Emergency and Disaster Preparedness

Overview

Recent studies and government reports continue to express concerns that hospitals are not adequately integrated into community planning. Moreover, many hospitals remain unprepared in terms of comprehensive response plans, adequate participation in drills, and resources and training. Many hospitals are also not collaborating with other agencies. Surveys of hospital emergency departments have found deficiencies in the knowledge, plans, and resources for responding to hazardous materials (HAZMAT) or radiation incidents. Recent events that were small in scale by comparison with the potential for damage have overwhelmed healthcare facilities; lack of appropriate preparedness plans or familiarity with them as well as the delayed use of personal protection equipment (PPE) have resulted in healthcare staff becoming unnecessarily exposed to toxic agents and subsequently becoming ill. Such was the case in Tokyo during the 1995 subway attacks with sarin nerve gas. Yet during the initial 2 to 3 days of a disaster, local agencies, including hospitals, are the initial responders. Therefore, hospital personnel must be able to meet the challenges of organizing and implementing a mass medical response that may require unfamiliar activities such as decontamination, which is not a part of daily routine practices.

Clearly, community emergency and disaster preparedness is a complex undertaking given the number of stakeholders and responder agencies, local vulnerabilities, disparate resources, and potential hazards. As such, it is imperative that all healthcare facilities have preparedness plans in place, practice these plans on a regular basis, and ensure that these activities are integrated with multiple agencies that are responsible for a mass casualty event.

Components of Disaster Planning

Preparing for mass casualties from natural disasters, technologic disasters, and terrorism requires a multisystem approach that involves local and federal public health agencies along with other emergency networks and healthcare facilities. The basic components of such a plan include the following: hospital incident command system (HICS), hospital personnel, network of communication, first responders, PPE, cancellation of nonessential services and procedures, obtaining necessary supplies and medications, triaging both patients and vital resources, medical surge capacity, security [Page 343]issues, National Incident Management System (NIMS) compliance, and critical analysis. Each of these components is discussed further below.