1. Preparing for Internal and External Emergencies and Disasters
Emergency Management
Preparing for Internal and External Emergencies and Disasters

2. Definition of an Emergency
A sudden, unexpected event requiring immediate action due to a potential threat to health and safety.
Joint Commission on Accreditation of Healthcare Organizations (JCAHO) defines an emergency as a natural or man-made event that suddenly or significantly:
Disrupts the environment of care
Disrupts care and treatment of patients
Changes or increases the demand for services

3. Definition of a Disaster
A sudden, unplanned event that makes it difficult, or impossible for a facility to carry out essential activities. During a disaster, the needed resources are greater than those available
A facility disaster is an event in which the demand for health services from the event or existing patients, exceeds the ability of the to provide those services.
A disaster can occur at any level – local, state, regional, country or multiple countries.

4. Classification of Facility Disasters
Internal Disasters- events that result in loss of resources used for regular activities.
Examples: fire, smoke, fumes, loss of utilities, worker strikes, release of chemicals or radiation, hostage situations, or bomb threats
External Disasters – events that occur in the community outside the hospital that may effect the facility’s ability to carry out regular activities.
Examples: hurricanes, tornados, floods, storms, earthquakes, train derailments, plane crashes, power outages, terrorist attacks, and riots.

5. Facility Emergency Preparedness
Facilities must be prepared to respond to a wide range of emergencies. These events may include natural disasters, terrorist attacks or any other situation that dramatically increases the number of patients who come to the facility needing treatment.
Facility emergency preparedness helps to reduce the impact of emergencies and disasters while continuing to provide essential day-to-day services.
Preparedness phases include:
Prevention
Response
Recovery
Mitigation

6. Emergency Management Activities
Prevention – activities aimed at avoiding or intervening to stop an emergency from occurring
ex. Examining the facility for potential dangers and correcting
Mitigation – lesson or eliminate the impact
ex. Back-up generator, Planning for likely events
Response – address the immediate effects of the emergency
ex. Transferring of Patients to Alternate Site
Recovery – actions taken to restore normal operations
ex. Clean-up operations

7. Goals and Objectives Ensure safety of employees, staff, visitors
Assure availability of dialysis care
Protect PHI
Mitigate Damage
Planning, Sharing of Resources, Building/Equipment/System Changes
Expedite return to normal operations
Comply with laws and regulations

8. Emergency Management Plans
Easy to understand
Functional, flexible and adaptive
Consider various views
Written and updated annually
Comprehensive, All-Hazard
Education and Training
Adhere to existing standards, requirements
Include outside agencies

9. Creating a Plan Planning Administrative Communications Preparation
Record Keeping
Security
Supplies
Transportation
Power
Water Systems
Waste Disposal
Recovery
Creating a Plan

10. Assumptions when Creating a Plan
Dialysis facilities are not usually included in state or local disaster plans
Disasters burden outside resources
Disasters may interrupt utilities services
Communications may be impacted
Staffing Shortages
Impractical to plan for all emergency types and sizes
Acute renal services may be in need

11. Risk Based Approach to Planning
Hazard Vulnerability Analysis
1) Identify Potential Risks/Hazards
Internal/External
2) Identify Possible Causes
3) Assign Risk Level (Probability)

12. Hazard Vulnerability Analysis
Natural Disasters
Criminal
Terrorist Action
Civil Disasters
Accident
Internal Disasters
 snowstorms
 hailstorms
 ice storms
 tornadoes
 floods
 earthquake
 bomb threat/incident
 nuclear, chemical or biological attack
 hostage incident with multiple victims
 demonstrations
 riots
 strikes
 buses
 planes
 multiple vehicle accidents
 explosions
 bridge collapse
 hazardous material spills/events
 Fire
 physical damage from natural disasters such as snow storms, ice storms etc
 utilities failure
 broken water mains
 hazardous material spills
 workplace violence
 hostage taking
 infant abduction
 acts of terrorism

13. All Hazard Planning
All-hazard planning, the foundation of preparedness, is a process that makes certain that each individual, each department and the entire facility is always ready for any type of emergency that might occur.
Although each event has specific needs, many of the functions performed remain the same during any type of event.

14. Plan Activation - Event Levels
Alert Phase
Minor Impact
Moderate Impact
Major Impact
Pre-disaster activation for alerting necessary staff to “stand by” in the event they are needed.
Administration is immediately notified.
Example:
Storm Warning
Delay in providing daily hemodialysis services.
Storm
Suspension of services requiring temporary facility closer.
Coordination with the Orleans/Genesee County Emergency Management Office is immediately enacted.
NYS DOH and ESRD Network are immediately notified.
Loss of Water, Power
This would be an overwhelming disaster requiring immediate facility evacuation and indefinite suspension of services.
911 call initiated
Hospital Administration is immediately notified.
Fire, Chemical, Radiological, Biological Event

15. Problems in Disasters
During disasters, problems often occur because hospital and management systems that work well on a day-to-day basis cannot effectively meet the additional needs of the disaster.
Lack of clearly defined leadership and chain of command
Lack of accurate facts and information
Lack of, miscommunication, right amount

16. Incident Command System

17. Possible Emergencies and Associated Components
Contaminated Water Supply
Loss of Utilities
Fire/Water Damage
Loss of Communications
Supply Shortages
Increase in Census/Surge
Staffing
Financial Concerns

18. Contaminated Water Supply
- May or May Not be Informed
- Indicated by water system monitoring.
Contact the municipal water supplier/County Health Department for present status of water supply
Adjustments may have to be made to your water treatment system
Contact water system vendor or manufacturer
Water meets EPA requirements or pre-existing quality prior to use
Increased Monitoring

19. Loss of Utilities Generator Calculate Power Requirements
Existing transfer switch
Power Plan – full or partial load
Fuel Plan
Monitoring
Test Emergency Power (Hospital Based)
Bulk Water (could delay recovery phase)
Calculate Consumption
Connections
Suspend Reuse
Shorten Treatments
Testing/Monitoring

20. Bulk/Tanker Water at the Facility
Typical Water Treatment Systems designs based on EPA MCL’s.
NYSDOH Certification of Approval for Distribution of Bottle or Bulk Water
Verification of compliance with EPA standards for drinking water
Testing Records for MCL’s
Disinfection Records
Approved Transportation Container

21. Fire/Water Damage Damage Assessment Check List (Two Types)
Survey Assessment – quick, brief
What you Have
What you Need
What you Lost
- Detailed Assessment
Physical/Equipment/Supplies
Current Condition and Safety Risk
Certified for use or service

22. Communications Loss of Landline Cell Phones – Machine Interference
Internet – HAN/HPN
Two Way Radio
Runners
TV/Media
Battery Powered Radio

23. Supply Shortages Days on Hand Dialysis Specific
What is required Per/Treatment
Emergency Purchase Orders/Cash on hand

24. Increase in Census/Surge
Limited to C of O
Rationing of Treatments/Alternate Schedules
Supplies, Utilities Consumption
PHI
Transportation
Staffing
NYS DOH Waivers?

25. Staffing Availability Cross Credentialing
Reserves and National Guard staff may be called
Travel – Driving Bans
Types Needed – Professional, Support
Who can do what?
Cross Credentialing
Providing for staff in sustained operations
Nutrition, Health, Rotation, Housekeeping, Family Issues,
Incentives, Communication
Educate Staff on Home Preparedness

26. Financial Concerns Obtaining Supplies Emergency Payroll Billing
Personnel Policies
Inventory Control
Insurance Review
Documentation

27. Summary Develop Emergency Management Plans Keep Plan readily available
Train, Review, Update Plans to Changing Environment
Be active with your local Emergency Management agency (EMO)
Mutual Aid Agreements (MOU’s)
List of local vendors/suppliers/labs for assistance
Preventative Maintenance
Establish a Decision Making Tree/Center (EOC)
Incident Command System

28. Emergencies Stop Being One
When You are Prepared for It

29. References

30. References