Disaster Management within the Hospital

• After a major disaster, terrorism and weapons of mass destruction, a hospital must assess the damage, care for the injured, assess the ability of the hospital to function, and prepare for the potential influx of victims.
• Some hospitals have an organized system to determine their operational status. The following is an example of the system used for hospitals in Los Angeles County:
• “Green”: the hospital is able to carry out both emergency and inpatient services in a normal manner.
• “Amber”: some reduction in patient care services, but overall, the hospital is able to continue providing emergency and inpatient services.
• “Red”: significant reductions in patient care services. Only emergency services being provided.
• “Black”: hospital is severely impacted and unable to provide emergency or inpatient services.

Damage Assessment

• This is mandatory after any disaster that is capable of causing structural damage (e.g., earthquake). This can be done locally by various hospital employees or globally by the hospital’s safety or engineering departments. The following are types of damage that need to be assessed and reported:
• Structural: this includes structural supports (posts, pillars), beams, floors, roofs, slabs and decks, load-bearing walls, and foundations.
• Gas: if a gas leak is suspected, evacuations must occur and the fire department notified immediately. All fire and heat sources must be promptly discontinued.
• Water: insufficient water supply, loss of water pressure, contaminated water supply, or flooding will all impact hospital functions.
• Telephones: loss of phone lines will require a backup system. Options include walkie-talkies, HAM radios, or a “runner” messenger system.
• Power: hospitals have a backup generator system for critical areas. Those areas without backup power may require evacuation and relocation. Preparation includes having additional portable generators and lights as well as flashlights in all offices and patient care areas.

Patient Census

• There must be a system in place to account for all patients including those being relocated or transferred.
• An inventory of open beds within the hospital must be determined. This includes critical care beds and specialized beds (e.g., neonatal, burn, “step down” units, etc.).
• It is important to identify all patients who can be discharged early and patients that can be “downgraded” from a critical care bed to a ward bed.

Personnel Inventory

• There must be a way to rapidly identify all available personnel. This includes medical staff, nursing personnel, ancillary staff, clerical staff, and volunteers.
• Determine if additional personnel will be needed. If this is necessary, a predetermined callback system should be utilized.
• Volunteers from outside the hospital may arrive and ask to help. The hospital must be able to keep track of these additional “personnel”.
• Other staffing issues:
• What should be done if there is too much staff (“staff triage”)?
• How are overtime issues handled?
• How long can you keep staff on duty?
• If staff desires to leave after their assigned shift, can they?
• How will the increased staff be fed?
• Can on-site childcare be provided for staff who volunteers to work?
• If calling in staff from home, is there enough parking available? Can they get through police line on the way to work? Can they bring their children?

Command Post Organization

• Hospitals need to have an organized system so that those managing the incident know their roles and responsibilities and so that chain-of-command issues are addressed.
• One system is called the Incident Command System (ICS). The ICS has been in place for many years and is used by the military, police, fire personnel, and disaster managers. The ICS has been modified for hospital use in some areas and is referred to as the Hospital Emergency Incident Command System (see Fig. 21.2). This system allows everyone to communicate through a common language. It also allows for a more dependable chain-of-command and facilitates mutual aid with other hospitals and agencies.
• Positions
• Incident Commander
• Has overall responsibility for the event
• Sets objectives and priorities and determines strategy.
• This is usually a hospital administrator with disaster management experience
• Operations: the “hands on” people who carry out the objectives (caregivers, custodial staff, engineering, etc)
  

  

  
  Hospital Emergency Incident Command System.

• Planning
• The “brains of the operation”
• Develops specific plans of action
• Logistics
• Provides the resources to meet the needs of the incident
• Requests all personnel and equipment
• Supplies transportation, housing, and meals
• Finance: monitors all cost related to the incident (money spent, items loaned, overtime accrued, etc.)
• Information Officer
• Provides information to the public including how to access medical care, what
• precautions to take, etc
• Provides news media with appropriate information
• Safety Officer
• Makes sure the operation runs smoothly in relation to the safety and welfare of the workers, patients, and visitors
• Identifies potential or real hazards and takes steps to correct them
• Liaison
• Communicates with others outside the hospital including formal requests to or from outside agencies
• Coordinates interagency activities
• Emergency Operations Center (EOC)
• Houses the command staff (incident commander, operations chief, finance officer, logistics chief, planning chief, safety officer)
• Purpose: allows the command staff to monitor the situation/event and establish a clear chain-of-command
• Location
• Centrally located in an uncongested area
• Easily relocated if necessary
• Relatively safe from further damage
• Familiar to all personnel/easy to find
• Communications capability
• Large enough to accommodate the command functions

Three Ingredients for a Successful Emergency Operation

• Management: leadership and organization
• Resources: personnel and supplies/equipment
• Communication: radios, telephones, and person-to-person