TJC Issues Sentinel Event Alert on Responding to Severe Weather Incidents

By Greg Freeman

On the heels of recent hurricanes and other severe weather, The Joint Commission (TJC) has issued a Sentinel Event Alert, “Environmental disasters: Preparing to safely evacuate or shelter in place.” The alert outlines steps for healthcare organizations to consider as they prepare for weather and climate-related disasters, such as hurricanes, tornadoes, wildfires, floods, and extreme heat.

The Sentinel Event Alert is available online at https://bit.ly/3Z4pAsp.

TJC wants healthcare organizations to think ahead when it comes to natural disaster preparedness, says Henry Norwood, JD, an attorney with the Kaufman Dolowich law firm in San Francisco. With natural disasters on the rise, patients under the care of health organizations may be at greater risk if the organization’s operations are knocked offline, he says. TJC’s standards require health organizations to implement a comprehensive emergency management program, providing an overall, detailed analysis of how the organization will handle environmental disasters, he notes.

The guidance permits either several specific programs for various types of environmental disasters or an “all-hazards approach” of designing a single plan for all environmental disasters. The organization’s plan should include details regarding continuing operations, providing essential needs to patients and staff, periodic risk and vulnerability assessments, evacuation and shelter-in-place procedures, and coordination with federal agencies, such as the Federal Emergency Management Agency, Norwood explains.

Ensuring critical operations can continue despite an environmental disaster may be the most challenging hurdle health organizations face, particularly for critical care organizations, such as hospitals, he says.

“Providing failsafe systems, such as backup electric generators, alternative water sources, an emergency communications system, and a backup data storage system, can help organizations to continue providing critical services during a disaster,” Norwood says. “Every organization can benefit from planning ahead for major environmental events. The Joint Commission’s Alert on environmental disasters is a canary in the coal mine that should be heeded by health organizations.”

The Sentinel Event Alert emphasizes the importance of readiness for severe weather like hurricanes and wildfires, says Paul F. Schmeltzer, JD, member with the Clark Hill law firm in Los Angeles. The key expectations are ones that hospitals already should have implemented in response to their annual security risk assessments, he says.

“Any comprehensive risk analysis undertaken by a hospital should include developing comprehensive emergency plans, ensuring resilient infrastructure, establishing clear communication strategies, and training staff for rapid response to any emergency, whether the emergency originates from external and internal threats from malicious actors or environmental disasters,” Schmeltzer says. “This is often accomplished by the hospital implementing an incident response plan and disaster recovery plan to mitigate the effects of a security event or environmental disaster, and minimize damage to the hospital’s operations, finances, and reputation.”

Hospitals should conduct hazard vulnerability assessments regularly and maintain supplies for extended disruptions. They also should consider their staffing needs during an emergency and train their staff accordingly as to how to adapt to whatever emergency occurs. In an environmental disaster, hospital staff may be forced to revert to paper records or manual patient monitoring, he says.

“They may also have to decide where they will evacuate acute or long-term patients during an emergency. If evacuation is not possible, does the hospital have the equipment such as generators to continue treating patients during the emergency?” he says. “Having an effective training program in place prior to an emergency can lower the overall impact to the hospital.”

Hospitals also will need to contemplate alternative forms of communication during an environmental disaster. The hospital should maintain a document that lists the phone numbers and email addresses of key staff members that can be quickly accessed during an emergency, Schmeltzer says.

There are several challenges that hospitals may face when trying to meet these expectations, Schmeltzer says, including the financial burden of infrastructure upgrades, logistical complexities in coordinating emergency supplies, and difficulties in maintaining communication during outages or widespread disruptions.

“Staffing constraints and the unpredictability of natural events also add layers of complexity,” he says. “However, if the hospital has properly considered and addressed the risks inherent to their organization, they should have addressed most, if not all, of these expectations as part of a risk management program.”

Difficult During Disaster

The alert’s expectations are useful, but they can be difficult to implement in the face of a real disaster, says Kevin Huffman, DO, a bariatric physician in Elyria, OH. Among the most critical demands is the ability to evacuate or hide patients and personnel safely, he says. This may seem obvious, but hospitals often treat severely ill, immobile patients who need specific medical attention.

“It’s important to create elaborate evacuation plans to address these needs. Furthermore, having enough supplies and equipment in the event of a disaster, including medication, oxygen tanks, and backup power sources, is critical for maintaining patient care during an extended shelter-in-place period,” Huffman says.

A second problem is communication in the aftermath of a disaster. The warning reiterates the need for a strong communications infrastructure, he notes.

Hospitals have to keep lines of communication open between employees, patients, and families even when communication infrastructures break down. Investing in good backups and educating your employees on alternate communication methods is essential, Huffman says.

“The Joint Commission’s Sentinel Event Alert offers a critical path to preparedness. But translating those goals into action plans means that they must take into account the unique demands and resources of a hospital setting,” he says. “Hospitals must carry out rigorous risk analyses, develop customized plans, and hold regular exercises to keep all employees prepared for a wide variety of environmental catastrophe scenarios.”

Healthcare organizations will face challenges when complying with TJC’s recommendations, says Maria Knöbel MBBS, ARCS, Dip, BSLM, IBLM, MRCGP, medical director of Medical Cert UK in London.

“The Joint Commission’s alert about disaster preparedness is spot-on, but in reality, hospitals face significant challenges when trying to meet those expectations,” she says. “The idea of having a clear disaster plan, making sure patients are safe, and having enough staff ready to respond sounds straightforward, but executing it is another matter.”

For starters, she says staffing always is a concern. In the middle of a disaster, many healthcare workers are affected, too, whether their homes are damaged or they need to take care of family members. That’s going to affect how many people can show up for work, and it’s not something you can just plan for, she says.

“Hospitals also need resources like backup power and emergency supplies, but securing and distributing those resources during a disaster is no easy feat. Transport delays or supply shortages can slow down even the best plans,” Knöbel says.

And then there is the technology side of things. Electronic health records are great, she says, but what happens if the system goes down or is not accessible? Hospitals need to have a plan B for that, too.

“Overall, while the guidelines are good, actually putting them into action when disaster strikes is tough,” she says. “There’s a lot to juggle, and it’s hard to account for every possible scenario.”

Sources

• Maria Knöbel MBBS, ARCS, Dip, BSLM, IBLM, MRCGP, Medical Director, Medical Cert UK, London, England. Email: [email protected].
• Henry Norwood, JD, Kaufman Dolowich, San Francisco. Telephone: (628) 219-9814. Email: [email protected].
• Paul F. Schmeltzer, JD, Member, Clark Hill, Los Angeles. Telephone: (213) 417-5163. Email: [email protected].

Greg Freeman has worked with Relias Media and its predecessor companies since 1989, moving from assistant staff writer to executive editor before becoming a freelance writer. He has been the editor of Healthcare Risk Management since 1992 and provides research and content for other Relias Media products. In addition to his work with Relias Media, Greg provides other freelance writing services and is the author of seven narrative nonfiction books on wartime experiences and other historical events.