Hospital Risk Assessment

Bonnie Henry, MD, FRCPC

Brian Schwartz, MD, CCFP(EM)

Disaster Preparedness Conference

2006
Case 1
A tornado has just hit your community;
dozens of walking wounded are appearing at
your ED, as well as individuals looking for
loved ones
Ambulance communications notifies you to
expect at least 30 patients of varying severity
in the next hour

Disaster Preparedness Conference

2006
Case 2
An explosion has occurred at the Bloor
station in the Toronto subway system
CBRN team is responding due to a phone
call to a local TV station from a terrorist
group chanting Death to Canada and
claiming that a radioactive substance has
been released

Disaster Preparedness Conference

2006
Case 3

A mysterious influenza-like illness

beginning in Southeast Asia has
been found to jump from birds to
people
Over 200 people of all ages have
been affected; mortality is 50%

Disaster Preparedness Conference

2006
Case 3

The disease is making its way west;

cases are turning up in Europe
The WHO announced that the world is
in Phase IV of the Pandemic phases
(evidence of localized human to
human transmission)

Disaster Preparedness Conference

2006
 Questions to ask:
1. Is my organization prepared to
respond to these events?
2. Does my organization need to be
prepared anyway?
3. What are our priorities?

Disaster Preparedness Conference

2006
Have you done your
risk assessment?

Disaster Preparedness Conference

2006
 Hospital Risk Assessment
Learning Objectives
Describe the need for and context of
risk assessment in emergency health
planning
Describe and prioritize the risks of
your organization to better prepare for
health care emergencies

Disaster Preparedness Conference

2006
 Phases of an Emergency
(F/P/T National Framework)
1. Risk assessment
2. Mitigation
3. Preparedness
4. Response
5. Recovery

Disaster Preparedness Conference

2006
Canadian Council on Health Services Accreditation
2005 Environment Standards

Minimizing Adverse Events - Section 5.0

The organization is prepared for disasters & emergencies

# 5.1 The organizations processes for an overall plan include:

(11 points):
identify the potential risk of a disaster/emergency
define how the hospital plan fits with the community disaster plan
determine who is responsible for coordinating/ managing the
response to emergency situations (regular and off hours)
taking in mass casualties in the event of a community disaster
including patients that might be contaminated or exposed to
dangerous substances

Disaster Preparedness Conference

2006
 Whats your risk?

Naturally occurring
events
Technological events
Human related events
Events involving
hazardous materials

Disaster Preparedness Conference

2006
 Natural events
Hurricane
Tornado
Extreme heat/cold
Ice storm
Snow storm
Flood
Epidemic/pandemic

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2006
 Epidemic/pandemic
Influenza
SARS
E Coli
Smallpox

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2006
 Technological events
Electrical failure
Transportation emergency
Water emergency
HVAC failure
Structural damage
Fire
HAZMAT exposure (internal)

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2006
 Human Related Events
Mass casualty incident (trauma)
Mass casualty incident (infectious)
Terrorism - biological
Hostage situation
Bomb threat
Civil disturbance

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2006
 Hazardous Material Events
Mass casualty HazMat incident
Terrorism chemical
Chemical exposure external
Radiological exposure

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2006
What is your risk for each?

Risk = Probability x Impact

www.ceep.ca

Disaster Preparedness Conference

2006
Risk = Probability x Impact

Disaster Preparedness Conference

2006
 Components of Risk
Probability? Impact?
A. Highly likely? 1. Marginal
B. Likely? 2. Serious
C. Possible? 3. Critical
D. Unlikely? 4. Catastrophic

Disaster Preparedness Conference

2006
 Probability
Probability
Description Detail
Rating

A Highly Likely nearly 100% probability in next year

between 10 and 100% probability in next

B Likely year, or at least one event in next 10
years

between 1 and 10% probability in next year,

C Possible
or at least one event in next 100 years

D Unlikely less than 1% probability in next 100 years

Disaster Preparedness Conference

2006
 Components of Impact
Impact Impact
Human 1. Marginal
Property 2. Serious
Business 3. Critical
4. Catastrophic

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2006
 Impact - Human
1. Unlikely to cause injury, illness or death in
staff or patients
2. Low probability of injury, illness or death in
staff or patients
3. High probability of injury or illness in staff
or patients; low probability of death
4. High probability of death in staff or patients

Disaster Preparedness Conference

2006
 Impact - Property
1. Unlikely to cause physical plant or
equipment damage requiring any
replacement costs or recovery time
2. Minor physical plant or equipment damage
requiring some replacement costs or
recovery time
3. Moderate physical plant or equipment
damage requiring moderate replacement
costs or recovery time
4. Extensive physical plant or equipment
damage with high replacement costs and
recovery time
Disaster Preparedness Conference
2006
 Impact - Business
1. Unlikely to cause service interruption or
damage to public image of the institution
2. Minor or limited or short term service
interruption or damage to public image
3. Significant/widespread or long term service
interruption
4. Unable to provide services due to factors
such as: employees unable to report to
work, clients unable to reach facility,
interruption of critical supplies, or legal or
health and safety issues

Disaster Preparedness Conference

2006
 Overall Impact Rating
11-12 Catastrophic Facility cannot provide necessary
services without extensive assistance
from provincial or federal resources

8-10 Critical Facility can provide a normal level of

service with assistance from outside
the local community or region; or,
facility can provide a minimal level of
service with normal resources
5-7 Serious Facility can provide a normal level of
service with assistance from within
region or within local community; or,
facility can provide a reduced level of
service with normal resources
3-4 Marginal Normal level of functioning or increased
level of service required from within

Disaster Preparedness Conference

2006
Risk Assessment - examples
Threat Probability Impact Risk
(H+P+B)
Tornado B 3+3+2 B8

Dirty Bomb B/C/D 3+1+2 B/C/D6

Pandemic B 4+1+4 B9
influenza

Disaster Preparedness Conference

2006
 Risk Rating
A B C D
Impact/Probability Highly Likely Possible Unlikely
Impact Likely
Rating

11-12:Catastrophic A11-A12 B11-B12 C11-C12 D11-D12

8 -10: Critical A8-A10 B8-B10 C8-C10 D8-D10

5 - 7: Serious A5-A7 B5-B7 C5-C7 D5-D7

3 - 4: Marginal A3-A4 B3-B4 C3-C4 D3-D4

Disaster Preparedness Conference

2006
 Priorities
1. Pandemic flu
2. Tornado
3. Dirty bomb

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2006
 Priorities
Perform this exercise for all:
Naturally occurring events
Technological events
Human related events
Events involving hazardous materials

Disaster Preparedness Conference

2006
 Summary
Assessment of risks is first step in
planning
Helps focus efforts and ensures no
possibilities are missed
Helps prioritize efforts in preparedness

Disaster Preparedness Conference

2006
The only thing more difficult
than preparing for an
emergency is having to
explain why you didnt

Disaster Preparedness Conference

2006