Emergency preparedness and disaster management planning at Meridian Health

Hospital Emergency Plan

According to a study, about 99% of hospitals have plans to cope with disaster, and 95% of them even had committees for that purpose. There were reports from 90% or more of the hospitals which showed that they were in collaboration with emergency treatment services (96%), emergency agencies for management (94%), agencies for law enforcement (95%), fire sectors (95%), along with health sectors (92%). 96% of the respondents sated that there were plans to cope with disaster throughout the hospital, and that they were accessible easily (Higgins et al., 2004, p. 328). Meridian Health has made it its responsibility to better the welfare and health of New Jersey residents. They do this by giving the best quality health services in the community, homes and hospitals, which put their focus on patients, and also by conducting clinical research and education for the enhancement of medicine (Meridian Health, 2016).

Objectives and goals of a Hospital Emergency Plan

The disaster / emergency plan in hospitals is aimed at optimal preparedness of the institutional resources and hospital personnel to perform productively in case of various kinds of disaster.

The disaster plans in hospitals need to address the mass fatalities that may come up as a result of Mass Casualty Incidents (MCI) that may have happened far from hospitals and also those incidents which may affect the hospitals such as explosions, earthquakes, fire or even floods (GOI-UNDP, 2002-2008).

III. Preparation of Plan

Meridian is a privately owned hospital equipped with an adequate number of beds; about 1000-2000, and is capable of handling emergencies 24 hours a day. This means that the hospital is able to deal with around 30-50 patients instantly without any form of interference to their routine services. However, if they have above 50-60 cases at a go or above 75-100 cases within a small number of hours, these would automatically create the need for emergency plans to be activated by that hospital. There are three stages of the emergency plan:

A. Pre-disaster Phase (Phase of Planning):

a. Emergency / Disaster management committee Constitution -- The committee will comprise a number of hospital officials, who will be led by the Medical Superintendent, Director or Dean. The officials will include:

Medical Superintendent/Director / Dean

Members

1. Addl. Medical Administrator (Casualty)

2. Ever one of the Addl. Medical Administrators

3. Head of the Surgery Department

4. Head of the Medicine Department

5. Head of the Neurosurgery Department

6. Head of the Anaesthesiology Department

7. Head of the Plastic Surgery and Burns Department

8. Head of the Radiology Department

9. Head of the Orthopaedics Department

10. Head of the Laboratory Medicine Department

11. Head of the Forensic Medicine Department

12. Officer of Public Relations

13. I/C Therapeutic Store Officer

14. I/C Overall Store Officer

15. Nursing Administrator

16. Officer in charge of Blood Bank

17. Executive Civil Engineer CPWD

18. Executive Electrical Engineer CPWD (Elec.)

19. Member / Transport and Head I/C Casualty Medical Officer

The Committee may appoint extra people depending on the kind of disaster or situation. It will hold its meetings at least on a quarterly basis in order to review the performance of the disaster plan, challenges that face the current disaster as well as an alteration or amendment for future application.

b. Delineation of Jobs according to Job Cards

There will be job cards for each of the areas dealing with the disaster plan. The cards will include a list of guidelines for the main individuals in each of their departments, in order to perform their duties successfully.

They will also contain the needed information to help individuals in following the guidelines such as pager and phone numbers and regularly updated addresses

There will be colour codes to represent various categories of personnel such as nurse, consultants, junior and senior residents for easer identification.

There will be labels for the cards and they will be stored in an area where they can easily be reached.

c. Control Room

The Dean's office should play the role of control and have good network for communication such as mobiles, landline and a Mobile Connection for CUG within the hospital, if possible. The CMS must make sure the control office has a secure, reliable contact number within the hospital and its personnel as stated in the disaster command.

d. Organization of Patient Treatment Areas

The Head of Operations (senior surgeon) needs to participate actively in making decisions on how the areas for treatment of patients should operate and coordinate, as she holds the responsibility of all health care when there is disaster. The committee needs to chart and handle these areas of patient care within the hospital:

1. Area for Receiving Patients: close to the emergency.

2. Area for Patient Resuscitation: emergency department.

3. Area for Observation of Patients: marked beside the emergency.

4. Area for Minor Treatment: far from emergency. It is also known as the Out Patient Section.

5. Vacating the Operation Theatre to accommodate emergency victims.

6. Arrangement of Wards.

7. Arrangement of the Morgue.

e. The Medical Support Services

The senior surgeon also has the responsibility to ensures timely investigations such as Laboratory and Radiology when necessary. The senior surgeon's assistant is the Head of Support Branch.

f. The Nursing Services

The chief surgeon is supposed to obtain information from the Nursing Services in charge. The nursing services should also provide requisite number of nursing personnel where needed.

g. Organization of the Logistics

The Head of Logistics or any member of the senior faculty is charged with the important responsibility after the declaration of a disaster; taking charge of every ancillary service within the hospital such as:

Transport

Sanitation

Dietary Supply

Electricity and Water

Communication

h. Medical Supplies

The office personnel in charge of stores needs to be available if the hospital needs the stores for medical supplies to be opened for accessibility at all times. The officer is also responsible for procurement and inventory of the required stock in case there is a disaster.

i. Security

The agency for security must be informed of the modalities for declaration of a contingency plan as well as what they should do when the plan is executed.

j. Public Relations Officer (PRO)

The designated officer/s should be in touch with the victims' relatives and let apprise them of their progress. They are also in charge of providing tents, drinking water and other requirements, media briefing, and outside casualty responsibility.

k. Documentation

The C.M.O will be in charge of documentation at Casualty. Every MLC will properly be recorded. However, priority will be given to patients and then paper work. Medical Administrator will make the decision of involving NGOs for a large number of Casualties.

l. Mortuary

Those who died or are brought to the hospital dead will be transferred to the Morgue until it is completely filled. The necessary legal formalities stated for Medico Cases shall be followed with discipline. The officer responsible for photography will be the one to take pictures of corpses if necessary.

b) Deactivation of Plan

This stage of the disaster plan is very important. The time of deactivation impacts the plan's successful outcome. It the deactivation is done prematurely, it may lead to arrival of casualties after the deactivation, while a delayed deactivation may cause unnecessary pressure on the resources of the hospital and normal activities would resume after a long time (GOI-UNDP, 2002-2008).

C. Post disaster debriefing

The chairperson will be the Medical Superintendent/Dean/Director (GOI-UNDP, 2002-2008).

IV. Threat and vulnerability assessment and response/prevention

The rise in the use of mobiles, social media, virtualization software, embedded devices and the high use of IT make the five most serious threats to security for hospitals today, according to Frank Andrus, the head officer of technology at the Bradford Networks. There was a provider of security solutions in Concord, N.H., who told Healthcare IT News the factors that healthcare organizations need to consider their biggest risks -- and suggested ways to minimize them (cited in Merrill, 2011).

i. So Many Mobile Devices, So Much Risk

Mobile devices today are found everywhere, and the types and number of devices that are used by nurses, staff, clinicians, administrators, physicians, visitors and patients is in healthcare organizations countrywide, with the upgraded operating system versions that are susceptible to infection.

Recommendation: Use NAC solutions, that is, the capacity to find every type of connected device and user, check that gadget for threats and protect them from spyware and outdated virus, and then create access depending on the gadget and the role of the user in the network.

ii. Embedded Devices Become the Norm

As mobiles and tablets with Wi-Fi and WAN capabilities, and systems for monitoring patients, imaging devices and medication scanners increase, entrenched connectivity makes monitoring, tracking and enterprise productivity management easier and helps reduce the amount of error. Nonetheless, embedded connectivity strains the bandwidth while posing a threat of increasing the risk of viruses for the network; the viruses may be from the many modern connected devices, which are not the same as the traditional PCs.

Recommendation: Integrate a security remedy that can protect integrity of private and critical data and seal any vulnerability loopholes within the network.

iii. Virtualization from Desktops to Servers

The aim of this strategy is obvious: Virtualization gives hope to all kinds of enterprises -- even the ones in medical care -- aiming at substantially reducing management and hardware expenses, execute green plans and maximize on the elasticity of virtualized desktops. Regrettably, more threats come as more device users shift towards virtualized environments.

Recommendation: HVDs (Hosted virtualized desktops) need to be perceived to be like traditional devices, with exposure to similar and at times new threats just like any other connected device. Before the explosion of adoption, make sure the network security devices and NAC solution can put an HVD on the same level as a PC.

iv. Viruses Spreading through Social Media

Twitter, YouTube, Facebook and other forms of social media are present anywhere; not even users in healthcare are immune to them. For this reason, it may not be possible to prevent access to social media at one's facility, even if they are a known platform for the spread of malware.

Recommendation: Quick identification of the infected devices; it is important in maintaining the security of networks and also protection of critical data.

v. IT Becomes Consumer Friendly

With the rise in user adaptation of their gadgets for professional purposes, healthcare institutions are exposed to more threats on network security. Actually, the rising reliance on IT is creating the need to have remedies for network security, which can cover many types of gadgets along with infrastructure components.

Recommendation: A strong NAC system may help prevent all threats. Use security remedies that can find any device that is consumer-adopted, check for deficiencies and threats, then solve the problems automatically or use provision access for any kind of device and any location (Merrill, 2011).