Hospitals have been hit hard by disasters
Protecting employees and dealing with chaos
Hospitals have been at the frontlines of dealing with some of the worst and most costly disasters in recent years, including Hurricane Sandy in 2012 and a Oklahoma tornado in 2013.
In the latter case, a 46-bed Moore, OK hospital was destroyed by 200-mile per hour winds unleashed by an F-5 tornado. Hospital workers survived the disaster, and later they ended up treating hurricane victims in a makeshift triage center located in a neighboring theater, according to local news reports.
After Hurricane Sandy struck New York City some hospitals were closed, and others — even a month later — used their lobbies to create more emergency room space. These stories highlight the unexpected ways hospitals and their staff can be impacted by disasters.
Hurricanes, fires, earthquakes, and tornadoes are the high profile disasters that can impact hospitals. There are many others that require some imagination to anticipate, says Mary Gene Ryan, MPH, COHN-S/SM, CSP, executive director of MGRyan & Co., Inc. (MACI) of Ventura, CA.
Some overlooked potential disasters could involve long power outages, bad storms that damage roofs, broken elevators, ice storms, heat waves, airborne disease epidemics, and flooding in non-coastal regions.
"The first thing hospitals should do to prepare for a disaster is conduct a vulnerability analysis, listing out the types of scenarios that could happen in their facilities," Ryan says.
"You will need to list even simple things like a stuck elevator or what happens if the utilities go out, which is a big one for a hospital," she says. "We don’t think about things like big heat waves causing the utilities to get overloaded and the power going out."
Vulnerability analysis
Ryan offers these suggestions for how hospital employee health departments can plan for disasters:
Follow FEMA’s vulnerability analysis algorithm: The Federal Emergency Management Administration (FEMA) has created a risk index table that lists such hazards as an aviation incident, bombing/terrorism, building collapse, civil disorder, dam failure, disease outbreak, drought, and others.
Each hazard is rated according to these factors:
- the frequency, from rare to moderate;
- duration from short to long;
- the area impacted from limited to widespread;
- speed of onset from slow to fast;
- spatial dispersion from diffuse to concentrated;
- temporal spacing from random to seasonal; and
- risk from low to high.
"You want to list the type of scenarios that can happen in your facility," Ryan says.
Start with the most likely disasters, including storms and branch out to the rare but still possible events, she adds.
Use the vulnerability analysis to create a contingency plan. From a hospital employee health perspective, the contingency plan should include staff safety and communication measures. For instance, if the hospital is located in a rural area one type of disaster might involve pesticide contamination that impacts staff or patients. In another scenario, an emerging disease could require the hospital to enact emergency safety measures. Occupational health nurses could contribute to contingency plans for these scenarios, Ryan suggests.
"Typically hospitals have infectious disease procedures, but when it comes to a community-based issue, they should have an additional contingency plan in how they’re dealing with it," she adds.
The contingency plan also should address what happens if the power is out for longer than the hospital’s generator can supply power, Ryan says.
"We tell everyone to have supplies and manage their facility for two or three days, but what happens when it goes out for a week or longer? How will you get resupplies?" she says. Break the contingency plan into segments, such as three days, one week, two weeks, and longer, she adds.
Other items to add are where patients and staff will be moved in the event of a disaster that wreaks the kind of havoc that demolished the Moore hospital.
"How do you rotate staff and manage the situation?" Ryan says. "One thing I find is that minor stuff can become major stuff if we don’t have a good contingency policy."
Prepare for that the possibility that community members may come to the hospital for shelter and safety even if they are not injured or sick, Ryan says. The contingency plan should detail how to refer these people for shelter elsewhere so hospitals can focus on those with medical needs. Be proactive by meeting with community emergency services to have a plan in place, she adds.
For hospital staff who during a disaster might be asked to work for days without time to head home and check on their families, it’s very important that they know their loved ones are safe, Ryan notes.
"If the hospital can’t physically handle employees’ families, then they need to make sure community resources are known to staff so when a fire or earthquake or another disaster happens, they can make sure their families are safe," she explains.
If facing a possible epidemic of an infectious agent, employee health should work hand-in-hand with infection preventionists to create a communicable disease emergency policy, Ryan says. This policy should include a screening process for everyone who enters the hospital, respirators for healthcare staff as needed, and rapid administration of a vaccine once it’s available, she says.
"Sometimes — like in the case of H1N1 flu — we didn’t have a vaccine at first, so we would reinforce hand hygiene and basic respiratory precautions," she says. "Put up signs to let people know what is happening. It gets back to communication."
Employee health can play a big role in staff communication during a disaster, Ryan notes.
"They can help identify staff who have less critical patient care roles and [can help with] communication links," she says.
