Surge Facility, Emergency Management Resources
While healthcare leaders agree on the need for comprehensive emergency management plans, which include surge capacity, consensus on the necessary components and assigned accountabilities has been scarce. Hospitals have been left to use federal or state requirements, Joint Commission standards, and guidance from hospitals associations. The Joint Commission has worked over the past several years with experts in the public and private sectors to bring broader agreement and guidance on these issues.
Detailed information about what surge facilities are, the kind of planning that these alternate care sites require, how they can be set up, and who should be responsible for their establishment and operation is available through the JCAHO publication, Surge Hospitals: Providing Safe Care in Emergencies (available at www.jcaho.org/about+us/public+policy+initiatives/surge_hospital.htm). This Web-based publication describes the different types of surge facilities, such as shuttered hospitals, closed wards in existing hospitals, and mobile facilities, and the design considerations for each. It also explores the challenges of planning for, establishing, and operating surge facilities, such as obtaining sufficient staff, supplies and equipment, and providing safe care.
Lessons learned from healthcare organizations following Hurricanes Katrina and Rita along the Gulf Coast and into Texas are also included. These case studies specifically look at a surge facility established by the Harris County Hospital District at Reliant Arena in Houston, a surge facility at the Dallas Convention Center that treated more than 4,000 hurricane evacuees in during a single week, the Louisiana State University acute care facility mentioned earlier in this article, a field hospital set up in the site of a former retail store, and a healthcare shelter established in a Texas veterinary hospital to care for nursing home residents, pediatric burn patients, handicapped children, and home-health-care patients.
Beyond the very specific issue of surge facilities, JCAHO offers guidance on community-wide emergency management planning:
- Standing Together: An Emergency Planning Guide for America’s Communities provides detailed information about steps that communities must take to prepare for and successfully respond to major local and regional emergencies. The free planning guide, published in 2005, is the result of a two-year project that drew upon the expertise of front-line emergency responders, emergency preparedness planners, and public health and healthcare organization leaders. It’s available at www.jcaho.org/about+us/public+policy+initiatives/planning_guide.htm.
- Health Care at the Crossroads: Strategies for Creating and Sustaining Community-wide Emergency Preparedness Systems provides recommended strategies for developing community-wide preparedness. This free 2003 white paper is available at www.jcaho.org/about+us/public+policy+initiatives/emergency.htm.
Conclusion
The serious shortcomings of the nation’s emergency management planning capabilities were made evident by the events surrounding Hurricane Katrina. Hospitals, along with other types of healthcare facilities, must take an active role in all community-wide emergency planning activities to mitigate the effects on patient care. Communities and the healthcare organizations within them must plan to operate largely on their own for several days or even longer following a disaster. Surge facilities are a major component of these plans. Hospitals must prepare for the possibility that their buildings could be too damaged to function during, as well as after, a disaster.
Developing plans that allow for adequate patient care during emergencies requires hospitals and the communities that they serve to overcome barriers such as assigning responsibilities for planning, how to fund emergency readiness efforts, the specifics necessary to create effective planning and response processes, and how to coordinate with state and federal emergency management resources. This broad-based approach will help healthcare planners consider the challenges associated with major emergencies and develop appropriate plans to respond to such crises. TH
Cappiello is the vice president for Accreditation Field Operations at JCAHO. He is responsible for management of accreditation processes including survey functions, surveyor education, standards interpretation, staff education and training, and accreditation process improvement.