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National Emergency Management Summit
Joe Cappiello, BSN, MA
VP, Accreditation Field Operations
The Joint Commission
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Who Is The Joint Commission?
Not-For-Profit, Non-Governmental Accreditation Body
Meets the US Government Conditions of Participation for reimbursement
Formed in 1951Currently accredit 17,000+ Health Care
Organizations (Hospitals, Long Term Care, Behavioral Health, Ambulatory Care, Home Care)
Accounts for 90% of all US Hospitals and 97% Beds
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Brief Hx of Joint Commission and Emergency Management
30+ years of emergency management– Disaster based planning– Primary focus – Response to disaster
–Snow storm–Tornado–Bus accident–Plane crash
– No large scale disasters– Community’s healthcare structure assumed intact– Evacuations within same building or local hospital
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Revamping Emergency Management Standards
Consider WMD - 2000Urged by Department of Defense, Veterans
Administration & others to consider WMDThe world was a more dangerous place for
USLittle interest found in healthcare industry
TERRORISM NOT SEEN AS REAL THREAT
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Domestic Terrorism as of January 2000
1995 (April 19) – Murrah Federal Building –Oklahoma City, Oklahoma
1993 (Feb 26) World Trade Center – New York City
And before that?
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December 29, 1975 – NYC – LaGuardia Airport
Bomb placed in coin operated locker11 dead, 75 hurt Responsible party remains unknown
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World-wide Terrorist Attacks on U.S. Interests
(A different story) 10/12/2000 – Yemen – Navy Destroyer USS Cole 8/7/1998 – Nairobi, Kenya & Tanzania –US
Embassy 6/25/1996 – Saudi Arabia – Khobar Towers Previous 10 years – another 9 events
A need for an upgrade of
Healthcare Emergency Preparedness Standards
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New Emergency Management StandardsJanuary, 2001
Hazard vulnerability analysis (risk)All hazard approach4 phases of emergency response
– Mitigation, Preparation, Response, Recovery
Planning requires community coordinationPlanning requires involvement of hospital
leaders
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Can hospitals handle a disaster?How about the rest of healthcare infrastructure?How do we know?Strengths?Weaknesses?What needs to be changed?
Questions Still Needing an Answer
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Hospital/Community Debriefings:Sample of Debriefings
• First - Tropical Storm Allison – June/2001
• 9/11 – September 2001• And the World Changed
• Power Outage – Summer 2003• S. California Wild Fires – Summer 2003• Hurricane Isabel – Fall 2003• SARS (Asia/Toronto) Spring 2003
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Major Issues Began to Surface
Problems with communicationInadequate emergency generator backupFaulty Incident Command SystemsLack of involvement with Emergency Ops
CenterThe extend of an organization’s planning is
dictated by the impact of their worst recent disaster
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Then came Two Years of Disasters
Of the Top 10 most Costly US catastrophes, 6 Occurred Between 8/2004 through 8/2005*
All HurricanesKatrina 8/2005 $42 Billion
Sept 11th $21.6 billionWilma 10/2005 $10.7 BillionCharlie 8/2004 $8 BillionIvan 9/2004 $7.7 BillionRita 9/2005 $5.2 BillionFrances 10/2004 $4.9 Billion
*2006 dollars
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Rethinking the Standards- The Hurricanes”Each one with a special lesson
1. 3 Florida Hurricanes – August/Sept 2004
2. Hurricane Katrina – August 2005
3. Hurricane Rita - Sept 2005
4. Hurricane Wilma – Oct 2005
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The Common Characteristics
Sustained Affected multiple communities simultaneously Impacted public services Threatened entire healthcare delivery system Stressed federal response
The limitation of these debriefings
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What Happened to Community Healthcare?
Home Care closedLong Term Care closedPhysician Offices closedOutpatient Pharmacy closedDialysis Center closed (no generators)Outpatient Cancer Centers closedVentilator & other special needsDischarged patients (wouldn’t leave)
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How Did These Pressures Affect Hospitals?
Increase admissionsDecreased dischargesCitizens seeking non-healthcare servicesIncreasing pressure on limited resources
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Major Issues Facing HospitalsCore of Debriefings
What were the common problems to be solved?
To “Shelter in Place” or to “Evacuate”?
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Critical Parameters
UtilitiesStaffSupplies (medical and non-medical)SecurityCommunication
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Utilities(Power, Water, Sewage)
Basis of survival Hospitals aren’t self sustainingInadequate planning for prolong loss of
utilities
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Staffing
Day Care (family/pets)Food, water, shelter (including family)Access to cash (meeting payroll)Help with family/home needsAssessing “duty to serve”Mental Health
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Supplies (medical/non-medical)
“If I need more, who will get it to me?”Common issue - Use of same vendors
– Ambulances– Fuel
Corporate entities most reliableFree-standing hospitals highly
vulnerable
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Security
End of “rule of thumb” – No civil unrestHospital controls precious resources
– Drugs– Fuel– Food/water
Local security force inadequate (search and rescue)
Inadequate system to control access
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Communication(can’t see, hear, or speak)
Isolated from the worldCan’t judge severity of damage in communityCan’t effectively be part of community decisions
No system was reliable– None had regularly tested community-wide systems
– Overloaded circuits
– Loss of antennae
– Compatibility problems
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Volunteers(Not Major but Common Issue)
Seen as double-edged swordDisaster Management Assistance Teams
(DMATs) model for volunteers– Self-sustaining– Present for substantial amount of time– Will treat the “less glamorous problems”– Are not integrated into hospital operations
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A Critical Lesson:It’s An Iterative Process
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Path of Hurricane Charlie 8/13/2004
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A Few Comparisons
Expectations of “Duty to Serve”Protection of hospital beds (Special needs
shelter)Yearly hurricane season preparations (each
May)Integration with DMATsHardened physical structure
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Characteristics of the Resilient Organizations
(to “shelter in place”)Substantial preparation to maintain utilitiesReliable supply lines outside of disaster areaSignificant experience with the type of disasterStrong trust in a committed upper management
– (to accept being placed in harm’s way)
Able to avoid the unknown:
Evacuation
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Community StressLow High
High
-Supply lines intact-Local evacuation-Plans often work
-Sustainable for unlimited time-Evacuation not needed
-Supply lines cut; -Distant evacuation-Improvisation-Clock is ticking
II IV
I III
-Rapid deterioration;-Only distant evacuation possible
HCO Stress
To Stay or To Leave?
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Summary
Hospitals can handle emergencies within intact community Ambulatory care collapses, increasing hospital stress Expect to be on your own for prolonged period of time Few hospitals are truly self-sustaining Hospitals with dedicated supply lines supported outside of
disaster zone do the best Few large community prepared to handle large scale
evacuations of acute and chronically ill – little planning Few major changes within healthcare ($$$)
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General Dwight D. Eisenhower
In preparing for the invasion of the European continent during WWII, General Eisenhower, Supreme Allied Commander
said the following about the construction of the invasion plan…
“Plans are nothing, planning is everything.”
