1. Gervais, Jerry CHFM, CHSP, BS

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In 2006, Standard EC.4.10, Emergency Management, with all 21 elements of performance, remains unaffected from 2005. Significant changes to EC.4.20, Emergency Drills, however, became effective July 1, 2006.


Q Could you highlight those changes?


A Hospital drills must now be developed from the hospital's hazard vulnerability analysis. Since the hospital indicates these at-risk emergencies, it's reasonable to place major emphasis on demonstrating preparedness here.


Next, designate a formal observer to assess the following four areas: event notification, communication, resource mobilization, and patient management. The observer can be from outside the hospital or an inside staff member who's familiar with the hospital's emergency plan. The observer can't perform in any capacity other than observer during the drill.


The hospital modifies its emergency management plan in response to drill critiques. Drill critiques must show involvement and participation from the following:


* administration


* clinical (including physicians)


* support staff



Q What has the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) learned from the hurricanes in the Gulf Coast in 2005?


A The events in the Gulf Coast defined a new level of disaster. Hospital disaster planning was not broad enough or fully integrated enough to adequately prepare for the four separate and connected disasters that occurred.


Emergency management planning now must consist of a continuum of response that can be escalated to match the demands placed on healthcare. This is important, as the acuity of the emergency escalates over time, and resources and capabilities continue to diminish as severity increases.


After numerous trips to the Gulf states to reopen more than 13 hospitals that evacuated, closed, then rebuilt damaged facilities, JCAHO named the following eight readiness strategies as critical success factors:


1. integrated community planning


2. communication strategies


3. incident management system-with incident command center


4. emergency utilities-developed and functional contingency plans


5. security


6. supplies (medical and nonmedical)


7. staffing


8. inventory of nonhospital assets



Q What part of the emergency management standards does JCAHO most commonly score during a survey?


A The elements of performance 10 through 21. These elements address a hospital's preparedness for evacuation; all associated tasks must be completed to achieve an expedient and safe evacuation.


Q What were the most challenging aspects of clinical care in the Gulf Coast disaster?


A One of the most common responses was the unanticipated impact of the lack of automated processes that hospitals take for granted during nonemergency operating modes. The lack of processes included the loss of automatic infusion pumps, unavailability of monitoring equipment to assess vital signs, loss of automated patient charting and order entry to pharmacy, and loss of utilities to provide adequate ventilation and cooling forthe environment. These incidents were all notwithstanding the intense stress staff operated under for days without knowing when and if relief would occur.