The disastrous impact of Hurricane Sandy once again had health care organizations asking themselves, "Are we prepared?"

While disasters come in all shapes and sizes, they have many similarities relative to preparation, mitigation and response. That is why adopting an "all-hazards" approach is a proven strategy for responding to a wide range of facility-specific vulnerabilities. Additionally, preparing an organization in cooperation with as much local support as possible is a best practice gleaned from studying successful disaster responses.

Health care organizations are becoming more adept in responding to their highest disaster vulnerabilities. This organizational skill is best crafted through routine testing of response capabilities. The intent of the Joint Commission's emergency preparedness standards emphasizes conducting a variety of drills from aggressive large-scale exercises to department-specific, tabletop exercises focused on identifying weaknesses and then developing plans to address them. Drills, small or large, should intentionally push to points of failure.

Upon discovery, creating appropriate alternate solutions is the clear Joint Commission expectation. Even after an actual disaster, surveyors will want to look not only at actions during the disaster, but what challenges were identified and how they have been addressed.

Appropriate activities for disaster exercises should include challenging vendors, realistic staffing plans and supply acquisition. For example, during a drill crafted to impact the availability of staff, consider coordinating with support services peers in area hospitals to stress the resources of local staffing agencies. This not only will give area hospitals insight into actual staffing capabilities, but also the agencies involved.

A waste hauler, laundry or supplier may state that it will provide service during disasters. Challenging them during an exercise to perform extra pickups or deliveries is often an eye-opening experience. Can they actually meet requested timelines? Do they have the resources to meet expanded disaster needs? Expense of an actual delivery or pickup need not be incurred, but confirming a delivery can occur within certain parameters is worth knowing.

For example, a statewide pandemic exercise may identify that a supplier is unable to provide alcohol hand sanitizer as agreed. Once identified, a plan to address the issue is possible. This could include building a larger on-site cache of hand sanitizers or requesting the vendor to maintain higher inventories and establishing health care organizations as highest priority. A process for rotating cache product with daily use product might be established to ensure product expiration dates do not elapse.

Tabletop exercises are excellent opportunities to do basic checks in-house and with vendors.

Practice may not make perfect, but support service departments will be much better prepared for having challenged their plans and vendors in advance of an actual disaster.

By Gregory May, CHESP, an at-large board member at AHE and director of environmental services, linen and sustainability at UC San Diego Health System.

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Valuable resources available

AHE is the membership organization of choice for professionals caring for the health care environment. Here are a few of the many educational resources that AHE offers.

• EXCHANGE 2013. Attend the industry's premier conference and trade show at the Indiana Convention Center in Indianapolis on Sept. 1518. Registration information is available at

• Shiny Floors: The Real Deal. Attend this valuable floor care webinar, which is available for free to AHE members and for $139 to nonmembers. It's on March 20 at 1 p.m. CST. For more, go to

• Practice Guidance for Healthcare Environmental Cleaning, 2nd edition. Purchase this valuable resource today or download the e-book. To order by phone, call 800-242-2626 and ask for product code #057034 or log on to

• From Top To Bottom: The Environmental Services Series. This multi-part DVD series is an excellent training solution for environmental services managers and infection prevention and control professionals who may be challenged with high employee turnover, limited time to train workers, language barriers and infection rates. For more go to