Disaster Preparedness Conference 2006 Hospital Risk Assessment Bonnie Henry, MD, FRCPC Brian Schwartz, MD, CCFP(EM)

Disaster Preparedness Conference 2006Disaster Preparedness Conference 2006

Hospital Risk AssessmentHospital Risk Assessment

Bonnie Henry, MD, FRCPCBonnie Henry, MD, FRCPCBrian Schwartz, MD, CCFP(EM)Brian Schwartz, MD, CCFP(EM)


Case 1Case 1

AA tornado has just hit your community; tornado has just hit your community; dozens of walking wounded are appearing at dozens of walking wounded are appearing at your ED, as well as individuals looking for your ED, as well as individuals looking for loved onesloved ones

Ambulance communications notifies you to Ambulance communications notifies you to expect at least 30 patients of varying severity expect at least 30 patients of varying severity in the next hourin the next hour


Case 2Case 2

An explosion has occurred at the Bloor An explosion has occurred at the Bloor station in the Toronto subway systemstation in the Toronto subway system

CBRN team is responding due to a phone call CBRN team is responding due to a phone call to a local TV station from a terrorist group to a local TV station from a terrorist group chanting “Death to Canada” and claiming chanting “Death to Canada” and claiming that a radioactive substance has been that a radioactive substance has been releasedreleased


Case 3Case 3

A mysterious influenza-like illness A mysterious influenza-like illness beginning in Southeast Asia has beginning in Southeast Asia has been found to “jump” from birds to been found to “jump” from birds to peoplepeople

Over 200 people of all ages have Over 200 people of all ages have been affected; mortality is 50%been affected; mortality is 50%


Case 3Case 3

The disease is making its way west; The disease is making its way west; cases are turning up in Europecases are turning up in Europe

The WHO announced that the world is The WHO announced that the world is in Phase IV of the Pandemic phases in Phase IV of the Pandemic phases (evidence of localized human to (evidence of localized human to human transmission)human transmission)


Questions to ask:Questions to ask:

1.1. Is my organization prepared to Is my organization prepared to respond to these events?respond to these events?

2.2. Does my organization need to be Does my organization need to be prepared anyway?prepared anyway?

3.3. What are our priorities?What are our priorities?


Have you done your Have you done your risk assessment?risk assessment?


Hospital Risk AssessmentHospital Risk AssessmentLearning ObjectivesLearning Objectives

Describe the need for and context of Describe the need for and context of risk assessment in emergency health risk assessment in emergency health planningplanning

Describe and prioritize the risks of Describe and prioritize the risks of your organization to better prepare for your organization to better prepare for health care emergencies health care emergencies


Phases of an Emergency Phases of an Emergency ((F/P/T National Framework)F/P/T National Framework)

1.1. Risk assessmentRisk assessment

2.2. MitigationMitigation

3.3. PreparednessPreparedness

4.4. ResponseResponse

5.5. RecoveryRecovery


Canadian Council on Health Services Accreditation Canadian Council on Health Services Accreditation 2005 Environment Standards2005 Environment Standards

Minimizing Adverse EventsMinimizing Adverse Events - - Section 5.0 Section 5.0 The organization is prepared for disasters & emergenciesThe organization is prepared for disasters & emergencies

# 5.1 The organization’s processes for an overall plan include: # 5.1 The organization’s processes for an overall plan include: (11 points):(11 points):– identify the potential risk of a disaster/emergencyidentify the potential risk of a disaster/emergency– define how the hospital plan fits with the community disaster plandefine how the hospital plan fits with the community disaster plan– determine who is responsible for coordinating/ managing the determine who is responsible for coordinating/ managing the

response to emergency situations (regular and off hours)response to emergency situations (regular and off hours)– taking in mass casualties in the event of a community disaster taking in mass casualties in the event of a community disaster

including patients that might be contaminated or exposed to including patients that might be contaminated or exposed to dangerous substancesdangerous substances


What’s your risk?What’s your risk?

Naturally occurring Naturally occurring events events

Technological events Technological events

Human related eventsHuman related events

Events involving Events involving hazardous materialshazardous materials


Natural eventsNatural events

HurricaneHurricane

TornadoTornado

Extreme heat/coldExtreme heat/cold

Ice stormIce storm

Snow stormSnow storm

FloodFlood

Epidemic/pandemicEpidemic/pandemic


Epidemic/pandemicEpidemic/pandemic

InfluenzaInfluenza

SARSSARS

E ColiE Coli

SmallpoxSmallpox


Technological eventsTechnological events

Electrical failureElectrical failure

Transportation emergencyTransportation emergency

Water emergencyWater emergency

HVAC failureHVAC failure

Structural damageStructural damage

FireFire

HAZMAT exposure (internal)HAZMAT exposure (internal)


Human Related EventsHuman Related Events

Mass casualty incident (trauma)Mass casualty incident (trauma)

Mass casualty incident (infectious)Mass casualty incident (infectious)

Terrorism - biologicalTerrorism - biological

Hostage situationHostage situation

Bomb threatBomb threat

Civil disturbanceCivil disturbance


Hazardous Material EventsHazardous Material Events

Mass casualty HazMat incidentMass casualty HazMat incident

Terrorism – chemicalTerrorism – chemical

Chemical exposure – externalChemical exposure – external

Radiological exposureRadiological exposure


What is your risk for each?What is your risk for each?

Risk = Probability x ImpactRisk = Probability x Impact

www.ceep.cawww.ceep.ca


Risk = Probability x ImpactRisk = Probability x Impact


Components of RiskComponents of Risk

Probability?Probability?A.A. Highly likely?Highly likely?

B.B. Likely?Likely?

C.C. Possible?Possible?

D.D. Unlikely?Unlikely?

Impact?Impact?1.1. Marginal Marginal

2.2. SeriousSerious

3.3. Critical Critical

4.4. CatastrophicCatastrophic


ProbabilityProbabilityProbabilityRating

Description Detail

A Highly Likely nearly 100% probability in next year

B Likelybetween 10 and 100% probability in next

year, or at least one event in next 10 years

C Possiblebetween 1 and 10% probability in next year,

or at least one event in next 100 years

D Unlikely less than 1% probability in next 100 years


Components of ImpactComponents of Impact

ImpactImpactHumanHuman

PropertyProperty

BusinessBusiness

ImpactImpact1.1. Marginal Marginal

2.2. SeriousSerious

3.3. Critical Critical

4.4. CatastrophicCatastrophic


Impact - HumanImpact - Human

1.1. Unlikely to cause injury, illness or death in Unlikely to cause injury, illness or death in staff or patientsstaff or patients

2.2. Low probability of injury, illness or death in Low probability of injury, illness or death in staff or patients staff or patients

3.3. High probability of injury or illness in staff High probability of injury or illness in staff or patients; low probability of deathor patients; low probability of death

4.4. High probability of death in staff or patientsHigh probability of death in staff or patients


Impact - PropertyImpact - Property

1.1. Unlikely to cause physical plant or Unlikely to cause physical plant or equipment damage requiring any equipment damage requiring any replacement costs or recovery timereplacement costs or recovery time

2.2. Minor physical plant or equipment damage Minor physical plant or equipment damage requiring some replacement costs or requiring some replacement costs or recovery timerecovery time

3.3. Moderate physical plant or equipment Moderate physical plant or equipment damage requiring moderate replacement damage requiring moderate replacement costs or recovery timecosts or recovery time

4.4. Extensive physical plant or equipment Extensive physical plant or equipment damage with high replacement costs and damage with high replacement costs and recovery timerecovery time


Impact - BusinessImpact - Business

1.1. Unlikely to cause service interruption or Unlikely to cause service interruption or damage to public image of the institutiondamage to public image of the institution

2.2. Minor or limited or short term service Minor or limited or short term service interruption or damage to public image interruption or damage to public image

3.3. Significant/widespread or long term service Significant/widespread or long term service interruptioninterruption

4.4. Unable to provide services due to factors Unable to provide services due to factors such as: employees unable to report to such as: employees unable to report to work, clients unable to reach facility, work, clients unable to reach facility, interruption of critical supplies, or legal or interruption of critical supplies, or legal or health and safety issueshealth and safety issues


Overall Impact RatingOverall Impact Rating11-12 Catastrophic Facility cannot provide necessary

services without extensive assistance from provincial or federal resources

8-10 Critical Facility can provide a normal level of service with assistance from outside the local community or region; or, facility can provide a minimal level of service with normal resources

5-7 Serious Facility can provide a normal level of service with assistance from within region or within local community; or, facility can provide a reduced level of service with normal resources

3-4 Marginal Normal level of functioning or increased level of service required from within


Risk Assessment - examplesRisk Assessment - examples

ThreatThreat ProbabilityProbability Impact Impact (H+P+B)(H+P+B)

RiskRisk

TornadoTornado BB 3+3+23+3+2 B8B8

Dirty BombDirty Bomb B/C/DB/C/D 3+1+23+1+2 B/C/D6B/C/D6

Pandemic Pandemic influenzainfluenza

BB 4+1+44+1+4 B9B9


Impact Rating

Impact/ProbabilityImpact/ProbabilityA

HighlyLikely

BLikely

CPossible

DUnlikely

11-12:Catastrophic A11-A12 B11-B12 C11-C12 D11-D12

8 -10: Critical A8-A10 B8-B10 C8-C10 D8-D10

5 - 7: Serious A5-A7 B5-B7 C5-C7 D5-D7

3 - 4: Marginal A3-A4 B3-B4 C3-C4 D3-D4

Risk RatingRisk Rating


PrioritiesPriorities

1.1. Pandemic ‘fluPandemic ‘flu

2.2. TornadoTornado

3.3. Dirty bombDirty bomb


PrioritiesPriorities

Perform this exercise for all:Perform this exercise for all:Naturally occurring eventsNaturally occurring events

Technological events Technological events

Human related eventsHuman related events

Events involving hazardous materialsEvents involving hazardous materials


SummarySummary

Assessment of risks is first step in Assessment of risks is first step in planningplanning

Helps focus efforts and ensures no Helps focus efforts and ensures no possibilities are missedpossibilities are missed

Helps prioritize efforts in preparednessHelps prioritize efforts in preparedness


““The only thing more difficult The only thing more difficult than preparing for an than preparing for an

emergency is having to emergency is having to explain why you didn’t”explain why you didn’t”

Disaster Preparedness Conference 2006 Hospital Risk Assessment Bonnie Henry, MD, FRCPC Brian Schwartz, MD, CCFP(EM)

Documents

recovery slide

catastrophic slide

ccfpem slide

hour slide

probability x impact

community disaster plan

human transmission slide

components of risk probability