Effective management of health and safety programs: a practical guide, 3rd edition. Moser R Jr., ed. Berverly Farms, MA: OEM Press, 2008 Mar; :39-55
Of all the events that can create doubts about the management and capabilities of a health and safety unit, inappropriate or disorganized response to a disaster situation ranks near, if not at, the top of the list. Many of us have consequently made a practice of reviewing the organization's disaster response plans within the first day or two of arrival as a new director. A colleague who followed this practice was able to respond effectively to a major disaster event two days after his arrival because he was familiar with the unit's response plans and capabilities. The tornados that have struck numerous towns this year (2007) have demonstrated that health care organizations might have little or no warning of an event that may produce mass casualties. The rapidity with which crisis situations can arise underscores the need for health care and safety organizations to plan to respond before such an event occurs. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) emergency management standards have long required accredited facilities to plan for emergency situations, but the potential for terrorism has made planning even more complex . Planning has typically been oriented toward training members of treatment and response teams, stockpiling equipment, and conducting "walk through" exercises that involve few members of response teams with a small number of simulated patients rather than the large numbers of people who would seek treatment after a major emergency incident . Other health organizations, such as public health departments, have requirements separate from care of the ill or injured but, nonetheless, are called upon to provide immediate responses to health threats created by disasters. An important piece of practicing the plan is the use of an After Action Review (AAR) [2,6]. On-site observers can be particularly helpful in accomplishing an AAR review, since the required activities of the participants may preclude their effective evaluation of the exercise. Nevertheless, the AAR should involve all participants so that there can be a critical review of command and control, communications, and coordination as well as overall exercise management. Discussions that cover what went well and what did not go well .provide opportunities for improvements to increase future functionality. In addition to bettering the plan, each participant becomes invested in the process and overall outcomes improve. SUMMARY: Health care units and safety groups face many difficult challenges and we are being asked to do more and be prepared for more than ever before. However, disasters and other emergency events, including terrorism, may occur without warning. The potential for large numbers of patients and concerned citizens descending on health care facilities requires planning before an event occurs. In addition to providing the usual medical and public health support, it is essential that plans address the 4 Cs plus 1. Attention to command and control, communications, coordination, and contingencies in planning and practice will enable health and safety organizations to make effective responses to a disaster and to respond efficiently to rapidly changing situations as the event evolves.
Management-personnel; Occupational-health-programs; Occupational-safety-programs; Decision-making; Training; Education; Occupational-health; Environmental-health; Disaster-planning; Biological-warfare-agents; Biological-weapons; Health-care; Health-care-personnel; Medical-personnel; Emergency-responders; Emergency-response; Emergency-treatment; Public-health; Safety-measures; Safety-practices; Standards; Work-operations; Work-organization