A disaster is generally defined as an event in which illness or injuries surpass resource capabilities of a community or medical facility (Ignatavicius & Workman, 2010). Disaster preparedness is a process of ensuring that an organization has complied with the preventive measures and is in a state of readiness to contain the effects of a predicted disastrous event to minimize loss of life, injury, and damage to property.
Disaster preparedness can also provide rescue, relief, rehabilitation, and other services in the aftermath of the disaster, as well as have the capability and resources to continue to sustain its essential functions without being overwhelmed by the demand placed on them. The American Nursing Association is helping to ensure that disaster preparedness and response is robust in this country to be personally and professionally prepared for a disaster. Being in a prepared profession can help cope and help the communities recover from disaster better, faster and stronger (Brewer, 2010).
According to the Maricopa Integrated Health System (MIHS) at Maricopa Medical Center, they have a specialized disaster preparedness plan to fit their current top three hazards. Maricopa Medical Center conducts a Hazard Vulnerability Assessment (HVA) annually. The current top three hazards K. F. , Manager of Fire Safety and Disaster Preparedness, at Maricopa Medical Center has identified include: Mass Causality Incidents (trauma, burns, pandemic, etc. ), Small Casualty Hazardous Materials Response (less than five patients), and Severe Weather Incidents (monsoonal action, thunderstorms, and haboobs).
This organization has a comprehensive Emergency Operations Plan that addresses the top three current hazards in the organization’s region. Maricopa Medical Center is also further developing their business continuity and recovery plans into stand-alone plans (K. F. , personal interview, February 13, 2012). In order to evaluate and determine the effectiveness of the disaster preparedness plan, Maricopa Medical Center annually conducts a minimum of two operational exercises, in addition to various discussion based exercises. The organization’s exercises follow the Homeland Security
Exercise Evaluation Program (HSEEP), which includes an after action report process with an improvement plan and corrective action plan sections. According to the Agency for Healthcare Research and Quality, many studies have showed that disaster drills have been an effective way to improve staffs knowledge of hospital disaster procedures (Catlett, 2004). Additionally, exercise objectives are developed in such a way to exercise pieces of the plan that have been identified as opportunities for continual improvement and/or grant deliverables.
Once opportunities for improvement of the disaster plan are identified, these improvements are remedied by being given corrective actions with specific time frames and the status is reported to senior management. Some recent corrective actions that have occurred within recent years include the development of position-specific training to further build comfort for those that are activated in the Hospital Command Center, plan changes regarding Casualty Care Areas during a response to a Mass Casualty Incident, and Standard Operating Procedure enhancement for the Hospital Emergency Response Team (K. F. personal interview, February 13, 2012).
The representation that is present on the disaster preparedness committee for Maricopa Medical Center does not include nursing management. The emergency management committee includes a cross-sectional representation from the entire health system. This includes Acute Care, Behavioral Health, Ancillary Services, and Outpatient Services. K. F. , stated, “Bedside nursing has been extremely instrumental within the various task groups that focus on plan changes. In fact, the task groups associated with Casualty Care, Fatality Management, and HERT development are chaired by bedside nursing staff.
There is also a Steering Committee for guidance that includes the Chief Operating Officer, Chief Medical Officer, Chief Information Officer, Chief Compliance Officer and the Vice President of Hospital Operations (K. F. , personal interview, February 13, 2012). ” The established relationships that are within the community to help implement the organization’s disaster preparedness plan are that K. F. is currently the Chair-Elect for the Az Coalition for Healthcare Emergency Response (AzCHER-Central), which brings hospitals, clinics, skilled nursing acilities, fire & Emergency Medical Services (EMS), public health, emergency management, and other community stakeholders together for planning. Maricopa Medical Center currently has three to four members on the general body of this group, including bedside nursing representatives. There are a number of governmental agencies that are involved in the organization’s disaster preparedness planning. K. F. is an active member with Coyote Crisis Collaborative, which includes some of those from AzCHER, but also universities and community colleges, utilities, private business, faith-based and other volunteer groups, etc.
The Chief Information Officer is currently the Chairman of the Board for Coyote Crisis Collaborative. Additionally, they participate in the Hospital Preparedness Program (HPP) Grant which is administered by Arizona Department of Health Services. All of these opportunities provide environments for collaboration, plan sharing, and developing solutions to issues that face all of those included (K. F. , personal interview, February 13, 2012). In order to implement this plan, staff has received adequate training.
The National Incident Management System and Incident Command System training is required for all identified Hospital Command Center staff. They have a “3-Deep” list for all identified positions. Required training includes Incident System-100, Incident System-200, Incident System-700, and Incident System-800 as a minimum. Incident System-300 and Incident System-400 are required for section chiefs and incident commanders. An overview of the Hospital Incident Command System is shared with all employees at New Employee Orientation.
The Hospital Emergency Response Team (HERT) members receive additional Hospital Incident Command System (HICS) training within the HERT course and must take Incident System-100, Incident System-200, and Incident System-800 as pre-requisites for HERT. At Maricopa Medical Center, HERT training is now the standard for the Emergency Department first-year residents during their orientation process. K. Fehr stated, “Additionally, position-specific training has been identified in a recent exercise as an opportunity for improvement. That training has been developed and is scheduled to be administered over the next 90 days (K. F. personal interview, February 13, 2012). ”
Maricopa Medical Center has an automated system for the Hospital Command Center that is based upon Hospital Incident Command System IV. This system allows for “virtual” command and has the ability to send status updates, as well as provide real-time status to the HCC Team. They have also just been given access to a Mass Notification program from Arizona Department of Health Services that can be used internally to ensure that communication during incidents is sent to every employee. HICS IV is the current model that is used, which is National Incident Management System compliant (K. F. , personal interview, February 13, 2012).
The standards that nurses are held to concerning their ethical obligations to their organization and community would be handled by the Incident Commander with guidance of wither a Legal Specialist or Medical Ethicist. Any issues that are specific to standards of care would be approved by the Incident Commander and forwarded to the staff during the event based upon available resources, etc. If the question is specific as to the nurses’ duty to respond to work during a disaster, they do not require them to respond. They hope that they would stay or be willing to come in.
The planning includes the set-up of child/elder care areas and sleeping areas for the staff to remove barriers that would take them away from their station. Planning does include the idea that at least 40 % of the staff will not remain or come in during an incident. Maricopa Medical Center has a Memorandum of Understanding and a Memorandum of Agreement with other regional hospitals and formal request processes at the county and state levels for additional staff. When asked whether staff buy-in was a coveted aspect in Maricopa Medical Center’s disaster plan, K. F. tates, “Staff is absolutely buy-in coveted for this organization’s disaster preparedness plan.
The best method that we have found for involvement includes the expansion of the HERT Program, covering the program during Health Fairs and Nursing Skills Fairs, and involving staff in exercises as mock patients (K. F. , personal interview, February 13, 2012). ” After my interview with K. F. , I was really intrigued into what all goes on with a disaster preparedness plan. I knew that disaster plans were in effect for many organizations, but I did not realize the actual extent of what goes n with the planning of it. I learned a lot through the interview and was very pleased with the information that I received about Maricopa Medical Center and their disaster preparedness plan.
I feel that what is involved in their plan is very relevant to the location of the organization, as well as how they every year they have two operational exercises, as well as discussion based exercises, to help test their plan and determine its effectiveness. I think this is a very important aspect to any organization because without testing the plan, it is unclear how effective it really it.
After these annual exercises, I think it is great that the organization has an after report with ideas for improvement to help make their disaster plan stronger and more effective. All in all, I believe that Maricopa Medical Center has a very effective and sufficient disaster preparedness plan for their organization and that they are consistently looking for areas of where they can improve and better their plan to help the community recover from disaster as it occurs (K. F. , personal interview, February 13, 2012).
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