Emergency Management

Dr Varsha Shahane

Objectives

• List of emergencies and disasters that could affect the clinical laboratory

• Identification of elements of an emergency management plan

• Implementation of emergency management plan

• Evaluation of the plan for regulatory compliance

Introduction

• ‘Disaster’ = calamity, occurring suddenly and usually on a larger scale. eg: great loss of life, flood, airplane crash, business failure etc....

• Emergency = unexpected situation / sudden occurrence of a serious and urgent nature that demands immediate attention

• An emergency, if not attended to immediately, can result in a disaster ! .....and......

• A disaster if not prevented can lead to emergency situations !

• External emergencies : tornadoes, hurricanes, snowstorms, sandstorms, landslides, floods, earthquakes, tsunamis, warfare, terrorism, transport accidents

• Internal emergencies : hazard spills, fires, bomb threats, personnel shortage, reagent shortage

LABORATORY UNABLE TO PROVIDE TEST

RESULTS OR SERVICES

← NATURAL EMERGENCIES

LABORATORY EMERGENCIES →

• Programs or plans that respond to these situations are called ‘emergency preparedness’, ‘emergency management’ or ‘disaster plan’

• Emergency management plan (EMP) is a part of the strategy of the health care organisation and also may be a part of the regional or national EMP

• Main objective of EMP – to prevent interruption or cessation of laboratory services, when an emergency or disaster occurs → appropriate planning and preparation

• EMP – it has to be documented contains all the information required by

employees to respond appropriately to any emergency.

It serves as a guide that enables individuals to use ‘good judgement’ or ‘common sense’

ACT accordingly in the given situation

Features of EMP

• Written comprehensive document that defines the scope and goals of the program

• Lists the responsible individuals• It should address both internal and external

disasters in such a way that the facility can respond to multiple scenarios

• It should document incidents• It should document training of staff

Contents of EMP

• The basic EMP should contain the following sections –

Purpose or policy Hazard analysis Program responsibilities Incident management system

(i) Purpose / Policy

• It states the need for a response plan that deals with the natural or human caused events that may disrupt normal operations

• It also assumes the responsibility to provide services to patients through effective utilisation of limited resources and to assist any injured individuals

(ii) Hazard analysis

• Laboratory personnel must prepare a risk assessment for the occurrence of both internal and external emergencies

• The risk assessment should be able to define the direct and the indirect impact on the facility

• It should be able to reduce the risk or diminish the damage resulting from the emergency.

(iii) Program responsibilities

• Should define the specific and general responsibilities of each individual in the laboratory

(iv) Incident management system

• It is used to manage emergency and disaster events through a flexible response regardless of when and where the event occurs

• Bureaucracy ...X Hierarchy ......X Every employee is expected to be the leader in

order to protect life and property in the face of an emergency.

He/she should carry out ALL responsibilities of the lab.

• Patient, visitor, employee safety• Report the incident to the proper authorities• Use proper procedures as outlined in the plan

EMP - 4 phases

• Identification of the emergency• Containment – limit the impact• Response – assist victims, confine the physical

damage• Recovery – restore organization’s normal

operation

A good quality EMP is

• complete and concise• Effective• Well written and easy to execute• Well known to all the lab staff – its location,

one’s role in executing it• Possible disaster scenarios should be covered

in the plan ( tsunami or earthquakes in Japan, sandstorm in KSA, terrorism in India)

• SAFETY – of all employees, patients, visitors, individuals with special needs

• Alternative sources of utilities ( fire extinguisher, alarm system, emergency exits, life saving jacket ), communications ( call police, fire brigade, hospital emergency services, swimming experts etc)

• Alternative roles and responsibilities of personnel during emergency ( some act as drivers, some may give first aid, some may man the traffic during traffic jams occurring in an event of road traffic accident etc)

• Emotional response – very important !

Eg : EMP in a lab

• Q 1. Are there sufficient instruments to perform the test/ tests ? Especially the critical instruments and those which run on emergency power.

• Q 2. Are there sufficient supplies and reagents to perform the tests ? supply chain, alternate sources of materials, inventories

• Q 3. Are there sufficient personnel to perform the testing ? transport system, emergency call back list

• Q 4. Is the test menu sufficient to provide requested services ?

• Q 5. If the lab is closed or cannot carry out the tests .....!! Which is the alternative lab?

Elements of emergency planning

• Identify the potential disasters and how the lab should respond to them –

Identify the authorities to be notified Identify critical positions and assign individuals Identify critical space and supplies Prepare security measures Develop criteria for evacuation

• Define level of service and impact on patient care

Ensure normal and full operations Prioritize the situationPrepare minimal test menu for the

emergencies

• Develop communication plan Identify critical health care staff Identify critical laboratory staff Identify critical supplies

• Alternative operations Identify alternative site of operationsIdentify alternative laboratory for service workPrepare alternative scheduling or staffing

• Mock Drills Assess performance of emergency plan Modify plan to correct deficiencies

Success of EMP plan depends on :

• Detailed flow charts available for events and the actions to be taken

• Prompt and appropriate level of lab services made available

• Availability of intensive care units (ICU) and emergency rooms (ER)

• Effective and updated communication • Alternative health service providers identified• Mock drills

• External emergencies ( RTA, earthquakes, hazardous spills, terrorism)- increase in number of patients and shortage of staff, relocation of patients and services, utilities and supplies disrupted, decontamination procedures to be intensified, public health authority notification

• Internal emergencies ( shortage ofsupplies, personnel, strikes, computer issues- crash, hacking etc) –services disrupted, data loss, manual work increased, assistance from other lab.

EMP – get set go.......

EMERGENCY OPERATION CENTER ( EOC) checklist, level of service, assume

responsibilities ↓ COMMUNICATIONS - cell, telephone, fax,

mail, radios, bell code. Contact person in charge, alternative in charge, conduct meeting, press conference, avoid rumours

MEDICAL TREATMENT ACCESS – availability of ERs and ICUs

↓ DAMAGE ASSESSMENT – evacuation required?

Life safety ? Structural problems? Environmental status?

↓ PERSONNEL POOL – availability and relocation ↓ LOCATOR SYSTEM – track location of employees,

patients and visitors ↓ SECURITY......

SECURITY – relief operations, restricts ↓ access to lab

TRAINING – responsibilities, roles, communication system, supply systems and mock drills

↓ MONITORING AND EVALUATION –

documentation of deficiences and their correction

DISASTERS !!

• Fire – RACE rescue, alarm, confine, evacuate• Hazardous material – RACE• Radioactive material – strict regulations,

trained personnel, policies• Utility failure – alternative services, relocation• Water• Electricity – power back up

• Bomb threats – security tightened, police, evacuation, good communication system

• Natural disasters –immediate survey of trapped people, damaged equipment, hazardous events, evacuation operations

TAKE HOME MESSAGE

Beware and be prepared !