Ch. 25: Emergency Management and Preparedness

11. A 50-car pileup occurs on a major freeway in California's Central Valley as a result of heavy fog. There are major injuries, and victims are expected to be transported to local emergency departments. Which type of disaster is this classified as? a. Mass casualty event b. Conventional disaster c. Biological disaster d. Radiological disaster

ANS: A A mass casualty event is a natural or manmade event generating large numbers of patients requiring medical care and that overwhelms a health care facility and prevents it from delivering medical services that are consistent with accepted standards (Agency for Healthcare Research and Quality [AHRQ], 2012).

1. All-hazards disaster is best defined as: a. all types of natural and human terrorist events. b. an event involving floods, tornadoes, hurricanes, and earthquakes. c. an unforeseen and often unplanned event causing great damage. d. any type of biological, chemical, radiological, or nuclear event.

ANS: A An all-hazards disaster includes all types of natural acts such as earthquakes, forest fires, floods, and hurricanes, or terrorist events such as biological, chemical, radiological, and nuclear attacks. A disaster is an unforeseen and often sudden event that causes great damage, destruction, and human suffering.

11. Which of the following questions should be considered in the hospital gap analysis survey of clinical operations readiness in the event of a disaster? (Select all that apply.) a. Does the facility have procedures in place to maximize staff safety in a disaster? b. Does the facility have procedures in place for use of PPE? c. Can the facility track patients until discharge or death while maintaining confidentiality? d. Does the facility have a lockdown plan in case of emergency? e. Does the facility have a mechanism of tracking costs associated with the event?

ANS: A, B, C Assessing the clinical operations readiness in the gap analysis survey can be answered by asking some of the following questions: Does the facility have procedures in place to maximize staff safety in a disaster? Does the facility have procedures in place for use of PPE? Can the facility track patients until discharge or death while maintaining confidentiality?

4. In a hospital's emergency operations plan, what would be the expected roles of the security department? (Select all that apply.) a. Overseeing facility security b. Lockdown of the facility as necessary c. Managing people entering and leaving the hospital d. Developing or refining the hospital's emergency operations plan e. Being the primary source of communication to nursing staff

ANS: A, B, C, D The primary responsibility for the safety and security department, in conjunction with nursing leadership, is to develop or refine the hospital's EOP for incidents based on the HVA. The safety and security department needs to have assigned oversight for facility security, quick lockdown or controlled access, and management of people flowing into and out of the hospital.

9. Hospital leadership should consider which of the following ethical dilemmas prior to experiencing an actual disaster? (Select all that apply.) a. Which clinical leader will make the decision about distribution of scarce resources b. Criteria to determine which patients receive aggressive treatment and which will receive palliative care c. Which nursing staff will be the first to report to the hospital in the event of a disaster d. How prophylactic pharmaceuticals will be distributed to protect staff and their families e. Who will be primarily responsible for external communication

ANS: A, B, D An emerging issue that challenges care during a disaster is allocation of scarce resources when the system is overwhelmed. Implementing periodic tabletop discussions regarding how to allocate resources in a time of scarcity will prove to be a powerful tool in setting the stage for what to do if such an event occurs. Collaborative professional staff and hospital leadership discussions about scarce resource allocation will present ethical dilemmas that need to be thoughtfully considered in a planning time that is devoid of emotion. Questions to be discussed at the tabletop include which hospital and/or clinical leader will make the final decision about ventilator allocation and other scarce resource distribution; the criteria used to determine which patients receive aggressive treatment and which will receive palliative care, both imminently and long term, as other life-threatening complications ensue; and how prophylactic pharmaceutical dissemination plans are going to be activated to protect staff and their families.

7. The hospital plays an important role in the community in the case of a disaster. What are some of the expected roles of the hospital? (Select all that apply.) a. Stockpiling emergency equipment b. Purchasing personal protective equipment (PPE) c. Providing additional security for the community d. Educating staff on all-hazards preparedness e. Providing emergency shelter to community members

ANS: A, B, D The hospital will play an important role in the community in the case of a disaster. The materials, equipment, and training required for hospitals to prepare adequately for their role in responding to disasters are very expensive. Capital expenditures will be required to create decontamination facilities; purchase PPE; train and educate staff on effective all-hazards preparedness; stockpile emergency equipment, supplies, and pharmaceuticals; ensure adequate isolation rooms; and outfit a hospital command center. Hospitals need financial assistance to do this well, and the AHPTF members can be advocates for federal and state funding.

8. Nursing leadership competencies in disaster planning and crisis management encompass which of the following domains? (Select all that apply.) a. Assessment of the disaster scene b. Technical skills c. Budget and resource allocation d. Risk communication e. Critical thinking

ANS: A, B, D, E Nursing leadership competencies in disaster planning and crisis management are invaluable, and fortunately they have been developed by a collaborative group led by the U.S. Department of Veterans Affairs, Office of Nursing Services. These disaster competencies are categorized into four domains: assessment of the disaster scene, technical skills, risk communication, and critical thinking (Coyle et al., 2007).

5. What are the major roles of nursing leadership in disaster planning? (Select all that apply.) a. Providing clearly defined roles for staff nurses in a disaster situation b. Ensuring the synchronization of department plans c. Encouraging staff to stay at home in the event of a disaster to decrease confusion d. Ensuring that the community is synchronizing internal department plans in the event of a disaster e. Developing or refining the hospital's emergency operations plan.

ANS: A, B, E Nursing leadership needs to ensure that all facility departments understand their role in a disaster situation. Nurse leaders are the coordinators in synchronizing department plans so that everything fits together to meet the essential needs of the staff, patients, hospital, and community. Once the comprehensive emergency management plans are complete, every department should understand their identified written role. Nursing leadership, in conjunction with security, develops or refines the hospital's EOP for incidents based on the HVA.

2. A disaster is a sudden event that can cause great destruction and human suffering and often requires external assistance. Which of the following statements are accurate depictions of various types of disasters or disaster-related definitions? (Select all that apply.) a. A cyber disaster is a catastrophic event that results from the use of information technology systems. b. A catastrophic event caused by the use of weapons is a radiological disaster. c. A biological disaster occurs when there is a deliberate or unintentional release of biological materials that may affect the health of those exposed. d. A chemical disaster occurs when there is deliberate or unintentional release of biological materials that may adversely affect the health of those exposed. e. A hazard vulnerability analysis is an exercise that identifies an organization's potential emergencies.

ANS: A, C, E A cyber disaster is a catastrophic event that results from the use of information technology systems to control or disrupt critical infrastructure systems. A biological disaster occurs when there is a deliberate or unintentional release of biological materials that may affect the health of those exposed. A hazard vulnerability analysis is an exercise that identifies an organization's potential emergencies, the likelihood of the event occurring, and the impact it would have on the organization.

10. Which of the following questions should be considered in the hospital gap analysis survey of safety and security readiness in the event of a disaster? (Select all that apply.) a. Does the facility have a lockdown plan in case of emergency? b. Does the facility have procedures in place for use of PPE? c. Does the facility have a mechanism of tracking costs associated with the event? d. Do you have a plan for allowing staff entry into the facility during an emergency? e. Does the facility have emergency-powered phones in case of a disaster?

ANS: A, D, E Assessing the readiness of safety and security in the gap analysis survey can be answered by asking some of the following questions: Does the facility have a lockdown plan in case of emergency? Do you have a plan for allowing staff entry into the facility during an emergency? Does the facility have emergency-powered phones in case of a disaster?

5. What is the role of the project facilitator in the emergency management committee? a. Creating key components of disaster protocols b. Keeping the plan current and in the forefront of strategic planning c. Establishing guidelines for policy and procedures d. Improving care by developing patient care plans.

ANS: B A project facilitator is helpful in getting the committee started and operational. The project facilitator can also serve in a pivotal maintenance role, keeping the emergency management plan current and in the forefront of the administration's strategic planning over time.

10. Which of the following warnings is used to alert the American people about credible terrorist threats? a. Imminent threat b. Elevated threat c. Unlikely threat d. Likely threat

ANS: B In April 2011, the federal government implemented a new alert system, the National Terrorism Advisory System (NTAS), which replaced the color-coded system implemented by Homeland Security. The new two-level system will warn the American public about elevated threats, which warns of a credible terrorist threat, or imminent threat, warning the public that a credible and specific terrorist threat is imminent (U.S. Department of Homeland Security, 2012).

6. The nursing leadership role once the all-hazards preparedness plan is completed is to: a. confirm that resources are allocated appropriately. b. ensure that every facility department understands their role is a disaster situation. c. establish goals for all-hazards preparedness. d. provide rewards for the committee's accomplishments.

ANS: B Nursing leadership needs to ensure that all facility departments understand their role in a disaster situation. Nurse leaders are the coordinators in synchronizing department plans so that everything fits together to meet the essential needs of the staff, patients, hospital, and community. Once the comprehensive emergency management plans are complete, every department should understand their identified written role.

13. A health care system's ability to rapidly expand beyond normal capacity to meet an increased demand for qualified personnel, beds, and medical care services in the event of a large-scale emergency or disaster is known as: a. acuity. b. surge capacity. c. mass casualty. d. natural disaster.

ANS: B Surge capacity is a measurable representation of the ability to manage a sudden influx of patients (American College of Emergency Physicians [ACEP], 2011). In addition to the overall all-hazards preparedness plans, the hospital will need to define procedures regarding what will be done in any biological, chemical, nuclear/radiological, or conventional disaster, and the surge capacity needs related to any of the events

8. All-hazard preparedness plan drills should occur at least: a. annually. b. biannually. c. monthly. d. quarterly.

ANS: B The benefits of conducting biannual emergency drills, both announced and unannounced, include being able to test the EOP, the command center, and staff roles and responsibilities.

4. The system-wide emergency management plan should conduct a gap analysis. What should be evaluated? a. Differences between standards and policies and procedures b. Differences between pieces of the program that are and are not in place c. Similarities between standards and policies and procedures d. Similarities between pieces of the program that are and are not in place

ANS: B The guiding principle for creating a hospital-specific all-hazards gap analysis is to keep it simple. One example of a simple way to assess the current state is to create an emergency preparedness survey that is easy to read and requires the department directors to answer in simple checklists one of two ways: (1) "Yes, we have it," or (2) "No, we don't have it." Survey questions need to be concise and clear. The goal is to begin by identifying the areas where there are gaps in the facility's preparedness plans.

1. What are the two agencies that require all health care facilities to have detailed all-hazard preparedness plans? (Select two that are correct) a. Patient Protection and Affordable Care Act b. Health Insurance Portability and Accountability Act c. The Joint Commission d. National Response Plan

ANS: B, C Health care executives across the country understand the need to dedicate resources to support effective all-hazards preparedness. The Health Insurance Portability and Accountability Act (HIPAA) and The Joint Commission (TJC) require all health care facilities to have detailed all-hazard preparedness plans. Nursing leaders are an integral part of the planning process and should have knowledge of the national response plan and state and local disaster response plans.

3. In an AHPTF, which of the following entities could be utilized as external ad hoc members? (Select all that apply.) a. Facility engineering b. Public health department representatives c. Community physicians d. Vendor representatives e. Chaplain services

ANS: B, C, D As the AHPTF evolves in its work, ad hoc members can be added as needed. Internal ad hoc members might include radiology, facility engineering, telecommunications, volunteer support, chaplain services, physician chairs, social work, case management, dietary, respiratory, and laboratory services. External ad hoc members might include representatives from the local public health department; government liaisons; police; fire and rescue; public school systems; representatives from the faith community; community physicians; and even vendor representatives, who can be contracted to provide things such as oxygen, ice, food, cots, and linens in the event of a disaster.

6. Testing the all-hazards preparedness plan requires drilling to identify and work through problems. Which of the following are examples of internal drills that can be used to test specific departments and/or hospital responses? (Select all that apply.) a. Surge capacity drills b. Lockdown of hospital entrances c. Prioritization of police response to biological events d. Simulating decontamination processes e. Setting up the command center

ANS: B, D, E Having comprehensive all-hazards preparedness plans requires frequent (at least biannual) drills to work through problems. Internal drills test specific department and/or hospital responses (e.g., setting up and operating the command center; recognizing a biological event both in the emergency department and on the units; lockdown of the hospital entrances; simulating decontamination processes; operating using downtime procedures during a communications or cyber disaster event; handling various surge capacity situations).

3. Which combination of leadership is recommended for chairing an emergency management committee? a. Chief executive officer and internal medicine physician b. Chief financial officer and emergency care nurse liaison c. Representative chief nurse officer and emergency care physician d. Representative chief information technology officer and critical care physician

ANS: C In health care systems, system-wide executive administrators need to be part of the emergency management committee. Having a senior executive administrator of the health care system serve as the chairperson of the committee will provide the leadership needed to communicate the importance of emergency preparedness as a system priority. A representative CNO and emergency medicine physician, serving as co-chairs with the senior executive administrator, can create a dynamic team that is uniquely prepared to tackle any issues that arise.

7. In a disaster, it is most important that the: a. clients are sent home quickly. b. medications and supplies are secure. c. nurses and their families feel safe. d. security department increases its workforce.

ANS: C It is most important that the staff members feel safe. In a disaster, the paradigm of keeping the patient safe first needs to change its focus so that staff members and their families feel as safe as possible. This way, staff members are best able to meet their patients' needs.

15. In an AHPTF, who would have primary responsibility for serving as spokesperson for emergency physician needs with regard to disaster preparedness? a. Chief nursing officer b. Marketing director c. Department medical director d. Chief information technology officer

ANS: C The emergency department medical chair would represent all aspects of emergency medicine and physician needs related to all-hazards preparedness.

2. An example of a cyber disaster is a catastrophic event caused by: a. the use of military weapons. b. an exposure to toxic materials. c. an outbreak of a pathogen. d. an attack initiated from one computer against another.

ANS: D A cyber disaster is a catastrophic event that results from an attack initiated from one computer against another computer with the purpose of compromising the information stored on it.

14. The Joint Commission's (TJC's) emergency management accreditation standards call for hospitals to sustain disaster operations for at least ______ hours. a. 24 b. 48 c. 72 d. 96

ANS: D TJC's emergency management accreditation standards call for hospitals to sustain disaster operations for at least 96 hours should an external disaster occur that impacts the local area or region (TJC, 2012). Lessons learned from Hurricane Katrina illustrate just how long it can take before assistance is available.

9. An all-hazards command center usually: a. facilitates planning meetings. b. provides a place for the commander to sleep. c. is operated by an emergency department triage nurse. d. is located near the security department.

ANS: D The command center usually is located near the security department and is commanded by the administrator on call, along with the chief nurse officer, emergency department-air care medical director, and safety and security director.

12. When working with the community, recognizable nomenclature is important for: a. response. b. education. c. reporting. d. communication.

ANS: D When working with the community, using common language becomes especially important for promoting interagency communication in crisis situations. Therefore the National Incident Management System (NIMS) was created by the U.S. Department of Homeland Security (2016) Secretary to further standardize and integrate response practices nationally