BY ROBIN DAVIS, MPA, CEM, System Emergency Manager, Memorial Hermann Health System
The call comes. There’s been an explosion at a chemical plant in Pasadena with mass casualties. You do not know how many; you do not know how badly they are injured; all you know is they are on the way to the hospital. Or, a man walks into the ER suffering with a severe headache, muscle aches, fatigue, and diarrhea. And, oh, by the way, he also reveals that he’s just returned from West Africa. Ebola, you think. What to do?
As an emergency manager at a Houston hospital the aforementioned scenarios are not only entirely possible, they are quantifiably probable. For a frontline hospital worker initially confronted with a mass casualty or Ebola scenario, it is natural for fear, nerves, and panic to manifest. What you do not want is inertia. Now is the time for action, not indecisiveness and inaction. The clock is ticking. You have a plan. Execute it. Lives are at stake.
The Joint Commission’s Emergency Management Standards requires that all hospitals, no matter how large or small, have an Emergency Operations Plan (EOP) that describes how it will respond to and recover from all hazards – including an expected explosion at a chemical plant or a suspected Ebola case walking through the door.
Those plans should include six critical elements:
• Resources and assets
• Safety and security
• Staff responsibilities
• Utilities and clinical
• Support activities
The reasoning behind the “all hazards” approach is it allows hospitals the ability to tailor Emergency Management Plans (EMP) and respond to a range of emergencies varying in scale, duration, and cause. A well thought out EOP provides the structure and processes that an organization utilizes to respond to and initially recover from an event and addresses key elements as:
• Response procedures
• Capabilities and procedures when the hospital cannot be supported by the community
• Recovery strategies
• Initiating and terminating response and recovery phases
• Activating authority
• Identifying alternate sites for care, treatment and services
A successful and comprehensive EOP should instill not only preparedness, but confidence that the hospital and staff will be ready to execute the plan. Disaster exercises offer an opportunity to bring leadership, staff, and physicians together to work as a team in addressing all aspects of the emergency and the appropriate response.
Founder of the Boy Scouts, Robert Baden- Powell once said:
“Be Prepared... the meaning of the motto is that a scout must prepare himself by previous thinking out and practicing how to act on any accident or emergency so that he is never taken by surprise.”
In other words, practice builds preparedness and confidence. That is why it is important that hospitals conduct exercises of their EOP with the goal of evaluating processes and to identify opportunities to improve and educate. Exercises – practice – must be taken seriously, and if possible, conducted like the hospital staff is dealing with the real thing. Not taking the emergency planning exercises seriously only breeds fear, panic, and inertia in a real event.
Exercises should be built on the crawl-walk-run mentality, meaning start small, engage multiple teams and build and improve the process based upon lessons learned. Fullscale exercises should stress the players. Give the staff an opportunity to think critically and build confidence with the process and procedures.
All too often, when a new threat such Ebola emerges, hospitals will try to reinvent the wheel instead of applying an all-hazards approach to planning and training. You have a plan already in place. Execute it, do not reinvent.
When Ebola dominated the news cycles in the United States last year, Memorial Hermann recognized that although this was a new threat, many of the current safety, infection control and emergency preparedness plans were already in place, but procedures would need to be tailored to the specifics of the infection.
We coordinated with local, state and federal agencies like the U.S. Centers for Disease Control and Prevention (CDC) and utilized a multi-disciplinary process to addressing the situation. Along with subject matter experts from our Infection Prevention, and Employee Safety, staff were identified and trained on updated personal protective equipment (PPE).
Incident Management Teams reviewed and rehearsed algorithms for identifying and isolating suspected “highly-infectious patients” and external partners – local, state and federal – were brought into the exercise process. The emergency room staff at each hospital also would set-up the isolation area and practice putting on the appropriate and tested personal protective equipment to ensure it was being donned properly.
This building block approach culminated in Operation Clean Room, a series of full-scale exercises that evaluated each Memorial Hermann hospital’s ability to successfully activate the infectious disease response plan while minimizing risk and providing safe patient care.
Just remember, the ultimate goal of every plan, training and exercise is to create a safe environment and provide the best care for our patients. While practice does make for a better and more confident execution of your Emergency Operations Plan, it also will save lives.