The Role of Hospital Medicine in Emergency Preparedness: A Framework for Hospitalist Leadership in Disaster Preparedness, Response, and Recovery
Recent high-profile mass casualty events illustrate the unique challenges that such occurrences pose to normal hospital operations. These events create patient surges that overwhelm hospital resources, space, and staff. However, in most healthcare systems, hospitalists currently show no integration within emergency planning or incident response. This review aims to provide hospitalists with an overview of disaster management principles so that they can engage their hospitals’ disaster management system with a working fluency in emergency management and the incident command system. This review also proposes a framework for hospitalist involvement in preparation, response, and coordination during periods of crisis.
© 2018 Society of Hospital Medicine
Hospitalists are well suited as leaders in disaster preparation given their ability to coordinate care among a large spectrum of stakeholders. For example, case managers and social workers are essential members of a well-structured Discharge Strike Team. Their input is critical to ensure that disaster tactics – such as care coordination contracts with local skilled nursing facilities willing to expedite discharge in emergencies to their facilities – are in-place before a real MCI. During Hurricane Sandy, mass evacuation of affected hospitals was effective through the Healthcare Facility Evacuation Center (a healthcare coalition of the New York Hospital Association) but nevertheless plagued with issues regarding situational awareness, poor communication between facilities, and difficulty bundling patients with medical records to receiving facilities – items which can be identified, anticipated, and thoroughly vetted by hospitalists well in advance of a real-world evacuation.26, 27
As the Joint Commission mandates regular exercises of the emergency plan, protocols must be drilled regularly to uncover deficiencies and areas for improvement.18 The most common failure patterns in Emergency Operation Plans (EOPs) include unrealistic and ineffective expectations and poor communication between different personnel and groups, resulting in confusion and obfuscation.28-30 Therefore, EOPs need to be both comprehensive and realistic – characteristics that can only be tested through repeated drills. These characteristics can be tested during tabletop exercises, where hospitalists assume the role of a part of the ICS structure and with JAS in hand, attempt to reason how to respond to a given scenario.31 Our experience is that small-scale drills conducted more frequently than the bare minimum mandated by the Joint Commission are far more effective for success in real-life situations.
Although no hospital EOP can anticipate every contingency, hospitalists can proactively practice contingency planning for sustained system-wide mass effect incidents, in which hospitals are unable to maintain normal operations and shift from standard to crisis conventions of care. For example, mass effect incidents (ie, hospital damage from an earthquake or a massive and persistent regional power failure), require planning for how a hospital-wide mass evacuation would unfold and how efforts from multiple ancillary hospital services (engineering, nursing, security, and patient transport) would be integrated. As of 2015, over 90% of hospitals have adopted an electronic health record, but only two-thirds of hospitals feature EOPs for information technology failures.32,33 Given the large footprint of hospitalists in clinical practice, HICS principles appear ripe for application in IT outages and through development of ICS positions structured specifically to this type of contingency.34
CONCLUSION
Disasters unfold rapidly with marked patient surges and the potential to strain healthcare systems over an extended period. However, in both instances, hospitalists are possibly some of the most qualified clinicians to prepare for and respond to such events. Hospitalists need to assume a leadership role in emergency preparedness to integrate seamlessly into hospital incident command structures and to shape the interdepartmental relationships vital to success – skills at which hospitalists excel. Although no plan can address all possible disasters, familiarity with HICS and well-prepared and well-written JASs should help groups respond and succeed in almost all hazards.
