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At Elkhart (IN) General Hospital, case managers play a critical role in the facility’s disaster plan, according to Shelby Morse, RN, director of case management.
Elkhart has a specific set of steps used to notify its support structure throughout the community in order to make room for the actual victims of the disaster who require hospitalization, she says.
To date, Elkhart only has experienced a few minor disasters. In those instances, Morse says, the key to success is being able to mobilize resources very quickly. "That’s the key." The other key ingredient is establishing good relations with the community so it understands the hospital.
According to Morse, community resources should include religious and community services capable of supplying funding, clothing, or other necessities in time of crises. For example, she says, a nearby explosion at a plant in the community once resulted in a clothing shortage due to chemical exposure. "We were able to have some of those facilities rally and support us," she reports.
Knowledge of the nursing home community and the number of beds likely to be available also is important in order to move patients into those settings, says Patrice Spath, president of Brown-Spath & Associates in Forest Grove, OR. In addition, hospitals must know how to access Red Cross resources, she adds.
In the event of an external disaster, Elkhart uses a call tree that includes the entire case management department as well as the nursing administration. That call tree usually can be completed within 10 minutes of the time the call is originated. "We’ve got a number of branches on the call tree," Morse explains. "If it is off-hours, all those personnel would be expected to come in."
Morse says the next step is to set up a discharge area. At the outset, Elkhart would begin making calls to the facilities in the area to inform them of the hospital’s needs. In fact, that process would begin while patients still are getting their initial triage.
That process would include only certain staff, however, with the remaining staff left to go out on the units and evaluate patients for potential discharges and then coordinate and facilitate those discharges with physicians and families. Where discharge is not possible, patients would be moved to a lower level wherever feasible. "That is fairly standard disaster response from a case management side," she says.
According to Morse, Elkhart previously held unannounced drills; however, word often leaked out and not everybody would participate. Now the hospital uses announced drills instead. "What we’ve found is that we have much better participation," she says. That offers a much better opportunity to review with staff what their actual responsibilities are, where they are supposed to be, and what they should be looking for.
"That has been much more successful," she says. "The reality of a real disaster is that it’s probably going to unfold over a period of time."
In the wake of recent events, many hospitals are reevaluating their security, disaster, and bioterrorism response plans. According to Patrice Spath, president of Brown-Spath & Associates in Forest Grove, OR, there are two separate types of disasters that hospitals must prepare for. "If the hospital itself has a disaster, generally the disaster plan will indicate where people need to go," she says. "Everybody has his or her own job to do in the hospital disaster plan."
Then there are disasters that do not directly affect hospitals where they must gear up to treat victims.
Here are several examples of policies and procedures available on the Internet that Spath says may be of interest to case managers: