Approved by the Board of Governors Nov. 16, 2020.
Statement of the Issue
Due to constantly evolving threats and the complex nature of emergency management, it is critical that healthcare executives ensure their organization develops an all-hazards emergency management program and plan relevant to their location and type of organization.
Hospitals and other healthcare delivery organizations must be prepared to care for those in need of medical services and, to the extent possible, protect staff and patients from being exposed to any further risk. The organization’s emergency operations plan should recognize that a healthcare organization may be directly impacted by a disaster and still continue to operate and receive victims of the event. Such disasters include incidents of terrorism and natural occurrences such as hurricanes, tornados, floods, earthquakes or epidemics/pandemics. Organizations should recognize that disasters such as pandemics may be long-lasting in nature, and multiple disasters may occur simultaneously.
It is vitally important that healthcare organizations develop an emergency management program to support the development and maintenance of critical emergency operations components such as the emergency operations plan, training and exercises and collaborative relationships. Healthcare organizations must monitor and update their emergency operations plans on an ongoing basis, maintaining a constant state of preparedness to ensure appropriate response and recovery within the shortest possible time frames. Such plans should be developed to include long-term disasters. Without proper planning, an incident involving the organization may result in either a temporary or permanent failure, thus disabling a crucial community resource. The emergency operations plan also should be fully integrated with that of other organizations and appropriate agencies at the local, state, regional and national levels. This is particularly important in situations such as a pandemic that may simultaneously impact large geographic areas for several months and disrupt national and international supply chains.
Policy Position
The American College of Healthcare Executives believes healthcare executives should actively participate in disaster planning and preparedness activities, striving to ensure that their emergency operations plan fits within overall community plans and represents a responsible approach to the risks an organization might face. CEOs should lead efforts to ensure that the plan is comprehensive, including establishing board policy that delineates the organization’s responsibilities and procedures to be followed. Healthcare executives also have a unique opportunity to help educate the community about infectious disease prevention and control efforts that may mitigate large-scale death during events such as a pandemic.
In developing a comprehensive emergency operations plan, ACHE encourages healthcare executives to pursue the following actions on an ongoing basis:
- Maintain a Relevant/Current Emergency/Disaster Plan: Establish a process to understand and stay current regarding applicable state and national standards for emergency preparedness, including the National Response Framework (http://www.fema.gov/national-planning-frameworks) and the Hospital Preparedness Program (http://www.phe.gov/Preparedness/planning/hpp/Pages/default.aspx). In addition to changes in standards, the organization’s emergency/disaster plan should be updated based on actual disasters or drills. Healthcare executives should also participate in training and educational programs to stay abreast of evolving disaster management systems. Organizations must keep up to date with local, state and federal regulations, including those dictated by the Centers for Medicare and Medicaid Services. During and after the disaster, organizations should debrief and prepare a list of "lessons learned" that can then be incorporated into the plan for future disasters or as a current disaster develops.
- Address the Safety of Staff/Patients/Families: Develop policies and processes to ensure that all reasonable efforts are made to protect employees, patients and families, as well as facilities, while maintaining quality patient care to the best of the organization’s ability during a crisis. Include plans to mitigate the impact on staffing of likely scenarios such as schools closing, public transportation closing, roads closing, damage to bridges, tunnels and other access points, and patients presenting with contagious/potentially lethal illnesses. Ensure that staff members receive education that allows them to make informed decisions and to understand what the organization is doing to protect them and their families. Organizations should maintain an adequate inventory/stockpile of personal protective equipment that includes some surge capacity for staff and patients. Some types of emergencies can be traumatizing for patients, their families and staff; incorporate disaster mental health services in the planning process to address needs that emerge during response and over prolonged recovery periods.
- Focus the Plan to Address the Most Likely Scenarios: Adopt an all-hazards framework to analyze the operational issues that would arise in relevant emergency situations to cover applicable responses to a natural disaster as well as potential CBRNE (chemical, biological, radiological, nuclear and explosive) emergencies and sustained events such as a pandemic influenza.
- Develop an Incident Command System: Adopt an incident command system and support the integration of a nationwide standardized approach to incident management and response (e.g., the National Incident Management System). Ensure frequent and consistent training and drilling on the activation and implementation of the incident command system. Secure telephones should be part of standard preparedness equipment.
- Assess Resource Availability: Coordinate and integrate organizational resources to address a full spectrum of actions (mitigation, preparedness, response and recovery), and ensure that the organization has the appropriate programs, trained and credentialed staff, staff personal protective equipment, and other supplies and equipment in place to quickly respond to events that their organization might face, as identified by the organization’s all-hazards analysis. Include a determination of the impact on hospital services of a scenario that requires maximum surge capacity.
- Plan for Continuity of Operations: Ensure that the hospital can be self-sustaining for at least 96 hours and that plans are in place for obtaining critical resources such as medications, oxygen, food, water, electricity, fuel for electric generators, and just-in-time supplies that may not be available due to the emergency. Maintain an updated roster of a multidisciplinary team available to stay at the facility for the first 72 hours of the emergency. Plan for long-term resources and staffing support if needed, including planning for supply-chain disruptions or potential competition with other organizations for resources. Review suppliers' capacity and vulnerability of their own supply chain to ensure their reliability during a disaster. Communicate in advance with local utilities, telecommunications, transportation companies and other essential vendors to plan for uninterrupted or redundant services to support continuity.
- Develop Protocols to Ensure Appropriate Resource Allocation: Ensure that services are provided equitably and impartially, consistent with ethical and legal standards relevant in a mass casualty event and based on the vulnerability and needs of the individuals and communities affected by a disaster. To mitigate or manage surge to hospital emergency departments, include in the pre-planning process any providers or agencies with expertise serving vulnerable populations in the community, particularly individuals with disabilities, serious chronic conditions and needs (e.g., dialysis or ventilator-dependent, seriously mentally ill), low-English proficiency, or access and functional needs. Work with other community and regional hospitals to build healthcare coalitions to deal with mass casualty incidents and other community disasters, and to reduce the duplications of responses and resource competition.
- Design Appropriate Communication and Coordination Protocols for Both Internal and External Audiences: Forge and maintain strong relationships and ensure active involvement in interagency planning efforts with all relevant organizations. Develop an integrated communication plan and communitywide exercises and drills to assess effectiveness and implement improvements.
- Enhance Disease Surveillance and Reporting: Enhance clinician awareness of events, signs, symptoms or diseases that may require reporting or activation of an emergency operations plan.
As a critical component of a community’s infrastructure, healthcare organizations should require proper planning for all-hazards events they may face. Healthcare executives should be active leaders in that planning and the creation of systems and processes to ensure that the emergency operations plan can be effectively and efficiently executed if ever needed.
Policy created: November 2006
Last revised: November 2018
Related Resources
ASPR's MSCC: The Healthcare Coalition in Emergency Response and Recovery https://www.phe.gov/Preparedness/planning/mscc/healthcarecoalition/Pages/default.aspx
McGlowan, K. Joanne, PhD, RN, FACHE, and Robinson, Phillip D., FACHE. Anticipate, Respond, Recover: Healthcare Leadership and Catastrophic Events. Chicago: Health Administration Press (2011).
Wargo, Michael, RN, and Geiger, James, FACHE. Surviving a Critical Incident (webinar CD; initially offered Dec. 7, 2011).
Centers for Medicare & Medicaid Services, “Emergency Preparedness Rule,” https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/Emergency-Prep-Rule.html.