What the best emergency plans have in common
Common threads
If you have been faced with an emergency in the past, chances are you have a preparedness plan in place. But many practices leave it to chance a mistake that can cost time, money, and even lives.
Putting together a plan takes teamwork, drills, and constant assessment of the plan’s effectiveness. (See related story, p. 61.) But the best plans all have some things in common, according to Roseann Gilchrist, practice administrator at Orthopedic Consultants Medical Group in Encino, CA.
1. Patient safety.
This is the top priority, she says. Be prepared to assist elderly and disabled patients to a place of safety. In Gilchrist’s plan, male aides are given the task of taking care of incapacitated patients.
Janet Connell, CMPE, practice administrator of Nephrology Associates of Kentuckiana in Louisville, KY, learned the importance of that policy when a neighboring practice left patients in examination rooms during a fire. "They didn’t know what to do or if it was a drill until they saw the smoke coming through the floor," she says.
Now, Connell says, when an alarm sounds, the first step taken is telling patients and helping them dress. If patients need help, someone has to be assigned to help them out of the building. And no one should return until given the all-clear signal, says Connell.
If you have very ill patients, you still have to get them out, she says. When they are in a safe place, you can then determine where they should go to ensure they are adequately cared for. Other patients can simply be rescheduled.
2. Clear responsibilities.
Connell’s experience with the neighbor practice highlights the importance of every staff member having clear responsibilities, says Gilchrist.
Sheila Campbell, financial counselor at Cardiology Consultants in Pensacola, FL, agrees. She assigns each department head tasks, and in case of absence, that person’s immediate subordinate.
Cardiology Associates’ staff each get a number, a duty, and a "buddy," Gilchrist explains, so that every job has two people who can do it. The responsibilities are a function of the position, not the person. If the person involved changes jobs within the organization, Gilchrist says that person will end up with a new number, a new duty, and a new buddy.
Connell has a caveat about responsibilities, "Make sure you have someone who is a nose counter," she says. "Someone has to know what staff were present, what patients were there, and that they are all accounted for."
3. Have a way to communicate with your staff.
Campbell makes sure that each staff member has a telephone list which includes the home numbers of every staff member, alternate numbers when applicable, and pager and cell-phone numbers for the medical staff. The list, kept at home rather than at the office, is updated monthly during hurricane season, and bimonthly the rest of the year.
She uses a daisy-chain model. The CEO calls managers, who then call the first persons on their alphabetical lists of staff and the last persons on those lists. Those people then call the persons either below or above them on the list. If the caller either gets no answer or a machine, then he or she calls the next person down or up on the list until someone answers.
Campbell also implemented a system in which the practice’s CEO leaves a message on an emergency line at each of the practice’s offices to let staff know whether they should come in to work following an emergency. He also retrieves messages from staff from those special lines.
4. Don’t forget computers.
In an emergency situation, it is often easy to forget that computers are an integral part of every modern practice, and Gilchrist says you have to remember that in some cases, you won’t be able to gain access to them. Her practice backs up the system every day, and two sets of backup tapes are stored one on site in a large fire safe and the other at the home of the systems administrator or Gilchrist.
Campbell also suggests finding a "hot site" where backup files can be sent with staff members to run systems remotely. She uses one in Atlanta and suggests contacting a local hospital or even a high-tech company in your area to find out what companies provide such sites in emergency situations. (For more help on emergency plan development, see related story, p. 64.)
5. Paper records are also at risk.
Despite the computerization of most practices, paper medical records are still kept on site at virtually all practices, and their safety must also be ensured. Campbell says her practice keeps those records in a fire-safe vault known as "the green monster." In case of an emergency that would require one of the offices to conduct business in another location, the supervisor of medical records would be in charge of moving the charts and ensuring their continued safety and confidentiality.
Computerized copies of the charts are put on tape and sent off site for safe keeping, Campbell adds.
6. Consider all possibilities.
Although people don’t think of Kentucky as earthquake country, Connell says there is a fault in her area. Her office has separate plans for snow, earthquakes, fire, tornadoes, and flooding. While basic elements of all plans are the same, there are some differences. For example, in case of fire, the main emphasis is getting staff and patients safely out of the building. In case of tornado, the emphasis is on getting to the safest part of the building. And with flooding, the importance shifts to minimizing damage to property.
Campbell says you should also consider other kinds of threats, such as a person with a gun coming into the facility or a bomb threat. She also notes that there are often severe lightening storms which knock out power and computers regularly, and these "mini" emergencies should be addressed in disaster plans.
• Roseann Gilchrist, practice administrator, Orthopedic Consultants Medical Group, Encino, CA. Telephone: (818) 788-7343.
• Sheila Campbell, financial counselor, Cardiology Consultants, Pensacola, FL. Telephone: (904) 444-1717.
• Janet Connell, CMPE, practice administrator, Nephrology Associates of Kentuckiana, Louisville, KY. Telephone: (502) 587-9660.
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