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Emergency privileges do not equal disaster privileges

Medical Staff Leader Connection, June 9, 2011

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About two years ago, I wrote a column about the confusion that existed between disaster privileges and emergency privileges. I find that many medical staffs still confuse the two. I thought it best to revisit this issue in light of the recent natural disasters.

The difference between emergency and disaster privileges is simple: Emergency privileges are granted to existing practitioners on the medical staff; disaster privileges are granted to practitioners outside the medical staff so that they can work in the institution on multiple patients when the disaster plan has been invoked.
When you draft bylaws language pertaining to privileges, remember that medical staffs grant emergency privileges to existing practitioners on staff to allow them to perform a task that is outside of the scope of the privileges they already have in order to save a patient’s life, limb, or organ. Then, as soon as a practitioner with appropriate privileges can assume care, the practitioner with emergency privileges relinquishes those privileges. Emergency privileges legitimize the actions of practitioners when patients are in extremis.
Use disaster privileges only when practitioners outside the medical staff require privileges to treat patients in your institution due to a disaster in the community. The Joint Commission has expanded and clarified the qualifications these practitioners need to have to obtain disaster privileges and detailed how the institution must monitor their performance. These guidelines are found under the Emergency Management section of the Comprehensive Accreditation Manual for Hospitals (EM.02.02.13).

Only implement disaster privileges when the hospital’s Emergency Operations Plan has been activated. The plan allows rapid credentialing of certain practitioners based on proper identification and their membership on one of several disaster management teams. Outside practitioners can also receive disaster privileges if existing medical staff members know them. Although these practitioners are identified as a member of a disaster management team or by personal reference, the medical staff services department must still try to primary source verify each physician’s licensure (within 72 hours, if possible). The medical staff then needs to determine how it will oversee their performance. Within 72 hours, the medical staff needs to determine, based on a practitioner’s performance, whether his or her disaster privileges should be continued. Note that disaster privileges automatically expire when the disaster is over.

The take-away message is that you should review your bylaws regarding emergency privileges and disaster privileges to ensure that they distinguish between the two. Please refer to standard EM.02.02.13 for all the nuances of disaster privileges and make sure that your bylaws are compliant.

Mary Hoppa, MD, MBA, CMSL, is a senior consultant with The Greeley Company, a division of HCPro, Inc. in Danvers, MA.
 

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