電子期刊 |
ISSN:1684-193X
|
Updated
Feb 25, 2003
|
Contents:
Volume 1, Nomber 2; Jan, 2003 |
|
Appraisal
of Disaster Response Plan of Hospitals in Taipei Judged by Hospital
Emergency Incident Command System (HEICS) |
Tzong-Luen Wang, MD, PhD and Hang Chang, MD, PhD |
From the Department of Emergency Medicine(Wang
TL, Chang H), Shin-Kong Wu Ho-Su Memorial Hospital.
Correspondence to Dr. Hang Chang, Department
of Emergency Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, 95
Wen Chang Road, Taipei, Taiwan. E-mail M001043@ms.skh.org.tw
|
Abstract
|
|
|
Taipei City government has begun
to ask the emergency response hospitals to implement HEICS in their
disaster response planning. We then evaluated the adequacies of
these plans and make comparisons among the plans of different hospitals.
Of the 53 plans, there were about 50 (94%) that had predictable
chain of management, and the average score was 78 points. As to
accountability of position function, there were only 10 (19%) plans
that met the criteria, the average score was only 45. Fewer hospitals
(n=8; 13%) had flexible organizational chart that allows flexible
response to specific emergencies, improved documentation of facility
and also common language to facilitate outside assistance. The scores
were 40, 40 and 48, respectively. Finally, only 6 hospitals have
provided prioritized response checklists, cost effective emergency
planning within health care corporations, and complete governmental
requirements. The scores were thus 35, 35 and 30 respectively. The
average score was significantly higher in tertiary center than in
other hospitals (68+8 vs. 45+14, P<0.001). For
7 individual categories, the average points of tertiary centers
were also significantly better than those of others. In summary,
there are still many engagements in training, understanding of HEICS
and the overwhelming idea of changing out an entire disaster plan
in our systems. (Ann Disaster Med. 2003;1:104-111)
Key words: HEICS; Disaster; Hospitals |
|
|
Introduction
|
|
|
|
The Hospital Emergency Incident
Command System (HEICS) has been developed to assist the operation
of a medical facility in a time of crisis in many countries. 1
Its general organizational chart shows a chain of command
that incorporates four sections under the overall leadership of
an Emergency Incident Commander. 1 The
four sections such as logistics, planning, finance and operations,
has their individual leader appointed by the incident commander.
The leaders in turn designate directors and unit leaders to subfunctions,
with supervisors and officers filling other crucial roles. This
structure limits the span of control of each manager in the attempt
to distribute the work. It also provides for a system of documenting
and reporting all emergency response activities. It is hoped that
this will lessen liability and promote the recovery of financial
expenditures.
In 1991 the administrative staff of the pilot hospitals were introduced
to the original HIECS program, trained and tested the plan in a
full functional exercise. This was all accomplished within a three-month
time span with very positive results. While 90 days may be rushing
it for some institutions, the length of the implementation/ transition
program for each medical facility will depend upon a variety of
factors. The size of the institution, the number of people committed
to the project, the funds available to promote the project and the
strength of management's support are just some of the factors that
will need consideration in the implementation program design. The
information and tools contained in this second edition will significantly
help this process, but the actual implementation time is the decision
of management and the HEICS implementation team. Taipei City government
has begun to ask the emergency response hospitals to implement HEICS
in their disaster response planning. We then evaluated the adequacies
of these plans and make comparisons among the plans of different
hospitals.
|
|
|
Methods |
|
|
There were 12 administrative areas
and overally 53 emergency response hospitalswhich accounted for
20,160 beds in Taipei City in 2002. Of the hospitals, seven were
the tertiary care medical centers and the remaining 46 secondary
hospitals. We then collected all of the disaster response plans
form these hospitals. We reviewed all the plans according to build-up
of HEICS with central focus upon the following: predictable chain
of management; accountability of position function; flexible organizational
chart allows flexible response to specific emergencies; improved
documentation of facility; common language to facilitate outside
assistance; prioritized response checklists; cost effective emergency
planning within health care corporations; governmental requirements
as is the case with public hospitals. For these 7 categories, there
were about 5 to 7 items to evaluate the adequacies of the plans.
Five independent experts in disaster medicine reviewed these plains
and gave scoring. The final scores were obtained after summing up
and taking the average of 5 individual scores. The scoring was then
compared according to the different levels (or rankings) of these
hospitals. |
|
|
Statistic Analysis |
All the data were processed and analyzed with Microsoft
Excel 2000 for Windows. The techniques applied to data analysis included
descriptive statistics generating and independent samples t-test
and chi-square test.
|
|
|
Results |
|
|
|
Performances of Disaster Plans Judged by
HEICS |
Of the 53 plans, there were about
50 (94%) that had predictable chain of management, and the average
score was 78 points. As to accountability of position function,
there were only 10 (19%) plans that met the criteria, the average
score was only 45. Fewer hospitals (n=8; 13%) had flexible organizational
chart that allows flexible response to specific emergencies, improved
documentation of facility and also common language to facilitate
outside assistance. The scores were 40, 40 and 48, respectively.
Finally, only 6 hospitals have provided prioritized response checklists,
cost effective emergency planning within health care corporations,
and complete governmental requirements. The scores were thus 35,
35 and 30 respectively.
|
|
|
Comparisons among Different Rankings of
Hospitals |
We compared the performances of 7 tertiary-care medical
centers with another 46 secondary hospitals. The average score was
significantly higher in tertiary centers than in other hospitals (68+8
vs. 45+14, P<0.001). For 7 individual categories, the average
points of tertiary centers were also significantly better than those
of others (Figure). |
|
|
Figure. Comparison of scorings under different
categories of evaluation [A: predictable chain of management;
B: accountability of position function; C: flexible organizational
chart allows flexible response to specific emergencies; D: improved
documentation of facility; E: common language to facilitate
outside assistance; F: prioritized response checklists; G: cost
effective emergency planning within health care corporations;
and H: governmental requirements as is the case with public
hospitals. P<0.01 for each category. |
|
|
|
Discussion |
|
|
|
HEICS is a set of response procedures,
which fit within a hospital's emergency preparedness plan. 1
The HEICS plan for hospitals offers the following benefits: 1,2
predictable chain of management; accountability of position function;
flexible organizational chart allows flexible response to specific
emergencies; improved documentation of facility; common language
to facilitate outside assistance; prioritized response checklists;
cost effective emergency planning within health care corporations;
governmental requirements as is the case with public hospitals.
Based upon the Incident Command System, emergency response plans
share many organizational qualities with other ICS based plans.
The commonalties shared between plans are a great attribute in times
of crisis. This can bind hospitals and non-hospitals together in
a crisis.
According to a survey conducted by San Mateo County (CA) Emergency
Medical Services Agency in Spring of 1997, 2 501 hospitals in California
were sent a survey to ask if they were utilizing the HEICS plan.
Of the 207 surveys returned, 116 responded that the HEICS plan was
being utilized at their facility. This equals about 56% of the survey
respondents. Hospitals in Vancouver, British Columbia (Canada) are
implementing the HEICS. The HEICS have also been adopted by Germany,
New Zealand, Japan, South America and Saudi Arabia. Over eighty
percent of those hospitals that have used HEICS during an actual
emergency rated their experience as "positive" in regards
to the plan. No respondents stated that their HEICS experience was
"negative".
However, our study revealed that most of the hospitals in Taipei
still did not make full use of the HEICS. We have to discuss the
possible reasons for the observation. Time, cost and a currently
working disaster/emergency preparedness plan are reasons for hesitancy
for a conversion. Sometimes the real reason is lack of understanding
of HEICS and the overwhelming idea of changing out an entire disaster
plan. All of these concerns are valid. However, all facilities need
to examine the real attributes and benefits of an Incident Command
System-based plan. There are distinctive advantages to the entire
disaster medical response community when all participants operate
in a similar, predictable fashion.
It has been argued that disasters are just large-scale emergencies
and the only disaster response is an expansion of the routine emergency
response, supplemented by the mobilization of extra personnel, supplemented
by the mobilization of extra personnel, supplies, accomodations,
and equipment. 3-5 However, the fact
is the disasters pose unique problems that require different strategies.
Disasters are not only quantitatively different, but also qualitatively
different. The disaster response involves variable destruction of
communication system, working with different people, solving different
problems, and using different resources than those for routine emergencies. 3,6-8
The low frequency of devastating disasters always poses a problem
for hospital planners, because few planners have had enough disaster
experience. Furthermore, no nationally institutionalized process
exists for collecting, analyzing, and disseminating the lessons
learned from past disasters so that future planning can benefit
from them.
Another issue is the so-called “paper plan syndrome”. Utopian planning
efforts that seek to address every possible disaster contingency
simply are not realistic. Even if these types of efforts were possible,
the planners would never have the funding to implement them. 5
Some believe that every disaster is unique, meaning that effective
planning is not even possible. However, empirical disaster research
studies certainly have identified a number of problems and tasks
that appear to occur with predictable regularity, regardless of
the disaster. These problems and tasks are the most amenable to
planning. For example, almost every major disaster requires collecting
information about the disaster and sharing it with the multiple
agencies and institutions that become involved in the response.
Other tasks include warning and evacuation, resource sharing, widespread
search and rescue, triage, patient transport that efficiently utilizes
area hospital assets, dealing with the press, and overall coordination
of the response. Effective planning involves identifying and planning
for what is likely to happen in disasters. It also requires procedures
for planned, coordinated improvisation to deal with those contingencies
that have not been anticipated in the plan. 5
A written plan can be an illusion of preparedness if other requirements
are neglected, which is so-called the paper plan syndrome. 3,6,9
To avoid the creation of impotent paper plans, the planning
should be based on valid assumptions about what happens in disasters,
inter-organizational perspective, 2,9
accompaniment with the provision of resources, 6
association with an effective training program so the users are
familiar with the plan,10 and being acceptable to the users. If
the plan users are involved in the planning process, they are more
likely to be familiar with the final product and make it practical,
realistic, and legitimate. 11,12
To gain the attention, respect, and cooperation of organization
members, disaster planning needs to be given the necessary status,
authority, and support. 1,13-16
One of the reasons things so often do not go according to plan
when disasters strike is the failure to provide the necessary resources
including funding, time and personnel. We expect the next step will
be the HEICS planning must be tied to the resources necessary to
carry out the mandate. 4,17,18
|
|
|
|
|
References |
|
|
|
1. |
International City Management Association. Emergency
planning: an adaptive approach. Baseline Data Report 1988;20:1-14 |
2. |
State of California Emergency Medical Services Authority. Hazardous
material medical management protocols, 2nd ed. Sacramento, CA: Emergency
Medical Services Authority, 1991 |
3. |
Quarantelli EL. Delivery of emergency medical case in disasters:
assumptions and realities. New York: Irvington Publishers, 1983 |
4. |
Tierney KJ. A primer for preparedness for acute chemical emergencyies.
Book and monograph series no. 14 Columbus, OH: Disaster Research Center,
Ohio State University, 1980 |
5. |
Klein JS, Weight JA. Disaster management: lessons learned. Contemp
Probl Trauma Surg 1991;71:257-66 |
6. |
Auf der Heide E. Disaster response: principles of preparation
and coordination. St. Louis, MO: CV Mosby, 1989 |
7. |
Barton A. Communities in disaster: a sociological analysis of collective
stress situations. Garden City, NY: Doubleday, 1969 |
8. |
Gibson G. Disaster and emergency medical care: methods, theories
and a research agenda. Mass Emerg 1977;2:195-203 |
9. |
Barton AH. Social organization under stress: a sociological review
of disaster studies. Disaster study no. 17, publication no. 1032.
Washington, D. C.: Disaster Research Group, National Academy of Sciences---National
Research Council, 1963 |
10. |
Adams CR. Search and rescue efforts following the Wichita Falls
tornado. Technical report no. 4, SAR research project, Department
of Sociology. Denver: University of Denver, 1981 |
11. |
Gordon D. High-rise fire rescue: lessons form Las Vegas. Emerg
Med Serv 1986;15:20-30 |
12. |
Gratz DB. Fire department management: scope and method. Beverly
Hills, CA: Glencose Press, 1972 |
13. |
Tierney KJ. Report on the coalinga earthquake of May 2, 1983. Publication
no. SSC 85-01. Sacramento: Seismic Safety Commisssion, State of California,
1985 |
14. |
Bush S. Disaster planning and multiagency coordination. Littleton,
CO: City of Littleton, 1981 |
15. |
Stevenson L, Hayman M. Local government disaster protection: final
technical report. Washington, D.C.: International City Management
Association, 1981 |
16. |
Drabek TE. Human system responses to disaster: an inventory of
sociological findings. New York. Springer-Verlag, 1986 |
|
|
|
|
|
|
|
|
|