Section 10

EmergencyOperations

Being Prepared if Disaster Strikes

June 2009

What is a disaster?

We have EXTERNAL disasters and INTERNAL disasters.

Any event that disrupts the hospital’s ability to provide medical care and treatment.

For example:

• Natural catastrophes such as earthquakes, fires, floods, or tornadoes

• Large-scale accidents involving air-craft, trains, explosives, or motor vehicles

• Accidents involving hazardous agents

• Riots or civil disturbances• Telephone or computer outages• Internal incidents such as oxygen

system cut off or boiler explosion

Disasters

What is a disaster plan?

An established plan of action for responding to and meeting the medical needs associated with any disaster.

What are my responsibilities in theevent of a disaster?

Your specific duties will be assigned to you on your unit or in your department; however, all Associates are responsible for the following general duties:

Read, understand,and follow the Disaster quick reference guide located in your department

General Responsibilities

In the event of a disaster, do not go to an area as a sightseer.

Do not call the operator to ask what is happening.

If you observe an unescorted media person(s) in the hospital, call Security.

How will I know when the Emergency Management plan has been activated?

It will be announced over the intercom using the hospital’s disaster paging codes:

There are 3 phases of disasters:

Dr. Able Stage I (Emergency Department Only)

Dr. Able Stage IIDr. Able Stage III

Minor DisasterSimultaneous influx of patients into the ED handled by ED personnel

In the event of a minor disaster, emergency department personneland assigned Associates will handle all incoming patients.

Large-scale, Major DisasterSimultaneous influx of patients into the ED with assistance needed from current on duty hospital staff

All on-duty Associates should follow their department's emergency procedure as outlined in the manual. All off-duty Associates would be called in to assist on-duty personnel.

Catastrophic DisasterA community-wide emergency with hospital personnel being called in

This level of disaster would involve a large number of significantly injured patients. The entire medical community could be needed. All off-duty Associates would be called in to assist on-duty personnel.

Stage I

Stage II

Stage III

• If this occurs, do not call the hospital, report immediately

• If a citywide event occurs and you cannot make it to your assigned hospital, please report to the closest hospital and attempt to notify your department

• There is a Dependent Care Area designated to care for Associate’s dependents during a major catastrophic event

Certain events may occur which require notification of staff immediately. Announcements may be made by local television

and radio stations requesting that all hospital personnel report to the hospital

Emergency Phone Numbers

Security516-7767……………University, North, South, Germantown

287-3111……………Le Bonheur

911……………Fayette

Hospital Emergency Incident Command System (HEICS)

This system allows for a clear chain of command and integrates hospital communications with the community emergency response agencies.

This system works along with the hospital disaster plan and provides staff the ability to function in a disaster with minimal instruction.

Hospital Emergency Incident Command System (HEICS) Components

A critical component of the system is the organizational chart. It lists all possible job duties needed during any type of disaster and is divided into teams and the responsibility of each team.

Each team has a team chief who reports to the command team. Information flows from chief to chief to ensure clear communication of problems or issues.

Component I

Safety and Security OfficerD: Dir. Safety/SecurityN: Snr. Security Officer

Incident Commander:D: Snr. Leadership (Admin, VP,)

N: Snr. Nsg. Mgmt (“House Supervisor”)

Public Information OfficerCorporate Media (Public) Relations

Liaison OfficerAsst. Administrator/VP or as appointed by I.C.

Logistics ChiefD: Director Facility ServicesN: Snr. Fac. Serv. Assocaite

Facility Unit LeaderD: Dir. Facility Services

N: Snr. Fac. Serv. Associate

Damage Assessment & Control Officer

D: Dir. Fac. Serv.N: Snr. Fac. Serv. Assoc.

Sanitation Systems OfficerD: Dir. Env. Serv.

N: Snr. Env. Serv. Assoc.

Communications Unit LeaderDir Telecommunications

Materials Supply Unit LeaderD: Dir. Fac. Serv.

N: Snr Fac. Serv. Assoc.

Planning ChiefD: Snr. Nsg/as

appointed by I.C.

Finance ChiefCFO or appointee at

each facility

Situation Status Unit Leader

Time Unit LeaderHuman Resources

Labor PoolUnit Leader

D: Dir. Env. Serv.N: Snr. Env. Serv.

Medical Staff Unit Leader

Med. Staff Office/QM

Nursing Unit leaderD: Nsg. Admin

N: “House Supervisor”

Patient Tracking Officer

Admissions/registration clerk

Patient Information Officer

as assigned

Procurement UnitLeader

Appointed by finance

Cost Unit LeaderAppointed by finance

Medical Staff DirectorChief of Staff app.

Medical Care DirectorDir ED

Treatment Areas Supervisor

D: ER Dir./Nures Mgr.N: ER Chg. RN

Triage Unit LeaderD/N: Triage RN

Immediate TreatmentUnit LeaderD/N: ER RN

Delayed Treatment Unit LeaderD/N: ER RN

Minor TreatmentUnit LeaderD/N: ER RN

Discharge Unit LeaderD/N: Case Manager

Operations ChiefSnr VP Nursing

Ancillary ServicesDirector

Dir. Rehab. Or App.

Laboratory Unit Leader

Dir. Of Lab or App.

Radiology UnitLeader

Dir. Of RadiologyOr App.

Pharmacy Unit Leader

Dir. Of Pharmacy orApp.

Human Services Dir.Chaplains

Staff Support UnitLeader

E.A.P./Chaplains

Psychological SupportUnit Leader

E.A.P./Chaplains

Dependent Care Unit Leader

Volunteers or appointed by I.C.

Respiratory TherapyDir. Of R.T. or App.

In-Patient Area SupervisorD: Admin. Nsg. Super.N: House Supervisor

Surgical Services Unit Leader

D: O.R. Dir/ Charge NurseN: O.R.On call or as app.

Maternal-Child Unit Leader

D: L&D Dir/Chg. NurseN: Charge RN

Critical CareUnit Leader

D: Dir. CCU/Charge RNN: Charge RN

General Nursing CareUnit Leader

D: Dir. Med. Surg/Chg. NurseN: Charge RN

Out Patient ServicesUnit Leader

D: Dir. SDS/Charge RNN: House Supervisor

Morgue Unit LeaderD/N: Lab Tech or

PCT/MA

YELLOW BLUE GREEN

BLACK

RED

D: = DayN: = Night

Nutritional Supply Unit LeaderD: Dir. F&N

N: Snr. Assoc. F&N

Transportation Unit LeaderD: Admissions Dir

N: Appointed

Property Damage ControllerInsurance Claims Representative

Telecommunication Unit LeaderAppointed

Information Systems Unit LeaderAppointed

Infection Control OfficerDir Infection Control

Decon Liaison Officer

Triage Unit Leader

Dressser / DryerGatekeeper

Decon Safety Officer

Decon Group Director

Stripper / Bagger/

Component I

The Black Team is the Incident Command team. This team is responsible for the overall management of the response.

Incident CommanderPublic Information Officer (PIO)Liaison OfficerSafety and Security OfficerInfection Control OfficerProperty Damage Controller

Hospital Emergency Incident Command System (HEICS) Components

Component I

The Yellow Team is the Logistics Team.

This team provides a safe and effective environment as well as materials for the overall hospital function during the emergency.

Logistics ChiefFacility Unit LeaderDamage Assessment / Control OfficerSanitation System OfficerCommunications Unit LeaderTelecommunications Officer

Information Systems OfficerClinical Engineering OfficerTransportation Unit LeaderMaterial Supply Unit LeaderNutritional Supply Unit Leader

Hospital Emergency Incident Command System (HEICS) Components

Component I

The Blue Team is the Planning Team.

This team prompts and drives all teams to develop long and shortrange plans, determines and provides for continuity of each teamobjective and tracks and manages staff and patient/victim issues.

Planning ChiefSituation Status Unit LeaderLabor Pool Unit LeaderMedical Staff Unit LeaderNursing Unit LeaderPatient Information OfficerPatient Tracking Officer

Hospital Emergency Incident Command System (HEICS) Components

Component I

The Green Team is the Finance Team

This team is responsible for providing funding for present medical objectives and stress facility–wide documentation to maximize financial recovery and reduction of liability.

Finance ChiefTime Unit LeaderCost Unit LeaderProcurement Unit Leader

Hospital Emergency Incident Command System (HEICS) Components

Component I

The Red Team is the Operations team. This team is responsible for carrying out the medical objectives for in-house patients and those victims who arrive because of the emergency. This section is broken up into four additional teams as well (treatment area, inpatient, ancillary and human services).

Operations ChiefMedical Staff DirectorMedical Care Director

Hospital Emergency Incident Command System (HEICS) Components

Component IThe Orange Team is the Decontamination Team. This team responds to manage victims that have potentially been exposed to a chemical, biological or nuclear agents. Only designated personnel may respond, and must be trained in hazardous material management.

Decontamination Group DirectorDecontamination Safety OfficerDecontamination Liaison LeaderDecontamination Stripper/ BaggerDecontamination Dryer/Dresser/ GatekeeperDecontamination Triage Unit Leader

Decon team members can be identified by a green clip on the employee badge and a hazmat sticker on the top left corner.

Hospital Emergency Incident Command System (HEICS) Components

Component Il

Disaster Vests

Each position on the organization chart has a vest which is color-coded by team color and has each position on the back as well as on the front left lapel.

The vest allows each role to be easily identified without knowing exactly who the person is filling the position.

Hospital Emergency Incident Command System (HEICS) Components

Component Ill

Job Action Sheets exist for each position on the organizational chart. The job action sheet is a task sheet that focuses on specific duties or tasks that must be addressed during the disaster. The duties are prioritized as well. Each job action sheet has a mission statement for each job which gives guidance on what the person’s goal or goals might be.

Sample Job Action SheetL O G IST IC S SE C TIO N C H IE F

Position A ssigned to :______________________________

Y ou Report T o:______________________________________ (Em ergency Incident Com m ander)

Com m and Center:_______________________________________ T elephone:___________________

M ission: O rganize and direct those operations associated w ithM aintenance of the physical environm ent and adequate

L evels of food, shelter and supplies to support the m edicalO bjectives.

Im m ediate ___ R eceive appointment from E m ergency Incident Com m ander. O btain Packet containing Section’s Job Action Sheets, identification vests A nd form s. R ead this en tire Job A ction Sheet and review organizational Chart (in this packet) P ut on position identification vest.___ O btain briefing from E m ergency Incident Com m ander.___ A ppoint Logistics Section U nit Leaders: Facilities U nit Leader, Com m unications U nit Leader, M aterial’s Supply U nit Leader, N utritional Supply U nit Leader; distribute Job Action Sheets and vests___ B rief unit leaders on current situation; outline action plan and designate tim e for next debriefing___ Establish Logistics Section Center in close proxim ity to Com m and Center. LIST O F PO TEN TIA L LO C A TIO N S IN TH IS PA C K ET .___A ttend dam age assessm ent m eeting w ith E mergency Incident Com m ander, Facility U nit Leader and D am age A ssessm ent and Control O fficer.

Interm ediate: ___ O btain information and updates regularly from unit leaders and officers; M aintain current status of all areas; pass status inform ation to Situation- S tatus U nit Leader.

___ C om m unicate frequently w ith E m ergency Incident Com m ander.___ O btain needed supplies w ith assistance of the Finance Section C hief, Com m unications U nit Leader and Liaison U nit Leader.

Extended: ___ A ssure that all com m unications are copied to the Com m unications U nit Leader.___ D ocum ent actions and decisions on a continual basis.___ O bserve all staff, volunteers and patients for signs of stress and

inappropriate behavior. R eport concerns to Psychological Support U nit Leader. P rovide for staff rest periods and relief.

___ O ther Concerns:

Hospital Emergency Incident Command System (HEICS) Components

Component IVPersonnel

The system is position-dependent, but there must be someone available to fill the job positions.

The positions and job actions closely match those functions that personnel do on a daily basis. Whenever possible, Associates should be assigned positions that are similar to those positions that they perform or are familiar with.

Hospital Emergency Incident Command System (HEICS) Components

Component VSupporting Forms

Promotes vigorous documentation of both personnel and the overall facility response to the crisis.

Message formsActivity LogSection Personnel Time SheetsProcurement SummaryStaff registrationFacility System Status ReportingPatient Tracking

Unified Incident Command Corporate Command Structure

In the event of a citywide emergency or an emergency that affects two or more hospitals in the system, the Corporate Incident Command will be initiated.

All Logistics ChiefN,S,G,U,L,F,B

Communications Controller

Logistics Controller

Transportation Controller

Nutrition Controller

Operations Controller

All Operations ChiefsN,S,G,U,L,F,B

Medical Care Controller

Ancillary Controller

Human Services Controller

Planning Controller

All Planning ChiefsN,S,G,U,L,F,B

Staff ControllerMD & Pt Care

Patient Information Controller

Sit//Stat Controller

Finance Controller

All Finance ChiefsN,S,G,U,L,F,B

Procurement Controller

Time Controller

All appointed PION,S,G,U,L,F,B

Public Information Controller

Facility ICN,S,G,U,L,F,B

Incident Command Controller

All Liaison Officers N,S,G,U,L,F,B

Liaison Controller

Property Damage Controller

All Damage AssessorsN,S,G,U,L,F,B

Ambulatory Care Controller

Free Standing Controller

Alliance Controller

Surgery Center Controller

Safety Controller

All Safety and Security OfficersN,S,G,U,L,F,B

Infection Control

Information Systems Controller

Telecommunications Controller

Corporate Command

The Corporate Structure mimics the Hospital Command Structure. The teams are the same; however, there or fewer jobs assigned at the Corporate level.

The Goal of the Corporate structure is to:• Unify the management of resources such as personnel,

supplies, and patient/victim management throughout the system

• Address needs from a cumulative standpoint and make decisions that will benefit the greatest good for the greatest number