Emergency and Disaster Relief Preparedness
MedSun: Newsletter #13, March 2007

By Yadin David, M.Sc., Ed.D., PE, CHSP, CCE
Edited By Jill Marion, FDA Patient Safety Staff

Abstract
After the multiple natural disasters in the United States over the past several years, particularly those in the Southern region, staff of Texas Children’s Hospital in Houston decided that they needed a more focused, comprehensive plan to handle emergencies in the future. They decided to overhaul their existing disaster plan, changing it into a global emergency preparedness program. The global emergency preparedness program would be designed to improve resource planning and allocation during extreme conditions with a goal of sustaining the level of care the hospital could deliver under disaster circumstances. The program would consist of two distinct plans rather than the existing single plan. The two plans would be composed of protocols and procedures to be used during an emergency to aid in disaster relief. One of the two plans would be medical device-specific, and the other a broader, hospital-wide plan.

Expanding and Updating the Existing Plan
To initiate the process of expanding and updating the hospital’s disaster plan into the global emergency preparedness program, Lynn Sessions, Director of Risk Management, appointed Yadin David, Director of Biomedical Engineering, and a multidisciplinary team of hospital personnel that included risk managers, facility engineers, information technology professionals, security employees, and telecommunication managers, to review the existing disaster preparedness plan. The focus of the new program was on sustaining clinical operations and on training staff to function under changing circumstances and abrupt curtailment of otherwise normal conditions.

The global emergency preparedness program documents everything from patient evacuation to the location of flashlights, radios, and scrubs, to placement of emergency power sources for charging medical devices. Administering an emergency preparedness plan is very demanding and occurs in a chaotic environment. Technical, clinical, and administrative leaders are often required to make decisions “on the fly.” Thus, to make the administration of such a plan successful during a disaster, there must be a well-planned strategy, trained staff, and collaboration of multiple teams with clear “buy-in” from all parties. To this end, the team met monthly with clinicians and hospital administrators to review the plan updates. The plan that was developed focused on the potential impact of hurricane conditions. (Hurricane season in Texas is between June and November.)

The hospital-wide plan provides guidance and recommendations on development and structure of multiple departmental-level command centers that are separate from the main hospital command center. It describes electronic and human communications protocols as well as how to maintain an asset inventory. The medical device-specific plan not only encompasses all the actions included for the hospital-wide plan, but also includes tracking of machines and their power requirements, and critical information on which devices must continue to function to support patients. Details on these plans are discussed in the following section on implementation of the plans.

Implementing the New Emergency and Disaster Relief Preparedness Plans
This new global emergency preparedness program was first implemented during Hurricane Rita in 2005. Afterward, staff involved with implementation of the plans at Texas Children’s Hospital met to identify unanticipated issues that arose during the disaster and ways to reduce the likelihood that such issues would be repeated in future disasters. The following are items of interest from the final global emergency preparedness program:

Issue: Difficulty tracking device problems via a central command center.
Strategies To Resolve the Issue:
•Keep an up-to-date inventory that includes optional power sources (such as a source of batteries and power source longevity), along with a listing of communications assets (handheld radios, paging towers, pagers, etc.). Make sure that the inventory reflects where and with whom the communication devices are located.
•Establish a priority listing of how to reallocate these assets to high-emergency areas. Track the devices so they can be recommissioned and returned to the owners after the disaster. Supply additional batteries to support telecommunication devices and generators for charging systems for batteries.
•Maintain peer networks that can share lessons learned on this and other issues.

Issue: Difficulty locating communication devices and supporting open communication channels.
Strategies To Resolve the Issue:
•Establish departmental-level command centers that are separate from the hospital command center. These centers focus on the coordination of service and equipment support needs.
•Maintain a constant flow of information between the department-level command centers and department staff. Establish clear communication protocols (for example, telephone triage) and train staff on protocol compliance.
•Post a white board in all command centers. Keep a list of staff that are onsite, their needs, the problems they face, and staff responsible for dealing with identified problems. The board must be updated continuously to be an effective tool, and that information can be used later to determine lessons learned.
•Designate, when other communications are not reliable, one physical runner to be in charge of relaying information from the hospital command center to the department command centers, and from the departments back to the hospital command center. Have forms prepared for such an event.
•Make sure that the command center structure is planned for communications coordination (for example, bank of radios, wired and wireless telephones, local TV station, computers), that the command center is in a protected location, and that its entrance is easily accessible and near elevators.
•Make sure that TV systems can be deployed throughout the hospital to pass information to patients and their families.

Issue: Difficulty in knowing the impact of power loss on various device systems and in maintaining device operations.
Strategies To Resolve the Issue:
•Develop a matrix rating the probability and extent of impact on the function of various systems (commercial power, bedside monitors, central suction, etc.) that may be lost when a particular system fails. When the commercial power is lost, for example, it is important to consider which medical devices will be affected and how this problem could be resolved (switch to emergency generator, batteries).
•Keep track of critical devices, like infusion pumps, their electrical power needs, their battery types, and battery longevity. Plan for power-charging rotation.
•Maintain a list of devices that must continue to function to support patient care.
•Meet with vendors to review their ability to provide supplies, equipment, and expertise to support the hospital during a disaster.
•Establish a backup plan with hospitals located outside the potential disaster area. (Note that during Hurricane Rita, Texas Children’s Hospital was unable to receive deliveries of radios from the regional FedEx warehouse, but it was able to get them from a hospital in Seattle through another route.)

Issue: Maintaining personnel hygiene and staff morale.
Strategies To Resolve the Issue:
•Require staff to store at work a personal hygiene package that includes a change of clothes and basic hygiene items.
•Because the hospital may not be able to feed everyone, the personal hygiene package should include bottled water and nonperishable food.
•Staff will need to rest, so identify housing areas within the hospital that could be designated as male only and female only, and then assign staff to specific areas.
•Establish and communicate a plan for meal distribution to staff.
•Ahead of emergencies, have all staff members designate themselves as members of teams with specific functions in order to avoid confusion during the emergency. For example, staff should be identified in terms of those who are willing to stay at the hospital for the duration of the emergency and those who will not stay but will provide relief to those who do.
•Keep track of damages that occur during the disaster by making digital photographs for use when making insurance claims later.

Conclusion
By developing a more comprehensive emergency preparedness program, the Texas Children’s Hospital has improved the level of resource allocation and so can sustain the care the hospital delivers during a disaster situation. By continuing to evaluate the program, to train staff, and to capture lessons learned after disasters occur, the hospital intends to continually improve this plan.

Additional Information:

For FDA tips on using home medical devices under disaster conditions, go to
http://www.fda.gov/EmergencyPreparedness/default.htm


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