June 15, 2011 | | Comments 0
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Beware the Ides of…July?

By now, I suspect that most of you have heard about some of the “editorial” changes that will be taking effect in a couple of weeks—just in time for the Independence Day festivities, though I don’t know that this should result in much in the way of fireworks.

So the first item revolves around the whole business occupancy as emergency services provider and/or community-designated disaster receiving station, which I suppose is a concern for some folks. But I can’t think of too many folks with business occupancies that provide emergency services or (even less likely I’m thinking) community-designated disaster receiving stations, and even if you do, why would you not include these locations in your regular exercise schedule? Again, something of which to be mindful, but I shouldn’t think would be a problem as long as you’re paying attention. Which leads me to the “other” point, otherwise known as Note 4 under EM.03.01.03, which appears to pile on a bit when it comes to your post-emergency exercise activities.

As with so many of the more intricate meanderings of the Joint, as far as I’m concerned, this merely clarifies what was already implied in the standard. To be honest, the exercise section of the Emergency Management chapter is actually kind of useful (along with the standards covering the management of volunteer practitioners during an emergency—that is a very well-crafted set of standards/expectation and can actually assist folks in identifying appropriate strategies, but I digress).

My interpretation of the whole EM.03.01.03 magillah is that it is a clear move to a classic performance improvement cycle: You do an exercise, you identify improvements, implement the improvements, use the next exercise to evaluate the changes, identify more improvements, implement them, use the next exercise to evaluate those changes, and so on. Where this can be tricky is when you’re “playing” with the community because they will almost invariably have a different agenda for the exercise than the hospital will, so the hospital then has to become creative in building their improvements (and the evaluation thereof) of that drill. Sometimes the improvements are so broad-ranging that they will easily “fit” in any scenario, but others maybe not so much. The other point to keep in mind (and this dovetails very nicely with the recent blog item on interim gas measures) is that if you cannot implement an identified improvement prior to the next drill, you are supposed to identify interim measure to “bridge the gap” until implementation (the “note” for EM.03.01.03, EP 16 states that when modifications requiring substantive resources cannot be accomplished for the next response exercise, interim measures are put in place until final modifications can be made). As far as I’m concerned the “requirement” in the new note already existed as EP 17, which requires subsequent exercises to reflect the modifications and interim measures identified in previous exercises. They’ve changed the language some (and perhaps made it more clear, but I thought that what they had was clear enough. It may be that they did no one favors by burying it at the end of the chapter and decided to move it to a position of greater prominence. All we have is conjecture at this point. So, my advice would be to utilize your organization’s performance improvement model to track exercises and performance therein and keep the ball rolling.

As to how this may impact organizational resources (or the lack thereof), I don’t know that I’m prepared to throw that towel in just yet. I see far too much procrastination when it comes to emergency management efforts; it’s almost always part of someone’s job, but not the primary part, so accountability for emergency planning slides down the hierarchy. Part of it is, from a historical basis, most hospitals don’t have to deal with what I will loosely describe as “overwhelming” events, so it becomes a cost- (or risk-) benefit analysis. We have to devote our resources towards the stuff that’s most important. Now I’m certainly not prepared to say organizations feel that emergency preparedness is not important, but when you don’t have the resources to even make critical infrastructure improvements (which can actually increase the likelihood of an overwhelming event), you spend more time fixing stuff, putting out fires, etc. As I’ve noted in more places than I care to think, emergency preparedness is a journey not a destination. We will never get to a point where we can look back and say that we’ve done all we can (unless, of course, the Mayans are correct about next year, then maybe, just maybe we won’t have to worry as much about this stuff).

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Steve MacArthur About the Author: Steve MacArthur is a safety consultant with The Greeley Company in Danvers, Mass. He brings more than 30 years of healthcare management and consulting experience to his work with hospitals, physician offices, and ambulatory care facilities across the country. He is the author of HCPro's Hospital Safety Director's Handbook and is contributing editor for Briefings on Hospital Safety. Contact Steve at stevemacsafetyspace@gmail.com.

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