Healthcare Disaster Preparedness: The New Normal

In the healthcare emergency preparedness arena, preparing for the unforeseen and the worst-case scenario are common themes in the development of an emergent event plan. However, Covid-19 has clearly demonstrated that healthcare institutions across the country were not properly prepared for the unforeseen. It has exposed healthcare’s inability to prepare for the worst-case scenario. Healthcare institutions need to start over, take a fresh look at how they prepare for, respond to, and train for emergent events. When developing and implementing an emergent event plan, healthcare institutions have to consider all possible scenarios and events no matter how improbable they may seem. Continually evaluate new scenarios, train hospital staff, and update emergency preparedness plans.

In my days as a security director sitting on the emergency preparedness committee, the Director of EMS, who chaired the committee, would come up with what we thought were the most outrageous disaster drill scenarios. Back in the late 1990’s we were drilling on floods, active shooters, radiological contamination and believe it or not pandemics. His insight prepared our hospital for 9/11, the city wide black out in 2003, SARS, H1N1 and the UPS driver who showed up to our ED covered in hydrochloric acid. Because of his ability to see the unforeseen, the security department was well prepared for several serious security events like a series of arsons, a murder, an active assailant event, a plane hitting an apartment complex next door, and an accidental death that could have resulted in many more if the security staff had not been properly trained.

Being prepared for any emergent event starts with a well-structured risk assessment to deepen and strengthen security response planning strategies. This means not only utilizing lessons learned, but seeking out best practices, and future trends as part of the assessment. A comprehensive assessment includes analyzing entry points, security staffing levels, traffic management, physical security systems, policies and procedures, visitor control, media relations, mass notification, and government agency support, to name a few. Emergent event risk mitigation starts with an assessment tool that can generally evaluate disaster risks. Many hospitals use the Kaiser HVA as their general assessment tool and jumping off point. To further deepen and strengthen risk mitigation efforts, healthcare institutions require an in-depth and thorough evaluation of disaster events and their potential impact on the healthcare institution. They also need to place their faith and confidence on both internal and external expertise to assist in the assessment. Utilizing experienced personnel in the disaster management helps to effectively develop an emergent event operations plan.

Risk mitigation is the most important part of any emergency preparedness process. Risk mitigation involves proactively identifying potential hazards before they occur. While a healthcare facility’s response to an emergent event begins after an incident has occurred, response activities should unfold according to a pre-planned progression determined in the mitigation phase, an Emergency Operations Plan or EOP. Key aspects in the mitigation phase of disaster planning is recognizing that a disaster is occurring, reporting the disaster to key personnel, launching the incident command center, activating the emergency operations plan, notifying and mobilizing all hospital personnel, and ensuring that all emergency units remain mobilized until the disaster is officially declared over.

Every security department should have an Emergency Operations Plan (EOP). Once an operations plan is finalized, it’s time to vigorously test the plan. This plan should be tested on a regular basis so that security personnel are familiar with the plan and their roles within the plan. Unfortunately, all too often many organizations never stress the emergency operations plan or the recovery plan. Continued testing and training on the EOP is most important. It can mean the difference between financial stability and bankruptcy. Frequently receive hands-on training reinforcing their critical role in handling disaster management issues. Training should be continuous so that Security knows their role when and if the emergency response plan is activated. A good rule of thumb is to have emergency response training conducted at annual in-service education initiatives, at in-house planned exercises, and intermittently at roll calls.  It’s important to always remember that proper planning always prevents poor performance. Operations plans should be designed with an “All-Hazards Approach,” scalable for event progression.

When managing an emergent event, security professionals must learn to adapt on the fly. Modify operations based on the current situation. Control the negative effects of the event by minimizing the impact on the facility, staff, patients, and operations. This requires competency in emergent management while understanding the long-term effects of decisions made during the management process. For example, restricting visitors and vehicles at the onset of the disaster instead of trying to implement a restriction after families and the Media have already infiltrated the facility.

Important considerations in the establishment of an emergency disaster plan is the development of procedures for re-establishing normal operations. Many emergency preparedness experts underestimate the resources and time necessary to recover adequately from an emergent event. Recovery operations should include provisions for staff, facilities, finances and community support. A detailed recovery plan should be established and include recuperation strategies that don’t interrupt normal hospital operations and help restore business operations as soon as physically possible. Recovery plans need to be reviewed and tested on a regular basis and programmatic enhancements enacted when necessary.  It is extremely important to choose the right person(s) to lead the recovery efforts when the disaster ends. A major step in the develop of an effective plan.

Considering today’s unique circumstances healthcare institutions should be enlightened to review their disaster plans. Regardless, whether the disaster is a pandemic event, terrorist attack, active assailant offense, workplace violence incident or a natural disaster, the institution must be ready to tackle the catastrophe. The key to staying one step ahead of failure is to continually evaluate existing emergency response plans and implement appropriate training to help keep hospital staff current and ready for future onslaughts.