Emergency planning: Preparing for an earthquake

Hospital Safety Insider, June 30, 2016

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As your hospital's emergency planner and safety professional, there's a lot on your plate these days, especially when it comes to keeping the facility operational and ready for the next emergency.

Most of your preparations no doubt center around possible events that could strike your hospital any day such as power outages, winter storms, flooding, infectious disease outbreaks, and traumatic events such as accidents and shootings that can overwhelm your ER are real threats that you need to make sure your facility and staff can handle.

But what about an event that might throw all of that at you at once, and that might, at best, hit once every 10 years? You don't know when exactly it will happen, and you don't know how bad it will be, but when it does it will test your hospital in a way you've never seen.

The fact is, in many parts of the country, a major earthquake is a statistical certainty. Sure, in places like California, it's a given that earthquakes (albeit mostly minor ones) strike on an almost daily basis. Make no mistake, however: Those hospitals are training regularly for "the big one," a tremor up to 9.0 on the Richter scale that could take out much of the infrastructure on the west coast. Hospitals are spending millions to fortify their facilities and train their staff, all to stay open and operating when that big quake hits.

But what if you're located in the Midwest, the South, or the Northeast, where earthquakes are less frequent? Chances are that earthquakes are the last thing on your mind, but emergency planners say that's a mistake. So does the U.S. government: In 2015, the Federal Emergency Management Agency (FEMA) released a warning estimating that 50% of U.S. hospitals lie in an "area of potential shaking" and could suffer at least moderate damage during a quake.

Those hospitals aren't ready-many urban hospitals were built well before there were seismic standards, and if there isn't much chance of a quake striking soon, convincing the CEO of the case for retrofitting, or for building a new hospital, is similarly unlikely. But "not much chance" doesn't mean "no chance," and as a safety professional invested in the job, there are things you can do to prepare. Our experts helped us compile a list of things you should be thinking about.

Start with an assessment. You've heard this before, and we're going to say it again: If you don't know the things that are likely to occur in your area, you won't know how to respond. Earthquakes may be rare in places like the Midwest, but they do occur. If your hospital is in Missouri and you've never heard of New Madrid, perhaps you should do some reading up. In 1811 and 1812, a major fault there caused the worst series of earthquakes in American history, and experts say it will happen again someday. There are faults running through many parts of the country, and many are still undiscovered. Smart emergency planners know what the risk is in their area, and coordinate their planning based on that assessment.

What is most crucial? At the end of the day, the core of your plan should be how to keep your facility running, no matter what crisis hits it. So what are the most important things to think about? The lights will need to stay on, patients (and staff and vendors) will need to be able to get to you, supplies will be need to be stockpiled, and patient care will need to continue. That's where your focus needs to be.

If the power goes out, do you have generators? Are they located in places that can withstand shaking? Do you have proper fuel supplies? Some facilities have begun installing important HVAC systems and backup generators in upper floors to avoid flooding, but is that the proper place? A large quake could send that generator flying out of the window. Some hospitals in quake-prone areas have installed generators on low-cost "sleds" designed to move with tremors.

Start making friends. Relying on neighboring facilities has been a common denominator in most disasters that hospitals have survived. When an EF-5 tornado hit St. John's Hospital in Joplin, Missouri, head-on in 2011, patients were taken to hospitals up to 30 miles away to keep services going. Other facilities sent nurses to help out, and supplies were restocked from the storehouses of other hospitals. These pre-coordinated relationships are what will keep you moving during a disaster. In the event of a major earthquake, however, where multiple facilities are taken out at once, you may not be able to rely on those friends. Have a contingency plan in place in the event you are operating alone. Something as simple as having an emergency trailer stocked with extra fuel, PPE, and other supplies may keep you going until help can get to you.

Secure and tie down everything. An earthquake doesn't have to be major to cause damage-in fact, experts say non-structural damage represents about 80% of the losses incurred during a small or moderate quake. Think of your hospital as a container with a bunch of bolts inside. During a quake, the container shakes, and everything inside gets jostled. Think of the carts and televisions in your hallways that will roll around, the supplies and pharmaceuticals on shelves that will get tossed off, light fixtures and signs that could fall to the ground, and hazardous chemicals stacked up high that could spill. These represent most of the damage that will occur in a quake, and the related costs are usually not covered by insurance policies.

You should consider small and inexpensive fixes that can help mitigate damage caused by shaking. A quick visit to a local hardware store can help. Bookcases can be bolted to the wall or floor, and chains can help secure medical equipment to walls. Thin wires stretched across a shelf can help keep medications in their places. Also, take a look above you: Anything stored high up will likely come crashing down in an earthquake, so consider storing items lower.

Consider elevations. If you live on the West Coast, or anywhere where a tsunami or considerable flooding could occur during a quake, you should consider the elevations around your hospital. Could water get into your underground parking garage or your underwater generator rooms during a major water main break? Flooding was a major problem that hospitals in the New York area encountered during Hurricane Sandy, ­leading to evacuations when they lost power. Something as simple as repaving your parking lots, installing drainage ditches, or installing uphill features or mechanical doors that can be closed in the event of flooding could mitigate this. In Boston, the new Spaulding Rehabilitation Hospital was built on the city's waterfront with the ground floor and all openings into the garage raised 2.5 feet above the current 500-year flood plain elevation to safeguard against projected sea level rise over the life of the building. If the first floor was completely flooded, critical care could still take place as usual. The hospital's parking garage is designed 19 feet above current flood levels, and the entranceway is designed with a special uphill "lip" that will cause water to pool, rather than rush down into the underground parking garage. Should water get down to the basement level, a 150,000-gallon emergency fuel tank in the basement is ballasted-that way, if there is flooding, the tank will float.

Expect to be the last one standing.
Staff at hospitals that have endured a major crisis often say they felt like they were like a "beacon of light on the hill" for the citizens of their community. There's a reason for this: For the most part, you may be the last building standing in a community after a quake, and the injured will look to you. Prepare as if you might be people's last hope. What will that look like if bridges and roads in your community are wiped out? Patients will still need your help, so you may need to think about how you will get to them.

In Gold Beach, Oregon, the brand-new Curry General Hospital is being built in a tsunami-prone area with this in mind. Scheduled to be completed sometime in 2016, the hospital's emergency plans call for transportation arrangements with local ambulance services to help patients and staff get to and from the hospital, and if needed, air ambulance service would be coordinated with helicopters and fixed-wing aircraft. The municipal airport is located right on the beach, so the new hospital is being built with a helipad in case the airport becomes unusable. Your hospital may not be prone to a tsunami, but having a helipad (or even a rooftop parking lot) could become a crucial part of your emergency plan if you need to land helicopters during a quake crisis.
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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