Joint Commission Update

New standards issued for disaster planning

Does your disaster plan include strategies for how your ED will work with other agencies? If not, you’re out of compliance with new standards for disaster planning from the Joint Commission on Accreditation of Healthcare Organizations in Oakbrook Terrace, IL.

"Surveyors want to see that you are not working on your own," says Ann Stangby, RN, CEM, emergency response planner for San Francisco General Hospital. "Your disaster plan must include communitywide interaction and interoperability."

The Joint Commission’s new Environment of Care standards became effective Jan. 1, 2001. They state that you are required to "integrate the hospital’s role with communitywide emergency response agencies (including the identification of who is in charge of what activities and when they are in charge) to promote interoperability between the hospital and the community." (See "Sources/resources" at the end of this article for information on obtaining a copy of the standards. See checklist for what your disaster plan should include, below.)

Checklist for Disaster Plan
Integration with community responders
Lock down/security access capabilities
Evacuation
Media relations
Establishing an alternate care site if the main ED is inoperable
How to receive extra critical supplies
Care of staff, including housing, transportation, and incident stress debriefing
How to identify personnel in a disaster
Personnel call down/notification procedure
How to initiate the disaster plan
How to maintain communications with radios
Demonstration of an incident command
Decontamination procedures, with facilities for radioactive or chemical isolation and decontamination
Appropriate training and personal protective equipment for staff

Source: Bettina Stopford, RN, Chair, Weapons of Mass Destruction (WMD) Work Group, Emergency Nurses Association, Chief Nurse, Central U.S. National Medical Response Team for WMD, U.S. Public Health Service, Denver.

Here are ways to comply with the standards:

• Work with first responders.

Identify the first responders in your community for disasters, and anticipate how you’ll need to work with them if a disaster occurs, says Stangby. These might include the fire department, emergency medical services (EMS), the police department, office of emergency services, and volunteer or neighborhood groups, she says.

"Will you need the help of the fire department to rescue victims on your campus from a fire or structural collapse? Would EMS and police respond to [a spill of] hazardous materials, a bomb threat, or a terrorist threat?" she asks. "If so, your plans should address this." Your plan should identify where these agencies respond, and whom they report to for information briefings, she explains.

Make a list of which agencies are in charge of what specific activities, and under what circumstances, recommends Bettina Stopford, RN, chair of the national Weapons of Mass Destruction (WMD) work group for the Des Plaines, IL-based Emergency Nurses Association and chief nurse for the Denver-based U.S. Public Health Service’s Central U.S. National Medical Response Team: WMD.

Surveyors also will want to see that anyone who may assume a management role in a disaster will be able to communicate using the standard community command structure, such as the hospital emergency incident command system, an emergency management system, Stopford explains.

• Invite community agencies to critique your disaster drills.

Develop a "roll call" of attendees, and routinely invite agencies to participate and critique your disaster drills, Stopford suggests. Surveyors will want to see evidence that you are interacting with the community, notes Stopford. "This can be documented by reviews and evaluations of the two disaster drills each facility should have each year."

When the ED at San Francisco General Hospital was developing a WMD chemical response plan, staff conducted drills with the fire department, reports Stangby. "It was a learning experience for all of us," she says. "We reviewed traffic control, perimeter control, and where decontamination should be set up." The drill was videotaped and is used for educational and orientation purposes, says Stangby.

When an earthquake drill was held, the fire department again was invited on-site, she says. "We know that we are vulnerable to earthquakes and that we will need help if there is a structural collapse," she explains. "We staged victims in areas that would challenge the fire department. They are now more familiar with our campus and its unique problems."

The Mayor’s Office of Emergency Services also was invited to evaluate the drill, adds Stangby. "They were able to see what we can do, how we interact with our community agencies, and where we will need assistance," she says.

• Involve volunteers from the community.

Dozens of volunteers from local Neighborhood Emergency Response Teams acted as victims for the ED’s disaster drills, notes Stangby. The team members had all taken a six-week course in self-preparedness for disasters, with instruction in fire safety, search and rescue, and first aid. Never turn away volunteers who offer help during a disaster, advises Stangby. "There is always a job to be done," she says. "Your disaster plans should address this and pre-plan what these jobs might be." The ED also has held earthquake preparedness fairs and on-site disaster education for the community, she adds.

• Offer to make your ED a training site for other agencies.

Most fire and police departments perform routine disaster drills, but drills can become boring if they’re done in the same location repeatedly, says Stangby. "Coming to a new site can be challenging and fun," she says. "You get to see what they can do, and they get first-hand experience with your hospital. Everyone wins."

Stangby’s ED will host a future drill for the police department bomb squad. "They will do education on bomb threats and searches for the hospital. Then they will use part of the campus to practice their response using their equipment, including dogs and robots," she says.

Sources/resources

For more information about accreditation standards for disaster planning, contact:

Ann Stangby, RN, CEM, Emergency Response Planner, San Francisco General Hospital, 1001 Potrero Ave., San Francisco, CA 94110. Telephone: (415) 206-3397. Fax: (415) 206-4411. E-mail: ann_stangby@sfgh.org.

Bettina Stopford, RN, Denver Health Medical Center, 777 Bannock St., MC 8200, Denver, CO 80204. Telephone: (303) 436-3431. Fax: (303) 436-6828. E-mail: Bettina.Stopford@dhha.org.

The Joint Commission on Accreditation of Healthcare Organization’s new Environment of Care Health Care standards became effective Jan. 1, 2001. The section that addresses disaster planning and communitywide response can be found in the following locations: EC.1.4 in the Comprehensive Accreditation Manual for Ambulatory Care (CAMAC), Comprehensive Accreditation Manual for Hospitals (CAMH), Comprehensive Accreditation Manual for Long Term Care (CAMLTC), the Comprehensive Accreditation Manual for Behavioral Health Care (CAMBHC), and in the July/August 2000 Joint Commission Environment of Care News Special Section. The Environment of Care Essentials for Health Care book has been updated for 2001. The cost is $60 (order code ECE-01). To order, call the Joint Commission's Customer Service Center at (630) 792-5800 between 8 a.m. and 5 p.m. Central time on weekdays. E-mail: customerservice@jcaho.org.