An internal disaster can occur in many forms, from a fire in the hospital’s kitchen, to a chemical spill, to a bomb threat. With the multitude of potential hazards, developing a plan to keep your hospital functioning during these times can be quite a challenge.


Thankfully, most internal disaster preparedness plans share some key elements. Let’s take a look at them - and also review special considerations that need to be taken for specific situations:


What is the level of the threat?

Every potential disaster situation should be evaluated in terms of its threat to safety, so that a decision can be made about how to proceed.


  • Level 1: Affects only the local area. Patient care can be continued without interruption.  No serious threat to patients, visitors or employees. Activate the Hospital Command Center.
  • Level 2: Patient care may be affected. The situation may extend beyond the local area, and there is potential for a safety threat to individuals. Activate the Hospital Command Center and await further instructions.
  • Level 3: There is a significant impact to patient care and individual safety extending beyond the local area. External resources are needed. Activate the Hospital Command Center and anticipate that action will need to be taken.

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Is an evacuation or relocation necessary?

Depending on the level of the threat, a decision will be made regarding whether patients need to be relocated to another area of the hospital or evacuated completely. If relocation is necessary, the plan should specify how patients should be moved. If full evacuation is necessary, the plan should contain information about how the evacuation will take place, as well as the location of holding areas for discharged patients who are waiting for available transportation.


What resources are available, and what is needed?

This section of your disaster plan should address the current state of the hospital and its ability to proceed with safe patient care. All patient care units should report their current census, acuity, critical issues resulting from the disaster, and number of staff members on site or with the ability to come in. 


The plan should also explain how other hospital employees including Social Work, Environmental Services, Transportation, and Safety and Security will assist during this time.


Additional supplies may be needed during an internal disaster, especially if relocation or evacuation is necessary. Critically ill patients may need to be transported and treated in non-typical patient care areas. Portable equipment such as ventilators and suction machines should be on standby. A crash cart should be available in every holding area. Stretchers may be needed to move patients on stairwells, if the elevators are not functioning.


Special considerations

Internal disaster plans should contain specific information on how to proceed during various types of situations.  Some examples are below:


  • Power loss: Does your plan specify what equipment can be plugged into the red emergency outlets? Do you have back-up medical equipment that does not require electricity, such as manual blood pressure cuffs, forehead thermometer strips, or battery-powered aspirators?


  • Communication disruption: Does your hospital have cellular phones or 2-way radios that can be used? If your paging system is not functioning, how will you communicate emergencies? Do you have an emergency phone tree established?


  • Hostage situation: How is a hostage situation communicated? What should an employee do if they are involved in one?


  • Hazardous Materials: Does your plan specify for the isolation of patients or employees if necessary? Do you have an adequate stock of personal protective equipment?


  • Water loss: Do you have emergency water available? Does your plan specify how to ration water? Does it take into account that water loss could  also affect medical vacuum and that portable suction will be needed?


  • Child or Newborn Abduction: Does your facility have the ability to automatically stop elevators and lock stairwells in the case of a potential child abduction? Are your newborns given an electronic tag that will alarm if they are removed from the unit?


Your hospital internal disaster plans need to address the wide array of potential situations that could arise and impact patient care. While most share a common core, the plans should be specified for each type of emergency in order to keep your patients and employees safe at all times.


Editor's Note: This blog was originally posted in September 2015, it has since been updated.