For the past several months, I have been participating in an international emergency management fellowship conducted by Professor Scot Phelps of the Emergency Management Academy. During many class discussions, we frequently visit the role of the emergency manager. This role is very complex, and involves wearing such hats as coach, social worker, insurance expert and resource coordinator, among others.
These discussions have given me new insight: If an emergency manager must be all these things, then a health-care emergency manager must be all these things — and more. Emergency managers in health care need to know how emergency management works and how those concepts apply to hospitals and health systems.
The Sanford Health System Program
Sanford Health is the largest rural health system in the United States, representing Sioux Falls, S.D., Fargo, N.D., and a newly added region in Bemidji, Minn.
The Sioux Falls region consists of 23 hospitals and more than 120 clinics. Within this region is a health-care emergency management committee that consists of a representative from each hospital facility, some of which also encompass clinics and long-term care/assisted living facilities. The committee was formed six years ago in an effort to standardize emergency management planning and education. So far, it has developed a very productive process.
Sanford health-care facilities participate in training and exercises with their partners throughout the region. Additionally the Sioux Falls region participates in a multiple-facility exercise once a year, which tests network area command capabilities, communications and resource management concepts at the system level, as well as the Incident Command System and other response functions at a local level.
Another committee role is to serve as a system incident management team with deployable personnel and equipment. The incident management team has traditionally had four levels of responders, with each level requiring an additional level of education. These initial levels were:
decontamination operations; decontamination team leader; emergency operations center manager; and incident management specialist.
Recently I began working with the South Dakota Department of Health on a project that’s related to the building and maintenance of comprehensive emergency management programs. The ultimate goal is to develop personnel for the South Dakota Incident Management Team to support Emergency Support Function 8, which was previously activated by FEMA and authorizes the U.S. Department of Health and Human Services to coordinate hospital medical needs and patient evacuations in support of the state.
From this experience, I realized it’s time to change how we train our health system emergency managers.
The Appropriate Path
Let’s look realistically at the traditional health-care emergency manager’s role. There are very few health system full-time equivalents dedicated to emergency management. Most are combined roles with safety officers, or environmental or facilities managers. Even some infection control and health-care quality personnel pick up the emergency management role, which is acceptable as long as we can provide them with a focus and structure that enables them to develop and maintain a comprehensive emergency management program at their facility. We must build their confidence so that they maintain their essential role in the hospital command center during times of crisis.
The odds are that most local emergency managers have been either a firefighter, law enforcement officer or emergency medical services (EMS) provider, and they’ve likely have been in the game for at least 15 to 20 years. They are most likely extremely knowledgeable in their roles, know all of the response partners, their partners’ capabilities and most importantly, where all the available resources are. These people are an invaluable asset to the response community, but they can also be quite standardized in their belief system.
Academy Educated
The common thread — be it with firefighters, EMS professionals, law enforcement and health-care providers — is that we were educated in “academy fashion” in our primary roles. Firefighters go to fire academy for training programs and police officers to the police academy; EMS professionals go from first responder to emergency medical technician to intermediate to paramedic.
So why not approach emergency management education in the same fashion — at least as an initial process and to build our health-care emergency managers from the ground up? By jump-starting your emergency manager, you jump-start your program and head toward successful compliance and a confident state of readiness. It makes a foundational knowledge base attainable in segments and fits in with many of the current emergency managers’ comfort zones in the escalating education model. Once we get them on the entrance ramp, they can get on the highway to professional certifications.
Finally, there must be face-to-face education in each and every level. Independent study classes serve a purpose, but somewhere along the line, a student needs face time with an educator. He or she needs to interact with the knowledge and to practice application of the newly learned skill set. The initial test should never be on the day of an incident.
In the Sanford model, I have defined five levels of escalating education: basic awareness and compliance; basic operations — basic emergency management and exercise concepts; intermediate operations — the National Incident Management System and Incident Command; advanced operations — leadership and response strategy; and incident management specialist — education for the deployable team member.
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