Emergency management & disaster preparedness

2. INTRODUCTION
• A DISASTER CAN BE DEFINED AS A SUDDEN CATASTROPHIC EVENT IN WHICH MANY
PEOPLE ARE INJURED AND/OR KILLED, AND PROPERTY IS DESTROYED.
• THE MORE SUDDEN THE EVENT, THE MORE LIKELY ITS VICTIMS WILL BE UNPREPARED;
AND THE MORE UNPREPARED, THE MORE LIKELY THE EFFECTS WILL BE SEVERE.
• BEING PREPARED FOR A DISASTER IN THE WORKPLACE HELPS MINIMIZE HUMAN
SUFFERING, AS WELL AS PROPERTY DAMAGE AND LOSS.

3. DISASTER PREPAREDNESS:
ALL HAZARDS PLANNING
• SINCE THERE ARE VERY FEW DISASTERS THAT PROVIDE AMPLE WARNING, FACILITIES MUST BE IN A CONSTANT
STATE OF READINESS, OR PREPAREDNESS.
• DISASTER READINESS INVOLVES STAFF TRAINING, COORDINATION WITH EMERGENCY MANAGEMENT SERVICES,
AND RESOURCE MANAGEMENT. IN ORDER TO RESPOND TO ANY DISASTER, FACILITIES MUST HAVE A PLAN.
• PLANS FOR EMERGENCIES THAT REQUIRE EVACUATION, AS WELL AS ONE FOR THOSE THAT REQUIRE SHELTERING-IN-
PLACE, INCREASE THE RESISTANCE TO THE EFFECTS OF DISASTERS.
• DISASTERS CAN OCCUR WITHIN THE FACILITY OR OUTSIDE THE FACILITY, AND CAN BE NATURAL OR MANMADE.

4. DISASTER PREPAREDNESS: HAZARD PLANNING
SOME EXAMPLES OF MANMADE DISASTERS INCLUDE:
➢ STRUCTURAL FAILURES (BUILDING COLLAPSES, GAS LEAKS, CHEMICAL EXPLOSIONS)
➢ FIRES
➢ TERRORISM
SOME EXAMPLES OF NATURAL DISASTERS INCLUDE:
➢ WILDFIRES
➢ FLOODS
➢ TORNADOES
➢ HURRICANES

5. DISASTER PREPAREDNESS: HAZARD PLANNING
SOME WEATHER-RELATED DISASTERS ARE DETECTABLE BY SATELLITE AND ARE
THEN PUBLICLY REPORTED ON RADIO AND TELEVISION.
ALERTS MAY BE REPORTED IN THE EARLY STAGES OF SEVERE WEATHER:
➢A WEATHER WATCH: THE POTENTIAL EXISTS FOR A NATURAL DISASTER TO
DEVELOP; THE WEATHER IS BEING WATCHED.
➢A WEATHER WARNING: CONDITIONS ARE SEVERE, AND A NATURAL DISASTER IS
LIKELY.

6. EMERGENCY MGMT CODES
EMERGENCY MANAGEMENT CODES ARE USED TO NOTIFY
EMPLOYEES OF A CRISIS OR DISASTER THAT MAY IMPACT
THE FACILITY. CODES ARE USED TO INFORM EMPLOYEES
AND BEGIN MOBILIZATION OF RESOURCES BEFORE GENERAL
NOTIFICATION OF PATIENTS, FAMILY OR VISITORS.

7. EMERGENCY MGMT CODES
•1. FIRE EMERGENCY (CODE RED)
•2. MISSING PATIENT (CODE PINK)
•3. SEVERE WEATHER/NATURAL DISASTER (CODE GREEN)
•4. UTILITY OUTAGE (CODE BLACK)
•5. HAZARDOUS MATERIALS INCIDENT (CODE ORANGE)
•6. WORKPLACE VIOLENCE OR THREAT OF VIOLENCE (CODE GRAY)
•7. NUCLEAR POWER PLANT EMERGENCY (CODE BROWN)
•8. SUSPICIOUS PACKAGE/BOMB THREAT (CODE YELLOW)
•9. MEDICAL EMERGENCY (CODE BLUE)
•10. EPIDEMIC/PANDEMIC EPISODE (CODE PURPLE)
•11. TERRORIST ATTACK (CODE WHITE)
•12. EVACUATION
•13. SHELTER-IN-PLACE

8. FACILITY INCIDENT COMMAND SYSTEM (FICS)
THE INCIDENT COMMAND SYSTEM (FICS) IS A PROVEN MANAGEMENT SYSTEM BASED ON SUCCESSFUL BUSINESS
PRACTICES. IT IS THE RESULT OF DECADES OF LESSONS LEARNED IN THE ORGANIZATION AND MANAGEMENT OF
EMERGENCY INCIDENTS. THIS SYSTEM REPRESENTS ORGANIZATIONAL “BEST PRACTICES” AND, AS A COMPONENT OF
THE NATIONAL INCIDENT MANAGEMENT SYSTEM (NIMS), HAS BECOME THE STANDARD FOR INCIDENT MANAGEMENT
ACROSS THE COUNTRY.
THE FICS CAN:
➢ BE ADAPTED TO DISASTERS OF ANY TYPE OR SIZE;
➢ ALLOW PERSONNEL TO MELD RAPIDLY INTO A PREDETERMINED MANAGEMENT STRUCTURE;
➢ PROVIDE LOGISTICAL AND ADMINISTRATIVE SUPPORT TO OPERATIONAL STAFF; AND
➢ BE COST EFFECTIVE BY AVOIDING DUPLICATION OF EFFORTS.
FICS CONSISTS OF PROCEDURES FOR CONTROLLING PERSONNEL, FACILITIES, EQUIPMENT, AND COMMUNICATIONS.
IT IS A SYSTEM DESIGNED TO BE USED OR APPLIED FROM THE TIME AN INCIDENT OCCURS UNTIL THE REQUIREMENT
FOR MANAGEMENT AND OPERATIONS NO LONGER EXISTS.

9. FACILITY INCIDENT COMMAND SYSTEM (FICS)
THERE ARE FIVE MAJOR MANAGEMENT FUNCTIONS THAT ARE THE FOUNDATION OF THE FICS.
THESE FUNCTIONS APPLY IN A ROUTINE EMERGENCY, FOR A MAJOR NON-EMERGENCY EVENT, OR
IN MANAGING A RESPONSE TO A MAJOR DISASTER.
• THE FIVE MAJOR MANAGEMENT FUNCTIONS ARE:
1. COMMAND: THE FACILITY’S INCIDENT COMMANDER IS THE SINGLE PERSON IN CHARGE OF THE
INCIDENT AT THE FACILITY AND INITIALLY FILLS ALL FIVE COMMAND STAFF POSITIONS. AS THE
INCIDENT GROWS, THE TASKS COVERED BY OTHER SECTIONS CAN BE DELEGATED, AND THOSE
NEW POSITIONS TAKE THE TITLE OF SECTION LEADER. THE INCIDENT COMMANDER IS
RESPONSIBLE FOR ALL ACTIVITY REGARDING THE INCIDENT AS WELL AS CREATING THE OVERALL
INCIDENT OBJECTIVES.

10. FACILITY INCIDENT COMMAND SYSTEM (FICS)
2. OPERATIONS: THE FACILITY’S OPERATIONS LEADER IS TASKED WITH DIRECTING ALL ACTIONS TO MEET
THE INCIDENT OBJECTIVES.
3. PLANNING: THE FACILITY’S PLANNING LEADER IS TASKED WITH THE COLLECTION AND DISPLAY OF
INCIDENT INFORMATION, PRIMARILY CONSISTING OF THE STATUS OF ALL RESOURCES AND OVERALL
STATUS OF THE INCIDENT.
4. LOGISTICS: THE FACILITY’S LOGISTICS LEADER IS TASKED WITH PROVIDING ALL RESOURCES, SERVICES
AND SUPPORT REQUIRED BY THE INCIDENT.
5. FINANCE/ADMINISTRATION: THE FACILITY’S FINANCE LEADER IS TASKED WITH TRACKING INCIDENT
RELATED COSTS, PERSONNEL RECORDS, REQUISITIONS AND ADMINISTERING PROCUREMENT CONTRACTS
REQUIRED BY LOGISTICS.

11. FACILITY INCIDENT COMMAND SYSTEM (FICS)
MOST FACILITIES ENLIST THE HELP OF THE LOCAL FIRE AND POLICE DEPARTMENTS FOR EMERGENCY AND DISASTER
TRAINING.
ONGOING TRAINING IS NEEDED TO:
1. FAMILIARIZE STAFF WITH DISASTER PREPAREDNESS, INCLUDING THE INCIDENT COMMAND SYSTEM.
2. DEMONSTRATE PROPER LIFE-SAVING TECHNIQUES.
3. EXPLAIN IMMEDIATE EVACUATION, PLANNED EVACUATION AND SHELTERING-IN-PLACE PROCEDURES.
4. ASSIGN ROLES AND RESPONSIBILITIES FOR SPECIFIC TYPES OF DISASTER RESPONSE.
5. PERFORM PRACTICE EXERCISES AND DRILLS.
RECORDS OF ALL DISASTER PREPAREDNESS TRAINING MUST BE KEPT. THIS INCLUDES:
➢ COURSE MATERIAL
➢ TESTS
➢ COMPETENCY TESTING
➢ FIRE DRILLS

12. DISASTER RESPONSE: WHEN DISASTER STRIKES
ACTIVATE THE EMERGENCY RESPONSE PLAN
EACH FACILITY SHOULD HAVE AN EMERGENCY RESPONSE PLAN IN PLACE, WHICH PROVIDES THE INITIAL STEPS IN THE EVENT THAT
DISASTER STRIKES.
GENERALLY, THE INITIAL STEPS IN THE EMERGENCY RESPONSE PLAN INCLUDE THE FOLLOWING:
1. THE FIRST PERSON WHO IS AWARE OF THE DISASTER MUST NOTIFY HIS OR HER SUPERVISOR OR THE ADMINISTRATOR
IMMEDIATELY.
2. THE MOST QUALIFIED STAFF MEMBER IN THE BUILDING AT THE TIME OF THE DISASTER ASSUMES THE ROLE OF INCIDENT
COMMANDER.
3. THE INCIDENT COMMANDER DECLARES THE SITUATION AN EMERGENCY.
4. THE EMERGENCY CODE IS PAGED AND ALL MANAGEMENT STAFF IS INSTRUCTED TO REPORT TO THE INCIDENT COMMAND POST.
5. THE RECALL ROSTER (A LIST OF KEY PERSONNEL WHO ARE ASKED TO RETURN TO THE FACILITY FOR DISASTER MANAGEMENT) IS
ACTIVATED BY THE INCIDENT COMMANDER IF NEEDED.

13. DISASTER RESPONSE: WHEN DISASTER STRIKES
FOLLOW THE GUIDELINES FOR RESPONDING TO SPECIFIC DISASTER SITUATIONS
THE FIRST PRIORITY IS SAFETY. IF THE SITUATION THREATENS IMMEDIATE AND SERIOUS DANGER
TO THE PATIENTS, VISITORS AND STAFF, THE INCIDENT COMMANDER MAY CALL FOR IMMEDIATE
EVACUATION OF THE BUILDING OR A SHELTERING-IN-PLACE.
IF THE DANGER IS SERIOUS AND IMMINENT, A PLANNED EVACUATION MAY BE ORDERED. ONCE THE
DECISION IS MADE, ALL PERSONNEL MUST ASSUME THE ROLES FOR WHICH THEY HAVE BEEN
TRAINED OR ASSIGNED.

14. DISASTER RESPONSE: WHEN DISASTER STRIKES
NOTIFY EMERGENCY MANAGEMENT SERVICES AND KEY PERSONNEL
CONTACT THE FIRE DEPARTMENT, POLICE, AMBULANCE, OR DISASTER MANAGEMENT
SERVICES AS NEEDED FOR HELP WITH, AND/OR INFORMATION ABOUT THE
DISASTER.
IN ADDITION, NOTIFY THE FACILITY DIRECTOR, CLINICAL DIRECTOR, MEDICAL
DIRECTOR, AND ANY OTHER KEY INDIVIDUALS IN OWNERSHIP OR MANAGEMENT.

15. DISASTER RESPONSE: WHEN DISASTER STRIKES
COMMUNICATE THE SITUATION TO PATIENTS AND FAMILIES
THE PATIENTS, FAMILIES AND RESPONSIBLE PARTIES SHOULD BE NOTIFIED AS QUICKLY AS POSSIBLE
WHEN THERE IS A DISASTER OR EMERGENCY SITUATION AT THE FACILITY.
THE FOLLOWING INFORMATION SHOULD BE COMMUNICATED:
➢ THE TYPE OF THREAT;
➢ ESTIMATED TIME AND SEVERITY OF THE IMPACT, OR EXPECTED IMPACT;
➢ CURRENT SITUATION;
➢ ANTICIPATED DISRUPTIONS TO SERVICES OR ROUTINES;
➢ WHAT THE FACILITY IS DOING TO LESSEN THE SEVERITY OF NEGATIVE OUTCOMES;
➢ WHEN TO EXPECT UPDATED STATUS REPORTS; AND
➢ WHAT THE PATIENTS, FAMILY MEMBERS AND RESPONSIBLE PARTIES CAN DO TO HELP.

16. EVACUATION SCENARIOS
• IMMEDIATE EVACUATION
IMMEDIATE EVACUATION MAY BE INITIATED IF THERE IS IMMEDIATE DANGER TO
THE BUILDING OR PARTS OF THE BUILDING. EVACUATION ROUTES AND
PROCEDURES ARE ESTABLISHED AS PART OF OVERALL DISASTER
PREPAREDNESS. ESCAPE ROUTES ARE CLEARLY IDENTIFIED ON FLOOR PLANS
POSTED THROUGHOUT THE FACILITY. EVACUATION ROUTES AND PROCEDURES
SHOULD BE PRACTICED DURING REGULAR DRILLS AND EXERCISES. ASSEMBLY
AREAS ARE PREDETERMINED GATHERING PLACES THAT SERVE AS A
DESTINATION POINT FOR THE EVACUATION.

17. EVACUATION SCENARIOS
• PLANNED EVACUATION
SOME SITUATIONS WARRANT A PLANNED EVACUATION. THESE SITUATIONS ARE
TYPICALLY DUE TO PREDICTED EXTREME WEATHER OR WEATHER-RELATED
CONDITIONS SUCH AS HURRICANES OR WILDFIRES. UNDER THESE
CIRCUMSTANCES, IT IS POSSIBLE THAT STAFF AND PATIENTS WILL BE AWAY FROM
THE FACILITY FOR AN EXTENDED PERIOD OF TIME. PLANNED EVACUATIONS REQUIRE
ADVANCED PLANNING AND COORDINATION WITH OTHER FACILITIES AND ARE
INITIATED WITH THE SUPPORT OF LOCAL EMERGENCY MANAGEMENT AGENCIES.
STAFF SHOULD BE TRAINED ON THE PROCEDURES NECESSARY TO SAFELY
EVACUATE IN ADVANCE OF THREATENING CONDITIONS.

18. EVACUATION SCENARIOS
• SHELTERING-IN-PLACE
SHELTERING-IN-PLACE MAY BE ORDERED IF THE DECISION IS MADE THAT THE
SAFEST PLACE FOR PATIENTS AND STAFF IS INSIDE THE BUILDING. AN AREA OF
REFUGE IS ESTABLISHED SO THAT ALL PERSONS IN THE BUILDING ARE
GATHERED IN ONE PLACE. SUPPLIES AND RESOURCES THAT ARE STOCKPILED IN
ADVANCE ARE UTILIZED TO MAINTAIN BASIC SAFETY AND SURVIVAL UNTIL THE
EMERGENCY SITUATION IS UNDER CONTROL. SHELTERING-IN-PLACE TAKES
ENORMOUS ADVANCED PLANNING AND COORDINATION AND SHOULD BE
INCORPORATED INTO FACILITY DISASTER PLANNING AND TRAINING EXERCISES.

19. MEDICAL EMERGENCIES DURING DISASTERS
DEPENDING ON THE NATURE AND SEVERITY OF THE DISASTER, SOME PEOPLE MAY REQUIRE IMMEDIATE MEDICAL
ATTENTION. ALL FACILITIES SHOULD HAVE FIRST AID KITS AVAILABLE. THE FIRST AID KITS SHOULD HAVE SUPPLIES AND
EQUIPMENT THAT CAN BE USED FOR THE FOLLOWING MEDICAL EMERGENCIES:
➢ BLEEDING
➢ BURNS
➢ CARDIAC ARREST
➢ CHOKING (HEIMLICH MANEUVER INFORMATION)
➢ DIABETIC COMA
➢ DIABETIC INSULIN REACTION
➢ FRACTURES
➢ SEIZURES
FACILITY NURSES AND PRACTITIONERS ARE REQUIRED TO ADMINISTER EMERGENCY MEDICAL TREATMENT AND LIFE-
SAVING TECHNIQUES WITHIN THEIR SCOPE OF PRACTICE UNTIL THE RESCUE TEAM ARRIVES. WHEN RESCUE PERSONNEL
ARRIVE, INJURIES ARE ASSESSED TO DETERMINE WHO REQUIRES TRANSFER TO AN EMERGENCY ROOM OR ANOTHER
MEDICAL FACILITY.

20. SUMMARY
DISASTERS CAN OCCUR AT ANY TIME IN ANY LOCATION.
TO PREVENT HUMAN SUFFERING AND MINIMIZE PROPERTY LOSS, IT IS
ESSENTIAL TO BE PREPARED.
DISASTER PREPAREDNESS MUST INCLUDE ADVANCE PLANNING,
COORDINATION WITH EMERGENCY MANAGEMENT AGENCIES, RESOURCE
MANAGEMENT AND STAFF TRAINING.