Rapid Infrastructure Survey Tool Consequence Module (RIST-C) Calculations

1. Overview

The Healthcare and Public Health (HPH) Sector RIST-C is a survey-based tool designed to assess both sector criticality and facility-specific consequences. Sector criticality is reported as a single, relative score from 0 to 100%. Each question in the survey is weighted equally and the percent of questions answered in a way that affirms criticality is the reported score. The sector criticality score is hazard-independent and depicts the relative impact of a potential facility disruption on the Sector as a whole. The facility-specific consequences, which are threat or hazard specific, are reported as three individual impact estimates:

Human Impact – the estimated number of potential injuries or lives lost.
Property Impact – the estimated cost ($) due to loss of or damage to capital equipment and the facility itself as well as the cost of setting up temporary facilities to continue critical services during a significant disruption.
Business Impact – the estimated cost ($) due to loss of critical supplies, disruption to the supply chain and staffing, lost business, and contract/regulatory fines.

Human, property, and business impacts vary based on the estimated effects of a specific threat or hazard.The user must select a threat/hazard that, in combination with the relevant survey answers,will calculate the three reported measurements of consequence associated with that threat or hazard.

2. Calculation of Facility Consequences

2.1 Human Impact

Human impact is calculated based on the potential effects caused by the selected threat or hazard. The impact is reported as the number of potential injuries or lives lost.

2.1.1 Calculations

Each threat/hazard event type is classified based on the anticipated effect: (1) Potential for facility evacuation; (2) direct injury or death to patients or staff; (3) indirect injury or death to patients due to disruption of power, water, cyber capability, staffing, or medical gas;or (4) no resultant injury or death. Theeffect classification of each threat/hazardevent type can be modified by the user.
The total human impact is calculated based on the subsector affiliation of the facility and the effect classification of the selected threat/hazard:
If the threat/hazard effect is (1)Potential for evacuation, the human impact is the total facility population, regardless of subsector affiliation. The model assumes that the simultaneous disruption of both power and water at a facility induces an evacuation.
If the threat/hazard effect is (2) direct injury or death to patients or staff, the human impact is the average anticipated human impact of that event (e.g., active shooter events have an average of seven deaths or injuries, thus the model outputs a human impact of seven for an active shooter threat), regardless of subsector.
If the threat/hazard effect is (3) indirect injury or death to patients due to power, water, cyber capability, staffing, or medical gas disruption, human impact is only calculated for a facility in the Direct Patient Care Subsector. The user provides the number of patients dependent on each of these facility systems, and the largest number of patients affected by a disrupted system is reported as the human impact for the selected event (assuming significant overlap in system-dependent patient populations).

2.2 Property Impact

Property impacts are dependent on the damage an event is capable of inflicting on a facility, as well as the costs associated with establishing a temporary facility should the primary facility be significantly disrupted. The impact is reported as an estimated cost in dollars.

2.2.1 Calculations

Facility/equipment damage. The cost for the repair and replacement of the facility/capital equipment is based on the amount of potential damage represented by the selected threat/hazard:
Each threat and hazard event type is associated with a typical amount of damage caused, as a percent of total facility value. The amount of damage produced by each threat/hazard event type can be modified by the user.
The user provides an estimate for the total facility replacement value (Question 2.1.6).
The facilityreplacement valueis multiplied by the percent damagecorresponding to the selected threat/hazard to determine the cost associated with facility/equipment damage.
Temporary facility cost. The cost of operating a temporary replacement site is determined by the need to establish and operate an alternative care or continuity of service capability.
Threats and hazards are categorized by the need for a temporary replacement care or continuity of essential services capability. Temporary sites are necessary for regional catastrophic events that would disrupt many facilities within an area. Users can modify whether a threat or hazard necessitates a temporary care or other essential service facility.
If the selected threat or hazard necessitates a temporary care or essential service facility, then the total cost to set up and operate the auxiliary site (specified by the user in Question 2.1.7) is incurred.
The total property impact is the sum of the costs associated with facility/equipment replacement and temporary facilities.

2.3 Business Impact

Business impactsare composed of the costs associated with business interruption, supply chain disruption, insufficient staffing, lost business, fines and legal costs. The impact is reported as an estimated cost in dollars.

2.3.1 Calculations

Business interruption is dependent on the duration of the effects corresponding to a specific threat/hazard event type. Each threat and hazard is associated with a typical duration, which can be modified by the user.
The business interruption cost per day if the facility or key satellite location is renderedinoperableis supplied by the user (Question 2.1.8).
This value is multiplied by the duration of the event.
The cost of supply chain disruption is dependent on the threat or hazard, and the area affected by the event.
The tool first determines if the selected threat or hazard affects the supply chain. This can be changed by the user.
If the supply chain is disrupted, the tool then determines if the event has regional or local impacts (this can be changed by the user). Local events are defined as a facility-specific impact, whereas regional events affect not only the facility itself but other facilities within the area.
Local events disrupt the internal critical supplies, and the cost associated with these events is the user-defined value of the critical supplies stored within the facility (Question 2.2.2).
Regional events can disrupt the entire critical supply chain. The cost associated with these events is the sum of the user-defined values of the critical supplies stored within the facility(Question 2.2.2) and the additional costs incurred by acquiring critical supplies through non-primary means (Question 2.2.1).
The cost associated with insufficient staffing is defined by the user (Question 2.2.3), and is included in the business impact score if the selected threat or hazard impacts staffing availability. The user can change if the threat or hazard affects staffing.
The total business impact score is the sum of the business interruption costs, supply chain disruption costs, insufficient staffing costs, and the user defined costs associated with contract fines, lost contract business, and regulatory fines (Questions 2.1.9 – 2.1.10).