Use disaster resources efficiently through methodical planning

Develop matrix of potential emergencies

The first step in developing a thorough disaster plan is to determine your hospital's and your pharmacy department's risks.

"It's important as you approach emergency preparedness in general that you use established methodologies to determine what your risk is," says Richard G. Thomas, PharmD, DABAT, emergency management coordinator at the Phoenix Children's Hospital in Phoenix, AZ. Thomas has worked in emergency management fulltime for a decade.

"The primary method we use is the Hazard Vulnerability Assessment and Analysis, which is used by hospitals, but also by federal government, states, and counties," Thomas says. "You look at all the possible hazards out there and then look at the probability of something happening and the impact if it did occur."

For instance, in the event of a hurricane, there's a fairly high probability that hospitals in coastal states, like North Carolina, South Carolina, Georgia, and Florida, will experience a hurricane emergency, he notes.

"There's a high likelihood they won't go too long before they're hit by a direct hurricane or are somewhere in that storm front," Thomas says.

With each possible emergency, it's then important to determine the likely impact.

"There are two components to impact: how prepared you are for it, and then also the magnitude of what it might be," he says.

For example, hospitals located in direct-hit hurricane areas typically have taken a variety of precautions to prevent flooding, losing their power and water supplies, and making certain windows can withstand high winds without shattering, Thomas explains.

"So even though there is an impact, it is offset by the things they've done to mitigate that impact," he adds. "We need to look at what we have in terms of mitigation, and what we have in terms of preparedness."

Hospitals that are very prepared will have minimal impact when the anticipated disaster strikes.

The next step is to develop a simple matrix that places potential disasters/emergencies in one of four categories:

Low frequency and minimal impact: An event like this might be a problem with internal flooding when a pipe breaks in a wall, Thomas suggests.

"A part of a patient care area can't be used for a day or so, but you already have processes in place to manage that," he explains. "It's an inconvenience certainly, but it will not cripple your ability to manage patient care."

Hospitals do not need to spend a lot of money on the low frequency, minimal impact disasters.

High frequency and minimal impact: "If you keep having a recurring problem that keeps affecting your ability to deliver patient care, then you need to do an analysis of the situation," Thomas says.

"Do a root cause analysis; figure out what the problem is and figure out some way to resolve it," Thomas says. "Manage it with the typical management techniques."

For example, if a computer or computer system keeps going down, then hospital managers should look at the cause and fix it because its frequency will have some impact, he adds.

"It's not a big problem, but it happens a lot," Thomas says.

High frequency and high impact: For coastal hospitals in the Southeast and Gulf states, hurricanes would fall under this category. In other parts of the country, tornadoes, floods, earthquakes, and blizzards might be in this category.

"If you know something probably will happen, then you need to do primarily mitigation efforts," Thomas says.

For instance, hospitals that know their area will lose power during an event should plan for this eventuality by adding generators.

"You do what you can to prevent or reduce the impact," he says.

Low frequency and high impact: This category poses the biggest challenge to hospitals, Thomas notes.

"When you have that sort of situation you probably are not going to spend a lot of money on mitigation efforts for something that happens so infrequently," Thomas says.

The types of disaster events that might fall into this category include the pandemic flu outbreak and bioterrorism attack.

"The pandemic influenza hasn't happened yet," Thomas says. "But everyone is confident that it's only a matter of time — whether it's in this decade or the next decade."

The key is to put some time and effort into developing a plan for these low frequency, high impact events, so if something does happen, then you're at least somewhat prepared for it, Thomas says.