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Anticipating the worst

April 1, 2007
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A little planning can go a long way during an emergency

Memories of the chaos caused by Hurricane Katrina, coupled with a post-9/11 awareness of the magnitude of emergencies that affect entire communities, have prompted behavioral healthcare organizations to examine their emergency plans, including their role in community-wide disaster-preparedness activities. Recent American disasters have demonstrated that even those organizations with solid plans face daunting challenges when the major parts of a community's infrastructure are damaged or overwhelmed by a population in need of assistance.

During an emergency, 24-hour behavioral healthcare settings must be prepared to care for the needs of their clients in place, while others will focus much of their energy on finding and providing resources for their clients in the community. And of course, some provider organizations will be called on to provide mental health first aid to early responders, witnesses of the event, and a wide variety of other community members who may experience post-trauma distress.

The Joint Commission and various regulators long have mandated that behavioral healthcare organizations plan for emergencies. The goal is to enable organizations and communities to care for themselves in the initial phase following natural or man-made disasters and to build on existing relationships so that comprehensive plans meet the needs of the communities they serve.

The Joint Commission, which has been actively involved in disaster preparedness for more than 30 years, increased its focus on emergency management two years before 9/11, and since has worked even more closely with emergency management experts and healthcare organizations to make this issue a priority. The resulting accreditation standards and overall guidelines developed by multiple expert roundtables better reflect the need for behavioral healthcare organizations to be involved in community-wide planning.

The Joint Commission's Management of the Environment of Care (EC) standards require behavioral healthcare organizations to develop a management plan that ensures an effective response to emergencies, to implement that plan, and to execute the plan by conducting emergency management drills. These standards also require behavioral healthcare organizations to participate with the community in establishing priorities among potential emergencies, defining an organization's role in the community's emergency management program, and linking with the community's command structure. The table lists the 2007-2008 Joint Commission behavioral care accreditation standards for emergency management planning.

Specific Challenges

Behavioral healthcare organizations face special challenges during an emergency. Hurricane Katrina showed that vulnerable populations can be at particular risk. Clients served by behavioral health organizations, especially those living in the community, might not have the information or resources to make a timely response to an emergency and, therefore, are most in need of the good judgment of providers and organizational leaders with whom they are familiar.

When working with community leaders to plan for emergencies, it is important for behavioral healthcare leaders to detail the special needs of their clients. Areas of consideration may include:

Communication.How will communication with clients be handled during the chaos of an emergency? Plans should include instructions to foster parents on emergency contact information. Methadone maintenance clients may need to be made aware of alternative sites for medication.

Basic functions.A 24-hour care setting must consider what resources will be needed to feed and care for the client population and staff in the event they must stay in place without access to community resources.

Mental health first aid.Some community-based providers must consider both the needs of their clients and their role in the community at-large to provide mental health first aid following a disaster.

An All-Hazards Approach

Behavioral healthcare organizations, in collaboration with community leaders, can address the challenges of responding to disasters. By conducting a hazard-vulnerability analysis, organizations can identify the types of emergencies that may occur in their communities and plan for how to respond.

For example, is the behavioral healthcare facility in an area subject to weather emergencies such as blizzards, floods, or tornadoes? Are there railroad tracks or highways nearby that could be the site of a hazardous chemical spill? The idea is to consider the effects that specific types of emergencies would have on the organization and the community, as well as the demand for services.

As part of this process, it is important to remember that an emergency might have a cascading effect. For example, in New Orleans Hurricane Katrina initially did not cause as much damage, but the resulting levee breaches caused devastating flooding that led to the loss of power, communications failures, blocked escape routes, and so forth.

After compiling as complete a list as possible, the organization should prioritize the emergencies based on the likelihood of occurrence. Finally, the areas of vulnerability that most demand organizational attention should be addressed.