DISASTER PLANNING, PART I: Overview of Hospital and Emergency Department Planning for Internal and External Disasters
Section snippets
PREPARING FOR DISASTER
The initial response of hospital personnel to an unexpected event must be based on awareness of the overall hospital disaster plan which has been acted out realistically during drills. As soon as possible, command and communication are established using incident command system (ICS) principles (see the article by Auf der Heide elsewhere in this issue). With a clear chain of command outlined for every department and a command post staffed with trained personnel, a sense of order should prevail
FEATURES OF THE DISASTER PLAN
Hospital disaster plans have several vital features (Table 3). First, each hospital must define the extent of its campus to be covered by the plan. If a hospital is affiliated with a research center, ambulatory care center of medical school, the plan must define precisely all areas covered by the plan and what would constitute a disaster for such a facility. A hospital's treatment capacity should be established but will vary depending on the resources available (power, water, structural
COMMAND CENTER
During all phases, a command post must be established. Command center function, location, and personnel should be clearly identified. In some hospitals the command center functions may be divided. A reporting center is separated from the command post to avoid confusion. In smaller facilities and during night shifts, the command center may need to be located near triage until sufficient personnel are available.
The command post should be staffed with key management personnel such as the hospital
FEATURES OF AN INTERNAL DISASTER PLAN
Internal disaster planning should be an extension of the hospital's external disaster plan with individual plans for a wide variety of potential internal calamities. The importance of planning for internal disasters has been highlighted by many recent hospital reports of disasters occurring within hospitals.1, 17, 26, 28, 38 Situations to be planned for include structural instability, hospital fire or flood, loss of power, loss of medical gases, elevator emergencies, loss of compressed air or
THE ROLE OF THE EMERGENCY DEPARTMENT DURING DISASTER
The emergency department plays a key role in any disaster plan. Acutely, it is the receiving area for all patients and must be responsible for ensuring that adequate decontamination has or will be carried out, as well as triage, stabilization, and initial treatment for all victims of the disaster. Unlike other areas of the hospital, in the weeks following a disaster, most emergency departments can expect increased patient visits. Many disasters have resulted in increased volumes for 2 to 3
LESSONS LEARNED
Experiences encountered during actual disaster situations form the basis for teaching disaster medicine and disaster planning. In "Disaster Planning, Part II," found elsewhere in this issue, Auf der Heide reviews events that have taught disaster planners much. An overview of these lessons learned is provided in this article. It serves to remind us that each disaster situation is unique, and any one type of disaster may be complicated by other events. For example, an earthquake near a nuclear or
CONCLUSION
Disasters are occurring more frequently and with greater impact because of the world's increasing population density. Hospitals are generally expected to provide for a community's health care needs in times of crisis. Yet, they too are vulnerable structures, highly dependent on technologic support to function. Because emergency physicians interface with EMS, the community, and the hospital, they must embrace their role as leaders in hospital disaster planning. Hospital disaster plans must
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Cited by (29)
Triage
2019, Critical Care ClinicsCitation Excerpt :The decision to implement “disaster triage” involves the additional component of resource allocation implicit in the meaning of the term “disaster.” A disaster can be defined as an event that results in injuries or loss of life and results in a demand for services that exceeds available resources.19 However, in terms of the health care response to an event, this binary concept of either being in a disaster or not is less helpful and likely impairs the response; thus, it is much more useful and common to consider the concepts of surge management.20–23
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2016, Ciottone's Disaster MedicineAssessing hospital emergency management plans: A guide for infection preventionists
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2006, Medicina ClinicaOperations and Logistics
2006, Disaster Medicine
Address reprint requests to C. Phuli Lewis, MD, Department of Emergency Medicine, University of Massachusetts, Medical Center, 55 Lake Avenue North, Worcester, MA 01655
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From the Division of Emergency Medicine, Department of Emergency Medicine, University of Massachusetts Medical Center, Worcester, Massachusetts