1. Certified Hospital Emergency Coordinator (CHEC) Training Program
Emergency Management Overview

2. Objectives Define “emergency” and “disaster”
Upon lesson completion, you should be able to:
Define “emergency” and “disaster”
Discuss some types of disasters
Define Emergency Management (EM)
Identify the four phases of the EM cycle
Identify key considerations in hospital disaster planning

3. Objectives, continued Identify the regulatory requirements for EM
Understand the importance of the
all-hazards approach
Describe how planning efforts at different levels are integrated into emergency response

4. Emergency Disaster Definitions
An unforeseen combination of circumstances or the resulting state that calls for immediate action (Merriam-Webster's Dictionary of Law. Merriam-Webster, Inc.)
Disaster
A disaster is a situation or event which overwhelms local capacity, necessitating a request for external assistance.
Click to reveal each term– each one will dim after you click to bring up the next one.
Make the point that an emergency may be handled in-house…it simply refers to something that needs immediate attention, like a person who goes into cardiac arrest…if care is not provided immediately , the person will die. However, the resources of the hospital will not be overwhelmed by running one code. However, there may be times when something that happened that requires emergent intervention, but that is on such a grand scale that it overwhelms the ability of those responding to handle it alone. When aid is required, it’s then a disaster.
An emergency is any sudden or unforeseen situation that requires immediate action.
The WHO defines a disaster as a "sudden ecological phenomenon of sufficient magnitude to require external assistance." The American College of Emergency Physicians (ACEP) states that a disaster has occurred "when the destructive effects of natural or man-made forces overwhelm the ability of a given area or community to meet the demand for health care."

5. Types of Disasters “All-Hazards”- Natural Man Made Tornado Hurricane
Flood
Man Made
Technological
Complex (natural and technological)
Emerging threats
Acts of terrorism
Train Wreck, Graniteville, SC, Courtesy of Jeff Wilkinson.

6. A Little More on Acts of Terrorism…
Weapons of Mass Destruction (WMD)
CBRNE (Chemical, Biological, Radiological, Nuclear, Explosive)
Weapons of Mass Effect (WME)
Mention that we used to show the video in class, but have deleted it, as most participants have already seen it. However, mention it as a good resource for all hospital employees at orientation and as a place where ides for further education can be found. WMD and CBRNE will now be covered in this lecture, and other types of disasters will be covered in more depth elsewhere in this course.
Video is included in the resource folder once certified.

7. WMD and WME Defined
Weapons capable of inflicting massive destruction to property and/or populations, using chemical, biological or radioactive material
Weapons that can kill many people and/or cause great damage to man-made structures (e.g. buildings), natural structures (e.g. mountains), or the biosphere in general; covers several weapon types, including CBRNE
Weapons of mass effect, or WME, are weapons capable of inflicting grave destructive, psychological and/or economic damage

8. Chemical Weaponry
Chemical warfare (CW) involves using the toxic properties of chemical substances as chemical weapons to kill, injure, or incapacitate an enemy
THE CHEMICAL WEAPONS CONVENTION (CWC)                 
 Brief Background In 1992, after a decade of long and painstaking negotiations, the Conference on Disarmament agreed to the text of the Chemical Weapons Convention (CWC), which was then adopted by the General Assembly at its forty-seventh session, on 30 November 1992, in its resolution entitled Convention on the Prohibition of the Development, Production, Stockpiling and Use of Chemical Weapons and on Their Destruction (A/RES/47/39).
The Convention is the first disarmament agreement negotiated within a multilateral framework that provides for the elimination of an entire category of weapons of mass destruction. Its scope, the obligations assumed by States Parties and the system of verification envisaged for its implementation are unprecedented. 
The Convention prohibits all development, production, acquisition, stockpiling, transfer, and use of chemical weapons. It requires each State Party to destroy chemical weapons and chemical weapons production facilities it possesses, as well as any chemical weapons it may have abandoned on the territory of another State Party. The verification provisions of the CWC not only affect the military sector but also the civilian chemical industry, world-wide, through certain restrictions and obligations regarding the production, processing and consumption of chemicals that are considered relevant to the objectives of the Convention. They will be verified through a combination of reporting requirements, routine on-site inspections of declared sites and short-notice challenge inspections. The Convention also contains provisions on assistance in case a State Party is attacked or threatened with attack by chemical weapons and on promoting the trade in chemicals and related equipment among States Parties.
The Secretary-General of the United Nations is the Depositary of the Convention. The Convention was opened for signature on 13 January 1993 in Paris by the Secretary-General of the United Nations with 130 States signing the Convention. On 31 October 1996, Hungary became the 65th State to deposit its instrument of ratification, thus triggering the process of entry into force of the CWC 180 days later. The Convention entered into force on 29 April 1997. 
The Organization for the Prohibition of Chemical Weapons (OPCW) was established in The Hague and is responsible for the implementation of the Convention.  The OPCW is mandated to ensure the implementation of its provisions, including those for international verification of compliance with it, and to provide a forum for consultation and cooperation among States Parties.
ENTRY INTO FORCE:  29 April DEPOSITARY: Secretary-General of the UN TOTAL NUMBER OF PARTIES AS OF AUGUST 2000: 140 Parties
Above from UN.org
Below from Wikipedia:
 The convention distinguishes three classes of controlled substance[1], chemicals which can either be used as weapons themselves or used in the manufacture of weapons. The classification is based on the quantities of the substance produced commercially for legitimate purposes. Each class is split into Part A, which are chemicals that can be used directly as weapons, and Part B which are chemicals useful in the manufacture of chemical weapons.
Schedule 1 chemicals have few, or no uses outside of chemical weapons. These may be produced or used for research, medical, pharmaceutical or chemical weapon defence testing purposes but production above 100 grams per year must be declared to the OPCW. A country is limited to possessing a maximum of 1 tonne of these materials. Examples are mustard and nerve agents, and substances which are solely used as precursor chemicals in their manufacture. A few of these chemicals have very small scale non-military applications, for example minute quantities of nitrogen mustard are used to treat certain cancers.
Schedule 2 chemicals have legitimate small-scale applications. Manufacture must be declared and there are restrictions on export to countries which are not CWC signatories. An example is thiodiglycol which can be used in the manufacture of mustard agents, but is also used as a solvent in inks.
Schedule 3 chemicals have large-scale uses apart from chemical weapons. Plants which manufacture more than 30 tonnes per year must be declared and can be inspected, and there are restrictions on export to countries which are not CWC signatories. Examples of these substances are phosgene, which has been used as a chemical weapon but which is also a precursor in the manufacture of many legitimate organic compounds and triethanolamine, used in the manufacture of nitrogen mustard but also commonly used in toiletries and detergents.
The treaty also deals with carbon compounds called in the treaty Discrete organic chemicals.[2] These are any carbon compounds apart from long chain polymers, oxides, sulfides and metal carbonates, such as organophosphates. The OPCW must be informed of, and can inspect, any plant producing (or expecting to produce) more than 200 tonnes per year, or 30 tonnes if the chemical contains phosphorus, sulfur or fluorine, unless the plant solely produces explosives or hydrocarbons.
[edit] Known stockpiles (of chemical weapons)
 Weapons of mass destructionBy typeBiological Chemical Nuclear RadiologicalBy countryAlbania Algeria Argentina Australia Brazil Bulgaria Canada PR China France Germany India Iran Iraq IsraelJapan Netherlands North Korea Pakistan Poland Romania Russia Saudi Arabia South Africa Syria Taiwan (ROC) United Kingdom United StatesList of treatiesv • d • eAs of 2007, there were six member countries which had declared stockpiles:
United States
Russia
India
Albania
[3]
An undeclared "state party", possibly South Korea
Iraq has not signed the treaty. Iraq's chemical weapons were destroyed under a United Nations reduction program after the 1991 Gulf War. Approximately five hundred degraded chemical munitions have been found in Iraq since the 2003 invasion of Iraq, according to a report of the US National Ground Intelligence Center.[4] These weapons contained sarin and mustard agents but were so badly corroded that they could not have been used as originally intended.[5]
[edit] Known production facilities (of chemical weapons)
Twelve countries declared chemical weapons production facilities:
Bosnia and Herzegovina
China
France
Iran
Japan
Libya
Russian Federation
Serbia and Montenegro
United Kingdom
A "state party"
By 2007, all 65 declared facilities had been deactivated and 94% (61) have been certified as destroyed or converted to civilian use.[6] As of the end of February 2008, 42 facilities were destroyed while 19 were converted for civilian purposes.[7]
[edit] World stockpile
The total world declared stockpile of chemical weapons was about 43,760 tons in early A total of 71,315 tonnes have been declared to OPCW of which about 29,602 tonnes (41.5%) had been destroyed by September 30, More than 35.4% (3.07) of the 8.67 million declared chemical munitions and containers have been destroyed.[8] (Treaty confirmed destruction totals often lag behind state-declared totals.) Several countries that are not members are suspected of having chemical weapons, especially Syria and North Korea, while some member states (including Sudan and the People's Republic of China) have been accused by others of failing to disclose their stockpiles.
[edit] Current progress
By July 2007, 33% of known chemical weapons stockpiles had been destroyed worldwide, falling far short of the 100% goal set for in 2007.[9] Furthermore, by April 2008, only 50% of countries had passed the required legislation to outlaw participation in chemical weapons production[10]. By December 31, 2007, 36.5% of Class 1, 52% of Class 2 and all Class 3 declared chemicals had been destroyed.[11]
Albania: On 11 July 2007, the OPCW confirmed the destruction of the entire chemical weapons stockpile in Albania. Albania is the first nation to completely destroy all of its chemical weapons under the terms of the CWC.[11] The Albanian stockpile included 16,678 kilograms of mustard agent, lewisite, adamsite, and chloroacetophenone. The United States assisted with and funded the destruction operations.[12]
A State Party: The unspecified "state party" had destroyed 96.3% of its stockpile by the end of 2007 and is expected to finish the process by the end of 2008.[11]
India: 93.1% of India's chemical weapons stockpile was destroyed by the end of 2007 and India is expected to finish destruction by April 2009.[11]
Libya: Libya's entire chemical weapons stockpile is expected to be destroyed by 2011[11]
U.S.A.: The United States of America completed Phase III in June 2007, having destroyed over 50.7% of its declared stockpile by December 31, 2007.[11] Over 66% of the chemical weapons destroyed in the world since the treaty came into force were destroyed in the U.S. The United States General Accounting Office has announced it does not expect the United States to complete its campaign until 2014, after the treaty's final deadline. The Pentagon, in late 2006, announced that it expected disposal of the U.S. stockpile to not be completed until 2023.[13]
Russia: Russia had destroyed 24% of its stockpile by the end of 2007.[9][11] Russia completed Phase II in 2007 and had received extensions on the remaining phases. The United States General Accounting Office has announced it does not expect Russia to reach 100% destruction until 2027; however, Russia has declared its intention to complete operations by the treaty deadline of 2012.[11]

9. Chemical Weaponry, continued
Lethal agents (some examples)
Blood agents: Cyanogen chloride, Hydrogen cyanide
Blister agents: Lewisite, Sulfur & Nitrogen mustard gases
Nerve agents:
G-Agents: Tabun (GA), Sarin (GB), Soman (GD)
V-Agents: VE, VG, VM, VR, VX
Pulmonary agents: Phosgene (CG), Diphosgene (DP)
Riot control agents: Pepper spray (OC), CS gas, CN gas (mace)
The use of nonliving toxic products produced by living organisms (e.g. toxins such as botox & ricin) is considered chemical warfare under the provisions of the Chemical Weapons Convention
The Moscow theatre hostage crisis, also known as the 2002 Nord-Ost siege,[1] was the seizure of a crowded Moscow theatre on October 23, 2002 by about armed Chechen rebel fighters who claimed allegiance to the separatist movement in Chechnya. They took 850 hostages and demanded the withdrawal of Russian forces from Chechnya and an end to the Second Chechen War. The siege was led by Movsar Barayev (aged 22 at the time).
After a two-and-a-half day siege, Russian OSNAZ forces pumped an unknown chemical agent into the building's ventilation system and raided it.[1] Officially, 39 of the terrorists were killed by Russian forces, along with at least 129 and possibly many more of the hostages (nine of them foreigners). All but two[2] of the hostages who died during the siege were killed by the toxic substance pumped into the theatre to subdue the militants.[3][4]
It was reported that efforts to treat victims were complicated because the Russian government refused to inform doctors what type of gas had been used. In the records of the official investigation, the agent is referred to as a "gaseous substance". In other cases it is referred to as an "unidentified chemical substance".[101] Government officials, who initially described the substance as a gas and now appears to have been an FSB-made aerosol version of carfentanyl, an artificial, powerful opium-like substance, still treat its contents as a state secret.
The Russian Federation, as a member-state of the Chemical Weapons Convention, undertook "never and under no circumstances to carry out any activities prohibited to member-states of this Convention" to develop, to accumulate, to stockpile and to use chemical weapons that can cause death, temporary incapacitation, or permanent harm to humans or animals.[102] The Convention obliges the states to fulfill the conditions of toxic chemicals use that allow to exclude or considerably reduce the degree of injury and gravity of consequences. However, during the special operation in Dubrovka this provision was disregarded, i.e. neither the type, nor the quantity of the chemical agent helped to attain the set purpose—to neutralize the terrorists so as to rescue the hostages. (The Convention allows the use of some chemical agents like tear gas for "law enforcement including domestic riot control", but requires that "riot control agents" have effects that "disappear within a short time following termination of exposure."[32]) From wikipedia
Past Chemical Wars (From wikipedia)
[edit] Dispersion
Dispersion of chlorine in World War I
Dispersion is the simplest technique of delivering an agent to its target. The most common techniques are munitions, bombs, projectiles, and warheads, which allow dissemination from spray tanks from low flying aircraft. It consists of placing the chemical agent upon or adjacent to a target immediately before dissemination, so that the material is most efficiently used.
World War I saw the earliest implementation of this technique. The actual first chemical ammunition was the French 26mm cartouche suffocante rifle grenade, fired from a flare carbine. It contained 35g of the tear-producer ethylbromacetate, and was used in autumn 1914 – with little effect on the Germans. The Germans on the other hand tried to increase the effect of 10.5cm shrapnel shells by adding an irritant – dianisidine chlorosulphonate – went unnoticed by the British when tried at Neuve Chapelle in October Hans Tappen, a chemist in the Heavy Artillery Department of the War Ministry, suggested to his brother, the Chief of the Operations Branch at German General Headquarters, the use of the tear-gases benzyl bromide or xylyl bromide. Shells were tested successfully at the Wahn artillery range near Cologne on 9 January 1915, and an order was placed for 15cm howitzer shells, designated ‘T-shells’ after Tappen. A shortage of shells limited the first use against the Russians at Bolimov on 31 January 1915; the liquid failed to vaporize in the cold weather, and again the experiment went unnoticed by the Allies.
The first effective use were when the German forces at Second Battle of Ypres simply opened cylinders of chlorine and allowed the wind to carry the gas across enemy lines. While simple, this technique had numerous disadvantages. Moving large numbers of heavy gas cylinders to the front-line positions from where the gas would be released was a lengthy and difficult logistical task. Stockpiles of cylinders had to be stored at the front line, posing a great risk if hit by artillery shells. Gas delivery depended greatly on wind speed and direction. If the wind was fickle, as at Loos, the gas could blow back, causing friendly casualties. Gas clouds gave plenty of warning, allowing the enemy time to protect themselves, though many soldiers found the sight of a creeping gas cloud unnerving. This made the gas doubly effective, as, in addition to damaging the enemy physically, it also had a psychological effect on the intended victims. Also gas clouds had limited penetration, capable only of affecting the front-line trenches before dissipating. Although it produced limited results in World War I, this technique shows how simple chemical weapon dissemination can be.
Shortly after this "open canister" dissemination, French forces developed a technique for delivery of phosgene in a non-explosive artillery shell. This technique overcame many of the risks of dealing with gas in cylinders. First, gas shells were independent of the wind and increased the effective range of gas, making any target within reach of guns vulnerable. Second, gas shells could be delivered without warning, especially the clear, nearly odorless phosgene – there are numerous accounts of gas shells, landing with a "plop" rather than exploding, being initially dismissed as dud high explosive or shrapnel shells, giving the gas time to work before the soldiers were alerted and took precautions.
The major drawback of artillery delivery was the difficulty of achieving a killing concentration. Each shell had a small gas payload and an area would have to be subjected to saturation bombardment to produce a cloud to match cylinder delivery. A British solution to the problem was the Livens Projector. This was effectively a large-bore mortar, dug into the ground that used the gas cylinders themselves as projectiles - firing a 14 kg cylinder up to 1500 m. This combined the gas volume of cylinders with the range of artillery.
Over the years, there were some refinements in this technique. In the 1950s and early 1960s, chemical artillery rockets and cluster bombs contained a multitude of submunitions, so that a large number of small clouds of the chemical agent would form directly on the target.
[edit] Thermal dissemination
An American-made MC-1 gas bomb
Thermal dissemination is the use of explosives or pyrotechnics to deliver chemical agents. This technique, developed in the 1920s, was a major improvement over earlier dispersal techniques, in that it allowed significant quantities of an agent to be disseminated over a considerable distance. Thermal dissemination remains the principal method of disseminating chemical agents today.
Most thermal dissemination devices consist of a bomb or projectile shell that contains a chemical agent and a central "burster" charge; when the burster detonates, the agent is expelled laterally.
Thermal dissemination devices, though common, are not particularly efficient. First, a percentage of the agent is lost by incineration in the initial blast and by being forced onto the ground. Second, the sizes of the particles vary greatly because explosive dissemination produces a mixture of liquid droplets of variable and difficult to control sizes.
The efficacy of thermal detonation is greatly limited by the flammability of some agents. For flammable aerosols, the cloud is sometimes totally or partially ignited by the disseminating explosion in a phenomenon called flashing. Explosively disseminated VX will ignite roughly one third of the time. Despite a great deal of study, flashing is still not fully understood, and a solution to the problem would be a major technological advance.
Despite the limitations of central bursters, most nations use this method in the early stages of chemical weapon development, in part because standard munitions can be adapted to carry the agents. Deployment involves precise knowledge of aero and fluid dynamics because of submission dispersed ft above ground - it puts the pilot at risk.
Soviet chemical weapons canisters from a stockpile in Albania
[edit] Aerodynamic dissemination
Aerodynamic dissemination is the non-explosive delivery of a chemical agent from an aircraft, allowing aerodynamic stress to disseminate the agent. This technique is the most recent major development in chemical agent dissemination, originating in the mid-1960s.
This technique eliminates many of the limitations of thermal dissemination by eliminating the flashing effect and theoretically allowing precise control of particle size. In actuality, the altitude of dissemination, wind direction and velocity, and the direction and velocity of the aircraft greatly influence particle size. There are other drawbacks as well; ideal deployment requires precise knowledge of aerodynamics and fluid dynamics, and because the agent must usually be dispersed within the boundary layer (less than 200–300 ft above the ground), it puts pilots at risk.
Significant research is still being applied toward this technique. For example, by modifying the properties of the liquid, its breakup when subjected to aerodynamic stress can be controlled and an idealized particle distribution achieved, even at supersonic speed. Additionally, advances in fluid dynamics, computer modeling, and weather forecasting allow an ideal direction, speed, and altitude to be calculated, such that warfare agent of a predetermined particle size can predictably and reliably hit a target.
World War I
A soldier with mustard gas burns, ca. 1917–1918.
Main article: Poison gas in World War I
The Hague Declaration of 1899 and the Hague Convention of 1907 forbade the use of "poison or poisonous weapons" in warfare, yet more than 124,000 tons of gas were produced by the end of World War I. The French were the first to use chemical weapons during the First World War, using tear gas. The German's first use of chemical weapons were shells containing xylyl bromide that were fired at the Russians near the town of Bolimów, Poland in January 1915.[12] The first full-scale deployment of chemical warfare agents was during World War I, originating in the Second Battle of Ypres, April 22, 1915, when the Germans attacked French, Canadian and Algerian troops with chlorine gas. Deaths were light, though casualties relatively heavy. A total 50,965 tons of pulmonary, lachrymatory, and vesicant agents were deployed by both sides of the conflict, including chlorine, phosgene and mustard gas. Official figures declare about 1,176,500 non-fatal casualties and 85,000 fatalities directly caused by chemical warfare agents during the course of the war.[13]
To this day unexploded WWI-era chemical ammunition is still frequently uncovered when the ground is dug in former battle or depot areas and continues to pose a threat to the civilian population in Belgium and France and less commonly in other countries. The French and Belgian governments have had to launch special programs for treating discovered ammunition.[citation needed]
After the war, most of the unused German chemical warfare agents were dumped into the Baltic Sea, a common disposal method among all the participants in several bodies of water. Over time, the salt water causes the shell casings to corrode, and mustard gas occasionally leaks from these containers and washes onto shore as a wax-like solid resembling ambergris. Even in this solidified form, the agent is active enough to cause severe contact burns to anybody coming into contact with it.[citation needed]
[edit] Interwar years
Dressing the Wounded during a Gas Attack, a 1919 painting by the British war artist Austin Osman Spare.
After World War I chemical agents were occasionally used to subdue populations and suppress rebellion.
Following the defeat of the Ottoman Empire in 1917, the Ottoman government collapsed completely, and the former empire was divided amongst the victorious powers in the Treaty of Sèvres. The British occupied Mesopotamia (present-day Iraq) and established a colonial government.
In 1920, the Arab and Kurdish people of Mesopotamia revolted against the British occupation, which cost the British dearly. As the Mesopotamian resistance gained strength, the British resorted to increasingly repressive measures. Much speculation was made about aerial bombardment of major cities with gas in Mesopotamia, with Winston Churchill, then-Secretary of State at the British War Office, arguing in favor of it.[14] In the 1920s generals reported that poison had never won a battle. The soldiers said they hated it and hated the gas masks. Only the chemists spoke out to say it was a good weapon.
In 1925, sixteen of the world's major nations signed the Geneva Protocol, thereby pledging never to use gas in warfare again. Notably, in the United States, the Protocol languished in the Senate until 1975, when it was finally ratified.
The Bolsheviks also employed poison gas in 1921 during the Tambov Rebellion. An order signed by military commanders Tukhachevsky and Vladimir Antonov-Ovseenko stipulated: "The forests where the bandits are hiding are to be cleared by the use of poison gas. This must be carefully calculated, so that the layer of gas penetrates the forests and kills everyone hiding there."[15]
During the Rif War in Spanish Morocco in 1921–1927, combined Spanish and French forces dropped mustard gas bombs in an attempt to put down the Berber rebellion. (See also: Chemical weapons in the Rif War)
In 1935, Fascist Italy used mustard gas during the invasion of Ethiopia in the Second Italo-Abyssinian War. Ignoring the Geneva Protocol, which it signed seven years earlier, the Italian military dropped mustard gas in bombs, sprayed it from airplanes, and spread it in powdered form on the ground. 150,000 chemical casualties were reported, mostly from mustard gas.
[edit] World War II
The chemical structure of Sarin nerve gas, developed by Germany in 1938.
Despite article 171 of the Versailles Peace Treaty and a resolution adopted against Japan by the League of nations on 14 May 1938, the Imperial Japanese Army frequently used chemical weapons. Because of fear of retaliation however, those weapons were never used against Westerners but against other Asians judged "inferior" by the imperial propaganda. According to historians Yoshiaki Yoshimi and Seiya Matsuno, the chemical weapons were authorized by specific orders given by emperor Showa himself, transmitted by the chief of staff of the army. For example, the Emperor authorized the use of toxic gas on 375 separate occasions during the battle of Wuhan from August to October 1938.[16] They were also profusely used during the invasion of Changde. Those orders were transmitted either by prince Kotohito Kan'in or general Hajime Sugiyama[17].
The Imperial Japanese Army used mustard gas and the recently-developed blister agent Lewisite against Chinese troops and guerrillas. Experiments involving chemical weapons were conducted on live prisoners (Unit 731 and Unit 516). The Japanese also carried chemical weapons as they swept through Southeast Asia towards Australia. Some of these items were captured and analyzed by the Allies. Greatly concerned, Australia covertly imported 1,000,000 chemical weapons from the United Kingdom from 1942 onwards[18][2][3] [4][5][6][7].
Shortly after the end of World War I, Germany's General Staff enthusiastically pursued a recapture of their preeminent position in chemical warfare. In 1923, Hans von Seeckt pointed the way, by suggesting that German poison gas research move in the direction of delivery by aircraft in support of mobile warfare. Also in 1923, at the behest of the German army, poison gas expert Dr. Hugo Stolzenberg negotiated with the USSR to built a huge chemical weapons plant at Trotsk, on the Volga river. Collaboration between Germany and the USSR in poison gas continued on and off through the 1920s. In 1924, German officers debated the use of poison gas versus non-lethal chemical weapons against civilians. Even before World War II, chemical warfare was revolutionized by Nazi Germany's discovery of the nerve agents tabun (in 1937) and sarin (in 1938) by Gerhard Schrader, a chemist of IG Farben. IG Farben was Germany's premier poison gas manufacturer during World War I, so the weaponization of these agents can not be considered accidental.[19] Both were turned over to the German Army Weapons Office prior to the outbreak of the war. The nerve agent soman was later discovered by Nobel Prize laureate Richard Kuhn and his collaborator Konrad Henkel at the Kaiser Wilhelm Institute for Medical Research in Heidelberg in spring of 1944.[20][21] The Nazis developed and manufactured large quantities of several agents, but chemical warfare was not extensively used by either side. Chemical troops were set up (in Germany since 1934) and delivery technology was actively developed. Recovered Nazi documents suggest that German intelligence incorrectly thought that the Allies also knew of these compounds, interpreting their lack of mention in the Allies' scientific journals as evidence that information about them was being suppressed. Germany ultimately decided not to use the new nerve agents, fearing a potentially devastating Allied retaliatory nerve agent deployment. Fisk, Robert (December 30, 2000). "Poison gas from Germany". Independent,
William L. Shirer, in The Rise and Fall of the Third Reich, writes that the British high command considered the use of chemical weapons as a last-ditch defensive measure in the event of a Nazi invasion of Britain.
On the night of December 2, 1943, German Ju 88 bombers attacked the port of Bari in Southern Italy, sinking several American ships – among them SS John Harvey, which was carrying mustard gas intended for use in retaliation by the Allies if German forces initiated gas warfare. The presence of the gas was highly classified, and authorities ashore had no knowledge of it – which increased the number of fatalities, since physicians, who had no idea that they were dealing with the effects of mustard gas, prescribed treatment improper for those suffering from exposure and immersion.
The whole affair was kept secret at the time and for many years after the war (in the opinion of some, there was a deliberate and systematic cover-up). According to the U.S. military account, "Sixty-nine deaths were attributed in whole or in part to the mustard gas, most of them American merchant seamen"[22] out of 628 mustard gas military casualties.[23] The large number of civilian casualties among the Italian population were not recorded. Part of the confusion and controversy derives from the fact that the German attack was highly destructive and lethal in itself, also apart from the accidental additional effects of the gas (it was nicknamed "The Little Pearl Harbor"), and attribution of the causes of death between the gas and other causes is far from easy.[24][25]
Rick Atkinson, in his book The Day of Battle, describes the intelligence that prompted Allied leaders to deploy mustard gas to Italy. This included Italian intelligence that Adolf Hitler had threatened to use gas against Italy if she changed sides, and prisoner of war interrogations suggesting that preparations were being made to use a "new, egregiously potent gas" if the war turned decisively against Germany. Atkinson concludes that "No commander in 1943 could be cavalier about a manifest threat by Germany to use gas."
The Grand Mufti of Jerusalem, Amin al-Husayni, the senior Islamic religious authority of the Palestinian Arabs and ally of Adolf Hitler was accused of sponsoring an unsuccessful chemical warfare assault on the Jewish community in Tel-Aviv during 1944 by The David S. Wyman Institute for Holocaust Studies. Allegations suggest that five parachutists were supplied with maps of Tel Aviv, canisters of a German–manufactured "fine white powder," and instructions from the Mufti to dump chemicals into the Tel Aviv water system. District police commander Fayiz Bey Idrissi later recalled, "The laboratory report stated that each container held enough poison to kill 25,000 people, and there were at least ten containers."[26]
[edit] Cold War
After World War II, the Allies recovered German artillery shells containing the three German nerve agents of the day (tabun, sarin, and soman), prompting further research into nerve agents by all of the former Allies. Although the threat of global thermonuclear war was foremost in the minds of most during the Cold War, both the Soviet and Western governments put enormous resources into developing chemical and biological weapons.

10. Biological
Anthrax, botulism, plague, smallpox, tularemia, and viral hemorrhagic fevers are diseases caused by the Category A biological agents, so-called because they pose particularly serious threats as bioweapons
In 1999, the Working Group on Civilian Biodefense expert panel reached consensus on the following list of key features of biological agents that pose particularly serious risks if used as weapons against civilian populations:
High morbidity and mortality
Potential for person-to-person transmission
Low infective dose and highly infectious by aerosol dissemination, with a commensurate ability to cause large outbreaks
Effective vaccine unavailable or available only in limited supply
Potential to cause public and healthcare worker anxiety
Availability of pathogen or toxin
Feasibility of large-scale production
Environmental stability
Prior research and development as a biological weapon.
The U.S. Centers for Disease Control & Prevention (CDC) applied the following 4 criteria to assess and characterize potential biological weapon agents that cause infections in humans into Categories A, B, and C:
Potential public health impact, which is based on an agent’s ability to cause illness and death
Dissemination potential, which is based on an agent’s stability, mass production and/or delivery potential, and the contagiousness, or the degree to which it will spread from person to person
Public perception, which is an estimation of how much fear is associated with an agent and how much civil disruption might ensue
Special public health preparations required, which is related to the stockpile, surveillance, and diagnostic requirements associated with an agent.
From:

11. Radiological
A radiological weapon or radiological dispersion device (RDD) is any weapon that is designed to spread radioactive material with the intent to kill, and cause disruption upon a city or nation
It is primarily known as a dirty bomb because it is not a true nuclear weapon and does not yield the same destructive power
It uses conventional explosives to spread radioactive material
spent fuels from nuclear power plants or radioactive medical waste may be used
Explanation
Radiological weapons have been suggested as a possible weapon of terrorism used to create panic and casualties in densely populated areas. They could also render a great deal of property useless for an extended period, unless costly remediation was undertaken. The radiological source and quality greatly impacts the effectiveness of a radiological weapon.
Factors such as: energy and type of radiation, half-life, size of explosion, availability, shielding, portability, and the role of the environment will determine the effect of the radiological weapon. Radioisotopes that pose the greatest security risk include: 137Cs, used in radiological medical equipment, 60Co, 241Am, 252Cf, 192Ir, 238Pu, 90Sr, and 226Ra. All of these isotopes, except for the latter, are created in nuclear power plants. While the amount of radiation dispersed from the event will likely be minimal, the fact of any radiation may be enough to cause panic and disruption.
[edit] History
The history of radioactive weaponry may be traced to a 1943 memo to Brigadier General Leslie Groves of the Manhattan Project. Transmitting a report entitled, "Use of Radioactive Materials as a Military Weapon," the memo states:
October 30, 1943 memo from Drs. Conant, Compton, and Urey to Brigadier General L. R. Groves, Manhattan District, Oak Ridge, Tennessee; declassified June 5, 1974
“As a gas warfare instrument the material would ... be inhaled by personnel. The amount necessary to cause death to a person inhaling the material is extremely small. It has been estimated that one millionth of a gram accumulating in a person's body would be fatal. There are no known methods of treatment for such a casualty.... It cannot be detected by the senses; It can be distributed in a dust or smoke form so finely powdered that it will permeate a standard gas mask filter in quantities large enough to be extremely damaging....
Radioactive warfare can be used [...] To make evacuated areas uninhabitable; To contaminate small critical areas such as rail-road yards and airports; As a radioactive poison gas to create casualties among troops; Against large cities, to promote panic, and create casualties among civilian populations.
Areas so contaminated by radioactive dusts and smokes, would be dangerous as long as a high enough concentration of material could be maintained.... they can be stirred up as a fine dust from the terrain by winds, movement of vehicles or troops, etc., and would remain a potential hazard for a long time.
These materials may also be so disposed as to be taken into the body by ingestion instead of inhalation. Reservoirs or wells would be contaminated or food poisoned with an effect similar to that resulting from inhalation of dust or smoke. Four days production could contaminate a million gallons of water to an extent that a quart drunk in one day would probably result in complete incapacitation or death in about a month's time.”
The United States, however, chose not to pursue radiological weapons during World War II, though early on in the project considered it as a backup plan in case nuclear fission proved impossible to tame. Some US policymakers and scientists involved in the project felt that radiological weapons would qualify as chemical weapons and thus violate international law.

12. Nuclear
A nuclear weapon/bomb is an explosive device that derives its destructive force from nuclear reactions (either fission or a combination of fission and fusion)
Both reactions release vast quantities of energy from relatively small amounts of matter
A weapon weighing little more than a thousand kilograms can produce an explosion comparable to the detonation of more than a billion kilograms of conventional high explosive
Slide from wikipedia

13. Explosive
Explosives can be anything from pipe bombs to improvised explosive devices (IEDs)
Explosives are becoming increasingly sophisticated and difficult to detect
Non-nuclear explosives are the most common terrorist weapon now in use
Weapons of mass destruction: Overview of the CBRNEs (Chemical, Biological, Radiological, Nuclear, and Explosives) . 
Journal of the Neurological Sciences , Volume 249 , Issue 1 , Pages
L . Prockop
Above is source of second bullet point

14. Other Considerations
Handguns and long guns, in the hands of terrorists, can be weapons of mass destruction
Mumbai, India and Charlie Hebdo
Beslan
Columbine and Newtown
Virginia Tech
Hospital shootings
Ft Lauderdale Airport Shooting
The Beslan school hostage crisis (also referred to as the Beslan school siege or Beslan massacre)[2][3][4] began when a group of armed rebels, demanding an end to the Second Chechen War, took more than 1,100 people (including some 777 children[5]) hostage on September 1, 2004, at School Number One (SNO) in the town of Beslan, North Ossetia-Alania, an autonomous republic in the North Caucasus region of the Russian Federation. On the third day of the standoff, Russian security forces stormed the building.[6] A series of explosions shook the school, followed by a fire which engulfed the building and a chaotic gunbattle between the hostage-takers and Russian security forces. Ultimately, at least 334 hostages were killed, including 186 children.[7][8] Hundreds more were wounded or reported missing. FROM wikipedia
Columbine:
The Columbine High School massacre occurred on Tuesday, April 20, 1999, at Columbine High School in Columbine in unincorporated Jefferson County, Colorado, near Denver and Littleton. Two students, Eric Harris and Dylan Klebold, embarked on a massacre, killing 12 students and a teacher, as well as wounding 23 others, before committing suicide. It is the fourth-deadliest school shooting in United States history, after the 1927 Bath School disaster, 2007 Virginia Tech massacre and the 1966 University of Texas massacre, and the deadliest for an American high school. FROM wikipedia
The Virginia Tech massacre was a school shooting consisting of two separate attacks approximately two hours apart on April 16, 2007, that took place on the campus of Virginia Polytechnic Institute and State University (Virginia Tech) in Blacksburg, Virginia, United States. The perpetrator, Seung-Hui Cho, killed 32 people and wounded many others[1] before committing suicide. The massacre remains the deadliest shooting incident by a single gunman in United States history, on or off a school campus.[2] FROM wikipedia
3 dead in hospital shooting - Crime & courts- msnbc.com
Mar 27, A retired teacher bearing a grudge over his mother's treatment at the hospital where she died fatally shot one of her nurses, k - Cached - Similar pages
Doctor, Staff Member Die In Hospital Shooting - Boston News Story ...
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CU officer cleared in hospital shooting - The Denver Post
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FOXNews.com - 3 Dead in Shooting at Hospital Where Gunman's Mom ...
3 Dead in Shooting at Hospital Where Gunman's Mom Died, retired teacher bearing a grudge over his mother's medical treatment at the hospital where she died k - Cached - Similar pages
Hospital Shooting | KIII TV3 South Texas | News
Police say the alleged shooter was arrested shortly after fleeing the hospital. Police did not know what provoked the shooting but said the man's wife was k - Cached - Similar pages
Two Killed in Hospital Shooting Rampage - New York Times

15. Definition and Description of EM
Emergency Management is:
An integrated, all-hazards approach to the management of emergencies utilizing response programs and activities
Emergencies are organized into four phases: mitigation, preparedness, response, and recovery
These phases apply to all types of emergencies and disasters
They are used by all levels of government and the private sector

16. All-Hazards Planning
“How you prepare for one disaster or emergency situation is the same for any other disaster. Whether you represent a business or nonprofit organization, work for a state or local government, or want to prepare your family for disaster, preparedness can be achieved through thoughtful planning before a disaster.”

17. Emergency Management Cycle
RESPONSE
PREPAREDNESS
RECOVERY
MITIGATION
“The disaster life cycle describes the process through which emergency managers prepare for emergencies and disasters, respond to them when they occur, help people and institutions recover from them, mitigate their effects, reduce the risk of loss, and prevent disasters such as fires from occurring.”
Mention that this is also the disaster cycle (they will see this when they take BDLS and ADLS
The next slides describe these phases.

18. The Four Phases
Mitigation—Preventing disasters through reduction of vulnerability
Preparedness—Building capability to manage the impact of hazards
Recovery—Short- and long-term restoration of the damages caused by disaster
Response—Decreasing or stopping the on-going negative effects of disasters
More detail on each phase…
These are the disaster phases mentioned in the disaster life support courses.
Hospital specific:
MITIGATION
Structural and nonstructural mitigation in order to remain operational
(E.g., laws, guidelines, standards, security measures, surveillance)
PREPAREDNESS
Training, education, exercises, stockpiling, and planning
RESPONSE:
Triage, treatment, transfer, disposition, and management of victims
Response-
Documentation actions should be initiated early in an emergency.
Although it may be tempting to forgo documentation during the emergency response,
adequate documentation:
Is essential to operational decision-making
May have future legal ramifications
May have implications for reimbursement eligibility
RECOVERY:
Operational and business recovery
Returning to normal operations
Mississippi, Hurricane Katrina
Courtesy of Charles Reneau

19. Hospital Specific Considerations
MITIGATION: Structural & nonstructural mitigation in order to remain operational
(E.g., laws, guidelines, standards, security measures, surveillance)
PREPAREDNESS: Training, education, exercises, stockpiling, and planning

20. Hospital Specific Considerations
RESPONSE: Triage, treatment, transfer, disposition and management of victims
Documentation actions should be initiated early in an emergency
adequate documentation:
Is essential to operational decision-making
May have future legal ramifications
May have implications for reimbursement eligibility
RECOVERY: Operational and business recovery; returning to normal operations

21. Pop quiz…

22. Match the cycle step with the correct action
Mitigation
Preparedness
Response
Recovery
Activate the EOP
Add wind retro-fits
Exercise with staff
Re-opening a wing of the hospital

23. Hospital Disaster Planning: Three Deadly Misconceptions
It will not happen here
It will not happen to me
Someone else will be there to take care of the problem
This is true for all planning…not just hospital planning…
Pass Christian, MS (Katrina)
Courtesy of Charles Reneau

24. Hospital Disaster Planning: Three Deadly Misconceptions
It will not happen here
It will not happen to me
Someone else will be there to take care of the problem
Be cautious of Optimism Bias
Pass Christian, MS (Katrina)
Courtesy of Charles Reneau

25. Hospital Disaster Planning: Why Plan?
The objectives of disaster planning are to improve the hospital’s current readiness capability and to ensure the handling of disasters with the least possible loss of life and property
These things are accomplished by:
Analyzing the current readiness level
Focusing on areas of vulnerability
Developing a plan based on realistic capabilities and resources
This is the first introduction to the processes of researching and writing a plan.
Disaster Planning
The objective of disaster planning is:
To prepare the healthcare facility to avoid a disaster by being pro-active to reduce possibility of a disaster & to reduce effects if a disaster happens
To expedite response and recovery efforts in an organized and systematic manner if there is a disaster by having contacts and information needed consolidated in a single place (THE PLAN), and by familiarizing staff with disaster response options and activities.

26. Why Else Should Hospitals Plan?
Because it’s required…

27. …by regulating bodies The Joint Commission DNV CMS
The JC sees an emergency as a natural, unintentional or intentional incident that significantly disrupts the environment of care
DNV
The hospital shall provide a comprehensive Emergency Management System to respond to emergencies in the hospital or within the community and region that may impact the hospital’s ability to provide services
CMS
Section 319 of the Public Health Service Act
Just make it a point to discuss that the words “disaster”, “emergency”, etc can all be used to connote a variety of specific events, but that the JC has taken to using the term emergency as a pretty much all encompassing one.

28. Emergency Management Requirements
Joint Commission Requirement EM
Hospital needs to have an emergency operations plan that comprehensively describes the response procedures to follow when emergencies occur
Plan must identify specific procedures that describe mitigation, preparedness, response, and recovery strategies
actions and responsibilities for each priority emergency must be included
This is a Joint Commission Requirement.
Part of the Joint Commission of Accreditation Hospital Organization (TJC)’s Environment of Care Standards.
These are emergency management standards…they are revised annually.
Among other things, they say that hospitals have to have EM plans with written EOPs that address many, many things…all of which will be discussed in this course.

29. TJC Emergency Management Standards Effective each January
Focus is on six areas:
Communication Strategies (EM )
Resources and Assets (EM )
Safety and Security (EM )
Staff Roles and Responsibilities (EM )
Utilities (EM )
Clinical and Support Activities (EM )
One way to look at this is to focus on these 6 areas.
These must be dealt with planning and within the plan.
The hospital specific things need to be handled:
Surge capacity
Planning and coordination
Training
Protecting the staff and patients
Limited resources

30. Changing Healthcare Roles During a Disaster
Institutional Threats must be considered and accounted for in planning:
Catastrophic event at hospital
Contamination of facility
Communications disruption
Capacity issues
Care-appropriate expertise
Challenge to continuation of the mission
Key components of a hospital disaster plan:
Command post activation
Command structure delineated
Department bed availability
Security
Contingencies for water, electricity, and transportation
Evacuation plans
Mutual Aid Agreements/Memorandum of Understanding
Patient management
Practice, practice, practice
Recall notification
Media

31. Hospital Disaster Planning: Issues with Impact on Hospitals and Healthcare Organizations
Surge capacity
Planning and coordination
Training
Protecting the staff and patients
Limited resources

32. Key Components of Hospital Disaster Planning
Command center activation
Command structure delineated
Department bed availability and immediate bed availablity
Security
To review…

33. Key Components of a Hospital Emergency Operations Plan
Contingencies for water, electricity, and transportation
Evacuation plans (vertical, horizontal, and complete)
Mutual Aid Agreements/Memorandum of Understanding
Patient management
Practice, practice, practice

34. Levels of Disaster Planning : Who/Where
Family Preparedness Planning
Departmental Level Planning
Organizational Planning (HEMC)
Local Community Planning (LEPC)
Regional Planning (Coalitions)
State and Federal Planning efforts
So who needs to plan…
Well, we all do…at many levels…
There will be built in redundancy, and that’s good.
Emphasize the importance of personal planning, because nobody will want to respond if they themselves (or their property) are threatened, or if they fear for loved ones’ safety and well-being. All planning starts at home…and, it then travels up and out.
Five Tiers of Disaster Planning:
Personal
Department
Organizational
Participate in regional planning
Participate in state and other organizations planning efforts

35. EM Overview: Who The Players Hospital Emergency Coordinator (HEC)
Hospital Emergency Management Committee (HEMC)
Key internal and external partners
Hospital staff and administrators
Use this slide to give the basic structure of all involved. Show the class how this has to be a team approach, and that everybody listed matters. If one group opts not to participate, success is unlikely. Point out how the HEC is listed first, and emphasize that he or she needs to be a leader as well as a team player.

36. Hospital Emergency Management Committee (HEMC)
Charting a course of action
Manage the Hospital Emergency
Management Program (HEMP)
Political competence
Staff experience
Ability to act
Define who’s on this and what their role is…
The committee is made up of the HEC and key internal and external leaders/partners/
Their job is to create the over-riding HEMP and write the EOP/COOP.
They must figure it all out and then share with the rest of the people involved.
They are the planners.
It is very important that the right people are on this committee.
Political Competence-is extraordinarily important, especially for senior level managers
Staff experience should include:
Administration activities
Physical building
Records, materials, patient tracking
Continuity of Operations experience
Medical services
Information technology services
Security

37. Hospital Disaster Planning: Internal & External Partners
Patients
Clinics
Mental Health
Nursing Homes
Schools
Public Health
Fire Service
EMS
Law Enforcement
Emergency Management
Volunteer Agencies
CISM Teams and Chaplains
The HEMC must consider everyone listed as either a group that they need to protect, or a group that they need to partner with in disaster planning and response.
Identify all those agencies that need to be considered as part of your disaster planning. This may include the following:
Your patients
Clinics
Mental Health
Nursing Homes
Schools
Public Health
Fire Service
EMS
Law Enforcement
Emergency Management
Volunteer Agencies
CISM Teams and Chaplains
Also consider faith-based organizations that may exist in your community and include them as another one of your support agencies in the disaster response plan.
Courtesy of Dr. Tim Boone, MC Strategies, USA Prepare

38. Hospital Disaster Planning: Big Wigs
Hospital CEO, CFO, Attorney, Chief of Staff, Chief of Security, etc
Their buy-in is essential, and thus, so is their integral involvement in the planning process

39. Where does planning start?
EM Overview: The HOW!
Where does planning start?
Take suggestions from the audience…and then move into the next slide…

40. Start at Home
If employees aren’t secure at home, they cannot be productive at work
If families are not accounted for, employees are likely not to show up to work

41. Family Preparedness Planning
Family Plan should include:
Home inventories
Escape routes/Evacuation
plans (maps)
Personal packs
Emergency car kit
Supplies for children & babies
Care for pets
Family communications
Special needs (e.g., Pharmacy info)
Again, planning starts at home. Once the HEC squares away him or herself and the people he or she loves, then that person can do the job of the HEC. Otherwise, either he’ll already have been a victim, or he’ll be too busy worrying about personal matters to come to work or stay at work.
Personal and Family Preparedness
Every employee needs to have a plan
Includes:
Home inventories
Evacuation routes
Personal packs with self sustaining supplies, important papers
Work Pack
Emergency Car Kit
Pet Plan
Photo © Microsoft Corporation

42. Departmental Planning
Call-down plans
Each department needs to understand its pre-assigned role
Plans should be discussed and made available to staff
Staff within each department should know where to go for information
Planning must be done from the lower denominator of the facility, and that’s usually by unit or department in a hospital.
Department Plans
Remember employees that live further away from work
Every department is essential
Each department needs to understand their preassigned role
Photo © Microsoft Corporation

43. Then Comes Organizational Planning
Plan details for how the hospital should respond as a system:
Hospital Command Center (HCC)
Incident Command Systems (ICS)
Policies, procedures, Emergency Operations Plan (EOP)
The hospital’s plan will dictate what goes on in departments, and it’s important that they learn the plan and their roles and take ownership of their own importance.
It’s the organization’s plan that this course focuses on…
Organization’s Plan
Details how the hospital responds as a system
Hospital Command Center
Hospital Incident Command System HICS
Policies, Procedures, Emergency Operations Plans
Photo © Microsoft Corporation

44. Community and Regional Planning
Local Emergency Planning Committees (LEPCs)
County Emergency Operations Center
Integrate hospitals into county Emergency Operations Plans
Regional Healthcare Coalitions /
Coordinating Hospitals (regional approach in many states)
Local Emergency Planning Committees address county-based emergency planning among community agencies, including fire, law enforcement, public health, hospitals, volunteer agencies, schools, and businesses. These committees are tasked with addressing county preparedness and response efforts, and sometimes sponsor training and exercises on a county-wide basis.
Some counties have a representative from the hospital present during county EOC activation, although this varies widely. In some cases, public health represents the Emergency Support Function #8 (health and medical) in the county EOC and communicates with hospitals as needed.
It is important that hospital emergency coordinator understand the hospital’s role in the County Emergency Operations Plan. Hospitals and other local emergency response agencies should have realistic expectations of what support and assistance each can provide in an emergency. In many counties, the hospital emergency operations plan is an annex to the county plan.

45. Statewide Planning
Understand state plans and know individuals in key agencies and organizations:
Public Health
Mutual Aid Tasks Force (MATF)
Office of Emergency Medical Services
Association for Primary Health Care
Association of Nursing Homes
Hospital Association
State EMA
Planning with the State and Organizations
Need to understand state plans and know individuals in key state and organizations agencies
Public Health (isolation and quarantine issues)
Office of Emergency Medical Services
Hospital Association
Law Enforcement
Emergency Management
Note:
No common boundaries

46. Federal Level Planning
Stafford Act
Department of Homeland Security
FEMA
Emergency Support Functions (ESFs)
National Response Framework
See pages in the NIMS for Physicians book published by the Medical Society of the State of NY—is a great resource for those who plan for hospitals to read to better understand the info published for providers within your facility.

47. Elements of Disaster Planning
Updating Internal Plans for Effectiveness R
Resources
Allocation of Sufficient Equipment and Facilities E
Evaluation
Testing of Contingencies for All Critical Systems
People
Ensuring Safety and Security for Staff and Patients A
Alliances
Establish and Maintain Relationships with Other Organizations
Readiness
Continuously train and evaluate performance
Experience
Incorporate Lessons Learned
This slide helps to remind one of the parts of the emergency planning cycle. This should be running through the HEC’s mind and the HEMC’s thoughts as they work on the HEMP and EOP/COOP.
Probably as healthcare people, the only thing we can have direct control of is our facility and its campus however, it may indeed be the last priority in the larger scheme of a disaster. It is important to understand these other parts and how they will effect the safety, recovery and restoration of services. Integration of need is crucial to an efficient and effective response operation.

48. Planning: A Cyclical Process
Orchestrated by the HEC
Plan is designed by the HEMC
Emergency Operations Plan (EOP) must be based upon a Hazard Vulnerability Analysis (HVA)

49. The Role of the Hospital Emergency Coordinator
Responsible for planning for all types of natural and manmade disasters
Must advise and help implement planning and coordination
Cannot act alone
Integrally involved in planning and response
Your job is to advise and help implement the planning and coordination of, mitigation of, preparedness for, response to, and recovery from all disasters.
You do not act alone in accomplishing emergency management in your facility. You are part of a partnership among your jurisdiction’s staff, the federal, state, and local governments, private business and industry, and the public. Your job includes building and maintaining a partnership that will help fulfill the integrated emergency management system.

50. HEMC Made up of key internal and external partners (can be ad hoc)
Works with the HEC in all phases of disaster planning and response
Must complete a Hazard Vulnerability Analysis on which to base the EOP
Must craft and continually update the EOP
Must ensure staff knowledge of plan through training and reassessment

51. Hospital Disaster Planning
For discussion
How might a HEMC:
Analyze current readiness level
Focus on areas of vulnerability
Develop a plan based on realistic capabilities and resources ?
This is an intro to the hazard vulnerability analysis…explain that there will be an entire unit on this later but that this is an intro. Pick one example for this, DO NOT attempt to teach HVA here or get ahead of the material.

52. When the worst happens: Disaster Follow-Up
All activities performed to mitigate another disaster, including:
Plan modification
Policy changes
Team revisions
Staff retraining
Facility modification
Risk assessment
Insurance issues
When you have to USE it!...and what you do afterwards…critical analysis helps you to improve for next time…

53. What Makes a Planner Successful?
Simplicity
Flexibility
Coordination
Leadership
Effective Communication
Use this slide to wrap up the overview, emphasizing the importance of the CHEC…
While previous slides represents what must e done to ensure quality planning, this slide discusses some of the personal characteristics of a quality planner…
Simplicity…make it easy for everyone to understand and do
Disaster routine
Minimize confusion
Personnel assignments
Flexibility
Facilitates adjustments
Decision framework
Coordination
Knowledge and understanding of different response roles
Advanced knowledge of capabilities and resources
Leadership
Personal and professional
Position authority
Communication
Internal and external
Redundancy
Effective Communication includes:
Chain of Command
Tested information flow process
Communicate accurate information
Photo © Microsoft Corporation

54. Certified Hospital Emergency Coordinator (CHEC) Training Program
Emergency Management
Overview
Questions?