Disaster Preparedness in Medicine: Tips for Hospitals

Describe your background and your role with the CHA.

My background starts in the hospital. I have over 25 years of hospital emergency clinical and management experience, including being a trauma nurse, paramedic radio nurse, paramedic coordinator, and ER/critical care manager. Following my hospital experience, I served three years as director of a large, urban county health disaster management program. Throughout my career, I have participated in multi-agency state and federal coalitions. I am also a member of the federal CA-1 Disaster Medical Assistance Team, where I have been deployed to multiple wildfires and hurricanes, including Hurricanes Ike and Katrina. Combining my hospital and governmental experience improved my understanding of both internal hospital and external local processes. The addition of my role as a federal responder furthered my understanding of the inclusion of outside assistance in a disaster.

NIMS requires the use of the Incident Command System (ICS), and I am member of the Hospital Incident Command System (HICS) National Workgroup, which designed a system that coordinates with responders from outside the hospital (such as fire and law enforcement) in an emergency. In my different roles, I teach classes and participate in both domestic and international projects with HICS, the Centers for Disease Control and Prevention (CDC), the United Nations, and numerous Homeland Security Exercises across the country.    

Beginning with a degree in nursing, I went on to become a Department of Justice Weapons of Mass Destruction Instructor, Homeland Security Exercise and Evaluation Program Instructor, as well as receive a Master’s Degree in Homeland Security and Defense from the Naval Postgraduate School. 

Why is disaster planning important? 

In order to continue your hospital’s mission of providing medical care to the community, it is important to begin planning before there is an emergency. That is when you have time to assess what your biggest risks are, develop plans for those risks, implement mitigation strategies, provide training on the plans, and then test the plans through exercises to find out if it works when put into practice.

For example, if your hospital is in a floodplain, don’t wait for the flood to happen before coming up with a response plan. Recognize that building in a floodplain will identify a flood as a potential hazard, just as being near a fault zone will identify an earthquake as a potential hazard. Once hazards are identified, begin developing specific plans to help mitigate threats and provide a plan for response. Next, provide education on these plans to staff. Finally, test the plans through specific exercises to identify what works well and what needs changed. The process will result in better preparation, mitigation, and response to hazards and their resulting threats.

However, not all plans result in an improved response just for an isolated scenario. For example, after 9/11, when white powder-laced letters were sent out as threats, many facilities developed plans for the threat of smallpox. Although there were ultimately no new cases of smallpox, we did see cases of severe acute respiratory syndrome (SARS), and we found that the plans for smallpox could be used for other highly infectious diseases. The same could be said for decontamination plans designed for smallpox — these same plans could be used for chemical or biological contamination incidents. 

Tell us about some of the planning topics that the CHA provides resources for.

Some of the planning topics that CHA provides resources and tools for include Surge Planning, Hospital Evacuation, Mass Fatality Resources, a Hospital Emergency Management Program, Shelter-in-Place, H1N1/Seasonal Influenza, Repopulation, Incident Action Plan, Exercise Program for Hospitals, Hospital Continuity Planning, and Active Shooter planning. The list goes on and on, with continual editing as well as new tools and resources added.

How are the CHA Hospital Preparedness Program’s checklists and tools developed?

To focus on which checklists, tools, and training courses need to be developed, CHA looks at issues identified in exercises and real response, such as recent wildfires, new regulatory requirements (e.g., CMS Emergency Preparedness Rule), accreditation requirements (e.g., Joint Commission), and requests from hospitals and healthcare coalitions around the state.

Tell us about some of the specific tools and resources developed by the CHA’s HPP Program.

The latest resource, CHA Activation of the Emergency Operations Plan Checklist, came out in response to requests after last year’s firestorms; hospitals expressed the need for direction when responding in the middle of the night with no or low notice, and when the majority of management staff is not at the facility. The checklist provides direction to opening Hospital Command Centers, activating Incident Commanders and other staff to HICS positions, and coordinating with local government and other partners.

What types of training and exercises are also available to hospitals?

Some of the courses CHA provides at no cost are HICS, Incident Action Planning, CMS Emergency Preparedness Rule, Homeland Security Exercise and Evaluation Plan (HSEEP), and After Action Reporting classes across the state.

Each of the HICS courses include tabletop exercises that can be chosen from a list by hosting hospitals. In addition, CHA participates in multiple exercises such as the California Statewide Medical and Health Exercise, where all healthcare partners can come together in the annual November exercise.

What are some suggested tips for hospitals to prepare in the event of a disaster, such as a wildfire?

First, identify if wildfires are a top hazard in your area. Next, find the associated HICS Incident Planning Guides available online (www.calhospitalprepare.org/hics). These planning guides assist hospitals in developing plans, policies, and procedures, and include scenarios that can be used to test their response.

What were some of the ways that the recent wildfires in California affected hospitals in the state? What were some of the important lessons learned?

Regardless if it is an exercise or real event, including the recent wildfires, communication is usually at the top of the list of issues to be resolved because there are so many participants involved, including healthcare facilities, agencies, and the general public. We are fortunate that the state of California has developed an Emergency Operations Manual that addresses the different roles in an event. Communication — both horizontally and up and down the spectrum — is always an issue, and remains an objective on every annual Statewide Medical and Health Exercise.

Tell us about the annual Disaster Planning Conference, held in September 2018. What key topics were covered? Who attends the conference? What is unique about this conference?

Highlights of this year’s Disaster Planning for California Hospitals: Voices of Experience, Lessons for the Future Conference included speakers from the Las Vegas shooting, hospitals who have experienced cyberterrorism and a ransomware attack, and information on the 2017 hurricanes and wildfires. There were three days full of presentations on emergency preparedness topics. 

What’s next for the CHA?

With emergency preparedness, the education and training never ends. New diseases, threats, and regulatory and accreditation requirements constantly pop up, so we are constantly on watch for innovative ways to improve our preparedness and response. We are currently working on a checklist to address demobilization and recovery that includes physical, financial, and behavioral health components.

Is there anything else you’d like to add?

The CHA Hospital Preparedness Program’s website is filled with emergency preparedness information, tools, and resources, and is continually reviewed an updated. Questions can be submitted to the website for additional information. For more information, please visit:
https://www.calhospitalprepare.org