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Hospital Safety Insider, April 7, 2016

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They say you can't construct a strong building without a solid foundation, and to do that, you need to know what you're building on. It won't do you much good to build on ground you didn't know was shaky.

The same can be said for your facility's emergency plan. You can do all the planning, drilling, and data collection you want, but it won't do you any good if you don't first do a proper assessment and know what you're up against. Why prepare, for instance, for a response to a hurricane if you live in Kansas where you'll never see one? On the other hand, there are a lot of freight railroad lines that run through rural Kansas; chances are more likely that you'll see a major train derailment and chemical spills there than, say, coastal Miami.

The Hazard Vulnerability Analysis (HVA) is known in emergency management circles as the base document that hospitals should develop to help guide their emergency response plans. It's a document that is required by The Joint Commission as part of the Emergency Management standards (EM.01.01.01, EP 2), and CMS requires it as part of their increasingly stringent survey standards requiring an "all hazards" approach to emergency planning.

By design, the HVA is a flexible document, should be reviewed annually and revised as needed, used as a planning document for your drills, and improved as you discover weaknesses (or strengths) in your facility's response plans.

Historically, what is likely to occur in your area?
This is a great starting point, because it helps you prepare for the things that are most likely to happen to your area and require the most resources. It stands to reason: if it's happened before, it will probably happen again. Therefore, if you're located in Miami, you'll probably want to plan for that response to a major hurricane. Hospitals in Minneapolis will have well-tested plans to hunker down during a blizzard. And in San Francisco, the prepared hospital safety officer knows to have those earthquake plans within an arm's reach.

What events occurred in the last year?
This is where you find the wild cards, the things that aren't likely to occur, but do sometimes, and they change the game for you. Review the events that occurred in your region once a year to figure these out, says Ward. Did anything increase in frequency or probability? Did you experience more than your normal number of severe weather events (such as Boston, which had perhaps its worst snow record ever in winter of 2015, or areas of the South that experienced more tornadoes than usual). Did you experience an increase in earthquakes in an area that's not usually prone to seismic activity?

Is there anything new going on? We've got one word for you: Ebola. It's something most hospitals never thought they'd have to think about in their emergency plans until that changed in 2014. All it took was one case to show up at Texas Health Presbyterian Hospital in Dallas, a couple of nurses coming down with the disease from patient contact, and the revelation that staff were not trained or equipped to deal with a disease of that magnitude for the Centers for Disease Control and Prevention (CDC) to step in and help hospitals reassess their emergency readiness and rewrite the plans. In some cases, the best-prepared hospitals were designated Ebola treatment centers by the CDC and trained some of their staff to be part of Ebola "SWAT" teams in the event of another outbreak. Your constant attention to changing needs around you, and updating plans accordingly, could be the single best thing you can do to help manage risk to your facility and be ready for the next tragedy.

Has anything in your facility changed? Did you acquire new equipment or personnel? Any changes in your facility are going to affect your ability to respond to emergencies quickly and efficiently, and so these changes should always be taken into account when updating your facility's HVA. Perhaps you've opened a brand new Level I trauma wing, with an increased number of trauma bays; that's going to update your ability to take in more patients. That plan changes in the other direction if your ED is under construction. Also take into consideration your staff, and the ability to handle a particular number of patients at any one time. You may have added trauma bays, but have you added nurses and physicians on staff who will be manning those bays? Use your HVA to reevaluate your staffing needs.

What happened during your last drill?
Perhaps the one main reason you do exercises in the first place is not so much to identify the strengths (though that's good, too), but the weaknesses in your hospital's response to emergencies. Much like a teacher assesses students and makes changes to lesson plans based on test results, you should be making changes to your facility response plans based on the outcome of your drills. In fact, your HVA will be the document that helps you plan what the next drill will be.

What are you NOT capable of? If your facility is small or has limited personnel or resources, it may be that in the event of a major catastrophe your hospital won't be able to help. It's a good idea to know this limitation and prepare for it now, rather than in the middle of a crisis when severely injured patients start arriving at your ambulance bays and flooding your waiting rooms. It's revelations like this that should drive your plan for improvement (maybe you build a new emergency wing or add personnel), or help you come up with a contingency plan (personnel can plan to be transferred from other hospitals in your area to help out, or ambulances can divert to other facilities after a predetermined number of patients arrive at yours).

This is an excerpt from the monthly healthcare safety resource Briefings on Hospital Safety. Subscribers can read the rest of the article here. Non-subscribers can find out more about the journal, its benefits, and how to subscribe by clicking here.

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