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Crisis management starts at home but doesn’t end there

The Joint Commission’s surveyors may be tough, but they’re nothing compared with a natural disaster.

So learned Ochsner Medical Center in New Orleans. When Joint Commission surveyors reviewed Ochsner’s emergency plan in July 2005, they found it lacking and gave the facility a requirement for improvement (RFI). One month later, in August 2005, Hurricane Katrina hit, and that same plan was tested.

Ochsner managed to remain open during one of the nation’s worst disasters when other facilities in the area were forced to shut their doors. The lessons the staff members learned can be a valuable resource for your own institution’s emergency preparedness.

Despite the RFI issued by The Joint Commission (formerly JCAHO), “our experience proves that we were prepared,” says Deoine Reed, PhD, epidemiologist and IC manager at Ochsner.

Reed says that to have a successful emergency plan, the planning should extend beyond meetings and documentation. It needs to be flexible and take into account easily overlooked factors.

The standard

Standard EC.4.12 is currently found in the “Management of the Environment of Care [EC]” chapter of the Comprehensive Accreditation Manual for Hospitals (CAMH). (The Joint Commission will establish a separate emergency management chapter in the CAMH in 2009, and the standard will be renumbered to EM.01.01.01.)

EC.4.12 requires hospitals to develop and maintain an emergency operation plan to help guide the hospital in its emergency response and recovery efforts.

Although this is an EC standard, ICPs play a critical role in a hospital’s plans to respond to disasters. Emergency planning is a challenge for most ICPs, and standard IC.6.10 requires hospitals to be prepared to respond to an influx of infectious patients as part of its emergency management activities.

Developing your plan

The first step in developing your emergency plan is performing a risk assessment to find out where your vulnerabilities lie. Determine what types of disasters are likely to affect your area, says Peggy Luebbert, MS, MT (ASCP), CIC, CHSP, an independent consultant and owner of Healthcare Interventions, Inc., in Omaha, NE.

For example, whereas the assessment at Ochsner identified a hurricane as one of the potential disasters in its area, Luebbert’s region would focus on tornadoes.

Look at potential disaster scenarios for your hospital, identify the associated IC risks, and develop your response plan accordingly, Luebbert says.

“The hardest part in developing your plan is getting people past the enormity of the event that you’re potentially talking about. People often become so overwhelmed that they shut down,” she says.

To avoid this problem, break your emergency response plan into small chunks, Luebbert says, and work on one section at a time. This helps staff members focus on important details, without overwhelming them with the big picture.

Planning starts at home

Personal planning is an often overlooked component of any emergency plan. Most hospitals have taken steps to ensure that their facility will be prepared in the event of an emergency, but not enough of them encourage employees to be prepared in their own homes. “Nobody thinks it will happen to them,” Luebbert says. “But in order for you to be an effective citizen of your community, you need to be able to show up for work and be an effective employee. You can’t do that if you’re not ready at home, if you don’t have the proper supplies, if you don’t have plans for your children, your pet, or your parents or grandparents.”

Encourage staff members to stock up on supplies and form disaster plans. Tell them to develop not only a Plan A, but also a backup plan in the event that the initial plan falls through, Luebbert says.

In the wake of Hurricane Katrina, staff members at Ochsner were asked to sign contracts guaranteeing that they show up in the event of disaster. These contracts list the benefits, including financial ones, for working during such an event, as well as the penalties for failing to do so, Reed says.

A considerable number of staff members reported to work during Katrina because they were dedicated and wanted to help, Reed says.

But potential barriers may prevent even dedicated employees from showing up, including the inability to find dependent care or pet care, problems with transportation, or lack of supplies.

The employee contract at Ochsner asks staff members to list their dependents and where they will stay during an emergency. People need to have a personal plan that includes where family members will stay while the employee is at work.

And it’s important that the employee is comfortable with the emergency plan. “Someone may come to work, but they are so distracted [by thoughts of their family] and not engaged in work-related activities,” Reed says. However, if staff members know that their family members are safe 100 miles north, their minds will be free to focus on the tasks at hand.

In some cases, staff members may be permitted to bring a family member with them to the facility. Prior to Hurricane Katrina, the policy at Ochsner was that staff members could bring an unlimited number of family members to the facility. However, in the wake of the disaster, it now limits each employee to one dependent to better manage similar situations.

“The hospital fed and provided services for everyone who came to the facility. Their needs were met, but it was a challenge,” Reed says.

Don’t forget about pets

Making provisions for pets is also critical in an emergency. People are reluctant to leave their pet behind, as was evident during Katrina when several New Orleans residents stayed in their homes to care for their pets instead of retreating to safety. Some of those people died as a result, says Reed.

Consequently, Ochsner permits employees to bring pets to work in an emergency, Reed says, provided they agree to take responsibility for the care of the animal. During Katrina, kennels were placed in the garage at the facility. Owners that didn’t have kennels were given baby cribs that they could turn upside down.

The animals brought some cheer into the facility during the disaster, Reed says.

Ensure adequate supplies

In addition to dependent and pet care, it’s also important to make sure that your workers have enough supplies to get them through a disaster. “We give our employees a checklist of items that we think are important,” Reed says. “All employees are requested to check in daily, or as often as possible, via e-mail or by calling the disaster hotline.”

When they come to work, employees are asked to bring several items with them, such as food, changes of clothing, batteries, radios, portable television sets, and even games and puzzles to take their minds off the event. Sleeping supplies, such as pillows and blankets, are also encouraged. Employees should also bring any necessary medications. However, the hospital should make plans to stock basic medications, such as insulin, drugs for hypertension, and, perhaps most importantly, coping drugs, Reed says.

To ensure that staff members are properly prepared for an emergency, it’s important to check for compliance, Luebbert says.

When you perform emergency drills, one critical component is checking to make sure the telephone numbers for staff members are correct. When you call staff members to verify those numbers, use the opportunity to survey them on their personal emergency plans, Luebbert says.

Ask them questions such as:

  • Do you have a four-wheel-drive vehicle?
  • How many people are you responsible for?
  • Do you have pets?
  • Do you have someone to take care of your pets during an emergency?
  • Do you have emergency provisions on hand?

Staff members need to know that this type of planning is a priority at your facility, Luebbert says.

“This needs to become part of the hospital culture to be prepared. It’s not something that should just be brought up at IC or safety meetings. The leadership needs to buy into it and promote it,” she says.

Additional strategies

Helping staff members prepare at home isn’t the only factor you should consider when developing your emergency plan. Consider implementing the following additional strategies:

Regularly reinforce good habits so they’ll carry through in a disaster. For example, by making sure staff members have good hygiene habits before a disaster, they will likely follow those same protocols during a crisis, Reed says.

Keep adequate supplies. Employees won’t be able to practice good hand hygiene if supplies are lacking. It’s important to not only ensure that these supplies are available, but also that someone is designated to stock them.

Prepare to maintain standard and isolation precautions during an emergency. Ensure that generators will keep negative pressure rooms operational during a crisis. And make sure isolation supplies are available so that you have the tools you need.

Educate staff members on your emergency plan. Ochsner put its plan on a Web site that staff members could easily access.

Focus on security. One of the key reasons Ochsner stayed open when other facilities were forced to close is because it was able to maintain adequate security during the crisis, Reed says. Ochsner had its own security staff in addition to enlisting the help of local parish officers and armed forces.

Develop partnerships with other departments, such as facilities, environmental services, and the nursing and medical staff. All of these departments play a role during crises, and it’s important to let staff members know that they are critical to the process.

Make environmental services’ job easier by setting up systems to identify dirty, clean, and sterile items. Make sure that environmental services workers have access to cleaning and disinfection items, rags, cloths, mops, and other related supplies. Take steps to ensure that your laundry service will be able to function during a crisis, particularly if it’s an off-site or contract service.

It’s also important to work out details such as how to respond if there is an ongoing construction project at the time of the crisis. Contract workers need to know what to do, says Reed, who recommends the following actions:

Remove any equipment, including any items on the roof that could be dislodged during a storm.

Set up barriers or temporary walls to ensure that people don’t go into unsafe areas during the crisis.

If you use contract services, establish agreements for the continued provision of services. “We have laundry, medical waste management, and food services on-site. However, we have a contract for disposal of sharps that was added after Hurricane Katrina,” Reed says. If you have similar contract services, write a guarantee that you will continue to have services provided during a disaster and get it signed. Have a backup in the event the first company can’t deliver. “You need to be able to maintain your operations on your own. You can’t rely on outside resources that may or may not come,” Reed says.

Train nursing and medical staff members to involve themselves in IC and EC rounds. They need to know what is expected and be trained to spot and correct potential problems, Reed says.

Partner with food services. Designate someone to test the water periodically to make sure it’s not contaminated and that proper refrigeration and other food safety measures are maintained.

Partner with local agencies, government, parishes, and county officials. Work out arrangements with local grocery stores and gas stations to provide supplies and fuel.

Often, stores will be stocked with food but shut their doors during emergencies, leaving the food to waste. Work out a contract with stores ahead of time. Have a store give you its keys and arrange to take needed items during a crisis, settling payment later. Doing so can help you ride out a disaster.

Develop covert ways to bring supplies into the facility. During Katrina, governmental agencies commandeered critical supplies, such as fuel. One organization used a milk truck to disguise fuel shipments. Having these plans can help prevent looting as well.

Create contingency plans to get supplies in if streets are blocked by obstructions or government officials enforcing road closures. Ochsner gave special ID cards to critical personnel to present to officials so they would be allowed into restricted areas.

The cards were approved by the Federal Emergency Management Agency ahead of time so that personnel wouldn’t be barred from getting to where they needed to be, Reed says.

Plan for potential airspace restrictions. Your facility will likely need to airlift patients, so make sure you have transportation agreements in place and sufficient space for landings.

Anticipate the unexpected. In the end, no matter how much time they spent studying their emergency plan, Ochsner staff members could not have anticipated the situation they encountered during Katrina. This is why it’s critical for your own plan to continuously evolve as the situation unfolds.

“Plans are static. Planning is important and does not stop; it continues even while the disaster is taking place. Throughout the circumstance, be flexible and adjust accordingly,” Reed says.