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Editors Note: This article is the 4th in a periodic series focused on incorporating emergency management principles into nursing practice.
I've often found that people latch on to one piece of preparedness and exclude others. Some people focus on training. Others focus on equipment and facilities. With so many aspects of preparedness, it becomes difficult to keep track of the big picture.
But there are ways to provide a process that keeps all these aspects in mind.
We talked about forming a team of experts who can help complete a risk assessment in a previous article. This is a great first step. It provides a well reasoned and scientific basis for how you'll spend time and money to prevent and prepare for an incident.
The next step is to define your capabilities.
Physical Assets
 In many cases, determining what physical assets you have is an easy and logical first step.
Physical assets can include:
Facilities - Building and physical space should be considered. Where are your facilities? What services do they provide (e.g. clinic, radiology, outpatient surgery, etc.)? How many beds do you have? (Break them down by specialty, e.g. emergency department, critical care, telemetry, pediatrics, etc.) On an average day, how many beds are occupied?
Equipment - Specialized and critical equipment should be considered. This should include radiology equipment (X-ray machines, CT scanners, MRIs, etc.), life support, monitoring equipment (ECGs, telemetry units), intravenous equipment (pumps and poles), and transportation equipment (gurneys, wheelchairs, etc.) It should also include support equipment (autoclaves, incinerators, backup generators, etc.) and security equipment. This list is not comprehensive. It does provide a starting point.
Expendables - This category covers anything that is consumed. This can include pharmacological supplies, intravenous fluids and tubing, blood supplies, needles, oxygen supplies, personal protective equipment, batteries and generator fuel. Counting every last glove and needle is a waste of time. Instead, consider how many day's worth of stock you have and compare it to what critical resources you will need to continue to operate for at least 72 hours after a disaster cuts off your supply source. You should have an idea of what supplies you'll run out of first and how much more you'll need to be self sustaining for that time period.
Staff - All staff must be considered. You should note the source of your staff. Almost every healthcare facility relies on temporary or agency staff. If you do, find out how many other facilities also use the agency or contractor. During a disaster, they may not be able to support you because they have sent their personnel to other clients. You should also check if your organization has a list of skilled and unskilled volunteers who can supplement your staff.
Dual Training
There are two areas of training that must be assessed.
The first involves job-specific training; the second involves emergency planning.
Emergency Management Series
You would expect your ED nurse to be trained in emergency nursing. But in what other specialties or areas could this nurse work? Can your med/surg physician work as an emergency physician?
Your risk assessment should identify critical functions, and you can focus on defining which staff can be pulled to support these functions. Also, you should consider where you can cross train people easily and cheaply.
And while all staff are trained what to do when there is a fire or if a child is missing, how many people are trained on the hospital's hazardous materials release plan?
How many are trained to evacuate the entire hospital?
With staff constantly turning over, you may find few people have been trained and are able to actually do the job.
Planning & Exercises
The Joint Commission requires medical facilities to plan for emergencies and exercise these plans to maintain accreditation. This provides a good starting point for assessing your plans.
However, the mere existence of the plan should not be the extent of your assessment. There are a few more things you should check...
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