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Hospital Preparedness

by Mitch Saruwatari: Practical emergency preparedness and management for hospitals

| Contact Mitch Saruwatari

October 17, 2011

As the emergency preparedness coordinator for your hospital, you’re responsible for ensuring the safety of staff, patients, visitors and your facility in a disaster or emergency. While your boss doesn’t need to know every detail of how you do your job, in honor of Boss’s Day on October 16th, here are five things your boss should know about why emergency preparedness is critical for your hospital.

1.     Every dollar spent on emergency preparedness saves the hospital money.
Most hospitals think of emergency preparedness as a cost center. After all, it’s an area that needs funds for supplies and personnel, and disaster exercises and training events require revenue-producing employees like doctors and nurses to take time away from treating patients.

However, studies show that the cost benefit for every $1 spent in preparedness creates $4-11 worth of valuable return, with savings coming from fewer and less severe casualties, reduced property damage, and a more expedient recovery to normal business operations. Check out studies from the Harvard School of Public Healthand FEMA for more background and let your boss know the money and resources going towards emergency preparedness are dollars well spent.
 
2.     The number of declared disasters in the US each year is increasing.
While the specific number fluctuates each year, the overall trend in the number of presidentially declared disasters in the US is steadily increasing (FEMA website). Last year, there were 81 declared disasters and with the number currently at 77, I wouldn’t be surprised to see the 2011 total easily surpass 2010.

I’m not sure why the number is growing. It might simply be because of improved reporting, though thinking back of the events from this year (Japan earthquake and tsunami, Midwest tornados, Washington earthquake, Northeast flooding, Southwest power outage and wild fires) makes me wonder if there’s a climate component to the change as well.

Regardless of why, the days of not worrying about disasters because they only affect “the other guy” are over. Disasters are happening in every part of the country so no one is immune.  Eventually, your boss may find himself or herself in front of the TV cameras, commenting on how your facility is handling the situation in your community, or worse, having to report to the Board regarding a response that could have been better planned. 

This month, the Natural Hazards Center in Boulder published a great article titled, “Better to Be Damned if You Do, Than Damned if You Don’t” about Hurricane Irene.  Several commented that it was simply too much effort considering that mass destruction never happened.   Unfortunately, complacency can really damage future response competency. 

3.     There are disruptions every week in our hospital.
Preparing for major events and disasters is a large part of your job as an EMC, but I’m sure you also spend a considerable amount of time dealing with more frequent events, one of the most serious of which is dealing with situations of violence in the hospital.

 A hotspot for violent situations in the hospital is the ER. Every week, there are stories of nurses and other ER staff attacked by patients, family members, and even addicts looking to steal drugs. Overcrowding, long wait times and lack of appropriate facilities all contribute to the problem. In California budget short-falls are impacting the number of available psychiatric beds throughout the state.  Subsequently, more mental-health-related illnesses are ending up in ERs that may be ill-equipped to manage the increase. A recent article in the LA Times highlighted this situation.

As the hospital emergency preparedness team, having a plan to quickly manage these types of disruptions is crucial for ensuring staff and patient safety on a daily basis.

4.     We save thousands or even millions of dollars by quickly recovering from an event.
One of the primary goals in an emergency response is to get operations back to normal as quickly as possible. In its Hurricane Ike report, FEMA reported The University of Texas Medical Branch - Galveston  lost $40 million per month because of reduced hospital operations post-Ike. Even if the hospital isn’t completely shut down, loss of even some services will significantly impact revenue.

Hopefully your boss knows that your emergency plan, exercises and training are intended to ensure your hospital gets back to business, as quickly as possible, after an event. And that means critical revenue for your hospital.

5.     Hospitals lose millions of dollars every year because they can’t produce documentation to support cost recovery.
Getting recovery funds after a response requires a great deal of documentation, and typically during a disaster response, documentation is the last thing on anyone’s mind. So, each year, hospitals forgo thousands of dollars in funds that they are entitled to, simply because they do not have the documentation to support claims.

With today’s tight margins in healthcare, being able to get reimbursements for the employee overtime needed in the snowstorm, hurricane, or flood can often make a big difference to the hospital’s bottom line. Let your boss know that this tracking of documentation is another area where the emergency preparedness program helps the hospital as a whole.

I hope these steps help raise emergency management awareness in your facility.  Without leadership support, our programs often suffer and subsequently, so does our response competency.  If you have any additional ideas or suggestions that have worked for you, please feel free to share them!


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October 05, 2011

I’m so glad to have the opportunity to write a blog about hospital emergency preparedness because every day, you see amazing things happening by hospital emergency teams. In the past few months, the amazing evacuations in east coast hospitals and the incredible efforts by hospital workers and the community in Joplin. And with the recent 10th anniversary of 9/11, there’s no better reminder of why I’m glad I’ve been part of this field since 1994.

In 1993, I participated in my first disaster response, one that I’m both proud of and still embarrassed about.  Several years after the end of WWII, my grandparents built their dream home in Southern California.  It served as a central hub for our extended family and I have fond memories of vacations and holidays spent there.  At the time, I was working at the San Diego Health Department and received a call from one of their neighbors that all had evacuated due to a raging fire.  I immediately left my office and made the 60 mile drive in record time.  The fire department had blocked off the street but I knew all the shortcuts through neighbor’s yards so was able to secretively make my way to their home.  I was relieved to find their house and neighborhood undamaged.  However, later that evening the fire began to move in and I spent the night with shovel and hose putting out embers as they pelted the house.  In the morning, my grandparents’ home survived with the exception of some smoke damage and a lot of burned areas in the yard.  I was glad the house was saved but later mortified to think my actions could have put others in danger.

This adventure was an epiphany and career changer.  Within a few months, I took a job in Los Angeles helping with recovery efforts following the Northridge Earthquake.   Since then, I’ve been a part of multiple public health and hospital emergency management planning campaigns as well as actual responses.  Following each incident, all involved worked hard to identify gaps in capabilities and seek out resources to fill those gaps using training, mitigation activities and subsequently better exercises.  However, it wasn’t until the September 11th attacks that the field of emergency management really changed.  Those events seemed to galvanize leaders from across the country to mobilize expertise and provide funding to better equip and support response agencies, including healthcare organizations for addressing new and existing threats. 

With this new support, response agencies have been able to plan and respond more frequently with other community organizations, including public health and healthcare.  To me, a few of the greatest benefits realized from this funding include more universal planning activities, a greater emphasis on coalition building and strategic planning helping to forge response plans that are more practical and make better sense.  So when I read about heroic medical responses like those in Tuscaloosa or Joplin and see state governors actively engaged days before a hurricane strikes, I’m thankful for the many who are committed to this field, their willingness to embrace change and the lives saved by their dedication.


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