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Health Center Guide to Emergency Preparedness

What kind of emergencies can health centers be prepared?
There are many kinds of emergencies that health centers can prepare on. First there are natural events, such as ice storms, snow storms, hurricanes, and tornados. Additionally, there are the unintentional events, such as plane or train accidents, power failures, chemical spills, fires, and building collapses. Finally, there are intentional events using weapons of mass destruction (biological, chemical, and/or radiological), large bombings, hostage situations, and riots.

Have health centers responded to these kinds of emergencies in the past?
Yes, health centers have responded to a variety of local and national emergencies. They have responded to: the New York City terrorist attacks in 2001; Hurricane Katrina in 2005 and H1N1 threat in 2009/2010.

What can health centers do to prepare for these kinds of emergencies?
They can do start by preparing for a natural disaster and prepare the team through personal preparedness activities, table top events and participation in state and regional planning exercises.  Please see the attached steps for emergency preparedness planning for health centers. 

Does the health center have a champion for emergency preparedness?
Preparing for emergencies requires a person that will see the project through to completion, or the project champion. The champion needs to be in a position to review current plans and policies, propose any changes to the plans or policies, and be able to implement training programs to the staff so they know what the plans and policies are in times of emergencies.

Has the health center conducted a Hazard Vulnerability Analysis (HVA)?
The champion of the project needs to take an “all-hazards approach” to emergency preparedness which lets health centers prepare for a multitude of emergencies. To accomplish this, the champion needs to conduct a Hazard Vulnerability Analysis (HVA) which is a proactive approach to discovering what can affect a health center and its surrounding community. The HVA needs address possible internal emergencies (fire, facility power loss, loss of oxygen, hazardous materials), external emergencies (natural disasters, regional power loss, terrorism, evacuation of community), and rank priority of potential emergencies. Please click here to view the HVA template.

Has the health center identified policies and procedures to responding to emergencies?
There are four phases in emergency preparedness: mitigation, preparedness, response, and recover. During mitigation phase, health centers identify hazards that can potential impact the operations of the health center or community. Conducting a HVA is a first step in this process, a cost-benefit analysis of the cost of a loss versus the need of taking action, and even simple things as placing all dangerous chemicals in a secure and controlled location or as expensive as having a back-up generator installed in the event of losing power.

In the preparedness phase, the health center takes steps to build any needed capacity and resources, an inventory that shows what resources are in place and agreements with outside organizations, orientating all new staff to responding to events, table top exercise and drills.

When an emergency occurs, the health center goes to the response phase. There will most likely be a community/regional response to the event, so it is imperative that the health center is integrated into the local emergency operation center. Potential organizations responding to such events are hospitals, EMS, county health departments, and even volunteers.

After an emergency ends, the health center goes into a recovery phase which is the process of bringing the health center back to normal operations. Planning for this phase should include inventory status to determine what extra purchases are needed, readjusting staff schedule, repairing any damaged caused to the health center, and applying lessons learned into a new mitigation phase to make adjustment to the emergency response plans.

Has the health center defined their role in responding to emergencies?
Health centers need to know what kind of emergencies they would and would not want to respond too. For some emergencies, it maybe better for the health center to close for the duration, but other emergencies it maybe better to remain open to help those that may not know where else to go. Once a health center does decide what emergencies they can assist in, it is imperative that they develop relationships with other health care organizations so there is a community response rather than many individual groups not working together.

Has an incident command system been established within the health center?
During times of emergencies, clear roles and responsibilities of all health center staff need to be communicated In normal health center operations, an employee may have multiple managers to report too, but in the incident command system, there is only one person that each staff member reports to, starting from those in triage all the way to the incident commander of the health center. This system cuts down on miscommunication, misinformation, and confusion on what the expectations are of staff members.

Has the health center incident commander successfully networked with other incident commanders of external organizations?
The health center, in particular the incident commander, needs to establish relationships and agreements with health care organizations and their incident commanders prior to an emergency. It is very difficult to establish these relationships during an event because of not understanding what health centers can do to help as well as finding the right person in timely manner during the emergency.

Has the health center developed Memorandums of Agreement with other local health care providers and/or organizations?
A health center involved with an emergency needs to network ahead of time with hospitals, other health centers, clinics, local county health departments, EMS, fire, and police. This will improve communications, reduce time in establishing who to speak with at each organization, and ease the transfer of patients and need medical supplies.

Has the health center developed protocols and procedures on when to initiate their emergency plans?
It is important for a health center to define when they are in an emergency, which emergency plan to use, and who activates each phase (mitigation, preparation, response, recovery), and their guidelines to decide when to change to a different phase.

Does the health center have a way to notify all of their staff when an emergency response plan has been activated?
The health center needs to have a developed contact tree so that all staff can be notified if there is an emergency, whether to stay at home or come to work, or be prepared to work at a different site.

Health center management needs to consider having contingency plans for the following emergency situations:

Patient care-related activities (scheduling, modifying/discontinuing services, control of patient information, patient transportation)
Staff support activities (housing, transportation, incident stress debriefing)
Family support activities (counseling, waiting area, communication with providers and social services)
Logistics relating to critical supplies (pharmaceuticals, medical supplies, food, water, linens)
Security for the health center (crowd control, traffic control)
Communication with the news media

Is there an evacuation plan for the health center if the facility cannot meet the need of patient care and treatment?
Guidelines need to be established to when the health center is not the best place for patients and staff to be in. This could be the result of structural damage to the facility, an evacuation order of the surrounding areas, or a threat to the center itself. The center needs to be able to have patients transported to other facilities that still need provider care, emergency shelters or sent home.

If the health center needs to be evacuated, has the health center considered:

Transportation of patients, staff, and equipment to the alternate care site?
Is there transportation of patient necessities (medications, medical records, personal belongings) to the alternate care site?
Is there patient tracking to the alternate care site?
Is there communication between the health center and the alternate care site?

Does the health center have a recovery plan after an emergency event?
After an emergency, the health center needs to have established agreements and protocols to address issues such as replenishing medical supplies, outsourcing certain services, readjusting staff schedules so returning to normal operations is as seamless as possible. Click here to view a PowerPoint on Continuity of Operations.