Greater Responsibilities, More Recognition for Hospital Emergency Managers

If the 9/11 terrorist attacks were the watershed moment for the nation’s emergency-management profession in general, the defining moment for hospital emergency management, particularly in the planning stages, was Hurricane Katrina.  That single event shattered what little confidence the public previously had in all emergency plans, especially those for hospitals.

For the emergency managers actually on the scene in Louisiana, and elsewhere on the Gulf Coast, it was disappointing, and somewhat disturbing, that their fellow citizens seemed either unable or unwilling to recognize the incredible sacrifices that so many responders, especially those outstanding healthcare providers who stayed with their patients at considerable risk to their own lives, made during and after that cataclysmic “once in a century” event. All but buried in the chaos and confusion that followed the hurricane were the facts that only the United States could have responded to such a disaster so quickly, that a great deal of incident-response planning did go right, and that probably no major U.S. institution, public or private, could have been fully prepared to respond to a catastrophic event of such unprecedented magnitude. 

Nonetheless, and despite all the things that did go right during Katrina and its overlong aftermath, the nation’s hospitals and other healthcare facilities should and must focus greater attention on the many aspects of their emergency-management plans and operational capabilities that obviously do require improvement. 

If nothing else, Katrina focused the attention of administrators and lawmakers alike on what must be admitted were inadequate assumptions and, therefore, poor emergency planning on the part of most if not all of the hospitals directly affected by the monster hurricane.  Prior to Katrina, most decision makers in the U.S. healthcare industry believed – erroneously, as it turned out – that a federal government response to an emergency, although perhaps not immediate, would follow in a few hours, not days.

One of Several Weak Links in the Chain

Most hospital administrators in New Orleans and surrounding areas, it seems safe to say, also believed  that “sheltering in place” until help would arrive was a more advisable alternative than immediate (and potentially very dangerous) evacuation.  These same officials, however, failed to see (among other things) the weakness of a hospital supply chain that sets a healthcare facility up for failure if reliable plans are not in place to ensure the re-supply of medicines, pharmaceuticals, and other medical consumables in a relatively short period of time – anywhere from 24 to 72 hours, for most practical purposes. 

In the context of their previous professional experience – and/or the lack thereof – clinical personnel also probably never believed that “the triage color,” black, would ever have to be used outside of a battlefield, or that physicians would be required to make some extremely difficult ethical decisions about the limited resources available to them – sacrificing some very seriously injured patients, for example, to save the lives of others who seemed more likely to survive.  

Looking back at the many reasons why emergency planning could and should have been better – but was not – during Katrina and the flooding that followed, the first and most obvious questions asked by hospital administrators, and by legislators as well as the print and broadcast media, were: (1) “Who were the hospital leaders?” (2) “Who did the healthcare institutions put in charge of the important task of preparing hospitals for emergencies?” 

The answers received were and are not surprising: Prior to Katrina, most U.S. hospitals and other healthcare facilities delegated those important planning roles and responsibilities to some of their best people. But almost all of those same people, understandably but unfortunately, had a huge number of other responsibilities as well. Until Katrina struck, and for some time after, most if not all U.S. hospital officials responsible for emergency planning usually had other full-time responsibilities as well, mostly in the provision of day-to-day healthcare for their hospital.  In short, prior to Katrina, hospital leadership during an emergency situation was at best a part-time responsibility. 

The Beginning of a Much-Needed Upgrading

Today’s emergency planning requirements for hospitals have been significantly elevated over the past several years, thanks in large part to Hurricane Katrina. The detailed new planning requirements mandated by the Joint Commission (JC) and/or by local state healthcare regulators, for example, now require hospitals to greatly increase their institutional preparedness efforts. Additional funding resources, although still limited, also are being provided, though, and those hospitals that avail themselves of the funding available through federal grant programs are finding that some incredible deliverables accompany the grants.

Funding is possibly the most difficult problem facing most of the nation’s healthcare facilities. The average citizen, or legislator, who knows what hospitals now are being asked to plan for probably would judge the long list of requirements to be both appropriate and reasonable. But very few if any emergency planners and hospital administrators believe that the funding currently available is adequate for the numerous tasks assigned.  That economic fact of life does not, of course, diminish the responsibility of healthcare institutions to plan for what can happen in even a worst-case scenario, to schedule and carry out drills and exercises on the more realistic planning assumptions that are, in fact, now in place, and to use those drills to significantly improve the hospital’s emergency planning and capabilities. 

Although the JC’s current requirements do not specifically spell out the need for a full-time or even part-time emergency manager, it seems clear that the job of emergency manager is now at least an FTE (full-time equivalent) position for most U.S. hospitals.  The JC has said in briefings with hospitals and trade associations that it will hold hospital senior leadership responsible, under the leadership standards, if they do not allocate enough resources to their planning efforts. And the Joint Commission itself plans to put even greater emphasis on emergency management in the future, so the standards may receive yet another upward revision. 

In 2007, the Health Research Institute (HRI) commissioned a new study of hospital preparedness by Pricewater Coopers. In that study – Closing the Seam: Developing an Integrated Approach to Health System Disaster Preparedness – HRI clearly identified leadership as a crucial need and encouraged the industry to select, train, and both develop and encourage what the institute calls “Disaster Masters” – i.e., a new and, it would seem, higher level of emergency-management professionals.

HRI also recommended, not incidentally, that hospitals: (a) Develop a standard curriculum and establish certification requirements for their future emergency leaders; (b) redefine the roles of all hospital staff personnel during emergencies; and (c) finally allocate the funding needed to support the development and maintenance of the on-going leadership skills required of emergency leaders.

Clearly, the time of the Hospital Emergency Manager has arrived. Now all that the hospitals have to do is find them. 

Theodore Tully
Theodore Tully

Theodore (Ted) Tully, AEMT-P, is President of STAT Healthcare, an Emergency Management consulting group. He previously served as Administrative Director for Emergency Preparedness at the Mount Sinai Medical Center in New York City, as Vice President for Emergency Services at the Westchester Medical Center (WMC), as Westchester County EMS (emergency medical services) Coordinator, and as a police paramedic/detective in Greenburgh, N.Y. He also helped create the WMC Center for Emergency Services, which is responsible for coordinating the emergency plans of 32 hospitals in the lower part of New York State.



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