Emergency preparedness sometimes takes a back seat to operational issues that confront health managers. It may seem more logical to deal with current crises and conserve limited resources by delaying preparations for unimaginable disastrous events.
However, recent natural disasters, such as last week's earthquake in Los Angeles, should convince every healthcare organization and manager to reconsider this procrastination. Cataclysmic events chip away at the brick and mortar and human fabric of healthcare facilities and surrounding communities, teaching us that disaster preparedness is as important and necessary as fiscal and operational management.
After a year of healing and recovering from Hurricane Andrew, our organization and others developed plans for a coordinated response to future disasters. Building on the spirit of cooperation that existed during and after the event, we're creating mutual disaster aid agreements.
Representatives from various levels of participating organizations created the framework for Disaster Aid Services to Hospitals, known by the acronym DASH.
The first step to forming a network is the careful selection of organizations that are similar in size, mission, corporate structure, provided services, existing relationships, mutual respect and levels of sophistication in disaster preparedness. Network members should be strategically scattered across the state to provide a geographic buffer if a disaster strikes a particular region.
It's also necessary to include volunteers in major job titles and functions when negotiating the formation of a disaster network. Human and material resources are essential for dealing with a disaster.
The ravages of disasters aren't limited to property. They severely injure a community's social and moral fabric. In terms of effects on hospitals, many employees will be physically and psychologically incapacitated, unable or unwilling to work.
We've found that volunteers dispatched to an organization in crisis are ineffective without some type of orientation. Management personnel should accompany them to the receiving facility to provide support and direction.
We've prepared two educational and informational packets for staff and management volunteers covering subjects such as criteria for volunteer selection; provisions and supplies to accompany the group; briefing upon departure; interaction and communication between leadership of the sending facility and receiving facility; and critical incident stress debriefing.
Every organization needs a plan for registering and credentialing volunteers. At Baptist Hospital of Miami, the human resources department is responsible for registering, identifying and assigning all non-professional volunteers, while the nursing services department handles professional and licensed volunteers. The assignment of onetime privileges for physicians are coordinated through the medical staff office, following procedures in the medical staff disaster plan.
Procuring supplies and provisions can be extremely difficult if local suppliers are victims of the disaster and telephone service is interrupted or overloaded, so a basic inventory of disaster supplies and provisions should be maintained. This effort should be coordinated by directors of materials management, nursing, engineering and food services. Without such preparation, a hospital won't be able to successfully manage an event, particularly in the first 24 to 48 hours.
Also, organizations must develop agreements with vendors in a variety of locales to ensure procurement of supplies if vendors in one area are incapacitated by a disaster. And it's not too much to ask to see local vendors' disaster plans to see if they have contingency plans in place.
In DASH, each member has agreed to act as purchasing agent for any facility affected by a disaster. Unaffected facilities will be responsible for ordering, shipping and paying for supplies needed by the distressed hospital. After the crisis, the sending facility can bill the recipient.
In a communitywide disaster, patient transport is next to impossible as all local life-support vehicles are busy and often commandeered by the local office of emergency management. This will make it difficult to evacuate facilities or to transfer stabilized patients.
To deal with this, each DASH member has developed agreements with local state-certified ambulance companies. Their vehicles, located outside the area of the disaster, remain under the direction and jurisdiction of the licensed management corporation and can be dispatched to the affected facility to be used to transport patients.
A coordinated response is the key to managing a disaster. To ensure coordination, DASH has developed an emergency response team that arrives at an affected facility in the first 12 hours after an event. They interface with the affected facility's senior management; help perform a needs assessment; ask network members for needed resources, thus decreasing the potential for duplication; and offer consultation and expertise.
The team places all network facilities on alert. To guarantee the greatest benefit and functionality from the response team, various matrices have been developed to identify which facility has the needed resources and services.
Before a disaster occurs, a document is needed to formalize the content, framework and responsibilities of the network so all parties understand their roles. One form that's often used is the memorandum of understanding, which is less restrictive than a contract and may easily pass the review of legal counsel. However, if legal counsel wants a more cautious approach, a letter of agreement may suffice.
A memorandum of understanding must include clarification and delineation of the parties to the agreement and the intended mission or goal; general responsibilities of the parties; particulars about volunteer staff, such as response time, length of assignment and payment of salaries; supply procurement; patient transfers; and limitation of liabilities.
Many plans and documents are developed with lofty goals and intentions. Often they're forgotten as the documents lay lifeless in a ring binder or file cabinet. To counter this, DASH has agreed to meet at least semiannually to discuss issues that might change the nature of the agreement. Also, we intend to conduct an annual paper or telephone drill to verify some of the communication links and test facilities' awareness and understanding of the program.