Healthcare facilities have until January 19 to offer their comments during a field review

With its proposed revisions to the emergency management standards now up for field review, it's clear the JCAHO is continuing to focus on how well healthcare facilities prepare themselves for community-wide catastrophes.

The proposal expands current standards EC.4.10 (establishing emergency management plans) and EC.4.20 (conducting emergency plan tests) into the following revised standard numbers:

• EC.4.11 (developing an emergency management program)
• EC.4.12 (developing an emergency management plan)
• EC.4.13 (establishing emergency communication strategies)
• EC.4.14 (managing resources during emergencies)
• EC.4.15 (managing safety and security during emergencies)
• EC.4.16 (managing staff responsibilities during emergencies)
• EC.4.17 (managing utilities during emergencies)
• EC.4.18 (managing clinical activities during emergencies)
• EC.4.20 (testing emergency operation plans)

The changes will remain posted for industry comment through January 19, 2007. Accredited hospitals, critical-access hospitals, and long-term care facilities all stand to be affected by the revisions.

Those familiar with the current emergency management requirements will recognize the intent of revisions, as they don't represent a shift in the JCAHO's philosophy. Rather, the proposal adds layers to the elements of performance for the standards.

Anticipate the flux of community calamities
The proposed changes reflect the idea of planning for an escalating disaster (e.g., Hurricane Katrina and the storm's fallout) and identifying appropriate response activities.

A key point made in the field review is that facilities will need to maintain their critical functions during disasters in which

• the facility's infrastructure is intact, but the local community can't support the organization for 96 hours or longer
• the facility's infrastructure is compromised for 96 hours or longer, but the local community can support the organization
• both the facility's and the local community's infrastructures are compromised for 96 hours or longer

The elements of performance associated with the standards will greatly increase. Currently, EC.4.10 and EC.4.20 for accredited hospitals have a combined 37 elements of performance. If all the proposed revisions go through, the elements will increase to 97 total.

Don't expect overnight fluency
The sheer amount of new elements could be daunting for safety officers and surveyors alike, says Steven MacArthur, safety consultant with The Greeley Company, a division of HCPro, Inc., in Marblehead, MA.

In early 2006, the JCAHO introduced a new, 90-minute emergency management session for hospitals with 200 beds or more, during which surveyors review emergency management plans and conduct a related tracer with staff.

"Even with an extra hour-and-a-half session, I don't know how you can survey [all of these new elements]," MacArthur says. "This is high-level stuff."

Look for further coverage of this development in Briefings on Hospital Safety.