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Volume 31, Issue 4

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A fire in your main power switch room! Loss of electricity to over 65 percent of your facility! Evacuation of patients and staff, and loss of communication systems! Is your hospital prepared for this kind of event? This is what Carilion Roanoke Community Hospital (CRCH) had to cope with when a fire broke out. As disasters go, this was a relatively minor event. However, it could have had a major impact on this hospital had they not been prepared and fortunate enough to have their sister hospital, Carilion Roanoke Memorial Hospital (CRMH), a mile away. Reviewing what happened, how hospital employees reacted and what lessons they learned from this event can help other hospitals and healthcare systems prepare for their own disasters.

The fire started at approximately 3:45 p.m. in the boiler room of the East wing of CRCH in the main power switch room. As a result, communication systems were lost immediately. While the fire alarms did go off, there was no way to communicate the location of the fire or to place an external call to the fire department. The resourceful switchboard operator found a cellular phone and called 911. The fire was extinguished within one-half hour and physical damage to the building was minimal. The fire department, however, had to cut the main electrical feed to contain the fire. In addition, toxic smoke filled most of the East wing of the hospital which houses the operating rooms. While the fire was the initial disaster, the loss of electricity, including emergency generators, had a more disruptive and lengthy impact. The end result was a loss of hot water, steam, phones, HVAC, elevators, the switchboard, and the paging system.

Two-thirds of the hospital, including patient rooms, OR, ER, pharmacy, lab paging, x-ray and food services, closed.

The limited impact of this disaster was not entirely due to luck and circumstances; CRCH had disaster plans and had tested them. In fact, they had recently completed a scenario test of the plans so employees knew their roles in an event. A command center was initially established on the fourth floor of the East wing, as indicated in the plan. However, it soon became apparent that this was not a practical location for the command center and it had to be moved to the other wing. Management teams were set up with calling trees to contact employees to notify them if and where they should report to work. Given that the telephone system was inoperable, the management team had to use personal cellular phones and make arrangements with a local phone provider to immediately provide additional cellular phones. The hospital's emergency generators were disabled by the fire. Using flashlights, the surgical procedures that were underway were completed. Emergency power was provided by mobile emergency generators.

Emergency room patients were evacuated to CRMH. The remainder of the patients were evacuated to the West wing of the hospital. There were no injuries or deaths associated with this event. The paging system was rerouted to CRMH. Food was shuttled over to CRCH. As a result of the extra patients and workloads, CRMH declared their own disaster and brought in additional staff and extended their hours of operation. Ambulatory service centers within Carilion Health System were also used to decrease the pressure on the hospitals.

While one-third of the hospital remained functional, other whose work areas were without power were able to work at their sister hospital (CRMH), accommodate the transferred patients and remain on the job. At CRCH, existing downtime procedures designed for use when computer systems are inoperable were implemented and allowed staff to manually check in patients, label specimens, and perform other tasks that normally require the computer systems. Having a sister hospital close by which shared CRCH's managers and organizational structure, and had common policies, information systems and suppliers significantly diminished the adverse impact of this event. It took sixteen days before all departments were up and running again, the emergency room being the last to open. Despite the impact of the fire, lost revenues were minimized by sending patients to CRMH, thereby keeping the patients within the Carilion health system.

It is clear from the details about this event that, as a result of CRCH's planning and the support of CRMH, the impact of this fire was minimized. What CRCH learned from this crisis experience can help other hospitals, healthcare organizations and other businesses prepare for their own disasters. The lessons learned from CRCH include the following:

(1) A command center location that is easily accessible should be defined and employees must be familiar with its location and function. This event, however, highlights the need for institutions to have backup command centers in case the first is damaged or inaccessible. In the case of CRCH, they could have a second choice in their own building and a third at their sister hospital. In relation to selecting a command center location, ensure the center and alternate command center locations are stocked with all supplies needed (e.g., extra phone lines, FAX machines, cellular phones, maps of the facility).

(2) Hospitals within HealthCare Systems should create and maintain common policies, procedures, supplies and systems to allow for easy transitions for staff and patients. System administrators should ensure that changes to these elements are consistently implemented across the system.

(3) External agencies, vendors and suppliers should be included in the disaster plan and should be trained in their roles. If outside groups have a role to play in the plan, make sure they know what it is and have agreed to it. For example, EMS needs to know what is expected of them and where they should take patients if the primary facility cannot receive them. Check with state and local officials and other organizations who depend on your institution to see if they have continuity or other disaster plans and find out what role, if any, they expect your organization to play in their response and recovery.

(4) Develop and maintain calling trees with the phone numbers of all staff in the order of priority for contacting in a crisis. Require that these be updated monthly.

(5) Establish an alternative communication system for use in the event of an emergency. This could include handheld radios/walkie-talkies for internal communication and/or cellular phones and pagers. Keep in mind that in regional disasters like earthquakes and hurricanes, cellular communications often become jammed, therefore have a back-up plan. Consider making arrangements with a particular radio station to broadcast messages to employees, patients and the community, and advise employees what station to listen to in the event of a disaster. In addition, identify ham radio groups in the area and determine how they can help if other methods of communication fail.

(6) Ensure that there is a disaster box on every floor which includes flashlights and working batteries. CRCH is also adding portable radios to their boxes. Educate all employees on the location of this box.

(7) Test your business continuity plans on a regular basis to ensure that they are current and that all employees know what is expected of them.

The most important lesson from any disaster is that all organizations, healthcare or otherwise, need a business continuity plan. A good business continuity plan involves more than just the seven lessons learned by CRCH. It includes a risk assessment, consideration of any existing contingency plans, a business impact analysis that examines internal and external interdependencies, and a thorough assessment of recovery options. A well-developed and executed continuity plan includes all critical business units, not just information technology.

Additionally, business continuity plans must be regularly updated and tested. Having a continuity plan is particularly important for healthcare organizations because communities look to them during disasters as safe havens and will expect them to be able to help in a crisis. A disaster can severely damage a hospital's image if they are unable to respond as the community expects. Failure to meet outsider expectations can lead to short- and long-term financial losses.

The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) has realized the importance of continuity plans. In their goals for network leaders (LD.2.5.8), JCAHO has mandated that healthcare organizations maintain an emergency management program that enables them to respond to disasters within their healthcare network and the community they serve. The mandate includes directives on identifying roles in disasters, the training of network staff, alternative communication systems and hospital sites. Their ultimate goal is that healthcare organizations be able to provide uninterrupted primary care access to members in all situations.

Fires, power outages, telecommunications failures and numerous natural disasters are increasing. As population density increases and people continue to live in hazard-prone areas and depend more heavily on technology, disasters will become more common. This case study of the CRCH shows how one hospital dealt with a relatively small disaster and shares what they learned. The most important lesson to take away from this event is that all organizations need to be prepared for crises. In today's increasingly risky world, don't think about what to do IF a disaster happens, prepare for what your organization will do WHEN disaster strikes.

Dr. Reshaur is a Senior Associate in the Business Continuity Services practice at PricewaterhouseCoopers. Prior to joining PricewaterhouseCoopers, she spent 7 years at the Disaster Research Center, University of Delaware, researching human behavior and businesses in disasters.

Mr. Luongo is a Senior Manager in the Business Continuity Services practice of PricewaterhouseCoopers. He is a Professional Engineer with over fifteen years of experience in conducting business continuity planning for a wide-range of businesses.