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Hospital Risk Assessment

Bonnie Henry, MD, FRCPC


Brian Schwartz, MD, CCFP(EM)

Disaster Preparedness Conference


2006

Case 1
A tornado has just hit your community;
dozens of walking wounded are appearing at
your ED, as well as individuals looking for
loved ones
Ambulance communications notifies you to
expect at least 30 patients of varying severity
in the next hour

Disaster Preparedness Conference


2006

Case 2
An explosion has occurred at the Bloor
station in the Toronto subway system
CBRN team is responding due to a phone call
to a local TV station from a terrorist group
chanting Death to Canada and claiming
that a radioactive substance has been
released

Disaster Preparedness Conference


2006

Case 3

A mysterious influenza-like illness


beginning in Southeast Asia has been
found to jump from birds to people
Over 200 people of all ages have
been affected; mortality is 50%

Disaster Preparedness Conference


2006

Case 3

The disease is making its way west;


cases are turning up in Europe
The WHO announced that the world is
in Phase IV of the Pandemic phases
(evidence of localized human to
human transmission)

Disaster Preparedness Conference


2006

Questions to ask:
1. Is my organization prepared to

respond to these events?


2. Does my organization need to be
prepared anyway?
3. What are our priorities?

Disaster Preparedness Conference


2006

Have you done your


risk assessment?

Disaster Preparedness Conference


2006

Hospital Risk Assessment


Learning Objectives
Describe the need for and context of
risk assessment in emergency health
planning
Describe and prioritize the risks of
your organization to better prepare for
health care emergencies

Disaster Preparedness Conference


2006

Phases of an Emergency
(F/P/T National Framework)

1. Risk assessment
2. Mitigation
3. Preparedness
4. Response
5. Recovery

Disaster Preparedness Conference


2006

Canadian Council on Health Services Accreditation


2005 Environment Standards
Minimizing Adverse Events - Section 5.0
The organization is prepared for disasters & emergencies
# 5.1 The organizations processes for an overall plan include:
(11 points):
identify the potential risk of a disaster/emergency
define how the hospital plan fits with the community disaster plan
determine who is responsible for coordinating/ managing the
response to emergency situations (regular and off hours)
taking in mass casualties in the event of a community disaster
including patients that might be contaminated or exposed to
dangerous substances

Disaster Preparedness Conference


2006

Whats your risk?


Naturally occurring
events
Technological events
Human related events
Events involving
hazardous materials
Disaster Preparedness Conference
2006

Natural events
Hurricane
Tornado
Extreme heat/cold
Ice storm
Snow storm
Flood
Epidemic/pandemic
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2006

Epidemic/pandemic
Influenza
SARS
E Coli
Smallpox

Disaster Preparedness Conference


2006

Technological events
Electrical failure
Transportation emergency
Water emergency
HVAC failure
Structural damage
Fire
HAZMAT exposure (internal)
Disaster Preparedness Conference
2006

Human Related Events


Mass casualty incident (trauma)
Mass casualty incident (infectious)
Terrorism - biological
Hostage situation
Bomb threat
Civil disturbance

Disaster Preparedness Conference


2006

Hazardous Material Events


Mass casualty HazMat incident
Terrorism chemical
Chemical exposure external
Radiological exposure

Disaster Preparedness Conference


2006

What is your risk for each?


Risk = Probability x Impact
www.ceep.ca
Disaster Preparedness Conference
2006

Risk = Probability x Impact

Disaster Preparedness Conference


2006

Components of Risk
Probability?

Impact?

A. Highly likely?

1. Marginal

B. Likely?

2. Serious

C. Possible?

3. Critical

D. Unlikely?

4. Catastrophic

Disaster Preparedness Conference


2006

Probability
Probability
Description
Rating

Detail

Highly Likely

nearly 100% probability in next year

Likely

between 10 and 100% probability in next year,


or at least one event in next 10 years

Possible

between 1 and 10% probability in next year,


or at least one event in next 100 years

Unlikely

less than 1% probability in next 100 years

Disaster Preparedness Conference


2006

Components of Impact
Impact
Human
Property
Business

Impact
1. Marginal
2. Serious
3. Critical
4. Catastrophic

Disaster Preparedness Conference


2006

Impact - Human
Unlikely to cause injury, illness or death in
staff or patients
2. Low probability of injury, illness or death in
staff or patients
3. High probability of injury or illness in staff
or patients; low probability of death
4. High probability of death in staff or patients
1.

Disaster Preparedness Conference


2006

Impact - Property
1.
2.
3.
4.

Unlikely to cause physical plant or


equipment damage requiring any
replacement costs or recovery time
Minor physical plant or equipment damage
requiring some replacement costs or
recovery time
Moderate physical plant or equipment
damage requiring moderate replacement
costs or recovery time
Extensive physical plant or equipment
damage with high replacement costs and
recovery time
Disaster Preparedness Conference
2006

Impact - Business
1.
2.
3.
4.

Unlikely to cause service interruption or


damage to public image of the institution
Minor or limited or short term service
interruption or damage to public image
Significant/widespread or long term service
interruption
Unable to provide services due to factors
such as: employees unable to report to
work, clients unable to reach facility,
interruption of critical supplies, or legal or
health and safety issues
Disaster Preparedness Conference
2006

Overall Impact Rating


11-12

Catastrophic

Facility cannot provide necessary


services without extensive assistance
from provincial or federal resources

8-10

Critical

Facility can provide a normal level of


service with assistance from outside
the local community or region; or,
facility can provide a minimal level of
service with normal resources

5-7

Serious

Facility can provide a normal level of


service with assistance from within
region or within local community; or,
facility can provide a reduced level of
service with normal resources

3-4

Marginal

Normal level of functioning or increased


level of service required from within

Disaster Preparedness Conference


2006

Risk Assessment - examples


Threat

Probability Impact
(H+P+B)

Risk

Tornado

3+3+2

B8

Dirty Bomb

B/C/D

3+1+2

B/C/D6

Pandemic
influenza

4+1+4

B9

Disaster Preparedness Conference


2006

Risk Rating
A
Highly
Likely

B
Likely

C
Possible

D
Unlikely

11-12:Catastrophic

A11-A12

B11-B12

C11-C12

D11-D12

8 -10: Critical

A8-A10

B8-B10

C8-C10

D8-D10

5 - 7: Serious

A5-A7

B5-B7

C5-C7

D5-D7

3 - 4: Marginal

A3-A4

B3-B4

C3-C4

D3-D4

Impact/Probability
Impact
Rating

Disaster Preparedness Conference


2006

Priorities
1. Pandemic flu
2. Tornado
3. Dirty bomb

Disaster Preparedness Conference


2006

Priorities
Perform this exercise for all:
Naturally occurring events
Technological events
Human related events
Events involving hazardous materials

Disaster Preparedness Conference


2006

Summary
Assessment of risks is first step in
planning
Helps focus efforts and ensures no
possibilities are missed
Helps prioritize efforts in preparedness

Disaster Preparedness Conference


2006

The only thing more difficult


than preparing for an
emergency is having to
explain why you didnt
Disaster Preparedness Conference
2006

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