Implementing the Emergency Plan

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Implementing the Emergency Plan
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Disaster Plans

• Hospital personnel, including administrators,
• vary widely on the value they attach to disaster
• plans. Some staff members see them as
• useless, a ritual necessary solely for
• accreditation most accept plans as having
• some use a few believe their plans can handle
• every conceivable emergency. 1

The facilitys Coordination Plandescribes how
it intends to behave during the response to, and
recovery from, disasters.
1 Quarantelli, 1970
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Disaster Planning Is...

• 1. A continuous process
• 2. Reducing the unknowns
• 3. Evoking appropriate actions
• 4. What is likely to happen?
• 5. Based on valid knowledge
• 6. Focused on general principles
• 7. An educational activity
• 8. Overcoming resistances
• 9. Testing
• 10. Not Disaster Management 1

1 Quarantelli, 1984
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Disaster PlanningIs Not The Same AsDisaster
Management
Planning For Disasters Must Be Differentiated
From The Principles That Guide Management Of
An Emergency 1
1 Quarantelli, 1984
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Disasters Are NotEasily Managed

• The management of routine, daily emergencies in
  the U.S. is influenced by a national preference
  for local control and private enterprise. The
  result is a complex, decentralized structure
  where the various tasks are divided among a
  myriad of independent public and private
  organizations. 1
• In larger than normal emergencies, this
  decentralized structure creates problems in
  interagency coordination.

1 Drabek, Quarantelli 1985, 1987, 1991
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Disasters Change Normal Organizational Routines

• Off-Duty Personnel Are Called In
• Personnel Are Re-Assigned To New Duties
• Everyday Procedures Priorities Are Altered
• Organizations Share Tasks Resources
• Involvement of Non-Emergency Responders
• Crossing of Jurisdictional Boundaries
• Non-Routine Tasks Are Created
• Damage To Normal Response Tools Facilities
• Formation Of New Organizations 1

1 Auf Der Heide, 1989
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Health Care FacilitiesHave Unique Characteristics

• Heavily occupied housing patients, visitors,
  staff and medical personnel on a 24-hour basis
• Complex structures having many small rooms and
  combining the functions of hotel, office,
  laboratory, warehouse, etc.

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Health Care FacilitiesHave Unique Characteristics

• Dependent upon utility services power, water
  supply, waste disposal, communications, etc.
• Supplies, necessary for patient treatment, and
  records necessary for accurate treatment are
  vulnerable to damage 1
• ?

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Health Care FacilitiesFace Certain Social
Realities

• Regardless of internal problems caused by a
  community incident, injured persons will arrive
  expecting treatment
• Inquiries by family and friends will place a
  heavy load on available communications and staff
• Volunteers of all types will arrive to lend a
  hand

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Health Care Facilities Will Have A Major Problem
With...

• Convergence of injured persons, relatives
  friends, the general public (volunteers),
  off-duty staff medical personnel, news media,
  etc. !
• Not a Scarcity of Resources ! 1

1 Quarantelli, 1970
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5 Key Weaknesses OfHealth Care FacilitiesFor
Disaster Operations

• 1. Mobilization
• 2. Information Processing
• 3. Task Assignment
• 4. Decision-making
• 5. Interorganizational Relationships 1

1 Quarantelli, 1970
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No man is an island, entire of itself... John
Donne

• He might well have been referring to the health
• care facility, for it exists within and for the
• community. It therefore follows that a disaster
• which affects the community will also have a
• direct or indirect impact upon the institution..
  1

1 Hanna, 1991
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Characteristics of Emergencies

• Existence of a warning period
• Location
• Scope
• Magnitude
• Duration
• Time of day
• Day of the week
• Season of the year
• Past, present and future weather
• ?

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Brewster, 1994
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Nature of the Event
WHAT?

• Type of Primary Event Wind, Water, Fire,
  Ground-shaking, Heat/Cold, etc.
• Its Magnitude
• Its Duration
• Likely Secondary Effects, caused by the primary
  hazard, the Cascading of Events

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Nature of the Event
WHEN?

• The existence of a Warning Period, and if so, how
  long?
• Time of Day morning, afternoon, or evening
• Day of the Week weekday, weekend
• Weather Conditions past, present and expected
• Season of the Year winter/summer, and tourism

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Nature of the Event
WHERE?

• Types of Land Uses
• Types of Critical Facilities

Public Safety Communications Centers, and High
Occupancy Structures Hospitals, Nursing Homes,
Schools, Jails, Shopping Malls, Office
Complexes, Industrial Facilities, etc.
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Potential Injury Causing Event
A
B
C
Stage
Static Dynamic
Controlled Disruptive Paralytic
Local P Regional I National C International E
0 I II III
Koenig, 1995
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Emergencies Can Present Themselves In 2 Ways
Unanticipated and/or Without Warning
Anticipated and/or With Warning
Oklahoma City Bombing
Hurricane Andrew
SWISSAIR Flight 800
Midwest Floods
Persian Gulf War
Northridge Earthquake
The Amount of Time Were Given To Pre-Organize
People and Pre-Stage Equipment Can Drastically
Change Our Response Effectiveness In Terms Of
Lives Saved and Property Conserved
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Who (initially) manages the emergencyResponders
or Managers?
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Responders
Managers
Take Immediate Action
Take Immediate Action
Incident Action Planning
To Save Lives
To Support Responders
Conserve Property
Project Requirements

• Set overall objectives
• Determine activity areas
• Specify control objectives/tactics for each area
• Specify resources needed by each area
• Specify facilities and reporting locations
• Place personnel and resource order
• Develop communications and traffic plan
• Finalize, approve and implement the action plan

13 Probable Steps Using Checklists
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Decision Starter
Insert Emergency Here
You are...
You have...
MANAGER
NO WARNING
RESPONDER
WARNING
Begin Action Planning
Begin 13 Steps
Brewster, 1993
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Evacuation Due To Fire
You are...
You have...
MANAGER
NO WARNING
RESPONDER
WARNING
Begin Action Planning
Begin 13 Steps
Brewster, 1993
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Responder Skills
Everyone should understand how to

• Act on the warning Protect yourself others.
• Assess what has happened, where it is going,
• and who may be in its way.
• Report what you have found out to others.
• Decide if you with others can control it -
  safely.
• Organize people to control it or move others
• out of its way.
• Talk about it, once Its over.

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1
Someone Takes Charge !
Initial Incident Commander
The First Person Who Doesnt Have To Get Involved
In Actions That Control Effects or Save Lives
Manager, not a Responder
ERI
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2
Size-up
A Process by Which... the Initial Incident
Commander Asks
o What Have I Got? (Situation) o Where
Is It Going? (Potential) o How Do I Control
It? (Resources)
SIZE-UP, a continuous process ... involves
a constant gathering evaluation of information.
ERI
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3
Establish a Command Post
Established As Soon As Possible.
Where Initial Management Occurs
The hub of all activities Easily
identified Central location for information
o Initial Incident Commander ...
STAYS THERE !
ERI
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4
Establish Communications from Command Post
to Emergency Operating Center
ERI
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5
Resource Analysis
Make note of numbers types of
responders on-scene with inventory of equipment
projected needs for resources additional
manpower.
After a thorough size-up of the
situation... request resources commensurate with
the needs now and for the next 8 hours.
ERI
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6
Develop an initial attack Strategy
Offensive
Defensive
During this time period, planning is
informal... probably done solely by the Initial
Incident Commander.
The Transition to a Written Plan Will Normally
Occur Only After Immediate Threats To Life are
Controlled
ERI
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7
Designate an Operations Chief
To Manage All Tactical Activities - Controlling
the on-going negative effects - Guiding search,
rescue, medical, security, mass
care, etc.
Brief on roles responsibilities Explain the
situation Describe what you want accomplished
Provide a Written Plan if possible !
ERI
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8
Designate a Safety Officer
the Safety Officer has the authority to STOP
UNSAFE ACTS
ERI
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9
Secure the Scene
Designate the Perimeter of the Incident Site...
...with zones for levels
of danger.
1. Hot Zone (maximum danger) 2. Warm Zone
(moderate danger) 3. Cold Zone (minimal danger)
ERI
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Deploy Responders
Operations...

• Matches resource capability or expertise to
  the objectives tasks.
• Monitors progress of priority tasks .
  re-assign responders to meet changing
  conditions.
• Evaluates hazards and commit only qualified
  responders into high hazard areas.

...and makes recommendations to the Incident
Commander
ERI
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Designate a Planning Chief
Tracks all incident data Develop
alternatives Conducts planning meetings
Proposes Incident Action Plan
Key tasks include
ERI
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12
Designate other Functions, as needed
Command Staff
Liaison Officer Information Officer
Which Functions Are Needed ?
General Staff
Logistics Section Chief Finance Section
Chief
ERI
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13
Continue to Organize Manage
Manage Shift Changes, Briefing De-briefing
Divide the Incident into Manageable Areas
Stay Ahead of the Power Curve !
Clearly Identify Zones IMS Positions
Establish Staging Area(s)
Establish Traffic Flow
Know Current Incident Resource Status
Coordinate Information Needed Support With EOC
Plan For What Happens Next !
ERI
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VA/DoD Contingency
You are...
You have...
MANAGER
NO WARNING
RESPONDER
WARNING
Begin Action Planning
Begin 13 Steps
Brewster, 1993
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Manager Skills
We Must First Understand The Situation To
Properly Respond To It !
What ? Where ? When ? Whos Involved ? Where Is
It Going ?
Initially

• INCIDENT BRIEFING
• Date/time of start of incident
• Type of incident
• Services involved
• Current incident status
• Current resource status
• Current strategy/objectives
• Communications systems being used
• Special problems/issues

Nature
Incident Briefing
Size
Location
Time of Day
Day of the Week
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Manager Skills (cont)

• Gather information through ongoing assessment
• Keep records on all resources
• Set overall objectives
• Determine activity areas
• Specify control objectives/tactics for each area

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Manager Skills (cont)

• Specify resources needed by each area
• Specify facilities and reporting locations
• Place personnel and resource order
• Develop communications and traffic plan
• Finalize, approve and implement the action plan

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Can We Predict What We Will Need to Do?
Can We Project What We Will Need to Do it With?
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Disaster ManagementInvolves...
o Warning o Pre-impact Preparations o Search
Rescue o Care of Injured Dead o Welfare
Needs o Restoration of Essential Services o
Protection against Continuing Threat o Community
Order
Agent-Generated Demands
Two Sets of Demands Occur Simultaneously!
o Communication o Continuing Assessment of
Situation o Mobilization Utilization of
Resources o Coordination o Exercise of
Authority
Response-Generated Demands
Quarantelli, 1985
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Pre-Impact
Initial Response
Situation Assessment Fire Suppression Hazmat
Control Search and Rescue Medical Services Public
Information Debris Clearance
Warning Protective Actions
Mass Care Individual Assistance Essential
Services Temporary Housing Debris Removal
Service Restoration Business Restoration Permanent
Housing Debris Disposal
Initial Recovery
Reconstruction
CUSEC Journal
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Major Functions

• Management
• Planning
• Logistics
• Finance Admin
• Operations
• Business Continuity
• Equipment, Plant Utilities
• Safety Security
• Health Medical Services

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Management Planning

• Mobilization/demob
• Emergency policies
• Liaison
• Public information
• Safety
• Incident action planning
• Situation and resource status
• Documentation
• Reporting

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Logistics, Finance Admin

• Supply
• Facilities
• Transportation
• Communications
• Food
• Medical (rehab)

• Time
• Procurement
• Comp/Claims
• Cost

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OperationsBusiness Continuity

• Telecommunications systems
• Service access
• Records preservation
• Business relocation

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OperationsEquipment, Plant Utilities

• Patient care systems
• Power/light systems
• Heating/cooling systems
• Water/sewer systems
• Buildings/grounds/roads

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OperationsSafety Security

• Alerting/warning
• Hazmat control/decon
• Fire suppression
• Search rescue
• Security

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OperationsHealth Medical Services

• Non-incident patient management
• Triage
• Treatment
• Evacuation
• Outreach
• Fatalities management

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Questions?