Hospital Response to

Disasters
HARRT 2004
 Hospital Preparedness
 9/11 had placed hospital preparedness under
the microscope at the local, state, and federal
levels
 Although the “All Hazards” approach is the norm,
hospitals have entered a new era in
preparedness
 At this point hospitals are amongst the last
players to join the community efforts, prior to
9/11, hospitals had not viewed themselves as
part of the local response system
 Hospital Preparedness:
 Clarification for HIPPA, EMATALA, and
EPA regulatory requirements and their
applications in emergency situations is
vital
 Relationship building amongst the
stakeholders takes time and trust
 Large scale events don’t just happen in
major metropolitan areas---all hospitals
are potential responders
 Hospital Preparedness for large
scale events:
 Hospitals have always planned for disasters, but
not large scale events
 Since 9/11, hospitals have begun to focus on
readiness for large scale terrorism events as well
 Community involvement
is necessary in large scale
planning---something
that hospitals have little
experience with
 Hospital Surge Capacity:
Inventories
 Just-in-time inventory models have
become the norm
 Pharmaceuticals (antibiotics, vaccines, anti-viral medications)
 Food stores
 PPE to handle large volumes
 Hospitals lack ventilators
 A recent GAO report revealed that most
hospitals have <10 ventilators per 100 staffed
beds
 Hospital Surge Capacity:
Inventories
 A 48-72 “stand alone” capability is
essential
 Hospitals also lack the space necessary to
accomodate enhanced caches, create
additional triage, patient care, and morgue
areas
 Hospital Planning:
 Planning is a dynamic process
 A plan is NEVER complete
 The best plans are based on predictable
behaviors
 Plans must be practiced
 Disaster drills are not punitive activities
 Disaster drills are learning laboratories
 Disaster drills provide opportunities
 HEICS and the Clinician
 Do you know what your role is in a
disaster?
 Have you ever been part of a disaster
drill?
 Have you been educated on the disaster
plan at your facility?
 What would you do in the event of a
disaster?
 HEICS:
Hospital Emergency Incident
Command System
 Incident Command System or Incident
Management System characteristics
 Universal language for all clinicians to use
 Small span of control
 Small span of control
 Delineation of authority
 Delayed Treatment Unit
 Actions
 Identification of Delayed Treatment Unit Leader
• Assignment of roles and responsibilities
• Increased responsibilities of care providers
 Disaster Medical Care
• A, B, C’s
• Pain Management
• ↑ Resource limitation utilization
 Secondary Triage
• Triage of patients in DTU
• Triage of incoming
 Emergency Operations Center:
Hospital
 Purpose----Under the direction of the EIC
 To maintain overall command of the overall
hospital operations
 Oversight of the Emergency Operations
Center
 To maintain communications both internal and
external
 Data gathering both internal and external
• Magnitude of event
• Resource availability