The Federal Emergency Management Agency requires hospitals to be adequately equipped and prepared to be operational for at least 96 hours under catastrophic conditions, including power outages, fire or flood. “This means that the hospital must be prepared to provide care to patients and a safe working environment for workers for that period of time and be ready to ensure availability of power, food, water, durable and expendable supplies, etc.,” said Robyn Gershon, MHS, DrPH, and clinical professor in the Department of Epidemiology at NYU School of Global Public Health.
Lessons from past disasters
Gershon co-authored a 2017 report about the effects of Superstorm Sandy on NYU Langone’s Tisch Hospital, a 725-bed facility. Researchers focused on the effects the 2012 disaster had on nurses. “Nurses, given the nature of their work, are at particular risk for certain mental health issues, including compassion fatigue, burnout, and trauma,” the report states.
The study found that communication was a key factor in the disaster response. Communication was challenging because of power outages, but nurses found several “creative solutions, including using batteries, unlocking medication carts in anticipation of the power outage, and handwriting medical summaries for patients being evacuated to other hospitals,” according to the report.
Social support also was a recurrent theme in the study. Nurses with disaster training reportedly felt the most prepared for the event, even without any firsthand experience. Nurses worked together collaboratively, supported one another, and proved to be remarkably resilient throughout the many challenges of the unprecedented disaster, including the successful evacuation of more than 300 patients. However, the emotional toll was significant in about 5% of the nurses studied, according to the report. Those nurses reported difficulty sleeping and “disturbing thoughts” after their experience with Superstorm Sandy.
Planning strategies for health care leaders, administrators
Hospitals must have adequate staff coverage and plans for backup staffing for all critical functions, Gershon explained.
“Hospitals must also comply with all (Joint Commission on Accreditation of Healthcare Organizations) emergency preparedness requirements. The main thing hospitals must do to survive on their own is to have a disaster plan that has been practiced by key leadership and staff. Hospitals must be prepared long before the disaster occurs for any type of event that may result in loss of power, loss of oxygen, loss of water, staff absences due to disease or transportation issue etc.,” Gershon concluded.
Patrick Hardy, a certified emergency manager and CEO of Hytropy Disaster Management, advised: “Get your planning committee together with your department heads and review the incident command assignments in the emergency response plan. You should also have regular, annual training with all employees on the disaster plan so everyone understands their responsibilities.”
Being prepared for a disaster “should be a way of life, not a game-time ‘pull out the manual’ type of response,” said Lauris Freidenfelds, a health care security consultant with 40 years of experience, including a stint as director of security and emergency preparedness for Rush University Medical Center in Chicago. “Each organization should routinely perform hazard/risk assessments. Be brutally honest. These exercises should identify what each organization should be prepared to manage. There should be collaboration with the public sector, as well as other local private organizations that have emergency preparedness programs. There were healthcare organizations that handled the pandemic response very well. They planned and practiced.”
Jennifer Adamski DNP, APRN, ACNP-BC, CCRN, FCCM has extensive experience in disaster preparedness, especially for critical care departments. In addition to her role as clinical assistant professor and director of the Adult-Gerontology Acute Care Nurse Practitioner Program at Emory University, Adamski works with the critical care flight team for Cleveland Clinic and serves on the national board of the American Association of Critical Care Nurses. She recommends the following:
- Be sure the institution’s hazard vulnerability analysis is updated annually, as well as before any large planned local event where a disaster could occur. Areas of high risk should be prepared for and anticipated. Think through potential shortages in necessary supplies, utilities, etc.
- During a disaster, ICU capacity and staffing may need to increase quickly. Having a plan to mobilize staff and expand the critical care space is essential and should not be decided on the fly. The plan should include how to notify staff and where additional patients should be placed. Also, consider how you will get any additional equipment that may be needed.
- Job action sheets should be in place for each unit or department to guide staff during the first few hours as to their duties before additional resources arrive. Regardless of the staff working at the time, job action sheets help ensure a consistent approach is employed.
- Risk management mght want to be part of the facility or health system’s emergency/disaster committee.
- Be involved. Meet with those who organize emergency and disaster response in the health system. Attend the drills and debriefings to learn about any areas for improvement.
- Keep in mind that crisis level operations in extreme disasters will tax the system and the normal standard of care likely will not be maintained.
Expert tips for personal safety
It’s paramount as a nurse to learn all you can about your employer’s disaster plan and to be as prepared as possible.
“When you are in disaster training, ask questions. Challenge the safety manager so that you know what your responsibilities are, and what the expectations are at the facility,” Hardy said.
“When hospitals experience a natural disaster, health care providers become both first responders — and victims,” which increases stress exponentially, the NYU study found.
“It takes an emotional toll on health care workers to keep their composure and work long hours helping patients during disaster times, especially while they’re wondering and worrying about the condition of their family back home,” said Bob Snedaker, owner of Simpler Life Emergency Provisions, which provides survival gear and emergency supplies to government agencies and health care facilities nationwide.
He recommended health care workers also have a survival plan and supplies for their families at home, in case they’re separated for an extended period of time.
“Have a family emergency plan (call tree, meeting place, backup power, food, water at home and in car) to ensure that you have adequate backup plans for family care (children, elders, disabled, pets, etc.) so that if you have to stay at work for extra shifts, your secondary responsibilities are attended to,” Gershon added.
Key supplies and provisions for disaster survival
Hospitals need “at least 10 days’ worth of food supplies, and all triage and trauma kits should be filled to their normal 20-day par levels,” Hardy advised. “Oxygen and vent supplies as well as surgical theater instruments should be checked based upon your trauma level capability.”
Experts agreed the primary survival item is a substantial reserve of clean drinking water. “In the event of a disaster, it could take days for water to become available,” RN Jonathan Steele said. “One of the biggest concerns I see is hydration.”
According to Snedaker, “Hospitals typically purchase pallets of canned water, which has the longest shelf life compared to other storage options for water.” Canned water has a shelf life of 50 years and can be purchased by the pallet. He added that cots and emergency kits are a few of the other items in high demand from hospital clients.
As far as personal supplies, most experts agree that nurses shouldn’t have to have extensive personal survival supplies on-hand, but it’s always advisable to keep an emergency kit in the car, just in case. Also, it’s important to have personal medications with you in case of an emergency.
“And don’t forget your cell phone charger,” Hardy said. “Also bring food and snacks that fit your diet. Don’t assume your employer has these.”
Pediatric disaster response
Experts also emphasized the importance of emergency planning and preparation specific to the needs of children.
“Children have unique physical and emotional needs that should be considered to adequately care for them throughout the disaster cycle, from planning, mitigation, response and recovery,” said Dr. Deanna Dahl Grove, who is a co-lead for the Disaster Domain within the Emergency Medical Services for Children Innovation and Improvement Center, a federally funded program that aims to improve emergency care for kids. “What happens to children during a disaster has the prospect of being life changing, and this is all dependent on the planning that families, communities, health systems and others do before the disaster even strikes. The CDC provides some tools to understand these differences, for families and healthcare professionals.”
Other pediatric disaster response resources include the American Academy of Pediatrics Council on Children and Disasters, which also provides materials to further support health care professionals and families. The Emergency Medical Services for Children Innovation and Improvement Center collaborated with the CDC and AAP to further disaster preparedness and to better provide for the needs of children.
“Integrating children and families every day and all the time when thinking about a ‘whole community or region’ that could have a disaster is (imperative) so that no one is left behind or forgotten,” Grove concluded.
Always be prepared
Disaster can strike anywhere. Experts seem unable to emphasize strongly enough the importance of ongoing training, education, awareness and preparation for all hospital staff. For optimal success and survival, every individual on staff needs to be prepared to take personal responsibility to bolster the employer’s emergency plans for the organization.
“Preparedness is a responsibility of life,” Snedaker said, “it should be integrated into your way of thinking every day. Difficult days will come. If you’re not prepared, you will suffer things you don’t need to suffer.”
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