Physician practices must prepare for emergencies by identifying risks, collaborating with local services, training staff, securing records and maintaining care to protect patients, staff and operations.
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In today's healthcare landscape, physician practices and ambulatory settings must be equipped to handle a variety of unforeseen emergencies and disasters, ranging from natural disasters such as hurricanes, floods and earthquakes, fires, utility outages, to man-made crises like cyberattacks, active shooter events and violent intruder. The onset of COVID-19 changed how Americans view safety and security as well.
As cited in the FEMA guide, A Whole Community Approach to Emergency Management: Principles, Themes, and Pathways for Action, the scale and severity of disasters are growing and will likely pose systemic threats. Accelerating changes in demographic trends and technology are making the effects of disasters more complex to manage. One future trend affecting emergency needs is continued population shifts into vulnerable areas (e.g., hurricane-prone coastlines).
It takes a village
A comprehensive disaster preparedness plan is essential for ensuring the safety of patients, guests, staff and the facility. Physician practices often have fewer resources than larger hospitals or health systems. Being prepared is crucial to minimizing disruptions and protecting lives.
Planning requires collaboration with local emergency services and neighboring businesses, clear communication protocols and an understanding of the specific risks facing the practice's geographical location. By investing in readiness now, practices can ensure their ability to respond quickly, protect vital medical records and provide care under challenging circumstances.
Effective disaster preparedness involves a community approach even for a modest sized physician practice. This would include planning, training and regularly updating procedures for different types of emergencies.
If a natural or man-made disaster or crisis impacted your office or outpatient service location, would you and your team know what your first steps should be?
Key areas for consideration include:
Hazard identification and planning
Hazard identification (HI) involves recognizing potential risks or threats that realistically could impact the free-standing physician practice, a setting not located within or adjacent to a hospital campus that will have onsite security personnel or facility engineers.
First, analyze where you are most vulnerable
Perform an analysis of potential disasters affecting your facility by reviewing patient, staff and physical plant safety as well as the protection of medical and business records. Are there potential hazards located nearby? Is there a river that may overflow, train track or a potentially volatile chemical plant?
Consider all possibilities such as utility failures, a natural gas explosion, a burst water main or a lightning strike causing a fire in your office when every treatment room is filled.
Prioritize events that may be unique to your setting such as women’s health centers being targets for bomb threats and violence.
Develop a specific plan for the prevention of workplace violence as well as domestic violence that could be brought to the work setting.
Develop your response
Keep your plan simple
Identify staff members who will help develop a written disaster response plan.
Use the written plan to communicate and train all levels of staff and anyone outside your organization who may be affected.
Create a checklist of things to do in case of an emergency.
Determine who will decide to evacuate and where to.
Build an emergency kit with flashlights, gloves, paper, pens, medications, bandages, etc. Use this list of items from the American Academy of Pediatrics.
Keep in mind that you, your patients and your staff should also develop a personal home preparedness plan. Determine how those plans might impact your practice’s plan.
Identify roles and responsibilities
What follows is a sample assignment grid that a medical office may use to create their own internal plans:
Sample assignment grid
Sample medical office emergency plans for internal medical emergencies and prevention of workplace violence can be designed specifically for the practice.
Staff
Task/role
Practice manager/designee
Act as incident command lead
Assign duties to staff members
In conjunction with the care physicians and/or advanced healthcare professional, determine the severity of the event and whether to remain in place or evacuate the medical office
Identify where to evacuate to in accordance with your written emergency preparedness plan
Work in conjunction with the physicians and/or advanced healthcare professional to identify next steps
Count the number of patients and guests in the waiting room and report information to manager/designee
Inform clinical staff and the practice manager of any issues or concerns in the waiting areas
Contact law enforcement/EMS as needed/directed
Activate fire alarm as needed
Move guests away from windows and doors if the situation involves a weather event
Secure records under the direction of the practice manager
Secure finances and financial records under the direction of the practice manager
Turn TV and/or radios to emergency notifications or broadcasts
Secure loose items and furniture that could cause harm
Assist the practice manager/physicians and/or advanced healthcare professional as needed
Medical assistants
Assist patients/guests in exam rooms
Move patients/guests out of office under the direction of the practice manager and physicians and/or advanced healthcare professional
Bring emergency equipment and emergency kit (See link for a sample document of a preparedness checklist from the American Academy of Pediatrics provided in this document) to the location of the emergency or to the point of evacuation
Provide care assistance within scope of role
Staff nurses
Secure medications and emergency supplies that reflect the type of emergencies likely to occur
Provide for care needs
Contact patients/family as needed
Assist with first aid, code situations and assessment of patients
Physicians and/or advanced healthcare professional
Focus on immediate patient care needs
Work closely with practice manager on key decisions
Work with local hospitals if there is a need for physicians and/or advanced healthcare professional to report
Make the decision to close the practice and when to reopen
Developing policies and procedures
Cited from “A Practical Guide for Emergency Preparedness for Office-Based Family Physicians,” consider outlining standard operating procedures for:
Staffing: Plan for unmet staffing needs. Key staff members and physicians might be unable to reach the office.
Phone lines: Ensure your phone lines keep running or are backed up and brought back quickly. Even if your office is not ready to reopen, place a message on your phone line to keep your patients and staff updated.
Computers: Consider that your team may not be able to access computerized information, such as important phone numbers and contacts. Ensure for a down time plan and keep that plan current.
Emergency supplies: Outline the most needed supplies for patients and staff. Sample.
Business paperwork: Maintain important documents such as loans, real estate records and contracts in a safe or safe deposit box for ease of access. Document their location.
Restoration and repairs: Plans should also consider that your office may need repair, and you may not be able to return for an extended period of time. Contingency planning is critical.
Disaster record: Create and retain a record of the disaster event and a list of any patient records affected, with recovery efforts, successes and failures outlined. This will allow for easy retrieval of general information should any legal or accreditation issues arise subsequent to the emergency.
Insurance discussions: Contact your insurance carrier. Review the available coverage for business interruptions, physical repairs, record restoration, setting up a temporary practice location and other practicalities to allow you to remain open or reopen.
Patient care: Create a checklist that reflects continued patient care needs and prioritizes patients by those who will need the most assistance in the event of a community disaster such as those who are bed-bound, on oxygen or possibly confused.
Evacuation and business interruption
Assess the financial impact of potential shutdowns to understand how long your practice can remain closed without significant financial strain.
Plan for an orderly evacuation, including communication with neighboring businesses.
Contact your insurance carrier and broker.
In surgical or diagnostic facilities, evaluate whether it is safe to continue procedures or if immediate transportation to another facility is necessary.
In multistory buildings, use the stairs instead of elevators during an evacuation.
Designate a meeting point outside for staff and patients.
Assign staff members to ensure all patients, visitors, and staff have evacuated the building.
If time permits, turn off equipment and secure drug cabinets and medical supplies.
Secure and remove cash/receipts if possible.
Forward calls to a secure source.
Redirect arriving patients and post closure notices at the building and on your website
Establishing a communication plan
In every emergency situation, it’s crucial to communicate with key individuals, including emergency government resources, physicians/advanced health care professionals, patients, vendors and staff.
Power outages: Ensure you have printed plans and an emergency contact list with phone numbers and emails for government emergency agencies, local hospitals, partners, colleagues, vendors and others.
Staff communication tree: Develop a communication tree that designates which staff members will contact those on the list. Regularly upload your computerized record system to the Cloud or other off-site storage. Additionally, download the information onto thumb drives, and ensure hard copies of charts are carried out if necessary.
Practice, practice, practice
Train staff: Ensure every team member understands their role during an emergency.
Conduct drills: Hold tabletop or simulation drills at least twice a year.
Continuous improvement: Always seek opportunities to enhance your emergency response.
Community Connections: Drill with community agencies, such as the Fire Department.
In closing, this emergency preparedness guide outlines the necessary steps to ensure the safety of patient, staff, guest and the facility during various emergency situations. By creating a state of readiness, the practice will aim to minimize disruptions, protect those under their care and maintain continuity of care during emergencies.
Disclaimer
Willis Towers Watson hopes you found the general information provided in this publication informative and helpful. The information contained herein is not intended to constitute legal or other professional advice and should not be relied upon in lieu of consultation with your own legal advisors. In the event you would like more information regarding your insurance coverage, please do not hesitate to reach out to us. In North America, Willis Towers Watson offers insurance products through licensed entities, including Willis Towers Watson Northeast, Inc. (in the United States) and Willis Canada Inc. (in Canada).
