The planning and management of emergency incidents and conditions that healthcare organizations face daily come in many sizes, shapes, and colors. While some of these situations are intentionally created by man, others result from unintentional accidents, and still others are weather related. Each and every day, facilities react to a variety of emergency conditions. Emergencies can be divided into internal and external situations for the purpose of this text. Regardless of the nature of the

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... gency, the organizational response will be quite different when the emergency condition exists within the facility from when it occurs at some distant location. The actual emergency response programs of healthcare facilities indicate that much more effort has gone into a prepared response to external emergencies than to internal emergencies. Exceptions can be found in the areas of fire safety and bomb threat programs, in which various regulatory and accrediting agencies have considerable involvement. A general list of situations that require emergency planning is difficult to compile; however, the situations listed in Table 42 -1 should serve as a starting point, depending on the geographical location and type of patient care facility. The media and healthcare management publications have reported case histories for all of these listed emergency situations. BASICS OF EMERGENCY PLANNING Patient care facilities should perform a hazard vulnerability analysis (HVA) to identify potential emergency events that have the potential to impact the ability to meet a demand for services. In reviewing the list of potential emergencies, security practitioners should divide these situations into two categories: those that are most likely to occur and those in which the security protection system will be involved most extensively. Security activity at the facility will be fairly standard if the emergency occurs away from the facility (external); that is, involvement will be in the general areas of access control (people and vehicles), information dissemination, and the procurement of supplies and equipment. The security response will primarily be a support role in the care and treatment of patients. A different involvement is indicated when the emergency situation occurs within (internal) or in the immediate area of the healthcare facility. As a general rule, the plan for security response to any emergency should be based, as a foundation, on everyday security safeguards and organizational resources in place. In other words, handling emergency protection needs should be viewed as an extension or expansion of the regular day-to-day security program. When facilities develop complex emergency plans that greatly differ from the normal handling of patients and basic pathways, confusion and inefficiency may result when the plan is activated. It is understood that circumstances may, however, dictate such changes. A case in point is the casualty triage receiving area. If this activity is moved from the normal triage location to another location, supplies and equipment must be moved, and police officers, firefighters, ambulance drivers, and facility personnel must be reoriented to respond to a new and perhaps unfamiliar location. The protection management plan then also becomes more complex and often unnecessarily burdensome.