Hospital Risk Assessment Bonnie Henry, MD, FRCPC Brian Schwartz, MD, CCFP(EM) Disaster Preparedness Conference 2006

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

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

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

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

Disaster Preparedness Conference 2006 Questions to ask: Is my organization prepared to respond to these events? Does my organization need to be prepared anyway? 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) Risk assessment Mitigation Preparedness Response Recovery Disaster Preparedness Conference 2006

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 organization’s 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

Disaster Preparedness Conference 2006 What’s your risk? Naturally occurring events Technological events Human related events Events involving hazardous materials Disaster Preparedness Conference 2006

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

Disaster Preparedness Conference 2006 Epidemic/pandemic Influenza SARS E Coli Smallpox Disaster Preparedness Conference 2006

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

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

Hazardous Material Events Mass casualty HazMat incident Terrorism – chemical Chemical exposure – external Radiological exposure Disaster Preparedness Conference 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

Disaster Preparedness Conference 2006 Components of Risk Probability? Highly likely? Likely? Possible? Unlikely? Impact? Marginal Serious Critical Catastrophic Disaster Preparedness Conference 2006

Disaster Preparedness Conference 2006 Probability Probability Rating Description Detail A Highly Likely nearly 100% probability in next year B Likely between 10 and 100% probability in next year, or at least one event in next 10 years C Possible between 1 and 10% probability in next year, or at least one event in next 100 years D Unlikely less than 1% probability in next 100 years Disaster Preparedness Conference 2006

Disaster Preparedness Conference 2006 Components of Impact Impact Human Property Business Impact Marginal Serious Critical Catastrophic Disaster Preparedness Conference 2006

Disaster Preparedness Conference 2006 Impact - Human Unlikely to cause injury, illness or death in staff or patients Low probability of injury, illness or death in staff or patients High probability of injury or illness in staff or patients; low probability of death High probability of death in staff or patients Disaster Preparedness Conference 2006

Disaster Preparedness Conference 2006 Impact - Property Unlikely to cause physical plant or equipment damage requiring any replacement costs or recovery time Minor physical plant or equipment damage requiring some replacement costs or recovery time Moderate physical plant or equipment damage requiring moderate replacement costs or recovery time Extensive physical plant or equipment damage with high replacement costs and recovery time Disaster Preparedness Conference 2006

Disaster Preparedness Conference 2006 Impact - Business Unlikely to cause service interruption or damage to public image of the institution Minor or limited or short term service interruption or damage to public image Significant/widespread or long term service interruption 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

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 (H+P+B) Risk Tornado B 3+3+2 B8 Dirty Bomb B/C/D 3+1+2 B/C/D6 Pandemic influenza 4+1+4 B9 Disaster Preparedness Conference 2006

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

Disaster Preparedness Conference 2006 Priorities Pandemic ‘flu Tornado Dirty bomb Disaster Preparedness Conference 2006

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

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

Disaster Preparedness Conference 2006 “The only thing more difficult than preparing for an emergency is having to explain why you didn’t” Disaster Preparedness Conference 2006