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On Sept. 11, ED staff sat waiting for hours for patients who never came — a wait partially caused by poor communication from the disaster sites at the World Trade Center and the Pentagon. Cell phones and land lines often did not work. Frantic staff were forced to get information by listening to police radios and television reports, so rumors were flying. Is communication a "weak link" in your disaster plan? Now is the time to find out — while it still can be corrected during disaster drills.
At St. John NorthEast Community Hospital in Detroit, the protocol for institutional communications during a disaster is included in the disaster response policy and the Hospital Emergency Incident Command System (HEICS) policy. (To see HEICS policy, click here.) "The HEICS policy improves communication during a disaster situation in several ways," according to Scott Berkseth, CPP, CHPA, the hospital’s director of safety and security. (See "Here are options for communicating" in this issue.) The HEICS system uses a logical management structure, defined responsibilities, and clear reporting channels to help you communicate with outside emergency responders, says Berkseth.
The HEICS system automatically goes into effect whenever a disaster situation occurs, whether it’s a drill or actual event, he explains. "The HEICS system is spelled out in a flow-chart fashion for each disaster situation," says Berkseth. The hospital’s HEICS program, developed by Berkseth, includes a policy, flow charts used for particular disaster situations, and job action sheets.
Dan Hanfling, MD, FACEP, chair of the disaster preparedness committee at Inova Fairfax Hospital in Falls Church, VA, points to the HEICS system as a "benchmark best practice" to adopt immediately. "This is really where EDs ought to be heading, in terms of disaster planning and preparedness," he says.
Here are benefits of the HEICS system:
• The language is the same as that used by other first responders. HEICS uses common terminology that is consistent with wording used by firefighters, police officers, and other emergency responders, explains Berkseth. "Common nomenclature helps to unify the hospital with other emergency responders," he says.
• There is compliance with accreditation standards. The system complies with new disaster planning standards, such as mitigation, preparedness, response, and recovery, required by the Joint Commission on Accreditation of Healthcare Organizations, says Berkseth.
• Other responders know whom to contact. At the World Trade Center and Pentagon disaster sites, there was a poorly functioning incident command system, so EDs had no idea of how many patients to expect. The HEICS ensures that police, fire, and other emergency providers know how the hospital’s emergency response is structured, says Berkseth. "They can interact with the appropriate hospital personnel in a disaster situation," he explains.
• Hospital staff know to whom to report. The HEICS program provides a "structural" approach to communications within the hospital, says Berkseth. "The roles and responsibilities of all staff are clearly detailed in flow charts and job action sheets," he says. (To see ICS Organizational Structure for Hazardous Material Response, click here. For a copy of the Job Action Sheet for Emergency Incident Commander, click here.)
During a mass casualty situation, HEICS provides the ED physician with a clearly defined communication process, he explains. "This assures the ED physician, who assumes the role as the incident commander under the HEICS program, that processes are in place to meet all the needs and demands that the situation poses," says Berkseth.
The ED physician has a formalized chain of command and communications with all clinical areas throughout the hospital, including critical care, telemetry, medical/surgical, surgery, pathology, radiology, pharmacy, and cardiology, says Berkseth. In addition, HEICS provides the physician with that same level of communication from nonclinical areas, such as social services, spiritual care, psychiatry, human resources, security, and plant operations, he adds.
• Additional resources can be obtained quickly. The system expedites the acquisition of additional resources as needed, says Berkseth. "This may be in the form of a request to obtain additional medical equipment, supplies, beds, medications, or staffing that are not available on site." This process is streamlined by expediting communications with the key individuals who make decisions regarding the purchase or acquisition of these resources, says Berkseth. "This is usually one of the weaker areas of the communication process, and it can slow down your response during a disaster," he adds.
For more information on improving communications during a disaster, contact:
• Scott Berkseth, CPP, CHPA, Safety/Security, St. John NorthEast Community Hospital, 4777 E. Outer Drive, Detroit, MI 48234. Telephone: (313) 369-5812. Fax: (313) 369-5830. E-mail: Scott.Berkseth@stjohn.org.
• Dan Hanfling, MD, FACEP, Inova Fairfax Hospital, Department of Emergency Medicine, 3300 Gallows Road, Falls Church, VA 22042-3000. Telephone: (703) 698-3002. Fax: (703) 698-2893.