Stockpiling and Logistics

• Must remain self-sufficient
• provide and sustain core services w/o external assistance for at least 96 hours
• goal of seven days
• Problems?
• lean organizations
• just-in-time inventory management are
• Reduce cost/waste, but:
• Limits critical resources such as pharmaceuticals, blood products, oxygen masks, disposables, and ventilators

Hospital emergency managers responsible for developing their institution’s emergency management plan must ensure that issues of staff availability be paramount and accurately reflect the true capabilities of their resources.

The ability for a healthcare institution to remain self-sufficient to provide and sustain core services without the support of external assistance for at least 96 hours from the inception of an incident, with a goal of seven days, remains a vexing problem for healthcare leaders.

Unfortunately, the stark realities of lean organizations and just-in-time inventory management are directly counter to effective hospital emergency management planning.

While these efforts seek to reduce costs and waste through the delivery of products on an as-needed basis, thin supply chains can lead to shortages of critical material resources such as pharmaceuticals, blood products, oxygen masks, disposables, and ventilators when demand for these goods rises sharply.

A simple rule of thumb when developing the stockpiling and logistics section of the hospital emergency management plan is, “If a resource is not accessible by foot, it does not exist.”

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Mitigation

This phase includes any activities that prevent an emergency, reduce the likelihood of occurrence, or reduce the damaging effects of unavoidable hazards. Mitigation activities should be considered long before an emergency.

For example, to mitigate fire in your home, follow safety standards in selecting building materials, wiring, and appliances. But, an accident involving fire could happen. To protect yourself and your family from the costly burden of rebuilding after a fire, you should buy fire insurance. These actions reduce the danger and damaging effects of fire.

Preparedness

This phase includes developing plans for what to do, where to go, or who to call for help before an event occurs; actions that will improve your chances of successfully dealing with an emergency. For instance, posting emergency telephone numbers, holding disaster drills, and installing smoke detectors are all preparedness measures. Other examples include identifying where you would be able to find shelter in a disaster. You should also consider preparing a disaster kit with essential supplies for you and your family.

Response

Your safety and well-being in an emergency depend on how prepared you are and on how you respond to a crisis. By being able to act responsibly and safely, you will be able to protect yourself, your family, others around you. Taking cover and holding tight in an earthquake, moving to the basement with your family in a tornado, and safely moving away from a wildfire are examples of safe response. These actions can save lives.

Recovery

After an emergency and once the immediate danger is over, your continued safety and well-being will depend on your ability to cope with rearranging your life and environment. During the recovery period, you must take care of yourself and your family to prevent stress-related illnesses and excessive financial burdens. During recovery, you should also consider things to do that would lessen (mitigate) the effects of future disasters.

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Modern incident command grew from the experience of firefighters in combating the California wildfires of the mid 1970s.

This new system, called FIRESCOPE (Firefighting Resources of California Organized for Potential Emergencies), was based upon principles gleaned from military experience and management theory, especially management by objectives concepts introduced in 1954 by Peter F. Drucker in his classic work, The Practice of Management.

FIRESCOPE’s core purpose was to provide a standardized, on scene, all-hazard incident management system that allowed its users to quickly implement an integrated organizational structure that was not impeded by jurisdiction boundaries, and was flexible and scalable enough to match the needs and resources for single, expanding, multiple, and complex incidents despite their special circumstances and unique demands.

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Growing out of FIRESCOPE is today’s ICS.

Then read slides

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The California Emergency Medical Services Authority adapted the public safety version of ICS for use in the management of disasters involving hospitals

This system is called the Hospital Incident Command System or (HICS) and is now used by most hospitals in America to be compliant with the federal government’s requirements for agencies to manage disasters using an ICS structure.

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The Incident Command System (ICS) is a standardized approach to the command, control, and coordination of emergency response [1] providing a common hierarchy within which responders from multiple agencies can be effective.

ICS was initially developed to address problems of inter-agency responses to wildfires in California and Arizona but is now a component of the National Incident

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Single incident commander – Most incidents involve a single incident commander. In these incidents, a single person commands the incident response and is the decision-making final authority.

A Unified Command involves two or more individuals sharing the authority normally held by a single incident commander. Unified Command is used on larger incidents usually when multiple agencies or multiple jurisdictions are involved. A Unified Command typically includes a command representative from major involved agencies and/or jurisdictions with one from that group to act as the spokesman, though not designated as an Incident Commander. A Unified Command acts as a single entity. It is important to note, that in Unified Command the command representatives will appoint a single Operations Section Chief.

Area command – During multiple-incident situations, an Area Command may be established to provide for Incident Commanders at separate locations. Generally, an Area Commander will be assigned – a single person – and the Area Command will operate as a logistical and administrative support. Area Commands usually do not include an Operations function.

*Preparedness & Disaster Management Nursing Assignment

A trauma system is defined as a comprehensive network of resources, integrated with the local public health system, that work together to coordinate and deliver optimal patient care to injured victims.

At the center of the trauma system is the trauma center

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Administrative, ancillary, and support (AAS) services provide the vital infrastructure upon which an effective trauma system can operate.

AAS components range from human and professional resources, system development, training, research, communication and information systems, quality improvement/quality assurance, and finance, to leadership and legislation.

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Acute care facilities include all levels of medical facilities that are capable of providing emergency medical care to ill or injured patients.

Most acute care facilities will accept ambulance patients and have a designated emergency department (ED).

The classification of these acute care facilities varies from state-to-state across the country.

Not all acute care hospitals are capable of managing a trauma patient.

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The American College of Surgeons (ACS) has developed criteria for the verification of trauma centers at four levels, which are summarized in Figure 3-3.

ACS verification criteria examine the resources available within an acute care hospital to provide care to an injured patient.

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The emergency medical services (EMS) system was created in 1966, in response to the National Research Council’s paper titled Accidental Death and Disability: The Neglected Disease of Modern Society.

This document listed trauma as the fourth leading cause of death in the United States, and the leading cause of death among people in the age group of 1–37years

In 1966 the newly created US Department of Transportation was given oversight of the development of national EMS standards and curricula.

In 1988, the National Highway Traffic and Safety Administration listed 10 key components of an EMS system, as shown in Figure 3-2.

These 10 components still exist today and are used to evaluate the EMS systems in states across the United States.

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Today’s trauma systems are designed to be seamlessly integrated into the EMS system, which acts as the critical point of entry into the healthcare system for injured patients.

The modern EMS system operates on the principles of citizen awareness and activation of the EMS system, dispatch and communications, first responder care, advanced prehospital care, hospital care, and rehabilitation.

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A major challenge for trauma systems in the United States has been finding the financial means to support disaster and public health preparedness activities.

Many hospital administrators find it difficult to spend money on preparedness activities when there is no direct return on investment (ROI) for these initiatives.

Federal funding for preparedness activities is minimal.

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The Occupational Safety and Health Act of 1970 (OSH Act), which applies to most private sector employers, requires employers to provide a place of employment free from hazards likely to cause death or serious physical injury.

OSHA 1910.120 – Compliance guidelines for hazardous materials clean-up.

OSHA Best Practices for Hospital-based First Receivers – information to assist facilities in developing and implementing emergency management plans that address the protection of hospital-based emergency department personnel during the receipt of contaminated victims from mass casualty incidents occurring at locations other than the hospital. Among other topics, it covers victim decontamination, personal protective equipment, and employee training, and also includes several informational appendices.

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A disaster declaration is a statement by a public official with the authority to do so, recognizing that a disaster exists.

A disaster declaration may trigger certain powers not ordinarily available to government agencies.

Under federal law, the President has the authority to declare a disaster after being requested to do so by the governor of the affected state.

The governor must have found that the emergency or disaster is so severe that it is beyond the capabilities of the affected state and local government, and therefore they require assistance from the federal government.

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The federal HIPAA Privacy Rule protects from disclosure individually identifiable protected health information (PHI) held by “covered entities.”

Covered entities include health plans and healthcare providers.

HIPAA does, however, permit covered entities to disclose PHI under a variety of circumstances.

Those circumstances include “to identify, locate, and notify family members, guardians, or anyone else responsible for the individual’s care of the individual’s location, general condition, or death.”

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HIPPA = The Health insurance Portability and Accountability Act of 1996 and requires the establishment of national standards for eletronic health care transactions and national identifiers for providers health insurance plans, and employers

HIPAA provided authorization for the creation of the patient locator database.

According to the U.S. Department of Health and Human Services (HHS):

“When necessary, the hospital may notify the police, the press, or the public at large to the extent necessary to help locate, identify or otherwise notify family members and others as to the location and general condition of their loved ones.”

“When a health care provider is sharing information with disaster relief organizations that are authorized to assist in disaster relief efforts, it is unnecessary to obtain a patient’s permission to share the information, if doing so would interfere with the organization’s ability to respond to the emergency.”

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The Emergency Medical Treatment and Active Labor Act (EMTALA), which applies to all hospitals with emergency departments that participate in the federal Medicare program, requires hospitals to provide a medical screening exam, stabilize, and transfer or treat all patients presenting to emergency departments.

The statute also applies when a patient is on hospital property or in a hospital-owned ambulance.

In 2002, legislation was enacted authorizing the Secretary of the U.S. Department of Health and Human Services to waive sanctions for EMTALA violations when the violation arises from a transfer of an unstable patient during a public health emergency.

In addition, EMTALA regulations provide that sanctions for inappropriate transfer during a national emergency do not apply to a hospital with a dedicated emergency department that is located in an emergency area, as defined in the Social Security Act.

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Healthcare facilities and public health agencies must ensure that volunteer staff are licensed and appropriately credentialed prior to granting privileges to them to practice clinically.

Licensing is conducted on the state level.

Credentialing (whether a practitioner has the education and training to appropriately treat patients) is done on an institutional basis.

A governor in an affected state may have the power to waive licensure requirements during a disaster or confer liability protection for volunteers under state law, if none exists.

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Some entities, such as hospitals and agencies that provide ambulance services, have entered into written agreements to share resources during emergencies or disasters, termed “mutual aid agreements.”

The agreements generally do not obligate entities to assist each other, but provide a mechanism to notify others of the disaster and request assistance.

The agreements are important in emergency planning because they evidence a prearranged agreement for entities to contact each other and request aid.

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Model State Emergency Health Powers Act = a proposed act to help America’s state legislature in revising their public health laws to control epidemics and respond to bioterrorism. It grants public health powers to state and local public health authorities to ensure a strong, effective, and timely planning, prevention, and response mechanism to public health emergencies while also respecting individual rights.

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A hospital emergency management plan is a concise, timely set of documents that provide both macro- and micro-level information on the institution’s efforts before, during, and after incidents that affect it, regardless of intensity, scope, or duration. Its value lies not only in its comprehensiveness, but also in its flexibility and scalability.

Maximize the hospital’s ability to provide and sustain core services in a safe environment for all staff, patients, visitors, and the community.

Achieve expected actions by key stakeholders (e.g., staff) before, during, and after emergency incidents.

Provide explicit guidance for key stakeholders to follow before, during, and after an emergency incident.

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In its most basic form, a hazard vulnerability analysis (HVA) is a tool that emergency managers employ to screen for risk and plan for the strategic use of limited resources.

The first step in conducting an HVA is the identification of potential hazards.

A common method is to list various types of emergencies and assign scoring values to each one that reflect its likelihood, its impact, and the institution’s readiness for the emergency.

For instance, a pandemic avian flu outbreak may be scored as very high impact, low likelihood, and intermediate readiness score.

A summation or product of the values then assigns a total score to the hazard (pandemic flu).

An HVA then lists the mitigation, preparedness, response, and recovery activities necessary for each hazard, with the resultant measures taken to manage each hazard varying for each.

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The emergency management plan is the core of the hospital’s emergency preparedness activities, which the hospital assumes to bolster its capacity and categorize resources that it may employ before, during, and after an emergency incident.

Preparedness efforts range from developing a resource inventory and conducting institution-wide emergency management training, drills, and exercises to leading an institution emergency management committee

• Preparedness & Disaster Management Nursing Assignment

Now when looking more closely at the Emergency Management Committee

The hospital’s emergency management committee should consist of membership reflective of a broad cross section of hospital departments, including those clinical, support, operational, and financial units.

Qualifications of the committee chairperson should include significant fluency in emergency management principles and practices, familiarity with the ever changing regulatory and accreditation requirements of this complex aspect of healthcare and organizationally empowered to enact the hospital emergency management plan and recommendations of the committee.

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Members should represent all hospital areas, including, at a minimum, senior leadership, legal, environmental health, security, laboratory, emergency department, chaplaincy, public affairs, clinical and academic affairs, human resources, occupational health, infection control, engineering, life safety, and housekeeping.

Though there is no literature that outlines the optimal makeup of an emergency management committee, inclusion of clinicians from departments such as emergency medicine, surgery, medicine, pediatrics, infectious diseases, and employee health should be strongly considered, given the expertise they can offer.

Key responsibilities of the hospital emergency management committee include overseeing and guiding the hospital’s mitigation, preparedness, response, and recovery efforts.

It is also responsible for carrying out planned drills and exercises that test the hospital’s resource and response capabilities. From there, the committee should collaborate to develop and review after-action reports that the institution can use to adjust and improve the emergency management plan.

This is similar to the continuous quality improvement (CQI) processes familiar to most administrators.

Meetings are held as needed by the institution; however, monthly meetings should be considered feasible and adequate to ensure that changes to the institution’s capabilities can be addressed.

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A key element of a hospital’s emergency management efforts is its training in and use of the Incident Command System (ICS).

Adopting HICS can be a rather complex undertaking because of the need for staff education on its structure, unfamiliarity with the HICS job titles and roles, and the fact that some job functions are difficult to fill with existing hospital staff.

However, adoption of HICS offers numerous benefits that include compliance with regulatory and accreditation requirements, and more importantly, enhancing the ability of individuals to perform essential activities during incidents.

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During incidents, healthcare leaders must impart judgment based on the best available data, which is often incomplete, incorrect, or both; remain cognizant of the time sensitive nature of the issue at hand and ensure that a well-defined command structure is initiated and remains intact throughout the duration of the incident.

Hospitals must take actions to attempt to lessen the likelihood and impact of hazards. These sustained efforts may be either structural or nonstructural in nature.

Structural efforts include those that the hospital performs through the construction or alteration of the physical environment through engineered solutions.

Nonstructural mitigation measures are those that the hospital undertakes by modifying human behaviors or processes.

Typically, mitigation activities are based on a cost-benefit analysis that assesses the costs of both the losses and the necessary action for mitigation against the likelihood of the incident.

The emergency management plan must specify the institution’s mitigation efforts and ensure that these elements meld into the other phases of the plan (preparedness, response, and recovery) to ensure a seamless approach.

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The most visible and well-supported of the emergency management plans’ activities are those that fall under the response phase.

Despite the significant time and effort that hospitals put into attempting to mitigate and prepare for emergency incidents, reducing the likelihood and consequences of the countless hazards hospital may face to zero is simply not possible.

Consequently, as part of their all-hazards approach to emergency management, hospital emergency managers must spend considerable time strengthening their organization’s response capacities.

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The primary goal of recovery efforts is to restore core service and normal operations.

From a hospital planning perspective, the institution’s recovery actions and implementation activities for its core financial, human resources, and support services should also be addressed.

Given the significant costs associated with incidents that directly impact hospitals, the recovery section of the emergency management plan should also detail its insurance coverage and include copies of the actual insurance certificates, key contact information for agents, and mechanisms to rapidly access funding.

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The first element of managing hospital surge deals with Important scarce resources that emergency managers work to identify to assist in managing surge are alternative care facilities, which include “locations, preexisting or created, that serve to expand the capacity of a hospital or community to accommodate or care for the patients or to protect the general population from infected individuals during mass casualty events.”

Further, to ensure compliance with The Joint Commission emergency management standards, hospitals must demonstrate the ability to handle scheduling, triage, assessment, treatment, admission, transfer, discharge, and evacuation elements for both incoming patients and those that are already in the hospital.

The activities associated with planning for a large, unexpected influx of patients involve two main components: rapid patient discharge and increasing inpatient bed capacity.

To ensure that the hospital can safely and rapidly discharge patients to make way for those with more urgent clinical needs, the hospital emergency management plan should include a section on rapid patient discharge.

In it, the hospital outlines its system for the rapid discharge of stable patients and includes a real-time assessment of individual patients by the clinical staff present in the hospital.

The second element of managing hospital surge is increasing inpatient bed capacity.

Attempts to do so are crucial to a hospital’s ability to manage an emergency incident and emergency management plans should specify the actions necessary to cancel elective surgeries and admission to the hospital.

While often a difficult decision given the ensuing loss of revenue, hospital leadership must remain aware that their entity’s primary mission is to provide care to the most gravely sick and that ethical, not financial, decisions must drive their choices, especially during crises.

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Hospital emergency managers responsible for developing their institution’s emergency management plan must ensure that issues of staff availability be paramount and accurately reflect the true capabilities of their resources.

The ability for a healthcare institution to remain self-sufficient to provide and sustain core services without the support of external assistance for at least 96 hours from the inception of an incident, with a goal of seven days, remains a vexing problem for healthcare leaders.

Unfortunately, the stark realities of lean organizations and just-in-time inventory management are directly counter to effective hospital emergency management planning.

While these efforts seek to reduce costs and waste through the delivery of products on an as-needed basis, thin supply chains can lead to shortages of critical material resources such as pharmaceuticals, blood products, oxygen masks, disposables, and ventilators when demand for these goods rises sharply.

A simple rule of thumb when developing the stockpiling and logistics section of the hospital emergency management plan is, “If a resource is not accessible by foot, it does not exist.”

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Hospital emergency managers responsible for developing their institution’s emergency management plan must ensure that issues of staff availability be paramount and accurately reflect the true capabilities of their resources.

The ability for a healthcare institution to remain self-sufficient to provide and sustain core services without the support of external assistance for at least 96 hours from the inception of an incident, with a goal of seven days, remains a vexing problem for healthcare leaders.

Unfortunately, the stark realities of lean organizations and just-in-time inventory management are directly counter to effective hospital emergency management planning.

While these efforts seek to reduce costs and waste through the delivery of products on an as-needed basis, thin supply chains can lead to shortages of critical material resources such as pharmaceuticals, blood products, oxygen masks, disposables, and ventilators when demand for these goods rises sharply.

A simple rule of thumb when developing the stockpiling and logistics section of the hospital emergency management plan is, “If a resource is not accessible by foot, it does not exist.”

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The Joint Commission is the primary credentialing group for hospitals in the United States and directly addresses emergency management in its accreditation processes.

While accreditation programs can improve overall quality, the costs involved in seeking accreditation may overshadow the increases in revenues.

Consequently, emergency management activities often compete for resources, making their implementation even less likely.

However, The Joint Commission created a separate chapter on emergency management effective January, 2009, so hospital leaders are now facing the need to address emergency management issues in the same light as other, more traditional healthcare activities, such as hand hygiene.

The hope is that this increasing attention will move emergency management to the forefront of healthcare leaders’ daily agendas to the point where emergency management truly becomes an expansion of day-to-day operations and covers the gamut of potential hazards that institutions may face.

Regardless, hospitals seeking The Joint Commission accreditation would do well to frame their entire emergency management program, particularly the development of the emergency management plan, around The Joint Commission’s standards.

While complex, the standards offer a comprehensive framework to build an emergency management plan and details individual elements of performance.

*Preparedness & Disaster Management Nursing Assignment

Developing the hospital emergency management plan is an essential element of a hospital’s overall, comprehensive emergency management program.

The plans should adopt an all-hazards approach to all emergency incidents based upon the institution’s hazard vulnerability analysis, from which the emergency management committee can collaborate to develop a core plan.

From the core plan, staff must ensure that hazard-specific annexes and appendices reflect the unique hazards, which are preferably divided into natural, technological, and intentional categories.

After it is developed, the plan must serve as a constant work in progress; a document or collection thereof, of guidance, policies, procedures, and related information that the institution routinely examines for timeliness and accuracy.

Key to this is ensuring that the plan serves as the nucleus around which all emergency management training, drills, and exercises revolve.

Prevention, preparedness, and public health are vital to the well-being of families and communities.

Through collaborative efforts to develop the hospital emergency management plan, our Nation’s healthcare system can ensure its readiness and resiliency to address the stark realities we must face.