Spotlight on the Standards

Emergency Response Plan

To ensure the health, safety and welfare of inmates, staff and visitors during emergencies, an effective emergency response is paramount. Emergency planning requires an appropriate health staff response and coordination with community emergency services when necessary.

Standard A-07 Emergency Response Plan requires that the health aspects of the plan include, at a minimum, the following elements: health staff responsibilities, triage procedures, predetermination of the site for care, phone numbers and procedures for calling health staff and the community emergency response system (e.g., hospitals and ambulances), patient evacuation procedures and backups for each of the plan’s elements. The plan must be approved by the responsible health authority and facility administrator.

Having security representatives and community response agencies participate in planning and implementing mass disaster and man-down drills is certainly beneficial and is encouraged. Your local health department may also be a helpful resource in developing an emergency response plan.

Mass Disaster Drill
Mass disaster drills are a critical component of every correctional facility’s emergency response plan. At least one mass disaster drill should be conducted annually so that over a three-year period each shift has participated (Compliance Indicator 2). It is not necessary for all shifts to participate each year.

NCCHC defines a mass disaster drill as a simulated emergency involving multiple casualties that require triage by health staff. It frequently involves a natural disaster (tornado, flood, earthquake), an internal disaster (riot, arson, kitchen explosion) or an external nonnatural disaster (mass arrests, bomb threat, power outage).

This year, correctional facilities across the country have been faced with outbreaks of novel influenza A (H1N1) virus. These outbreaks present an opportunity for health staff to implement the health aspects of the facility’s emergency response plan. The exposure control plan also comes into play as the health staff strive to contain (or practice to contain) these outbreaks because of the actions taken to eliminate exposures to pathogens and minimize transmission of communicable disease among inmates (see standard B-01 Infection Control Program).

However, it is likely that multiple individuals will have symptoms of illness at the same time, which would require health staff to triage large numbers of patients in groups. The mass casualty aspect of an influenza outbreak enables staff to apply H1N1 virus drills and actual events to the mass disaster drill requirement. (Helpful information on responding to an H1N1 outbreak is available from the Centers for Disease Control and Prevention, Interim Guidance for Correctional and Detention Facilities on Novel Influenza A [H1N1] Virus.)

Man-Down Drill
The health emergency man-down drill also enables health staff to practice aspects of the emergency response plan. NCCHC defines such a drill as a simulated emergency affecting one individual who needs immediate medical intervention. It involves life-threatening situations commonly experienced in correctional settings, for example, an inmate collapsing on the basketball court or sustaining a severe burn in the kitchen. This drill should be practiced once a year on each shift where health staff are regularly assigned (Compliance Indicator 3).

Compliance Indicator 5 states that if full-time health staff are not assigned to a particular shift, that shift is exempt for drills, and if there are no full-time health staff, drills are not required. It should be noted that this standard focuses on the preparation of health staff; therefore, an event occurring on a shift where no health staff are on duty and involving only security staff would not be eligible to meet the intent of the standard.

Critiques and Exercises
Perhaps the most important aspect of conducting mass disaster and man-down drills and participating in actual events is the critique that occurs afterward. Critiques document activities including response time, names and titles of health staff, and the roles and responses of all participants. The critique should contain observations of appropriate and inappropriate staff response to the drill. The critique report should be shared with all health staff (Compliance Indicator 4). Staff who cannot attend the drill should later document their review of the critique.

Through the critique process, weaknesses in the disaster plan may be identified and solutions can be discussed and implemented to improve future emergency response. Sharing the critiques with all health staff enables everyone to benefit from the discussion and make improvements when indicated. Individual responsibilities may be clarified or changed, and often the need to purchase or repair equipment is discussed during a critique.

Tabletop exercises are discussions about health staff’s projected response to emergencies and can assist staff in planning for a drill. However, tabletop or classroom exercises themselves do not meet the intent of the standard. Remember, even if an actual event does not involve injuries, as long as the event is critiqued, the intent of the standard is met.

[This article first appeared in the Fall 2009 issue of CorrectCare.]

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