We all know that disaster can strike at any time. A raging fire in a nearby neighbourhood, a plane crash at an airport, or the threat of wide spread illness within the community can send a hospital into an emergency response situation.
At St. Joseph’s Health Centre, being ready when our community needs us is a mandate we have worked hard to put in place across the organization. We do this using several strategies to provide front line staff and the leadership team with ongoing education, training and opportunities to practice their abilities and judgment skills in a crisis situation.
Each emergency code response is reviewed at least every two years and the front line staff education includes completion of an on-line learning module and participation in unit level mock exercises.
Education for the leadership team – Managers, Directors, Vice-Presidents and our CEO – is centered on mandatory, quarterly table top exercises that our Emergency Preparedness Committee (EPC) develops based on emergency situations that our hospital or others have experienced and mock scenarios with storylines that we hope to never encounter.
“Table top exercises are a non-threatening way to provide leaders with an opportunity to experience and work through how they would react and manage in a crisis situation. Educating staff with a policy alone isn’t enough,” explains Silvana Biscaro, Administrative Program Director, Emergency and Critical Care at St. Joseph’s and Co-chair of the Emergency Preparedness Committee.
St. Joseph’s follows the Incident Management System (IMS) structure, a framework that helps to create order in a crisis situation by facilitating communication, response activities and coordination within the organization (and with external partners when necessary) so that the emergency situation can be managed effectively. The objectives of the table top exercises include:
– Understanding the IMS structure – how it works and different roles needed to manage an emergency situation
– Setting up the Command Centre – the mock exercise allows participants to set up the Command Centre, the centralized location where our staff leading the emergency response would gather and operate from, as if they were in a real crisis
– Testing a code – the group runs through the exercise using the code policy and IMS structure to manage the situation appropriately
– Debriefing – at the end of the exercise, the team reviews the code, policy and their response and share their opinions about what worked and what didn’t, so that improvement opportunities can be identified and acted on
The exercise gets the team to jump into action and think about all of the necessary steps needed to manage the situation. For example, if the exercise was centered on calling a Code Orange (an external disaster) due to a plane crash at Pearson International Airport and we were notified by Toronto EMS that 30 patients would be coming to our emergency department for treatment, what immediate steps would the Command Centre team need to address, as outlined in the emergency plans, to respond.
The team needs to work together – quickly and under pressure – to launch contingency plans and make decisions to ensure the hospital continues to function efficiently and maintains safety for our patients and staff while in crisis. Planning for a surge in staffing needs to support the influx of patients; changes to or closure of services to manage the immediate crisis; ongoing communication within the organization to staff, physicians and volunteers; keeping patients, families and general public informed; preparing statements to the media; involving our other community health care partners for assistance and liaising with the necessary government level personnel. These are just some of the challenges and issues that the team needs to address to be successful at managing the crisis.
“We have observers sit in on the mock table top session to observe what everyone is doing and how they are responding to the disaster and working together as a team to make decisions. They are important because they share impartial feedback to help us improve,” says Noreen Jivraj, Manager of Emergency Planning and Security Services. And EPC Co-Chair “We’ve had other community organizations sit in on our exercises so they can learn about our approach to emergency preparedness as well.”
The EPC has received valuable feedback from the table top exercises and have made significant improvements to our emergency codes, policies and plans, especially in the physical set up of the Command Centre. Simple things like switching from desktop computers to lap tops has made the IT set up in the Command Centre faster. “It takes about seven minutes to set up now, which is down from 20 minutes,” says Biscaro.
Separate working areas based on job actions have been created so that the group can work more efficiently and cohesively as a team, and individual job action packages have been created so when staff arrive at the Command Centre and are assigned a role, all the information they need to understand what they need to do is in a centralized place. Another improvement includes updating the language used in the emergency code policies so it aligns with the Ontario Hospital Association (OHA) standards and reflects best practice.
To ensure our emergency plans and procedures are working effectively, Biscaro and Jivraj work together with the EPC to review each code incident that takes place at the hospital. “As co-chairs we communicate the learnings from code responses and periodically update the administrative on-call team,” says Biscaro. “It is essential to share experiences from code responses with the leadership team regularly as another way to build capacity and judgment in crisis and emergency management.” The EPC also has an identified executive sponsor who is a member of our Senior Leadership Team and through this role provides a corporate focus on safety by our senior leaders and supports the EPC by ensuring the availability of necessary resources needed by the group.
“Safety is ingrained in our culture and everything we do at St. Joe’s. Emergency planning is one of many ways we prioritize safety to demonstrate our commitment to Put Patients First,” says Kathy Millar, Vice President Of Quality, Safety snd Performance Excellence and executive sponsor for EPC. “As with any strategy, our emergency plans are reviewed often, to ensure that our processes are effective in responding to emergency situations and continue to meet best practices as well as the needs of our patients and staff.”