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Emergency preparedness plans should be multidimensional, in writing, and include policies and procedures.
As hurricanes, floods, tornadoes, and fires continue to pose major emergency threats, ASCs might need to take a closer look at their emergency preparedness policies, procedures, and planning.
Emergency preparedness plans are needed for regulatory compliance and should be demonstrated at surveys. But they’re also important in the event of an actual disaster or emergency. “Develop an emergency preparedness program that is multidimensional, includes a written plan, and also includes policies and procedures,” says Stan Szpytek, president of Fire and Life Safety Inc. of Mesa, AZ. Szpytek’s background is as a firefighter, fire marshal, and deputy fire chief. “These include the emergency operation plan itself and all relevant policies and procedures that support the plan, along with training, equipment, and supplies, drills, and exercises.”
One type of emergency preparedness exercise that could work for smaller healthcare organizations, like many ASCs, is a tabletop drill. Tabletop drills can be a precursor to a full-scale disaster drill. These also can work better and safer when an organization wants to prepare staff for certain types of scenarios, such as an active shooter situation, Szpytek says.
“Some drills are conducive to tabletop drills, and one is the active shooter drill, which is difficult and challenging, and there are legal risks and vulnerability,” he explains.
When organizations enact a full-scale active shooter drill, it could result in people experiencing symptoms of PTSD in cases in which they were previously exposed to gun violence. It also could scare people.
For example, in 2014, there was a full-scale active shooter drill held in a nursing home in Denver. The drill employed actors and mock guns. An employee sued the provider, alleging the drill caused PTSD and emotional harm, Szpytek says. (Editor’s Note: Readers can view more details about the suit at: .)
“There is no value in simulating a bad guy coming into a building, blasting away,” Szpytek says.
The following are some steps ASCs can take to improve emergency preparedness:
ASC leaders must assess all potential threats and perils that could affect their facilities, both internally and in the community, Szpytek says.
These emegencies might include fire, flood, power failure, armed intruder or active shooter, technology or other mechanical failures, workplace violence, missing patient or resident, hurricanes, earthquakes and tsunamis, volcanoes, tornadoes, mudslides, civil disturbance (including riots), and demonstrations. ASC administrators make a mistake if they focus on only obvious emergencies. Instead, they should think about anything or everything that could happen, Szpytek adds.
Another mistake is to focus only on geocentric possibilities, such as hurricanes on the coast or earthquakes in California. “Look at the possibility of every type of event,” Szpytek says.
The purpose of a hazard vulnerability tool is to provide some insight into the likelihood a particular disaster might occur.
“The tool uses an algorithm to factor in the possibility of occurrence and gives a descriptive percentage of how likely you are to have this incident happen at your facility,” Szpytek explains.
With help from this tool, ASCs can identify the top five emergencies that are of most concern. ASCs should develop plans around those most common hazards.
For an idea about how to create or find a hazard vulnerability tool, the U.S. Department of Health and Human Services recommends several tools, including one by Kaiser Permanente. (Editor’s Note: Readers can view more details about this plan online at: .) This tool is in an Excel spreadsheet listing “events” in the far left column. It suggests assessing risk by probability, from not applicable all the way to high. The tool accounts for many factors, including but not limited to physical losses and damages, interruption of service, and possibility of injury or death.
The tool identifies many events, including but not limited to mass casualty events, infant abductions, bomb threats, and hostage situations. The assessment tool can be adapted for an organization’s particular community and the risks most often faced in that locale. To get the most out of using the tool, organizations should make completing it a collaborative process, Szpytek suggests. “Don’t just hand the tool to the director of nursing or maintenance and say, ‘Fill it out,’” he says. “The process is designed to be collaborative. So, get a committee together to do it by consensus.”
The assessment tool can be used annually to see if any new threats have appeared.
This program should include an emergency operation plan with policies and procedures, Szpytek says.
“Policies and procedures will say how the facility will maintain three days of food and water in case people have to shelter in place,” he says. Regulations do not require healthcare sites to maintain an emergency water supply. However, if healthcare site policies say they keep an emergency water supply on hand, facility leaders should ensure supplies are stocked, Szpytek adds. ASCs are required to conduct emergency drills and exercises, and how leaders plan to execute these drills should be included in the policies and procedures. For instance, administrators could conduct a community-based drill, a facility-based drill, or a tabletop exercise.
“A surveyor looks for evidence of the drill and a sign-in sheet,” Szpytek says. “You have to document any changes to the plan or program subsequent to completion of the drill.”
The plan should be tested, and if it needs to be modified, then the ASC’s action plan should cite any changes that were made to the plan, Szpytek adds. The action report would list strengths, vulnerabilities, gaps, opportunities for improvement, and cite any changes made to the plan or program after the findings were discovered.
“The Centers for Medicare and Medicaid Services has taken a programmatic approach to emergency preparedness,” Szpytek says. “It’s no longer just a plan; it’s an entire program to ensure safety and welfare of occupants inside the facility.”
“First, identify the goals and objectives of the exercise,” Szpytek offers.
He says leaders should ask: “What do we test?,” “What component of emergency management program or emergency plan do we test?,” “What is the objective?,” and “What are goals?”
“Test the evacuation plan, and build a scenario about what the goals and objectives are,” Szpytek says. “The key is to make it realistic and plausible, not a zombie apocalypse, not a nuke went off at the stadium.”
Instead, the drill scenario should be something the ASC’s staff will want to practice and role-play. “Utilize real-life possibilities,” Szpytek recommends.
For tabletop exercises, create a situation manual that provides all assumptions, parameters, rules of play, and technical details, Szpytek adds.
“The purpose of the tabletop exercise is to simulate the team’s management of the emergency, using the plan and, hopefully, using the incident command system,” Szpytek explains. Also, leaders should tell participants in the tabletop exercise that this is a no-fault environment.
“It’s designed for people to not be intimidated, and there are no right or wrong answers,” Szpytek says. “People feel comfortable to be transparent and to express their opinions honestly as they sit around the table with the CEO or administrator.”
For example, suppose an emergency plan designates the facility’s south wing as the primary means to evacuate surgical suites, Szpytek suggests.
“In the context of the drill, someone will point out, ‘Wait a sec, our plan says to use the south exit, but we built a new addition at the south exit, and now the north exit is the primary exit,’” he explains. “The tabletop exercise gives you the opportunity to discuss and debate if the plan is accurate or not.”
DBEs can help ASCs identify gaps and vulnerabilities during the plan’s full-scale exercise. “It’s trying to get people to participate,” Szpytek says. “You pull in people from different areas and ask them, ‘What is your concern right now?’”
These might include how to cope with a power outage that lasts a few days or feeding people who are staying in the center for safety.
“In a real-world situation, there’s a system of command and control that utilizes delegation,” Szpytek explains. “Incidence command is management by objectives. You are identifying what your objectives are, and once those are determined, and instead of spinning wheels, you come up with strategies to satisfy those objectives.”
Financial Disclosure: Editor Jonathan Springston, Editor Jill Drachenberg, Editorial Group Manager Terrey L. Hatcher, Author Melinda Young, Physician Editor Steven A. Gunderson, DO, FACA, DABA, CASC, Consulting Editor Mark Mayo, MS, Nurse Planner Kay Ball, RN, PhD, CNOR, FAAN, and Author Stephen W. Earnhart, RN, CRNA, MA, report no consultant, stockholder, speaker’s bureau, research, or other financial relationships with companies having ties to this field of study.