How are vulnerability risk and hazard related



Topic Collection: Hazard Vulnerability/Risk Assessment

Hazard vulnerability analysis (HVA) and risk assessment are systematic approaches to identifying hazards or risks that are most likely to have an impact on a healthcare facility and the surrounding community. Conducting a risk assessment / HVA is also a requirement in the CMS Emergency Preparedness Rule.  The Joint Commission Emergency Management and NFPA (Healthcare 99-101, Chapter 12, Emergency Management) also require an HVA. Multiple tools and resources are available to help healthcare organizations and public health departments prioritize their planning efforts based on these identified hazards.  

Ideally, an HVA should be conducted with input from experts from outside the institution/agency to ensure the incorporation of additional context for the risk assessment. For example, jurisdictional emergency management, NOAA, and state agencies may have quantitative and qualitative probability and impact data based on risk assessments and actual events that can contribute to the facility/coalition HVA. This data may prompt additional discussions and provide valuable input and resources for consideration in addition to contributing to the HVA. 

Each resource in this Topic Collection is placed into one or more of the following categories (click on the category name to be taken directly to that set of resources). Resources marked with an asterisk (*) appear in more than one category.

Must Reads


Brown, A.(2010).Choosing the Right Tool for Hospital Risk Assessment: Focused Risk Vulnerability Analysis.Compass Clinical Consulting: Hospital Accreditation and Compliance Journal.

The author reviews Focused Risk Vulnerability Analysis, a planning tool that predicts the impact that events or occurrences might have on a hospital. An example case study is provided followed by an analysis of the results.

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Campbell, P., Trockman, S.J., and Walker, A.R.(2011).Strengthening Hazard Vulnerability Analysis: Results of Recent Research in Maine.Public Health Reports. 126(2):290-293.

The authors discuss results from interviews with staff members at eight hospitals in Maine to document HVA processes and develop recommendations for improvement. Researchers conducting the interviews were from the Harvard School of Public Health and the Southern Maine Regional Resource Center for Public Health Emergency Preparedness.

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Drexel University School of Public Health, Center for Public Health Readiness and Communication.(2013).Pennsylvania Public Health Risk Assessment Tool (PHRAT).Pennsylvania Department of Health.

This tool guides public health planners through an analysis of the health-related impacts of various hazards that can occur in their jurisdictions, and helps them prioritize planning efforts for those emergencies.

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Federal Emergency Management Agency.(2018).Comprehensive Preparedness Guide (CPG) 201: Threat and Hazard Identification and Risk Assessment (THIRA) and Stakeholder Preparedness Review (SPR) Guide. (Third Edition.)

This guide provides communities with a three-step process for conducting a Threat and Hazard Identification and Risk Assessment (THIRA). While it incorporates healthcare, this guide is community-based. It builds upon previous versions of the CPG and describes a standard process for identifying community-specific threats and hazards; setting capability targets for each core capability identified in the National Preparedness Goal; and estimating resources needed to meet the capability targets. This edition also includes the three-step process for a Stakeholder Preparedness Review (SPR) (formerly State Preparedness Report), as this process is interconnected with the THIRA process. Healthcare should be aware of the THIRA process and assure that their input is considered and that accurate numerics are used.

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Kaiser Permanente(2017).Kaiser Permanente Hazard Vulnerability Analysis (HVA) Tool.

This tool provides a systematic approach to analyzing hazards that may affect demand for hospital services, or a facility’s ability to provide those services, helping to prioritize planning, mitigation, response, and recovery activities. This revised version of the commonly used tool incorporates data on actual activations experienced by the user, to more fully inform risk analysis.

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Los Angeles County Department of Public Health, Emergency Preparedness and Response Program(2013).Health Hazard Assessment and Prioritization (hHAP).

This tool was developed by the Los Angeles Department of Public Health—in collaboration with the Orange County Health Care Agency, the Long Beach Department of Health and Human Services, and the Pasadena Department of Public Health—and provides a 6-step hazard vulnerability assessment process. It offers a health-focused mechanism to engage the community, identify organizational priorities, and improve an agency’s or community’s capability to successfully prepare for, respond to, and recover from potential emergency threats. Both the hHAP Instrument and Manual are provided as downloads.

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U.S. Department of Homeland Security.(2016).Healthcare and Public Health Sector-Specific Plan.

This plan, updated in 2016, is designed to guide the Health and Public Health (HPH) Sector’s internal, collaborative, and cross-sector efforts "to enhance the security and resilience of HPH critical infrastructure to all-hazards across its physical, cyber, and human dimensions." Updates include refreshed goals and objectives and more emphasis on select priorities (e.g., information sharing and emergency response).

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University of California, Los Angeles (UCLA) Center for Public Health and Disasters(2006).Hazard Risk Assessment Instrument (HRAI).

This workbook is intended for public health agencies and provides guidance in determining the likelihood of a hazard occurring, assessing their community’s vulnerabilities and current resources, and prioritizing resources in planning for disasters.

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Access and Functional Needs


*Wisconsin Department of Health Services(2013).Nursing Home and Assisted Living Residence Hazard and Vulnerability Analysis.

The Wisconsin Department of Health Services tailored the Kaiser Permanente Hazard Vulnerability Analysis Tool for use by nursing homes and assisted living residences. This resource provides a copy of the tailored template for review.

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Education and Training


Columbia University, Earth Institute, National Center for Disaster Preparedness (NCDP)(2015).PREP 1112: Methods of Risk Assessment in Planning for Disasters. (Requires free registration.)

This free course is designed to introduce learners to the basic process of conducting a hazard and vulnerability assessment for their community, and the fundamental concepts of hazard identification and vulnerability assessment in determining public health risk for emergency planning purposes.

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*(n.d.).Conducting a Hazard and Vulnerability Analysis. (Accessed 4/10/2019.)

This slide set from a presentation describes how to conduct a Hazard Vulnerability Analysis (HVA) in the healthcare setting; highlights specific tools that can be used to mitigate risks once hazards have been identified and prioritized; shares the use of HVA in annual emergency management planning activities and demonstrates a new way to prioritize risks using actual incident information.

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Federal Emergency Management Agency.(2013).IS-318: Mitigation Planning for Local and Tribal Communities.

This free course can help local or Tribal government officials, first responders, and other stakeholders: learn more about the Stafford Act; identify and bring together experts and stakeholders (e.g., hospital and other healthcare facility planners) to assist with the process; and use local or tribal mitigation planning guidance to develop a hazard mitigation plan.

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Geneau, J. and Burhans, B.(2017).Hazard Vulnerability Analysis.Montana Hospital Association.

This presentation briefly discusses the hazard vulnerability assessment (HVA) process and its value to healthcare facilities. Lessons learned for two facilities are included.

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Iowa Department of Public Health and University of Iowa, College of Public Health, Upper Midwest Preparedness and Emergency Response Learning Center (UMPERLC).(2012).Community Partnering: A Risk Assessment and Emergency Operations Planning Scenario.

This hour-long community-based planning course includes discussion of how to apply risk assessment to the development of emergency operations plans; considerations for conducting risk assessments; and how to determine resources and information necessary to analyze threats, hazards, operational priorities, and courses of action. The intended audience is local public health administrators and local county emergency managers.

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Texas A&M Engineering.(2019).Critical Asset Risk Management.

This free two-day course is offered in several locations across the U.S. and helps participants understand risks to their facilities and mitigation strategies. Students will be able to practice conducting vulnerability assessments on-site (at local facilities) and identify potential mitigating strategies.

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Texas A&M Engineering.(2019).Disaster Preparedness for Hospitals and Healthcare Organizations Within the Community Infrastructure.

This two-day course is offered in several locations across the U.S. and can help a variety of healthcare industry staff (e.g., planners, directors, regulatory personnel) understand the natural, technological, and human-caused hazards that may make their facilities vulnerable. Participants will learn about response and recovery issues specific to medical facilities, including which resources may be necessary for response and recovery.

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Environmental Hazards


Borden, K.A., and Cutter, S.L.(2008).Spatial Patterns of Natural Hazards Mortality in the United States.International Journal of Health Geographics. 17(7):64.

The authors examine the spatial patterns of natural hazard mortality at the county-level for the U.S. from 1970–2004 using a combination of geographical and epidemiological methods. This information can help to better inform local emergency practitioners who plan for and respond to disasters in their communities.

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Borden, K.A., Schmidtlein, M.C., Emrich, C.T., et al.(2007).Vulnerability of U.S. Cities to Environmental Hazards. (Abstract only.) Journal of Homeland Security and Emergency Management. Volume 4, Issue 2, ISSN (Online) 1547-7355.

The authors of this paper explore the variability in vulnerability to natural hazards among 132 urban areas using three indices of vulnerability: social; built environment; and hazard impact. They also examine the relative levels of vulnerability compared to federal Urban Areas Security Initiative (UASI) funding.

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Lane, K., Charles-Guzman, K., Wheeler K., et al.(2013).Health Effects of Coastal Storms and Flooding in Urban Areas: A Review and Vulnerability Assessment.Journal of Environmental and Public Health. Article ID 913064.

The authors provide a review of the health impacts of U.S. coastal storms, with a focus on outcomes relevant to New York City (NYC) and urban coastal areas, and incorporate lessons learned from Superstorm Sandy. Based on the literature reviewed, indicators of health vulnerability were selected and mapped within NYC neighborhoods.

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National Oceanic and Atmospheric Administration (NOAA).(2011).Coastal County Snapshots.

Users can select their county to get more information on exposure and resilience to coastal hazards that can be used to inform their hazard vulnerability analysis (HVA) and associated response and recovery plans. The snapshots incorporate data from the Federal Emergency Management Agency (FEMA) floodplain maps, U.S. Geological Survey critical facilities database, and NOAA land cover and demographics databases.

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Guidance


*(n.d.).Conducting a Hazard and Vulnerability Analysis. (Accessed 4/10/2019.)

This slide set from a presentation describes how to conduct a Hazard Vulnerability Analysis (HVA) in the healthcare setting; highlights specific tools that can be used to mitigate risks once hazards have been identified and prioritized; shares the use of HVA in annual emergency management planning activities and demonstrates a new way to prioritize risks using actual incident information.

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