Disaster Planning for Community Hospitals
On Sunday, July 16th, the staff at the Cherry County Hospital in Valentine, Nebraska found themselves facing an escalating crisis. A grass fire, now known as The Big Rock Fire, ignited and quickly spread across the Sandhills section of north central Nebraska. The 113°, 9% humidity, and 39 mph winds swept the fire quickly toward the north side of town. The dry cedars and prairie grass acted as tinder for the fast-moving flames.
The trees didn’t just burn—they exploded. Residents described a “tornado of fire” that preceded the flames. Smoke and ashes choked the air throughout the town of 3,000.
As the fire advanced toward the hospital, the air system began to force the acrid smoke and ashes into the building. Staff quickly shut down the air conditioning system. The situation grew more dangerous by the minute.
Staff quickly made arrangements with the two closest hospitals—both over 45 miles away—to transfer the patients in the even of hospital evacuation. Paperwork, medications, family notifications, all necessary arrangements were completed within minutes.
At 6:50pm, administrator Brent Peterson gave the order to evacuate the patients and abandon the hospital. The highly-trained staff performed as a unified bloc, notifying patients and preparing for the transfer. Nurses and physicians, receptionists and housekeeping staff, lab and radiology workers worked together to move their patients to safety.
Once the hospital had closed and the patients were out of harm’s way the staff created a temporary remote treatment center at the middle school. They transferred necessary equipment and supplies to handle the emergency needs of the hundreds of firefighters and citizens. They equipped the site to treat multiple cases involving burns, smoke inhalation, heat illnesses, cardiac arrest, and obstetrics. Thirty minutes from the decision to form the remote site, it opened.
Throughout the ordeal, several members of the team suffered distraction as their own homes were threatened by the fire. Two of the staff lost their homes in the inferno.
Hospitals create disaster recovery plans to keep their institutions running during an interruption due to natural, man-made, or technological disruption.
These disturbances may come in the form of:
- Extended power interruption.
- Terrorist attack.
- Catastrophic viral outbreak.
- Tornado/hurricane.
- Fire.
- Mudslides.
- Server crash.
- An influx of patients from a nearby hospital in crisis.
We understand the need for such planning for hospitals near the Gulf Coast, but what about the rest of the country? Ask Shirley Knudsen, safety officer at Cherry County Hospital in Valentine, Nebraska.
Their critical access hospital sits more than 1500 miles from the nearest coastline. Terrorists will not likely target them. Yet Shirley and her emergency preparedness team prepared and performed so soundly that they can serve as models for the rest of us. Rudy Giuliani knows something of disaster response. He said, "When you confront a problem, you begin to solve it."
First and foremost, you must form an effective disaster team. Include staff members from a variety of levels and departments. Keep the team small enough that you can efficiently build a workable plan. Your disaster team will work together to formulate the plan, train hospital staff, and supervise drills. The team should include employees committed to reporting for the duration of an emergency.Planning for and meeting the challenges of such emergencies requires leadership. Your disaster team must be prepared and empowered to make decisions. Distributing the authority across a prepared team will improve the quality of the response.
Communications Plan
Create a plan to communicate with employees, professionals, your vendors, community leaders, and the public. Appoint a spokesperson to provide official statements to the media. The team head must not be distracted by constant reporter questioning.
You must plan so that you can contact every employee and professional, even the newest. You may need them to report to work immediately, or you may need them to meet at a remote location. You may need them to bring tools or other resources when they report.
Contact vendors who supply food, medical supplies, generator fuel, emergency water supplies, and other necessities. Include multiple methods for making the needed contacts. Your hospital central phone system may or may not function. Cell phones may or may not work. In their post-emergency debriefing, Cherry County Hospital recognized that they should have transferred their hand-held radios to the remote treatment center. The radios would have enabled communications with the ambulances.
They also realized that they should have transferred the main hospital phone line to the remote center.
Be creative, but realize that you may not have the ability to communicate to everyone. Improve your opportunities by planning multiple methods.
Security Plan
During the aftermath of Hurricane Katrina, some hospitals were overpowered by desperate and hungry survivors seeking food, shelter, and other necessities. Work with community leaders to determine the types of emergencies for which your facility will provide non-patient community services.
Make arrangements with local law enforcement officials and private security firms to provide security reinforcements as needed.
Fuel and Other Supplies
Determine the number of days your current backup generator fuel will supply your facility with electrical power. Arrange with your fuel supplier to provide you top priority in the event of an emergency.
You will need seven to ten days of fresh water, food and essential medical supplies. Develop written agreements with your suppliers.
Back up Patient and Employee Records
These backups must be readable on common computers and stored offsite. Investigate what essential data reside on employees' local drives. These files will not be stored in your backups.
Evacuation Plans
As Cherry County Hospital learned, some emergencies require full patient evacuation and transfer. Their plan considered quick evacuation in case of facility fire or collapse, but not a mass-transfer. Your hospital may be too disabled or unsafe to house your patients safely. Make prior arrangements with nearby hospitals to transfer your patients safely and efficiently. Cherry County's memoranda of understanding with their two closest hospitals proved to contribute greatly to their safe transfers. In such an exchange, both evacuating and receiving institutions need plans to administer the transfers effectively.
Community Planning
Work with local officials of government, law enforcement, utilities, schools and community organizations to plan emergency responses. A unified, prepared community can greatly enhance the safety and efficiency of your community emergency. The Cherry County's Emergency Command Center proved to be a valuable resource in planning for and activating the hospital's evacuation.
Disaster Drills
Hire a third-party to stage a table top drill for your facility. Choose someone who did not participate in developing your plan. He will create scenarios that will test your plan. The drills will help you identify plan weaknesses and missing elements.
Your hospital may never experience a devastating prairie fire like Cherry County. You may never feel the effects of hurricanes, tornadoes, or terrorist attacks. But you will face an emergency that will test the strength of your plan and your team. Learn from those with experience. Evaluate and modify your plan often. Change before you must.
