EMERGENCY OPERATIONS PLAN 1 An Emergency Operations Plan for King Abdulaziz Naval Base Armed Forces Hospital FA T February 20, 2020 EMERGENCY OPERATIONS PLAN 2 Abstract Emergency Operations Plans are an important component of public health emergency preparedness. They are vital to mitigating the consequences of a disaster. The Emergency Operations Plan (EOP) in King Abdulaziz Naval Base Armed Forces Hospital, Al-Jubail needs to be revised and updated to better respond to and recover from emergencies. This paper a proposed EOP model which contains five mission areas: protection, prevention, response, mitigation, and recovery. These mission areas are defined and followed by an outline of planning principles that feature a consideration of all potential hazards and threats, leadership, provision for functional needs and access to resources, and the use of a collaborative procedure in EOP planning. The principles are followed by instruction in the six steps of the planning process: forming a collaborative planning team; identifying hazards and threats and risk assessment; determining objectives and goals; developing an action plan; preparing, reviewing, and approving the plan; and planning maintenance and implementation. EMERGENCY OPERATIONS PLAN 1 1.1 3 An Emergency Operations Plan for King Abdulaziz Naval Base Armed Forces Hospital Background of Study King Abdulaziz Naval Base Armed Forces Hospital (KANBAFH) in Al-Jubail takes a proactive role to mitigate, respond to, and recover from any possible technological and natural hazards or terrorist events. The hospital is occasionally monitored by a risk manager to determine the occurrence or the potential occurrence of an event that could result in an emergency or a disaster. KANBAFH, a Ministry of Defense facility accredited by the Joint Commission, on January 2019, and with different regulations and standards government hospital, hopes to prevent emergencies as soon as they occur and to facilitate an efficient and orderly response to and recovery from all emergencies and disasters. This hospital directly managed by the Medical Services Division of the Ministry of Defense and Aviation, handles emergencies with the help of an Emergency Operations Plan (EOP), which is a tool that provides the processes and the structure that the organization uses to respond to and initially recover from an event. This EOP is the response and recovery component of the hospital’s Emergency Management Plan. While the hospital already has an EOP, the need to revise and update it to better respond to and recover from emergencies was identified, especially since the EOP was last updated in 2015. While KANBAFH is only located in Al Jubail, there are other armed forces hospital in Saudi Arabia. Nonetheless, the facility’s EOP is meant to be an all-hazards plan and is designed to respond to all the emergencies that could affect hospital operations as identified in the Hazards Vulnerability Analysis. It is established to ensure that there are available personnel, equipment, supplies, facilities, and other resources required to continue with patient care during emergencies. Furthermore, the plan addresses victims’ medical needs during emergencies. KANBAFH’s current Emergency Operations Plan includes of the six critical elements of: EMERGENCY OPERATIONS PLAN • Staff responsibilities • Utilities • Resources and assets • Communications • Security and safety • Clinical Supports services 4 It has been five years since the hospital’s EOP was last updated. Within this period, there have been several occurrences all over the world, including the COVID-19 pandemic, landslides, wildfires, and even influenza surge. Specific to Saudi Arabia, the COVID-19 pandemic, fires, the 2017 Middle East respiratory syndrome coronavirus outbreak which was first reported in 2017 and floods, are some of the incidents that have occurred within the past five years. In the past, Saudi Arabia has seen disasters such as heavy rains, fire during hajj, Jizan floods, Jeddah floods and Rift Valley Fever outbreak. Among other disasters to look out for are technological hazards such as the breakdown of hospital equipment, disasters such as terrorist attacks and major MVCs, natural disasters like floods, rains, and epidemics. All these incidents have shown the need to constantly review and update the Emergency Operations Plan, thus the following proposal. 1.2 Purpose Statement The mission of the KANBAFH is to improve people’s health in the society by providing quality health, cost-effective, and hospital services consistent with this mission. The hospital’s administration, medical staff, and the governing body have established and provided for ongoing support for an Emergency Management Program as conceived by the hospital’s formal Emergency Management Committee. However, there is a need to review this Emergency Operations Plan and EMERGENCY OPERATIONS PLAN 5 provide recommendations on how to improve it to meet the hospital’s mission and vision better. The current EOP has not been updated for five years. It is important to assess, review, and update it since there have been various disasters, such as the ongoing novel coronavirus and the 2017 Middle East respiratory syndrome coronavirus outbreak, that have shown the need to update the Emergency Operations Plan constantly to support pandemic illness planning. Hospitals are currently required to identify outbreaks and implement effective isolation and suspected cases quickly. This requirement calls upon the need to regularly update the Emergency Operations Plan to accommodate for such emergency disasters. The researcher set out to propose an updated Emergency Operations Plan, for KANBAFH to respond effectively to disasters that pose immediate threat and danger to the safety and health of the staff, patients, and visitors. The goal was to assemble a strong team of department representatives whose early involvement in the plan will speed up the coordination of hospital assistance to impacted areas of the hospital. The coordinated efforts of this team would supply and re-supply assets and resources that are necessary for meeting the urgent needs that arise from disasters. They will work to coordinate all the crisis management functions that are crucial to the hospital’s restoration and recovery. This project aims to describe the response as well as the recovery process of the hospital facility from all hazards such as uncontrolled fires, earthquakes, floods as well as bombing and explosions. It entails the response to both internal emergencies, that is, situations that affect the hospital staff and patients and external disasters that disrupt the hospital environments increasing the demand for healthcare services. It gives an outline of the need for the project, the personnel in charge of the whole emergency process, the resources and activities to be carried out as well as a description of the interaction between these activities to achieve maximum response to the EMERGENCY OPERATIONS PLAN 6 emergency. Furthermore, the methodologies utilized in the project completion are documented. These methodologies include the conduction of interviews to look for views on the Emergency Operations Plan (EOP) used within the Hospital under study as well as the various recommendations on how it can be further improved for maximum disaster management. When conducting this review, KANBAFH’s emergency management checklist was used as a benchmark to ensure that all the planning elements are addressed. 1.3 Need for the Project An Emergency Operations Plan (EOP) is an essential requirement in the overall process of disaster management, as outlined by the Federal Emergency Management Agency (FEMA). This comprehensive approach to disaster management aids in the achievement of the maximum patient and healthcare personnel safety as well as a timely return of the healthcare facility into its predisaster level. Its main role is to give an outline of the responses as well as the recovery process of the various healthcare facilities to all hazardous events. These disasters could affect hospitals directly by damaging their buildings and disruption on the essential utilities such as power, or could result in mass effects within its surroundings hence increasing the demand for healthcare services. Saudi Arabia is prone to various disasters, which include both natural and man-made events. These include floods, earthquakes, tsunamis, hurricanes, uncontrolled fires, bombings as well as dust and sandstorms (Pararas-Carayannis, 2013). Al Jubail for instance, is located in the eastern province of the country which is mainly affected by shifting dunes as well as dust storms which have a direct effect on the people living within those environments especially those suffering from lung diseases as it serves as an exacerbating factor.. Dust storms also reduce visibility which results in increased cases of both traffic accidents and plane crashes. This will, in EMERGENCY OPERATIONS PLAN 7 turn, increase the demand for healthcare services in the healthcare facilities in that region. Bioterrorism attacks such as explosions and bombing are also prevalent in some parts of the country with some being targeted on the healthcare facilities hence affecting the healthcare personnel, patients as well as an overall disruption in the healthcare provision process. Furthermore, there have been some fire incidents in Al Jubail such as the fire in the petrochemical factory. The prevalence of the above disasters in the country necessitates a well-formulated EOP within KANBAFH. The standards of The Joint Commission facilitate this formulation. According to Canton (2019), through unmatched expertise, knowledge, and leading practices, the Joint Commission helps organizations across the continuum of care to lead the way to zero harm. The six elements within The Joint Commission’s Emergency Management Standards should thus, be incorporated during the document formulation as noted by Canton (2019). These key elements include- “communication, resources and assets, security and safety, hospital staff responsibilities, utilities as well as various clinical support activities” to facilitate the coordination of the overall response to the emergency (Canton, 2019). They are necessary as they enhance accountability of the EOP. Moreover, the various mission areas of the Emergency Management Cycle, including mitigation, preparedness, response, and recovery, should be considered during the EOP formulation. The reason for this is that these mission areas are vital to making plans, identifying, and providing resources to protect people from hazards. A systematic approach would be to treat each of the four actions as one phase of a comprehensive process, with each mission area building on the accomplishments of the preceding one so as to achieve the overall goal of minimizing the impact caused by emergencies. The formation of the EOP should also be based on the national standards as well as a systematic analysis of the various disasters that show prevalence within the EMERGENCY OPERATIONS PLAN 8 region. The national standards, systematic analysis, collaboration, and the four mission areas of the emergency cycle are key for the effectiveness of an EOP (MacVarish, 2016). They are necessary for the achievement of the main goals and objectives of the hospital EOP, which are to ensure effective preparation and management of disasters and to restore hospital operational capacities to normalcy. According to MacVarish (2016). The functions of the EOP include: 1. The assignment of the various roles to the health organization, including the healthcare providers, should be carried out in the cases of emergencies exceeding their capacities. 2. Description of how the various activities will be coordinated to achieve its goals and objectives. 3. Description of how disaster victims will be provided with safety and security in cases of disasters. It also outlines the various property protection measures. 4. Identification of the resources, the disaster management personnel, and the essential equipment and alternate sources for supplies to be utilized in the response and recovery process. The fulfillment of the above-outlined roles, goals, and objectives of the hospital Emergency Operations Plan substantiates the need for an effective scheme that ensures proper management and response to various health emergencies. The ultimate result of the EOP is attention to national standards, four mission areas of the emergency management cycle, systematic analysis of hazards, and collaboration. Together, these considerations will result in the formulation of an efficacious approach to any future emergencies thus, facilitating early prevention of their effects on disaster victims, the healthcare staff, and the overall health organization. EMERGENCY OPERATIONS PLAN 9 Emergency preparedness is mandatory for numerous situations in day to day operations of KANBAFH. Without it, it would be impossible for the hospital to lessen the threat posed by emergencies. As such, it should use the resources at its disposal to prepare for and handle possible threats to the hospital, its personnel, and other people within it. According to the Institute of Medicine, Board on Health Care Services, and Committee on the Future of Emergency Care in the United States Health System (2007), an analysis of various emergencies such as tsunamis and earthquakes shows that although proper planning may be done, it is still possible not to respond to and recover from emergencies. World Health Organization Director Dr. Michael Ryan provided much-needed insight into how planning in the Emergency Operations Centers affects the proper handling of a disaster (Ryan, 2013). He posited that planning is critical to the success of the overall situational awareness and field operations. It provides a foundation from which an organization operates during disasters. The most important thing is that the success of the disaster management operations is dependent on how well prepared the organizations involved are and the level of cooperation they have (Ryan, 2013). These centers usually bring various professionals with expertise in different sectors and from different organizations that have diverse ways of handling situations. These professionals are then divided into small groups. They have to find a way to understand the current situation and work out a way of allocating the scarce resources that they have. During an emergency, a hospital is most likely already operating at full capacity, and is forced to take in more patients (Ryan, 2013). The number of beds, pharmaceutical resources, and rooms available may be limited. It is also not uncommon for the hospital to be lacking a particular specialist who can treat various injuries (Ryan, 2013). EMERGENCY OPERATIONS PLAN 10 Notably, the commonly used method of communication is verbal communication, which presents another set of challenges. The presence of conflicting information could lead to confusion which makes the situation worse (Ryan, 2013). Richard Oloruntoba, in his analysis of the challenges to plans of the 2009 Victoria bushfires, described how those handling the disaster were distracted from the main problem and instead focused on a smaller problem that they were able to define and handle more easily. The paper also points out how training focuses on teaching people how to handle and respond to a presumed threat. The primary focus here is the response to the disaster, rather than making the process an investment into the future, for instance by using previous disasters as a foreshadow and thereby being able to prepare for a wider range of challenges (Oloruntoba, 2013). After conducting a study on Finland’s disaster management, Kimmo Laakso and Jari Palomaki pointed out how poor communication can make the situation go from bad to worse when handling a disaster. The main problems identified by these authors were poor awareness of the situation and poor flow of information among those involved in disaster management. The drills in which those involved were trained also failed to function as they should have. Experts involved in the study argued that the planning of the rescue drills was very often poor and there was poor commitment of training attendees. Lack of communication at the time disaster struck and after also had consequences (Palomaki, 2013). This project seeks to ensure that in the operations of hospitals, the most important philosophy of disaster management is observed: ensuring that every emergency is handed efficiently especially when considering geographical and organizational demographics. This will require improved communication systems, better planning and response of emergencies and involvement and cooperation of all the stakeholders, especially those at the local level (Institute of Medicine; Board on Health Care Services; Committee on the Future of Emergency Care in the EMERGENCY OPERATIONS PLAN 11 United States Health System, 2007). This project looks at what it means for a hospital to accommodate the changing situations, occurrences and threats by updating its EOP. The project will clarify what makes hospital Emergency Operations Plans fail, and go a step further to find new ways to handle emergencies. Coordination and planning between hospitals and other important stakeholders, such as air medics to facilitate the patient transfer, were highlighted. Ways in which those in the same region can work together to find ways of dealing with sudden increases in capacity includes training, to familiarize personnel with their responsibilities and to acquire the skills needed to perform assigned tasks. Training, tailored towards personnel roles when effectively responding to emergencies, should give thought to the future and how mistakes made in previous emergencies can be avoided as well as the provision of important and scarce resources such as personal protective equipment and pharmaceuticals. A look at the training of hospital personnel to deal with disasters, shown that a lot of progress has been made over the years, but we need to look into new methods that can ensure the training is standardized and the environment in which it is undertaken is open to further education and expansion (Institute of Medicine; Board on Health Care Services; Committee on the Future of Emergency Care in the United States Health System, 2007). Looking into Emergency Operations Plans especially in hospitals, is very important because if a tragedy occurs, be it natural or human-made. This plan could be what determines the extent to which individual lives in the community will be affected. Although some research has been done in this area, very little focuses on the medical field. As highlighted above, there are numerous challenges faced when individuals who don’t normally work together have to do so and often; such situations are unplanned. Given the seriousness of the task they are assigned, it is EMERGENCY OPERATIONS PLAN 12 important that the planning and the systems they use work extremely well and that is what this research paper is hoping to facilitate. 2 Literature Review 2.1 Introduction Emergency management has been attributed to being among the most critical departments in any organization that deals with and avoids risks, especially those that have catastrophic repercussions for regions, communities, and entire countries (National Research Council; Mapping Science Committee, 2007). Emergency management denotes the dynamic process of preparing for, mitigating, reacting to, and recovering from an emergency. The concept deals with the coordination and administration of the resources and activities for dealing with all humanitarian aspects of emergencies. The primary aim of emergency manag…
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