Biomedical Engineering Reference
In-Depth Information
against being the “Scene” itself. Hospital planners
consider the “All Hazards” philosophy and theorize
that the potential exists that the hospital itself can
be the target of a terrorist attack. The hospital can
also be “Location 0” for a Pandemic crisis as well
as the receiving facility for a patient contaminated
with a toxic material at work.
Coming full circle, the hospital emergency
planning community considers many different
scenarios based upon the results of its HVAs
including the man-made and natural disasters in
the Nation, terrorist activity and dissemination
methods as well as the existence of airborne and
blood borne vectors that can cause a pandemic
crisis. The identification of the vulnerabilities
drives the development of the EMPs. The results
of the HVA also prioritize the vulnerabilities from
most likely to least likely. The development of a
hospital drill considers all of these factors and the
hospital emergency planners determine the need
to exercise and evaluate a response to a specific
vulnerability, the mitigation of this vulnerability
and the recovery from the incident. The hospital
emergency planner then develops an evaluation
tool around each evolution of response and collects
the tools when the exercise is over. The evalua-
tion scores and comments are queried and a list
of goals and objectives is developed. This list can
be measurable (with a numerical value added to
each objective) or not. The primary goal of this
list of “Lessons Learned” is to continually improve
the process of the hospital. Evaluation and process
improvement with regard to drills and exercises
will be an integral part of the accreditation stan-
dards moving forward (Figure 22.3).
Hospitals are now required to think like they
are the “First Responders” and that the incident
site can very reasonably be within the hospital
facility. The business of incident command, decon-
tamination, surge capacity, lock down, and trans-
portation is now a part of the hospital emer-
gency management planning meeting agenda.
The EMPs are identifying how the hospital
will deal with “All Hazards” incidents and
they detail its response, mitigation, and recovery
as well as its ability to maintain an incident
1. The hospital tests the response phase of its emer-
gency management plan twice per year, whether
in response to an actual emergency or in planned
drills.
2. Drills are conducted at least four months apart
and no more than eight months apart.
3. Hospitals that offer emergency services or are
community designated disaster-receiving stations
must conduct at least one drill a year that includes
an influx of volunteers or simulated patients.
4. The hospital participates in at least one
community-wide practice drill a year (where appli-
cable) relevant to the priority emergencies iden-
tified in its hazard vulnerability analysis. The drill
assesses the communication, coordination, and
effectiveness of the hospitals and community's
command structures.
5. All drills are critiqued to identify deficiencies and
opportunities for improvement.
Figure 22.2
JCAHO Criteria (JCAHO Standard EC 4.20).
The assistance of the federal government through
the Department of Health and Human Services
(HHS): Health Resources and Services Adminis-
tration (HRSA), the Centers for Disease Control
and Prevention (CDC) and other federal and state
funded programs have introduced incentives and
reimbursement to hospitals for time spent planning
and exercising. The increased attention coupled
with the financial incentives backed by federal and
state agencies, as well as enhanced scrutiny by
regulatory and accrediting bodies makes drill plan-
ning and exercise development more of a priority
for hospitals.
In the past, hospitals were reliant upon the
first response services to respond to and miti-
gate large-scale disasters. Historically, the local
Fire Department is responsible for the on-scene
management including decontamination, extrica-
tion and fire suppression as the Police Department
is responsible for scene protection and evidence
collection. The EMS Agent is responsible for the
on-scene triage, treatment, and transportation of a
victim and is responsible to follow local guidelines
to appropriately choose the receiving facility. All
of this continues to be true, however, the hospital
is beginning to realize that it is not immunized
