Terrorist attacks show preparedness is more than accreditation exercise

Health care system prepared well, but now is time to review your plans

The Sept. 11 tragedy is causing quality and peer review professionals to revisit their emergency preparedness plans and to view them with a greater sense of importance. Those plans no longer seem like a formality to satisfy the Joint Commission on Accreditation of Healthcare Organizations, and the days are gone when you imagine a tornado or hurricane as the only disaster likely to set the plan in motion.

Specialists in emergency preparedness are getting a lot of calls from quality professionals who suddenly are more interested in their hospitals’ emergency plans. Cameron Bruce, CSP, PE, a health care consultant in Orinda, CA, says the recent terrorist attacks have convinced some people that emergency preparedness deserves more attention.

"Some people saw it as a formality a few weeks ago, something you had to have on the shelf for the Joint Commission," he says. "Others saw it as more than a formality, but they still didn’t have a solid plan in place. There’s a new attitude now that’s spurring people to take it more seriously."

Bruce says that "most hospitals are woefully unprepared" for a disaster. His colleague, consultant Sheila Hennessey, says that even when quality professionals and safety experts were serious about wanting to create a good emergency plan, the hospital often did not lend much support.

"Let’s put it this way: It’s not revenue generating," she says. "It doesn’t come as a top priority for administration. That’s really a pity, because when a disaster happens, it’s only through good planning that you can have a quick, organized response that really serves your patients and your community."

That apathy may be pushed aside by the nationwide concern over more terrorist strikes, Hennessey points out. Chances are good that administrators will provide a better budget for emergency preparedness from here on out, she says. And it can take a significant budget to develop such a plan, especially if you use outside consultants.

"It can take you more than 1,000 hours of time to write a good emergency preparedness manual. That can cost you $30,000 to $60,000 if you do it right," Bruce explains. "You can slap something together in a few days before your Joint Commis-sion survey, and it might be enough to get by the surveyor. But that’s nothing I would rely on in an emergency."

Now is the perfect time to review your organization’s emergency preparedness plan, Hennessey says. And don’t get complacent just because the Joint Commission has seen your emergency preparedness plan and given it a stamp of approval.

"The Joint Commission requirements are open-ended and vague," Bruce says. "You can fulfill the requirements with 200 hours of work, 600 hours of work, or 1,000 hours of work. You can show them something that is fairly weak as a workable tool, yet it will pass most surveyors’ casual scrutiny. Some surveyors don’t spend more than three or four minutes flipping through the emergency preparedness plan."

So passing the Joint Commission’s scrutiny doesn’t necessarily mean the emergency plan is a practical, workable tool. And Bruce says that you should review your plan now even if the Joint Commission surveyor really studied it and raked you over the coals. The potential hazards are not the same as they were on Sept. 10. (For more on how to put together an emergency preparedness plan, see "Resources for educating staff, physicians on terrorist threats," in this issue.)

Health care system ready for attacks?

The concern over terrorist attacks is reaching all levels of health care. Overall, the U.S. health care system is ready for terrorist attacks, or at least as ready as it can be, according to Secretary of Health and Human Services (HHS) Tommy Thompson. The reassuring comments came when Thompson was speaking before an audience of manufacturers recently. He said HHS now has eight packages containing 50 tons of medical supplies distributed around the country and a network of 81 state laboratories connected to the Centers of Disease Control and Prevention (CDC) monitoring for anything suspicious.

With that plan, the agency could respond within seven hours to either conventional or biological attack, Thompson said. He is "very confident as secretary of health that if a terrorist attack hits us, we are able to respond very quickly." Thompson noted that HHS is continuing to pursue its domestic agenda. He predicted that a patients’ bill of rights will be passed soon if Congress can address the differences between the House and Senate versions of the bill.

Thompson also said HHS will be improving security at places such as the CDC and the National Institutes of Health as well as stocking additional supplies of pharmaceuticals and vaccines. Thompson reassured listeners that the health care system is ready for whatever might happen, but not everyone agrees with that assessment.

If one arm of the Chicago-based American Medical Association (AMA) has its way, the Joint Commission will start evaluating health care providers for their emergency plans specifically regarding terrorism. The AMA Council on Scientific Affairs (CSA) issued a report in 2000 on "Medical Preparedness for Terrorism and Other Disasters," calling for substantial improvements. One of the key recommendations was to "encourage the Joint Commission . . . and state licensing authorities to include the evaluation of hospital plans for terrorism and other disasters as part of their periodic accreditation and licensure."

The Joint Commission has not acted on that recommendation, though it did beef up its emergency management plan for 2001.

Effective January 2001, the Joint Commission’s emergency preparedness plan (EC.1.4) was expanded and made more specific, requiring providers to address four phases of emergency management activities: mitigation, preparedness, response, and recovery. The new rule calls for providers to conduct a "hazard vulnerability analysis" to determine how the facility might be affected by different threats. The new language in the rule also lays out specific requirements, such as identifying personnel during emergencies, but it is an all-purpose rule on emergency management that could apply to a range of disasters. Terrorism is not mentioned.

The Joint Commission has focused on terrorism, however. In 2001, several congressional committees explored the issue, and the Joint Commission actively participated.

One of the most prominent groups was the Advisory Panel to Assess Domestic Response Capabilities for Terrorism Involving Weapons of Mass Destruction, also known as the "Gilmore Commission" for its chairman, James S. Gilmore III, governor of Virginia. AMA representatives presented the CSA report to the Commission and discussed it with them during the Commission’s meeting on March 30, 2001. The commission responded positively to the report, and the CSA predicts that the Gilmore Commission’s prominence in Washington, DC, will help its efforts to improve the health care response to terrorism.

In the March meeting of the Gilmore Commission, representatives from the Joint Commission and the CDC both spoke about the need for an increased focus on terrorist threats. The AMA council reports that "The [Joint Commission] has taken a significant step toward addressing the AMA’s concern that disaster preparedness should be evaluated in hospital accreditation."

The emergency management standard requires the health care organization to have an emergency management plan describing an effective response to disasters, with provisions for integrating with the surrounding community’s disaster response organization. The standard lists essential elements of a plan, including an annual evaluation of its effectiveness.

But the AMA council notes that the standard "does not include recommended or mandatory strategies for disaster response planning, leaving these specifics to the health care organization. It also does not explicitly describe a role for medical staff to participate in developing the emergency management plan.

However, the Joint Commission representative to the March Gilmore Commission meeting stated that the accrediting body would be willing to participate in the public-private entity’ described in the AMA recommendation."

The recent terrorist attacks should prompt quality managers to conduct a new hazard analysis, as required by the Joint Commission, Hennessey says. Previous hazard analyses probably underestimated the potential for terrorism, and she says Joint Commission surveyors are likely to be on the lookout for proof that you have considered the risk.

"They’re like everybody else now, thinking about it all the time. It’s on our minds and will be for a long time," she says. "It’s only natural they’re going to look for it."

In addition to revising your emergency preparedness plan, Hennessey points out that you also must test it with disaster drills.

"You can go through this whole process of developing a wonderful plan and then not drill it. That would be tragic, because you have no way of knowing if it works until you actually test it," she says.

One of the hospitals in New York City had tested its emergency preparedness plan just weeks before the World Trade Center tragedy. Saint Vincents Hospital and Medical Center had held a disaster drill about three weeks before and used that experience to improve its emergency plan, according to a hospital spokesman.

In Wareham, MA, Tobey Hospital held its most recent disaster drill in June, but a spokeswoman says the terrorism threat may prompt the hospital to drill again on a more frequent basis.

Tobey Hospital has several disaster drills each year to test its emergency guidelines and to meet the Joint Commission requirements, according to spokeswoman Joyce Faria. The hospital’s emergency preparedness plan puts all hospital departments on alert, and any staff whose services are not directly required go into a manpower pool to wait for assignments. All on-call staff are called in, and a supervisor assures personnel are available to record incoming patient information and assigns arriving staff members. The pharmacy supplies emergency drugs to treatment areas. Respiratory care provides personnel to proceed to the emergency department to help assist, stabilize, and transfer patients. Social services mobilizes to provide counseling and assistance to families.

"We take the emergency planning very seriously, and we were pleased with the results of our last drill," Faria says. "But there are always ways to improve it, things you find in the drills that you just couldn’t see on paper. So we always do drills, and there’s no doubt that we’ll do more of them now. It looks like we need them now more than ever."

Disaster Planning Audio Conference

The unimaginable has happened in New York City. At Saint Vincents Hospital, less than three miles from the site of the World Trade Center attack, the disaster plan was put to the test as dedicated professionals rose to the unique challenge of responding to the attack. American Health Consultants, publisher of Hospital Peer Review, invites you to learn from the firsthand experience of the professionals at Saint Vincents how to take a new look at your disaster plans so that you will be ready if the unimaginable happens in your community:

  • Responding to the Unimaginable: How Saint Vincents Coped with the World Trade Center Attack
  • Wednesday, Nov. 14, 2001
  • 2:00 to 3:40 p.m. EST
  • An audio conference educating you and your entire staff on how to respond effectively in a crisis situation.

Each participant will have the opportunity to earn 1.5 free AMA Category 1 CME credits or approximately 2 free nursing contact hours. For details, visit www.ahcpub.com, or call (800) 688-2421 to register today!