Managing emergencies in general practice

Part B – Emergency planning and response

Design and develop your plan

Last revised: 21 Jan 2020

Staff contact details

In an emergency, the practice may need to contact practice staff urgently. This may be to advise staff not to attend the practice due to an imminent threat or to advise them that the practice requires extra support as a result of a recent emergency.

To ensure swift access to staff contact details, it is recommended that a list of all staff members’ phone numbers is created and made available to all staff and that it is regularly reviewed and updated. The staff contact list should be kept in a secure place at the reception desk for easy access. An additional copy of this list should be stored in the practice’s emergency kit.

Practice staff could also each keep a laminated, pocket-sized card with all staff contact numbers. Additionally, with the consent of practice staff, it is recommended that all staff have up-to-date contact phone numbers stored in their mobile phones.

Establishing a communication tree is a good way to ensure all staff are swiftly informed of an imminent disaster. The communication tree can be initiated by the emergency management coordinator where he or she calls another staff member and that staff member calls a third staff member, and so forth.

Response agency contact details

During an emergency, staff may need to urgently seek assistance from the relevant emergency response agency. It is recommended that a relevant state and territory response agency list is created and kept in a secure place at the reception desk for easy access during an emergency. A copy should also be stored in the practice’s emergency kit.

The emergency management coordinator should have a laminated, pocket-sized list of all relevant emergency agencies with them at all times.

Other health services contact details

In the event of an emergency, practice staff may need to communicate with other health services and organisations including local hospitals, staff from nearby practices, primary care facilities, government health departments and PHNs. Practice staff may need to access referral and discharge papers or seek assistance from other organisations due to capacity issues. To ensure that communications can occur quickly, a list of nearby health services should be created.

Key business services contact details

If the practice is adversely affected by an emergency, practice staff will need to communicate with a range of service providers including insurance, telephone and internet, utilities, and disaster recovery specialists. To ensure that such communications can occur easily and quickly, it is recommended that a list of service providers is created and regularly updated and includes contact details, account and/or policy numbers.

Registering to receive notifications

The majority of local councils have well-developed text messaging services to notify residents and individuals of potential and/or imminent disasters. The emergency management coordinator should register for this service via their local council or local emergency service if available.

Telephone communication

Emergencies will affect phone systems in different ways, so it is important to ensure that you have a tested contingency plan in the event of an emergency. For example, mobile phone towers may be affected or overwhelmed during an emergency and should not be solely relied upon, or there may be a power outage which could disable landline phones reliant on electricity.

In the event of a power outage, practice staff will need to rely on landline phones that do not require a power source, or on mobile phones that are fully charged. How your practice’s phone system is set up will determine how the system may be disrupted in the event of a power outage or other emergency.

If your phone line runs through your internet connection, you should check its functionality and reliance on a power supply. Every provider is slightly different and the functionality also differs between National Broadband Network (NBN) connections and copper network connections.

Further information about NBN services and connectivity can be found  the National Broadband Network website .

In the event that communication lines (landlines) are affected, it is likely that mobile phones will be used in an emergency. In this instance, the practice’s landline can be diverted to a mobile number to ensure business continuity. Ensure mobile phones are fully charged and consider also purchasing a portable USB power pack charger as a back-up charging device.

Internet

Communication via the internet may also be impacted during a disaster such as during a power or network outage. Check with your individual provider how a power outage might affect your internet connection.

Programs and information such as pathology and radiology reports, patient discharge summaries and My Health Records may be unavailable during this time.

To ensure the continuation of services, hard copies of essential information should be kept. This may include important phone numbers, patient appointments and other resources relating to the Medicare Benefits Schedule (MBS) such as the MBS Fee Summary.

Practice staff may consider investing in an alternative internet connection to ensure ongoing access to the internet during a disaster. Alternative options include mobile data devices and satellite dishes. Practices should also consider alternative ways for conducting business in the event that internet access is lost. This could include provision for cash transactions and manual credit card/Medicare card machines which could be stored in the practice’s emergency kit.

Radio

When other communication lines are down, a battery-powered radio can be used as a reliable means of receiving important information regarding an emergency. Practice emergency kits should be equipped with a batterypowered radio and a supply of batteries. Practice staff can tune into ABC Radio for up-to-date information regarding emergencies affecting their area.

Establishing a temporary practice

Emergencies can cause significant damage to a building’s infrastructure, causing it to be uninhabitable and unsafe. Therefore, when preparing the practice for a disaster, it is worth considering how the practice will continue providing essential services to the community if it is damaged or affected.

If it is determined that the practice will continue to provide services, then an appropriate and safe location for the temporary practice will need to be identified.

To facilitate this process, emergency management coordinators are encouraged to approach other business owners who might agree for a temporary clinic to be set up in their building if the need arises. Possible venues might include community halls, schools or vacant shops. These arrangements should occur as part of the planning process. If an agreement is made, it should be documented in writing and a copy kept by both parties. Further, all staff should be made aware of any arrangements so that in the event that the practice needs to temporarily relocate, all staff can assist with the physical relocation and communicate this to patients.

GPs should clarify with Medicare whether they are able to use the same provider number within the temporary practice or if a temporary provider number can be accessed. It is also suggested that GPs operating from a temporary location/practice seek endorsement from their relevant medical indemnity organisation to ensure that they are adequately covered.

Planning for reduction in staffing

In an emergency, practices may experience a significant reduction in staffing capacity. This may mean a decrease in the level of service they can provide to patients.

The emergency management coordinator is advised to consider how the practice will continue operating with a reduction in key staff. One way to help alleviate staffing issues in the event of an emergency is to provide staff with education and training in other roles (where a similar level of expertise is required) within the practice so they may be able to provide other duties.

It may be possible to make a reciprocal arrangement with a nearby practice to provide staff for a short period of time in the event of an emergency and to pool staff and resources in an emergency. PHNs may also be able to provide advice and/or support in the event of an emergency.

Vaccines

It is essential to maintain the temperature of vaccine fridges between +2 °C and +8 °C. To ensure temperature maintenance, vaccine fridges must be stored in a well-ventilated room with good circulation. Practice staff should monitor and record the temperatures at the start and end of each day.

There needs to be a contingency plan for managing vaccines in the case of a disruption to power. For example, it is recommended that practice staff make arrangements with local pharmacies and hospitals to store vaccines at appropriate temperatures in the event of an emergency. There is also the option of installing a back-up battery for vaccine fridges which automatically powers fridges when the power is cut off and shuts off when power resumes. Such batteries last 36–48 hours and when power is restored the batteries are automatically recharged.

Familiarity with vaccine management guidelines for the relevant state or territory health department is recommended.

The Department of Health’s National vaccine storage guidelines – Strive for 5 (2nd edn) outlines the basic principles for safe vaccine management.

Information technology and data

Practice operations rely increasingly on computer hardware, software and IT systems for the general practice setting. This equipment can be damaged or its functionality lost in the event of an emergency.

Hardware

During the emergency planning process, it is advisable to stocktake all hardware and equipment in the practice. In the event that any equipment is destroyed or damaged, staff will be able to ascertain what needs to be replaced. This list can be used as part of the practice’s asset register.
If the practice leases computers and hardware, it is important to contact the leasing company as soon as possible to discuss the damage and the process involved in replacing items.

If IT equipment has been damaged as a result of a disaster, determine the operational status of equipment. For safety purposes, seek advice from a professional. Practices may need to transfer any equipment and computers that have not been damaged to a safe operational area within the practice to ensure their protection.

After an emergency, the practice may have limited or no access to computers. This may be due to damage to computers or damage to or loss of functionality of the server.

Practices should keep at least one fully charged laptop stored with current practice/patient data or ensure access to the previous day’s back-up (whether physical or on a secure cloud).

It is important that practices have suitable media-reading devices to effectively restore data when IT systems  are affected.

Software and applications

Software is generally stored on a disk or other device, is downloadable from the vendor’s website, or stored in the computer’s permanent memory. When first purchased, software is either registered to the practice or to an individual working within the practice.

It is recommended that a list of all software and access codes be created and maintained, including software support phone numbers. This list can be used as part of the practice’s asset register.

If software and applications do not work due to server damage, assistance should be sought from an experienced IT technician, who will need to reinstall them.

Data protection

In the general practice setting, data protection is key to effective business continuity. Information management and information technology should always be considered as a high priority in emergency planning. Advanced planning will make the recovery phase significantly easier and faster.

Critical information should be kept current and stored off-site as part of high-quality back-up systems for information technology. As a minimum, daily back-up of all data should be performed (including email, shared documents, network file and databases and clinical and practice software) and verified. When a disaster is imminent, a hard copy list of all patients seen should be kept so that records can be updated when business as usual resumes.

Restore procedures should also be tested regularly. This may include contacting software vendors for productspecific recommendations regarding restoration processes and data integrity checks.

A regular recovery check should also be performed (dependent on the risk assessed by the individual practice) to ensure that recovery methods are working and appropriate for the practice. This can be coupled with a test plan to verify data integrity (eg searching for patient X to confirm their history and demographics are correct as documented in the test plan).

It is important to conduct regular audits on desktop computers/workstations to ascertain what data is being stored on local drives. There may be some applications that are not connected to the server and therefore not backed-up daily.

Paper medical records

If your practice still has paper medical records in storage, there are a range of activities staff can undertake to minimise damage to these records in an emergency. However, paper medical records can be damaged irrespective of the protective measures employed.

During disaster planning and preparations, a list of disaster recovery specialists in the area should be created, including their names, phone numbers and area of expertise. If paper medical records are damaged by water or fire, practices will need to have systems in place to assess whether the records can be recovered. It is advisable to access services from disaster recovery specialists during the emergency planning process to understand what services they provide.

When dealing with damaged paper records:

  • assess the damage and review the possible options for recovery
  • separate the damaged records from the undamaged records
  • handle them as little as possible – even if the paper record is saturated, in most cases the majority of the writing will remain legible if water-fast pens have been used
  • it may be appropriate to air or fan dry them onsite, if only slightly damaged by water
  • it is recommended that practices contact an appropriate disaster recovery specialist for records that have significant damage.

Power

Power supplies to practices may be disrupted or lost in the event of an emergency. Disruption to or loss of power supply will affect many of the practice’s appliances and systems. Consideration of how computer systems, telephone systems, automatic doors, heating and cooling systems and lighting will be affected is key to  disaster planning.

Uninterrupted power supply

The majority of practices will have an uninterrupted power supply (UPS) installed, which is designed to protect the computer server for a short period of time in the event of a power outage. UPSs are usually not intended to be used for long periods of operation. However, if this is a significant concern, it may be worth considering increasing the capacity of the power supply during emergency preparations.

UPSs need to be regularly checked as they have a limited lifespan. It is also worth comparing the cost of replacing a UPS battery with the cost of replacing the whole UPS. It might be that replacing the whole UPS is as cost effective as replacing the battery.

Power generators

Diesel or petrol generators can provide the practice with power if power supplies are disrupted. Generators can be used for back-up lighting, vaccine refrigerators, computer systems and other appliances in specific areas. Used in conjunction with a UPS, power generators can ensure that power is delivered to sensitive equipment such as computers and medical equipment.

Practices may wish to consider hiring or purchasing back-up power generators as part of the emergency planning process. Reserving a generator in the event of an emergency may involve an annual reservation fee to ensure that the practice is given priority during significant demand.

Lighting

Battery-powered emergency lighting to highlight exit routes is a mandatory requirement for facilities accessed by the public. These need to be tested regularly to ensure they are in working order.

However, this lighting will likely not be sufficient for all rooms and parts of the practice if there is a disruption to the power supply. Therefore, for safety purposes, ensure that practice staff have easy access to the emergency kit and additional torches, as well as a supply of batteries.

Wind-up or solar dynamo torches may be purchased, which can also be used to charge mobile phones.

Computer systems

If computers are not shut down properly during a power outage, they can incur significant damage. Some practices may have a UPS, which should continue to deliver power to the practice’s main server to allow extra time for computers to be shut down correctly and/or to initiate a forced shutdown of the system.

Water

Practices may experience disruptions to their water supply in an emergency. Water pipes may be damaged within the building, local water supplies may be affected either through loss of supply or contamination, or water supply may be completely cut off to the area.

It is crucial that staff know where the water main is located and how to turn it off. The location of the water main should be highlighted on the practice map.

Keep a well-stocked supply of bottled water and alcohol sanitiser in the event that the local water supply is contaminated. Bottled water can be stored in the emergency kit. Arrangements for boiling and storing water for additional supplies should also be considered during the disaster planning process.

If there is damage to the water pipes and flooding results, practice staff will need to shut off the main water supply to the practice.

Building, contents and business insurance are essential for any business, and general practices are no exception. During the disaster planning process, it is recommended that insurance policies for the practice are reviewed regularly to ensure adequate coverage for the practice.

To ensure adequate coverage, it is important that the policy covers:

  • all natural and man-made disasters
  • extensive damage and total loss of the building
  • the entire contents of the building, including loss and damage to medical equipment and supplies
  • costs associated with interruption to the business (may include staff pay and loss of revenue) – this may trigger a higher premium
  • costs associated with relocating to a temporary practice – this may trigger a higher premium

It is recommended that key information about your insurance policy such as name of insurer, policy number, type of insurance coverage and contact details are kept off-site in the event of damage to the practice.

There are also practical safeguards that staff can undertake to help protect the facility and reduce the amount of damage caused to the practice’s infrastructure and contents in the event of a natural disaster such as a bushfire, earthquake, cyclone or flood. See below for some of the key preventive steps that practices should take in preparation for natural disasters.

Box 4. Preparing the practice for a bushfire

  • Remove excess rubbish, leaves, litter and shrubs from around the practice.
  • Remove any flammable materials such as paint from the premises.
  • Clear guttering surrounding the practice regularly.
  • Cut the grass and remove all trimmings regularly.
  • Ensure there is a wide firebreak around the practice.
  • Remove all tree branches so that the building is clear from overhanging branches.
  • Install a sprinkler system around the practice.

Box 5. Preparing the practice for a cyclone

  • Check with your local council or a professional builder/architect that the practice has been built to meet cyclone standards.
  • Check that the practice’s infrastructure is in sound condition.
  • Maintain the roof and eaves regularly.
  • Fix all loose guttering around the practice.
  • Remove or secure any dangerous debris outside the practice.
  • Fit all windows with shutters or metal screens for added protection during high winds.
  • Heavily tape windows shut

Box 6. Preparing the practice for an earthquake

  • Remove heavy objects from shelves or store them on lower shelves.
  • Secure or fasten heavy equipment to a fixed surface or wall (eg television in waiting room).
  • Secure all wall-mounted objects (eg whiteboards/clocks).
  • Ensure all power boards are being used appropriately and not overloaded.
  • Secure and fasten large expensive medical equipment to a fixed surface or wall.
  • Ensure that medications and small medical equipment are stored in a safe place.

Box 7. Preparing the practice for a flood

  • Identify all indoor items that need to be raised off the floor in the event of a flood.
  • If practical, consider alternatives to carpet such as tiles.
  • Relocate all low power points well above previous flood levels (using a licensed electrician).
  • Secure any objects in the practice that are likely to float.
  • Install flood-proofing equipment (eg sandbags) if locking up the practice for an extended period of time.
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