Office physicians, nurses, and medical assistants should take responsibility for developing a written plan to follow in the event of an emergency. The plan should detail the steps to follow in a variety of emergencies. A practice emergency occurs whenever an event disrupts or could potentially disrupt the flow of office work for more than 24 hours. Each office staff member should be assigned specific roles and responsibilities in such instances. Guidelines for the storage, use, and maintenance of emergency equipment and supplies should be listed. It is also critical that staff assess the level of preparation and test the plan through the use of mock codes or drills. Such testing can ensure patient safety, heighten staff sensitivity, and increase staff awareness of the proper location and use of emergency equipment and supplies.
The Institute for Rural Health, along with the Medical Group Management Association, has designed a checklist for offices to use in formulating the details of their emergency plan. A paramount item on the list is patient safety. This includes a patient and staff evacuation plan. This plan may vary depending on the presence or absence of electrical power and communication capability. It should be noted who in the office is authorized to trigger or enact the full or partial evacuation of the office. A staff member should be assigned to ensure that all parties are accounted for and have reached a pre-established area of safety. The details of the plan should also specify what office items should be removed and by which personnel. Backup power sources should be identified and support plans for disposition of patients to alternative facilities such as clinics or hospitals should be created. Emergency inventories of stock supplies and emergency supplies should be specified.
Another component of the emergency plan is employee security and safety. The plan should include the suggested chain of command and a backup to support loss of key employees. Management staff should be held responsible for tracking their employees and training them in emergency procedures. A central location that is off-site should be agreed upon as a meeting place following an emergency. Preventive vaccinations may be needed at this time in an outbreak or bioterrorist attack. An effort should be made to design and test a communication tree or communication system that can be used if the office phones and computer systems are not functional or out of commission due to weather emergencies.
The practice capability of the medical office will be another key area to focus on in an emergency plan. This will include access to patient records and charts and a plan to duplicate and secure off-site data storage and data retrieval files. An office spokesperson should be identified and this person should be comfortable responding to public officials, the press, and the general public about the status of medical care and the practice. If downtime due to the emergency is anticipated, a plan for patient referral for short-term disruptions of care should be stated. Offices may want to establish a contract or agreement for disaster cleanup and office system replacement in the event of a disaster that impacts the physical space and facility. The practice may want to coordinate with the local public health system and define their role in a local community’s disaster plan. Key personnel may need to be trained to respond to large-scale disasters and participate in public disaster drills.
A final but significant component of an emergency plan is the financial survival of the practice. Cash flow may be disrupted and a backup financial plan may be needed. It may be prudent to locate a safe to hold cash on a temporary basis. Financial records, including up-to-date transaction records, should be stored in secure off-site locations. Personnel who are authorized to access off-site records should be identified and made aware of their duties and responsibilities in a disaster or emergency. A plan for payment of staff wages in full or in part should be considered. It is also critical that the insurance coverage of the office be accessible. Many businesses are covered for interruptions as well as property damage and equipment failure. The office staff needs to know the insurance carrier and should promptly contact the insurer with claim information.
There
is no definitive profile of a potential active shooter. There may be no warning
of an attack, and the attack may be sudden. However, the incidence is increasing,
and health care professionals should be aware of indications of a potential
risk. Behaviors that demonstrate planning, research, or preparation for an
attack or behaviors that demonstrate a pathological preoccupation with a person
or persons are not to be taken lightly. Likewise, a communication to a third
party or even direct communication from the potential shooter could constitute
a warning sign of a pending attack.
As
with any threat of a potential hazard or danger, offices should proactively plan
ahead with a course of action and practice drills, much like facilities do for
a fire drill. Planning may include the following.
The
risk of a natural disaster is, of course, influenced by the geographic location
of the practice as well as the particular time of year. But like medical
emergencies, man-made disasters, terrorist attacks, and natural disasters
such as tornadoes, hurricanes, earthquakes, flash flooding, or wildfires may
occur with little or no warning. Emergency preparedness is imperative to
preserve life and limit injury. The CDC, as well as other federal organizations
such as the Department of Health and Human Services and the Federal Emergency
Management Association, has multiple resources that are beneficial in
planning and preparing for natural disasters.