Hospital Emergency Plans

The terrorist attack on the World Trade Center in New York took over 2,500 lives, and caused at least 9,000 injuries. The injured flooded hospitals looking for treatment and assistance. Emergency responders were put to the test, reminding everyone that emergency management is usually not visible in our daily lives, but it is always relevant. The same happened after hurricane Katrina caused over 1,800 deaths, and 7,000+ injuries; hospitals were overrun and tirelessly called upon for emergency services.

According to the Red Cross, a “disaster” is an occurrence of low probability and high impact involving ill or injured individuals. Generally any event that is responsible for more than 10 deaths, affects more than one hundred people or causes an outcry of help from the affected, can be considered a disaster. In the context of hospital plans and responses, a disaster is an event that causes a large, brief spike in demand for emergency services.

The delivery of these services requires extraordinary measures. During emergencies and disasters, hospitals utilize an effective and rapid response method for treating a surge of patients, maintaining essential services and protecting health care workers.

Hospital Overload

Disasters, whether caused by man or nature, quickly create an unforeseen influx of people who have one destination: the hospital. Hospitals usually operate close to full capacity and even a temporary surge can exacerbate their ability to assist the injured. It is during these periods the hospital will respond with non-routine approaches; some that may sound contrary to the purpose of helping.

Disasters force hospitals to refocusing their care on saving lives, instead of delivering an equal and standard amount of care to every person. For example, if victims are able to transport themselves, they need to do so. Resources are stretched too thin to reach everyone, so mobile victims are usually responsible for their own travel arrangements.

Another change in protocol concerns the procedure for casualties. Preserving life becomes priority No. 1, and casualties (victims who died previous to emergency response with no hope of resuscitation) may have to wait for inspection, decontamination and identification. Health care workers become focused on the living and those with the best chance of survival. In the extraordinary event that the influx of people renders the hospital ineffective, the facility may go into lockdown.

Maintain Effective Services

Unfortunately, there are a few situations when a hospital must refuse help and follow lockdown procedures. One instance occurs when the amount of injured clamoring for service completely overwhelms the hospital.
To maintain effective services, hospitals must regulate the amount of people arriving in correlation to the amount of help available. Panic is dangerous, so hospitals cooperate with other services like fire and police to protect victims, establish order and prevent chaos.

Another instance of a lockdown occurs when the hospital falls victim to a disaster itself. When a disaster such as hurricane Katrina hits, hospitals need to be prepared for victim saturation as well as limited resources. Preparations may include reserve generators, on-call workers, emergency supplies and resilient building construction — but there is no true preparation plan for every disaster. In the event a hospital itself is rendered ineffective, there is a plan to utilize staff, vehicles, equipment and resources elsewhere. The key in an emergency is to take advantage of whatever is available to offer the best assistance possible.

Protecting Health Care Workers

Health care personnel are critical in an emergency, and protecting their health is equally as critical. Without their ability to administer help, emergency medical resources and equipment are rendered useless. Therefore, it’s important for hospitals to protect their employees, especially in an emergency. Furthermore, emergency personnel work with many patients, and they are vulnerable to the dangers within a hospital. For example, an outbreak of SARS in Toronto began with one patient.

In 2003, a man waiting in the Toronto emergency room for a few hours became infected with the Severe Acute Respiratory Syndrome (SARS). Unfortunately, the hospital was late in identifying the contagious infection, and it spread. Because health care workers were unprotected and working closely with others, the hospital suffered 31 infections. While it wasn’t the hospital’s fault for unknowingly spreading SARS, it brought attention to the critical need to protect staff for their sake and that of their patients.

Outbreaks are rare, but they are extremely dangerous. The SARS incident served as a wake-up call to health care professionals, motivating them to develop further plans that proactively protect the safety of hospital employees. The developed strategies are not just limited to outbreaks or natural disasters, but man-made disasters as well such as an active shooter on hospital grounds.

Violence in the Hospital

In 2015, a California hospital for the disabled was attacked by an active shooter, someone killing or trying to kill people in a crowded location, which revealed how little they were prepared for the abrupt and horrifying event. The Governor’s Office of Emergency Services created an awareness guide for hospitals, first responders and law enforcement so that quicker, more effective action can be taken in such a situation.

The guide reveals what action should be taken when an active shooter appears, and advises everyone to stay calm and focused. It is almost always a surprise, and it’s taxing to stay wary of an extremely rare event, so being prepared is that best policy. The best response is to evacuate in an orderly fashion by listening to health care professionals and law enforcement on scene. The health care managers should have evacuation plans up to date and plastered throughout the building for easy access.

Another response is to hide. Sometimes the exits are blocked, or confusion has made it difficult to follow a pattern, so hiding is the only option. While it is hard to plan a hiding place, patients and professionals need to know how to find a safe spot to conceal themselves. The guide says to turn off phones, find full range of coverage but don’t become trapped in a tight space, remain quiet, and lock any doors. Similar to evacuating, it is the hospital employees’ responsibility to take care of the patients as best they can, and give clear instruction when the turmoil has ended.

Finally, the last response is to fight and incapacitate the shooter. This option should be exercised only when evacuation and hiding are not possible, and has to be taken with aggression. Basically, if fight is the only way, then hospital employees and patients alike need to commit and fight by yelling, throwing objects, showing resilience and attacking with all their might. The fight may be interrupted by law enforcement, in which case everyone needs to have their wits about them and be prepared to listen to their instruction. An active shooter situation is dangerous, terrifying, sudden and can be minimalized with preparedness and organization.

Disasters that cause disease and/or injury are an unfortunate reality of this world. Hospitals must be prepared for rapid, unique situations whether or not they happen — and they must protect everyone under their roof in the process.

Learn More

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Sources:

http://www.renew911health.org/statistics/

https://www.nap.edu/read/11621/chapter/9#280

http://www.euro.who.int/__data/assets/pdf_file/0008/268766/Hospital-emergency-response-checklist-Eng.pdf

http://www.accruent.com/blog/entry/7-key-areas-of-a-hospital-emergency-operations-plan

https://www.ncbi.nlm.nih.gov/pubmed/16697414

http://www.calhospitalprepare.org/sites/main/files/file-attachments/cal_oes_-_active_shooter_awareness_guidance_2016_update.pdf