You may have an effective, well-rehearsed disaster plan, but have you included the community in your planning? A report from the Joint Commission on Accreditation of Healthcare Organizations makes it clear that surveyors will be looking for evidence that you have done so. "All EDs need to look at the relationship they have with the local and regional emergency management teams," emphasizes Patricia Gabriel, RN, BSN, CEN, ED nurse manager at Overlook Hospital in Summit, NJ. Joint Commission surveyors are looking at this inclusion, says Gabriel. "The key is multiagency cooperation," she emphasizes.
To comply with the report’s recommendations, you must do the following:
• Involve the community in your drills.
"Invite anyone you can think of to your disaster drills," advises Gabriel. This includes local police, fire, emergency medical services, local health officers, and representatives from airports or industrial facilities, she says. "While they are watching the drill, you have the opportunity to learn from their experiences and point of view," she says. "This has been particularly successful for us."
In one drill, local police realized that they needed a secondary command site to be developed, Gabriel says. "At another drill, we learned that the radios we were going to use with our sectors were conflicting with a neighboring county EMS [emergency medical services] frequency, and since they have a number of repeaters’ to carry the signal, our communications couldn’t be heard," she reports. To correct the problem, the radios were reprogrammed to a different frequency, says Gabriel.
• Involve all staff with community preparedness.
This is an excellent opportunity to develop future leaders and involve staff in disaster planning, says Gabriel. "Most agencies are not picky about the title of the representative; they are just happy to have the hospital represented," she notes. "As long as the ground rules are set — such as a staff nurse can’t make an agreement or policy decision for an institution — it is a great way to reward someone with expertise."
At least once a year at Overlook Hospital, a disaster drill is held at 6 a.m. to include nurses on off-shifts, she says. "The night staff love it because they are included, the day shift is happy to not have it, and the town agencies usually can send someone to participate or watch," Gabriel says.
• Assess communication between your ED and community resources.
You need to assess field communication that will be in place for any disaster, says Gabriel. "All shifts need to be able to respond quickly on their own without waiting for managers to direct them," she says. Conduct drills with simulated patients that move through the system’s resources, says Gabriel. This drill allows for identification of real problems that might not otherwise be noted, she explains. "For example, is the number for the Office of Emergency Management [OEM] correct and easy to locate? Does a person answer it, or is it voice mail hell? If no one calls it, the hospital never knows," Gabriel says.
Other important questions to address are what communication is available from the site, does it go directly to the ED or to a hospital command center, and how long does it take for the information to reach health care providers, she says. Instead of using the drills as teaching moments, have observers document the event in real time and then have a debriefing as soon as possible, advises Gabriel. "Allowing the drills to continue without intervention allows for the real consequences of the decisions to be seen, felt, and heard," she says.
• Include all areas that receive patients.
Biological events can be identified from many points, such as laboratories, hospital clinics, or the labor and delivery area, so these should be included in disaster planning, says Gabriel. "These areas frequently are left out of the loop regarding training," she says.
• Participate in community drills.
"When you feel that you have the kinks worked out and under control, go for community based, multi-agency drills," advises Gabriel. "The volunteer EMS folks love to participate, especially when it is scheduled on weekends."
• Develop relationships.
ED staff should develop relationships with local police, fire, and EMS, says Gabriel. "The roles and responsibilities of each group need to be clearly understood," she emphasizes. Contact the local OEM agency and the local board of health and invite them to a roundtable discussion of resources, best practices, and new ideas, she suggests. "Ongoing meetings would be best, and they allow for excellent networking," Gabriel says. "In our area, the community health folks have lots of contacts and were willing to help us set things up."
Every year during EMS week, the ED holds a dinner to honor them, says Gabriel. A guest speaker does a 30-minute presentation, and the hospital recognizes one member of each area EMS unit who is selected based on a recommendation by the squad captain, she says. "It is always well attended and not too costly because the catering is done on site by food services," Gabriel adds.
For more information on the Joint Commission on Accreditation of Healthcare Organizations and community preparedness, contact:
• Patricia Gabriel, RN, BSN, CEN, Nurse Manager, Emergency Department, Overlook Hospital, 99 Beauvoir Ave., Summit, NJ 07902. Telephone: (908) 522-2148. Fax: (908) 522-2210. E-mail: Patricia.Gabriel@ahsys.org.
The Joint Commission’s white paper, Health Care at the Crossroads: Strategies for Creating and Sustaining Communitywide Emergency Preparedness Systems, can be accessed at no charge at www.jcaho.org/news+room/press+kits/emergency+prep.htm.