Guide for hazard and risk assessment for hospitals in the state of Perak

1. HAZARD , VULNERABILITY, RISK
ASSESSMENT(HVRA) FOR HEALTHCARE
FACILITIES DR LEE OI WAH
MD (UKM)

2. HVRA
• Hazard (H)
• Vulnerability (V)
• Risk (R)
• Concept of HVRA
• Purpose of HVRA
• Tools for HVRA
• Methodology to conduct HVRA

3. HAZARD (H)
Definition
A source or situation with the potential for harm in terms of
human injury or ill health, damage to property, damage to the
environment or a combination of these.
(ILO- OSHMS : 2001, MS OSHMS 1722 : 2003)

4. CATEGORIES OF POTENTIAL HEALTHCARE
HAZARDS
• Naturally occurring events
• Human related events
• Technologic events
• Hazardous materials events

5. HAZARD IDENTIFICATION
• Hazard identification—the process of recognizing that a
hazard exists and defining its characteristics.

6. VULNERABILITY
• Vulnerability—people, property, infrastructure, industry
and resources, or environments that are particularly
exposed to adverse impact from a hazard event.

7. RISK(R)
Definition
Probability or likelihood of harm occurring in relation to a
particular hazard & the magnitude or severity of harm.
• Risk—the chance of injury or loss as defined as a measure
of the probability [likelihood] and severity of an adverse
effect to health, property, the environment, or other things of
value.
• Risk analysis—the systematic use of information to identify
hazards and to estimate the chance for and severity of, injury or
loss to individuals or populations, property, the environment, or
other things of value

8. RISK ASSESSMENT
The risk of an event is assessed based on:
 Threat to life and/or health
 Disruption of services
 Damage or failure possibilities
 Loss of community trust
 Financial impact and legal issues
American Society of Healthcare Engineering 2001

9. HVRA
• The Joint Commission, previously called the Joint
Commission of Accreditation of Healthcare Organizations
(JCAHO), requests an HVRA for organizations to
determine the focus of their emergency planning
• However,there is no specific tool nor method defined

10. PURPOSE OF HVRA
• The HVA is a tool used to evaluate the potential risks for a
facility
• It is not an evaluation of the potential for evacuation
• However, risks identified in the process may focus the
organization toward the need to mitigate and prepare for
circumstances that could include evacuation
• The purpose is a prioritization process that will result in a
risk assessment for “all hazards”.
• The focus is on organization planning and resources and
/or the determine that no action may be required. This is
an organization decision

11. WHY IS HVRA IMPORTANT ?
• Preparedness efforts, plans and resources are directly related
to the organization’s HVRA
• Engineering controls may occur as a result of HVRA thus
reducing risk for the work force
• Safety factors are considered
• Process promotes understanding of current resources that may
not have been known beyond the “expert”
• When a risk is identified in the HVRA that would potentially
result in an evacuation, the organization should focus on issues
that could impact the need to evacuate or to mitigate the risk.
Examples:
– Routes
– Locations
– Personal Protective Equipment (PPE)
– Communication to employees with special needs
– Special situations - management of family on site

12. MODELS FOR HVRA
• There are a number of models for an HVA.
• Two well known models are from
– American Society of Healthcare Engineering (ASHE)
– Kaiser Foundation (Kaiser Permanente)
• Both models can be adjusted to fit the organization.
• Security organizations and other vendors also market
HVA tools

13. KAISER PERMANENTE METHODOLOGY

14. PRINCIPLES OF KAISER 2001
• Based on mathematical formulas that are embedded in
the document (Excell tool-kit)
• The factors considered in the assessment includes the
assumption that the risk occurs at the worst possible time
and with a full patient census
• Threat events considered are:
- natural events
- human events
- technological events
- HAZMAT events

15. PRINCIPLES OF KAISER 2001
• 5 worksheets covering 4 groups of threats and summary
• Need to complete all worksheets (natural , technological ,
human and HAZMAT)
• The summary section will automatically provide your
specific and overall relative threat.

21. KAISER PERMANENTE MODEL
• Kaiser model also includes the listed variables :
– Probability
– Human, property and business impacts, each
considered as a separate issue
– Response factors (preparedness , internal response &
external response)

22. PROBABILITY
Issues to consider for probability include, but not limited to :
 Known risk
 Historical data
 Manufacturer / vendor statistics
 Subjective evaluation / best estimate
 Local Emergency Planning Committee input

23. MEASURE OF PROBABILITY
SCORE LIKELIHOOD OF OCCURENCE
0
(N/A)
Almost never happen before or in future
1
(Low)
Occasional or slight chance (little recorded
historical evidence and return interval of 10-30 years
is possible)
2
(Moderate)
Moderate (historical record with a frequency of 3 –
10 years)
3
(High)
Frequent ( have a high number of recorded or
anecdotal evidence , occurring every year )

24. IMPACT
Includes evaluation of :
 Human Impact
 Property Impact
 Business Impact

25. HUMAN IMPACT
Issues to consider for human impact include , but are not
limited to :
 Potential for staff death or injury
 Patential for patient /visitor death or injury
 Emotional / psychological impact
 Local cultural norms

26. MEASURE OF HUMAN IMPACT (FATALITY)
SCORE NO OF FATALITY
0
(N/A)
No deaths or non-applicable
1
(Low)
Less than 5 deaths
2
(Moderate)
5-10 deaths
3
(High)
More than 10 deaths

27. MEASURE OF HUMAN IMPACT (INJURY)
SCORE NO OF INJURY
0
(N/A)
No injury or non-applicable
1
(Low)
Less than 10 injuries
2
(Moderate)
10-30 injuries
3
(High)
More than 30 injuries

28. PROPERTY IMPACT
Issues to consider for property impact include , but not
limited to :
 Cost to replace
 Cost to set up temporary replacement
 Cost to repair
 Time to recover
 Environmental impact

29. MEASURE OF PROPERTY DAMAGE
SCORE EXTENT OF PROPERTY DAMAGE
0
(N/A)
No property damage or non-applicable
1
(Low)
Localized damage
2
(Moderate)
Localized severe damage (extending within a district
or community)
3
(High)
Widespread & severe damage (extending beyond a
single district)

30. MEASURE OF ENVIRONMENTAL IMPACT
SCORE EXTENT OF ENVIRONMENTAL IMPACT
0
(N/A)
Minimal impact or non-applicable
1
(Low)
Localized impact
2
(Moderate)
Localized severe impact (extending within a
district or community)
3
(High)
Widespread & severe impact (extending beyond
a single district)

31. BUSINESS IMPACT
Issues to consider for business impact include , but not
limited to :
 Business interruption
 Employees unable to report to work
 Customers unable to reach facility
 Company in violation of contractual agreements
 Company in violation of statutory standards
 Imposition of fines and penalties or legal costs
 Interruption of critical supplies
 Interruption of product distribution
 Reputation and public image
 Financial impact / burden

32. MEASURE OF BUSINESS IMPACT –
CLOSURE OF FACILITIES
SCORE EXTENT & DURATION OF CLOSURE
0
(N/A)
No evacuation or non-applicable
1
(Low)
Temporary relocation/ closure ( less than 24 hrs)
2
(Moderate)
Temporary relocation/ closure ( more than 24
hrs but less than 14 days)
3
(High)
Long term disruption or closure more than 14
days

33. MEASURE OF BUSINESS IMPACT – DISRUPTION OF
LIFELINES (WATER, GAS, POWER ETC)
SCORE DURATION OF DISRUPTION
0
(N/A)
No disruption or non-applicable
1
(Low)
Interruption (less than 24 hrs)
2
(Moderate)
Interruption ( 24 hrs – 72 hrs)
3
(High)
Interruption (more than 72 hrs)

34. RESPONSE
Issues to consider for response include , but not limited to :
 Time to marshall an on-scene response
 Scope of response capability / staff training
 On-site support resources / supplies
 Estimated severity & duration of the incidence
 Historical evaluation of response success
 Local Emergency Planning Committee input

35. PREPAREDNESS
Issues to consider for preparedness include, but not limited
to :
 Status of current plan
 Frequency of drills
 Training status
 Insurance
 Availability of alternate sources for critical supplies /
services

36. MEASURE OF PREPAREDNESS –IAP/ CP
SCORE AVAILABILITY OF IAP/CP
0 Non-applicable
3
(Low)
IAP/CP available but outdated
2
(Moderate)
IAP / CP available and updated & communicated
to all staffs
1
(High)
IAP /CP available, up to date , communicated and
tested .

37. MEASURE OF PREPAREDNESS –TRAINING
OF STAFFS & DRILLS
SCORE TRAINING PROGRAMS & DRILLS
0 Non-applicable
3
(Low)
No structured programme or Training given in form
of briefing & orientation programme
2
(Moderate)
Annual Table-top exercise , evacuation exercise or
live drills involving only internal staffs
1
(High)
Annual Table-top exercise , evacuation exercise or
drills involving internal staffs and other agencies

38. INTERNAL RESOURCES
Issues to consider for internal resources include , but are not
limited to :
 Types of supplies on hand / will they meet need?
 Volumes of supplies on hand / will they meet need?
 Staff availability & training
 Coordination with MOB’s
 Availability of back-up systems
 Internal resources ability to withstand disasters /
survivability

39. MEASURE OF INTERNAL RESPONSE -
SUPPLIES
SCORE AVAILABILITY OF RESOURCES
0 Non-applicable
3
(Low)
Supplies not available
2
(Moderate)
Supplies available but unable to meet needs
1
(High)
Supplies available and able to meet needs

40. MEASURE OF INTERNAL RESPONSE –
BACK-UP SYSTEM
SCORE AVAILABILITY OF BACK-UP SYSTEM
0 Non-applicable
3
(Low)
No back-up system
2
(Moderate)
Back-up system unable to meet needs
1
(High)
Back-up system able to meet needs

41. EXTERNAL RESOURCES
Issues to consider for external resources include, but are not
limited to :
 Types of agreements with community agencies / drills
 Coordination with local and state agencies
 Coordination with proximal health care facilities
 Coordination with treatment specific facilities
 City / County EMS services capabilities
 Community volunteers / training
 Vendor pre-incident response plans / contracts
 Other community resources

42. MEASURE OF EXTERNAL RESPONSE – AGREEMENT
& COORDINATION WITH OTHER AGENCIES
SCORE AVAILABILITY OF AGREEMENT &
COORDINATION WITH OTHER AGENCIES
0 Non-applicable
3
(Low)
No standing agreement , no standing order for
dispatch or coordination with external agencies
2
(Moderate)
Existing mutual understanding to dispatch and
coordination
1
(High)
Formal agreement and well –documented SOP for
activation , dispatching and coordination with
external agencies

43. MEASURE OF EXTERNAL RESPONSE-VENDOR PRE-
INCIDENT RESPONSE PLANS & CONTRACT
SCORE AVAILABILITY OF VENDOR PRE-INCIDENT
RESPONSE PLANS & CONTRACT
0 Non-applicable
3
(Low)
No existing vendor pre-incident response plan or
contingency plan
2
(Moderate)
Existing vendor pre-incident response plan or
contingency plan
1
(High)
Existing vendor pre-incident response plan or
contingency plan plus additional back-up
contingency plan/contract with 3rd party providers