Corporate Support for a Healthcare Facility in Crisis

An increasing number of U.S. hospitals and skilled nursing/long-term care facilities are becoming part of the nation’s overall corporate healthcare system. These new alliances raise the question: “What is corporate’s role in emergency preparedness?” The answer to that core question, which should and must be asked in the pre-incident state of planning, starts with a realization that the primary corporate responsibilities are to: (a) promote system-wide readiness; (b) facilitate the delivery of requested assistance during an emergency; and (c) ensure optimal recovery of the facility from the crisis.

To meet these objectives effectively requires that those responsible for leading corporate emergency preparedness efforts craft a truly comprehensive emergency management program (EMP). An effective EMP addresses a broad spectrum of topics including but not limited to the following: response roles and responsibilities; a hazard-vulnerability analysis (for the corporation); an emergency operations plan (EOP); and an incident command system (ICS – the primary management tool specifically designed for corporate headquarters/system to employ during an emergency). Various Memorandums of Understanding (MOUs) and other resource-management documents – e.g., vendor lists, and contracts – should be included in the EOP as well.

The EMP also addresses the education and training strategies that should be used to periodically familiarize corporate personnel, as well as the leadership at each partner facility, with: (a) the ICS itself; (b) the relevant response procedures that should be used; and (c) the technological systems and equipment available for information sharing throughout the system. Tabletop and functional exercises specifically involving the corporate members also should be periodically conducted – and should include the completion of an honest, accurate, and detailed post-exercise “Hot Wash” as well as the writing, and sharing with all of the participants, of comprehensive after-action reports.

Much of the work associated with the EMP should be carried out by a corporate emergency preparedness committee composed of the emergency manager(s) and/or other appropriate representatives from each facility along with pre-designated senior personnel from corporate headquarters. The committee should meet on a regular basis, either in person or by teleconference, andeally should be led by the corporate emergency manager (or another senior official selected by the group itself). The minutes of each meeting should be published and distributed to all committee members – all of whom also should be encouraged not only to keep their facility colleagues current on corporate-level emergency preparedness activities but also to bring their own facility issues andeas to committee meetings for all-hands discussions.

The Corporate Incident Management Team An important aspect of the corporate headquarters’ ability to respond to its own internal incident – a building fire or bomb threat, for example – or to a system-wide emergency would be the effective utilization of an ICS that: (1) is consistent with National Incident Management System (NIMS) principles; and (2) mirrors, as closely as possible, the appropriate elements of the Hospital Incident Command System (HICS) that their hospital partners would and should be using both before and during response operations.

Among the senior corporate command positions that may be needed in many if not quite all situations are the following: Incident Commander; Liaison Officer; Public Information Officer Planning Section Chief; Logistics Section Chief; and Finance/Administration Chief. A number of subordinate positions also should be included on the Incident Management Team (IMT) chart and filled as necessary during the incident. (An Operations Section is usually not needed because, except on very rare occasions, there would be no actual operations being conducted at Corporate Headquarters – unless, of course, that is in fact the location of the emergency.)

The pre-designation of two or three persons for each subordinate position also is not only recommended but vital to the success of the corporate response. All of them should be provided with the management tools required – Job Action Sheets, for example, as well as command vests, and designated forms – and scheduled for the periodic training they would need to carry out their roles and responsibilities.

Corporate Support During an Actual Response Generally speaking, it will not be corporate’s role to actively be “in charge” and direct individual facility responses. What will and should be corporate’s role, rather, will be to gather information about each facility’s response efforts to ensure that: (a) the assistance requested – personnel, equipment, or supplies – is in fact being provided; and (b) all other response issues are being effectively addressed as well. The information sharing that is needed to fulfill these responsibilities might be met by requiring that each facility submit an Incident Action Plan for every operational period, posting information on an intranet-based corporate information-sharing system as well as through phone calls and well facilitated teleconferences.

The corporate Public Information Officer (PIO), working with his or her facility PIO colleagues, would collaborate to ensure that all media messaging needs are being addressed and the public is kept as fully and accurately informed as possible about the collective response efforts. Meanwhile, other members of the corporate IMT, obviously, should be working with each facility to ensure that recovery operations, not just response needs, are also being optimally met. If and when necessary, the corporate IMT also may and should interact with local, state, and federal authorities and/or other corporate healthcare systems to address response issues and concerns.

To briefly summarize: A growing number of U.S. healthcare facilities are now required to network and collaborate not only with other community response partners but with corporate headquarters as well. Critical to the success of this new interaction with corporate colleagues are: (a) a mutual understanding of the role of the corporate response; (b) recognition of how the corporation is designed to integrate with the facility (both during and after the crisis); and (c) development and promulgation of the plans needed to facilitate an effective “system” response if, as, and when needed.

Craig DeAtley

Craig DeAtley, PA-C, is director of the Institute for Public Health Emergency Readiness at the Washington Hospital Center, the National Capital Region’s largest hospital. He also is the emergency manager for the National Rehabilitation Hospital, and co-executive director of the Center for HICS (Hospital Incident Command System) Education and Training. He previously served, for 28 years, as an associate professor of emergency medicine at The George Washington University. In addition, he has been both a volunteer paramedic with the Fairfax County (Virginia) Fire and Rescue Department and a member of the department’s Urban Search and Rescue Team. An Emergency Department PA at multiple facilities for over 40 years, he also has served, since 1991, as the assistant medical director for the Fairfax County Police Department.



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