by Mitch Saruwatari: Practical emergency preparedness and management for hospitals

As the emergency preparedness coordinator for your hospital, you’re responsible for ensuring the safety of staff, patients, visitors and your facility in a disaster or emergency. While your boss doesn’t need to know every detail of how you do your job, in honor of Boss’s Day on October 16th, here are five things your boss should know about why emergency preparedness is critical for your hospital.

1.     Every dollar spent on emergency preparedness saves the hospital money.
Most hospitals think of emergency preparedness as a cost center. After all, it’s an area that needs funds for supplies and personnel, and disaster exercises and training events require revenue-producing employees like doctors and nurses to take time away from treating patients.

However, studies show that the cost benefit for every $1 spent in preparedness creates $4-11 worth of valuable return, with savings coming from fewer and less severe casualties, reduced property damage, and a more expedient recovery to normal business operations. Check out studies from the Harvard School of Public Healthand FEMA for more background and let your boss know the money and resources going towards emergency preparedness are dollars well spent.

2.     The number of declared disasters in the US each year is increasing.
While the specific number fluctuates each year, the overall trend in the number of presidentially declared disasters in the US is steadily increasing (FEMA website). Last year, there were 81 declared disasters and with the number currently at 77, I wouldn’t be surprised to see the 2011 total easily surpass 2010.

I’m not sure why the number is growing. It might simply be because of improved reporting, though thinking back of the events from this year (Japan earthquake and tsunami, Midwest tornados, Washington earthquake, Northeast flooding, Southwest power outage and wild fires) makes me wonder if there’s a climate component to the change as well.

Regardless of why, the days of not worrying about disasters because they only affect “the other guy” are over. Disasters are happening in every part of the country so no one is immune.  Eventually, your boss may find himself or herself in front of the TV cameras, commenting on how your facility is handling the situation in your community, or worse, having to report to the Board regarding a response that could have been better planned.

This month, the Natural Hazards Center in Boulder published a great article titled, “Better to Be Damned if You Do, Than Damned if You Don’t” about Hurricane Irene.  Several commented that it was simply too much effort considering that mass destruction never happened.   Unfortunately, complacency can really damage future response competency.

3.     There are disruptions every week in our hospital.
Preparing for major events and disasters is a large part of your job as an EMC, but I’m sure you also spend a considerable amount of time dealing with more frequent events, one of the most serious of which is dealing with situations of violence in the hospital.

A hotspot for violent situations in the hospital is the ER. Every week, there are stories of nurses and other ER staff attacked by patients, family members, and even addicts looking to steal drugs. Overcrowding, long wait times and lack of appropriate facilities all contribute to the problem. In California budget short-falls are impacting the number of available psychiatric beds throughout the state.  Subsequently, more mental-health-related illnesses are ending up in ERs that may be ill-equipped to manage the increase. A recent article in the LA Times highlighted this situation.

As the hospital emergency preparedness team, having a plan to quickly manage these types of disruptions is crucial for ensuring staff and patient safety on a daily basis.

4.     We save thousands or even millions of dollars by quickly recovering from an event.
One of the primary goals in an emergency response is to get operations back to normal as quickly as possible. In its Hurricane Ike report, FEMA reported The University of Texas Medical Branch – Galveston  lost $40 million per month because of reduced hospital operations post-Ike. Even if the hospital isn’t completely shut down, loss of even some services will significantly impact revenue.

Hopefully your boss knows that your emergency plan, exercises and training are intended to ensure your hospital gets back to business, as quickly as possible, after an event. And that means critical revenue for your hospital.

5.     Hospitals lose millions of dollars every year because they can’t produce documentation to support cost recovery.
Getting recovery funds after a response requires a great deal of documentation, and typically during a disaster response, documentation is the last thing on anyone’s mind. So, each year, hospitals forgo thousands of dollars in funds that they are entitled to, simply because they do not have the documentation to support claims.

With today’s tight margins in healthcare, being able to get reimbursements for the employee overtime needed in the snowstorm, hurricane, or flood can often make a big difference to the hospital’s bottom line. Let your boss know that this tracking of documentation is another area where the emergency preparedness program helps the hospital as a whole.

I hope these steps help raise emergency management awareness in your facility.  Without leadership support, our programs often suffer and subsequently, so does our response competency.  If you have any additional ideas or suggestions that have worked for you, please feel free to share them!

To say we’re in a dynamic time in history is an understatement. There are fundamental social changes occurring rapidly everywhere — and disasters are changing too.

A warming climate may be causing drought in some areas and flooding in others, but only time will tell if we are on the brink of real change via sea level rise and an increase in damage to countries that border oceans. We can argue the cause all we want, but in the world of emergency management, our role is clear: prepare for these changes.

I attribute the greatest change in the impact of disasters to the increase in the world’s population and where people live, which is primarily in densely populated cities. Mega-cities are springing up everywhere, and our population is expected to have another burst of growth in cities. Urbanization is good when you’re trying to maximize urban transit systems, but packing people into urban areas increases a disaster’s impacts.

The existing infrastructure in our cities is aging quickly. Water, sewer, road and bridge systems don’t last forever, and we’ve long deferred the maintenance and replacement of these systems. We have a “fix on failure” mentality, which increases the financial impact of disasters.

The American mindset is one that’s very comfortable living with risk. We continue to flock to areas that are at high risk for disasters. The movement to our nation’s coasts puts people and property in the greatest danger from hurricanes and catastrophic earthquakes.

I’m also seeing America’s thinking evolve into what I call the “shake and bake” mentality of disaster response. We now have several generations of Americans who’ve grown up in the microwave world, and they expect immediate solutions tailored to their needs. Their patience for the time it takes for the logistics tail to catch up with no-notice events can be measured in hours, not days or weeks. One manifestation of this is that people expect to access government help via social media.

But there’s also the social media counterpoint. Extensive commercial media coverage of disasters means more information is on social media channels, and people want to be involved in response and recovery efforts. I attribute this directly to social media’s and citizens’ ability to self-organize into virtual and physical teams.

Governments have a tremendous opportunity to leverage this citizen knowledge and interest by directing people’s efforts and incorporating them into disaster response and recovery efforts. The question is, however, are emergency managers and first responders ready to accept the help and incorporate civilian volunteer efforts into disaster response?

Disasters are becoming more frequent and significant — several disasters that cost more than $1 billion occurred in 2011. Government resources are being reduced while people’s expectations are increasing, and there’s a mismatch between what citizens want and what government can reasonably deliver. More communication is needed about the extent of governmental capabilities, as is a new emphasis on mitigation and disaster preparedness that includes the American people in the equation. And social media must be part of the solution, not the problem.

Eric Holdeman is the former director of the King County, Wash., Office of Emergency Management. His blog is located at www.disaster-zone.com.

David J. Kaufman serves as the director of FEMA’s Office of Policy and Program Analysis. He is responsible for providing leadership, analysis, coordination and decision-making support to the FEMA administrator on a wide range of agency policies, plans, programs and key initiatives.

Kaufman has been a faculty member at the Naval Postgraduate School’s Center for Homeland Defense and Security, where he taught in the center’s graduate- and executive-level education programs, and has previously served in several senior positions in the U.S. Department of Homeland Security and FEMA.

In his current position, he led the coordination effort to develop the Strategic Foresight Initiative (SFI). This initiative brought together a wide cross-section of the emergency management community to explore key future issues, trends and other factors, and to work through their implications. The result is a 36-page document titled Crisis Response and Disaster Resilience 2030: Forging Strategic Action in an Age of Uncertainty.

Kaufman responded to a series of questions about the report and its implications for the future of emergency management in the U.S.

Question: What was the impetus for establishing the SFI and how did it get initiated?

Answer: The SFI was established in 2010 to explore the factors driving change in our world, and to analyze how they will impact the emergency management field in the U.S. over the next 20 years. We wanted to understand the collective challenges and opportunities facing the emergency management community and to begin addressing those challenges and opportunities today. FEMA has coordinated the dialog and is providing the space for conversation.

How will the report help guide efforts to better prepare people and programs for the expected changes?

The report is intended to provide planners and managers with insights that can shape a range of critical decisions, starting now. Such decisions, which can be made in advance of disasters, include improving prioritization of resources and investments, managing new and unfamiliar risks, forging new partnerships, and understanding emerging legal and regulatory hurdles.

Although we have begun addressing our future needs, our progress is not enough. To build a more resilient, adaptive and proactive emergency management community, we must approach the future with urgency, and increase our pace of change. We hope that this report fosters the necessary conversations and ideas to do that.

Economic and political drivers were discussed. In the past, these might have been skipped, yet they can have a significant impact on the future. What drove the inclusion of these elements?

The reality of our current operating environment — globalization, increasing interdependencies in government institutions and business, and limited economic growth constraining government budgets and creating resource limitations — drove the inclusion of these drivers. These drivers are key influences on the strategic, long-term decisions we need to make today to maximize our capabilities in our daily operations in the future.

We live in an increasingly dangerous world. As you look at the hazards evolving, what are the challenges of potential cybersecurity and nuclear attacks?

The hazards we face continue to evolve and we have to stay ahead of the curve. Two drivers of change identified through the SFI process included technological innovation and dependency, and the evolving terrorist threat. We identified some trends in each of these drivers that could impact the future emergency management landscape. As we become more connected through mobile devices, sensors and monitoring technology, among other technological advancements, we have more data on which to base decisions, and we can understand faster what is going on in the world. However, these advancements also increase our vulnerabilities, including vulnerabilities to cyberattacks and other cyberevents.

Our research showed that terrorism will likely evolve in the coming decades. Some of the trends we identified include:

• Terrorists may favor attack methods that exploit perceived vulnerabilities, such as adopting active shooter tactics and finding new methods of concealing dangerous materials.
• Terrorists will continue to pursue opportunities to inflict mass casualties.
• The nature of the threat from international Islamic terrorist groups is likely to change, particularly considering the Arab Spring and death of Osama bin Laden.
• Homegrown violent extremism will likely continue to emerge as a significant threat.

The SFI is one of the first FEMA documents to mention climate change. Will FEMA play a role in climate adaptation? How do mitigation, prevention and protection fit into the emergency management role for climate change?

As we have learned through our SFI, the general sense from the emergency management community is that regardless of why the climate is changing, it is changing and will affect how the community operates in the future. We also recognize that climate change becomes particularly challenging when considered in combination with other drivers such as increased urban populations and aging critical infrastructure. To that end, FEMA recently issued a policy statement to help guide our climate change adaptation efforts, as well as enable us to become more flexible in identifying and responding to future risks. Specifically, we are looking at grant investment strategies (public assistance, preparedness and mitigation grants); climate change impacts on the National Flood Insurance Program; identifying areas for community engagement and support; improving risk information and risk data; and promoting building standards and practices that consider the future impacts of climate change.

One particular area of interest is the Threat Hazard Identification and Risk Assessment (THIRA) process. We realize that changes in the climate could affect the accuracy and practice of using historical records to predict the magnitude, location and frequency of future hazards, which would have negative consequences for our state and local partners. With assistance from the climate science community, we are working to gain a better understanding of the changing, dynamic nature of future risks so we can use that information to influence community planning efforts and better assist them in conducting their THIRAs. We are also looking at potential ways to make our grant investment process more flexible and allow us to fund or provide incentives for projects that are more resilient, or take into account the impacts of future risks, including those caused by climate change. These are good examples of how climate change fits into emergency management’s mitigation, preparedness and recovery missions.

How do you see social media impacting the future of emergency management and what types of applications might we envision being in place in 2030 when it comes to social media?

The rapid innovations in technology are transforming media and communication, altering how people interact with each other and relate to society and institutions. The role of social media in emergency management will likely increase in the future and its impact will create a more complex and sometimes challenging operating environment. As information becomes more widely distributed from numerous sources, emergency managers will need to practice omnidirectional knowledge sharing and use the power and influence of social networks to remain relevant to the public in the complex media environment.

What role do you see emergency management playing in the Whole Community effort at the state and local levels?

As a concept, Whole Community is a means by which residents, emergency management practitioners, organizational and community leaders, and government officials can collectively understand and assess the needs of their respective communities and determine the best ways to organize and strengthen their assets, capacities and interests.

The recently released Whole Community Approach to Emergency Management, a doctrinal piece, aims to support emergency managers in understanding how to effectively apply Whole Community as an approach to the daily business of emergency management, prompting new actions and soliciting new ideas and strategies.

What purpose will performance measures and accreditation play in the future world of emergency management?

With the state of the economy impacting government budgets at all levels, being able to show the value that funded programs and initiatives provide will be critical. This will be no different for emergency managers in the future. Looking for efficiencies and continuing to be effective in our operations is crucial for our community as we move forward in this resource-strained environment.

Did you have any “aha” moments in going through the planning process that grabbed your attention and brought you new insights into the future?

The world is becoming more complex, and as we look to the future, we have many challenges ahead. The biggest “aha” moment for me in going through this process was realizing that it is not just that complexity is increasing, but also that predictability is decreasing. This combination really challenges many aspects of how we do business today. The good news is, based on our findings, the emergency management community already is taking some of the necessary steps to meet the challenges we will face. However, even though there are many actions already under way within the emergency management community to meet these challenges, we need to do more and at a faster pace to keep up with the velocity at which change is occurring.

What do you think was the single most important achievement obtained by doing the future planning?

A key part of the SFI mission is to advance a culture of “futures thinking” within the emergency management community that produces tangible benefits for the community. By revisiting and refining our collective understanding of the future and our needs, and through building a shared sense of direction and urgency to meet those needs, we set ourselves on a dynamic path.

On a final note, the SFI is an ongoing initiative. In the months and years ahead, we will continue the dialog to refresh and expand our research, align strategies to advance foresight within the emergency management community, and increase awareness around the initiative and its findings. To facilitate this ongoing dialog, we are launching an online discussion page through FEMA’s Collaboration Community website, hosted by IdeaScale. To access the SFI discussion page and other topics, visit http://fema.ideascale.com.