Emergency Preparedness and Health and Safety Procedures for Rehabilitation Businesses

Original Editor - Wanda van Niekerk based on the course by Jacquie Kieck

Top Contributors - Wanda van Niekerk and Jess Bell  

Introduction

As rehabilitation professionals, it is vital to ensure the safety of our clients and staff, not only when providing care but also in emergency situations. Though it is unpleasant to think about emergencies, proper preparation protects your patients, staff and business when the unexpected happens. Being prepared allows professionals to respond confidently and effectively in any situation.

Electrical Safety in a Clinical Setting

Rehabilitation practices use various electrical devices. Administrative spaces and clinician offices typically contain computers, printers, and other office equipment. Treatment areas may house specialised electrical apparatuses for therapy, such as ultrasound machines, electrotherapy devices, and exercise equipment. Working with electrical devices has inherent risks, as contact with electrical currents can lead to serious harm, including burns and organ injury or failure. Such contact may occur due to defects in the electrical device, frayed cords, or damaged plugs or wires. Unsafe practices near electrical devices, such as handling exposed wires, using multiple extension plugs, overloading a multiplug, or exposing a wire, increase the risk of electrical accidents.

It is essential to implement an electrical safety programme to ensure the safety of everyone in your practice. This planning can help prevent incidents which cause harm, reduce productivity and incur costs.

The following steps can help to increase electrical safety in your practice:

• complete regular servicing and maintenance of electrical equipment
• have an up-to-date electrical certificate
• ensure qualified electricians install electrical devices
• make sure there is enough space for equipment and for clinicians to move freely around equipment
• keep all electrical devices far from water
• create staff awareness about electrical hazards
• provide training to staff on the correct handling of electrical devices

Safety of Electrical Modalities in Rehabilitation

Physical agent modalities (PAMs) are a range of rehabilitation techniques, including electrical stimulation, neuromodulation, antalgic and interferential currents, extracorporeal shock wave therapy, laser therapy, electromagnetic therapy, diathermy, and therapeutic ultrasound. Hot thermal agents and cryotherapy are also examples of PAMs, but for this page, we will concentrate on the electrical modalities.

These modalities are often used in physiotherapy and rehabilitation practices for pain relief and to improve healing. They are usually integrated into a rehabilitation session along with other rehabilitation interventions. It is important to ensure that these modalities are safe to use for both the clinician and the patient.

A recent Delphi study was conducted to create the SAFE PAMP consensus, which includes safety statements for PAMs in physiotherapy and rehabilitation practice. The “experts agreed on the safety of PAMs in the adult population (> 18 years) when prescribed and applied by a healthcare professional who is adequately trained and informed, as required by education and licensure.”

Implications for Clinicians and Stakeholders

Before suggesting PAMs to patients, it is essential to take a detailed medical history to determine the diagnosis and prognosis, as well as treatment goals and outcomes. Evidence-based research, clinical expertise, patient needs and preferences should all be considered when deciding on the most effective treatment route. The safety and effectiveness of treatment are important, and patients must be informed of possible adverse events.

International and national organisations should manage good practices for patient safety with monitoring systems and shared international initiatives. Healthcare providers, patients and policy-makers should be informed about the safety of PAMs in different rehabilitation settings.

If you would like, you can read the complete consensus statement here.

The video below provides three key points about the use of PAMs in occupational therapy. Remember that PAMs are not a stand-alone treatment and they should support a specific goal. Rehabilitation professionals must make sure they are aware of their state / country requirements for using PAMs.

Fire Safety

Your personnel need to be prepared for a fire emergency. A strong relationship exists between sufficient fire safety knowledge and emergency preparedness; as fire safety knowledge increases, so does emergency preparedness.

However, research has shown that healthcare workers often lack adequate fire safety knowledge and emergency preparedness. They are often unfamiliar with the different types of fire and fire extinguishers. Some healthcare workers have reported that they have never taken part in a fire drill, an emergency evacuation drill or fire safety training. Moreover, many healthcare providers don't even know the contact number of their local fire department. These gaps in knowledge highlight the need for focused interventions and fire training programmes in healthcare and rehabilitation businesses.

As a business owner, you have the responsibility to address any gaps in fire safety and emergency preparedness in your rehabilitation business. Targeted training programmes and detailed safety protocols are essential to protect all people in your clinic.

Health-Related Emergency Responses in a Rehabilitation Practice

Health-related emergencies (e.g. chest pain, fainting, cardiac arrest, adverse reactions to treatment, dizziness, an acute complication of a co-existing medical condition, such as hypoglycaemia, cerebrovascular accident, etc.) can occur in rehabilitation practices. These events require immediate and appropriate management. Therefore, a rehabilitation business needs to have a medical emergency procedure / response plan.

A medical emergency response plan should stipulate the roles and responsibilities of each team member and all staff should be familiar with the plan. All personnel should have the necessary skills and knowledge to identify and safely manage medical emergencies. It is also essential to properly maintain your business's emergency equipment and supplies.

Here are some general guidelines to help manage medical emergencies:

• be prepared to deal with a medical emergency
• make sure that personnel are trained to handle medical emergencies
• stay up-to-date with medical advances and emergency management with regular training and continuing education
• make sure that the necessary medical supplies and equipment are stored appropriately and organised for quick and easy access
• have regular clinical audits to review your emergency procedures to ensure that all staff members are prepared and trained to manage medical emergencies
• check for signs of life (breathing and circulation) when a patient collapses and if signs of life are absent, provide cardiopulmonary resuscitation (CPR)
• record the medical emergency in detail (what happened and how it was managed)

Adverse Events in Rehabilitation

Patient safety is essential in every type of rehabilitation setting. However, adverse events do occur. Adverse events can vary in their severity, type of injury, associated signs and symptoms, and the psychological or traumatic impact they produce.

An adverse event is “an incident in which harm resulted to a person receiving healthcare”. A serious adverse event is “any undesirable experience occurring during intervention which requires further medical attention or extended hospital stays.”

Adverse events can be unintentional or treatment-related. Consequences of adverse events may include: no harm done, rapid recovery, possibility of prolonged hospital stay or a serious clinical decline which requires further medical care.

While rehabilitation treatments by allied health professionals, such as physiotherapists, occupational therapists and athletic trainers, are usually safe, they can result in unintended adverse events. In musculoskeletal rehabilitation settings, common adverse events include increased stiffness or pain, especially after treatments such as manual therapy, exercise therapy and electrotherapy. In cardiovascular rehabilitation settings, treatments, such as early mobilisation, exercise therapy and airway clearance therapy, may cause desaturation and haemodynamic instability. Adverse events in neurological rehabilitation can include falls and fatigue.

In rehabilitation settings, all clinicians should be aware of possible adverse events. They need to be able to recognise potential risks and create strategies to reduce the occurrence of these events. Rehabilitation professionals need to monitor their patient’s symptoms during interventions and be able to adjust the treatment or exercise intensity. While more experienced clinicians may be able to notice the signs earlier, inexperienced clinicians can benefit from specific education on adverse events in rehabilitation settings. Through education and awareness, clinicians are better able to monitor patient responses, educate patients and their caregivers of possible risks and implement strategies to reduce the possibility of adverse events.

Disaster Planning for Rehabilitation Businesses

A disaster, natural or man-made, can have a severe impact on a business. Research shows that 40% of small businesses do not reopen after a disaster, so it is important that business owners are as prepared as possible.

Disaster preparedness is defined as “the measures taken to prepare for and reduce the effects of disasters”. This includes identifying risks to which your rehabilitation practice is susceptible, taking the necessary steps to reduce these risks, and preparing for disasters.

The following steps are recommended as part of disaster planning for your rehabilitation practice: (1) prepare an emergency preparedness plan, (2) have practice and client data back-ups, (3) ensure that you have legal and financial safeguards in place and (4) put together an office emergency kit. These steps are discussed in more detail below.

Prepare an emergency preparedness plan: in this plan, outline the possible risks and the impact of disasters on your rehabilitation business. You need to identify the disasters that are possible in your specific area (e.g., hurricanes, floods, wildfires, earthquakes) and the potential impacts of these disasters (e.g., loss of power or water, limited access to supplies, transportation or communication difficulties, etc). Put together a contingency plan if you are experiencing some of these impacts, such as loss of power or internet, for a few days or weeks. Have emergency contact numbers for staff, emergency services and the local authorities in your plan, but also clearly visible in your practice.

Have practice and client data back-ups: you can use secure cloud storage to keep practice data and client data files, or if all the information is on the computers at your practice, regularly schedule off-site backups for these files. It may also be a good idea to create an offline document with all the relevant contact details of patients and other professionals you work with. In situations where it is not possible to work from your physical premises, have options available, such as access to telehealth services, to stay connected with your patients and continue with their treatments.

Ensure that you have legal and financial safeguards in place: make sure that your business insurance covers natural disasters and that any structural or equipment damage is covered. Be sure to review and update your policy to make provision for any income disruptions due to disasters. If you plan to use telehealth sessions in disaster situations, make sure that your professional liability insurance covers this. It is also good practice to have a financial contingency fund to cover any unexpected expenses.

Put together an office emergency kit: this kit should contain a first aid kit, flashlights, extra batteries, blankets and emergency shelter supplies. A wrench or pliers will be handy to turn off utilities if necessary. Have enough water and non-perishable food for several days. The kit can also have copies of important documents.

Phases of Disaster Planning

"A systematic approach to deal with the disaster effects and risks can include a combination of pre-disaster measures and post-disaster actions." This approach can be divided into different phases, which are: mitigation, preparedness, response and recovery. Mitigation refers to the actions taken to identify and examine long-term risk to human life and their properties." Preparedness involves "taking the measures to develop working schemes and capabilities prior to a disaster." Response refers to "protecting lives and properties by taking immediate actions before the disaster, during the disaster or just after the disaster." Recovery includes the "efforts and processes that will give rise to an immediate, medium and long-term redevelopment of an area, after the disaster event."

Example: Planning for a Disaster

The following fictional case scenario illustrates possible earthquate preparation measures for a rehabilitation business.

The owner and director of a medium-sized rehabilitation clinic is concerned about possible earthquakes in their area following a recent earthquake in a nearby region. The clinic, which has 15 staff members and provides physiotherapy, occupational therapy and speech and language therapy to approximately 200 active patients, is located in an earthquake-prone area. As a result of these concerns, the business owner has decided to implement a comprehensive earthquake preparedness plan.

Phase 1: Knowledge Development

The owner began by gathering educational materials about earthquake preparedness for rehabilitation businesses. A staff meeting was organised to discuss earthquake risks in their region and the importance of being prepared. All staff members attended a specialised first aid course that included trauma care relevant to earthquake injuries. Monthly earthquake drills were implemented, with scenarios specific to their clinical setting, including how to protect patients with mobility issues during tremors. The owner also funded staff participation in a local emergency preparedness workshop hosted by the city’s emergency management department.

Phase 2: Financial Protection

After meeting with their insurance broker, the business owner upgraded the clinic’s insurance policy to include comprehensive business contents insurance, protecting their expensive rehabilitation equipment. Business interruption insurance was added to cover ongoing expenses and lost revenue if the clinic had to close temporarily. The clinic building was vulnerable to damage from an earthquake, and the owner added specific earthquake insurance to cover structural damage. In consultation with an emergency management consultant, the owner developed a detailed business disaster recovery plan that outlined steps for quickly resuming operations after an earthquake. This was complemented by a business emergency response plan that specified immediate actions during an earthquake, including patient evacuation procedures and staff responsibilities.

Phase 3: Survival Readiness

The business owner stocked multiple first aid kits throughout the practice and added specialised medical supplies that would be useful in earthquake-related injuries, such as splints, tourniquets and wound care items. The clinic designated a storage area for emergency water and non-perishable food sufficient for all staff and patients for at least 72 hours.

Given the need for specific rehabilitation equipment that requires power, the owner ensured the clinic had backup batteries for essential devices. The owner also reached an agreement with a colleague who owns a rehabilitation facility 80 km (50 miles) away to serve as a temporary relocation site if their building became unusable. The clinic invested in a commercial-grade generator with automatic switching capability to maintain power for critical equipment during outages.

Phase 4: Physical Protection Measures

The owner implemented a robust digital records system with daily cloud backups of all patient information and business data. They hired a structural engineer who conducted a thorough seismic assessment of their building, identifying vulnerable areas.

All tall shelving units and storage cabinets were secured to walls, and cabinet doors were fitted with latches to prevent contents from spilling during tremors. The staff ensured that heavy rehabilitation equipment was positioned on lower shelves or directly on the floor when not in use.

Critical business records, insurance policies and emergency supplies were secured in waterproof and fireproof containers. Based on the engineer’s recommendation, the owner invested in a partial seismic retrofit of the building, focusing on strengthening structural connections and reinforcing treatment rooms with the most vulnerable patients.