A Sample Fire Safety Plan…3 Hospital Planning Considerations…4 Aging Services Facility Planning Considerations…7 Emergency Management Self-assessment Checklist…10 Resources…12 REPUBLISHED 2013 Emergency Management Planning: Assessing the Risks, Preparing for Recovery Hurricane Sandy in October 2012 incapacitated four New York those organizations that have invested sufficient effort in recovery City hospitals (including Bellevue Hospital, the city’s major public planning will be better able not only to minimize losses and costly trauma center), disrupting the city’s healthcare delivery system. interruptions, but also to provide essential emergency services for Similarly, the massive tornado that flattened much of Joplin, their community. (For more detailed information about continuity Missouri in May 2011 destroyed one of the town’s two hospitals, and insurance considerations, see “What’s So Important About killing several patients and staff – exactly when the local populace Business Interruption Coverage?,” a CNA risk management bulletin.* was most in need of emergency care. The two disasters served Brokers are another important source of information about busi- as a grim reminder of nature’s ability to inflict catastrophic loss on ness interruption risks and strategies.) healthcare facilities of every description, from large systems to This CNA resource presents general strategies and safety meas- small specialty providers. ures to help identify disaster-related risks and potential losses, Hurricane Sandy and the Joplin tornado also demonstrate why all protect patients/residents and staff from danger, and minimize organizations need a workable, detailed, enterprise-wide emergency disruption to both clinical practice and business operations. Side- management plan addressing both natural and man-made crises. bars address specific planning considerations for hospitals and The time spent creating this plan – and on reviewing and updat- aging services settings. ing it – can be of vital importance if disaster strikes. It may even Faced with the pressing concerns of the moment, leadership may mean the difference between organizational survival and failure. be tempted to postpone emergency preparedness planning. A key element in any risk management strategy is adequate insur- However, such delay can have serious consequences for patients, ance, including professional and general liability, as well as coverage staff and the organization, as well as the larger community. The for property damage, fire and business interruption. However, time to plan for disasters is now. insurance generally will not cover all losses and cannot safeguard * “What’s So Important About Business Interruption Coverage?” can be downloaded at http://www.cna. patients/residents, prevent loss of vital records and data, or restore com/vcm_content/CNA/internet/Static%20File%20for%20Download/SalesCenter/NonCo-brandable/ Risk%20Control/RcArtBusinessInterruption_CNA.pdf. Readers can also contact CNA Risk Control, which the organization’s reputation if care is compromised due to post- has a team of accredited business continuity specialists on staff, by telephone at (866) 262-0540. disaster operational breakdowns. In the event of a catastrophe, A RISK MANAGEMENT RESOURCE FOR THE HEALTHCARE INDUSTRY INItIAtINg tHE PLANNINg PRoCESS By understanding all four phases of emergency management, While natural disasters cannot be prevented, their effect may be organizations are better prepared to address a crisis from beginning mitigated through careful planning. According to the American to end, thus minimizing uncertainty and facilitating recovery. Society for Healthcare Risk Management, a comprehensive emer- Leadership can initiate the planning process and assess organiza- gency management plan has four basic components: tional readiness by asking certain fundamental questions: Prevention – Identification and minimization of avoidable risks by Does the organization have a top-down commitment an educated and committed leadership team. to emergency management planning? What types of adverse incidents or disasters are most Preparation – Drafting of a wide-ranging interdisciplinary plan, likely to occur? encompassing hazard vulnerability analysis, emergency coordina- tion, response measures, mandatory staff training, and testing of Are administrators and staff adequately prepared to vital operational and backup systems. respond to these emergency/disaster scenarios? What insurance coverage is needed, based on the Implementation – Designation of a command center, evacuation organization’s specific exposures? determination, patient/resident tracking, and initiation of emer- What other steps can the organization implement in order gency security and communication procedures, as well as docu- to reduce its vulnerability to loss? mentation of decisions and other actions taken during the critical period just before, during and immediately after a disaster. Is there an adequate infrastructure in place – e.g., robust communication system, sturdy construction features, estab- Recovery – Business continuity planning, as well as such post-event lished command structure, and backup power and water actions as insurance carrier notification, debriefing, and assess- supplies – to withstand an emergency or disaster? ing the emergency management plan in terms of both concept Are communication channels in place with local and and execution. regional authorities and disaster response agencies? Have plans been drafted to safeguard patients/residents in an emergency/disaster situation, whether the decision is made to evacuate or shelter in place? Are paper records and files adequately protected in case of a potential fire, flood or other disaster, and are electronic data backed up and stored off site? By understanding all four phases of Is a continuity plan in place to help the organization continue operating, even if one or more facilities are emergency management – prevention, damaged or destroyed? preparation, implementation and The emergency management plan is an ongoing response to these questions. Once the plan has been created and implemented, it recovery – organizations are better must then be tested for effectiveness, disseminated to staff, and regularly reassessed and updated. prepared to address a crisis from IDENtIFyINg RISkS beginning to end, thus minimizing Begin the process of identifying disaster-related risks by assem- bling an emergency planning and response team. The team should uncertainty and facilitating recovery. comprise not only risk management and security personnel, but also managers from such areas as human resources, safety, infor- mation management, finance and all clinical disciplines. It should be large enough to function even if some members are incapaci- tated or out of contact when the event occurs, and should include participation by senior management to ensure enterprise-wide acceptance. The team will also be responsible for implementing the plan in the event of a disaster. 2 CNA EMERGENCY MANAGEMENT PLANNING… A Sample Fire Safety Plan Fires are the most common emergency situation and hence serve as a good starting point for emergency planning efforts. During a serious fire or similar emergency, firefighters will probably take command of the facility. Therefore, it is important to develop the fire prevention and safety plan in coordination with local fire departments. The fire safety plan should assign responsibility for the following measures, among others: Before After - implementing and enforcing proper disposal procedures - securing the fire area to avoid reignition for flammable materials - accounting for all patients/residents and staff by name - regularly inspecting the electrical system - notifying authorities if arson is a possibility - ensuring that evacuation routes are well-marked - informing relevant insurance companies as soon as and clear of obstruction possible, and following their recovery suggestions - checking and maintaining fire protection equipment – - cleaning up excess water quickly to reduce staining, including extinguishers, smoke detectors, sprinklers, mold and other post-fire damage fire doors and alarm systems – according to manufacturer - beginning salvage operations, while taking care not to recommendations disrupt ongoing insurance or criminal investigations - Conducting in-place fire drills at regular intervals, - debriefing staff and evaluating emergency response followed by evaluation and recommendations protocols and plan execution During This basic format can be followed for other types of disasters, - declaring an emergency and mobilizing internal including tornadoes, floods, utility outages, hazardous chemical emergency responders releases, wildfires and disease outbreaks. - notifying the fire department of the intensity and exact location of the fire - implementing initial safety steps, such as ensuring that fire doors have closed properly - dousing smaller and more manageable fires manually, using the facility’s extinguishers or hoses - evacuating employees, patients/residents and visitors, if necessary - ensuring that fire protection valves are open and fire pumps are operating - providing clear access for fire trucks and other emergency vehicles - meeting arriving firefighters and providing them with necessary information - removing or covering combustibles, such as oxygen tanks, when possible CNA EMERGENCY MANAGEMENT PLANNING… 3 Hospital Planning Considerations Hospital emergency management plans must address emergency