The National Safety Council has designated June as its annual National Safety Month  as a way to focus on “reducing leading causes of injury and death at work, on the road, and in our homes and communities.” In accordance with that, HCPro’s safety team will highlight a different healthcare-oriented safety topic each week in the month of June by sharing an excerpt from one of our many safety books, all available on HCMarketplace.com .
The focus this first week is on emergency preparedness.
The excerpt is from The Emergency Management Handbook , authored by Mary Russell, EdD, MSN, CEN, RN. Whether you need to launch a program or revamp your training, this resource provides the step-by-step road map for how to set up a program, obtain buy-in, and train staff. This excerpt focuses on completing a hazard vulnerability analysis.
One of the most valuable tools in your emergency planning repertoire is the risk assessment process. A hazard vulnerability analysis (HVA) is a tool designed to help you become familiar with hazards that your facility may face and to help you prioritize your planning, training, exercises, and corrective action improvements for your facility based on the likelihood of an event occurring.
Hospitals need to complete an HVA for their facility that identifies actual or potential events that can result in a demand for medical services or can affect the ability of the hospital to provide services. Your hospital’s HVA must consist of an assessment of each facility on its campus and any satellite outpatient centers it considers part of the hospital complex. The focus is to identify vulnerabilities that could affect the safety of patients, visitors, or employees during an emergency. It should also identify hazards within the larger community setting inclusive of the hospital’s campus. In this way, the HVA can uncover valuable opportunities for planning and mitigation to reduce vulnerabilities to specific threats. The HVA process will also identify scenarios that are a priority for your hospital to exercise.
Hospitals are part of a community’s critical infrastructure because of their role in providing medical care and services for the ill and injured. Because of this role, however, there are inherent vulnerabilities in terms of daily operations. These include the following:
- Twenty-four-hour-a-day operational needs
- Critical power dependence due to lifesaving equipment and procedures that hospitals offer
- An essential need for effective communication both within the hospital and externally to physician providers, other hospitals, EMS, and other partners
- Utilities support, including electric, water, waste disposal, IT, and communication support
- A high density of persons on-site at any one time, including inpatients, outpatients, employees, the medical staff, volunteers, visitors, students, vendors, service personnel, and others
- Inpatients with high acuity levels, including a high percentage that could be non-ambulatory (the vast majority will require some level of assistance if an evacuation is necessary, as most persons are tethered to some form of equipment)
- Hazardous materials in the form of pharmaceuticals, antineoplastic drugs, anesthetic gases, lab specimen solvents, formaldehyde, radiological materials, xylene, compressed gases, bulk liquid oxygen, biohazardous waste, on-site fuel, cleaning materials, and others
- Structural aspects of hospitals (e.g., many small rooms) that can make evacuation difficult, especially in older structures that include dead-end corridors and added-on wings
Hospitals that proactively take steps to reduce their vulnerabilities for one hazard will benefit from doing so by providing a level of reduced risk for other hazards. For example, hospitals that use shuttering and window protection systems to shield from hurricane winds know that such systems also offer security protection during any other hazard. The same concept goes for perimeter fencing around a facility as a mechanism to restrict access and manage crowd control, regardless of the scenario.
The hospital should review their HVA annually with key community partners as well as with the hospital’s emergency management team and Environment of Care Committee. The review should also assess the hospital’s capability to respond to various threats, advance mitigation strategies, inventory resources and assets to manage an incident, and plan exercises to trend progress in meeting objectives.
The HVA is a living document. Some things will not change, such as your hospital’s geographic location and its major transportation routes. Other things, such as local businesses and industries, can change from year to year. Agencies that can assist you with the development or annual review of your HVA include, but are not limited to, the following:
- Local fire-rescue services can be a great resource to update you on any new environmental threats in your area as fire inspectors become aware of new hazards in the community during business inspections and as part of their ongoing risk surveillance
- Police are aware of crime statistics, substance abuse issues, and potential terrorist threats, including persons of interest or groups such as gangs and activists
- Local, county, or regional emergency managers can be consulted to ensure that your HVA encompasses proximity to area hazards in which your facility may not be in the immediate impact zone but could be a receiving facility for casualties who flee the scene
- Local utility companies for electricity, water, and communications can detail risk and their mitigation strategies that are proposed or already in place for the grid location of your hospital complex
- Local chamber of commerce, which maintains an updated listing of population demographics, businesses, seasonal events, and other resource information
- Your local healthcare coalition includes additional key community partners beyond those listed above that can contribute both threat and hazard information and knowledge of existing resources to a local or regional HVA that is also applicable to an individual hospital HVA
The following are five steps you can take to complete your HVA.
Step 1: Complete your HVA community profile
Completing a community profile will help you understand the surrounding community and give you a context within which your hospital will consider its priorities (e.g., social, economic, political, and legal realities). A profile contains details related to your geographic location; demographics of the community; resident, seasonal, and tourist populations; top employers; weather and climate; economic status of residents; educational levels; multimodal transportation systems; and other considerations.
Step 2: Identify all hazards in your community risk profile
Insert all known community and area hazards into a hazard vulnerability matrix to create a community risk profile. Request the assistance of your community partners to ensure that your list is complete. These stakeholders can help you determine the probability that the hazards you identify will occur, and your facility’s vulnerability to them. Hospitals can also identify hazards in a visual way using community maps or a summary PowerPoint slide. Provide clear detail on top-ranked hazards so that your hospital’s emergency management team, Environment of Care team, and HICS team can all clearly articulate each risk and what they are doing to prepare for such potential occurrences to the organization.
Step 3: Assess the hazard’s risk
The risk of a hazard is a product of its likelihood, and the impact or consequences of the hazard on the community, and how it would affect the hospital’s ability to manage such an event. Determine risk by estimating the potential number and types of casualties your facility could expect from a given hazard; in most cases, you should base your estimation on your community’s population.
The risk of a hazard occurring can be assigned a score based on expert judgment or actual intelligence, or it can be assigned to a category of risk—for example, low, medium, or high. Some hazards may not be applicable due to a hospital’s geographic location. Factors that influence ranking of hazards include history of prior occurrences, vulnerability of population and property, and probability for the hazard to occur, based on both short-term and long-term predictions.
Step 4: Analyze the vulnerability to each hazard
Analyze each hazard separately to determine the likelihood of it affecting your hospital in terms of susceptibility, impact, and consequences to the organization. Impact can be determined in terms of the human impact (patient or staff injury, workforce availability), property impact (damage to facility, flooding, equipment damage, debris), and operational impact (disruption of services, utility failure).
Step 5: Prioritize the vulnerabilities for hazards and identify risk interventions
It is not enough to fill out an HVA for your hospital simply to identify hazards and rank them. The next critical step is to look at the hazards you have identified to find common vulnerabilities across different scenarios and establish shared mitigation measures. A subsequent exercise can determine whether the mitigation was successful for a specific scenario; however, such interventions will reduce vulnerability for other threats too. The severity of a hazard can be identified by the magnitude of the incident as measured by potential human, property, or business impacts but mitigated by preparedness (preplanning, training, exercises), internal response (initiating an efficient and effective response and mobilizing resources), and an external (community or mutual aid) response.
The highest-priority vulnerability is for patient and staff safety concerns—that is, those hazards that can result in illness or death or other health risks. Another high-ranking concern is business continuity, which translates into minimizing service disruption or failure and maintaining the trust of the community.
Local residents expect that hospitals will do all they can to protect the facility from harm and to prepare both the facility and its staff for threats. Hazards that result in property damage are also important, as they can affect access to the facility and can cause disruption in services.
To purchase The Emergency Management Handbook, please click here . And, as we highlight Safety Month, check back next Monday for another free HCPro book excerpt that focuses on a different healthcare safety topic.