Digging at the root of The Joint Commission’s 96-hour principle

Regarding the 96-hour provision in EM.02.01.01, the purpose of this whole magillah (and The Joint Commission has done an absolutely poor job of explaining this to folks) is for each organization to determine at which point they can no longer safely continue to provide care. Based on this determination, the organization can make the decision to reduce services, partially evacuate, or fully evacuate while it is still safe to do so.

The big failure mode that was identified for facilities post-Katrina is that the hospitals in New Orleans waited too long to make the decision to get out, so by the time they had made that determination, it was too late and they were stuck.

I believe that the key to this 96-hour concept is event recognition — in other words, being able to recognize when you have an event or combination of events that would result in the organization having to face tough decisions. My advice to folks when looking at this has been to go back to the hazard vulnerability analysis and look at whether the events are reasonably likely to result in the organization being completely isolated from the surrounding community for a period of 96 or more hours.

In nearly all cases, the number of events that could legitimately result in such isolation is very small (there may be organizations for which this is, for all intents and purposes, a physical impossibility).

Once organizations have determined what, if any, disaster scenarios might result in such an occurrence, they need to determine if these events would be the result of a rapid onset or a slow onset. Ultimately, it’s about being appropriately prepared and knowing when you have to break out the heavy response.