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Book Excerpt: Hot Topics in Emergency Management

Emergency Management Alert, August 28, 2007

These days, the world of emergency management is awash with new information-creating a new risk that information of true importance can disappear. Here to help safety officers home in on the main issues of concern for emergency managers is Steven MacArthur, a safety consultant for The Greeley Company, a division of HCPro. In the Hospital Safety Director's Handbook, appearing this month, MacArthur covers today's hot topics for those who manage risk in the healthcare environment. This first of two excerpts covers weather, pandemics, and terrorist acts.

Experience has shown that hospitals frequently cannot be equally prepared for every potential emergency. This is where your hazard vulnerability analysis, as a function of a structured PI process, helps you prioritize your efforts. That said, there are some hot topics receiving a great deal of attention from both the media and regulatory authorities. I recommend that you include the following in any discussion of your organization's vulnerabilities and response planning activities:

Natural disasters: Weather
Traditionally, hospitals generally have a pretty good handle on the likelihood of the various weather conditions with which they might be faced. Those residents of the Northeast are generally well prepared for snow conditions, and those in the Deep South are somewhat less so. But as long as your preparation and planning priorities address those events that you are most likely to experience, or at least those you should be well prepared for, then you should be adequately ready to respond to most such events, or on your way to being so.

What we have seen over recent years is an upswing in events that move through the severity continuum, from merely disastrous to the truly catastrophic. Again, one of the key elements of your response plan is a process for identifying the point at which your organization can no longer safely provide care, treatment, and services. Recognizing that this is somewhat anathema to the planning process, this is the most important aspect of your preparation activities.

Natural disasters: Pandemics
The onset of avian influenza throughout the world has clearly captured the attention of emergency planners, public health officials, governmental agencies, the media-the list goes on and on. Hospitals have been engaging in a great deal of planning and preparation work to anticipate the effects of a genuine pandemic event. History can only hint at the magnitude of such an event, and as this book went to press there were far more questions than answers. Will the virus mutate? If it does, when? Where will the mutation show up first? How long will we have before it reaches us? Is all this planning going to work or is this just another example of overpreparing for an event that will never occur (think Y2K)?

The fact of the matter is there is no way to determine when we will be able to answer any of these questions, and if avian flu turns out to be a variation on Y2K, these questions may never be answered. However, hospitals do have an obligation to the community they serve, and sometimes those obligations result in less useful activities than one might want. In a perfect world, we would be able to make planning and response decisions based on real threats and vulnerabilities, as opposed to threats and vulnerabilities that may or may not happen. To some extent we can make those determinations based on the data we have at our disposal (just check the list of suggested emergencies in Figure 8.1-you can probably remove at least a few items from it). For better or ill, the planning process has to serve sometimes disparate ends.

Terrorist Acts
Although the immediacy of terrorist attacks in this country has somewhat faded over time, one could make a case that it is a more immediate threat than a pandemic. However, if we look at a terrorist event as a function of the agent of terror as opposed to specifically representative of an act of terror, you will find that you are probably dealing with parallel response plans.

The predominant terror agents for which healthcare organizations would prepare can be loosely categorized as chemical, biological, radiological, or explosive. I submit to you that your organization could face any of the identified categories without ever facing a terrorist. The reality of the situation is that your organization needs to be prepared to one extent or another to deal with patients suffering from exposure to any of these causes, and these patients could arrive at any time of day or night. The guiding principle of incident command and emergency response is that your plan can be implemented effectively regardless of the occurrence.

While I would certainly not advocate ignoring the threat of a terrorist act (especially if your facility is in a higher-risk location) for planning purposes you might find it more useful for your organization to focus first on accidental releases of chemical agents, biological agents, radiological agents, and explosives. From there, create a level of response to reflect a purposeful release of those materials.

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