The devastation of American cities caused by Hurricane Katrina, combined with World Health Organization warnings about the possibility of an influenza pandemic and a continued heightened awareness of potential terrorist attacks, raise new concerns about the ability of the healthcare system to effectively respond to disasters. During crises, healthcare organizations must act quickly to meet the demands of their communities.
Makeshift—or “surge”—facilities provide care for the surging number of patients until normal operations can resume. These care sites can’t be thought of in traditional terms of brick-and-mortar hospitals. Instead, surge facilities protect brick-and-mortar facilities from a surge of patients who do not require acute intervention, or to protect brick-and-mortar facilities attempting to recover from damage.
Hurricane Katrina demonstrated, however, that even those communities with comprehensive plans for emergency response face considerable difficulties when major parts of infrastructure for medical care are significantly damaged. If almost all healthcare capabilities in a neighborhood, city, or even an entire region are damaged and the water supply, sewage system, and electricity are affected, how do communities cope with the surge? Such destruction also may force surge facilities to continue operations for weeks or months—instead of the hours or days that have typically been contemplated in the past.
The challenge for healthcare organizations is to work with local, state, and federal officials to develop comprehensive plans for meeting medical needs during community-wide emergencies. This article explores the obstacles and strategies to developing comprehensive, community-wide emergency plans, how healthcare and community leaders can understand the role of surge facilities, and how to establish these critical links to maintaining care. The goal of emergency planning is mitigation, preparedness, response, and recovery. Surge facilities may have a role in most of the components of emergency planning.
Planning for Emergencies
The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and the federal government have long required thorough accreditation standards and Conditions of Participation, respectively, in order to help hospitals plan for emergencies. JCAHO, which has been actively involved in disaster preparedness for more than 30 years, increased its focus on emergency management in January 2001—nine months prior to the September 11 attacks on New York City and Washington, D.C. It has since worked even more closely with emergency management experts and healthcare organizations to make this issue a priority.
The resulting modified accreditation standards and overall guidelines developed by expert consensus reflect the need for hospitals and other healthcare organizations to be involved in community-wide planning, in addition to planning for an emergency at that particular institution.
Develop Emergency Management Plans
JCAHO’s Management of the Environment of Care (EC) standards call on hospitals to develop an emergency management plan that—among other requirements—ensures an effective response to emergencies through the implementation of the plan and execution of the plan by conducting emergency management drills. Hospitals also must participate with the community to establish priorities among potential emergencies, define the organization’s role in the community’s emergency management program, and link with the community’s command structure. (Note: EC.4.10, which addresses the entire topic of emergency management, also calls for hospitals to conduct a hazard-vulnerability analysis, which is discussed below.)
While recent national attention has focused on the emergencies created by Hurricane Katrina and the perceived lack of rapid federal response, JCAHO standards emphasize the need to consider a variety of natural or manmade events that suddenly or significantly disrupt the environment of care, disrupt care and treatment, and change or increase demands for the organization’s services.