An Initiative of Leadership Required

Hospitals must take a lead in emergency preparedness as population shifts to areas prone to natural hazards

By Michael Barrick

This week, the United States Census Bureau reported that 47 of the 50 fastest-growing areas in the United States were in the South and West. This is significant news for hospitals serving those growing populations, for these are the same areas that are among the most likely to experience natural hazards.

What this means is that hospital administrators and emergency managers must exercise an initiative of leadership in planning for the increased mortality, morbidity and financial costs sure to arise from these dangerously merging trends.

This year, the Joint Commission – the independent organization that accredits and certifies hospitals and other health care organizations – has dramatically increased its scrutiny of hospital emergency management plans. And, for 2009, it will likely focus even greater attention on those plans, as it is proposing to take emergency management out of the Environment of Care Chapter and make Emergency Management its own chapter, meaning a hospital’s plans for emergency plans and operations will be on par with the other seven chapters that cover major aspects of hospital clinical and support activities.

These increasingly stringent standards are overdue and should be welcomed. Yet, it may still not be enough if hospitals do not assert leadership roles for disaster planning within these rapidly growing regions. According to the Census Bureau report, communities in Florida, North Carolina, Georgia, Texas, Arizona, California, Louisiana and Nevada were among the nation’s ten fastest growing locations.

So, regions that are prone to natural hazards such as hurricanes, earthquakes, tornadoes, wildfires, and droughts are seeing the greatest population growth. As natural hazards impact these areas, hospitals will be overrun with victims from mass casualty incidents; and, financial losses (property damage, health care delivery costs, and the cost of response and recovery) will increase.

These are hazards that hospitals cannot afford to ignore. Recent disasters caused by naturally-occurring events have proven that “all roads lead to the hospital.” In other words, disaster victims often bypass first responders and transport themselves to the hospital. Yet, for even those that are transported by ambulance, how they get there is ultimately irrelevant – they will get there. So, while other community responders and agencies may be entering the recovery (or final) phase of a disaster, the hospital will find itself in the middle of the response phase – and may for an extended period of time.

It is true that laws in many states mandate that counties or municipalities serve as the primary entity responsible for disaster planning and response. These statutory requirements, however, cannot be used by hospitals as an excuse for not taking an aggressive, leading role in collaborative community planning for natural hazards. Hospitals must be active partners in developing community all-hazards plans that account for population growth – which includes not only more people, but more structures that pose risks in severe weather. They must also take into consideration historical climate data, the identification of available resources, and plans for finding funding streams to meet the shortfalls in needed resources for the inevitable risks caused by these migration patterns.

Obstacles to effective disaster planning, preparedness and response must also be identified, acknowledged and overcome. Much of government funding – especially since the terrorist attacks of September 11, 2001 – has been directed to response agencies. There remains a reluctance among responders and receivers to establish, cultivate and maintain the necessary relationships to understand and work together to complement each others’ roles. Also, the hospital industry is growing increasingly competitive. So, a culture of mistrust between hospitals filters into areas where it should not, such as emergency preparedness. These political, cultural and economic factors must not be allowed to stand in the way of hospitals fulfilling their ethical responsibilities.

Too often, they do. Yet, this is not because of a lack of regulation. In addition to the Joint Commission, the Federal Emergency Management Agency (FEMA) now requires that hospitals demonstrate that they are preparing for and managing disasters utilizing a proven and standardized command structure and system – the Hospital Incident Command System (HICS).

So, while systems are in place that should foster interoperability and standardized approaches for emergency planning and response, their success is dependent upon the people responsible for implementing them. Consequently, those running hospitals must exert an initiative of leadership to account for increasing populations in areas prone to natural hazards. Anything less is a recipe for disaster.

© The Barrick Report, 2008. Michael Barrick works in a hospital in the field of emergency preparedness.