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The author discusses a new requirement in NFPA 99 for healthcare facilities--the implementation of an Incident Command System in the event of a disaster. He offers suggestions on how facilities can change their disaster plans to meet this new standard.
INTRODUCTION: Recently, mass-casualty incident (MCI) preparedness and training has received increasing attention at the hospital level. OBJECTIVES: To review the existing evidence on the effectiveness of disaster drills, technology-based interventions and tabletop exercises in training hospital staff to respond to an MCI. METHODS: A systematic, evidence-based process was conducted incorporating expert panel input and a literature review with the key terms: "mass casualty", "disaster", "disaster planning", and "drill". Paired investigators reviewed citation abstracts to identify articles that included evaluation of disaster training for hospital staff. Data were abstracted from the studies (e.g., MCI type, training intervention, staff targeted, objectives, evaluation methods, and results). Study quality was reviewed using standardized criteria. RESULTS: Of 243 potentially relevant citations, 21 met the defined criteria. Studies varied in terms of targeted staff, learning objectives, outcomes, and evaluation methods. Most were characterized by significant limitations in design and evaluation methods. Seventeen addressed the effectiveness of disaster drills in training hospital staff in responding to an MCI, four addressed technology-based interventions, and none addressed tabletop exercises. The existing evidence suggests that hospital disaster drills are effective in allowing hospital employees to become familiar with disaster procedures, identify problems in different components of response (e.g., incident command, communications, triage, patient flow, materials and resources, and security) and provide the opportunity to apply lessons learned to disaster response. The strength of evidence on other training methods is insufficient to draw valid recommendations. CONCLUSIONS: Current evidence on the effectiveness of MCI training for hospital staff is limited. A number of studies suggest that disaster drills can be effective in training hospital staff. However, more attention should be directed to evaluating the effectiveness of disaster training activities in a scientifically rigorous manner.
The fiery crash of a DC-10 at Sioux City, Iowa, on July 19, 1989, caused a crisis of major proportions, with attendant mental health needs. Various articles have described the need for psychological response teams in such crises. The present article provides practical guidelines for the preparation of a mental health disaster plan and for the coordination of a mental health team responding to a major air disaster. Such disasters can occur in any part of the country at any time. It is hoped that the suggestions in the present article will help teams that respond to future air disasters provide more rapid, effective, and efficient delivery of services to the survivors and their families, and the families of those who are killed.
Preparing for and recovering from disasters Planning is the most important thing a medical practice can do to prepare for a disaster. Learn from the experiences of a medical group in Florida that weathered four hurricanes in 2004. Its trials provide insights for other groups that might suffer calamities such as blizzards, floods, tornadoes, earthquakes, blackouts and even acts of terrorism.
OBJECTIVE: Recent school shootings and terrorist events have demonstrated the need for well-coordinated planning for school-based mass-casualty events. The objective of this study was to document the preparedness of public schools in the United States for the prevention of and the response to a mass-casualty event. METHODS: A survey was mailed to 3670 school superintendents of public school districts that were chosen at random from a list of school districts from the National Center for Education Statistics of the US Department of Education in January 2004. A second mailing was sent to nonresponders in May 2004. Descriptive statistics were used for survey variables, and the chi2 test was used to compare urban versus rural preparedness. RESULTS: The response rate was 58.2% (2137 usable surveys returned). Most (86.3%) school superintendents reported having a response plan, but fewer (57.2%) have a plan for prevention. Most (95.6%) have an evacuation plan, but almost one third (30%) had never conducted a drill. Almost one quarter (22.1%) have no disaster plan provisions for children with special health care needs, and one quarter reported having no plans for postdisaster counseling. Almost half (42.8%) had never met with local ambulance officials to discuss emergency planning. Urban school districts were better prepared than rural districts on almost all measures in the survey. CONCLUSIONS: There are important deficiencies in school emergency/disaster planning. Rural districts are less well prepared than urban districts. Disaster/mass-casualty preparedness of schools should be improved through coordination of school officials and local medical and emergency officials.
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When one agency's building was in danger of collapsing, administrators and employees worked together to keep things running during the crisis. Afterwards, they created new disaster plans from the knowledge they gained from the experience.
INTRODUCTION: This study was conducted to examine the preparedness of emergency departments (EDs) to safely receive, decontaminate, and treat chemically contaminated patients. METHODS: The safety officers of all 58 acute-care hospitals in the five-county philadelphia metropolitan region were surveyed by mail, with a repeat mailing to nonresponders followed by telephone contact. The 16 survey questions addressed the ability of EDs to safely decontaminate and treat chemically contaminated patients. RESULTS: Thirty-eight of 58 hospitals (66%) returned usable surveys. Of these, 24 (63%) have a written plan for decontamination and treatment of chemically contaminated patients in the ED, and 19 (50%) have a hospital-wide disaster plan that includes contingencies for decontamination and treatment of one or more chemically contaminated patients. Thirteen hospitals (34%) conducted a drill of either of these plans in 1994. Twenty (53%) EDs have a specific treatment area for chemically contaminated patients. A stock of supplies for protecting the ED from secondary contamination is maintained by 16 (42%). While 24 (63%) store personal protective equipment, most of these involve only gowns, gloves, and surgical masks; only 13 provide any type of respiratory protection. Nine respondents were certain that patients brought in by local EMS would have been adequately decontaminated in the field, eight stated that they believed or felt decontamination would be adequate, and 12 were concerned that field decontamination might not be adequate. Eighteen hospitals (47%) reported treating one or more chemically contaminated patients in 1994. The authors believe the return rate reflects reluctance to commit hospital policies to paper. This was confirmed during telephone follow-up of nonrespondents when, for example, one safety officer discussed hazardous materials (hazmat) principles for 40 minutes, but refused to complete the survey. CONCLUSIONS: Hospital hazmat preparedness in this area varies tremendously. A significant proportion of hospitals lack a written plan and equipment to allow the ED to safely and effectively handle the chemically contaminated patient. There is reluctance to discuss this topic.
Gender is a central organising principle in social life and hence in disaster-affected communities, yet gender issues are rarely examined by disaster scholars or practitioners. Building on findings from emerging and industrial nations, three key research directions are identified: How is gendered vulnerability to disaster constructed? How do gender relations shape the practice of disaster planning and response in households and organisations? How are gender relations affected over time by the social experience of disaster? The discussion suggests how analysis of the gendered terrain of disaster both develops disaster theory and fosters more equitable and effective disaster practice.
In the event of a bio-terrorism event, the role of the hospital security department will be critical if the disaster plans of health care providers are to be successfully carried out. It is imperative, says the author, that security providers be involved in every step of disaster and emergency response planning.
Disaster planning is an arduous task. Perhaps no form of disaster is more difficult to prepare for than one resulting from the intentional, covert release of a biological pathogen or toxin. The complexities of response operations and the perils of inadequate preparation cannot be overemphasized. Even with detailed planning, deviations from anticipated emergency operations plans are likely to occur. Several federal programs have been initiated to assist communities in enhancing their preparedness for events involving biological and other agents of mass destruction. Many of these, such as the Metropolitan Medical Response Systems (MMRS) Program [37,38], will be discussed elsewhere. Community preparedness will be enhanced by: 1. Implementing a real-time public health disease surveillance program linking local healthcare, emergency care, EMS, the CDC, local law enforcement, and the FBI 2. Improved real-time regional patient and healthcare capacity status management 3. Development of affordable, accurate biological agent detection systems 4. Incorporation of standardized education and training curricula (appropriate for audience) on terrorism and biological agents into healthcare training programs 5. Expansion of federal and state programs to assist communities in system development 6. Increased public awareness and education programs.
Two major train crashes in February--one in Northern New Jersey and the other in Silver Spring, MD, near Washington, DC--posed severe challenges to the disaster plans of area hospitals. The first crash involving two commuter trains near Secaucus, NJ, tested the effectiveness of emergency plans at the Jersey City Medical Center, Jersey City, NJ, and the Meadowlands Hospital Medical Center, Secaucus. The incident occurred at approximately 8:40 a.m. and resulted in three deaths and 162 injuries. The Silver Spring crash, which took place a week after the one in New Jersey, occurred in early evening and involved an Amtrak and a commuter train. It resulted in 11 deaths and 26 injuries. Holy Cross Hospital, Silver Spring, was the primary caregiver. In this report, we'll provide details on how the incidents impacted on nearby hospitals and their security staffs; how challenges, anticipated and unanticipated, were met; and what conclusions were reached in follow-up critiques.
Although having a comprehensive disaster plan in place and augmenting it with regular drills is essential in preparing for an emergency, unforeseen challenges inevitably arise when a disaster occurs. In this article, hospital officials who have experienced such emergencies share the lessons they learned from an actual event.
The State of Rhode Island conducted an exercise to obtain and dispense a large volume of emergency medical supplies in response to a mass casualty incident. The exercise was conducted in stages that included requesting supplies from the Strategic National Stockpile and distributing the supplies around the state. The lessons learned included how to better structure an exercise, what types of problems were encountered with requesting and distributing supplies, how to better work with members of the private medical community who are not involved in disaster planning, and how to become aware of the needs of special population groups.
The discussion herein concerns important factors in the local management of disasters. We contrast this with the related but distinct process of disaster planning. Our assumption is that what is crucial is not management per se, but good management. Thus, to assess intelligently the management of community disasters requires an answer to the question: What is good management? The results of empirical research carried out by social scientists over the past 40 years are drawn upon in considering this question. The criteria identified entail: (1) correctly recognising differences between response and agent-generated demands; (2) adequately carrying out generic functions; (3) effectively mobilising personnel and resources; (4) generating an appropriate delegation of tasks and division of labour; (5) adequately processing information; (6) properly exercising decision-making; (7) developing overall coordination; (8) blending emergent and established organisational behaviours; (9) providing appropriate reports for the news media; and (10) having a well-functioning emergency operations centre. An issue also raised in the paper is how applicable these research findings-derived mostly from developed countries-are to the developing world.
Every hospital has a fire safety plan, although some fail to update their plans when circumstances change, such as when the facility is refurbished or new fire protection equipment is added, or when new wings bring in additional patients and staff. Others may fail to develop new education programs to heighten staff awareness of what is expected of them during a fire and to train employees to meet those expectations. In this report, we'll examine the new fire safety plans at two Massachusetts hospitals and the revisions they made to address these issues. We'll offer suggestions for effectively evaluating and revising your own fire safety plans.
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