In November 2013, Typhoon Haiyan ripped through the central Philippines, causing an immense amount of destruction and taking the lives of thousands of people. Closer to home, Hurricane Sandy had a devastating impact on New York and New Jersey in October 2012. In Joplin, Missouri, an EF-5 tornado cut a damaging path through town in May 2011, directly hitting the hospital. Severe storms and flooding are regular events throughout large areas of the United States every year, disrupting normal life and the delivery of services, including healthcare services.
Natural disasters occur frequently, and few geographical areas are exempt from their effects. Along with all the other effects of these events, they inevitably have consequences for hospitals and laboratories in the affected regions. Other types of disasters as well can affect laboratory operations. A pandemic influenza scenario might reduce the availability of staff. A major computer failure may hinder a laboratory’s business continuity and its ability to serve the public. The dreadful possibility of violence or terrorism must be acknowledged, too.
The clinical laboratory has both a regulatory and an ethical responsibility to its patients and its staff during a disaster situation. That responsibility includes service (when possible), protection, and the ability to recover quickly from an event. With careful preparation, planning, and testing, a comprehensive laboratory emergency management plan can ensure that those responsibilities are fulfilled.
Preparation and regulations
Given the wide variety of possible disasters that can affect a laboratory, it may seem impossible to be prepared for every type of event that could occur. Some labs take a reactive approach and create individual plans for different disaster types. For example, a lab manager may decide to create a blizzard response plan after a major winter storm—a plan that is separate from any previously existing lab emergency response plan. The best type of emergency response plan, however, is a single plan that will enable the laboratory to continue to provide services in a variety of disaster scenarios.
The Joint Commission (TJC), a hospital-regulating agency, requires that the laboratory must have an emergency management plan, preferably its own, unless the hospital’s plan includes sufficient detail for the lab’s response. This Emergency Management (EM) plan should identify the laboratory’s capability and response for up to 96 hours after the disaster strikes. This does not mean that the lab has to stockpile enough supplies to last for 96 hours, but it must have a detailed plan as to what the response will look like during that time frame. TJC also requires that the laboratory EM plan describe the details of the recovery of normal laboratory operations after a disaster event ends. Also, the laboratory is required to evaluate the effectiveness of its EM plan. This can be accomplished through drills or even through assessments after a real event. Det Norske Veritas, another increasingly utilized hospital-regulating organization, states that pre-planning and training are the most critical elements of the laboratory emergency management process
The College of American Pathologists (CAP) mandates that a lab must have policies and procedures for both internal and external disaster preparedness. This is a broad directive, and many details must be put in place in order to meet this regulation. Internal disasters may include fires, utility outages, computer service issues, and staffing shortages. The potential external disaster types are numerous, which is why laboratory plans need to be detailed and adaptable. CAP also requires laboratories to have comprehensive and workable evacuation plans. These plans must feature methods of evacuating employees, patients, and disabled persons.
Response
Because there have been so many disasters affecting hospitals and laboratories, there can be much to learn from reviewing the responses of others. Labs can use this information to improve their own emergency management strategies in the course of varying events they may face. Many tragic but instructive stories are still surfacing from the aftermath of Hurricane Katrina (2006) in New Orleans. Hospitals were not prepared for a disaster of that magnitude, and much has been learned since then about how to improve readiness in order to save lives. The same is true of Superstorm Sandy. When the storm made landfall in the New York City area, there had to be more hospital evacuations than anticipated because of the lack of on-site generators; this is a correctible problem from which facilities can learn.
Because of the magnitude of disaster scenarios such as Sandy and Katrina, the laboratories affected were left without the ability to rely on support or aid from organizations in the surrounding areas. One thing we have learned is that in such situations, labs must have strategies to remain operational.
Marsha Donaldson, Laboratory Coordinator of Safety and Continuing Education at DCH Health System in Tuscaloosa, Alabama, experienced one of these types of scenarios first hand. In 2011, the state experienced the worst tornado outbreak in its history. One of the largest of the tornadoes that day was a mile-and-a-half wide, and it left a six-mile path of destruction in the city before traveling on for another 80 miles across the state. The storm caused 64 fatalities and 1,500 residents were injured; many more were left homeless. Many support agencies were either destroyed or heavily damaged. The Salvation Army and the Emergency Management office were destroyed. Fire departments, police stations, water towers, and even the Red Cross office sustained damage. As darkness fell, shortly after the tornado, the hospital was the sole standing building in the middle of the destruction. Its lights were a beacon for the injured who converged on the building.
The laboratory’s response at DCH first involved obtaining sufficient staff to keep the lab operational. This proved difficult since travel to and from the hospital was hindered by large debris. Despite that, retired physicians and other staff came in to provide assistance in the lab and throughout the hospital. The extra help was critical in this case since the influx of patients was so large. Fortunately, the recovery for the laboratory after the tornado was fairly rapid. Emergency power remained functional until regular power could be restored, and supplies and staff were brought in once the roads were cleared.
Donaldson made several changes to the laboratory’s disaster response as a result of lessons learned from the incident. The lab re-evaluated its emergency power needs, and lab leaders began to evaluate “push to talk” devices, since cell phone service was disabled during and after the storm. Even with a comprehensive emergency management plan in place, Donaldson says there will always be unexpected events during a disaster. It is important to remain flexible and to be able to adapt to situations as they occur
In Joplin, Missouri, the EF-5 tornado disaster response was much different. In that scenario, Mercy Hospital took a direct hit from the tornado and operations inside had to cease. Patients and point-of-care laboratory testing were moved to a nearby hospital and convention center. Supplies were moved to an off-site warehouse. Chemistry analyzers were provided by vendors on trucks, but it was often too hot for them to function properly. Other vendors also provided much needed lab supplies and equipment, and because LIS servers were kept off-site, the computer recovery process was augmented.
Lab directors and other stakeholders understand the importance of learning from situations that occurred elsewhere and how labs responded to them; their own lab may benefit from the experiences of others if a similar disaster occurs in their area. For example, most laboratories in Virginia had not thought to include earthquake response in their disaster plans; since a seismic event in 2011, earthquake education has been given across the state. The effectiveness of a given lab’s disaster response will be defined in part by its knowledge of what others have experienced, and by learning what worked well in those situations.
Recovery and readiness
The EM plan for the laboratory should guide it through a disaster, but it should also lay our procedures for recovering. The path to normal operations may be fraught with roadblocks and detours, particularly when the lab must deal with other departments in a hospital or belongs to a system of labs that were also affected by the disaster. The recovery phases should include staff stabilization, utility checks, and supply replenishment. It should also include procedures for returning to the original operation location if a lab evacuation was part of the emergency response.
The most comprehensive laboratory EM plans can be very large and complex. Because they are such a vital set of procedures, it is important that lab staff can read and easily follow their multiple steps. It is also important that leadership and other departments that will interact with the lab in an emergency understand how the department response will influence them.
Performing disaster drills is a method the lab can use to ensure that staff understands how to use the EM plan. Because procedures may be intricate, it is important for labs to work through them to make sure they will work when a real emergency situation arises. Labs can create several scenarios that could affect their lab operations and perform table-top drills to discuss the details of how the plan would be followed. This is a helpful technique with which to make improvements when they encounter plan features that may not be effective or workable.
Labs should be prepared for the unexpected. They should drill with scenarios that they have not encountered, or those which are unlikely but not impossible in their area. This will enable the laboratory to generate the most effective emergency management plan, and it will allow the staff to be truly ready when a real disaster occurs.
