ASTM E2413-04
(Guide)Standard Guide for Hospital Preparedness and Response
Standard Guide for Hospital Preparedness and Response
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.
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Designation:E2413–04
Standard Guide for
Hospital Preparedness and Response
This standard is issued under the fixed designation E 2413; 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 (e) indicates an editorial change since the last revision or reapproval.
1. Scope 3. Terminology
1.1 This guide covers concepts, principles, and practices of 3.1 Definitions of Terms Specific to This Standard:
an all-hazards comprehensive emergency management pro- 3.1.1 all-hazards, adj—hazard is an inherent property of an
gram for the planning, mitigation, response, recovery, and event, product, or object that represents a threat to human life,
coordination of hospitals in response to a major incident. property, or the environment. In this context, all-hazards refers
1.2 Thisguideaddressestheessentialelementsofthescope, to any incident or event that could pose such a threat.
planning, structure, application, and coordination of federal, 3.1.1.1 Discussion—These may include special equipment
state, local, voluntary, and nongovernmental resources neces- and processes that are used less frequently on a daily basis and
sary to the emergency operations plan for a hospital. require routine training to be most effective during a major
1.3 This guide establishes a common terminology for hos- incident.
pital emergency management and business continuity pro- 3.1.2 basic societal functions, n—those basic functions
grams necessary to fulfill the basic service requirements of a within a community that provide services for public health,
hospital. health care, water/sanitation, shelter/clothing, food, energy
1.4 This guide provides hospital leaders with concepts of an supply, public works, environment, logistics/transportation,
emergency management plan, but an individual plan must be security, communications, economy, and education.
developed in synchrony with the community emergency op- 3.1.3 business impact analysis (BIA), n—management level
erations plan and the National Incident Management System. analysis that identifies the impacts of losing the entity’s
1.5 This guide does not address all of the necessary plan- resources by measuring the effect of the resource loss and
ning and response of hospitals to an incident that involves the escalating losses over time to provide the entity with reliable
near-total destruction of community services and systems. data upon which to base decisions concerning hazard mitiga-
1.6 For the purposes of this guide, the definition of hospital tion, recovery strategies, and continuity planning.
will be the current definition provided by the American 3.1.4 capacity, adj—capability at a given time for a hospital
Hospital Association for an acute care facility. toprovideagivenservicethatisdistinctfromcapability,which
1.7 This standard does not purport to address all of the defines an ability to provide a service under normal operating
safety concerns, if any, associated with its use. It is the conditions.
responsibility of the user of this standard to establish appro- 3.1.4.1 Discussion—A facility may have the capability to
priate safety and health practices and determine the applica- treat acute major incident patients in a cath lab, but if a critical
bility of regulatory requirements prior to use. resource is missing at the time of a disaster (for example,
personnel, equipment, space, or electricity), the facility would
2. Referenced Documents
not have the capacity to care for such a patient at that time
2.1 NFPA Standards: when there is a need.
NFPA 1600 Standard for Disaster/Emergency Management
3.1.5 communications systems, n—those processes and re-
and Business Continuity Programs sources (physical, procedural, and personnel related) that
NFPA 1994 Standard on Protective Ensembles for
provide information exchange during an identified major
Chemical/Biological Terrorism Incidents incident.
3.1.6 community/region, n—that area in which a hospital
provides health services and basic societal functions.
3.1.7 continuity of essential services, n—services that hos-
This guide is under the jurisdiction of ASTM Committee E54 on Homeland
Security and is the direct responsibility of Subcommittee E54.02 on Emergency
pitals provide as a vital daily function that must be maintained
Preparedness, Training, and Procedures.
as long as possible and then restored at the earliest opportunity
Current edition approved Nov. 1, 2004. Published November 2004.
after managing the necessary elements of the emergency
Available from National Fire Protection Association (NFPA), 1 Batterymarch
Park, Quincy, MA 02269-9101. incident. This is a business continuity planning focus.
Copyright © ASTM International, 100 Barr Harbor Drive, PO Box C700, West Conshohocken, PA 19428-2959, United States.
E2413–04
3.1.8 damage assessment, n—appraisal or determination of haveadequatetechnicalcapabilityandpersonneltosupportthe
the effects of the disaster on human, structural, economic, and operation of the incident and the hospitals response.
natural resources.
3.1.14 hospital evacuation, n—evacuation of a hospital
3.1.9 disaster, n—sudden calamity, with or without casual- refers to those actions by medical staff to remove inpatients,
ties, so defined by local, county, state, or federal guidelines; outpatients, and staff physically from the location of a hazard,
before a disaster declaration, a disaster is an event that exceeds thus interrupting the pathway of exposure and includes evacu-
(ormightexceed)theresourcesforpatientcareatthattime,for ation within the facility (horizontal or vertical) and away from
the facility.
a community, a hospital, or both.
3.1.9.1 Discussion—The definition of casualty is expansive 3.1.14.1 Discussion—Evacuation is a short-term or long-
and could include acute injuries, illnesses, or deaths, exacer- term protection strategy. An alternative short-term protection
bation of chronic medical conditions as a result of poor access technique may be sheltering, but in some circumstances
to primary care following the disaster (disaster-related acute (earthquake-damaged hospital), it would need to be to another
major incident), and post-traumatic stress disorders.Adisaster safe structure.
could also include sustained infrastructure incapacity and the
3.1.15 hospital major incident, n—major incident is any
inability to access necessary external resources and supplies. event that approaches or exceeds the capability of a hospital or
3.1.10 fatality management, n—processes designated by health care organization to maintain operations or requires
significant disruption to the routine operations of the facility to
existing plans or local officials overseeing fatalities from an
incident(medicalexaminerorcoroner)toorganize,coordinate, address.
manage, and direct manage incident fatalities and identify 3.1.15.1 Discussion—The definition may be institution-
temporary morgue facilities.
specific since hospitals on a daily basis operate with different
resources and capabilities to respond to different crises.
3.1.10.1 Discussion—Fatalities that occur during the time
of the incident are managed in uniform fashion, whether the 3.1.16 hospital management (group supervisors/leaders/
deaths appear connected to the incident or not. managers), n—qualified personnel who control a specific
department, unit, area, or task assignment.
3.1.11 hazard vulnerability analysis (HVA), n—process by
which a hospital’s personnel identify real or potential hazards 3.1.17 hospital mutual aid, n—coordination of resources,
that would affect hospital operations, particularly those with including but not limited to: facilities, personnel, vehicles,
negative implications for health care, and identify internal equipment,supplies,pharmaceuticals,andservices,pursuantto
capabilities and community preparedness to address those an agreement between hospitals and other health care organi-
hazards and, in a region of health care providers, this may zations, providing for such interchange on a reciprocal basis in
include a needs assessment as a preliminary survey of real or responding to a major incident or disaster.
potential hazards to a specific group of hospitals.
3.1.18 hospital surge capacity, n—ability of a hospital to
3.1.11.1 Discussion—This will be accomplished with a expand rapidly and augment services in response to one or
systematic approach to the probability and consequence of multiple incidents.
hazards and events that threaten the continuity of a hospital’s 3.1.18.1 Discussion—This response is under the control of
business operations. This would normally consist of determi-
the facility’s emergency management plan and may include
nation of the likely and potential hazards to the operations of integration with regional authorities responsible for processes
thehospital,anevaluationofthevulnerabilityofthehospitalto
to manage and provide logistical and resource support to
those hazards, and determination of the resources necessary to manage the patient influx.
reduce those hazards and vulnerability. The analysis provides
3.1.19 incident command system (ICS), n—resource man-
the basis for establishing relevant major incident management
agement system identified by a chain of command that adapts
plans and should be coordinated with local or state authorities,
to an emergency event; the system adopted by the hospital
or both, and regional health care facilities as appropriate.
should follow accepted ICS processes and be compatible with
3.1.12 hospital, n—health care institution with an organized the National Incident Management System.
medical and professional staff and inpatient beds available
3.1.19.1 Discussion—ICS contains common terminology,
around the clock, whose primary function is to provide
individual ICS position responsibilities, integrated communi-
inpatient medical, nursing, and other health-related service to
cations, modular composition of resources, unified command
patients for both surgical and nonsurgical conditions and that
structure, manageable span of control, consolidated action
usually provides some outpatient services, particularly emer-
plans and resource management, and plans for termination and
gency care, for licensure purposes.
restoration of business continuity. The system allows emer-
3.1.12.1 Discussion—Each state has its own definition of
gencyrespondersfromhospitalsandotheremergencyresponse
hospital, which affects licensing under laws of that state. organizations to coordinate activities with familiar manage-
ment concepts and request and implement mutual aid.
3.1.13 hospital emergency operations center (HEOC),
n—(also known as a command center) designated area of the 3.1.20 incident commander, n—individual responsible for
hospital that serves as a meeting area, with strategic and the overall management and coordination of personnel and
tactical support for the incident command system/incident resources involved in a major incident.
management system.
3.1.20.1 Discussion—With a hospital event, the hospital
3.1.13.1 Discussion—Reference to the HEOC will avoid incident commander is that official within an entity (for
confusion with the community/county EOC. The EOC must example, hospitals or group of hospitals) who serves as the
E2413–04
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—This equipment would meet mini-
3.1.21 incident management system (IMS), n—in emer-
mum design, performance, testing, and certification require-
gency management applications, the combination of facilities,
ments for use during emergency operations, as identified from
equipment, personnel, procedures, and communications oper-
the HVA.
ating within a common organizational structure with responsi-
3.1.30 preparedness, adj—encompasses those actions taken
bility to accomplish stated objectives pertinent to an incident
before an incident to improve the capability and capacity to
effectively.
respond to a major incident within the hospital, community, or
3.1.21.1 Discussion—Thesystemidentifiesmanagementre-
region. Preparedness efforts include, but are not limited to:
sponsibilities and establishes policies and procedures for coor-
assessments of hazards, risks, response needs, and vulnerabili-
dinating emergency response, business continuity, and recov-
ties; planning functions; interagency collaboration; education
ery activities across hospital departments, outside agencies,
and training functions; exercise activities; attaining minimal
and jurisdictions and that maintains compliance with state or
capacities; and necessary engineering controls or structural
federal regulations. The incident command system is an
changes to facilities and do not include mobilization of
integral component of the incident management system.
response resources under circumstances other than simulated
3.1.22 major incident, n—this is defined within the context
events.
of all-hazards preparedness as any event that approaches or
exceedsthecapacityofahospitalorhealthcareorganizationto
3.1.31 public health surge capacity, n—ability of a defined
maintain operations or requires significant disruption to the
community and its health care system to rapidly expand
routine operations of the facility.
beyond normal services to meet the increased demand for
3.1.22.1 Discussion—A major incident may be defined
medical care and public health that would be required to care
differently for an individual hospital, a system of hospitals
for the casualties and fatalities resulting from a large-scale
operatingasoneentity,oragroupofindependenthospitalsthat
public health emergency or disaster; included are the resources
have a regional responsibility for planning and response. It is
for mass care, mass prophylaxis or vaccination, laboratory
essential t
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