What Does BZ Mean?

Bravo Zulu when conveyed by flaghoist, morse code, or voice comms at the end of a mission means Well Done. It was introduced between allied forces in World War II.

This blog is a BZ to you.





"All-Hazards Healthcare Emergency Preparedness" with NCH Healthcare System

Robin was joined by Jennifer Smith, Emergency Management Coordinator at NCH Healthcare System in Florida to hear all about what emergency management looks like at a multi-hospital healthcare system.

Jennifer’s Background

Jennifer has dedicated over 20 years of service to public safety; including emergency medicine and emergency management. Before joining NCH, Jennifer served in various roles with the Department of Health. She held the position of Regional Emergency Response Advisor to Region 6 for the Florida Department of Health for five years. In this role, she supported 10 counties in all phases of emergency management aspects specific to public health. In addition, Jennifer has been a member of the National Disaster Medical System with the Department of Health and Human Services for over 17 years and has been deployed to multiple events ranging from National Special Security events to disasters. Jennifer began her career as a paramedic where she received certifications in flight paramedicine and specialty response.

Jennifer holds an undergraduate degree in Health Sciences and a Master of Arts Degree in Emergency and Disaster Management. She holds multiple certifications in emergency preparedness and most recently became a Certified Emergency Manager by the International Association of Emergency Managers. She currently serves as a member of the Regional Domestic Security Task Force Executive Board for Southwest Florida.

Healthcare Emergency Preparedness Hazards in Florida

NCH Healthcare System is a multi-hospital healthcare system in Southwest Florida. The system is physically located in Collier County which is one of the most southernmost counties in the state of Florida. The area has a hot, tropical climate. It is also a popular tourist location. As of the 2020 census, the population of Collier County was 375,752. NCH also provides services in Lee County, which is a neighboring county with a population of about 800,000.

The area is very coastal which makes them at risk for flooding; whether that’s localized flooding or storm surge. NCH’s biggest risk when it comes to emergency preparedness is hurricane season which runs from May/ June to November each year.

Responsibilities of a Healthcare Emergency Management Coordinator

As the Emergency Management Coordinator at NCH, Jennifer is responsible for ensuring the hospitals are ready for any kind of emergencies such as hurricanes, fires, pandemics, and utility failures. Jennifer’s primary focus during an emergency is ensuring that the hospital can maintain its operations and continue to take care of patients.

Working in conjunction with the NCH system leadership, Jennifer coordinates pre and post-emergency event activities by creating emergency plans for all phases of emergency management. She conducts hospital-based exercises and drills, as well as NIMS training with hospital staff. She also documents incidents or events as they occur including after-action reports. As part of her role, Jennifer also maintains positive relationships with community partners such as county emergency management and local sheriff’s departments.

Healthcare Emergency Planning

NCH Healthcare System has an all-hazards emergency operations base plan that covers generic structure and operations, they also have hazard-specific plans for activities like evacuations. The hospital may need to be evacuated due to incidents such as hurricanes, fires, or utility failures.

The hospital does rely on community partners to help execute plans, but they try to be as self-sufficient as possible. As NCH is a health system, as opposed to a standalone hospital, they generally have a place where they can relocate patients and borrow staff and resources. Trying to evacuate a hospital such as NCH’s Baker Hospital can be challenging as the hospital has about 300 patients at any given time, plus visitors and staff. It is important that NCH drills down emergency evacuation plans, prioritizes objectives, and works to constantly improve plans after exercises and real-life events.

NCH’s emergency plans are very detailed. For example, for an evacuation, it’s important that the process is very controlled and not chaotic in any way. Jennifer has maps drawn up for when the ambulances arrive to move patients during an evacuation. These maps are diagrammed to show the route of travel around the hospital, which doors are exit points for patients and the order in which certain patients should be evacuated. There are also plans that specify which tools and resources should be used to physically move patients down stairwells in the event of a power outage.  

The Hospital Emergency Operations Center (EOC)

NCH is currently in the process of updating and building a larger communications center. At the moment, they have a dedicated room with a large conference table and multiple computers that are always turned on and ready to go. They also have a wall with several monitors where they can display the news, weather, their D4H incident management dashboard, and video surveillance.

It can be atypical for a hospital to have a dedicated room that is always set up for coordinating emergency operations but because NCH needs to be prepared for many different types of emergencies, often ones that happen with no notice, it is important for them to keep a posture of readiness at all times.

Running Drills for Emergency Situations

Jennifer runs drills frequently as it allows NCH to test their plans and make changes to them as needed. Every hospital in the US is governed by an accreditation body. NCH is governed by the Centers for Medicare & Medicaid Services and the Joint Commission. These accreditation bodies require NCH to run at least two large exercises each year. They also require NCH to run fire drills on a quarterly basis.

NCH runs additional training exercises beyond what is required. Two weeks ago, Jennifer ran an exercise at the mother and baby unit and NCH’s North Hospital. The exercise ran through a ‘code pink’ drill, which is an infant abduction. They activated that response and ran through the paging protocol at the hospital. The staff then had to respond accordingly to this mock scenario. This included checking on the other mothers and babies and performing a search for the ‘missing baby’. Although there are multiple fail-safes in place, staff still need to determine if the ‘missing baby’ has left the facility. The drills are very robust and staff must coordinate search efforts, communicate back to the public safety security staff, and liaise with law enforcement that would respond to such an incident.

Another recent drill they ran was for a ‘code black’, which is a bomb threat. They test for very varied eventualities because it is often impossible to predict what can happen.

Communicating During an Incident

NCH uses multiple different tools for communicating during an incident. Their primary method of communicating during an emergency is D4H Incident Management, and Jennifer prefers that all communication goes through the platform for documentation purposes. They also use their landline telephones during an incident, and they have satellite phones at each of their campuses in case of a landline outage.

For daily communication at the campuses, the emergency management staff use two-way radios. They also have two-way radio communication with the local county emergency management agency.

After-Action Reporting

NCH’s accreditation process is not only doing training exercises but also documenting what the exercises revealed and what improvements they are making. If a real event occurs they also write up lessons learned from that. A big part of emergency management and planning is acknowledging shortcomings and applying corrections to prevent them from happening again in the future.

"One of the things that I really like about D4H, especially after using it for a recent IT incident, was not only the ability to create incident action plans but also the fact that I had everything I needed to create the incident after-action. When the incident ended, I had all of the snapshots of the situation reports and all of our ICS forms that were filled out. It was exactly what we needed for learning and making things better."
— Jennifer Smith, Emergency Management Coordinator, NCH Healthcare System.

The records created from D4H Incident Management are also exactly what the healthcare system needs for reimbursement purposes after an incident.

"For events like Hurricane Irma where there is FEMA reimbursement, we need to be able to show what the impacts to our facilities were, what the response actions were, and the recovery actions. Using D4H for emergency management means we’re able to clearly show what happened, how we fixed it, and what we’re still working on."
— Jennifer Smith, Emergency Management Coordinator, NCH Healthcare System.

Healthcare Disaster Equipment

Every hospital is different in terms of its resources and capabilities. For NCH, they have two 26-foot enclosed emergency management trailers. These contain their decontamination equipment such as hazmat suits, equipment to set up the decontamination area, and positive air pressure respirators.

Everyone from engineering staff to security staff is trained in using various pieces of emergency equipment. One positive impact of COVID-19 was that the NCH staff were using the respiratory protective equipment at the peak of the pandemic and they became familiar with it. Should they need to use the equipment for a hazmat incident in the future, they will be far more comfortable using it as they are more familiar with it.

Coordinating with Community Partners

Certain threats such as active shooters and active assailants require the healthcare system to work closely with local community partners. NCH is currently working with Collier County Sheriff’s Office to integrate closely with them, ensure they are on the same page, and enhance their combined response capabilities. This includes implementing electronic mapping to feed into the Sheriff’s Command Center, allowing them to pull maps up and direct officers to certain areas within the hospital during an incident. They are also working on integrating NCH’s security surveillance system with the Sheriff’s Office so that they can see a live feed of the hospital if required. NCH also has the capability of being on the same radio frequency as the Sheriff’s Office in the event of an emergency.

Watch the full interview


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