Hospital Emergency Management Planning

– Look at two of my classmate’s posts. I need you to respond to each one separately. Don’t write about how good their posts or how bad. All you need to do is to choose one point of the post and explore it a little bit with one source support for each response. In the attachment, you will find all the classmates posts. – APA Style. – Reading: Reilly, M., &Markenson, D. S. (2010). Health Care Emergency Management: Principles and Practice • • Chapter 6: Introduction to Exercise Design and Evaluation Chapter 8: Education and Training Emergency management principles and practices for healthcare systems (2006). Kaji, A, Langford, V, Lewis,R (2008) Assessing Hospital Disaster Preparedness: A Comparison of an On-Site Survey, Directly Observed Drill Performance, and Video Analysis of Teamwork, Annals of Emergency Medicine V52, No3, 195-201 • Assessing Hospital Disaster Preparedness.pdf – Discussion Board Question? * What are some of the biggest challenges in developing and implementing a preparedness exercise in a hospital setting? * What differences/similarities exist between hospital and municipal preparedness exercises? Student 1 post: Challenges Facing the Healthcare System During Emergencies The healthcare system plays an important role in times of disasters. Through proper planning, training, command, and coordination the system should always be responsive. However, the situation on the ground is different. Most hospitals are caught up in times of disasters which end up making the already bad situation worse. The main challenge lies with developing and implementing the required preparedness action. Among the greatest challenges in hospice organizations is a surge in capacity. Most hospitals in the densely populated areas operate at or near full capacity. Consequently during disasters, the hospitals are seriously limited on their expansion capability (Kaji & Lewis, 2004 ). Some of the surveys done, for example, have found that availability of beds, ventilators, isolation beds, and drugs are insufficient in times of large scale disaster. Another challenge is the lack of a good communication network. There is a need to put more emphasis on the importance of a good flow and channel of communication. It’s a fact that communication assists in ensuring victims are directed to the most appropriate facilities. Besides, hospitals have a prior alert on the number of victims to expect and the type of response is required. According to Niska and Burt (2005), very few hospitals have a provision for their bioterrorism response plan at 72% . Hence, it can be stated that the communication systems for most hospitals are considerably weak. Similarities Between the Municipal and Hospital Preparedness The teams tasked with the tackling emergencies in cases of a disaster are the municipal and the healthcare workers. Hospital Emergency Management Planning

Both teams share a lot when it comes to disasters management. The municipal team for instance provides emergency plan templates training and exercises development and facilitation of the same. In addition, the municipal enhance information sharing with the different hospitals; creating situational awareness on the primary care needs before and after a disaster. In conclusion, the mutual partnership between healthcare providers and the local authorities is imperative and more resources should be channeled to enhance this cooperation. The management of hospitals around the country should come up with realistic policies that can be implemented to make sure disasters and emergencies are averted in the shortest possible time. References Kaji, A. H., Langford, V., & Lewis, R. J. (2008). Assessing hospital disaster preparedness: A comparison of an on-site survey, directly observed drill performance, and video analysis of teamwork. Annals of emergency medicine, 52(3), 195-201.doi: 10.1016/j.annemergmed.2007.10.026. Niska, R. W., & Burt, C. W. (2005). Bioterrorism and mass casualty preparedness in hospitals: United States, 2003. Emmitsburg, MD: National Emergency Training Center. Rand Corporation. (2004). RAND study shows compensation for 9/11 terror attacks tops $38 billion. Businesses Receive Biggest Share. Retrieved from http://www.rand.org/news/press.04/11.08b.html Student 2 post: Hospital preparedness especially when it comes to disasters is a common requirement that should be taken seriously. Majority of hospitals in the urban and rural sectors do not use disaster preparation techniques in managing disasters (Beitsch et al,2006). This usually results to most of them failing when a disaster takes place. It is essential that hospitals should always be prepared in handling these situations since they handle the lives of people. There are many challenges that make it difficult for hospitals to either develop or implement their preparedness plans; this paper will discuss some of them. Budgets are some of the leading problems that affect planning an implementation of preparedness plans. The hospital sector will always require enough financial allocations for buying emergency types of equipment that will help in rescuing people from arising dangers. In some cases, the hospitals may be forced to spend too much on patients’ recovery. This, therefore, means that there should always be money that is available to take care of this. Some finances can be used for other preparations and the training of staff. Some hospitals face problems with the administration; The administrators do not consider emergencies when they are planning for or allocating the available resources. Hospital Emergency Management Planning

This, therefore, leads to the misuse of resources that would have instead been used for preparing for disasters. Training of staff is a requirement that should be accomplished in every hospital so that they are able to deal with emergencies (Leinhos et al, 2014). Emergencies in the health-care sector cannot be handled by just anyone, special knowledge is required so as not to cause more harm. There is also a lack of enough guidelines to provide direction to the staff; this can help in avoiding switching of roles. Communication is another important factor that is not taken seriously in health care preparedness. Through good communication, the nurses and other staff are informed of their roles beforehand so they know what to do, this avoids any sort of confusion. Communication is important in ensuring there is coordination. Coordination is also another problem that affects the development and implementation of preparedness plans in the hospital setting. Coordination between different sectors such as wards and the administration help in ensuring a hospital is fully prepared. The above-explained factors help in showing that indeed there is a difference between the municipal preparedness and the hospital preparedness for an emergency. The hospital, for instance, requires qualified staff that are fully trained on how to handle emergency situations (CAUDLE, 2009). The hospital setting is more important hence requires more attention. The importance is derived from its ability to also treat the affected people from any emergency situation. It is also important to remember that both sectors are similar in a way; they both deal with emergency and require revenue. This, therefore, means that financial allocation affects all of them. In summary, emergency services are always important since they ensure any disaster or sudden occurrence is controlled properly. It is clear that capital is important in planning for control of such situations. Training of the staff is also another factor that helps in the efficiency of the operation. The management in hospitals and the municipal sectors are also expected to be qualified so that they can do their work as required and for proper use of resources. They should also ensure that they work with all sectors to enable the process of emergency control. Through communication, every staff will be made aware of the situation whenever it comes about. Hospital Emergency Management Planning

The hospitals should also contain the emergency department section with the teams who work together in controlling disasters. This can help in specialization in this sector so that it is remembered when funds are being allocated. References Beitsch, L., Kodolikar, S., Stephens, T., Shodell, D., Clawson, A., Menachemi, N., & Brooks, R. (2006). A State-Based Analysis of Public Health Preparedness Programs in the United States. Public Health Reports (1974-), 121(6), 737-745. CAUDLE, S. (2009). AN OPTION FOR HOMELAND SECURITY PREPAREDNESS REQUIREMENTS: Consensus Management System Standards. Public Performance & Management Review,33(1), 141-155. Leinhos, M., Qari, S., & Williams-Johnson, M. (2014). Preparedness and Emergency Response Research Centers: Using a Public Health Systems Approach to Improve All-Hazards Preparedness and Response. Public Health Reports (1974-), 129, 8-18. DISASTER MEDICINE/ORIGINAL RESEARCH Assessing Hospital Disaster Preparedness: A Comparison of an On-Site Survey, Directly Observed Drill Performance, and Video Analysis of Teamwork Amy H. Kaji, MD, MPH Vinette Langford, RN, MSN Roger J. Lewis, MD, PhD From the Department of Emergency Medicine, Harbor–UCLA Medical Center, Los Angeles, CA (Kaji, Lewis); David Geffen School of Medicine at UCLA, Torrance, CA (Kaji, Lewis); Los Angeles Biomedical Research Institute, Torrance, CA (Kaji, Lewis); The South Bay Disaster Resource Center at Harbor–UCLA Medical Center, Los Angeles, CA (Kaji); and MedTeams and Healthcare Programs Training Development and Implementation, Dynamics Research Corporation, Andover, MA (Langford). Study objective: There is currently no validated method for assessing hospital disaster preparedness. We determine the degree of correlation between the results of 3 methods for assessing hospital disaster preparedness: administration of an on-site survey, drill observation using a structured evaluation tool, and video analysis of team performance in the hospital incident command center. Methods: This was a prospective, observational study conducted during a regional disaster drill, comparing the results from an on-site survey, a structured disaster drill evaluation tool, and a video analysis of teamwork, performed at 6 911-receiving hospitals in Los Angeles County, CA. The on-site survey was conducted separately from the drill and assessed hospital disaster plan structure, vendor agreements, modes of communication, medical and surgical supplies, involvement of law enforcement, mutual aid agreements with other facilities, drills and training, surge capacity, decontamination capability, and pharmaceutical stockpiles. Hospital Emergency Management Planning

The drill evaluation tool, developed by Johns Hopkins University under contract from the Agency for Healthcare Research and Quality, was used to assess various aspects of drill performance, such as the availability of the hospital disaster plan, the geographic configuration of the incident command center, whether drill participants were identifiable, whether the noise level interfered with effective communication, and how often key information (eg, number of available staffed floor, intensive care, and isolation beds; number of arriving victims; expected triage level of victims; number of potential discharges) was received by the incident command center. Teamwork behaviors in the incident command center were quantitatively assessed, using the MedTeams analysis of the video recordings obtained during the disaster drill. Spearman rank correlations of the results between pair-wise groupings of the 3 assessment methods were calculated. Results: The 3 evaluation methods demonstrated qualitatively different results with respect to each hospital’s level of disaster preparedness. The Spearman rank correlation coefficient between the results of the on-site survey and the video analysis of teamwork was – 0.34; between the results of the on-site survey and the structured drill evaluation tool, 0.15; and between the results of the video analysis and the drill evaluation tool, 0.82. Conclusion: The disparate results obtained from the 3 methods suggest that each measures distinct aspects of disaster preparedness, and perhaps no single method adequately characterizes overall hospital preparedness. [Ann Emerg Med. 2008;52:195-201.] 0196-0644/$-see front matter Copyright © 2008 by the American College of Emergency Physicians. doi:10.1016/j.annemergmed.2007.10.026 INTRODUCTION A disaster may be defined as a natural or manmade event that results in an imbalance between the supply and demand for resources.1 Events of September 11, 2001, and the devastation from Hurricanes Katrina and Rita have recently Volume , .  : September  highlighted the importance of hospital disaster preparedness and response. Previous disasters have demonstrated weaknesses in hospital disaster management, including confusion over roles and responsibilities, poor communication, lack of planning, suboptimal training, and a Annals of Emergency Medicine 195 Assessing Hospital Disaster Preparedness Editor’s Capsule Summary What is already known on this topic Extremely little is known on how to objectively and accurately rate hospital disaster preparedness. Scales and measurements have been developed but not extensively validated; most evaluations are highly subjective and subject to bias. Hospital Emergency Management Planning

What question this study addressed At 6 sites, 3 evaluation methods, an onsite predrill survey, a real-time drill performance rating tool, and a video teamwork analysis, were used and correlations among evaluation methods examined. What this study adds to our knowledge The 3 methods produced disparate evaluations of preparedness, suggesting that the instruments are flawed, they are measuring different things, or both. How this might change clinical practice Better assessment tools for hospital disaster preparedness need to be developed, perhaps beginning with the careful definition of what aspects of preparedness are to be measured. lack of hospital integration into community disaster planning.2 Despite The Joint Commission’s emphasis on emergency preparedness for all hospitals, including requirements for having a written disaster plan and participating in disaster drills, there is currently no validated, standardized method for assessing hospital disaster preparedness. This lack of validated assessment methods may reflect the complex and multifaceted nature of hospital preparedness. To be prepared to care for an influx of victims, a hospital must have adequate supplies, equipment, and space, as well as the appropriate medical and nonmedical staff. Survey instruments, either self-administered or conducted on site, may be used to assess these resources. Although surveys and questionnaires attempt to capture a hospital’s level of preparedness through quantifying hospital beds, ventilators, isolation capacity, morgue space, available modes of communication, frequency of drills, and other aspects of disaster preparedness,3-8 it is unclear whether they are reliable or valid predictors of hospital performance during an actual disaster, or even during a drill. In contrast to surveys, which assess hospital resources and characteristics during a period of usual activity, disaster drills make use of moulaged victims to gauge hospital preparedness and assess staff interactions in a dynamic environment in real time. Although hospitals routinely conduct after-drill debriefing sessions, during which participants discuss deficiencies warranting improvement, there is no commonly used and 196 Annals of Emergency Medicine Kaji, Langford & Lewis validated method for evaluating hospital performance during disaster drills. To address this gap, the Johns Hopkins University Evidence-based Practice Center, with support from the Agency for Healthcare Research and Quality (AHRQ), developed a hospital disaster drill evaluation tool.9 The tool includes separate modules for the incident command center, triage area, decontamination zone, and treatment areas. In a recent study, conducted in parallel with the study reported here, we described the AHRQ evaluation tool’s internal and interrater reliability.10 We found a high degree of internal reliability in the instrument’s items but substantial variability in interrater reliability.10 Recently, evidence has suggested that enhancing teamwork among medical providers optimizes the provision of health care, especially in a stressful setting, and some experts working in this area have adopted the aviation model as a basis for designing teamwork programs to reduce medical errors.11 In 1998, researchers from MedTeams, a research corporation that focuses on observing and rating team behaviors, set out to evaluate the effectiveness of using aviation-based crew resource management programs to teach teamwork behaviors in emergency departments (EDs), conducting a prospective, multicenter, controlled study. Hospital Emergency Management Planning

12 The MedTeams study, publis hed in 2002, demonstrated a statistically significant improvement in the quality of team behaviors, as well as a reduction in the clinical error rate, after completion of the Emergency Team Coordination Course.12 Because effective teamwork and communication are essential to achieving an organized disaster response, assessing teamwork behavior may be a key element in a comprehensive evaluation of hospital disaster response. Evaluating teamwork behaviors involves the assessment of the overall interpersonal climate, the ability of team members to plan and problem-solve, the degree of reciprocity among team members in giving and receiving information and assistance, the team’s ability to manage changing levels of workload, and the ability of the team to monitor and review its performance and improve its teamwork processes.12 In addition to observing team members in real time, MedTeams researchers routinely review videotaped interactions among team members as a method of quantifying teamwork behaviors. The objective of our study was to determine the degree of correlation between 3 measures of assessing hospital disaster preparedness: an on-site survey, directly observed drill performance, and video analysis of teamwork behaviors. MATERIALS AND METHODS Six 911-receiving hospitals, participating in the annual, statewide disaster drill in November 2005, agreed to complete the site survey and undergo the drill evaluation and video analysis. The selection of the sample of hospitals and their characteristics has been described previously.10 The drill scenario included an explosion at a public venue, with multiple victims. To preserve the anonymity of the hospitals, they are designated numerically 1 through 6. Because all data were Volume , .  : September  Kaji, Langford & Lewis deidentified and reported in aggregate, our study was verified as exempt by the institutional review board of the Los Angeles Biomedical Research Institute at Harbor–UCLA Medical Center. We used an on-site survey (included in Appendix E1, available online at http://www.annemergmed.com), which included 79 items focusing on areas previously identified as standards or evidence of preparedness.1-3,13-28 The survey was a modification of an instrument we used in a previous study.8 Compared with the original survey instrument, the number of items was reduced from 117 to 79 by the study investigators to eliminate items that had limited discriminatory capacity and to reduce redundancy and workload. Hospital Emergency Management Planning

Survey items included a description of the structure of the hospital disaster plan, modes of intra- and interhospital communication, decontamination capability and training, characteristics of drills, pharmaceutical stockpiles, and each facility’s surge capacity (assessed by monthly ED diversion status, number of available beds, ventilators, negative pressure isolation rooms, etc). Because a survey performed in 1994 demonstrated that hospitals were better prepared when the medical d … Hospital Emergency Management Planning