Biomedical Engineering Reference
In-Depth Information
government regulations (a recent example is
the Health Insurance Portability and Account-
ability Act [6]—HIPAA) and are strongly
affected by changes in Medicare reimburse-
ment patterns, but accredited hospitals also deal
with the non-governmental Joint Commission for
the Accreditation of Healthcare Organizations
(JCAHO). To achieve and maintain accreditation,
hospitals must adhere to JCAHO's consensus stan-
dards as demonstrated during periodic onsite and
remote surveys. Standards are diverse in scope
and generally derived from clinical, ethical, tech-
nological, environmental, or occupational indica-
tions. Like many government regulations, they tend
to add expense and are not accompanied by new
revenue streams.
Hospitals rely on public trust as much as on
reimbursement revenue. More than most corpora-
tions or government agencies, a healthcare facility
that suffers a crisis of public confidence stands to
lose both funding and patients along with its repu-
tation. Public expectations, commonly in the form
of blind assumptions, are that hospitals should be
able to handle whatever they receive—and do it
right the first time. With respect to disasters, this
includes:
or involve the hospital (for example, a flood or
hurricane), a prepared facility and staff may be the
difference between minimal loss of life and a true
catastrophe.
1.3 Hospital Requirements
Hospitals have been required to have and exercise
emergency preparedness plans (formerly known as
“disaster plans”) for many years. As of January
2001, hospitals wishing to achieve or retain
JCAHO accreditation had to have a comprehensive
plan in place, covering the four traditional phases
of emergency management (mitigation, prepared-
ness, response, and recovery) [7]. A hazard vulner-
ability analysis, part of the new standards, not
only determines both the most likely and the most
catastrophic incidents, but also identifies the range
of hazards for a given hospital. This all-hazard
approach, like municipal emergency operations
plans, allows preparedness and a measured, flex-
ible response to a variety of potential incidents.
Plans may contain annexes for specific hazards, but
an all-hazard plan should obviate a separate plan
for each hazard (an “earthquake plan,” a “terrorism
plan,” etc.). Plans are supposed to be tested and
updated by at least one tabletop or similar exercise
and one full-scale exercise or actual activation
per year. The standards also establish require-
ments for staff training and familiarization with the
plan.
The wave of training and other preparedness
programs, accompanied by requirements and
expectations regarding preparedness for acts of
terrorism, has not ignored hospitals. The Defense
Department's Domestic Preparedness Program
(continued by the Justice Department) in the late
1990s provided basic training on medical manage-
ment of casualties affected by chemical, biological,
and radiological warfare agents. Curriculum and
training were limited by design: it was largely
military in origin, focused on the response phase,
and did not contain much depth in hospital
preparedness. The Metropolitan Medical Response
System (MMRS) [8], initially overseen by the
Department of Health and Human Services and
now part of the Department of Homeland Security,
Managing medical assessment, treatment, and
continuing care for acute incidents involving
large numbers of patients
•
•
Effectively managing contaminated patients
•
Recognizing, identifying, and managing conse-
quences of bioterrorism
•
Protecting employees, patients and their fami-
lies, and anyone else within the facility
•
Dealing with all of these while continuing to
provide everyday emergency care
Public agencies responsible for preparedness and
response have little direct control over public
hospitals and none over private facilities (which
are not accountable to public officials). There is
no suitable alternative to engaged hospitals when
trying to plan for or manage a mass-casualty inci-
dent or other type of large-scale disaster affecting a
community. Should the incident be at the hospital
itself (such as a fire or hazardous material release)
