Assessing Your Clinic's Risk

By Tom Terranova / 14 Sep 2021

Accreditation and safety leader Thomas S. Terranova explains the importance of emergency preparedness plans and considering unexpected scenarios

The response to the COVID-19 pandemic is a perfect example of the breadth of analysis required to anticipate emergencies.

Although your chance of encountering some of the emergency situations mentioned in this article are likely very slim, the pandemic has highlighted that it is important to consider the possibilities of such events and have an all-hazards emergency preparedness plan (EPP) in place. This article provides insights on EPPs to help businesses prepare for foreseeable contingencies and provide a mechanism to effectively adjust to surprises.

Importance of your emergency preparedness plan (EPP)

An all-hazards EPP aims to address the resources and steps a business may need to take both before and after an emergency happens, such as infectious diseases, natural, and man-made disasters.

To be effective, it is crucial to integrate EPP throughout operations in a cycle to assess risk, plan and test responses, examine deployments, and utilise lessons through training all staff on their respective roles in the EPP. It is easy to think of your clinic in isolation. However, it should instead be viewed as part of the community response, more importantly, many offices of emergency management consider all facilities to be part of a coordinated community effort. This is more than the average fire evacuation plan, which concerns how fire would affect your facility and how to evacuate.

Continuing from facility-centric risks, a solid plan builds outward; a water main break on your block, a citywide blackout, flooding in your area, or a massive natural disaster or pandemic. Even small businesses must understand their roles within the community, which requires coordinating with first responders, community leaders, hospitals, and other businesses.

Risk assessment

Most are familiar with risk assessment for regionally relevant disasters, like flooding or heavy snowfall, which might be more prevalent in the northern areas of the UK.1 As mentioned in the recently published Intergovernmental Panel on Climate Change (IPCC) report by the United Nations, severe weather is changing the frequency, ferocity, and even type of disasters each region should consider.2 The same approach to risk assessment should apply to human-made disasters such as civil unrest, terrorist attacks, pandemics, and risks posed by equipment used in nearby businesses.

To create your all-hazards EPP, you need to think creatively, beyond apparent and obvious risks like a fire in your clinic. Addressing each risk point-by-point according to the following areas creates a more complete emergency plan with appropriately diverse responses to risks. Note that this is not an exhaustive list, and not all responses or risks are identical; they depend on geography and community capabilities. For example, a nearby plant that uses volatile chemicals or dangerous equipment presents very specific risks, and you should consider the risks their operations present to you, your staff, and your patients.

Safety and security

Much like seismically active locations should investigate specialised equipment that protects from debris, in the UK it may be appropriate to evaluate protections against safety concerns around road and building collapses from extreme heat, for example earlier this year when roads melted in several areas of England.3 In times of civil unrest for example the London riots of 2011, plans for lockdowns involve securing people and information.

Specific to COVID-19, EPP intersected with normal infection control practices to enhance protections. Facilities with isolation protocols could quickly apply these protocols to treat all patients as potentially exposed, screen staff and patients, limit visitors, and increase hand hygiene and mask protocols. Many increased existing turnover practices to allow terminal cleaning and air exchange to reduce transmission. They increased scrutiny on aerosolising cases. Facilities with quality protocols for sanitisation of high-touch items quickly broadened their focus by removing reading material, cleaning doorknobs, and elevator buttons outside care areas.

To create your all-hazards EPP, you need to think creatively, beyond apparent and obvious risks like a fire in your clinic

Health and medical

Healthcare providers specialising in same-day care can sometimes overlook the potential possibility of encountering chronic or acute medical conditions, such as diabetes, epilepsy, or heart attack. Of course, you should have a designated first-aid officer and it's quite likely you have personal experience working with medical emergencies in the NHS, but the possibility should be considered, and plans should be in place. Ensure in your consultation you are asking if a patient has chronic condition(s), make sure this is on file, and know how you and your staff might manage a situation should it occur. It is critical to overcome the sense that ‘no one stays in the clinic for very long, so we do not need to worry about it’.

Power and electricity

Consider what might happen to your business if there is a power cut? Flooding, extreme heat or snow may interrupt your clinic’s electricity, for example, which could cause a cut for hours. Consider what a lack of power means for your business and have a plan in place to follow should this happen. For example, what will this mean for your temperature-controlled medications? Will you be able to access patient records to contact patients and rearrange treatment times? If your data is not cloud based, then perhaps you will not be able to access all of your records. During the recent and unprecedented flooding in east London on July 25, damage was caused to Whipps Cross Hospital, resulting in a loss of power and a damaged electrical system. This issue could equally be applied to the aesthetic industry, as a random power cut during a treatment that relies on electricity such as laser or LED treatment.

Communications and data

Contingency plans for when communications fail are often overlooked because internet capable mobile phones are ubiquitous. However, extreme weather or industrial accidents can interrupt internet and phone service. Businesses that have a cloud-based data system should ensure alternative access for critical information during an interruption (e.g. emergency contact numbers). If mobile service is interrupted, consider alternative means of communicating with patients and staff, such as walkie talkies or a Tannoy system.

Hazardous materials

Many businesses are adept at handling hazardous materials daily and are fully aware of how to deal with such materials. However, additional precautions may be appropriate based on your clinic’s neighbours – research here is vital. Consider the 2020 fertiliser warehouse explosion in Beirut, where nearly 2,750 tonnes of improperly stored ammonium nitrate exploded.5 If a neighbouring business processes chemicals that could potentially compromise your safety should something go wrong, evaluate what you might need to do to keep you, your patients, and staff safe.

Integration with other businesses

As the world continues to respond to COVID-19, facility-centric, locally executed, and government coordinated incident response remains essential. In the future, your business may need to join others to help when disaster strikes. There must be advanced communication between businesses and the local communities and government, including the capacity of your facility to participate. Central authorities will focus on major institutions, while local responders will coordinate equipment, space, and supplies with small facilities that can contribute to the collective effort.

Reviewing your EPP

In an emergency, you should follow your EPP. Throughout the emergency and after, you should evaluate your performance, revise its plan, and incorporate specific information into the plan for future use. You should see the changes you have implemented throughout. Discuss the execution of the EPP with leadership and document insights.

Review, discussion, and evolution of an EPP is an integral part of the plan. You should analyse tabletop and live exercises to revise your EPP. Minimally, after action reports must examine the plan, conduct, successes, and failures. Such feedback not only promotes safety and protects lives but demonstrates your business has made all reasonable efforts to protect the wellbeing of your staff and patients, which can be protective in reducing liability, particularly during a prolonged emergency like the pandemic. Catastrophes will surely not fit the EPP exactly, but the act of planning gives your clinic a template from which to deviate in meaningful ways to respond appropriately. By several accounts, facilities worldwide that implemented EPPs to comply with accreditation requirements, never contemplated COVID-19 exactly; however, existing EPPs allowed them to adapt quicker and reopen more safely by applying principles and processes to the extant emergency.

In some instances, businesses had EPPs for bioterrorism or infectious agents, which while not precisely applicable, became a framework from which to proceed when the severity of the pandemic became obvious. In other cases, flu planning, a major source of EPP in much of the world, provided concepts that spring boarded businesses to how they are functioning now. The process of planning, as required by accreditation, proved quite useful in developing a response.

Expect the unexpected

Not every contingency plan needs to be complex, but you should know the risks, incorporate guidance from authorities, and establish reasonable mitigation steps. By just considering that the unexpected can happen, brainstorming what risks you have and having some procedures in place for your staff to follow, you can really help manage the situation in the best possible way, should the unexpected happen.

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