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Rethinking the Unthinkable for Homeland Defense

November 1, 2001
by Hugh E. Teitelbaum, JD, MS, and Valerie Day Wilden
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  As tragedy struck New York, Washington, DC and Pennsylvania on September 11, 2001, members of St. Barnabas Health System's senior management asked themselves, "What could be next?" and "Are we prepared?" They realized that the healthcare organization, located within 100 miles of the Somerset, Pennsylvania plane crash, could have been the victim of attack or asked to serve as an emergency relief site. Within hours of the first disaster, St. Barnabas' officers assembled for an emergency meeting.

The group discussed the implications of the recent attack, particularly if its focus had been, accidentally or by design, one of the seven St. Barnabas communities. They were briefed on terrorist tactics by a vice-president who is also an Air Force lieutenant colonel. By the meeting's end, emergency procedures had been discussed, each officer knew his or her role should disaster strike, and all rushed to their offices to review and revise the existing Y2K and other disaster plans in light of the new danger.

The next day each officer carried at all times the St. Barnabas Health System Crisis and Emergency Manual-a compilation of plans, procedures and contact information. Also, the organization's chaplain was featured on WPXI-TV in Pittsburgh, offering tips for discussing the "attack on America" with elderly parents and loved ones (see "Talking About It, page 20"). The chaplain also conducted prayer services throughout the week for residents and, with social services workers, individually counseled those in need of comfort. By week's end, thousands of resident families, employees, volunteers, donors and community members received a letter from the Health System's president indicating that a top-down review of operations had been conducted and that St. Barnabas was poised to handle any emergency.

Although most healthcare facilities have a disaster plan, for most, the only time the plan is consulted is during mock drills, annual accreditation surveys and following the occasional havoc raised by Mother Nature. Now that most organizations realize that the time is ripe for a top-to-bottom review of disaster planning and response, St. Barnabas Health System, on the basis of its recent experience, offers the following suggestions.

As first steps, hold a planning session, form an emergency response team and designate a planning group. The planning group's mission statement must be concise and direct. Assume that the recent events are not once-in-a-lifetime experiences, but will be repeated. Within this context, develop plans to ensure the well-being of residents, patients and staff, and the survival of facilities and how they can function as a community resource. Review essential functions of your or-ganization to ensure that they can be performed, regardless of the nature or scope of the disaster. Clearly identify key personnel who are responsible for implementing the plan. Don't assume that
existing manuals dictate who is in charge. Speak to individuals personally and confirm their roles in writing.

Next, review disaster plans, create a crisis kit, resurrect your Y2K response plans, and have the planning group review them and all emergency and disaster policies currently in place. Many of these plans will, hopefully, contain detailed information for dealing with a va-riety of misfortunes. However, revise dis-aster plans to accommodate large-scale crises to include patient transfer agreements; the local community's emergency response plans, and policies and procedures for evacuations, fire drills, tornadoes and bomb threats; and disruptions of food, water, supplies and utilities.

The plans should be incorporated into a "Crisis and Emergency Information Kit" that is distributed to key personnel (e.g., corporate officers and facility managers). The kit should include phone listings and addresses of essential personnel (internal and external), government and community emergency resources and utilities, local maps, revised disaster plans for each building, security manuals, a media response plan, and critical vendor listings. Kits must accompany key personnel at home and at locations away from the facility so that pertinent information is readily available at a moment's notice.

Appropriate personnel should be issued special identification cards identifying them as "critical" healthcare personnel. The cards should request authorities to permit their movement in the event of an emergency and allow for access to their facilities should public roads be blocked, etc.

One obvious problem for the long-term care industry is that evacuation might not be an option. Facilities are the residents' homes. Unlike people at an office or factory, residents do not have somewhere else to go. Another consideration is that during a disaster of significant magnitude, long-term care facilities-especially nursing homes-might be required to accept overflows or diversions from hospitals or to serve as community resource centers. The disaster plan must provide for this new role. Two particular concerns emerge: backup communications and transportation/supply.