing of an Emergency Plan, the testing of that document by means of various types of exercises, and the development of employee education programs which are intended to strengthen familiarity with the Plan. However, no Emergency Plan is a blueprint to guide a community or organization through its successful response to a disaster. Every disaster is different in multiple ways and is extremely complex. If we could simply preplan and preprogram every type of emergency response from start to finish successfully, we would be in possession of crystal balls, and the need for Emergency Managers would be minimal.

This series of books differs from other well-written and useful emergency management textbooks in two important respects. Firstly, it will deal exclusively with the practice of emergency management as it should occur specifically within a healthcare setting. Secondly, it will attempt to introduce the use of contemporary mainstream business planning practices to the practice of emergency management; something with the potential to build bridges between the Emergency Manager and the senior executive who has little knowledge or understanding of the subject.

The application of emergency management to a healthcare setting is essential. It can be argued that any healthcare institution is, in fact, a highly specialized community. It can also be argued that virtually every type of service or agency found in a normal community has some type of counterpart within the specialized community of a healthcare setting. It is also important to remember that the vast majority of a community’s most vulnerable population will typically be found within some sort of healthcare setting, whether an acute care hospital, a specialty care hospital, or a long-term care facility. In order to mitigate against such vulnerabilities and to protect those who possess them, a certain degree of understanding of the clinical context is required. The clinical context is, in the majority of cases, a substantive source of each individual’s vulnerability. This is not to say that the Emergency Manager must be an expert clinician, but they do need to possess an understanding of relevant clinical issues. In emergency management, the best Emergency Manager available cannot simply be dropped into a hospital to work, any more than they can do so in an oil refinery, a postsecondary institution, a busy international airport, or any other highly specialized institution.

This series of books attempts to introduce several new mainstream business and academic concepts into the practice of emergency management. These will include formal Project Management, applied research methodology, Root-Cause Analysis, Lean for Healthcare, and Six Sigma. All of these concepts have a potentially valuable contribution to make to the effective practice of emergency management. Of equal importance is the fact that for many years, the Emergency Manager has been challenged to affect the types of preparedness and mitigation-driven changes that are required within the organization or the community. Part of this has been the challenge of limited resources and competing priorities, but an equally important aspect of this has been the fact that the Emergency Manager has typically used a skill set and information generation and planning processes which were not truly understood by those to whom they reported and from whom they required project approval.

These mainstream business and academic processes and techniques are precisely the same ones which are used to train senior executives and CEOs for their own positions. As a result, the information generated is less likely to be misunderstood or minimized in its importance, because it comes from a process which the senior executive knows and uses every working day. This de-mystifies the practice and the process of emergency management, giving both the Emergency Manager and emergency management itself dramatically increased understanding and credibility, potentially making the Emergency Manager a key player and contributor to the management team of any organization in which they work, and far more likely to be regarded as an expertise resource.

CHAPTER 1

What Is Emergency Management?

Introduction

This series of books is about the practice of emergency management. Emergency management is not a new concept; it has a long history and touches our lives on a regular basis, usually without us ever being aware of it. The practice of emergency management in a healthcare setting is a special case; communities practice emergency management, and healthcare settings can be argued to be specialized communities, but with fundamental differences. Where regular communities worry about the protection of vulnerable residents, in a healthcare community, the majority of those who do not work there are arguably the most vulnerable people in any community. It is often difficult enough to move one elderly person safely out of a building during a fire. Imagine if your building housed one hundred or more such people! In normal settings, evacuees can be moved to a neighbor’s home, a community center, or even left standing in front of the building in some circumstances, but what do you do when the clinical condition of the evacuee dictates that the only safe place for them is another hospital? Equally challenging is the problem of the emergency occurring in the community, and generating large numbers of injured people, who are arriving at a hospital that is already completely full.

The argument of the hospital or healthcare facility as a specialized community is a valid one. Virtually every type of resource or service that could be found in the outside community also exists in some form within the walls of the hospital. Public utilities such as water, sewers, electricity, and telecommunications are required in both places, both have food distribution networks, public transit becomes portering, policing becomes hospital security, emergency medical service (EMS) is the Code Response Team, and so on. There are also services within hospitals which rarely exist in regular communities, including diagnostic imaging, laboratories, operating rooms, and other types of treatment areas.

Moreover, there are many different types of healthcare facilities, some of which have very special needs. Patients with certain clinical conditions require specialized care and support; in some cases, even evacuating them puts them at increased levels of risk. Both infants and children present special problems, as do the elderly. Some facilities house patients with serious mental health issues, who must be managed with consideration of their own protection, and in some cases, the protection of others. Both acute care and specialty hospitals, long-term care facilities, and other types of healthcare facilities all require emergency management, but given the environment in question and the type of population, it can often be very different from mainstream emergency management, as it is practiced in the community.

This series of books focuses on the practice of emergency management in a healthcare setting. While there are similarities to mainstream emergency management, there are also substantial differences. While both types of emergency management will be considered, the needs of a clinical setting will be paramount. Understanding the realities of the clinical needs of patients is a central component to emergency management, as it is practiced in a healthcare setting. While one can train a person with a clinical background to be an effective emergency manager, it usually takes considerably longer to train even an effective emergency manager to be a clinician. This book attempts to contribute to the creation of emergency managers specifically for clinical settings and to the more complete understanding of the realities of clinical settings by mainstream emergency managers. Both must work together, and both must understand the realities of each other’s work, as well as the operational differences, and the occasionally differing procedures and priorities.

Learning Objectives

At the conclusion of this chapter, the student should be able to describe the concept of emergency management and its history. The student should also be able to describe the basic principles of the practice of emergency management, sources of emergency management education, and how to access the professional bodies which oversee emergency management and certify practitioners.

History of Emergency Management

Emergency management is not a new concept; it has always existed in some form in human communities. It has been known by various names, including civil defense, civil protection, emergency planning, and civil contingency planning, in various places around the world, and at different points in history. Once the exclusive mandate of the military, it has grown through decades into an emergency profession, with its own standards and body of knowledge.

Human beings have always attempted to manage hazards in their environment; indeed, one of the most common reasons for early humans to cluster together in groups was probably because life in groups was far safer from the predations of wild animals and other bands of humans. When natural hazards struck, these were also easier to deal with in groups, which would have more members, more diverse abilities, and access to greater resources than would an individual. Life was harsh, with life expectancy normally somewhere around 30 years, and a 40-year-old was normally considered to be a venerable elder! Knowledge related to safety, such as the safest places to cross a river, for example, was collected as memory by the elders of each group, and often by a chief or a shaman. There is evidence that some of the earliest human settlements, other than caves, were, in fact, palisaded, and one might argue that those palisade walls (Figure 1.1) represent the very first emergency management-related public works project!

Emergency management has traditionally had some associations with the military. In historic times, the general public would rely upon the military for protection against all types of perils. Certainly, raiding and looting were among these, but in ancient times, one of the primary reasons why a peasant would agree to subject themselves to the rule of a given noble was to be under the protection of the Lord’s men-at-arms in all types of circumstances. This evolved, over the centuries, into the concept of providing military aid to civil authority, and to ex-military officers becoming a prime source of emergency planners for communities.

Figure 1.1 A reproduction of a typical Celtic village in Wales. Note the palisade walls

Modern emergency management begins, in practical terms, during the Second World War. In London, and indeed, across the United Kingdom, air-raid wardens from the Civil Defense Corps, volunteer firemen from the Auxiliary Fire Service, and volunteer ambulance drivers from the Auxiliary Transport Service, worked tirelessly, night after night, to keep the public as safe as possible from enemy bombs. Office workers became air-raid wardens or volunteer firemen, fighting fires with fire engines which had been improvised from converted London taxis, and housewives became volunteer ambulance drivers. Others, who have previous skills, such as structural engineering or construction trades, actually formed a volunteer heavy rescue service in London, a forerunner of today’s Heavy Urban Search and Rescue (HUSAR) teams. With normal emergency services overwhelmed, they staffed additional fire engines and ambulances, in order to respond to the chaos.

Indeed, most of these brave individuals were, in fact, volunteers! With most of the able-bodied men either conscripted to the military or serving in essential wartime industries, such jobs fell to those men who were too old, or had health issues or jobs which made them ineligible for regular military service, or, for the first time, to women! In fact, even Princess Elizabeth, later Her Majesty, Queen Elizabeth, served for a time as a volunteer ambulance driver (Figure 1.2) in the Auxiliary Territorial Service, in the streets of wartime London! More than 800 of these brave volunteers lost their lives, and a further 7,000 were injured, in their attempts to protect their communities from a major crisis (Figure 1.3).

Figure 1.2 A young Princess Elizabeth as a wartime ambulance driver

Also, in Britain, for many civilians, the practice of civil defense was largely about the provision of information and education. A remarkably resilient population sewed and installed blackout curtains, according to instructions, and courses in first aid and firefighting were taught in local community halls. In a remarkable demonstration of practical education, civil defense authorities even used cigarettes as a means of education! In those days, the dangers of smoking were unknown, and most adults actually smoked. An entire set of collectable cards was placed into cigarette packages, with an album to hold them available for a penny, where the cigarettes were purchased. The cards contained an amazing array of potentially useful emergency information, including first aid tips, do-it-yourself firefighting and rescue, and how to build a bomb shelter in your back garden!

Figure 1.3 Medical care has often been associated with emergency management

During the Cold War era, as superpowers built nuclear arsenals, this process, still called civil defense, the field focused increasingly on the ability to protect communities from nuclear attack. Communities built fallout shelters, and in the United States, the Federal Civil Defense Administration (the forerunner of the modern FEMA) produced training films for school children, advising them to shield themselves under their desks in the event of a nuclear blast. Fortunately, no such attacks actually occurred, because there really was no practical defense against them, but if one searches in the backs of file cabinets in emergency management agencies which have