If on-site surveys of physician offices conducted by SCPIE’s Risk Management Department, plus calls to SCPIE’s Risk Management Hotline, are any indication, a large percentage of medical practices do not have emergency response plans in place. As a result, most are unprepared to respond effectively to untoward events.

It’s easy to ignore the need to plan ahead for emergencies, but such challenging events are not as rare as one might think. Obviously, plans should be in place for dealing with natural disasters such as earthquakes—but any event that involves potential injuries or the disruption of a medical practice’s ability to function should be anticipated and planned for.

For example, are you and your staff ready to respond quickly and efficiently if a child collapses in your office following an allergy injection? What would you do if a patient undergoing a routine procedure in your office went into cardiac arrest? When was the last time your office staff carried out a fire drill—or even discussed what to do in case of fire?

In addition to the threat of fire, many other negative events related to your physical plant could take place. A few of the possibilities: electrical outages, water supply disruptions, water leaks, bomb threats and robberies. The sudden loss of key personnel, the accidental or deliberate destruction of medical or financial records, the failure of computer systems—all could imperil your normal practice operations.

Basic Steps in Planning
Not only can the ability of a medical office to respond effectively to any type of adverse event help insure optimal patient care, it can also help preserve the physician’s reputation and reduce the likelihood of lawsuits being filed. While it is neither possible to anticipate every contingency nor practical and affordable to put every conceivable precautionary measure in place, it takes relatively little time, money and effort to predict the most likely problems and to institute basic reaction plans for them.

Given the range of potential crises, it’s a good idea to decide in advance which ones you hope to cope with should the need arise, and which you plan to respond to by closing your doors altogether. Be sure to include your staff when formulating and rehearsing response plans, since successful operations in an emergency require flexibility and teamwork. The goal of developing and carrying out workable strategies will be much more achievable if everyone is on board.

Although untoward events take many different forms, a uniform basic approach can be used to plan for all of them. The most important steps are the following:

• Identify potential crises.
• Decide which to prepare for.
• Develop basic contingency plans.
• Procure needed resources.
• Train staff to carry out the plans, and reinforce the training with periodic drills. Test your plans at least once every six months.

Also, assign various members of your staff specific responsibilities in the event of injuries. Some examples:

• Call 911.
• Assess the condition of any injured individual and initiate CPR if needed.
• Pull the medical records of the injured person, if available.
• If he or she is new to your practice, search the person’s belongings for pertinent medical information, or query any companions present.
• If appropriate, escort other people out of the immediate area. There are a number of things you, the physician, need to do when an unexpected negative event takes place.
• Stabilize the injured person.
• Provide an example for your staff by remaining calm.
• Talk to your staff about which facts can be ascertained and which remain unknown.
• Explain the known facts to the injured person and/or his or her family; use plain, nontechnical language.
• Empathize with the injured individual and/or the family by acknowledging their shock and worry; admit your own concern as well. Do not place blame for the event on anyone, however.

Document What Happened
Whenever an event inconsistent with the routine operation of your office takes place, fill out and keep an incident report to preserve the facts and to help identify, investigate and correct problems.

Report only the facts—details such as date and time of the event, full name of the individual who was injured, names and addresses of witnesses, etc.—and document them in the injured person’s chart. Again, be careful not to assign blame or document opinions as to the cause of the event. The incident report itself should not be filed in the chart, nor should any reference to the report be made in it.

If one or more pieces of equipment are suspected to have contributed to the incident, have an expert evaluate the equipment and document the chain of custody of all items involved. Don’t discard any containers, laboratory specimens, preventive maintenance logs, proof-of-purchase slips, ECG and other monitoring strips, syringes, vials, other medication supplies and equipment involved in the occurrence. They could become vital pieces of evidence in future litigation; conversely, their absence could give the impression of a deliberate cover-up.

Always remember: If an unexpected event involves injuries to patients or staff members, the immediate priority and focus should be on clinically treating and emotionally supporting those individuals. Then, if it appears a claim may ensue, notify SCPIE as soon as possible, while the details of the event are still fresh in your mind.