How Hospitals Plan for Disasters Post 9/11
The events of Sept. 11, 2001 changed the rules of hospital emergency preparedness, and more than a decade later, the rules are still changing
The events of Sept. 11, 2001 changed the rules of hospital emergency preparedness. And now, more than a decade later, the rules are still changing, driven by multiple high-profile events that have highlighted the important role of health care facilities in disaster response.
The tragedy that took place on 9/11 prompted leaders of hospitals around the country to rethink their emergency response strategies. The scale of the disaster served to emphasize the need for more preparation, more training, more equipment and more involvement by hospitals across the nation to be able to respond when a large-scale event occurs.
New York's hospitals were integral to the emergency response to 9/11. Hospital EMS personnel were among the first to respond to the World Trade Center site, and many hospital personnel volunteered at ground zero to attend to rescue workers. Hospitals helped in the weeks after 9/11 by providing phone banks for relatives of victims seeking to locate their loved ones, organizing blood drives and providing grief counseling, among the many services they provided.
Disaster in many forms
Just weeks after 9/11, the anthrax scare raised another group of emergency preparedness issues and spotlighted the challenges of managing the medical and public health consequences of a biological terrorist attack. The attacks brought to light the insufficient level of bioterrorism preparedness and resources at many hospitals and illustrated the huge role that the health care community would need to play in such incidents.
In effect, the anthrax attacks extended the mission of emergency preparedness to include defending against anything unforeseen. In such situations, hospitals must be as well prepared as police, fire, rescue and other public safety services.
Between November 2002 and July 2003, an outbreak of SARS (Severe Acute Respiratory Syndrome) in Hong Kong almost became a pandemic, with 8,422 cases and 916 deaths worldwide. For the United States, the impact was minimal (there were few confirmed cases and no deaths), but a media storm spread panic and hospitals and healthcare facilities were challenged to prepare for the worst.
Later, in 2009, the emergence of the H1N1 swine flu virus again showed the need for hospitals to be prepared for a surge of activity that comes with medical pandemics.
In 2003, the second most widespread power blackout in history affected 10 million people in Ontario, Canada, and 45 million people in eight US states in the Northeast and Midwest. The blackout emphasized yet another aspect of emergency response for the nation's hospitals.
Finally, the recent spate of natural disasters, from Hurricane Katrina to tornadoes ripping through numerous states, are further evidence of the need for hospitals to prepare for disasters of all types. In natural disasters, despite the critical need to retain staff to serve patients, it is a challenge as they may have been affected personally by the disaster.
Applying lessons learned
All of these events revealed the shortcomings of hospitals to respond to mass disasters, whether a chemical, biological or nuclear attack or an accident. In response, hospitals sought to enhance disaster response capabilities by acquiring new equipment, by emphasizing training in areas such as hazardous materials and weapons of mass destruction and with additional disaster response exercises performed in collaboration with local, regional, state and federal agencies and organizations.
The onslaught of incidents also sparked several rounds of new compliance regulations. Hospitals were already familiar with the need to adhere to standards such as The Joint Commission's hospital accreditation program. In the wake of terrorist attacks and natural disasters from 9/11 to Hurricane Katrina, federal agencies have also become involved in promoting and assessing preparedness of the nation's healthcare system.
These include the Centers for Disease Control and Prevention's (CDC)'s Public Health Emergency Preparedness Program and the Health Resources and Services Administration's (HRSA) National Bioterrorism Hospital Preparedness Program.
Federal agencies from the Department of Homeland Security to the Federal Emergency Management Agency (FEMA) within it now have a stake in ensuring that hospitals are prepared for future emergencies.
Today, hospitals continually update their emergency preparedness plans to reflect lessons learned from 9/11 and other events and to base them on exercises, training and other informational resources. These emergency plans reflect the understanding of the broader role and capabilities of hospitals as part of a community's emergency response system.
An additional lesson learned is the need for target hardening at hospitals. Hospitals must lock down to protect their facilities in emergency situations and to protect important systems such as utilities and climate control (HVAC). Integrated security systems, technology and security manpower services can support a facility, mitigate risk and safety concerns and help maintain compliance.
Security and safety surveys should be conducted initially and annually thereafter to identify safety threats to a hospital and staff, while protective strategies to mitigate those threats should be taken. Documentation is an important aspect of security and safety management, including planning, post orders, hazard vulnerability assessments (HVA) and emergency operations center (EOC) annual reviews.
Informative “town meetings” can help to educate hospital administration and staff and encourage discussion of specifics on hospital security and safety procedures, personal safety tips and crime prevention awareness. Such meetings can also provide a platform for basic training in violence prevention.
Finally, drills are an important ongoing component of emergency preparedness for hospitals in the post-9/11 environment. A hospital's emergency preparedness plan should be implemented at least twice a year, whether in response to an actual emergency or as a planned drill. Internal and external disaster drills should be included, with emphasis on lessons learned and continuous improvement.
Currently, disaster preparedness in hospitals is shifting to also encompass workplace violence concerns, specifically active shooter responses. Active shooter scenarios are becoming more popular as part of emergency drills in the healthcare setting.
The trend evolves from concerns about a troubling increase in hospitals that have become targets of patients, visitors or staff who are unhappy with their treatment, or with the course of their lives, and decide to shoot doctors, nurses or significant others who are visiting or working in the healthcare setting.
This increase in healthcare violence led The Joint Commission, in June 2010, to issue Sentinel Event Alert 45 that required hospitals and healthcare institutions to develop workplace violence prevention programs and to monitor workplace violence within their institutions. Because of the horrific nature of an active shooter event, these drills should be conducted as table top exercises only.
Drills should focus on staff response to an event in the workplace, evacuation of affected areas and notification of staff and local authorities. Drills should also address law enforcement response and how to handle the media and public relations aftermath.
Preparing for the unpredictable
Timely and efficient emergency response is critical to enable the nation's hospitals to react to a worst-case scenario. The elements of the next big disaster are unpredictable; its scope is unknown. What is clear, however, is that when something does happen, it will be too late to plan and prepare to protect facilities, assets and people. Hospitals, therefore, must commit time and resources to get ready before it’s too late.
Ben Scaglione, Director of Healthcare, G4S Secure Solutions (USA).
This article was published in Homeland Security Today on July 17, 2012: How Hospitals Plan for Disasters
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