Questions: How difficult is it to operationalize HICS (Hospital Incident Command System)? What are some of the chall

Questions:

How difficult is it to operationalize HICS (Hospital Incident Command System)? What are some of the challenges associated with HICS implementation? What are some solutions to the identified challenges?
Who needs to be trained in HICS and why?
Should different staff receive different levels of training?

Reference to appropriate authoritative resources and official websites. Must be accessible online. Use New Times Roman 12 font with 1” margins and APA style.The answer should be at least 250 words.

In the attachments some readings may help you to understand the idea:

Reilly, M., &Markenson, D. S. (2010). Health Care Emergency Management: Principles and Practice

Chapter 2: Introduction to Hospital and Healthcare Emergency Management
Chapter 9: Functional Roles of Hospital Workers in Disasters and Public Health Emergencies

Reilly, M., &Markenson, D. S. (2009). Education and training of hospital workers: Who are essential personnel during a disaster?Prehospital and Disaster Medicine, 24(3), 239-245.

Jensen, J. and Waugh, W. L. (2014), The United States’ Experience with the Incident Command System: What We Think We Know and What We Need to Know More About. Journal of Contingencies and Crisis Management, 22: 5–17. doi: 10.1111/1468-5973.12034


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Page i
HEALTH CARE EMERGENCY MANAGEMENT
PRINCIPLES AND PRACTICE
Editors
Michael J. Reilly, DrPH, MPH, NREMT-P
Director, Graduate Program in Emergency Preparedness
Assistant Director, Center for Disaster Medicine
Assistant Professor, Public Health Practice
New York Medical College
School of Health Science and Practice
Valhalla, New York
and
David Markenson, MD, FAAP, FACEP, EMT-P
Medical Director and Vice President
Disaster Medicine and Regional Emergency Services
Westchester Medical Center
Director, Center for Disaster Medicine
Associate Professor, Public Health Practice
Professor of Pediatrics
New York Medical College
Valhalla, New York
55133_FMxx_Reilly:Achorn Int’l
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Library of Congress Cataloging-in-Publication Data
Health care emergency management : principles and practice / [edited by] Michael J. Reilly and David S.
Markenson.
p. ; cm.
Includes bibliographical references and index.
ISBN-13: 978-0-7637-5513-3 (pbk.)
ISBN-10: 0-7637-5513-3 (pbk.)
1. Emergency medical services. 2. Emergency management—Planning. 3. Hospitals—Emergency services.
I. Reilly, Michael J. II. Markenson, David S.
[DNLM: 1. Disaster Planning—organization & administration. 2. Emergencies. 3. Emergency Service,
Hospital—organization & administration. WX 185 H4336 2011]
RA645.5.H38 2011
362.18068—dc22
2010001554
6048
Printed in the United States of America
14 13 12 11 10
10 9 8 7 6 5 4 3 2 1
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Page iii
Dedication
MICHAEL REILLY
I dedicate this text to my family and friends who have supported me
throughout this project. I especially thank my parents, who have provided their unwavering advice and support throughout my life and career. I also dedicate this text to my professional mentors Dr. Linda Degutis
and Dr. Robyn Gershon, who continue to give me invaluable guidance
throughout my professional development. Finally, I dedicate this book to
my coauthor David, who has provided me with the opportunity to pursue academic emergency and disaster medicine professionally, and who
continues to encourage and support my development as a scientist and
scholar in this evolving area of medicine and public health.
DAVID MARKENSON
This text is dedicated to my parents, who have always guided, supported,
and encouraged me, and who, as physicians, have shown me through
their work that providing care to others in a compassionate and knowledgeable way can be a rewarding endeavor. This text is also dedicated to
my brothers, sister, and sisters-in-law, who are a constant source of advice, support, and energy; without their help and involvement in my life
none of my efforts could have been accomplished. Most importantly
this text is dedicated to my wife Heidi and my wonderful children, Emily,
Rachel, and George, who not only support me but who were willing to
give of their time with me to allow me to write this text.
iii
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iv | Dedication
MICHAEL REILLY AND DAVID MARKENSON
Lastly, this text is dedicated to all healthcare providers, emergency managers, and those in their care. Healthcare providers and emergency
managers work each day in an environment that is unpredictable, often
dangerous, and constantly challenging. They have become champions in
changing the system to become better prepared. They dedicate their lives
to aid the sick and the injured and prepare for any disaster, terrorism
event, or public health emergency, driven only by their care for others and
their devotion to this profession we call healthcare emergency management. We salute all of you in your professionalism and dedication. Also,
we dedicate this to our patients who, in allowing us the privilege to provide them care, teach us each day about humanity.
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Page v
Contents
About the Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix
Contributors. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xix
Section
I
Chapter
1
Chapter
2
Principles of Emergency Management for
Healthcare Facilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
Introduction to Hospital and Healthcare
Emergency Management. . . . . . . . . . . . . . . . . . . . . . . . . . . 3
Michael J. Reilly, DrPH, MPH, NREMT-P and
David S. Markenson, MD, FAAP, FACEP, EMT-P
Healthcare Incident Management Systems . . . . . . . . . . . . . 21
Arthur Cooper, MD, MS
v
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vi | Contents
Chapter
3
Chapter
4
Chapter
5
Chapter
6
Chapter
7
II
Chapter 8
Section
Chapter
Chapter
9
10
Section
III
Chapter
11
Chapter
12
Improving Trauma System Preparedness for Disasters
and Public Health Emergencies . . . . . . . . . . . . . . . . . . . . . 47
Michael J. Reilly, DrPH, MPH, NREMT-P
Legal Issues and Regulatory Compliance . . . . . . . . . . . . . 67
Doris R. Varlese, JD
Developing the Hospital Emergency Management Plan . . . 89
Nicholas V. Cagliuso, Sr., MPH; Nicole E. Leahy, RN, MPH;
and Marcelo Sandoval, MD
Introduction to Exercise Design and Evaluation . . . . . . . . 111
Garrett T. Doering, MS, EMT-P, CEM, MEP
Integration with Local and Community Resources . . . . . . 143
Isaac B. Weisfuse, MD, MPH
Hospital Workforce Issues . . . . . . . . . . . . . . . . . . . . . . . . 161
Education and Training . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Sean M. Kelly, MA, CCEMT-P and
Lindsey P. Anthony, MPA, CEM, CHEC-III
Functional Roles of Hospital Workers in Disasters
and Public Health Emergencies . . . . . . . . . . . . . . . . . . . . 187
Tony Garcia, RN, CCEMT-P
Credentialing and Management of Volunteer
Health Professionals . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205
Deborah Viola, PhD, MBA and Peter Arno, PhD
Hospital Operations During Disasters and
Public Health Emergencies . . . . . . . . . . . . . . . . . . . . . . . 221
Quantitative Planning for Epidemic and Disaster Response:
Logistics and Supply Chain Considerations . . . . . . . . . . . 223
Nathaniel Hupert, MD, MPH; John A. Muckstadt, PhD;
and Wei Xiong, PhD, MS
Risk Communication and Media Relations . . . . . . . . . . . . 233
Linda C. Degutis, DrPH, MSN and Lauren Babcock-Dunning, MPH
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Contents | vii
Chapter
13
Chapter
14
Chapter
15
Chapter
16
IV
C h a p t e r 17
Section
Chapter
18
V
C h a p t e r 19
Section
Chapter
20
Chapter
21
Chapter
22
Security and Physical Infrastructure Protections. . . . . . . . . 271
Robert Michael Schuler, BGS, NREMT-P and
Veronica Senchak Snyder, MHS, MBA
Hospital Decontamination and Worker Safety . . . . . . . . . . 299
Michael J. Reilly, DrPH, MPH, NREMT-P
Pharmaceutical Systems Management in Disasters. . . . . . 317
David S. Markenson, MD, FAAP, FACEP, EMT-P
Laboratory Preparedness. . . . . . . . . . . . . . . . . . . . . . . . . 331
Ramon Rosal, PhD
Clinical Considerations. . . . . . . . . . . . . . . . . . . . . . . . . . . 339
Principles of Disaster Triage . . . . . . . . . . . . . . . . . . . . . . . 341
E. Brooke Lerner, PhD and Richard B. Schwartz, MD
Managing an Infectious Disease Disaster:
A Guide for Hospital Administrators . . . . . . . . . . . . . . . . . 353
Ariadne Avellino, MD, MPH
Special Topics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 369
Vulnerable Populations and Public Health
Disaster Preparedness. . . . . . . . . . . . . . . . . . . . . . . . . . . 371
Elizabeth A. Davis, JD, EdM; Rebecca Hansen, MSW;
and Jennifer Mincin, PhD (ABD)
Altered Standards of Care in Disasters and
Public Health Emergencies . . . . . . . . . . . . . . . . . . . . . . . 401
John Rinard, BBA, MSCPI
Mass Fatality Management . . . . . . . . . . . . . . . . . . . . . . . 423
Barbara A. Butcher, MPH and Frank DePaolo, RPA-C
Research in Emergency and Disaster Medicine . . . . . . . . 447
Kobi Peleg, PhD, MPH and Michael Rozenfeld, MA
Appendix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .463
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .469
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Page ix
About the Authors
MICHAEL J. REILLY, DRPH, MPH, NREMT-P
Dr. Michael Reilly is currently the Assistant Director of the Center for
Disaster Medicine at New York Medical College in Valhalla, New York.
Additionally, he is an Assistant Professor of Public Health Practice and the
Director of the Graduate Program in Emergency Preparedness at the
School of Health Science and Practice.
Dr. Reilly has over a decade of multidisciplinary experience in
emergency preparedness, public safety, intergovernmental relations,
public health, and emergency management. He has been published in
the world’s leading disaster medicine and public health preparedness
journals, and received international awards and recognition for his
work on trauma systems and health systems in the context of disaster
and public health preparedness. Dr. Reilly is an internationally recognized expert in the areas of emergency medical services, and health system preparedness and response, with direct experience in responding
ix
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x | About the Authors
to mass casualty events and public health emergencies. Dr. Reilly is frequently called upon to provide expert consultation, subject matter expertise, and to evaluate healthcare systems preparedness, emergency
planning, and drills and exercises.
Dr. Reilly has designed numerous educational curricula and training programs for a variety of preparedness functional roles for public
health, emergency management, and public safety audiences at the
professional and graduate levels. He is a senior lecturer for multiple
federal agencies including the Department of Justice, Department of
Homeland Security, and the Occupational Safety and Health
Administration. Additionally, he is an active member of several state and
national committees on homeland security and emergency management programs.
He received his undergraduate education at Northeastern University in paramedic technology and health science. He earned his
Masters of Public Health from Yale University, and a doctorate in public health from New York Medical College.
Dr. Reilly remains active as a paramedic in the Metro New York City
region and maintains numerous specialty and technical certifications
and instructor credentials in the areas of emergency medical services,
worker safety, environmental health, hazardous materials emergency
response, emergency management, counterterrorism, and weapons of
mass destruction preparedness and response.
DAVID SAMUEL MARKENSON, MD, FAAP, FACEP, EMT-P
Dr. David Markenson is a board-certified pediatrician with Fellowship
training in both pediatric emergency medicine and pediatric critical care.
He is the Vice President and Medical Director of Disaster Medicine and
Regional Emergency Services at the Westchester Medical Center and Maria
Fareri Children’s Hospital. In addition, he is the Director of the Center for
Disaster Medicine and the Interim Chair of Epidemiology and Community
Health at the School of Health Sciences and Practice at New York Medical
College. Dr. Markenson is also a Professor of Pediatrics and an Associate
Professor of Public Health at the School of Health Sciences and Practice
at New York Medical College in Valhalla, New York.
He is an active member of, and has served in leadership positions
within, multiple professional societies, including the American
Academy of Pediatrics (AAP), the American College of Emergency
Physicians, the Society of Critical Care Medicine, the American College
of Physician Executives, and the National Association of EMS Physicians.
Dr. Markenson has been actively involved with the American Red Cross
for over 20 years and currently serves as the National Chair of the
Advisory Council which oversees disaster health, preparedness, and
health and safety. In this role he directs the scientific and technical as-
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About the Authors | xi
pects of all programs and products in these areas including their development, implementation, and research. Prior to coming to
Westchester Medical Center and New York Medical College he was the
Deputy Director of the National Center for Disaster Preparedness at
the Mailman School of Public Health, Columbia University, and was
also the Director of the Program for Pediatric Preparedness of the
National Center, a program dedicated to improving the care children
receive in times of disasters or acts of terrorism.
His career has been dedicated to improving the approach to pediatric care, disaster medicine, EMS, and emergency medicine. He is the
principal investigator on several federal grants related to pediatric disaster medicine, including Model Pediatric Component for State Disaster
Plans and National Consensus Conference on the Needs of Children in
Disasters. He has also addressed the needs of other special and vulnerable populations and directed a federal grant to develop the first and only
national guidelines for emergency preparedness for persons with disabilities. In addition to this, he has conducted research on healthcare preparedness and healthcare provider and student education. In this area he
was the principal investigator for a federal grant which developed the first
competencies for all healthcare students in emergency preparedness and
then piloted this set of competencies in a medical, dental, public health,
and nursing school. Dr. Markenson has been recently appointed to the
FEMA National Advisory Council as the In-Patient Medical Provider representative. The FEMA NAC is comprised of emergency management
and law enforcement leaders from state, local, and tribal government
and the private sector to advise the FEMA Administrator on all aspects of
disaster preparedness and management to ensure close coordination
with all partners across the country.
He is a frequent presenter and lecturer at medical conferences
across the country, serves in editorial roles for multiple professional scientific journals, and has authored numerous articles and books on pediatric care, disaster medicine, and prehospital medicine. His work in
disaster medicine started during his college career when he worked in
disaster services in upstate New York providing direct services and education to other disaster services workers on behalf of the local Red
Cross and county office of emergency management. Dr. Markenson is
a graduate of Albert Einstein College of Medicine in the Bronx,
New York.
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Page xiii
Contributors
Lindsey P. Anthony, MPA, CEM, CHEC-III
Operational Medicine Education Coordinator
Center for Operational Medicine
Medical College of Georgia
Augusta, Georgia
Peter Arno, PhD
Professor
Department of Health Policy and Management
New York Medical College
School of Health Sciences and Practice
Valhalla, New York
xiii
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xiv | Contributors
Ariadne Avellino, MD, MPH
Research Associate
Center for Disaster Medicine
New York Medical College
Valhalla, New York
Lauren Babcock-Dunning, MPH
Research Associate
Center for Transportation Safety, Security and Risk
Rutgers, The State University of New Jersey
New Brunswick, New Jersey
Barbara A. Butcher, MPH
Chief of Staff
Office of the Chief Medical Examiner
City of New York
New York, New York
Nicholas V. Cagliuso, Sr., MPH
Corporate Director
Emergency Management
Continuum Health Partners, Inc.
New York, New York
Arthur Cooper, MD, MS
Professor of Surgery
Columbia University College of Physicians & Surgeons
Director of Trauma and Pediatric Surgical Services
Harlem Hospital
New York, New York
Elizabeth A. Davis, JD, EdM
Principal
EAD & Associates, LLC
Brooklyn, New York
Linda C. Degutis, DrPH, MSN
Associate Professor of Surgery (Emergency Medicine) and Public
Health
Director, Center for Public Health Preparedness
Yale University School of Medicine
New Haven, Connecticut
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Contributors | xv
Frank DePaolo, RPA-C
Director
Special Operations Division
Office of the Chief Medical Examiner
City of New York
New York, New York
Garrett T. Doering, MS, EMT-P, CEM, MEP
Director of Emergency Management
Westchester Medical Center
Valhalla, New York
Tony Garcia, RN, CCEMT-P
Training Specialist
Texas Engineering Extension Service
Texas A&M University System
College Station, Texas
Rebecca Hansen, MSW
Senior Project Manager
EAD & Associates, LLC
Brooklyn, New York
Nathaniel Hupert, MD, MPH
Associate Professor of Public Health and Medicine
Weill Cornell Medical College
New York, New York
Sean M. Kelly, MA, CCEMT-P
Lecturer
New York Medical College
School of Health Sciences and Practice
Valhalla, New York
Nicole E. Leahy, RN, MPH
Manager
Burn Outreach and Professional Education
New York-Presbyterian Hospital / Weill Cornell Medical Center
New York, New York
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xvi | Contributors
E. Brooke Learner, PhD
Associate Professor
Department of Emergency Medicine
Department of Population Health
Medical College of Wisconsin
Milwaukee, Wisconsin
David S. Markenson, MD, FAAP, FACEP, EMT-P
Medical Director and Vice President
Disaster Medicine and Regional Emergency Services
Westchester Medical Center
Director, Center for Disaster Medicine
Associate Professor, Public Health Practice
Professor of Pediatrics
New York Medical College
Valhalla, New York
Jennifer Mincin, PhD (ABD)
Senior Project Manager/Director
EAD & Associates, LLC
Brooklyn, New York
John A. Muckstadt, PhD
Acheson/Laibe Professor
Business Management and Leadership Studies
School of Operations Research and Industrial Engineering
Cornell University
Ithaca, New York
Kobi Peleg, PhD, MPH
Director, Israel National Center for Trauma and Emergency Medicine
Gertner Institute for Epidemiology and Health Policy Research
Sheba Medical Center
Co-chair, The Multi-disciplinary Program for Emergency and
Disaster Management
School of Public Health
Tel-Aviv University
Tel-Aviv, Israel
Michael J. Reilly, DrPH, MPH, NREMT-P
Director, Graduate Program in Emergency Preparedness
Assistant Director, Center for Disaster Medicine
Assistant Professor of Public Health Practice
New York Medical College
School of Health Sciences and Practice
Valhalla, New York
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Contributors | xvii
John Rinard, BBA, MSCPI
Milano, Texas
Ramon Rosal, PhD
Chemical Response Director
Public Health Laboratory
New York City Department of Health and Mental Hygiene
New York, New York
Michael Rozenfeld, MA
Researcher
National Center for Trauma & Emergency Medicine Research
Gertner Institute for Epidemiology and Health Policy Research
Sheba Medical Center
Tel Hashomer, Israel
Marcelo Sandoval, MD
Faculty, Department of Emergency Medicine
Co-Chair, Emergency Management Committee
Beth Israel Medical Center / Petrie Division
New York, New York
Robert Michael Schuler, BGS, NREMT-P
Training Coordinator
Texas Engineering Extension Service
The Texas A&M University System
College Station, Texas
Richard B. Schwartz, MD
Chair and Professor
Department of Emergency Medicine
Medical College of Georgia
Augusta, Georgia
Veronica Senchak Snyder, MHS, MBA
Emergency Management Coordinator
Emergency Management Services
Geisinger Health System
Geisinger Medical Center
Danville, Pennsylvania
Doris R. Varlese, JD
Visiting Lecturer
New York Medical College
School of Health Sciences and Practice
Valhalla, New York
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xviii | Contributors
Deborah Viola, PhD, MBA
Associate Professor of Public Health Practice
Department of Health Policy and Management
New York Medical College
School of Health Sciences and Practice
Valhalla, New York
Isaac B. Weisfuse, MD, MPH
Deputy Commissioner
Division of Disease Control
New York City Department of Health and Mental Hygiene
New York, New York
Wei Xiong, PhD, MS
Instructor in Public Health
Weill Cornell Medical College
New York, New York
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Acknowledgments
he material contained in this text reflects the contributions of many
authors, editors, emergency managers, healthcare providers, reviewers, and others who provided assistance and valuable suggestions. While here we acknowledge them, our sincere appreciation for all
of their efforts is truly hard to express in this limited space. In addition,
we could not possibly acknowledge all those who participated in this
important endeavor, and so we would like to also extend our sincere appreciation to every person who helped with this project, whether listed
by name or not.
Many talented people at Jones & Bartlett Learning have been involved in developing and producing this new text. As authors and editors, we turned our manuscript to the exceptional editorial staff and
publishers at Jones & Bartlett Learning to create this finished product.
We are fortunate to have been able to work with this team of people,
who have contributed so much and had such a tremendous impact on
T
xix
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xx | Acknowledgments
the quality of the textbook you now have in your hands. Specifically
Michael Brown, Publisher, assisted by Catie Heverling and Kate Stein,
has been our support at Jones & Bartlett Learning. As Publisher, Mike
is committed to publishing quality books; his energy, intelligence, patience, and helpful efforts have enabled us to create an exceptional
product. With the additional day-to-day support and guidance of both
Catie Heverling and Kate Stein we were able to keep our project on track
and ultimately produce this important text.
A significant amount of coordinating and operational support in
moving this project forward would not have been possible without the
tireless work of our administrative assistant Patience Ameyaw. We thank
her for her hard work and support of this project along with Geordana
Roa, Nina Luppino, and our numerous disaster medicine interns over
the past several years.
Components of this text have been based on the exceptional work
of the Center for Disaster Medicine at the New York Medical College,
School of Health Sciences and Practice for which we serve as the
Director and Assistant Director. Without the support of our Center, the
prior research and models developed, and the strong and supportive
academic environment of New York Medical College, this work would
not have been possible. We would like to specifically thank Dean Robert
Amler of the New York Medical College, School of Health Sciences and
Practice, who in his own right is an internationally recognized expert
in public health and healthcare preparedness, for providing his personal
expertise and his leadership in creating an academic environment
where work such as this text is not only encouraged but supported, and
for his continued dedication to providing education to improve emergency preparedness.
We would like to also acknowledge the Westchester Medical Center
and its Maria Fareri Children’s Hospital, which serves as the regional
center for healthcare emergency preparedness. The source and realworld testing of many of the theories and models in this text come
from the preparedness efforts of this institution, which is recognized
as not only a regional but as a national leader in emergency preparedness. We would like to thank the leadership of this institution for allowing us to use the wonderful preparedness work they have done as
models for others to follow. While not being able to list all, we would
like to acknowledge the members of the senior leadership who day in
and day out support the preparedness activities: Mr. Michael Israel,
Mr. Gary Brudnicki, Dr. Renee Garrick, Dr. Michael Gewitz, Ms. Marsha
Casey, and Mr. Anthony Costello. Lastly, we would especially like to
thank the institution’s Director of Emergency Management and chapter contributor Mr. Garrett Doering for sharing his professional insight and experience with us as we completed this project.
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Acknowledgments | xxi
Finally, we are extremely grateful to the numerous healthcare
providers, emergency managers, educational consultants, and members
of the preparedness academic community who carefully critiqued the
manuscript to ensure that the information in this text would be both
relevant and appropriate. Many more dedicated professionals than we
could name here gave unstintingly of their own time and expertise.
Their enthusiastic participation has been a motivating force behind
this project, and they received no compensation beyond the knowledge
that they were helping to create a greatly needed resource. We hope the
final product lives up to their efforts, hopes, and expectations.
Our warmest and kindest regards,
Michael and David
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Page 1
Section
I
Principles of
Emergency
Management
for Healthcare
Facilities
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Chapter
1
Introduction to Hospital and
Healthcare Emergency
Management
Michael J. Reilly, DrPH, MPH, NREMT-P and
David S. Markenson, MD, FAAP, FACEP, EMT-P
Photo by Jocelyn Augustino/FEMA News Photo
Learning Objectives

Describe the need for and responsibilities of healthcare
emergency management.
■ Describe the role of the hospital emergency manager.
■ Identify the activities performed by healthcare emergency
management.
Emergence and Growth of Healthcare Emergency
Management
The concept of healthcare emergency management is not entirely new,
but may seem strange and foreign to those who have worked in healthcare or emergency management and, until recently, have not known
anyone working in this profession. If one looks back more than 30 years,
it would be almost impossible to find a hospital role called hospital
3
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Introduction to Hospital and Healthcare Emergency Management
emergency management or even a position for a healthcare emergency
manager in a hospital or medical center.Yet healthcare emergency management responsibilities have always been addressed by hospitals, such
as fire safety, backup power, and the ability to handle victims from a
mass casualty event.
A fundamental tenet of emergency management is that institutions
must prepare for events that may rarely occur while taking protective
actions to mitigate any likelihood that they will occur at all. Due to the
low frequency of events testing the health system’s ability to respond
to a disaster, an act of terrorism, or a public health emergency, the
ability to evaluate the strengths and weaknesses of hospital emergency
preparedness is limited. In addition, the public has strong expectations of the roles hospitals should play during times of disaster.
Healthcare institutions are expected to provide both emergency care
and continuance of the day-to-day healthcare responsibilities regardless of the volume and demand. Recently, they have also become sites of
community refuge, bastions of safety in a threatening and dangerous environment. The public believes that hospitals will have light, heat, air conditioning, water, food, and communications capabilities, regardless of the
fact that the institution may itself be affected by the calamity. During
the terrorist attacks in the fall of 2001 and the Northeast Blackout of
2003, the public flocked to hospitals, even when they did not require
medical care. Furthermore, with increased intelligence of the vulnerabilities of the healthcare infrastructure and the desire of terrorists to
exploit this, institutions have been forced to focus limited resources on
safety and security rather than on comprehensive emergency management efforts.
A major change in the way hospitals plan for hazards and vulnerabilities includes less planning for specific single issues or threats but
rather the adoption of an all–hazards comprehensive emergency management planning process. Additionally, hospitals need to look beyond
their emergency department doors and engage community stakeholders to assist in this process, reaching out to local and regional emergency
planners to assist in larger communitywide emergency preparedness
planning. The interest of nonhospital entities in health system emergency preparedness can be seen through several examples, including
emergency management and public health initiatives on mass vaccination, pandemic planning, increasing hospitals’ ability to perform decontamination of casualties contaminated with hazardous materials, etc.
Recent reflection of the role of the hospital in emergency management
and population health can been seen in revised laws, regulations, and
even accreditation standards. An example of this is The Joint Commission
on the Accreditation of Healthcare Organizations’ (JCAHO) change
from placing emergency preparedness standards in the Environment
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Emergence and Growth of Healthcare Emergency Management | 5
of Care section to placing the standards in a separate and distinct section with specific goals and requirements, as well as the release of the
Occupational Safety and Health Administration (OSHA) document Best
Practices for Hospital-Based First Receivers.1–3
Over the past eight years we have embarked on an interesting
marriage of these two separate disciplines—health care and emergency management—whose common ground has historically been
brought together in the street or on the disaster scene by emergency
medical services workers, or sometimes brought into the emergency
departments of hospitals and trauma centers across the country. Both
disciplines have separate roles and responsibilities, but where the seemingly disparate goals of these fields come together is the reduction of
morbidity and mortality following disasters, acts of terrorism, and
public health emergencies.
Emergency management agencies have traditionally been responsible for bringing first respon