In the past, the HCO EOP was commonly (and inaccurately) referred to as the disaster plan. Fortunately, this has begun to change as the EOP evolves into a guide to address less overwhelming emergencies and hazard threats. For early response activities, the EOP uses operational checklists (or job action sheets) for designated functions. Later stages of response, and initial stages of recovery, should be addressed by a proactive management method that emphasizes documentation of response objectives, strategies, and specific tactics.
Key Components of the HCO EOP:
- The management structure and methodology that will be used in an emergency, including the organization and operation of the internal HCO Incident Command Post (ICP). This should be easily identifiable to external coordinating agencies.
- General organizational descriptions of Operations, Planning, Logistics, and Administration/Finance Sections, which personnel perform them, and the processes/procedures to be used.
- Essential activities to be performed during each stage of emergency response. These activities should be coordinated with other HCOs (through Tier 2) and with jurisdictional incident management (Tier 3) to maximize MSCC across the system.
- Methods for adequately processing and disseminating information during an emergency, including names and contact information for external liaisons and contacts at other HCOs and the jurisdictional level (Tier 3).
- Processes to promote continuity of HCO operations, including patient care, business continuity, and pre-identified sources for external support (e.g., mutual aid partner facilities).
- Guidance on how to develop and release public messages during emergencies, including coordination with the jurisdiction (Tier 3) public information function.
- Guidance for very unusual hazards or for special circumstances, such as hospital evacuation or "shelter in place." Typically addressed in annexes to the EOP, this guidance should use the same processes established for other emergencies.
The structure of the EOP in emergency management is becoming more standardized, and HCOs should consider conforming to this structured approach. Figure 2-1 provides a synopsis of the EOP structure demonstrated in the National Response Plan (NRP)[8] and the example below provides an EOP structure and format specifically for HCOs.
Figure 2-1. Organization of the National Response Plan
The material developed for the EOP should be formatted for ease of use during response and recovery yet must remain comprehensive. This EOP format is consistent with the common format of other disciplines and is consistent with the NRP format[9]:
Introduction (may be considered part of the Base Plan)
- Title page
- List of changes (with dates) to the EOP
- Table of contents
- Executive summary: Provides an awareness level of proficency with the EOP.
EOP Base Plan - Provides an understanding of how the organization responds and how it interfaces with the outside environment during response. Essential sections include:
- Purpose/Mission: goal and objectives
- Scope
- Situation and assumptions
- Concept of Operations (including a System Description)
EOP Funtional Annexes - Specific more detailed description of the response guidance for each functional area, including;
- Each functional annex provides the general response objective for the functional area, the response structure, activation and mobilization procedures specific to that function, and its concept of operations
- Position descriptions and qualifications, operational checklists (job action sheets) for positions
- Forms (including ICS forms) and other jobs aids to accomplish the tasks.
EOP Support Annexes - Specific processes and procedures that apply to all or most of the response functions and support response and recovery, including:
- Common administrative requirements
- Continuity of operations process and procedures
- Occupant emergency procedures
- Worker safety and health procedures
- Media policy and procedures
- Resource ordering procedures
- Response and recovery financial management procedures
- Emergency credentialing and privileging of volunteers and mutual aid personnel
- Others
Incident Annexes - Contingency considerations for specific hazards, sites, and situation (roles, responsibilities, procedures), to include:
- Pre-plans for common hazards:
- Weather emergencies
- Hazardous materials
- Infectious disease outbreak
- Explosive threat
- Security situations
- Infant abduction
- Care for the High Level Protectee
- Civil disturbance
- Others as identified through HVA.
Appendices - Additional materials that are revelant to guidance for emergency response and recovery, including:
- Glossary
- Acronyms
- Authorities (if not incorporated into the Introduction)
- Compendium of pertinent local and regional response plans and procedures
- Resource lists and content information
It is important to recognize that many private physician offices, neighborhood clinics, and other "smaller" Tier 1 assets do not have the management infrastructure or personnel necessary to establish complex processes for incident preparedness and response. However, these entities may find themselves, during a major incident, compelled to participate in the community response beyond simply referring patients to a hospital or closing down their clinical operations. This is because:
- Victims often seek medical care in settings they are familiar with, such as a personal physician's office
- When medical surge demands severely challenge hospitals, patients may seek care at alternative facilities
- Some victims' treatment requirements, or persons with medical special needs, may be adequately managed in these smaller settings
- Certain events, such as a biological agent release, may be prolonged in duration and generate patients that can be safely evaluated in these settings, thus relieving some of the burden on larger HCOs.
The approach to emergency preparedness and response for these Tier 1 assets can be relatively simple. They may elect to integrate with each other and with the community response in one of two ways:
- Associate with a larger Tier 1 organization (e.g., hospital, integrated healthcare system, large outpatient facility) where they have privileges, or with a local professional medical society. The organizing body must have the ability to manage ongoing EMP activities and, during response, to perform incident management processes, such as incident action planning and disseminating information to its participants.
- Participate in at least the information processing function of the ICS. For this to occur, the smaller Tier 1 asset must know where to obtain authoritative information and where to report information. The exchange of incident-related informaton should include the following:
- Where to obtain information on personal protection and other incident-specific safety measures for practitioners, their staff, and patients.
- Where to obtain reliable incident information that allows anticipation of medical needs, such as unusual patient treatment requirements.
- Where to obtain guidance on the specific medical evaluation of incident cases, such as the availability of confirmatory lab tests and the test limitations.
- Where to obtain pertinent information on populations at risk (e.g., for a biological event, understanding the community- wide approach to risk stratification for potentially exposed patients).
- Where to obtain information on whether public health emergency powers have been invoked, allowing release of private patient information, and other deviations from standard medical practice.
- Where to send reports and what information to transmit on patients who have been evaluated and/or treated at the practitioner's location. This helps jurisdictional authorities (Tier 3) determine the size and scope of the event and monitor incident parameters.
- U.S. Department of Homeland Security, National Response Plan, August 2004
- Emergency Management Principles and Practices for Healthcare Systems: Unit 1
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