JCAHO: Small communities not well prepared

Hospitals should take role in planning

Even before hurricanes Katrina and Rita struck the Gulf Coast, the Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL, worried that small communities were not doing enough to prepare for a disaster.

In a new report, the Joint Commission details 13 steps that communities should take to be prepared for a disaster. The guide is not just for hospitals, but it offers specific suggestions on the role hospitals can play in broader community planning.

Standing Together: An Emergency Planning Guide for America’s Communities stresses the need to collaborate with other community entities, consider all possible hazards, and prepare for surge capacity, communication needs, and sufficient resources. (The guide is available at www.jointcommission.org/PublicPolicy/ep_guide.htm. For a list of the 13 steps, click here.)

A wake-up call

With Katrina, emergency preparedness made a difference in how well hospitals fared, says Robert Wise, MD, vice president of the Joint Commission’s Division of Standards and Surveying Methods. But that was no surprise. The Joint Commission has been reviewing the impact of disasters on hospitals since Tropical Storm Allison flooded Houston in 2001 and forced a middle-of-the-night evacuation of Memorial Hermann Hospital, he says.

"If [Katrina] is a wake-up call, there have been a number of wake-up calls along the way," Wise says. "Hopefully, you don’t need a hammer in the head to get up in the morning."

If your community is not at risk of hurricanes or earthquakes, there’s no reason to feel off the hook, he says. Every community has a range of potential crises, from a major industrial accident to a terrorism attack. " There are some real risks associated with just being a city in the United States," Wise says.

Or, as it says in the planning guide, " Challenges abound, but perhaps the most threatening of these challenges is complacency."

Too often in smaller communities, there is no single voice for hospitals and they end up being left out of the local emergency planning committee. Wise advises hospitals to set aside their competitive nature and ensure they have a role in communitywide planning.

The Joint Commission developed the guide in partnership with the Illinois Department of Public Health, the Maryland Institute of Emergency Medical Services Systems, and the National Center for Emergency Preparedness at Columbia University. It also convened two expert roundtable meetings in 2004.

Wise notes these lessons learned from past disasters:

• Hospitals must be able to stand alone for at least 48 to 72 hours.

In the immediate aftermath of a disaster, your hospital may be on its own — no water, power, transportation or other resources from the outside. You need to have resources, including equipment, medication, generator power, and water to survive.

Many hospitals are not prepared to provide for all their own needs, says Wise, who visited New Orleans about three weeks after Katrina hit.

"It’s uncommon for emergency generators to handle all of the necessary utilities within a hospital," he says. "They often don’t handle an HVAC. If you do not have your air conditioning or heating, it gets pretty miserable in there pretty quickly."

For example, the Ochsner Clinic Foundation in Jefferson Parish, LA, had well water as well as generator power and was able to stay open during and after the hurricane, says Wise.

• Hospitals must take care of the personal needs of their staff.

The disaster that is devastating the community is also devastating the lives of your staff — destroying their houses, scattering their loved ones, altering their lives.

"These community disasters have typically impacted the staff as much as it does the other victims. It has produced an unusual stress," says Wise.

Hospitals that manage successfully during a disaster understand that they need to take care of their employees’ needs, he says. For example, after Hurricane Charley hit Charlotte County, FL, one hospital sent crews to employees’ houses to put up tarps and make repairs.

"[Hospitals] can have perfectly running generators and all the water and food, but if they don’t take care of the staff — and the staff has to take care of their personal disasters — they will not be able to run the hospital," Wise says. "Your staff cannot feel endangered, cannot feel pulled away from their families."

• Maintaining a communications system is crucial.

Even if you make it on your own, you need contact with the outside world. Hospitals need an emergency communications system, says Wise.

For example, after Sept. 11, New York hospitals developed an 800 MHz phone system that would connect hospitals and the Emergency Operations Center. The closed-circuit system would not be affected by overloading on the public circuit. The phone system worked well during the Northeast blackout in 2003.