(This article was originally published 5/4/2020 and last updated 2/9/2024)

Hospitals play a critical role in their communities, especially in times of crisis. In today’s world, disaster comes in many forms: natural disasters such as hurricanes and tornadoes, pandemics such as COVID-19, and cyber attacks such as ransomware. In the past few years, some hospitals have had to deal with all three at once. Just as these disasters can wreak havoc on society, they can also be devastating for hospitals if they aren’t prepared for them. We’ll take a look at how hospitals can prepare for different types of disasters and emergencies, respond to them when they arise, and recover from them when the dust settles.

Putting a Plan in Place

While each type of disaster or emergency is different and presents its own challenges, having a general Emergency Action Plan, or EAP, is the first step in preparedness. The World Health Organization (WHO) provides a checklist healthcare organizations can use to gauge their emergency preparedness and response. The emergency response checklist recommends having nine key components in place. Let’s take a look at each one.

1. Command and Control

Establish a chain of command for evaluating and executing the hospital’s emergency response.
Designate a command center location to convene and coordinate emergency response activities.
Designate leaders responsible for the coordination and management of the nine key components, as well as their potential replacements for continuity’s sake.

2. Communication

Ensure dependable primary and back-up equipment for internal and external communication channels are established and maintained.
Designate a spokesperson and briefing center for external communications approved by the incident commander/team.
Draft messages for targeted audiences to be released for the appropriate disaster.
Ensure all staff know their roles and patient prioritization protocols.

3. Safety and Security

Appoint a security team.
Prioritize security needs.
Ensure the control of patient and visitor traffic flow and restrictions.
Identify and respond to IT security threats.
Establish quarantine/decontamination and isolation areas.

4. Triage

Ensure triage areas are safe and provide adequate lighting and workspace and are in close proximity to essential personnel, supplies, and service areas.
Identify a contingency site and triage protocols for mass-casualties.
Establish a clear method of identifying triage patients.

5. Surge Capacity

Calculate max capacity of beds and staff.
Estimate increases in demand for hospital services.
Identify ways of expanding capacity.
Designate alternative sites for patient overflow and temporary morgues.
Prioritize surgeries and procedures based on medical necessity and potentially cancel elective/non-essential procedures.

6. Continuity of Essential Services

Identify and maintain essential hospital services, as well as the resources these services require.
Ensure evacuation plans provide for the continuity of essential services.
Ensure critical supplies such as food and water are available.

7. Human Resources

Establish a clear staff sick-leave policy, including the care of sick loved ones.
Prioritize staffing requirements and deploy staff accordingly.
Recruit and train additional staff to prepare for patient surge during emergencies.
Minimize burnout by ensuring adequate rest, rotation, and self-care for staff. For tips on reducing burnout, check out our recent blog on the issue.

8. Logistics and Supply Management

Maintain an inventory of all equipment, supplies, and pharmaceuticals, including a short-supply alert mechanism.
Estimate supplies usage during the most likely disaster scenarios, and coordinate with local authorities to ensure continued access to these supplies during an emergency.
Evaluate storage space within the hospital and stockpile supplies and medication in accordance with national guidelines. Ensure an unbroken cold chain for refrigerated supplies.
Ensure prompt maintenance and repair of essential equipment and supplies is achievable and postpone maintenance and repairs of non-essentials if necessary.

9. Post Disaster Recovery

Ensure a comprehensive structural integrity assessment is performed in case of physical damage to the hospital.
Assemble a team to conduct post-disaster inventory assessment.
Establish a post-disaster recovery support program for staff that focuses on emotional and mental support.
Recognize staff, volunteers, and others for their contributions during the disaster.

Natural Disasters

Natural disasters, such as tornadoes, earthquakes, and hurricanes can overwhelm a hospital in several ways.

Patient Surge

First, the hospital will almost certainly see an influx of patients due to injuries from the disaster. A severe natural disaster combined with a highly populated area can be the perfect storm that stretches hospitals to capacity. This is why it’s important for hospitals to have a plan in place to deal with an influx of patients, such as hiring and training additional staff and alternative sites available for patient overflow.

Physical Damage

To complicate matters even more, natural disasters can also result in significant damage to hospitals themselves, as well as local infrastructure. Structural damage to the facility may include flooding, broken windows, and damage to roofs and walls. Not only do these damages result in costly repairs, they may render the facility unusable until repairs can be made. Additionally, damage to local infrastructure can result in a loss of power and delays in supply deliveries. For these reasons, it’s important for hospitals to conduct structural integrity assessments, have an evacuation plan in place, and ensure supply inventories are well-stocked and the hospital is able to coordinate with local officials in the event of supply chain disruptions.

Staff Shortages

The damage caused by a natural disaster can make it difficult or even impossible for some staff to travel to the facility. In times of crisis, it’s imperative for hospitals to have all hands on deck. In addition to hiring staff and cross-training staff on different departments, modern technology allows staff who can’t make it in to do at least part of their job remotely. Remote staff could also take on clerical work to free up on-site staff to deal directly with patients.

How Hospitals Have Responded to Natural Disasters

While natural disasters present a plethora of challenges for hospitals, adequate preparation can help them effectively respond to and recover from disaster. After Hurricane Sandy ravaged the East Coast in the Fall of 2012, the Office of the Inspector General (OIG) conducted a study on how hospitals in the affected areas responded to the disaster. The study found that 93% of the Connecticut, New Jersey, and New York hospitals surveyed (those in the most affected areas) sheltered in place, while the other 7% either fully or partially evacuated. None of the hospitals surveyed suffered any patient deaths as a result of the hurricane.

65% of hospitals that sheltered in place received patients from other hospitals. In order to manage the influx in patients, these hospitals coordinated with local agencies to ensure they had enough staff and supplies on hand. They also addressed capacity and patient safety issues by discharging patients deemed safe for discharge, canceling non-essential surgeries and procedures, and moving patients to different departments to more evenly distribute hospital resources. Hospitals that chose to partially evacuate chose to keep the most critical patients on-site on the safest floors and either discharged the remaining patients or moved them to other hospitals.

Nearly 70% of hospitals experienced electrical issues. While backup generators worked for two-thirds of them, hospitals whose generators failed resorted to measures such as hauling fuel in buckets from basement fuel pumps to generators on the 13th floor and deciding which patients to pull off life support in order to provide limited emergency power outlets to less critical patients (which thankfully never had to be enacted).

Pandemics

While natural disasters carry a combination of challenges related to physical damage, staff shortages, and patient surge, pandemics can have even deadlier consequences. The COVID-19 pandemic pushed hospitals and healthcare workers around the globe to their max. As of January 2024, nearly 775 million people have been infected by the virus, and over 7 million are confirmed to have died from it, making COVID-19 one of the most devastating outbreaks since Spanish Influenza about 100 years ago. Pandemics like COVID-19 pose many challenges to hospitals.

Patient Surge and Virus Spread

Just as natural disasters often result in patient surge, so too do pandemics. Unlike natural disasters though, the influx of patients brought on by a pandemic poses a direct hazard to hospital staff and other patients: infection. When responding to pandemics, it’s crucial for hospitals to have protocols in place to limit the virus spread throughout the facility. These protocols include screening patients at entrances, canceling elective procedures, restricting visitors, and designating certain areas of the hospital for quarantine to keep non-infected patients safe.

Protecting Staff

While protecting non-infected patients from being exposed to a pandemic is challenging enough, protecting hospital staff is even harder. One of the first steps hospitals can take to protect staff is to allow as many employees as possible to work remotely. Many EHR’s allow remote access, tools like Zoom and Ring Central make video conferencing easy, and even our own medical order management software, iOrder, can be accessed through the cloud on any device, anywhere. Just like in a natural disaster, remote staff can take on the clerical responsibilities while on-site staff cares for patients.

For staff dealing directly with infected patients, proper PPE is crucial for protecting them from infection. The COVID-19 outbreak has shown just how important it is to maintain adequate stock of PPE, such as gloves and masks. At a time when staff is already stretched to the max, doctors and nurses catching the virus themselves and having to miss work can be potentially devastating. For more ways to protect employees and contain the spread of a pandemic, read our blog How Hospitals are Handling the Coronavirus Pandemic.

How Hospitals Have Responded to Pandemics

Each hospital will need to adapt to each pandemic differently. However, there are some effective measures some hospitals have taken that can be incorporated into most response plans. In a Becker’s Hospital Review article, Chief People Officer of Providence St. Joseph Health, Greg Till, described some of the measures Providence took to respond to the COVID-19 outbreak. Measures include:

Enlisting volunteers to sew masks and produce face shields. This resulted in a surplus of PPE that is being distributed to caregivers in hard hit communities.
Postponing elective surgeries.
Employing the use of telehealth and virtual care.
Restricting hospital visitors.
Re-purposing medical masks per CDC guidelines to replenish supplies.
Redeploying medical staff whose normal responsibilities have been paused to other areas where their skills can be of use, and investing $20 million towards guaranteed pay for up to six weeks for staff who can’t be redeployed.
Providing healthcare workers with 80 hours of emergency paid leave if they run short of their allotted PTO or sick time, and guaranteed income replacement of 65% for an extended period for workers infected by COVID-19.
Offering low-cost child or eldercare for employees or a $100 per day reimbursement for those using their own care providers.

While larger health systems like Providence may have more resources to respond to a pandemic, many rural hospitals do not. Scotland County Hospital in Memphis, MO is one such rural hospital. In an NPR interview, CEO Randy Tobler, MD stated that the 25-bed hospital had to layoff and furlough some of its staff to reallocate resources toward PPE supplies. The hospital purchased Tyvek suits and full face mask respirators for staff that will be working directly with COVID-19 patients. He also said the hospital had two negative-pressure isolation rooms. These rooms have been converted to a “makeshift isolation corridor” that now consists of eight rooms with 13 beds.

Cyber Attacks

The final disaster we’ll examine is no less serious than the others. While an increasing shift to digital health has many benefits, it also increases the risk of cyber attacks, such as ransomware. Cyber criminals are constantly trying to gain access to critical hospital databases to steal information and hold it for ransom. Criminals may also shut down critical systems, offering a “key” to reopen the systems in exchange for money. Because patient information is so sensitive and hospital systems are so vital to the continuance of care, it is of utmost importance to have an IT security plan in place. Steps hospitals can take to prevent cyber attacks include:

Providing employees training on how to recognize phishing attempts.
Employing anti-virus and file scanning software.
Shutting down computers as soon as a threat is detected.

How Hospitals Have Responded to Cyber Attacks

This past December, a 130-bed hospital with multiple sites across the southeast U.S. fell victim to ransomware. As a Novarad South customer, the hospital fortunately had access to iPro’s top-notch support. While doing routine server maintenance, A Novarad South/iPro support team member realized the hospital’s PACS had been affected by ransomware. He immediately notified the appropriate contacts at the facility. While the facility was aware some of its other systems had been infected, they didn’t know about the PACS. An iPro team member was dispatched to the site the very next day to help rebuild the 4 PACS servers.

Over the next 30 hours, the Novarad South/iPro team was able to bring the PACS back online before any of the other systems. As a result of iPro support’s quick action, only 3% of the 90 million images on the PACS server had been encrypted. The support team was able to help recover these encrypted files from backups stored on another server.

How We Can Help with Disaster Response and Recovery

As shown in the above example, a dependable software vendor can make a world of difference in times of crisis. When systems go down or staff is operating at max capacity, 24/7 support is critical to ensure issues are handled promptly so hospitals can focus on caring for patients. At iPro, our vision is to help every client be successful with our software solutions through quality services and support. That’s the way we’ve operated since 1998. Plus, our solutions are accessible from any device, anywhere.

We also offer solutions that enable healthcare staff to work remotely in times of disaster. From cloud PACS to remote viewers and an entire ecosystem of mobile radiology solutions, we empower your teams to go mobile when it matters most.

If you’d like to learn more about how we can help you prepare, respond to, and recover from disasters, contact us today. For more information on how you can better prepare for disasters, read our blogs on what hospitals are doing to improve supply chain management and the seven keys to thriving during COVID-19 and other crises.

When Disaster Strikes: How Hospitals can Prepare, Respond, and Recover