Hospital Risk Assessment Q We

Hospital Risk Assessment
Bonnie Henry, MD, FRCPC

Brian Schwartz, MD, CCFP(EM)
Disaster Preparedness Conference 2006
Case 1
A tornado has just hit your community;
dozens of walking wounded are appearing at
your ED, as well as individuals looking for
loved ones
Ambulance communications notifies you to
expect at least 30 patients of varying severity
in the next hour
Disaster Preparedness Co
Case 2
An explosion has occurred at the Bloor
station in the Toronto subway system
CBRN team is responding due to a phone call
to a local TV station from a terrorist group
chanting Death to Canada and claiming
that a radioactive substance has been
released
Case 3
A mysterious influenza-like illness

beginning in Southeast Asia has been
found to jump from birds to people
Over 200 people of all ages have
been affected; mortality is 50%
Case 3
The disease is making its way west;

cases are turning up in Europe
The WHO announced that the world is
in Phase IV of the Pandemic phases
(evidence of localized human to
human transmission)
Questions to ask:
1. Is my organization prepared to
respond to these events?

2. Does my organization need to be
prepared anyway?
3. What are our priorities?
Have you done your

risk assessment?
Hospital Risk Assessment

Learning Objectives
Describe the need for and context of
risk assessment in emergency health
planning
Describe and prioritize the risks of
your organization to better prepare for
health care emergencies
Phases of an Emergency
(F/P/T National Framework)
1. Risk assessment
2. Mitigation
3. Preparedness
4. Response
5. Recovery
Canadian Council on Health Services Accreditation

2005 Environment Standards
Minimizing Adverse Events - Section 5.0
The organization is prepared for disasters & emergencies
# 5.1 The organizations processes for an overall plan include:
(11 points):
identify the potential risk of a disaster/emergency
define how the hospital plan fits with the community disaster plan
determine who is responsible for coordinating/ managing the
response to emergency situations (regular and off hours)
taking in mass casualties in the event of a community disaster
including patients that might be contaminated or exposed to
dangerous substances
Whats your risk?

Naturally occurring
events
Technological events
Human related events
Events involving
hazardous materials
Natural events
Hurricane
Tornado
Extreme heat/cold
Ice storm
Snow storm
Flood
Epidemic/pandemic
Epidemic/pandemic
Influenza
SARS
E Coli
Smallpox
Electrical failure
Transportation emergency
Water emergency
HVAC failure
Structural damage
Fire
HAZMAT exposure (internal)
Human Related Events

Mass casualty incident (trauma)
Mass casualty incident (infectious)
Terrorism - biological
Hostage situation
Bomb threat
Civil disturbance
Hazardous Material Events

Mass casualty HazMat incident
Terrorism chemical
Chemical exposure external
Radiological exposure
What is your risk for each?

Risk = Probability x Impact
www.ceep.ca
Risk = Probability x Impact
Components of Risk
Probability?
Impact?
A. Highly likely?
1. Marginal
B. Likely?
2. Serious
C. Possible?
3. Critical
D. Unlikely?
4. Catastrophic
Probability
Probability
Description
Rating
Detail
Highly Likely
nearly 100% probability in next year
Likely
between 10 and 100% probability in next year,

or at least one event in next 10 years
Possible
between 1 and 10% probability in next year,

or at least one event in next 100 years
Unlikely
less than 1% probability in next 100 years
Components of Impact
Impact
Human
Property
Business
Impact
1. Marginal
2. Serious
3. Critical
4. Catastrophic
Impact - Human
Unlikely to cause injury, illness or death in
staff or patients
2. Low probability of injury, illness or death in
staff or patients
3. High probability of injury or illness in staff
or patients; low probability of death
4. High probability of death in staff or patients
1.
Impact - Property
1.
2.
3.
4.
Unlikely to cause physical plant or

equipment damage requiring any
replacement costs or recovery time
Minor physical plant or equipment damage
requiring some replacement costs or
recovery time
Moderate physical plant or equipment
damage requiring moderate replacement
costs or recovery time
Extensive physical plant or equipment
damage with high replacement costs and
recovery time
Impact - Business
1.
2.
3.
4.
Unlikely to cause service interruption or

damage to public image of the institution
Minor or limited or short term service
interruption or damage to public image
Significant/widespread or long term service
interruption
Unable to provide services due to factors
such as: employees unable to report to
work, clients unable to reach facility,
interruption of critical supplies, or legal or
health and safety issues
Overall Impact Rating

11-12
Catastrophic
Facility cannot provide necessary

services without extensive assistance
from provincial or federal resources
8-10
Critical
Facility can provide a normal level of

service with assistance from outside
the local community or region; or,
facility can provide a minimal level of
service with normal resources
5-7
Serious
Facility can provide a normal level of

service with assistance from within
region or within local community; or,
facility can provide a reduced level of
service with normal resources
3-4
Marginal
Normal level of functioning or increased

level of service required from within
Risk Assessment - examples

Threat
Probability Impact
(H+P+B)
Risk
Tornado
3+3+2
B8
Dirty Bomb
B/C/D
3+1+2
B/C/D6
Pandemic
influenza
4+1+4
B9
Risk Rating
A
Highly
Likely
B
Likely
C
Possible
D
Unlikely
11-12:Catastrophic
A11-A12
B11-B12
C11-C12
D11-D12
8 -10: Critical
A8-A10
B8-B10
C8-C10
D8-D10
5 - 7: Serious
A5-A7
B5-B7
C5-C7
D5-D7
3 - 4: Marginal
A3-A4
B3-B4
C3-C4
D3-D4
Impact/Probability
Impact
Rating
Priorities
1. Pandemic flu
2. Tornado
3. Dirty bomb
Priorities
Perform this exercise for all:
Naturally occurring events
Human related events
Events involving hazardous materials
Summary
Assessment of risks is first step in
planning
Helps focus efforts and ensures no
possibilities are missed
Helps prioritize efforts in preparedness
The only thing more difficult

than preparing for an
emergency is having to
explain why you didnt

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Hospital Risk Assessment

Bonnie Henry, MD, FRCPC

Disaster Preparedness Conference 2006

A mysterious influenza-like illness

The disease is making its way west;

respond to these events?

Have you done your