The Joint Commission recently published Sentinel Event Alert #69 “Environmental disasters: Preparing to safely evacuate or shelter in place,” emphasizing the need for U.S. healthcare facilities to prepare for environmental disasters like hurricanes, wildfires, and floods due to the increasing frequency and severity of such events caused by climate change. CMS, TJC, DNV, CIHQ, ACHC, CARF, Social Current (COA), and state agencies agree that healthcare organizations, including psychiatric hospitals and community Behavioral Health Care & Human Services providers, must have well-defined plans to either evacuate or shelter in place, ensuring the safety of patients/clients, staff, and others present. The alert outlines how hospitals can mitigate risk by updating emergency plans, building partnerships with local authorities, and developing resilient communication systems.
Recent natural disasters, such as Hurricane Milton and the Maui wildfires, highlight the growing urgency of these preparations. The article also mentions the economic impact of disasters, noting that since 1980, the U.S. has incurred billions in damage costs. Joint Commission standards require healthcare facilities to maintain an emergency management program with systematic planning and readiness for a wide range of hazards.
Disaster Behavioral Health Recommendations
The specific recommendations for disaster behavioral health include:
1) Revisiting Emergency Plans Annually
Given the rapid changes in climate-related threats, The Joint Commission advises that healthcare facilities revisit and update their emergency plans every year, or even more frequently, depending on new risks identified. This ensures that plans remain relevant and address current vulnerabilities, such as the intensifying frequency and strength of hurricanes, wildfires, and floods. Each facility’s Hazard Vulnerability Analysis (HVA) should guide these updates, prioritizing specific risks and refining protocols based on emerging threats.
2) Establishing Relationships with Local and Federal Emergency Services
Building strong, collaborative relationships with local emergency services, such as fire and police departments, as well as state and federal agencies, is crucial for a coordinated response. Hospitals should work with emergency medical services, local health authorities, and other healthcare facilities to ensure smooth patient/client transfers and coordinated care in the event of evacuations or large-scale incidents. Regular communication with these partners, as well as pre-arranged agreements with nearby facilities, can streamline patient/client evacuations and ensure timely access to critical resources during a disaster.
3) Building a Resilient Communication Infrastructure
Reliable communication is essential during disasters when traditional channels may fail. Healthcare facilities are advised to develop primary and backup communication methods to keep staff, patients/clients, and partnering organizations informed during emergencies. In addition to landlines and cell phones, organizations should consider Voice over Internet Protocol (VoIP), satellite phones, cloud-based messaging platforms, and radio systems. Establishing redundancies in communication ensures that even if primary methods go down, there are alternative ways to receive alerts and coordinate with emergency personnel and nearby facilities.
4) Ensuring Resource Sustainability for Up to 96 Hours
Joint Commission standards require that healthcare facilities be equipped to sustain resources for at least 96 hours. This includes having adequate food, water, medical supplies, power, and staff to maintain care for patients/clients during prolonged events where resources may be cut off. Facilities should have protocols for rationing resources and a contingency plan to acquire additional supplies if the emergency extends beyond 96 hours. Preparing with sustainability in mind is especially important during widespread disasters, which can disrupt supply chains and create competition for limited resources.
5) Conducting Training Exercises
Regular emergency management training exercises are crucial for preparing behavioral health staff to address the specific needs of their patients/clients during disasters. Tailored tabletop simulations, drills, and full-scale exercises allow staff to practice key procedures like evacuation and sheltering in place under high-stress conditions, with special attention to patients/clients who may have heightened anxiety, trauma responses, or cognitive impairments. Training includes techniques for safely guiding patients/clients through evacuations, using de-escalation and maintaining a therapeutic environment during shelter-in-place situations. Exercises also assess alternative transportation methods and strategies for relocating patients/clients with behavioral health challenges, helping identify gaps and refine plans to ensure a safe, calming response tailored to this unique population.
6) Planning for Special Needs Patient/Clients
During evacuations or shelter-in-place situations, special considerations are necessary for patients/clients who may have mobility limitations, chronic illnesses, or communication barriers. Healthcare organizations should include specific protocols for vulnerable patients/clients, such as those who require dialysis equipment, and ensure they have priority access to resources and backup power sources. Planning should also account for pediatric patients/clients, individuals with limited English proficiency, and patients/clients who may need additional support to communicate or understand instructions.
These proactive measures help healthcare facilities maintain continuity of care during disasters and protect the health and safety of everyone on site.
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