Disasters — both natural and manmade — are a fact of life. Hospitals sometimes spend significant amounts of time and money preparing for situations they hope never arise, but know would make maintaining their operations more critical than ever.
Late last month, several hospitals in southeast Texas had to evacuate patients as Hurricane Harvey hit the area. With unprecedented flood waters, some of them will be cleaning up for at least the next few months. Not long after, Hurricane Irma forced about three dozen hospitals in Florida to close down or call for evacuation. Health systems and clinics in both areas were dealing with power outages and impassable roads during the worst of the storms.
Health systems have learned many lessons from the latest hurricanes in Texas and Florida, as well as less recent but incredibly impactful storms like Hurricanes Katrina and Sandy. Every part of the country is susceptible to different types of natural disasters, while a terrorist attack like a bombing or release of a biological weapon could strike anywhere.
Such events are by their nature unpredictable. But as the importance of preparation becomes increasingly clear — and the likelihood of severe weather grows — federal regulators and accreditors are looking to make sure hospitals are as ready as they can be.
The issues healthcare organizations need to consider when preparing for a disaster are myriad. They include supply chain integrity, information sharing, protecting and preserving patient records, shelter-in-place plans, essential equipment, evacuation plans, patient surge and managing mass fatalities.
Experts say most hospitals are not currently fully prepared for any disaster, but those looking to improve don't have to look hard for guidance or financial assistance. Hospital executives and board members must adopt a long-term outlook in order to recognize the importance of continually investing in preparedness.
In less than two months, providers will be required to adhere to a new CMS rule titled "Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers." Its purpose is to establish national emergency preparedness requirements and ensure “coordination with federal, state, tribal, regional and local emergency preparedness systems.”
It requires all 17 provider and supplier types that receive CMS reimbursement to develop an emergency plan based on an “all-hazards” risk assessment.
They must also:
- Develop and implement policies and procedures to address issues such as subsistence needs, evacuation plans, and procedures for sheltering in place as well as tracking patients and staff during an emergency.
- Develop a communication plan to coordinate patient care within the facility, across healthcare providers, and with state and local public health departments and emergency management systems.
- Develop and maintain training and testing programs, demonstrate knowledge of emergency procedures and provide training at least annually.
- Conduct drills and exercises to test the emergency plan.
- Review and update these policies and procedures at least annually.
Chad Beebe, deputy executive director of the American Society for Healthcare Engineering, told Healthcare Dive many healthcare facilities are already well on their way to compliance with the new CMS rule, which was drafted with an eye toward how providers have responded to previous emergency situations.
“Based on lessons learned from Hurricane Katrina, hospitals are now required to conduct more emergency preparedness drills, and update their plan annually,” he said. “These community-wide planning exercises, as well as hospital-specific drills, have improved coordination and communication during actual emergencies.”
Other organizations offer guidance as well. The National Fire Protection Association has a healthcare facilities code. The Joint Commission also evaluates organizations on their emergency operations plans. It looks for regular testing and monitors adequate communication, supplies and security, as well as clear staff roles and responsibilities, utility self-sufficiency and clinical activity that maintains care and supports vulnerable populations.
What does it mean to be prepared?
Researchers who published an analysis of the challenges to hospital emergency preparedness in the journal Disaster Medicine and Public Health Preparedness defined readiness as “the ability to effectively maintain hospital operations, sustain a medically safe environment and adequately address the increased and potentially unusual medical needs of the affected population.”
The article, written in 2009, concluded that hospital readiness is uneven across the U.S. and many hospitals remain unprepared. One of the authors, Dr. Joseph Barbera, associate professor of engineering management and systems engineering at George Washington University, told Healthcare Dive that information is still relevant today.
But hospitals shouldn't be alone in trying to achieve and maintain readiness, Barbera added. Hospitals should focus on being able to continue a medically safe operation for current patients, personnel and visitors. "If the community wants full readiness to care for all patients coming to them from a disaster, the community should be providing funding necessary for that expensive tasking," he said.
A key part of being ready for a disaster is knowing the potential emergency events that could occur. That can be straightforward — hurricanes, for example, are more likely in certain areas and certain seasons. Regions with a history of earthquake activity already have some specialized requirements like building codes that account for the hazard.
Facilities must also be ready, however, for an unusual or unexpected disaster. Scientists predict continuing climate change will make severe weather more frequent and more severe — and these weather events could begin occurring in areas not historically used to seeing them. Terrorist attacks of all kinds are always possible, and infectious disease outbreaks can’t necessarily be predicted.
The authors of the Disaster Medicine and Public Health Preparedness study argue a traditional hazard vulnerability analysis can negatively affect risk perception by ranking hazards in order of priority instead of evaluating vulnerabilities. “If hospitals measure the success of their preparations strictly in terms of being prepared for Armageddon-level terrorism hazards or other massive hazard types ... then the psychological effect of trying to prepare for these overwhelming situations may result in a sense of futility or complete apathy,” they wrote.
The 2017-2022 Health Care Preparedness and Response Capabilities report produced by the Office of the Assistant Secretary of Preparedness and Response (ASPR) outlines four key capabilities for healthcare organizations: foundation for healthcare and medical readiness, healthcare and medical response coordination, continuity of healthcare service delivery and medical surge of incoming patients.
“These capabilities illustrate the range of preparedness and response activities that, if conducted, represent the ideal state of readiness in the United States,” according to the report.
The costs of readiness
Hospital budgets are already stretched thin by reduced patient volumes and flattening reimbursement rates. It can be difficult for a healthcare executive to promote the investment required to maintain proper disaster preparedness when there are not necessarily immediate, tangible benefits.
The Disaster Medicine and Public Health Preparedness journal article notes that removing employees from day-to-day work in order to train and practice preparedness can be challenging because replacements have to be found or work has to be set aside. “Building a surge capacity may require investing in equipment and supplies that may never be used. Resources must be stored, maintained and frequently replenished or rotated because of shelf-life limitations.”
Health systems can find outside funding help, though. HHS runs the Hospital Preparedness Program (HPP), which is designed to “promote a sustained national focus to improve patient outcomes, minimize the need for supplemental state and federal resources during emergencies, and enable rapid recovery.”
The program falls under the ASPR, which was created after Hurricane Katrina. HPP has awarded $255 million in grants for each fiscal year from 2015 to 2017, and there have been 62 total awardees over that span, according to a government fact sheet.
Hospitals can save money in other ways as well, such as bulk purchasing agreements, tax exemption and cost-sharing with other organizations. They can also obtain private funding.
Healthcare leaders who have been watching the medical response as hurricanes have pummeled the U.S. and its territories in the past several weeks may consider evaluating their readiness for such a disaster. There is much to consider. Being truly prepared requires substantial investments, but the issue is too important to ignore.