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This document is a sample Hazard Vulnerability Analysis tool. It is not a Issues to consider for prep
substitute for a comprehensive emergency preparedness program. Individuals or 1
organizations using this tool are solely responsible for any hazard assessment and 2
compliance with applicable laws and regulations. 3
4
INSTRUCTIONS: 5
Evaluate potential for event and response among the following categories using
the hazard specific scale. Assume each event incident occurs at the worst Issues to consider for inte
possible time (e.g. during peak patient loads). 1
2
Please note specific score criteria on each work sheet to ensure accurate recording. 3
4
Issues to consider for probability include, but are not limited to: 5
1 Known risk 6
2 Historical data
3 Manufacturer/vendor statistics Issues to consider for exte
1
Issues to consider for response include, but are not limited to: 2
1 Time to marshal an on-scene response 3
2 Scope of response capability 4
3 Historical evaluation of response success 5
Issues to consider for human impact include, but are not limited to: Complete all worksheets i
1 Potential for staff death or injury The summary section will
2 Potential for patient death or injury
Issues to consider for property impact include, but are not limited to:
1 Cost to replace
2 Cost to set up temporary replacement
3 Cost to repair
4 Time to recover
Issues to consider for business impact include, but are not limited to:
1 Business i
2 Employees unable to report to work
3 Customers unable to reach facility
4 Company in violation of contractual agreements
5 Imposition of fines and penalties or legal costs
6 Interruption of critical supplies
7 Interruption of product distribution
8 Reputation and public image
9 Financial impact/burden
External Emergency
An External Emergency involves an incident beyond the immediate boundaries of the LSUHSC-S campus. This typ
Mass Causality Emergency
A Mass Causality Emergency involves a large influx of victims from an internal or external event requiring treatment
Any series of events which creates an overload situation in the Emergency Department may necessitate the use of
The Safety Committee has developed appropriate specific emergency response plans based on priorities establishe
MITIGATION - Activities designed to reduce the risk of and potential damage due to an emergency (i. e., the installation of sta
PREPAREDNESS - Activities that organize and mobilize essential resources (i. e., plan-writing, employee education, preparati
RESPONSE - Activities the hospital undertakes to respond to disruptive events. The actions are designed with strategies and a
RECOVERY - Activities the hospital undertakes to return the facility to complete business operations. Short-term actions asse
Issues to consider for preparedness include, but are not limited to:
Status of current plans
Frequency of drills
Training status
Insurance
Availability of alternate sources for critical supplies/services
Issues to consider for internal resources include, but are not limited to:
Types of supplies on hand/will they meet need?
Volume of supplies on hand/will they meet need?
Staff availability
Coordination with MOB's
Availability of back-up systems
Internal resources ability to withstand disasters/survivability
Issues to consider for external resources include, but are not limited to:
Types of agreements with community agencies/drills?
Coordination with local and state agencies
Coordination with proximal health care facilities
Coordination with treatment specific facilities
Community resources
Complete all worksheets including Natural, Technological, Human and Hazmat.
The summary section will automatically provide your specific and overall relative threat.
SUHSC-S campus. This type of incident can result in arrival of multiple casualties, including contaminated or contagious victims
nal event requiring treatment, such as the result of a fire, explosion, train wreck, or bioterrorism event that directly affect hospita
may necessitate the use of the emergency procedures described in the Mass Casualty Discharge Plan. The mass casualty em
based on priorities established as part of the Hazard Vulnerability Analysis. Each Emergency Response Plan will address the fo
employee education, preparation with outside agencies, acquiring and maintaining critical supplies).
designed with strategies and actions to be activated during the emergency (i. e., control, warnings, and evacuations).
ations. Short-term actions assess damage and return vital life-support operations to minimum operating standards. Long-term actions focus
nated or contagious victims, which involve the Emergency Department. These type of external emergencies include; utility outa
t that directly affect hospital operations. The victims may arrive at the Emergency Department via ambulance or other emergen
Plan. The mass casualty emergency may be combined with other response plans used to protect the facility, such as in the even
nse Plan will address the four phases of emergency management activities:
ards. Long-term actions focus on returning all hospital operations back to normal or an improved state of affairs.
Kemungkian
Probabilitas akan Kehilangan dan Gangguan Waktu, efektifitas, Masyarakat/Bantua
meninggal atau Praperencanaan Ancaman relatif*
terjadi kerusakan fisik pelayanan sumberdaya n umum dan supli
cedera
BANJIR 2 2 2 2 3 2 2 48%
gempa 1 3 3 3 3 3 1 30%
Angin Putting Beliung 0%
0%
TOLONG DITAMBAHKAN 0%
0%
TOLONG
DITaMBAHKAN
Insiden Masal/kecelakaan
3 3 3 3 2 1 1 72%
lalu lintas (Trauma)
Insiden Masal
3 3 0 2 2 1 1 50%
(medis/infeksius)
PENCURIAN 3 3 1 1 3 2 1 61%
0%
TOLONG DITAMBAHKAN 0%
0%
0%
NILAI RATA-RATA 1.40 1.20 0.70 1.10 1.10 0.80 0.50 14%
TOLONG 0%
DITAMBAHKAN
0%
0%
Hazmat
Natural
Human
Probability 0.06 0.12 0.47 0.33 0.98
1.00
0.90
0.80
0.70
0.60
0.50
0.40
0.30
0.20 0.14
0.10 0.07
0.01 0.01
0.00
Natural Technological Human Hazmat
R e la tiv e Im pa c t on Fa c ility
0.98
1.00
0.90
0.80
0.70
0.60
0.50
0.40
0.30
0.20
0.10
0.00
Probability Severity
This document is a sample Hazard Vulnerability Analysis tool. It is not asubstitute for a comprehensive emergency preparedness program.
Individuals or organizations using this tool are solely responsible for any hazard assessment and compliance with applicable laws and regulations.