Written by Mitch Saruwatari

The President signed the Homeland Security Presidential Directive (HSPD)-5 In February, 2003 to insure the development of a new National Response Plan (NRP). This Plan provides a framework that will align all federal, state, local and private resources into a unified, all-discipline and all-hazards approach to domestic incident management.

Since then, the NRP has been crafted and the national response framework established.  However, several reports published following Hurricanes Katrina and Rita highlighted Plan areas yet to be implemented on both the local and national levels.

One key area identified was the prioritization, coordination and distribution of critical medical and health resources.  Hospitals and healthcare organizations have long trained to stand alone in disasters.  However, faced with extended loss of water and utilities, no access for evacuation, limited medical supplies and critically ill patients, hospitals struggled to meet basic care needs. 

It became clear to federal and national authorities that hospitals and healthcare organizations are a critical component of any community. As such, they must be included in preparedness activities and response priorities.  Hospitals are now being asked to participate in community planning meetings and regional disaster drills. They are also required to meet many new regulatory and accreditation standards.  Below are a few that will need to be addressed.

The Joint Commission

The Joint Commission conducted a five-year national survey among hospitals to identify activities that indicate how they may best survive a disaster.  The results indicated that resource sharing through community integration and healthcare networks was a high predictor for favorable outcomes.  

As a result, in January 2008, the Joint Commission revised their Emergency Management requirements to include 9 Standards (previously 2) that address six critical areas. These include communication, resources and assets, safety and security, staff responsibilities, utilities management, and patient clinical and support activities. Also included are 85 Elements of Performance (25 new) that must be met.  In 2009, the Emergency Management Standards will be removed from the Environment of Care and included in an entirely new Emergency Management chapter, further emphasizing the importance of emergency preparedness.

FEMA

The National Response Plan (NRP) identifies specific activities within the National Incident Management System (NIMS) for all government response agencies to comply in order to receive federal funding and support.  In 2006, these activities were translated for hospitals and healthcare organizations and are now a requirement for receiving federal emergency preparedness grant funds (e.g., HRSA, ASPR).

In 2007, hospitals were only required to meet 4 NIMS Elements.  However, by September 1, 2008 all 17 NIMS Elements and subsequent activities must be met.

NFPA

The National Fire Protection Association (NFPA) released a revised set of standards for Business Continuity and Emergency Preparedness in 2007.  Although not mandatory among hospitals and healthcare organizations, these activities provide a national standard which many other agencies, including the Joint Commission, use when building their own requirements.

HSEEP

The Homeland Security Exercise and Evaluation Program (HSEEP) is a comprehensive set of standards for conducting and evaluating disaster exercises.  Its intent is to collaboratively include all community agencies in standardized drills that will reinforce competencies used during real events.  The HSEEP standards are not yet required for hospitals and healthcare organizations. However, to be effectively integrated with community agencies, it is critical to begin meeting these guidelines.

AHRQ

The U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality (AHRQ) funded a project to develop a list of standard hospital bed definitions that will assist in standardizing resource requests during disasters.  This new set of guidelines, the National Hospital Available Beds for Emergencies and Disasters (HAvBED) System, is now being implemented among local and state health departments and emergency medical services agencies.   As a result, many hospitals must modify their existing bed tracking systems to comply.

On October 18, 2007, the President released another Presidential Directive (HSPD-21) that further addresses public health and medical preparedness.  Its purpose continues to help shore our community response capabilities.  However, specific activities outlined in this document address biosurveillance, stockpiling and distribution, mass casualty care and better preparing the public.  Eventually, these activities and other activities will continue to be translated into even more responsibility placed on the hospitals and healthcare systems. 

In order to address this fast-changing landscape of emergency preparedness compliance, hospitals must allocate more resources, including staff time and executive support.  An additional solution is to consider software tools that organize, track and measure these activities while better integrating resources with the community.  A proven leader in this area is the LiveProcess Platform, wherever its solutions are being implemented throughout the country.