Joint Commission Critical Aspects of Emergency Pick 2 of the six Joint Commission’s six critical aspects of emergency response. Describe them and provide s

Joint Commission Critical Aspects of Emergency Pick 2 of the six Joint Commission’s six critical aspects of emergency response. Describe them and provide supporting documentation on why they are defined as critical by the Joint Commission.600 words, APA style Health Care
at the Crossroads
Strategies for Creating and Sustaining
Community-wide Emergency Preparedness Systems
Joint Commission
on Accreditation of Healthcare Organizations
© Copyright 2003 by the Joint Commission on Accreditation of Healthcare Organizations.
All rights reserved. No part of this book may be reproduced in any form or by any means without written permission from the publisher.
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Health Care
at the Crossroads
Strategies for Creating and Sustaining
Community-wide Emergency Preparedness Systems
Joint Commission
on Accreditation of Healthcare Organizations
Joint Commission Public Policy Initiative
This white paper is the second work product of the Joint
Commission’s new Public Policy Initiative. Launched in 2001, this
initiative seeks to address broad issues that have the potential to
seriously undermine the provision of safe, high-quality health care
and, indeed, the health of the American people. These are issues
which demand the attention and engagement of multiple publics
if successful resolution is to be achieved.
For each of the identified public policy issues, the Joint
Commission already has state-of-the-art standards in place.
However, simple application of these standards, and other unidimensional efforts, will leave this country far short of its health care
goals and objectives. Thus, this paper does not describe new Joint
Commission requirements for health care organizations, nor even
suggest that new requirements will be forthcoming in the future.
Rather, the Joint Commission has devised a public policy action
plan that involves the gathering of information and multiple
perspectives on the issue; formulation of comprehensive solutions;
and assignment of accountabilities for these solutions. The execution
of this plan includes the convening of roundtable discussions and
national symposia, the issuance of this white paper, and active
pursuit of the suggested recommendations.
This paper is a call to action for those who influence, develop or
carry out policies that will lead the way to resolution of the issue.
This is specifically in furtherance of the Joint Commission’s stated
mission to improve the safety and quality of health care provided
to the public.
Health Care at the Crossroads: Strategies for Creating and Sustaining Community-wide Emergency Preparedness Systems
Table of Contents
Preamble . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
Part I. Enlist the Community in Preparing the Local Response . . . . . . . . . . . . . . . . . . . . . . 10
Enlisting the Community . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Forging New Partnerships . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
An Exemplary Effort . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
Lessons Learned . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Getting There . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
Part II. Focus on the Key Aspects of the Preparedness System that Will
Preserve the Ability of Community Health Care Organizations to Care for
Patients, Protect Staff and Serve the Public . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Define Surge Capacity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Preserve the Organization – Protect the Staff . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Ensure Care for the “Other” Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Manage the Incident . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Consider the Threat to Mind, as well as Body . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Enlist the Public . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
Identify Communication and Information Needs and Meet Them . . . . . . . . . . . . . . 31
Test, Learn, Improve and Be Ready . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34
Part III. Establish Accountabilities, Oversight, Leadership and
Sustainment of Community Preparedness Systems . . . . . . . . . . . . . . . . . . . . . . . . . . 37
A Question of Accountability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Sustainable Funding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Guiding the Effort . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Knowing What Works . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Recommendations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43
Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44
End Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
3
Health Care at the Crossroads: Strategies for Creating and Sustaining Community-wide Emergency Preparedness Systems
Preamble
But now, in the face of an atrophied public
health infrastructure and lack of leadership
and coordination among other emergency
preparedness constituencies, hospitals and
other health care organizations are being
asked to step up their level of emergency
preparedness involvement. This unfortunately is occurring at a time when many of those
entities face severe resource constraints and
may not always be able to manage current
day-to-day patient care demands.
It does not take long for complacency to settle in. Eighteen months after the September
11, 2001 attacks and the subsequent, insidious, selected and deliberate dispersion of
anthrax spores, there are clear signs that the
focus of American attention has long since
moved on. The sense of urgency to prepare
has now become a wait-and-see sense.
Vigilance eventually gives way to ambiguity.
Indeed, the two occasions during the past
six months in which the national terrorism
level has been raised to Orange (high threat)
have generally provoked public mysticism as
to what individuals should do to prepare.
This confused state of non-readiness is what
terrorists lay in wait for. And, the world in
which we carry out our daily lives can
change in an instant.
At a recent national symposium on
emergency preparedness, Jerome Hauer,
acting assistant secretary of the Office of
Public Health Emergency Preparedness of
the Department of Health and Human
Services (DHHS), remarking on the strong
likelihood of another terrorist attack in the
near future, said,“At the end of the day, it is
medical care that will be needed.” But if
medical care capacity is already in variable
and sometimes scarce supply, planning for
unexpected surges in demand becomes all
the more critical. So, too, does funding and
federal leadership for these efforts.
This is not our world as we once knew it. It
is no longer sufficient to develop disaster
plans and dust them off if a threat appears
imminent. Rather, a system of preparedness
across communities must be in place everyday. Such systems make effective responses
to emergencies possible, and they also serve
as deterrents to actual attacks. And, they are
needed – whatever the level of our sense of
security – to facilitate the management of
crises that seem to be becoming everyday
occurrences.
The purpose of this report is to frame the
issues that must be addressed in developing
community-wide preparedness and to delineate federal and state responsibilities for
eliminating barriers, and for facilitating and
sustaining — through leadership, funding
and other resource deployment –
community-based emergency preparedness
across the United States.
The concept of community-wide preparedness systems is new to most health care
organizations. While most have long prepared and tested disaster plans, health care
organizations have operated in isolation, and
their disaster plans reflect this mindset.
4
Health Care at the Crossroads: Strategies for Creating and Sustaining Community-wide Emergency Preparedness Systems
Introduction
apparent, priority brought into sharp relief
fundamental new needs for emergency preparedness that would call for leadership and
coordination at the community level, which
did not then, and largely does not now, exist.
On the day that America experienced its
worst violation at the hands of terrorists, the
many “first responders” involved in rescuing,
treating and protecting the thousands of
people who were victimized, or had the
potential to be, valiantly performed their
jobs. But for many, their efforts were futile in
the face of such enormous destruction.
Emergency medical personnel and health
care workers from nearby and far away were
drawn to these scenes of destruction to lend
their support and expertise. Hospitals in the
vicinity of the World Trade Center, despite
being overwhelmed by power outages,
disabled telecommunications, and the rush of
the injured and those fleeing the
smoke-choked streets for shelter, were
nevertheless able to summon a response.
This does not gainsay the continuing
extraordinary efforts of the three public
safety agencies that this country has long
relied on – law enforcement, fire and rescue,
and emergency medical services. Nor does it
ignore the sometimes heroic efforts of
underfunded public health agencies and
health care provider organizations in
managing extremely challenging situations.
But in most communities there is no team,
nor teamwork, among all of these players
and other municipal and county leaders.
And, there is no community emergency preparedness plan, nor program, nor system.
And then, while the country was still reeling
from the September 11 attack, a different
kind of attack, this time with a biological
agent, anthrax, unfolded in Florida, New York,
New Jersey,Washington D.C. and
Connecticut.These disasters, wrought by
terrorism, rapidly focused the nation’s
attention on national security – the need to
protect American ideals and resources, and
most fundamentally, the very safety and
health of the American people. Both for
America’s leaders and for this nation’s
communities, this compelling new, or newly
While the cast of emergency preparedness
players in a given community can lengthen
rapidly, there is no denying the central role
that hospitals can and must play in these
efforts. However, these are difficult and
occasionally overwhelming times for
hospitals, even without this expanded
responsibility. In fact, many hospitals are
struggling to meet the daily demands for
their health care services.
It is no longer sufficient to develop disaster plans and dust them off if a threat appears
imminent. Rather, a system of preparedness across communities must be in place everyday.
5
Health Care at the Crossroads: Strategies for Creating and Sustaining Community-wide Emergency Preparedness Systems
Add to this brewing cataclysm the need for
“surge capacity” – the ability to care for perhaps hundreds to thousands more patients at
a given time – in hospitals already full,
already stressed, and already searching for
more resources to provide care, and the
challenge of preparedness becomes even
more daunting.
As a matter of public policy, this country has
purposefully shrunk the installed capacity of
its health care delivery system over the past
two decades. This has translated into the
closure of many hospitals and even more
emergency departments, despite the
escalating demands for services. In addition,
many hospitals now are experiencing severe
shortages of nurses and other essential
health care personnel. This is further reducing the capacity of these hospitals to deliver
care, including emergency care. Today’s hard
reality is that hospital emergency departments across the country are overcrowded
and, even absent any external disaster, likely
to be diverting patients on any given day.
Since the Fall 2001 terrorism attacks, there
has been a flurry of activity focused on the
preparation of emergency preparedness
plans.The emphasis on plans substantially
understates what are really needed –
emergency preparedness programs.
According to a recent report,“Preparedness
at home plays a critical role in combating
terrorism by reducing its appeal as an
effective means of warfare.”4 However, this
level of preparedness implies a tightly knit
system among the key emergency
preparedness participants that simply does
not exist in most communities today. “All
emergencies are local” is a truism that
conveys the responsibility of the community
to plan, prepare and respond to an
emergency. But as this paper points out, that
truism is today far more a call to action than
a reality. This paper is a call to action for
federal and state governments as well, for
weaving the tightly knit system of
preparedness also takes resources,
leadership and guidance.
Adding to these problems are sky-high
liability insurance premiums for physicians
that are limiting the availability of critical
specialists in certain jurisdictions. Further,
most states in the country, with strapped
budgets, are reducing the numbers of people
on their Medicaid rolls.1 Medicare too is
threatening more cuts in hospital reimbursement2 and the numbers of uninsured are on
the rise.3 All of these factors promise to further undermine the ability of hospitals to
meet the routine, let alone the extraordinary,
needs of their communities.
6
Health Care at the Crossroads: Strategies for Creating and Sustaining Community-wide Emergency Preparedness Systems
none yet that present evidence-based models
which are likely to be adaptable to the
varied urban, suburban and sparsely
populated communities that make up
the United States.
Since the events of September 11 and the
subsequent anthrax attacks, the federal
government has stepped forward to fund
the rehabilitation of the public health
system, and to a significantly lesser extent,
the preparedness efforts of the nation’s
hospitals. However, although the federal
plan enlisted state governments to allocate
federal funds to their hospitals well over a
year ago, the money has not yet reached hospitals and some local public health agencies.
There unfortunately is an oft-repeated refrain
of money not making it from Washington to
the trenches where it is needed.5 The
money may eventually make it, but the funds
are a small sum in comparison to what is
actually needed.6
Given the urgency for community-based
emergency preparedness and the obvious
barriers to achieving this goal across the
country, the Joint Commission convened an
expert Public Policy Roundtable to discuss
emergency preparedness issues and to frame
specific recommendations, fulfillment of
which would permit achievement of a level
of preparedness that could truly offer
protection and assurances to the American
public. Among the specific issues addressed
by the Roundtable were the resources and
requirements for community-based response
systems; the need for collaboration between
the medical care and public health
establishments, as well as other new
partnerships that must be forged; issues of
accountability and mechanisms for validating
readiness; and the appropriate roles of
federal and state governments.
In addition to the disputes and confusion
over meeting what remains today for many
hospitals, an unfunded mandate, hospitals
and their communities are struggling to
know how to get started. There is a fundamental need for templates or scalable models
of community-wide preparedness to guide
planning before, and actions taken during
and after, an emergency. Several nascent
templates are emerging; however, there are
In addition to the disputes and confusion over meeting what remains today for many hospitals,
an unfunded mandate, hospitals and their communities are struggling to
know how to get started.
7
Health Care at the Crossroads: Strategies for Creating and Sustaining Community-wide Emergency Preparedness Systems
Based on those discussions, the following
recommendations are proposed:
II. Focus on the key aspects of the
preparedness system that will
preserve the ability of community health
care resources to care for patients,
protect staff and serve the public.
• Prospectively define point-in-time and
longitudinal surge capacity at the
community level.
• Establish mutual aid agreements among
community hospitals and other health care
organizations.
• Ensure a 48-72 hour stand-alone capability
through the appropriate stockpiling of
necessary medications and supplies.
• Fund and facilitate the creation of a
credentialing database to support a national
emergency volunteer system for health care
professionals.
• Make direct caregivers the highest priority
for training and for receipt of
protective equipment, vaccinations,
prophylactic antibiotics, chemical
antidotes, and other protective measures.
• Support the provision of decontamination
capabilities in each hospital.
• Maintain the ability to provide routine care.
• Make provision for the graceful degradation
of care.
• Provide for waiver of regulatory
requirements under conditions of extreme
emergency.
I. Enlist the community in preparing the
local response
• Initiate and facilitate the development of
community-based emergency preparedness
programs across the country.
• Constitute community organizations that
comprise all of the key participants – as
appropriate to the community – to develop
the community-wide emergency preparedness program.
• Encourage the transition of
community health care resources from an
organization-focused approach to
emergency preparedness to one that
encompasses the community.
• Provide the community organization with
necessary funding and other resources and
hold it accountable for overseeing the planning, assessment and maintenance of the
preparedness program.
• Encourage the pursuit of substantive
collaborative activities that will also serve to
bridge the gap between the medical care
and public health systems.
• Develop and distribute emergency planning
and preparedness templates for
potential adaptation by various types of
communities.
8
Health Care at the Crossroads: Strategies for Creating and Sustaining Community-wide Emergency Preparedness Systems
• Adopt incident management approaches
that provide for simultaneous management
involvement by multiple authorities and
fluidity of authority.
• Make provisions for accommodating and
managing the substantial acute mental
health needs of the community.
• Directly address the fear created by terrorist
acts through targeted education, application
of risk reduction strategies and the teaching
of coping skills.
• Provide public education about emergency
preparedness.
• Actively engage the public in emergency
preparedness planning.
• Anticipate the information needs of the
community.
• Create redu…
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