Understanding Facility Vulnerabilities
By identifying weaknesses in facilities and plans, managers can improve an organization's resilience in an emergency.
Every day, institutional and commercial facilities face potential threats from natural disasters. No matter a facility’s function, it is vital that maintenance and engineering managers and their peers be prepared for the worst.
In the United States in 2018, there were 108 natural disasters, including severe storms, floods, hurricanes, wildfires, winter storms, tornadoes and earthquakes. The estimated losses totaled $81.9 billion. Worse, there were 355 fatalities. If the wildfires in California in 2018 and Australia in 2020 are any indication, even facilities that are not typically in the path of destruction must prepare for natural disasters.
Institutional and commercial facilities of all types have to properly invest in effective planning, mitigation and preparation. When the emergency plan is activated, ensuring the protocols are current, efficient, and followed is the key to a successful outcome. Where should managers begin? Along with other emergency planners, they need to perform risk assessments that identify and prioritize the most likely potential threats, spotlight specific vulnerabilities and undertake upgrades to mitigate worst-case scenarios.
Each year, weather-related calamities lead to about 500 deaths and $15 billion in damages. It is important to identify which disasters are common or imminent for different facilities, as it is unlikely a facility will experience every type of natural disaster in a year. But it is possible the side effects from one disaster will impact a facility after the major event.
For example, when Hurricane Harvey made landfall in August 2017, the primary damage was flooding, not high-speed winds. Facilities that were only bracing for high winds without preparing for flooding would have been hit with unforeseen damages.
So-called 100-year storms occur more frequently. Not only should managers identify the most common disasters facing their facilities. They also should identify the extreme versions of these disasters. It also is advisable to review history. What major storms have impacted this area before? What major storms have impacted this facility before?
It is not enough to borrow plans from other organizations. Examining the way a neighboring institution prepared for and weathered a storm can help guide a facility’s plans, but each plan must be specific to the organization’s location and the unique risks associated with that location. Managers also should include local response organizations in the planning process so they can assist and practice before an emergency.
In an emergency, the most critical improvement identified in the after-action report is usually not a piece of equipment. Instead, it is communication inside and outside the organization. Before fortifying HVAC systems, managers need to ensure that everyone inside the organization is part of a comprehensive communication plan to keep them informed. To effectively manage an emergency, all personnel must be on the same page – medical, legal, custodial and facilities management. Everyone must understand actions and expectations. Outside partners such as local, regional, state and federal response organizations, as well as vendors and other local healthcare facilities, also need to be a part of the plan.
Communication is essential for proper disaster preparedness, and staff communication should begin as part of the planning process. Understanding which staff are available to assist during a disaster and any needs they have — child, family or pet care, for example — is crucial. Who is essential personnel, and who is not? By determining this in advance, managers can ensure everyone knows their role in a crisis.
Another unforeseen hindrance many facilities run into with emergency management is leadership – or a lack thereof. Some executives view emergency management and safety as a line item in a spreadsheet or a compliance issue. Consequently, many leaders choose to drastically reduce costs in this department in order to save facilities money. But that decision can have long-lasting and damaging effects.
When leaders understand the importance of emergency preparedness, they are more likely to dedicate resources. They also will ensure the right people are managing the program, rather than assigning the oversight as an additional duty to someone already overwhelmed or lacking the experience and knowledge necessary to oversee an emergency program simply because it is something they should do.
In the case of a storm, leadership will play an integral role in decision making. For example, in preparing for a hurricane, critical decisions like additional resources and evacuation need to be made at least 48 hours before landfall, when the exact impact area and intensity are still unknown. The leadership team also is responsible in determining staffing plans, canceling electives and closing off-site locations.
After accounting for facilities’ more intangible vulnerabilities, managers can perform a risk assessment that includes vulnerabilities to water and wind damage, flood-prone areas of a campus, and generator capacity — for example, seeing if HVAC systems are connected to generator power.
Finally, every facility must maintain records or systems, such as the medical records department in a hospital. Those departments need a certain amount of physical space, access to files and software systems to get through every day.
What happens when a disaster occurs and knocks the software systems offline or blocks access to records? How will the hospital operate? Managers often wait until a disaster has created a problem before trying to find a solution, losing precious time in the process. They need to address every vulnerable area of facilities. A business continuity plan will help to identify the hardware, software, space, and other resources that each area of a facility requires to remain operational. It is crucial to recognize these needs in order to develop alternative solutions before a disaster disrupts any of the requirements.
Uninvested leadership or communication breakdowns can hinder emergency preparation well before the tornado sirens start blaring. If a manager has been hesitant to upgrade critical equipment such as generator-backed flood lights or computer systems, this might be an irritation in day-to-day work. But in an emergency, it could paralyze a facility.
Managers need to take a systematic approach to examining all equipment necessary for facility operations by examining their age, reliability, necessity, and how often technicians use them for operations, then ranking the equipment from most vulnerable or outdated to least and comparing that with its necessity in an emergency. A generator might be functional, but if it cannot handle the capacity for the system it is linked to for an extended period of time, it might be time for an upgrade.
For example, old handheld satellite phones have given way to satellite technology that connects the entire phone system. This allows managers to maintain published phone numbers, and the technology is more cost effective than the handheld phones.
FirstNet, a cellular priority network sponsored by the federal government, gives the emergency response team top priority communication during a disaster, which is important when thousands of cell phones are competing for access. FirstNet also is one of the first cellular services restored after a disaster.
Health care facilities offer a host of examples of opportunities for managers to upgrade critical equipment to contribute to emergency preparedness.
One example involves aging equipment. Tools such as decontamination shelters, respirators and protective coveralls purchased years ago must be maintained and replaced. While many of these items were purchased with federal grants, those funds are diminishing while the need for the equipment remains the same. Reviewing hazards, vulnerabilities and mitigation strategies can help managers decide which pieces of equipment are priorities.
Managers also should remember that health care facilities remain soft targets, given the increasing rate of workplace violence. Health care security is not only a part of the patient safety program. It also is part of emergency preparedness. Coordinating in-house teams and ensuring they are available during a disaster and not committed to other agencies is crucial.
One common mistake facility leaders make is hesitating to activate an incident command system (ICS) and hospital command center (HCC), which primarily serve to gather information, make decisions, and communicate. Waiting too long to activate these resources can create gaps in the decision-making and communication processes. It is much easier to scale back or close an ICS than it is to start too late.
Better safe than sorry has always been a prudent strategy, and proper preparation pays off in the face of catastrophe. Institutional and commercial facilities have differing roles to play during emergencies, from vital operations to simple shelter. But no matter the function, all involved must understand the plan in a crisis, and it is up to emergency planners to identify those roles.
By prioritizing and proactively addressing potential threats, finding and planning fixes for vulnerabilities, and understanding necessary upgrades to mitigate worst-case scenarios, managers and emergency planners can ensure that no matter the disaster or its severity, the facility will be able to continue operations or bounce back and continue performing its core mission.
Scott Cormier is vice president of emergency management, environment of care and safety at Medxcel specializing in facilities management, safety, environment of care, and emergency management. He leads the development and implementation of emergency management, general safety and accident-prevention programs for a national network of hospitals.