Emergency Management for Healthcare: Emergency Response Planning

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: Aug 31, 2022
• ISBN: 9781637422229

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.

Book preview

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 will attempt 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

Emergency Response Planning

Introduction

The successful Emergency Manager attempts to leave as little as possible to chance. Creating an Emergency Response Plan for a healthcare setting is, in many respects, simply another project. As such, it is very much amenable to the processes described in detail elsewhere in this series, including applied research methodology, Root-Cause Analysis, Project Management, Lean, and Six Sigma. Each of these can have a significant impact on both the project and the quality of the result.

That being said, the practice of emergency management has its own major components, and these can provide the Emergency Manager with further assistance, by identifying those issues which must be addressed in order to create an effective and interoperable Emergency Response Plan. Understanding each of these components, and the associated issues, is essential; without careful analysis and understanding of these issues, and the advance work need to resolve them, the Emergency Manager will never really have a clear picture of what planning needs to occur. This chapter will address the basic components of emergency management, and the major issues which must be resolved prior to the creation of an Emergency Response Plan.

Learning Objectives

On completion of this chapter, the student should be able to identify the four major components of emergency management and describe how each component works. The student should be able to describe how these components influence the process of creating an Emergency Response Plan. Finally, they should be able to understand and describe how these components operate in a healthcare setting, in order to generate requirements for advance research, dialogue, and problem-solving, prior to beginning to write an Emergency Response Plan.

The Fundamentals

In all types of emergency management, and in all types of settings, there are four separate and distinct components to practice which have become universal. These four components encompass the entire range of the emergency management process from beginning to end and have been in common usage for more than 30 years now. The first of these components is mitigation¹; the process whereby the Emergency Manager attempts to treat existing risk exposures effectively, so that their effects are either reduced or eliminated. This should always be the first component to any emergency management practice.

The second component is preparedness²; those activities which accept that a risk exposure is present, but which attempt to ensure in advance that the organization or community has the ability to deal with the risk exposure, should it occur. The third component is response; those activities directed at being able to deal with a risk exposure effectively and safely, when it does occur. The fourth and final component is recovery; those activities and measures which will restore the organization or community to an operating state of normal or near normal operations, after a risk exposure has occurred, and has been addressed. Each of these four components will be addressed separately, and in much greater detail, later in this chapter.

There is a fifth component which has been proposed in some circles; prevention, however, there is considerable debate among emergency management professionals regarding how and why this proposed component differs from the accepted mitigation component.³ The four components to practice are often depicted graphically as a cycle; however, the experienced Emergency Manager recognizes that this model is not necessarily rigid, and that opportunities to address some elements of each of the various components may often occur even while another component is occurring. To illustrate, opportunities for mitigation are often identified and put into place during both the response and recovery components, and both mitigation and preparedness planning will often occur concurrently.

Mitigation

Mitigation is the modification of a vulnerable process or location within the healthcare facility or the community, in order to either reduce the amount of risk exposure, should a hazard event occur. It may also involve the complete elimination of the possibility of occurrence for the hazard event, thereby eliminating the risk exposure completely.

In some quarters, there is an argument for a fifth component of the emergency management cycle, specifically, prevention. This, to some extent, reflects the influence of FEMA being absorbed by the U.S. Department of Homeland Security. As a result of the influence of currently dealing with terrorism, instead of simply natural and technological disasters, there is a new emphasis on prevention being the first of the five stages of homeland security, and on it receiving primacy over the four stages of emergency management.⁴

There are those who argue that prevention refers to the elimination of the event occurring, and is specifically associated with terrorism, while mitigation deals with the reduction of effects, should the event actually occur.⁵ However, the majority in the field, at least, thus far, continue to believe that Prevention is simply the outcome of Mitigation performed well,⁶ although sometimes varying by the extent to which the effects of the hazard or risk event are eliminated.

As one example, consider the hospital’s vulnerability to interruptions in the community’s electrical distribution system. Within a hospital, or indeed, in many types of healthcare facilities, uninterrupted access to electricity can be critical; there are often patients who are dependent upon technology-based life support systems which are powered by electricity. In addition, there may be patients who are undergoing critical procedures, such as surgery or childbirth. There are patients who, while not in such an immediate threat, would begin to suffer fairly quickly during a power disruption, such as those in the newborn nursery.

There are also other critical processes with the potential to be disrupted by a power outage, including the laboratories, diagnostic imaging, and the Blood Bank. Finally, there are processes which, while not immediately life-threatening, have the potential to substantially disrupt the business of the hospital, including computers, digital telephones, paging systems, food refrigerators, drug refrigerators, and in some cases, elevators. One of the most vulnerable aspects of any hospital to power interruption is the heating, ventilation, and air conditioning systems. Because of their power demands, such systems are not universally included in the emergency power grid. The vulnerability of a hospital to a power outage is substantial, and such outages occur on a fairly regular basis in many communities.

Figure 1.1 A hospital’s emergency generators; one of the most essential and most misunderstood items of emergency equipment in the facility

In an attempt to mitigate against such problems, most hospitals have installed emergency power generators (see Figure 1.1). These generators are designed to activate automatically, during any power disruption. Such systems are often installed at the time of construction, and only rarely revisited, apart from regular testing and inspections. The only time that many such systems are updated is when the facility is undergoing major renovations. One of the challenges with such systems is that while medical technology, and therefore, the demand for electricity, continue to grow, the emergency generator system often does not.

Many of these systems are decades old, and the initial need for such systems was seen to be the powering of a limited number of essential devices in each location, but not the entire facility. In many cases, older systems power as little as 20 percent of the facility’s daily needs, with just a few emergency power plugs (often red) on each Unit, and it is common to find systems which power only a single elevator, although the hospital may have several. In newer facilities, such systems are designed to cope with all of the power needs of the facility which were current at the time of installation, but even these only rarely fully address the needs of the building’s heating, ventilation, and air conditioning systems, which typically draw enormous amounts of power.

Potential mitigation measures include the installation of newer, more powerful, electrical generators, to replace the older systems. When a facility is extensively renovated, it may be possible to greatly expand the number and distribution of emergency power plugs on the various Units, as work progresses. Another relatively low-cost and creative way to mitigate against electrical failure is to connect the healthcare facility to two separate segments of the community’s electrical distribution grid, so that if a power failure occurs in one portion of the grid, the hospital simply takes its supply from the other point of connection.

It may also be possible to have battery back-up systems, or Uninterruptable Power Supplies (UPS) for essential devices, and such systems, which have been common in computer networks for, are growing in use with medical devices, as well. Indeed, it may be possible to add this feature to the specification process for a new device being purchased. Taken collectively, the items described represent a menu of options, and a layered approach to mitigation against power failures, with all of the options being possible, and even considered to be good ideas, with the only challenging factor being the cost of doing all of these things.

A recurring theme in the mitigation process is that of cost versus potential benefit. No one would ordinarily simply refuse to upgrade a hospital’s emergency power generators, for example, but a hospital is a dynamic organization in a constant state of growth. There are many different items which various parties within the organization believe to be a priority, and there is always a limited budget. The challenge is for the Emergency Manager to justify mitigation measures in the face of many other competing, and equally valid, priorities for the hospital’s limited resources. Some mitigation measures may be easier to sell than others; particularly if there is no immediate budgetary impact, or when both parties can get what they require from the transaction.

To illustrate, the Emergency Manager wants to reduce vulnerability to power failures in the hospital’s critical systems, and the Director of Critical Care Services wants to upgrade the five-year-old cardiac monitors in the Intensive Care Unit and the Recovery Room. If the Emergency Manager can persuade the hospital administration to go ahead with the purchase, but to also create a mandatory policy which adds UPS to the specification list for both this purchase and all future technology purchases, both parties win.

The Emergency Manager has achieved a change in policy which does not create any substantial new budget demand but which ensures that critical technologies have built in mitigation against vulnerability, and the Director of Critical Care has the new monitors. Such mitigation measures are easier to sell, because, on the face of it, they are not competing, and there is no hard budget outlay to pay for the mitigation. In the process, this type of cooperation may even begin to generate some new supporters, or even champions, for the emergency management process.

The challenge of mitigation is to fix as many areas of vulnerability as are feasible before any hazard event occurs. The problem is that, from the perspective of many on the management team, the Emergency Manager is still attempting to divert much-needed resources to an event which might never happen. In all types of mitigation efforts, a sound business case, suitably referenced and cited, will often be required, just as it is for the rest of the hospital’s proposed