Planning for Environmental Disasters/Emergencies in the Physician Office Practice

Environmental disasters/emergencies have the potential to disrupt services for extensive periods. These hazards may even require relocation to alternative locations. When completing the HVA, don’t be afraid to think outside of the box when considering environmental hazards. Environmental disasters may not just be natural disasters such as tornados or hurricanes. They may also be gas leaks, explosions and failures of utilities such as electricity. Environmental disasters could also be man-made hazards such as bombs and bioterrorism. Possible scenarios can be numerous and it can be easy to get overwhelmed. Care should be taken to develop your organization’s response, contingency plan, communication plan and staff training for each likely scenario.

Risk Assessment and Development of a Written Plan

• Conduct an HVA to determine the types of environmental emergencies that your organization is most likely to encounter. When using the template HVA linked above, remember that this assessment must be customized to your practice’s location, characteristics and community surroundings. Consider collaborating with state and local emergency preparedness agencies for input on the assessment to ensure that all of the possible scenarios have been considered. In many cases, a community environmental HVA may have already been conducted by these agencies and they can assist you in coordinating your response. Utilize the HVA to develop your plans and be sure to keep a copy of the HVA on file in your organization.
• Create written plans to address each type of environmental emergency that is most likely to impact your organization. Be sure to consider that an event may or may not directly impact your organization, but your organization may be called upon to be involved in assisting others as part of a community response. Staff responsibilities should be designated in the plan according to skill level or job position.
• When developing these plans, it is very important to collaborate with state and local emergency preparedness agencies to ensure an integrated response.

Development of Policies and Procedures

Your policies and procedures should support the response plans that are developed but should, at a minimum, address:

• Evacuation
  If you need to evacuate the building, where will occupants go and how will this be handled in a safe, organized manner? An alternate off-site location should be established for evacuation and a contingency plan should be determined in the event the off-site location is not available due to the disaster. Consideration should be given to patient safety, employee safety and business continuity when evacuating. The plan should address the structure of the building (stairwells, corridors, etc.) and the placement of exit signs to aid in evacuating the building. Care should be taken to plan for the needs of individuals who may have limited mobility, need oxygen or other equipment/supplies. Staff responsibilities should be designated in the plan, included in job descriptions and employee training.
• Shelter In Place
  In some types of disasters, for example, a tornado, evacuation may not be an option and shelter in place may be a more appropriate choice. Planning should address the criteria to determine shelter in place.
• Health Information Management
  Plans must consider how patient health information will be accessed, transferred or retrieved to maintain continuity of care for patients. In addition, develop a process for documenting on patients who may remain in the care of the practice during a disaster.
• Staffing
  Staffing needs should be considered as a part of the organization’s continuity of care. Staffing may be reduced if employees are unable to come to work due to conditions or caring for their own families during a disaster. Limitations on services provided by the practice may need to be implemented if there is not enough staff to care for patients. Alternatively, emergency staffing strategies may need to be developed if the practice is essential to providing assistance during disasters.

Communication Plan

Keep lists of emergency contacts within the community close at hand. This list should be accessible if evacuation is required. If the information is electronically stored, evidence of a back-up process is required. CMS requires the communication plan to include:

• Names and contact information for the following:
  • Staff
  • Entities providing services under arrangement
  • Patients’ physician (if more than one physician in the practice)
  • Other organizations – preferably who are similar to your organization
  • Volunteers
• Contact information for the following including primary and alternate means:
  • Federal, state, regional and local emergency preparedness staff
  • Other sources of assistance
  • Organization staff

Testing and Training

• Conduct drills to test your plans and keep documentation that these were done. Conducting these drills will help reduce staff fear during the event and promote efficiency through practice. Drills are required annually.
• Document staff training in emergency preparedness upon hire, then annually.
• Participate in community-wide emergency response drills at least every other year as required by CMS.
• Conduct an analysis of the organization’s response during drills or during actual disasters and use the findings to improve plans and improve staff training.