A comprehensive Hospital Emergency Management Team is a team designed to cope with any internal or localized emergency, which can also be integrated seamlessly into a regional Incident Command System. Because of its complexity, the success of the team relies heavily on effective emergency communication.
Hospital Emergency Management Teams are far more complex than Emergency Management Teams found in non-medical environments. Not only do Hospital Emergency Management Teams have to prepare for emergencies affecting their own internal operations (i.e. active shooters or cyber-attacks); but, when a natural or man-made disaster strikes a wider area, communities look to hospitals to care for the ill and injured, to provide food and shelter, and to help coordinate disaster recovery.
Due to the additional services expected of a hospital, the organizational structure of a Hospital Emergency Management Team goes a lot deeper than a typical organizational structure. Furthermore, with so many more roles to fill than a non-medical organization, the “order of succession” adds an additional level of complexity to communication systems when a person with a role to perform is unable to execute their duties (due to incapacity) and the role has to be delegated to a Deputy.
The Typical Structure of a Non-Medical Emergency Management Team
To best demonstrate the complexity of a comprehensive Hospital Emergency Management Team, a good place to start is by comparing it to the typical emergency management structure of a non-medical organization.
Typical emergency management structure of a non-medical organization based on ICS 300. Image Source.
The typical emergency management structure of a non-medical organization usually follows the ICS 300 model inasmuch as there is an Incident Commander responsible for initiating the Emergency Plan, a team of Command Staff below him or her (Public Information Officer, Safety Officer and Liaison Officer), and then a team of Section Chiefs below the Incident Commander with responsibility for operations, planning, logistics, finance, and administration.
Below each Section Chief, there are multiple Divisions. The Divisions can relate to different branches of a multi-location organization or to different resources. Each Division will usually have a Divisional Leader and a Deputy trained to perform their role in case the Divisional Leader is incapacitated. In smaller organizations, if no Deputy is appointed (or the Deputy is also incapacitated), the Incident Commander assumes the vacant role or brings in a third party from another agency.
How the Structure of a Hospital Emergency Management Team Differs
At the top end of the organizational structure, there is little difference between a Hospital and a non-medical Emergency Management Team. Sometimes a Hospital Emergency Management Team will include a technical or medical specialist at the Command Staff level depending on the nature of the emergency; but this isn't always the case, and it is more likely to find technical and medical specialists at Divisional Leader level.
The significant structural differences occur below the Section Chief level, with many Divisions having Groups and Sub-Groups assigned to specific roles that simply don't exist in a non-medical organization. These unique roles can include addressing the security of a mental health unit, crowd control, bed control, and transportation - and each Group or Sub-Group is likely to have its own chain of command to ensure emergency procedures are carried out efficiently in order to maximize health and safety.
The organizational structure of a Hospital Emergency Management Team below the Operations Chief level can be immense depending on the medical services provided by the hospital and the likely demand from the community in the event of a regional emergency. Whether or not all the roles are activated can depend on factors such as situational needs and incident priorities. A sample structure may look like:
During an emergency the Planning Section is responsible for collecting and evaluating information for decision support. Consequently, Divisions within the planning section need to maintain resource status information at all times and therefore the effectiveness of communications in the Planning Section has a direct impact on the availability of information needed for critical, strategic decision-making.
It is the role of the Logistics Section to coordinate support requirements before, during, and after an emergency. This role may involves acquiring resources from external sources such as State, County and Local Operations Centers, and therefore effective internal and external communication systems are critical in order for the Logistics Section to fulfill its role.
Although the Finance/Admin Section of a Hospital Emergency Management Team has the same structure as a non-medical Emergency Management Team, it has a lot more to do than just account for the costs of an emergency response. Additional responsibilities include recovering the cost of patient treatment, vendor expenses, and mutual aid financial remuneration.
Communicating Before an Emergency
Hospital emergency planners and disaster coordinators know they have to cover every possible scenario when developing an Emergency Preparedness Plan, and that communication is key before, during, and after an emergency - regardless of its scale. Because many types of emergencies involving hospitals are on the larger scale, many healthcare organizations have taken advantage of FEMA's Multi-Agency Coordination System “WebEOC” as their external communications system.
WebEOC enables hospitals, regional incident managers and emergency responders to share information, increase situational awareness, and coordinate responses. However, as part of the emergency planning process, it is essential the system is tested to ensure everybody within multiple agencies understands their roles and is capable of fulfilling their responsibilities. This can create an issue during emergency exercises when hospitals use an internal communication system incompatible with WebEOC.
One of the objectives of an emergency exercise is to identify any vulnerabilities in emergency planning and resolve them. It is not practical to give every Divisional Leader and Deputy access to the WebEOC system; so a hospital may have to use WebEOC for its external communications and a second system for its internal communications. If the two communications systems are incompatible, it will create unnecessary delays and potentially introduce human errors.
Communicating as an Emergency Begins
As an emergency begins, it is important to notify the Hospital Emergency Management Team as quickly as possible in order to initiate the Emergency Plan. Different hospitals have different systems for doing this, and some systems are more effective than others at communicating the emergency notification and ensuring every person with a role to perform has received the notification. If any role is left vacant, the efficiency of the emergency response could be compromised.
Consequently, the hospital's internal communication system records when notifications have been received and read, so key personnel can be accounted for by the Section Chief, and so follow-ups can be sent when there is a lack of response. A lack of response doesn't necessarily mean the person in charge is incapacitated. Possibly they never received the notification. However, if the follow-up is unanswered, a Deputy can be contacted to fill the role until the reason for a lack of response is established.
This process not only requires a lot of planning and organization. It is also necessary that the contact details of key personnel are kept up-to-date. Therefore, the hospital emergency notification system should synchronize its contact details with a live database - for example an HR database - so that, as personnel leave, as mobile number are changed, and as key personnel are assigned different roles, the hospital emergency notification system remains current.
Communicating During an Emergency
During an emergency, two-way communication becomes essential for enhancing situational awareness and prioritizing where resources should be deployed. Incident Commanders and Section Chiefs need to know that the Emergency Plan is being executed effectively- and when things do not go as practiced, so that contingency plans can be activated. In these scenarios, group communications need to be precise, ordered, and efficient - something that is not always possible during a stressful situation.
To resolve this potential issue, a Hospital Emergency Management Team should create a series of templates for the hospital emergency notification system in order to prepare for the scenarios they are likely to encounter. This will help accelerate requests for resources and communicate the requests in plain English so there is no risk of communications being misunderstood. It will also accelerate responses to requests for resources in order to facilitate better outcomes.
It is also important to keep “people on the ground” informed about whether they should seek shelter, evacuate, or take some other course of action. Keeping personnel informed is a key element of the successful execution of an Emergency Plan, and it also has the benefit of preventing rumors circulating on social media that can result in a greater volume of casualties and injuries. They say “no news is good news”, but that's not the case during an emergency incident.
Communication after an Emergency
Naturally it is everybody's interests to have any emergency incident resolved as quickly as possible and for normal operations to resume. In a hospital environment, the speed and quality of post-emergency recovery may be critical to thousands of citizens who have sought shelter or help from the hospital. Therefore, not only does post-emergency communication have to be fast, it also has to be accurate and informative or else people will look to other channels for their information.
In this situation, a Hospital Emergency Management Team needs to know which departments are operating, which need more resources, and which have the resources but need a little more time. Updates should be sent to the Incident Commander via the Command Staff so that departments requiring resources are prioritized and the public is kept informed about where they can seek medical attention or obtain medication, etc.
In many respects, a Hospital Emergency Management Team is only as good as its communications system. If the system is not capable of supporting multi-modal group messaging at scale, cannot be relied upon to get the right message to the right people at the right time, or doesn't effectively monitor requests for resources and responses, the hospital's Emergency Plan will not be executed as efficiently as possible - with potentially serious consequences for the lives of the people it is supposed to protect.
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