# Presentation: 920528

## Implementing the Emergency Plan

## “Disaster Plans”

- Hospital personnel, including administrators,
- vary widely on the value they attach to disaster
- plans.  Some staff members see them as
- useless, a ritual necessary solely for
- accreditation;  most accept plans as having
- some use;  a few believe their plans can handle
- every conceivable emergency.  1

*The facility’s “Coordination Plan”describes*
_*how it intends to behave*_
*during the response to, and recovery from, disasters.*

- 1 Quarantelli, 1970

## “Disaster Planning” Is...

- 1.		A continuous process
- 2.		Reducing the unknowns
- 3.		Evoking appropriate actions
- 4.		What is likely to happen?
- 5.		Based on valid knowledge
- 6.		Focused on general principles
- 7.		An educational activity
- 8.		Overcoming resistances
- 9.		Testing
- 10.	_Not Disaster Management _ 1

- 1 Quarantelli, 1984

## “Disaster Planning”Is Not The Same As“Disaster Management”

***Planning For Disasters Must Be ***
***Differentiated From The Principles***
***That Guide Management Of An***
***Emergency ****** 1***

- 1 Quarantelli, 1984

## Disasters Are NotEasily “Managed”

- “The management of routine, daily emergencies in the U.S. is influenced by a national preference for local control and private enterprise. The result is a complex, decentralized structure where the various tasks are divided among a myriad of independent public and private organizations.” 1
- In larger than normal emergencies, this decentralized structure creates problems in interagency coordination.

- 1 Drabek, Quarantelli  1985, 1987, 1991

## Disasters Change Normal Organizational Routines

- Off-Duty Personnel Are Called In
- Personnel Are Re-Assigned To New Duties
- Everyday Procedures & Priorities Are Altered
- Organizations Share Tasks & Resources
- Involvement of Non-Emergency Responders
- Crossing of Jurisdictional Boundaries
- Non-Routine Tasks Are Created
- Damage To Normal Response Tools & Facilities
- Formation Of New Organizations 1

- 1 Auf Der Heide, 1989

## Health Care FacilitiesHave Unique Characteristics

- _Heavily occupied_:  housing patients, visitors, staff and medical personnel on a 24-hour basis
- _Complex structures:_  having many small rooms and combining the functions of hotel, office, laboratory, warehouse, etc.

## Health Care FacilitiesHave Unique Characteristics

- _Dependent upon utility services_:  power, water supply, waste disposal, communications, etc.
- _Supplies_, necessary for patient treatment, and r_ecords _necessary for accurate treatment _are vulnerable to damage  _ 1
- ?

## Health Care FacilitiesFace Certain Social Realities

- _Regardless of internal problems_ caused by a community incident, _injured persons will arrive expecting treatment _
- _Inquiries by family and friends will place a heavy load on available communications and staff_
- _Volunteers of all types will arrive_ to “lend a hand”

## Health Care Facilities Will Have A Major Problem With...

- _Convergence_ of injured persons, relatives & friends, the general public (volunteers), off-duty staff & medical personnel, news media, etc. !
- _Not_ a Scarcity of Resources !  1

- 1 Quarantelli, 1970

## 5 Key Weaknesses OfHealth Care FacilitiesFor Disaster Operations

- 1.  Mobilization
- 2.  Information Processing
- 3.  Task Assignment
- 4.  Decision-making
- 5.  Interorganizational Relationships 1

- 1 Quarantelli, 1970

## “No man is an island, entire of itself...” John Donne

- He might well have been referring to the health
- care facility, for it exists within and for the
- community.  It therefore follows that a disaster
- which affects the community will also have a
- direct or indirect impact upon the institution..  1

- 1 Hanna, 1991

## Characteristics of Emergencies

- Existence of a warning period
- Location
- Scope
- Magnitude
- Duration
- Time of day
- Day of the week
- Season of the year
- Past, present and future weather
- ?

## Brewster, 1994

## Nature of the Event

*“**WHAT?”*

_*Type of Primary Event*_ ~ Wind, Water, Fire, Ground-shaking, Heat/Cold, etc.
- Its _*Magnitude*_
- Its _*Duration*_
_*Likely Secondary Effects*_, caused by the primary hazard, & the “Cascading of Events”

## The existence of a Warning Period, and if so, how long?
Time of Day:  morning, afternoon, or evening
Day of the Week:  weekday, weekend
Weather Conditions:  past, present and expected
Season of the Year:  winter/summer, and tourism

_*Time of Day:*_  morning, afternoon, or evening
_*Day of the Week:*_  weekday, weekend
_*Weather Conditions:*_  past, present and expected
_*Season of the Year:*_  winter/summer, and tourism

- Nature of the Event

*“**WHEN?”*

## Nature of the Event

- Types of Land Uses
- Types of Critical Facilities

*“**WHERE?”*

**Public Safety Communications Centers,**
**and High Occupancy Structures:  **
**Hospitals, Nursing Homes, Schools, Jails, **
**Shopping Malls, Office Complexes, **
**Industrial Facilities, etc.**

## Potential Injury Causing Event

- A

- B

- C

- Stage

- Static
- Dynamic

- Controlled
- Disruptive
- Paralytic

- Local			P
- Regional		I
- National		C
- International	E

- 0
- I
- II
- III

- Koenig, 1995

**Notes:**
A standard nomenclature that concisely describes any disaster is currently lacking.  This slide shows a model taxonomy system.  Instead of the word “disaster,” a root word “PICE,.” “Potential Injury causing Event.”  Descriptive modifiers to account for all possible scenarios surround the root word, as illustrated.

A modifier is chosen from each column and a stage is assigned to each PICE. (Describe A, B and C).

Stage 0 means there is little chance that outside medical resources will be needed, while Stage III means immediately dispatch resources to assist the stricken area(s). 

## Emergencies Can Present Themselves In 2 Ways

***Oklahoma City Bombing***

***SWISSAIR Flight 800***

***Hurricane Andrew***

***Midwest Floods***

***Persian Gulf War***

***Northridge Earthquake***

***The Amount of Time We’re Given***
***To Pre-Organize People and Pre-Stage Equipment***
***Can Drastically Change Our Response Effectiveness***
***In Terms Of Lives Saved and Property Conserved***

_***Anticipated***_
***and/or***
_***With ***_***Warning***

_***Unanticipated***_
***and/or***
_***Without***_*** Warning***

## Who (initially) manages the emergency:Responders or Managers?

## Responders

- Set overall objectives
- Determine activity areas
- Specify control objectives/tactics for each area
- Specify resources needed by each area
- Specify facilities and reporting locations
- Place personnel and resource order
- Develop communications and traffic plan
- Finalize, approve and implement the action plan

*** ******Take Immediate***
***Action***

***Responders***

*** ******Take Immediate***
***Action***

***Managers***

**Incident**
**Action**
**Planning**

**13**
**Probable**
**Steps**
**Using**
**Checklists**

**To Save Lives**

**To Support Responders**

**Conserve Property**

**Project Requirements**

## “Decision Starter”

- “Decision Starter”

**MANAGER**

**NO WARNING**

**RESPONDER**

**WARNING**

***You are...***

***You have...***

*“**Insert Emergency Here”*

***Begin Action Planning***

***Begin 13 Steps***

- Brewster, 1993

## Evacuation Due To Fire

**MANAGER**

**NO WARNING**

**RESPONDER**

**WARNING**

***You are...***

***You have...***

*Evacuation Due To Fire*

***Begin Action Planning***

***Begin 13 Steps***

- Brewster, 1993

## Responder Skills

**  **Act on the warning: Protect yourself & others.
-   Assess what has happened, where it is going,
-    and who may be in its way.
-   Report what you have found out to others.
-   Decide if you with others can control it - safely.
-   Organize people to control it or move others
-    out of its way.
-   Talk about it, once Its over.

_***Everyone***_*** should understand how to:***

## #1

**The First Person Who Doesn’t**
_***Have To Get Involved In Actions***_
**That Control Effects or Save Lives**

***“******Initial Incident Commander”***

_***Manager***_**,**
**not a**
**Responder**

- ERI

- Someone Takes Charge !

## #2

**A Process by Which...**
**       ****the Initial Incident Commander Asks:**

***o  What Have I Got?        (Situation)***
***o  Where Is It Going?      (Potential)***
***o  How Do I Control It?  (Resources)***

_***SIZE-UP***_**, a continuous process ... involves a**
**constant gathering & evaluation of information.**

- Size-up

- ERI

## #3

**Established As Soon As Possible.**

****  The hub of all activities***
****  Easily identified***
****  Central location for information***

**o  Initial Incident Commander ... **
**                                         ****STAYS THERE !**

***Where Initial***
***Management Occurs***

- Establish a Command Post

- ERI

## #4

**Establish**
**Communications from**
**Command Post to**
**Emergency**
**Operating Center**

- ERI

## #5

**Make note of numbers & types of responders**
**on-scene with inventory of equipment &**
**projected needs for resources &**
**additional manpower.**

***After a thorough size-up of the situation...***
***request resources commensurate***
***with the needs now and for the next 8 hours.***

- Resource Analysis

- ERI

## #6

***During this time period,***
***planning is informal...***
***& probably done solely by the***
***Initial Incident Commander.***

***The Transition to a Written Plan***
***Will Normally Occur Only After***
***Immediate Threats To Life are Controlled***

**Offensive**

**Defensive**

- Develop an
- “initial attack” Strategy

- ERI

## #7

***To Manage All ***_***Tactical***_*** Activities***
**-  Controlling the on-going negative effects**
**-  Guiding search, rescue, medical, security,**
**                ****mass care, etc.**

***Brief on roles & responsibilities***
***Explain the situation***
***Describe what you want accomplished***

- Designate an
- Operations Chief

***Provide a***
***Written Plan***
***if possible !***

- ERI

## #8

***the Safety Officer***
***has the authority to***
***STOP UNSAFE ACTS***

- Designate a
- Safety Officer

- ERI

## #9

**Designate the Perimeter of the Incident Site...**
**                         ****...with zones for levels of danger.**

***1.  Hot Zone (maximum danger)***
***2.  Warm Zone (moderate danger)***
***3.  Cold Zone (minimal danger)***

- Secure the Scene

- ERI

## #10

***   ******Matches resource capability or expertise to the objectives & tasks.***
***   ******Monitors progress of priority tasks &. re-assign          responders to meet changing conditions.***
****  Evaluates hazards and commit only qualified responders into high hazard areas.***

- Deploy Responders

**Operations...**

**...and makes recommendations**
**to the Incident Commander**

- ERI

## #11

****  Tracks all incident data***
****  Develop alternatives***
****  Conducts planning meetings***
****  Proposes Incident Action Plan***

**Key tasks**
**include:**

- Designate a
- Planning Chief

- ERI

## #12

***Command Staff***

***General Staff***

****  Liaison Officer***
****  Information Officer***

****  Logistics Section Chief***
****  Finance Section Chief***

***Which***
***Functions***
***Are Needed ?***

- Designate other
- Functions, as needed

- ERI

## #13

*** ******Manage Shift Changes, Briefing & De-briefing***

***Divide the Incident into Manageable Areas***

***Clearly Identify Zones & IMS Positions***

***Plan For What Happens Next !***

***Establish Staging Area(s)***

***Establish Traffic Flow***

***Know Current Incident & Resource Status ***

***Coordinate Information & Needed Support With EOC***

***Stay Ahead***
***of the***
***Power Curve !***

- Continue to
- Organize & Manage

- ERI

## VA/DoD Contingency

**MANAGER**

**NO WARNING**

**RESPONDER**

**WARNING**

***You are...***

***You have...***

*VA/DoD Contingency*

***Begin Action Planning***

***Begin 13 Steps***

- Brewster, 1993

## Manager Skills

***We Must First ***
***Understand The Situation***
***To Properly***
***Respond To It !***

_**INCIDENT BRIEFING**_
**Date/time of start of incident**
**Type of incident**
**Services involved**
**Current incident status**
**Current resource status**
**Current strategy/objectives**
**Communications systems being used**
**Special problems/issues**

***Nature***

***Size***

***Location***

***Time of Day***

***Day of the Week***

***Initially***

**Incident**
**Briefing**

***What ?***
***Where ?***
***When ?***
***Who’s Involved ?***
***Where Is It Going ?***

## Manager Skills (con’t)

- Gather information through ongoing assessment
- Keep records on all resources
- Set overall objectives
- Determine activity areas
- Specify control objectives/tactics for each area

## Manager Skills (con’t)

- Specify resources needed by each area
- Specify facilities and reporting locations
- Place personnel and resource order
- Develop communications and traffic plan
- Finalize, approve and implement the action plan

## Can We Predict What We Will Need to Do?

- Can We Project What We Will Need to Do it With?

## “Disaster Management”Involves...

**o  Warning**
**o  Pre-impact Preparations**
**o  Search & Rescue**
**o  Care of Injured & Dead**
**o  Welfare Needs**
**o  Restoration of Essential Services**
**o  Protection against Continuing Threat**
**o  Community Order**

**o  Communication**
**o  Continuing Assessment of Situation**
**o  Mobilization & Utilization of Resources**
**o  Coordination**
**o  Exercise of Authority**

**“****Agent-Generated Demands”**

**“****Response-Generated**
**Demands”**

***Two Sets of***
***Demands Occur***
***Simultaneously!***

- Quarantelli, 1985

## Pre-Impact

**Protective Actions**

**Situation Assessment**
**Fire Suppression**
**Hazmat Control**
**Search and Rescue**
**Medical Services**
**Public Information**
**Debris Clearance**

**Mass Care**
**Individual Assistance**
**Essential Services**
**Temporary Housing**
**Debris Removal**

**Service Restoration**
**Business Restoration**
**Permanent Housing**
**Debris Disposal**

*Pre-Impact*

*Initial Response*

*Initial Recovery*

*Reconstruction*

- CUSEC Journal

## Major Functions

- Management
- Planning
- Logistics
- Finance & Admin
- Operations
- Business Continuity
- Equipment, Plant & Utilities
- Safety & Security
- Health & Medical Services

## Management & Planning

- Mobilization/demob
- Emergency policies
- Liaison
- Public information
- Safety
- Incident action planning
- Situation  and resource status
- Documentation
- Reporting

## Logistics, Finance & Admin

- Supply
- Facilities
- Transportation
- Communications
- Food
- Medical (rehab)

- Time
- Procurement
- Comp/Claims
- Cost

## Operations:Business Continuity

- Telecommunications systems
- Service access
- Records preservation
- Business relocation

## Operations:Equipment, Plant & Utilities

- Patient care systems
- Power/light systems
- Heating/cooling systems
- Water/sewer systems
- Buildings/grounds/roads

## Operations:Safety & Security

- Alerting/warning
- Hazmat control/decon
- Fire suppression
- Search & rescue
- Security

## Operations:Health & Medical Services

- Non-incident patient management
- Triage
- Treatment
- Evacuation
- Outreach
- Fatalities management

## Questions?