1、Designation: E 2413 04Standard Guide forHospital Preparedness and Response1This standard is issued under the fixed designation E 2413; the number immediately following the designation indicates the year oforiginal adoption or, in the case of revision, the year of last revision. A number in parenthes
2、es indicates the year of last reapproval. Asuperscript epsilon (e) indicates an editorial change since the last revision or reapproval.1. Scope1.1 This guide covers concepts, principles, and practices ofan all-hazards comprehensive emergency management pro-gram for the planning, mitigation, response
3、, recovery, andcoordination of hospitals in response to a major incident.1.2 This guide addresses the essential elements of the scope,planning, structure, application, and coordination of federal,state, local, voluntary, and nongovernmental resources neces-sary to the emergency operations plan for a
4、 hospital.1.3 This guide establishes a common terminology for hos-pital emergency management and business continuity pro-grams necessary to fulfill the basic service requirements of ahospital.1.4 This guide provides hospital leaders with concepts of anemergency management plan, but an individual pla
5、n must bedeveloped in synchrony with the community emergency op-erations plan and the National Incident Management System.1.5 This guide does not address all of the necessary plan-ning and response of hospitals to an incident that involves thenear-total destruction of community services and systems.
6、1.6 For the purposes of this guide, the definition of hospitalwill be the current definition provided by the AmericanHospital Association for an acute care facility.1.7 This standard does not purport to address all of thesafety concerns, if any, associated with its use. It is theresponsibility of th
7、e user of this standard to establish appro-priate safety and health practices and determine the applica-bility of regulatory requirements prior to use.2. Referenced Documents2.1 NFPA Standards:2NFPA 1600 Standard for Disaster/Emergency Managementand Business Continuity ProgramsNFPA 1994 Standard on
8、Protective Ensembles forChemical/Biological Terrorism Incidents3. Terminology3.1 Definitions of Terms Specific to This Standard:3.1.1 all-hazards, adjhazard is an inherent property of anevent, product, or object that represents a threat to human life,property, or the environment. In this context, al
9、l-hazards refersto any incident or event that could pose such a threat.3.1.1.1 DiscussionThese may include special equipmentand processes that are used less frequently on a daily basis andrequire routine training to be most effective during a majorincident.3.1.2 basic societal functions, nthose basi
10、c functionswithin a community that provide services for public health,health care, water/sanitation, shelter/clothing, food, energysupply, public works, environment, logistics/transportation,security, communications, economy, and education.3.1.3 business impact analysis (BIA), nmanagement levelanaly
11、sis that identifies the impacts of losing the entitysresources by measuring the effect of the resource loss andescalating losses over time to provide the entity with reliabledata upon which to base decisions concerning hazard mitiga-tion, recovery strategies, and continuity planning.3.1.4 capacity,
12、adjcapability at a given time for a hospitalto provide a given service that is distinct from capability, whichdefines an ability to provide a service under normal operatingconditions.3.1.4.1 DiscussionA facility may have the capability totreat acute major incident patients in a cath lab, but if a cr
13、iticalresource is missing at the time of a disaster (for example,personnel, equipment, space, or electricity), the facility wouldnot have the capacity to care for such a patient at that timewhen there is a need.3.1.5 communications systems, nthose processes and re-sources (physical, procedural, and
14、personnel related) thatprovide information exchange during an identified majorincident.3.1.6 community/region, nthat area in which a hospitalprovides health services and basic societal functions.3.1.7 continuity of essential services, nservices that hos-pitals provide as a vital daily function that
15、must be maintainedas long as possible and then restored at the earliest opportunityafter managing the necessary elements of the emergencyincident. This is a business continuity planning focus.1This guide is under the jurisdiction of ASTM Committee E54 on HomelandSecurity and is the direct responsibi
16、lity of Subcommittee E54.02 on EmergencyPreparedness, Training, and Procedures.Current edition approved Nov. 1, 2004. Published November 2004.2Available from National Fire Protection Association (NFPA), 1 BatterymarchPark, Quincy, MA 02269-9101.1Copyright ASTM International, 100 Barr Harbor Drive, P
17、O Box C700, West Conshohocken, PA 19428-2959, United States.3.1.8 damage assessment, nappraisal or determination ofthe effects of the disaster on human, structural, economic, andnatural resources.3.1.9 disaster, nsudden calamity, with or without casual-ties, so defined by local, county, state, or fe
18、deral guidelines;before a disaster declaration, a disaster is an event that exceeds(or might exceed) the resources for patient care at that time, fora community, a hospital, or both.3.1.9.1 DiscussionThe definition of casualty is expansiveand could include acute injuries, illnesses, or deaths, exace
19、r-bation of chronic medical conditions as a result of poor accessto primary care following the disaster (disaster-related acutemajor incident), and post-traumatic stress disorders. A disastercould also include sustained infrastructure incapacity and theinability to access necessary external resource
20、s and supplies.3.1.10 fatality management, nprocesses designated byexisting plans or local officials overseeing fatalities from anincident (medical examiner or coroner) to organize, coordinate,manage, and direct manage incident fatalities and identifytemporary morgue facilities.3.1.10.1 DiscussionFa
21、talities that occur during the timeof the incident are managed in uniform fashion, whether thedeaths appear connected to the incident or not.3.1.11 hazard vulnerability analysis (HVA), nprocess bywhich a hospitals personnel identify real or potential hazardsthat would affect hospital operations, par
22、ticularly those withnegative implications for health care, and identify internalcapabilities and community preparedness to address thosehazards and, in a region of health care providers, this mayinclude a needs assessment as a preliminary survey of real orpotential hazards to a specific group of hos
23、pitals.3.1.11.1 DiscussionThis will be accomplished with asystematic approach to the probability and consequence ofhazards and events that threaten the continuity of a hospitalsbusiness operations. This would normally consist of determi-nation of the likely and potential hazards to the operations of
24、the hospital, an evaluation of the vulnerability of the hospital tothose hazards, and determination of the resources necessary toreduce those hazards and vulnerability. The analysis providesthe basis for establishing relevant major incident managementplans and should be coordinated with local or sta
25、te authorities,or both, and regional health care facilities as appropriate.3.1.12 hospital, nhealth care institution with an organizedmedical and professional staff and inpatient beds availablearound the clock, whose primary function is to provideinpatient medical, nursing, and other health-related
26、service topatients for both surgical and nonsurgical conditions and thatusually provides some outpatient services, particularly emer-gency care, for licensure purposes.3.1.12.1 DiscussionEach state has its own definition ofhospital, which affects licensing under laws of that state.3.1.13 hospital em
27、ergency operations center (HEOC),n(also known as a command center) designated area of thehospital that serves as a meeting area, with strategic andtactical support for the incident command system/incidentmanagement system.3.1.13.1 DiscussionReference to the HEOC will avoidconfusion with the communit
28、y/county EOC. The EOC musthave adequate technical capability and personnel to support theoperation of the incident and the hospitals response.3.1.14 hospital evacuation, nevacuation of a hospitalrefers to those actions by medical staff to remove inpatients,outpatients, and staff physically from the
29、location of a hazard,thus interrupting the pathway of exposure and includes evacu-ation within the facility (horizontal or vertical) and away fromthe facility.3.1.14.1 DiscussionEvacuation is a short-term or long-term protection strategy. An alternative short-term protectiontechnique may be shelteri
30、ng, but in some circumstances(earthquake-damaged hospital), it would need to be to anothersafe structure.3.1.15 hospital major incident, nmajor incident is anyevent that approaches or exceeds the capability of a hospital orhealth care organization to maintain operations or requiressignificant disrup
31、tion to the routine operations of the facility toaddress.3.1.15.1 DiscussionThe definition may be institution-specific since hospitals on a daily basis operate with differentresources and capabilities to respond to different crises.3.1.16 hospital management (group supervisors/leaders/managers), nqu
32、alified personnel who control a specificdepartment, unit, area, or task assignment.3.1.17 hospital mutual aid, ncoordination of resources,including but not limited to: facilities, personnel, vehicles,equipment, supplies, pharmaceuticals, and services, pursuant toan agreement between hospitals and ot
33、her health care organi-zations, providing for such interchange on a reciprocal basis inresponding to a major incident or disaster.3.1.18 hospital surge capacity, nability of a hospital toexpand rapidly and augment services in response to one ormultiple incidents.3.1.18.1 DiscussionThis response is u
34、nder the control ofthe facilitys emergency management plan and may includeintegration with regional authorities responsible for processesto manage and provide logistical and resource support tomanage the patient influx.3.1.19 incident command system (ICS), nresource man-agement system identified by
35、a chain of command that adaptsto an emergency event; the system adopted by the hospitalshould follow accepted ICS processes and be compatible withthe National Incident Management System.3.1.19.1 DiscussionICS contains common terminology,individual ICS position responsibilities, integrated communi-ca
36、tions, modular composition of resources, unified commandstructure, manageable span of control, consolidated actionplans and resource management, and plans for termination andrestoration of business continuity. The system allows emer-gency responders from hospitals and other emergency responseorganiz
37、ations to coordinate activities with familiar manage-ment concepts and request and implement mutual aid.3.1.20 incident commander, nindividual responsible forthe overall management and coordination of personnel andresources involved in a major incident.3.1.20.1 DiscussionWith a hospital event, the h
38、ospitalincident commander is that official within an entity (forexample, hospitals or group of hospitals) who serves as theE2413042EOC executive and coordinates the assets of the entity in theresponse to an event. The hospital incident commander shouldbe the best qualified depending on the nature of
39、 the incident.This may be the senior physician on site, a department head, anursing or house supervisor, or a hospital administrator. If thescope of the incident involves more then the hospital alone, thecommunity official responsible for community response maybe the incident commander of record.3.1
40、.21 incident management system (IMS), nin emer-gency management applications, the combination of facilities,equipment, personnel, procedures, and communications oper-ating within a common organizational structure with responsi-bility to accomplish stated objectives pertinent to an incidenteffectivel
41、y.3.1.21.1 DiscussionThe system identifies management re-sponsibilities and establishes policies and procedures for coor-dinating emergency response, business continuity, and recov-ery activities across hospital departments, outside agencies,and jurisdictions and that maintains compliance with state
42、 orfederal regulations. The incident command system is anintegral component of the incident management system.3.1.22 major incident, nthis is defined within the contextof all-hazards preparedness as any event that approaches orexceeds the capacity of a hospital or health care organization tomaintain
43、 operations or requires significant disruption to theroutine operations of the facility.3.1.22.1 DiscussionA major incident may be defineddifferently for an individual hospital, a system of hospitalsoperating as one entity, or a group of independent hospitals thathave a regional responsibility for p
44、lanning and response. It isessential that each hospital plan for incidents that could occurat any of these levels.3.1.23 major multiple casualty incident, n(also known asa mass casualty incident) incident producing large numbers ofcasualties approaching or beyond local health care capacities.3.1.24
45、medical disaster, ntype of significant medicalincident that exceeds the patient care capacity of local re-sources and routinely available regional or multi-jurisdictionalmedical mutual aid.3.1.25 mitigation, nstructural and non-structural activitiestaken to eliminate or reduce the probability of the
46、 event orreduce its severity or consequences, either before or followinga disaster or emergency.3.1.26 multiple casualty incident (MCI), ntype of signifi-cant medical incident for which local medical resources areavailable and adequate to provide for field medical triage andstabilization and for whi
47、ch appropriate local facilities areavailable and adequate for diagnosis and treatment.3.1.27 mutual aid, nprearranged agreement developedbetween two or more entities to render assistance to the partiesof the agreement.3.1.27.1 DiscussionMutual aid agreements between enti-ties are an effective means
48、to obtain resources in emergencysituations and augment surge capacity.3.1.28 mutual aid agreement, ncooperative assistanceagreements, intergovernmental compacts, or other documentscommonly used for the sharing of resources.3.1.29 personal protective equipment (PPE), nensemblesand ensemble elements t
49、o protect health care workers fromcontact with dangerous agents, including chemicals, biologicagents, blood, and body fluids, when providing victim orpatient care during emergency medical operations; levels ofPPE are defined in NFPA 1994. Also refer to Centers forDisease Control HICPAC Isolation Guidelines.3.1.29.1 DiscussionThis equipment would meet mini-mum design, performance, testing, and certification require-ments for use during emergency operations, as identified fromthe HVA.3.1.30 preparedness, adjencompasses those actions takenbef
