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Post one:

Based on your readings and experience, comment on the effectiveness of HVAs. Are they too subjective? How would you approach developing an HVA?

Hazard Vulnerability Analyses conducted yearly by hospitals as per the requirements of the Joint Commission are in theory, fundamental to their preparedness in managing emergencies within their community. For proper emergency responses, hospitals are supposed to collect relevant information on local vulnerabilities, analyze them and develop disaster management programs that are efficient enough to deal with these potential hazards (Campbell, Trockman, & Walker, 2011). However, the lack of standardized methods of collection, analysis, and the application has left a majority of hospitals ineffective in properly utilizing HVA. This paper shows a more functional approach of using the HVA tool in the effort to customize it to a health facility in a specific location facing unique vulnerabilities.

Effectiveness of HVA

HVA, according to The Joint Commission is “the identification of hazards and the direct and indirect effects these hazards may have on the hospital” (Campbell et al., 2011). Moreso, these facilities are expected to incorporate the whole community in which they serve in their functions, including in their HVA analysis. Considering that the emergency plans developed are as good the assessments done to collect information they are based on, the effectiveness of HVA in the country is below the potential. Leaving hospitals to develop, execute, train and exercise broad-spectrum and comprehensive emergency management programs on all phases of mitigating, preparing, responding and facilitating the recovery from disasters without standardization breeds ineffectiveness.

Subjectivity of HVA

To be more effective, the HVA should be subjective. They should have the ability to consider local priorities before federal and state requirements since every locality has its unique vulnerabilities. Assessment of these priorities should be done thoroughly to ensure that the subjectivity of HVA helps in the development of better and custom emergency plans (Campbell et al., 2011). Data accuracy should be evaluated before using it in the HVA process to ensure relevant and reliable intel is derived. Assessment capabilities should also be enhanced so that analysis was done can assist in developing better management programs and functional facility incident command systems (Fares et al., 2014).

Better HVA Approach

While developing an HVA process, a higher degree of standardization should be achieved. Time frames concerning risk assessment and emergency planning should be specified and applied across all facilities. Expertise required in the HVA should also be clarified to enhance the quality and effectiveness of the process. Periods after which HVA should be conducted should also be lengthened after a year to ensure the procedure has substantial data that is helpful to the facility in developing better emergency plans. Hospitals should focus on vulnerabilities by researching through multiple resources such as emergency management and public safety agencies. Organizational efforts should be formalized, well documented and interactive to facilitate individual contribution and consensus. Results should be widely distributed within the institution to increase collaboration, development, and adoption of the plan(Campbell et al., 2011).

Develop an HVA for a hospital in your community. Provide details on the hospital (bed numbers, location, ect.). List the top 5 hazards. Defend your answers.

HVA on The Johns Hopkins Hospital

Located in Baltimore, Maryland, The Johns Hopkins Hospital contains 1,000 beds with a “level 1 trauma and comprehensive stroke center” (Johns Hopkins Medicine, 2017). The emergency department has over 30,000 square feet with six trauma and intensive care bays. There are 71 patient care rooms and 17 beds in the acute care unit. The psychiatric emergency services unit has eight secure beds. The top vulnerability in the City of Baltimore is flooding, which is considered top around the country. Then secondly is extreme summer heat, classified code red by the Baltimore City Health Department. Explosions come in third, due to the easiness of carrying explosive devices. In fourth place, there are hazardous materials incidents due to the industries and organizations dealing with such materials in and around the City of Baltimore, including The Johns Hopkins Hospital. Finally, there are hurricanes and storms, which are prevalent in Maryland (Baltimore Mayor’s Office of Emergency Management, 2018). The hospital should prioritize emergency plans in that sequence to meet the results of the HVA conducted in the City of Baltimore.


In summary, the importance of having a thorough and standardized HVA has been established. The lack of guidance on how to conduct the process has led to hospitals developing ineffective emergency plans based on inadequate HVA processes. The approach that should be used should be standardized across all institutions and designed to prioritize local vulnerabilities before incorporating the requirements demanded by the state and federal institutions. Having well documented and formalized processes that support cooperation and contributions from various experts within the facility helps perform a better HVA. Eventually, better emergency plans are designed and implemented based on the information gathered after such intricate procedures.


Baltimore Mayor’s Office of Emergency Management. (2018). Hazards. Retrieved from

Campbell, P., Trockman, S. J., & Walker, A. R. (2011). Strengthening hazard vulnerability analysis: results of recent research in Maine.Public Health Reports (Washington, D.C. : 1974), 126(2), 290–293.

Fares, S., Femino, M., Sayah, A., Weiner, D. L., Yim, E. S., Douthwright, S., … Ciottone, G. (2014). Health care system hazard vulnerability analysis: an assessment of all public hospitals in Abu Dhabi. Disasters, 38(2), 420–433.

Johns Hopkins Medicine. (2017, October 1). Hospital Profiles. Retrieved from

Post Two:

Comment on the effectiveness of HVAs. Are they too subjective? How would you approach developing an HVA?

The process of identifying risks for an HVA is still unclear after this week’s readings – that goes to show just how subjective it is. There is no standardized method or tool for conducting hazard vulnerability analysis’. I completed an HVA for my home city in another class using the Kaiser model, and I based the risks on my own knowledge of my geographical location, weather experience, and combined that with information from local threat information and data from local emergency agencies- for example, the fire department had detailed information on the number and type of house fires (turns out its Portland’s number 1 disaster risk). I assumed at the time I just didn’t have information on the correct way to identify risks, but I see now that there just isn’t a correct way to identify risks. Anyway, if an HVA is conducted by an emergency manager or disaster planning expert then HVA’s are extremely effective, however if its conducted by staff who have limited disaster planning or response experience (which is likely because hospitals are required to conduct and revise their HVA yearly but are left to determine how they will collect information on probability and severity on their own), the HVA may be less effective. This is why it is important for hospitals to maintain emergency management staff, and/or rely heavily on external stakeholder participation- police, EMS, fire department, city emergency management bureau, NOAA, local civic agencies, in addition to hospital archives.

According to this week’s readings, the hospital risk identification process is typically lacking in diverse (external) input, and especially in documentation.

If I were a hospital emergency manager, I would identify risks based on my own expertise and experience, as well as consult with the local and regional emergency bureaus, fire department, weather agencies, geological agencies, police department, and local non-governmental organizations involved in crisis in order to collect objective data on regional threats across all four hazard types- natural, technological, human, and hazmat. I would then continue to follow the Kaiser model and rank these hazards based on likelihood and severity, and then base my preparedness activities and all-hazards EOP (with appendices) on these risks.

Develop an HVA for a hospital in your community. Provide details on the hospital (bed numbers, location, ect.). List the top 5 hazards. Defend your answers.

Legacy Emanuel Medical Center is a short term acute care hospital- one of two Level 1 Trauma centers in Portland. It is located in North Portland, has 554 beds, is home to Oregon’s only burn center, and is nationally accredited for stroke care.

I created this HVA using the Kaiser Permanente template. I omitted some template columns to simplify the assessment and make it relevant. I based my scores off of threat and hazard data from the city. Instead of including all threats I took the top three of each type of hazard. The hazards that the Oregon Healthcare Coalition found to be the highest risk to the hospital operations are technological failures and wildfires. I included the earthquakes in the top three natural hazards despite its risk percentage because if I were ranking the top three natural hazards in the PNW I would put the earthquake as number one. The Pacific Northwest is preparing in full force for a 9+ magnitude earthquake resulting from a Cascadia Subduction Zone slip. While earthquake forecasting is far from perfect, history shows that this specific fault is overdue for a mega slip. Because preparedness activities are developed based on HVA’s, I would want an earthquake to show a higher percentage of risk so that preparedness activities can be earthquake preparedness focused. I would score earthquake probability as a “2”. Moderate probability, extremely high severity.

Campbell, P., Trockman, S. J., & Walker, A. R. (2011). Strengthening Hazard Vulnerability Analysis: Results Of Recent Research In Maine. Public Health Reports, 126(2), 290–293.

Fares, S., Femino, M., Sayah, A., Weiner, D. L., Yim, E. S., Douthwright, S., & … Ciottone, G. (2014). Health care system hazard vulnerability analysis: an assessment of all public hospitals in Abu Dhabi. Disasters, 38(2), 420-433. doi:10.1111/disa.12047

Healthcare Coalition Preparedness Plan. (2018) Oregon Healthcare Preparedness Region 1 NW Oregon Health Preparedness Organization. Retrieved from

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