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Is it time to evacuate the hospital? 96 Hour Planning Part Two

96 hour planning as a decision making tool

How do you decide when to evacuate your hospital or healthcare facility? Who makes that decision and what resources are called into action? Chances are these things are covered in your emergency management plans. But how do you know when its time to activate those plans? Your 96 hour plan can help identify trigger events and make the evacuation decision.

Part one of this series on 96 hour planning discussed the Joint Commission on Healthcare Accreditation (JC) requirement for  emergency planning on the part of hospitals and healthcare facilities. We discussed the need to have an operational plan that sustains the facility when access to external resources are no longer available. Commonly known as the 96-hour plan, healthcare facilities must prove that they've considered the possibilities and impact on operations when they become cut off from the rest of the world by some catastrophic event. 96 Hour planning may be seen as something of a fuel gauge to manage inventory and as a means to survival for the facility. The process includes an assessment of materials on hand and consumption rates. Like other disaster plans, the 96-hour plan must integrate the facilities Hazard Vulnerability Assessment (HVA), existing community response plans and identify the ability to sustain communication, resources and assets, security and safety, staff, utilities and patient care.

The decision to shelter in place or evacuate is not a one-time-only event. This critical decision requires continual reevaluation and situational awareness. While keeping tabs on the external situation or crisis at hand is vital, it is equally important to understand how long you can safely remain in your location and continue to operate. These points are actually the premiss for doing an self-evaluation and creating a 96 hour plan. The value of this process is seen when you realize how the amount of supplies and materials you have (or don't have) on hand and how long your stockpile will last. In other words, given your occupancy rate, how fast will you consume these materials. One way to start this process is by asking how bad can this situation get or what if it did happen here?

This same process can be used to make the switch between standard of care and sufficiency of care. Let's define standard of care as the way we do business every day, with our normal resources and operation. With the normally available resources limited only to what we have stored (no resupply) how long will they last during normal operation? Chances are you'll recognize that you cannot (nor should you) maintain the standard of care (normal operation) when you access to outside resources are cut off the resupply becomes impossible. Switching to sufficiency of care means you'll do what you can or the minimum needed to keep the situation from getting worse. You may be faced with the burden to decide who lives and dies during disaster. Based on the findings of your 96 hour planning process you may:
  • Choose to conserve in-house resources early
  • Supplement with community resources if availble
  • Close to new patients (if that's possible) or redirect incoming people
  • Maintain staff for extended operational periods
  • Consider limited or full evacuation
The 96 hour plan as part of your larger emergency management plan and can help on your search for preparedness. These plans must include assessment of agreements with vendor/suppliers as well as a means of monitoring and reporting on the status of in-house materials. 

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