Professional Documents
Culture Documents
available online in the Drills and Exercises section of the Emergency Preparedness Resource Center on GNYHAs Web site, www.gnyha.org/ eprc/general/drills_exercises. Following actual emergency events (for instance, the regional power outage of August 2003), GNYHA has held debriefing sessions with members and governmental agencies to discuss lessons learned from those events. GNYHA staff has also coordinated the hospital component for numerous exercises organized by the New York State Department of Health, the New York City Department of Health and Mental Hygiene, the New York City Office of Emergency Management (OEM), the Westchester County Department of Emergency Services, and other governmental agencies that have held regional emergency management exercises. Finally, GNYHA has organized two tabletop exercisesone in June 2003 designed by the Naval War College, and the other designed by GNYHAs Workgroup on Emergency Management Drills in June 2004as well as four drills of the New York State Health Emergency Response Data System, known as HERDS, and drills of OEMs 800 MHz radio system.
ACKNOWLEDGMENTS
GNYHA would like to thank its Workgroup on Emergency Management Drills, and specifically Karen Biancolillo, R.N.; Kevin Brown, M.D.; Kevin Chason, D.O.; Andrew Chen; Jack Delaney; Dario Gonzalez, M.D.; Mark Marino; Frank Mineo; Brian ONeill; Steven H. Silber, D.O.; and Joseph Stevens. This brochure was produced by GNYHA and funded by a generous grant from the Federal Health Resources and Services Administration to the New York State Department of Health and Health Research, Inc., under grant/contract number 6U3RMC000260203.
ii
Drills and exercises should ideally test as many of the four phases of emergency management as possible, although they may not necessarily test them all at the same time.
identify potential emergencies that could affect the need for its [the health care facilitys] services or its ability to provide those services.3 Facilities that are accredited by the JCAHO are required to conduct an HVA.4 Facilities that are not JCAHO-accredited should also conduct one. The purpose of the HVA is to enable a health care facility to identify, within its emergency management plan, the possible emergencies that it may need to address and their probable impact if they were to occur. When conducting an HVA, the facility staff should start by listing the emergencies that might affect the facility, including various factors in the surrounding area. For example, is the area prone to floods? Is a chemical plant located nearby? The HVA should include internal events (such as fires) as well as external events (such as power outages). The HVA should focus on the naturally occurring and man-made hazards that are most likely to have an impact on the facility and the surrounding community (such as floods, HAZMAT incidents, terrorist attacks). The probability that those events will occur should then be considered. The analysis is based upon history as well as events that might not have actually occurred but might be expected to occur. Next, the staff should consider how each event will affect the facility (sometimes called the severity of an event). For example, will lives be lost if the event occurs? Will the facility be damaged? Finally, staff should review the extent to which the facility and the community are prepared for each type of event. If an organization is not well prepared for a certain type of incident, it might want to devote more resources to preparing for that type of incident. Similarly, if community resources would not be available to assist in addressing the incident, then the facility would probably want to devote more resources to addressing it.
An organization may undertake the HVA in a variety of ways. The emergency management plan should reference the HVA in order to document that it was undertaken. Several tools have been designed so that health care organizations may undertake effective HVAs. Examples of these tools appear in Appendix 1 and on GNYHAs Web site, www.gnyha.org, in its Emergency Preparedness Resource Center.
3. Ibid. 4. Ibid. 2
Full-Scale Exercise, or Field Exercise: A full-scale exercise is often the culmination of previous drills and exercises. It tests the mobilization of all or as many as possible of the response components, takes place in real time, employs real equipment, and tests several emergency functions. In the hospital context, a full-scale exercise often involves pre-hospital as well as hospital response, and usually involves actors simulating patients and the activation of the EOC. It may also include other health care facilities in order to test mutual aid agreements. Controllers, who maintain order and ensure that the exercise proceeds according to plan, are also usually used. Full-scale exercises are generally intended to evaluate the operations capability of emergency management systems in a community and to evaluate interagency coordination.
RATIONALE FOR CONDUCTING DRILLS AND EXERCISES: ACCREDITATION AND REGULATORY STANDARDS
Hospitals that are accredited by JCAHO are required by JCAHO Environment of Care (E.C.) standard 4.20 to conduct drills regularly to test emergency management. Further, the elements of performance for E.C. 4.20 include the following:5 Hospitals must test the response phase of their emergency management plans twice a year, either in response to an actual emergency or in planned drills. Drills that involve packages of information that simulate patients, their families, and the public are acceptable. Hospitals must conduct drills at least four months apart and no more than eight months apart. Hospitals must conduct at least one drill a year that includes an influx of volunteers or simulated patients if the hospitals offer emergency services or are community-designated disaster receiving stations. For purposes of the influx of simulated patients requirement, tabletop exercises are not acceptable. Hospitals must participate in at least one communitywide practice drill a year (where applicable) relevant to the priority emergencies identified in their HVAs. The drill must assess the communication, coordination, and effectiveness of the hospitals and communitys command structures and may be conducted by means of a tabletop
5. Joint Commission on Accreditation of Health Care Organizations, 2004 Comprehensive Accreditation Manual for Hospitals, Environment of Care Standard 4.20 (Oakbrook Terrace, Ill., 2004). 4
exercise.Communitywide may range from a contiguous geographic area served by the same health care providers to a large borough, town, city, or region. The drill involving the influx of volunteers may be separate, simultaneous, or combined with the communitywide practice drill. Drills must be critiqued to identify deficiencies and opportunities for improvement.
In addition, many state regulations require hospitals to conduct drills. For example, New York State regulations that apply to hospitals require each hospital to have a written emergency and disaster preparedness plan that must be rehearsed and updated at least twice a year, with procedures to be followed for the proper care of patients and personnel, including but not limited to the reception and treatment of mass casualty victims in the event of an internal or external emergency or disaster arising from certain events.6 The New Jersey Administrative Code requires each hospital to conduct 1) at least one evacuation drill each year, either simulated or using selected patients, and 2) at least one drill a year in which a large influx of emergency patients is simulated.7 Under the New Jersey code, actual emergencies of each type are considered drills, if they are documented. Even if they were not required, drills are a good way to test an emergency management plan.
6. 10 New York Code, Rules and Regulations Section 405.24(g). 7. New Jersey Administrative Code Section 8:43G-5.16(h),(i). 5
An example of an evaluation form appears in Appendix 2 and may be found at www.gnyha.org/eprc/general/presentations/ Disaster_Eval_Tool.pdf. Additional evaluation tools developed by the Johns Hopkins Evidence-Based Practice Center for the Agency for Healthcare Research and Quality as well as by the U.S. Department of Homeland Security can be found at www.ahrq.gov/research/hospdrills/ index.html. Federally Funded Drills and Exercises. Beginning in 2005, for drills and exercises that are undertaken using Federal funding (including hospital drills and exercises undertaken with Federal funding from the Health Resources and Services Administration), the Homeland Security Exercise and Evaluation Program (HSEEP) will be the framework within which those drills and exercises will be initiated, implemented, and evaluated. The purpose of the program is twofold: 1) to evaluate performance on critical tasks, and 2) to validate strengths and identify improvement opportunities, all with the goal of improved preparedness. Performance during drills and exercises will be analyzed at different levels, including task level, agency/ discipline/function level, and mission level (within and across communities), and will be required to utilize both Homeland Security Exercise Evaluation Guides and HSEEPs After-Action Report template. A link to HSEEP can be found at www.gnyha.org/eprc/general/ drills_exercises/ under Design and Evaluation Tools.
to prepare staff on the decontamination team to be outfitted in personal protective equipment (PPE) within a specific period of time; to prevent contaminated patients from entering the emergency department without being decontaminated; and to successfully decontaminate ambulatory and non-ambulatory patients within a certain period of time after their arrival at the emergency department.
Measures. The exercise can be evaluated using the following measures: How long did it take the hospital to get its decontamination equipment ready? How long did it take staff to be outfitted in PPE? Were patients stopped before entering the emergency department? How long did it take to decontaminate patients?
For additional information on drills and exercises, visit the Drills and Exercises section of the Emergency Preparedness Resource Center on GNYHAs Web site at www.gnyha.org/eprc/general/ drills_exercises.
APPENDIX 1
12
13
INSTRUCTIONS:
2001 Kaiser Foundation Health Plan, Inc. Reprinted with permission. Natural Hazards: Hazard Assessment KP.xls
14
2001 Kaiser Foundation Health Plan, Inc. Reprinted with permission. Technological Hazards - Hazard Assessment KP.xls
15
2001 Kaiser Foundation Health Plan, Inc. Reprinted with permission. Human Hazards - Hazard Assessment KP.xls
16
2001 Kaiser Foundation Health Plan, Inc. Reprinted with permission. Hazardous Materials - Hazard Assessment KP.xls
17
18
APPENDIX 2
20
21
Greater New York Hospital Association 555 West 57th Street, 15th Floor New York, New York 10019 212.246.7100 / FAX 212.262.6350 www.gnyha.org