ASTM E2413-04(2009)
(Guide)Standard Guide for Hospital Preparedness and Response (Withdrawn 2018)
Standard Guide for Hospital Preparedness and Response (Withdrawn 2018)
SIGNIFICANCE AND USE
This guide is intended to assist the leaders of hospitals in the design, planning, and response to be undertaken by hospitals and health care organizations to an event that necessitates the activation of an emergency operations plan.
This guide provides procedures to coordinate and provide a systematic and structured response to manage an incident.
This guide provides management tools that can assist in providing essential training objectives and decision-making models for hospital leadership and hospital regulatory agencies.
This guide will be as consistent as possible with the following existing industry standards: Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) Environment of Care (EC) standards, NFPA 1600, the National Incident Management System (NIMS), and the Health Resources and Services Administration (HRSA) Hospital Bioterrorism (BT) Preparedness Program.
Compliance with the JCAHO standards is of paramount concern to health care organizations. JCAHO’s EC standards include safety, security, hazardous materials and wastes, emergency management, fire safety, medical equipment, and utilities management. The EC chapter addresses planning and implementation and measuring and improving activities, with education and training activities addressed in standards relating to human resources.
NFPA 1600 is highly regarded as a national preparedness standard. NFPA 1600 serves as the basis for the standard used by the Emergency Management Accreditation Program (EMAP) for state, local, and tribal governments.
The National Incident Management System (NIMS) was required for all federal departments and agencies as a part of Homeland Security Presidential Directive #5. NIMS is also required for state and local government entities who receive federal grant funds. This impacts hospitals (public and private sector) through participation in the HRSA Hospital BT Program as well as the JCAHO Incident Command System/Incident Management System ...
SCOPE
1.1 This guide covers concepts, principles, and practices of an all-hazards comprehensive emergency management program for the planning, mitigation, response, recovery, and coordination of hospitals in response to a major incident.
1.2 This guide addresses the essential elements of the scope, planning, structure, application, and coordination of federal, state, local, voluntary, and nongovernmental resources necessary to the emergency operations plan for a hospital.
1.3 This guide establishes a common terminology for hospital emergency management and business continuity programs necessary to fulfill the basic service requirements of a hospital.
1.4 This guide provides hospital leaders with concepts of an emergency management plan, but an individual plan must be developed in synchrony with the community emergency operations plan and the National Incident Management System.
1.5 This guide does not address all of the necessary planning and response of hospitals to an incident that involves the near-total destruction of community services and systems.
1.6 For the purposes of this guide, the definition of hospital will be the current definition provided by the American Hospital Association for an acute care facility.
1.7 This standard does not purport to address all of the safety concerns, if any, associated with its use. It is the responsibility of the user of this standard to establish appropriate safety and health practices and determine the applicability of regulatory requirements prior to use.
WITHDRAWN RATIONALE
This guide covered concepts, principles, and practices of an all-hazards comprehensive emergency management program for the planning, mitigation, response, recovery, and coordination of hospitals in response to a major incident.
Formerly under the jurisdiction of Committee E54 on Homeland Security Applications, this guide was withdrawn in July 2018 in accordance with section 10.6.3 of the Regul...
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Standards Content (Sample)
NOTICE: This standard has either been superseded and replaced by a new version or withdrawn.
Contact ASTM International (www.astm.org) for the latest information
Designation: E2413 − 04 (Reapproved 2009)
Standard Guide for
Hospital Preparedness and Response
This standard is issued under the fixed designation E2413; the number immediately following the designation indicates the year of
original adoption or, in the case of revision, the year of last revision. A number in parentheses indicates the year of last reapproval. A
superscript epsilon (´) indicates an editorial change since the last revision or reapproval.
1. Scope NFPA1994 StandardonProtectiveEnsemblesforChemical/
Biological Terrorism Incidents
1.1 This guide covers concepts, principles, and practices of
an all-hazards comprehensive emergency management pro-
3. Terminology
gram for the planning, mitigation, response, recovery, and
coordination of hospitals in response to a major incident. 3.1 Definitions of Terms Specific to This Standard:
3.1.1 all-hazards, adj—hazard is an inherent property of an
1.2 Thisguideaddressestheessentialelementsofthescope,
event, product, or object that represents a threat to human life,
planning, structure, application, and coordination of federal,
property, or the environment. In this context, all-hazards refers
state, local, voluntary, and nongovernmental resources neces-
to any incident or event that could pose such a threat.
sary to the emergency operations plan for a hospital.
3.1.1.1 Discussion—These may include special equipment
1.3 This guide establishes a common terminology for hos-
and processes that are used less frequently on a daily basis and
pital emergency management and business continuity pro-
require routine training to be most effective during a major
grams necessary to fulfill the basic service requirements of a
incident.
hospital.
3.1.2 basic societal functions, n—those basic functions
1.4 This guide provides hospital leaders with concepts of an
within a community that provide services for public health,
emergency management plan, but an individual plan must be
health care, water/sanitation, shelter/clothing, food, energy
developed in synchrony with the community emergency op-
supply, public works, environment, logistics/transportation,
erations plan and the National Incident Management System.
security, communications, economy, and education.
1.5 This guide does not address all of the necessary plan-
3.1.3 business impact analysis (BIA), n—management level
ning and response of hospitals to an incident that involves the
analysis that identifies the impacts of losing the entity’s
near-total destruction of community services and systems.
resources by measuring the effect of the resource loss and
1.6 For the purposes of this guide, the definition of hospital escalating losses over time to provide the entity with reliable
will be the current definition provided by the American data upon which to base decisions concerning hazard
Hospital Association for an acute care facility. mitigation, recovery strategies, and continuity planning.
1.7 This standard does not purport to address all of the 3.1.4 capacity, adj—capability at a given time for a hospital
safety concerns, if any, associated with its use. It is the
toprovideagivenservicethatisdistinctfromcapability,which
responsibility of the user of this standard to establish appro- defines an ability to provide a service under normal operating
priate safety and health practices and determine the applica- conditions.
bility of regulatory requirements prior to use. 3.1.4.1 Discussion—A facility may have the capability to
treat acute major incident patients in a cath lab, but if a critical
2. Referenced Documents
resource is missing at the time of a disaster (for example,
2 personnel, equipment, space, or electricity), the facility would
2.1 NFPA Standards:
not have the capacity to care for such a patient at that time
NFPA 1600 Standard for Disaster/Emergency Management
when there is a need.
and Business Continuity Programs
3.1.5 communications systems, n—those processes and re-
sources (physical, procedural, and personnel related) that
provide information exchange during an identified major
This guide is under the jurisdiction of ASTM Committee E54 on Homeland
Security Applications and is the direct responsibility of Subcommittee E54.02 on
incident.
Emergency Preparedness, Training, and Procedures.
3.1.6 community/region, n—that area in which a hospital
Current edition approved June 1, 2009. Published August 2009. Originally
approved in 2004. Last previous edition approved in 2004 as E2413 – 04. DOI:
provides health services and basic societal functions.
10.1520/E2413-04R09.
3.1.7 continuity of essential services, n—services that hos-
Available from National Fire Protection Association (NFPA), 1 Batterymarch
Park, Quincy, MA 02269-9101. pitals provide as a vital daily function that must be maintained
Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959. United States
E2413 − 04 (2009)
as long as possible and then restored at the earliest opportunity hospital that serves as a meeting area, with strategic and
after managing the necessary elements of the emergency tactical support for the incident command system/incident
incident. This is a business continuity planning focus. management system.
3.1.13.1 Discussion—Reference to the HEOC will avoid
3.1.8 damage assessment, n—appraisal or determination of
confusion with the community/county EOC. The EOC must
the effects of the disaster on human, structural, economic, and
haveadequatetechnicalcapabilityandpersonneltosupportthe
natural resources.
operation of the incident and the hospitals response.
3.1.9 disaster, n—sudden calamity, with or without
3.1.14 hospital evacuation, n—evacuation of a hospital
casualties, so defined by local, county, state, or federal guide-
refers to those actions by medical staff to remove inpatients,
lines; before a disaster declaration, a disaster is an event that
outpatients, and staff physically from the location of a hazard,
exceeds (or might exceed) the resources for patient care at that
thus interrupting the pathway of exposure and includes evacu-
time, for a community, a hospital, or both.
ation within the facility (horizontal or vertical) and away from
3.1.9.1 Discussion—The definition of casualty is expansive
the facility.
and could include acute injuries, illnesses, or deaths, exacer-
3.1.14.1 Discussion—Evacuation is a short-term or long-
bation of chronic medical conditions as a result of poor access
term protection strategy. An alternative short-term protection
to primary care following the disaster (disaster-related acute
technique may be sheltering, but in some circumstances
major incident), and post-traumatic stress disorders.Adisaster
(earthquake-damaged hospital), it would need to be to another
could also include sustained infrastructure incapacity and the
safe structure.
inability to access necessary external resources and supplies.
3.1.15 hospital major incident, n—major incident is any
3.1.10 fatality management, n—processes designated by
event that approaches or exceeds the capability of a hospital or
existing plans or local officials overseeing fatalities from an
health care organization to maintain operations or requires
incident(medicalexaminerorcoroner)toorganize,coordinate,
significant disruption to the routine operations of the facility to
manage, and direct manage incident fatalities and identify
address.
temporary morgue facilities.
3.1.15.1 Discussion—The definition may be institution-
3.1.10.1 Discussion—Fatalitiesthatoccurduringthetimeof
specific since hospitals on a daily basis operate with different
the incident are managed in uniform fashion, whether the
resources and capabilities to respond to different crises.
deaths appear connected to the incident or not.
3.1.16 hospital management (group supervisors/leaders/
3.1.11 hazard vulnerability analysis (HVA), n—process by
managers) , n—qualified personnel who control a specific
which a hospital’s personnel identify real or potential hazards
department, unit, area, or task assignment.
that would affect hospital operations, particularly those with
3.1.17 hospital mutual aid, n—coordination of resources,
negative implications for health care, and identify internal
including but not limited to: facilities, personnel, vehicles,
capabilities and community preparedness to address those
equipment,supplies,pharmaceuticals,andservices,pursuantto
hazards and, in a region of health care providers, this may
an agreement between hospitals and other health care
include a needs assessment as a preliminary survey of real or
organizations, providing for such interchange on a reciprocal
potential hazards to a specific group of hospitals.
basis in responding to a major incident or disaster.
3.1.11.1 Discussion—This will be accomplished with a
3.1.18 hospital surge capacity, n—ability of a hospital to
systematic approach to the probability and consequence of
expand rapidly and augment services in response to one or
hazards and events that threaten the continuity of a hospital’s
multiple incidents.
business operations. This would normally consist of determi-
3.1.18.1 Discussion—This response is under the control of
nation of the likely and potential hazards to the operations of
the facility’s emergency management plan and may include
thehospital,anevaluationofthevulnerabilityofthehospitalto
integration with regional authorities responsible for processes
those hazards, and determination of the resources necessary to
to manage and provide logistical and resource support to
reduce those hazards and vulnerability. The analysis provides
manage the patient influx.
the basis for establishing relevant major incident management
3.1.19 incident command system (ICS), n—resource man-
plans and should be coordinated with local or state authorities,
agement system identified by a chain of command that adapts
or both, and regional health care facilities as appropriate.
to an emergency event; the system adopted by the hospital
3.1.12 hospital, n—health care institution with an organized
should follow accepted ICS processes and be compatible with
medical and professional staff and inpatient beds available
the National Incident Management System.
around the clock, whose primary function is to provide
3.1.19.1 Discussion—ICS contains common terminology,
inpatient medical, nursing, and other health-related service to
individual ICS position responsibilities, integrated
patients for both surgical and nonsurgical conditions and that
communications, modular composition of resources, unified
usually provides some outpatient services, particularly emer-
command structure, manageable span of control, consolidated
gency care, for licensure purposes.
action plans and resource management, and plans for termina-
3.1.12.1 Discussion—Each state has its own definition of
tion and restoration of business continuity. The system allows
hospital, which affects licensing under laws of that state.
emergency responders from hospitals and other emergency
3.1.13 hospital emergency operations center (HEOC), response organizations to coordinate activities with familiar
n—(also known as a command center) designated area of the management concepts and request and implement mutual aid.
E2413 − 04 (2009)
3.1.20 incident commander, n—individual responsible for 3.1.27.1 Discussion—Mutual aid agreements between enti-
the overall management and coordination of personnel and ties are an effective means to obtain resources in emergency
resources involved in a major incident. situations and augment surge capacity.
3.1.20.1 Discussion—With a hospital event, the hospital
3.1.28 mutual aid agreement, n—cooperative assistance
incident commander is that official within an entity (for
agreements, intergovernmental compacts, or other documents
example, hospitals or group of hospitals) who serves as the
commonly used for the sharing of resources.
EOC executive and coordinates the assets of the entity in the
3.1.29 personal protective equipment (PPE), n—ensembles
response to an event. The hospital incident commander should
and ensemble elements to protect health care workers from
be the best qualified depending on the nature of the incident.
contact with dangerous agents, including chemicals, biologic
This may be the senior physician on site, a department head, a
agents, blood, and body fluids, when providing victim or
nursing or house supervisor, or a hospital administrator. If the
patient care during emergency medical operations; levels of
scope of the incident involves more then the hospital alone, the
PPE are defined in NFPA 1994. Also refer to Centers for
community official responsible for community response may
Disease Control HICPAC Isolation Guidelines.
be the incident commander of record.
3.1.29.1 Discussion—Thisequipmentwouldmeetminimum
3.1.21 incident management system (IMS), n—inemergency
design, performance, testing, and certification requirements for
management applications, the combination of facilities,
use during emergency operations, as identified from the HVA.
equipment, personnel, procedures, and communications oper-
3.1.30 preparedness, adj—encompasses those actions taken
ating within a common organizational structure with responsi-
before an incident to improve the capability and capacity to
bility to accomplish stated objectives pertinent to an incident
respond to a major incident within the hospital, community, or
effectively.
region. Preparedness efforts include, but are not limited to:
3.1.21.1 Discussion—The system identifies management re-
assessments of hazards, risks, response needs, and vulnerabili-
sponsibilities and establishes policies and procedures for coor-
ties; planning functions; interagency collaboration; education
dinating emergency response, business continuity, and recov-
and training functions; exercise activities; attaining minimal
ery activities across hospital departments, outside agencies,
capacities; and necessary engineering controls or structural
and jurisdictions and that maintains compliance with state or
changes to facilities and do not include mobilization of
federal regulations. The incident command system is an
response resources under circumstances other than simulated
integral component of the incident management system.
events.
3.1.22 major incident, n—this is defined within the context
3.1.31 public health surge capacity, n—ability of a defined
of all-hazards preparedness as any event that approaches or
community and its health care system to rapidly expand
exceedsthecapacityofahospitalorhealthcareorganizationto
beyond normal services to meet the increased demand for
maintain operations or requires significant disruption to the
medical care and public health that would be required to care
rou
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