Children's Hospital of the King's Daughters
Emergency Response App

Created by Wellspring Info 

MISSION STATEMENT:
To provide resilient health care during emergency events when conditions are less than ideal, and services are most critical.

PURPOSE:
The purpose of this plan is to improve the capability of the organization to prepare for, respond to, recover from and mitigate the negative outcomes of risks identified through the Hazardous Vulnerability Analysis (HVA) process, but can also be adapted to other emergencies that the organization may experience. The organization stresses an all hazard approach.

POLICY:
It is the organizations policy to provide an Emergency Operations Plan (EOP) that is integrated with internal stakeholders including department leadership, medical staff, and executive leadership and with external stakeholders and subject matter experts from jurisdictional emergencymanagement, first responders, healthcare organizations, public health and Local Emergency Planning Committee private and public partners.
The plan addresses the emergency management program maintenance, communications, resource management, clinical care, safety and security, utility management, and staff and volunteer management. Activation of the EOP is part of an escalated event response process initiated as result of an incident that significantly impacts safety or services. Authority for activating the plan rests with the Daily Safety Officer or their designee.

The Emergency Operations Plan undergoes an annual, and as needed review ensuring risk planning gaps identified through the Hazardous Vulnerability Analysis (HVA) process, and event (or exercise). After Action and corrective action process are addressed.
Review of the EOP and Emergency Management Program takes into consideration new technology, response roles, partner integration, vendor/contractor capability, staff and staff dependent (including pets) needs, and current medical standards or practices.
The review is conducted by the Director of Emergency Management, and key stakeholders with a vested interest in the organizations capabilities including members of the Environment of Care Safety Committee, Executive Leadership, Medical Leadership, campus partners, jurisdictional emergency management and responders, and the Local Emergency Planning Committee public and private partners.
The Emergency Management Program and Emergency Operations Plan are overseen by the Director of Emergency Management.

Performance Improvement
The organization conducts an annual review of the objectives and scope of its Emergency Operations Plan; results are reported and reviewed to the Performance Improvement Committee. Senior leadership and medical staff are part of this Committee.

Exercise and Event Management
The organization evaluates the effectiveness of its emergency management planning activities and Emergency Operations Plan at the minimum twice a year, through exercises or real time events which require activation of the EOP. Buildings classified as “business occupancy” and do not offer emergency services during a disaster conduct one exercise annually (or one actual event) which is evaluated for effectiveness of preparedness, response and recovery.

  • Exercise scenarios are based upon priority risks identified through the Hazardous Vulnerability Analysis (HVA) process.
  • Exercise objectives are established to evaluate the Emergency Operation Plan, previous revisions to the plan based upon identified “areas for improvement” noted during exercises or real-time events.
  • An exercise “Planning Committee” incorporating staff, medical staff, executive leadership, community partners and responders is developed and tasked with ensuring multi discipline testing of the six critical function areas (Communication, Roles and Responsibilities, Safety and Security, Utility Management, Clinical Activities, and Resource Management).
  • After every exercise event debriefings are held in a timely fashion, in order to capture lessons learned, after the disaster or exercise.
  • The organization identifies individuals, knowledgeable in the organization operations and role, whose sole responsibility during an emergency response exercise is to monitor performance and document areas for improvement.
  • Real time event response and recovery is reviewed by a request for comments immediately after an event to staff, medical staff, executive leadership, and any community partners or first responders involved during the event preparedness, response or recovery stages. Internal and external subject matter experts, not directly involved in the event, may be requested to review comments and the event After Action Report, aiding in identification of areas for improvement.
  • Events impacting the community are evaluated by the jurisdictional Emergency Manager through request for information (Lesson’s Learned, identified areas for improvement) and are discussed with jurisdictional partners at the Local Emergency Planning Committee meetings. “Lesson’s Learned” from within the community evaluation process are shared with stakeholders (staff, executive leadership and medical staff). Organizational process improvement may occur based upon identified areas.
  • Written After Action Reports (AAR) are completed providing documentation of successes and areas for improvement. Corrective action objectives are incorporated into the Emergency Operations Plan, and exercised/drilled or evaluated during the next exercise or real-time event.
  • The Director of Emergency Management is responsible for coordinating exercise/event AAR and corrective action planning. Exercises include:
    • Realistic scenarios that evaluate handling of communications, resources, safety and security, roles and responsibilities (staff), clinical activities, and utilities
    • Integration with Community
    • Escalating event requiring community assistance, that is limited and inadequate in supporting hospital needs
    • Patient Influx - At least one event evaluates patient influx (simulated or actual)

Staff Training Requirements and Tracking
All employees, including licensed independent practioners receive education and training during new employee orientation and at least annually. Educational programs, workshops, drills, and exercises include information about identified priority risks, expected consequences and how to mitigate, prepare, respond and recovery from these risks. Attention is also placed on the need for ongoing situational awareness, ensuring ability to always receive emergency alerts from frontline communicators (National Weather Service (NWS), or jurisdictional Emergency Managers) and having an “all hazards” readiness. Programs include, but are not limited to:

  • The organization's Emergency Management Program and Emergency Operations Plan
  • Specific departmental emergency preparedness, response and recovery activities
  • Their role and responsibility as an employee of a healthcare organization to ensure they are prepared to meet the needs of patients and their families in an emergency
  • Rave Alert Mass Notification
  • Personal and Professional Emergency Plan design for home and work (“Go-Pack”) addressing emergency alert capability, communicating with others, dependent care (including pets), alternative driving directions to hospital, and organizational resources provided to staff during disasters
  • Safety including preparedness, response and recovery to priority risks. Importance of situational awareness, initial alert information sharing, sheltering, defend in place and evacuation knowledge
  • Resource availability including PPE, Shelter In Place, Defend in Place, Safe Areas within their work environment for sheltering, hazardous materials in their work area, Safety Reference Chart, department Emergency Tool Kit location, Environment of Care Emergency Response Badge and other risk specific education

Staff with a direct role in response to an incident will be trained in Incident Command System (ICS) and Hospital Incident Command System.

A. Hazardous Vulnerability Analysis (HVA) is performed annually and as needed for critical services of the organization (hospital, Trauma Program, Kidney Transplant Program, Urgent Care Centers, Surgery Centers, Physical Therapy clinics, and major healthcare centers).
The HVA provides a systematic approach to recognition and prioritization of hazards that may affect safety or demand for health care services.

  1. The organization strives for “all hazard” readiness with additional focus on priority risks identified through the HVA process.
  2. Risks are analyzed and prioritized based upon probability, warning and duration, impact on safety and services, and community integration.
  3. Strategies and objectives are developed in order to mitigate impact, and strengthen preparedness for areas of perceived vulnerability.
  4. The HVA is reviewed by key stakeholders including:
    1. Internal: Environment of Care Safety Committee, Kidney Transplant Program, Care Connection, Pharmacy, Executive Leadership and Medical leadership.
    2. External:
      • Eastern Virginia Medical Campus Emergency Management Committee
      • Norfolk Emergency Management staff & Public Health partners
      • Eastern Virginia Healthcare Coalition

B. As part of mitigation activities the health system along with community stakeholders identify agency response roles performed during and after an event. The organizations primary roles are patient care and family information and support.

  1. Identified priority risks are reviewed, assessing the following:
    1. Current medical care environment, services provided, and
    2. Organizational plans, education and training, capability and needs.
    3. Resource needs and vulnerabilities.
    4. Jurisdictional assistance capability in management of specific events.

C. Where possible hazard mitigation or retrofitting measures are undertaken to lessen the severity or prevent impact of a hazard.

D. The Director of Emergency Management annually, and as needed, shares the HVA and discusses key objectives of the Emergency Operations Plan with leadership of the organizations Trauma Program, Surgical Services, Organ Procurement, Transplant, Dialysis, Care Connection, and other services that oversee the care of medically fragile children and their families. 

General
A. The organization has developed the EOP to be National Incident Management System (NIMS) consistent with standardized incident management system that provides guidance stressing common functions and terminology to support clear communication and effective collaboration amongst responders and stakeholders.

B. The organization has adopted the Hospital Incident Command System (HICS). This system utilizes a structured, flexible approach to all-hazards planning, response and recovery that can be escalated based on the event. HICS enables effective and efficient incident management via the integration and coordination of five major function areas: command, operations, planning, logistics and finance. It provides specific forms to guide incident action planning and facilitates clear communication by instituting a formal communication process. HICS is flexible, scalable, allowing functional areas to be added as necessary and terminated when no longer necessary. HICS stresses span of control and unity of command-one leader, with oversight of limited staff. HICS is similar to the ICS utilized by Community stakeholders.

C. Approach, Goals and Implementation
The EOP will have a function approach, organized around six critical functions that must be performed (and monitored) throughout all stages of emergency management. These functions are based upon The NIAHO and DNV GL Emergency Management standards and include: Communication, Utility Management, Resource Management, Staff Roles and Responsibilities, Safety and Security and Clinical Activity


Emergency Management Cyclic Process
Emergency management activities are divided into four phases: mitigation, preparedness, response and recovery and are overseen by the Director of Emergency Management.

A. Mitigation
Mitigation activities are those that eliminate or reduce the impact of a disaster upon the organization. This can include: redundant essential utility systems, hardening security, and other activities.
B. Preparedness
Preparedness activities develop the response capabilities that are needed during an event. These activities include developing emergency operations plans and procedures, conducting education and training (drills and exercises) with staff and stakeholders.
C. Response
Response includes those actions that are taken when an emergency occurs. It encompasses the activities that address the short-term, direct effects of an incident.
D. Recovery
Recovery focuses on restoring operations to a normal or improved state of affairs. It occurs after event stabilization. Examples of recovery activities include the restoration of non-vital functions, replacement of damaged equipment, facility repairs, an organized return of patients into the facility and reconstitution of patient records and other vital information systems. Another key consideration in the recovery and response phases of an incident is the tracking of staff hours, expenses and damages incurred as a result of the emergency. Detailed records will need to be maintained throughout an emergency to document expenses and damages for possible reimbursement or to properly file insurance claims.

The Emergency Operations Plan will be activated in response to internal or external threats that may escalate, or currently present significant safety or service concerns that alters or overwhelms the organizations capability to deliver healthcare services. The EOP may also be activated for preparedness and planning of a “potential” event that requires integrated response with multi services and/or external partners.

A. Threat Awareness & Validation
Upon awareness of an event that constitutes a threat information should be:

  • Validated with reliable sources.
  • Determine impact on safety and services.

B. Initial Alert and Information Sharing 
In order to facilitate timely communication and response to an event that impacts safety or services the “Initial Alert and Information Sharing Process” will be implemented.

  1. Step One: First Person Aware of Event Will:
    1. Ensure Safety of building occupants.
    2. Contact immediate leadership to report event.
  2. Step Two: Contacted Leadership Will:
    1. Determine if event can be managed at the “local level” within the department, or require further resource integration from the organization or community.
      If the event impacts safety or significantly impacts services mass notification should be initiated by:
      • Contact Emergency Management and request initiation of “Rave Alert” messaging to the appropriate “Building Information (location)” distribution list or Group Management Plus (Rave List).
      • Provide the following information:
        • Event type (e.g. power outage)
        • Initial actions taken
        • Your name and contact number
      • All further event information will be sent through Outlook, utilizing the appropriate “Building Information (location) distribution list.
  3. Step Three: Leadership of Services Within Building Will:
    1. Determine impact on safety and services and take appropriate actions.
    2. Share initial and ongoing information with staff.
    3. Leadership of the impacted service (e.g.: Power failure-Engineering) should provide timely updates to the building occupants, including next update.
    4. If necessary establish a conference call.
  4. Step Four: Alerted Vice President Will:
    1. Review safety of building occupants and impact on services, determine need to activate the Emergency Operations Plan (EOP). Upon activation take on role of Incident Commander (IC)
    2. If EOP is activated: identify incident management team (IMT), and initiate the incident action process. An immediate decision may have to be made to curtail or suspend services based upon safety.
    3. The IC will verbalize immediate safety objectives (911, controlled access, resource deployment to area of impact, Safety Analysis, Facility Status Assessment).
    4. The IC will integrate with the Public Information Officer to ensure communication to essential stakeholders (staff, medical staff, community partners including fire/rescue and police, patients/families) through Rave Alert and other external contact processes. Provide the following:
      • Type of event and impact on personal safety and/or building services
      • Prioritizing response and recovery objectives
      • Effectiveness of communication, and sharing of next update time

C. Persons Responsible for Plan Activation
The following individuals have the authority to initiate the Emergency Operations Plan.
Primary:
Daily Safety Officer-Vice President

Back Up:
Administrator on Call-Director of Patient Care Services

Back Up:
Nursing Administrative Supervisors

Back Up:
Director of Emergency Management

D. Alerting External Agencies
The organization works closely with external partners including, but not limited to:

Agency: Eastern Virginia Medical Campus Emergency Management Committee (EVMC_EM)
Method of Alerting: Rave Alert

Agency: Norfolk Emergency Operations & Local Emergency Planning Committee (LEPC) partners- Fire, EMS, Police, Norfolk Public Health and other government and private sector partners
Method of Alerting: 911/Norfolk WebEOC/Norfolk Conference Calls/Direct Call

Agency: Eastern Virginia Healthcare Coalition (EVHC) Representatives from regional hospitals, Long Term Care, EMS, emergency managers, public health agencies, and private sector business united to assist partners during an event.
Method of Alerting: Regional Healthcare Coordination Center (757-243-2134)/VHASS Alerting/Direct Call to Managers


RESPONSE TO ACTIVATION OF THE EOP

A. The Incident Commander will initiate the Hospital Incident Command System:

  1. Validate information, assess the situation and impact on safety and services.
    Determine strategies and actions necessary to maintain operations, expand services (MCI), or as a last resort implement guidelines to establish alternative services or curtail all services due to significant safety risks.
  2. Identify the staff needed to fill critical roles of the Incident Management Team (IMT).
  3. Implement “HICS Form 251-Facility Status Assessment” (review of facility operational status).
  4. Identify objectives and strategies required in order to provide safe and effective patient care and staff support.
  5. Determine resource needs and ensure availability of resources. (Appendix-96 hour Operational Impact Chart)
  6. Ensure effective information sharing to staff (including licensed independent practioners, and executive leadership), patients, families, community partners, media and others as needed.
  7.  Issue assignments to IMT, who should then share with their teams.
  8. Frequent reassess and adjust the plan, flex IMT to meet the needs.
  9. Establish the next Operational Period briefing and share information with stakeholders.

B. Department Leadership will:

  1. Assess status of their department for safety and ability to continue operations.
  2. Initiate appropriate departmental response, based upon the emergency event.
  3. Department leadership will complete the “Department Status Report; evaluating their capability to continue and/or expand services as needed. This report should be emailed to HICS@chkd.org or delivered to the Hospital Command Center. The report includes:
    1. Staff numbers and mix (including LIP).
    2. Bed availability, including written and potential discharges, or those stable enough to be transferred or discharged.
    3. Critical equipment-stretchers, IV pumps, wheel chairs,
  4. “Stand-By” for further instructions and report any problems to Incident Command.

C. Staff will:

  1. Ensure safety and continue normal operations within capability; stand by for further instructions.
  2. If not in their department staff should contact their department charge nurse/supervisor and provide their location.
    1. Prior to returning to their department ensure that it is safe to travel through hallways.
    2. If staff and patient seek shelter in another location, the staff member should contact department charge nurse/supervisor.
  3. Maintain situational awareness and prepare to initiate safety measures. (Reference Hospital or Office Building/ASC/Urgent Care Safety Reference Charts).
  4. Staff must not leave their work area until relief has arrived and they are dismissed by department leadership.

Command Structure
The organization utilizes the Hospital Incident Command System (HICS) to coordinate services and assign responsibilities during disaster response. This system is flexible and allows the organization to activate and organize a command structure based on the needs of the actual event.

  • A core group of leadership has been identified as those most likely to serve in roles of disaster management and fulfill Job Functions of the ICS structure (incident management team). These individuals receive ongoing education and training.
  • Staff assigned to the incident management team, in most cases will assume disaster response responsibilities consistent with their primary responsibilities.
  • Job Action Sheets for each function are available in the Hospital Command Center resource cart.
  • The chart below illustrates the structure of response activities under HICS.


KEY JOB FUNCTIONS
(REFERENCE JOB ACTION SHEETS AVAILABLE IN HCC COMMAND BOX)

Incident Commander
Gives overall strategic direction for incident management during all stages. It is the only position always filled.
(Crosswalk: Daily Safety Officer, Administrator on Call, Nursing Administrative Supervisor)

Public Information Officer
Serves as the conduit for information to internal and external stakeholders including staff, patients and family, staff dependents, and media.
(Crosswalk: Public Relations)

Safety Officer
Ensures health and safety of building occupants and environment.
(Crosswalk: organization Safety Officer, Emergency Management, Infection Control, Occupational Health-event dependent)

Liaison Officer
Functions as the incident contact person for representatives from other agencies.
(Crosswalk: Emergency Management, Director Safety and Security, Life Safety Officer)

Medical Technical Specialist
Subject matter expert assigned to Hospital Command Center acts as advisor to the Incident Commander.

Operations
The Operations Section conducts the tactical operations (e.g. patient care, environmental services, security, infrastructure, clinical support services, patient and family support etc.) to carry out the plan.
This section is typically the largest in terms of resource demand, control and coordination. To maintain effective span of control “branches” are implemented as needed.
(Crosswalk: Director of Patient Care Services, Director of the Hospital Operations Center)

Planning Section
The Planning Section prepares and documents the Incident Action Plan to accomplish objectives, collects and evaluates information, maintains resource status and maintains documentation for incident records.
(Crosswalk: Director of Patient Care Services, Nurse Manager, Nursing Administrative Supervisors)

Logistics Section
The Logistic Section provides support, resources, and other essential services to meet the operational objectives set by the Incident Commander.
(Crosswalk: Director of Materials Management, Nursing Administrative Supervisor, event dependent)

Administration/Finance
Monitors financial assets and accounting for financial expenditures. Oversees costs related to the incident, providing accounting, procurement, time recording, cost analysis and guidance on documentation related to event response and recovery.
(Crosswalk: Finance leadership)

Span of Control
The incident command systems stresses span of control. Each section/branch leader should only oversee 4-6 positions. ICS system supports Incident Management Team flexibility in activation and deactivation of positions based upon needs.

Formal and Informal Lines of Communication
Communication of objectives follows strict lines of authority, top down. Subordinates follow directives provide by immediate leader, unless overridden by the Safety Officer. Only the Safety Officer is able to override a directive from the Incident Commander. Discussion concerning event management may occur across lines.

Unified Command
Disaster event management typically involves external agency assistance. The organization integrates with community agencies during all stages of the emergency management process.
Within the Incident Command System (ICS) the organization may expand into a “Unified Command”.
The Unified Command structure brings together the Incident Commanders of all major agencies involved in the incident in order to coordinate an effective response while at the same time carrying out their own jurisdictional responsibilities.
The Unified Command structure provides a forum for agencies to make consensus decisions, common set of incident objectives and strategies, share information, maximize the use of available resources, prevent duplication of effort and enhance overall efficiency of response/recovery.

A. Internal Communication
To ensure staff (including Licensed Independent Practioners) is informed throughout the course of the event the organization provides updates and general information through one or more of the following mechanisms:


B. External Communication
Communication to external staff, Licensed Independent Practioners, subject matter experts, and other external partners and stakeholders can occur through any of above mechanisms plus the following:


C. Public Information and the Public Information Officer (PIO)
Upon activation of the Emergency Operations Plan Public Relations will assume the role of PIO and coordinate information for all stakeholders. Media and other information requests will be directed to the PIO. No other staff should discuss event details with the media unless approved and coordinated through the PIO and Incident Commander.

D. Coordination of Public Information with Response Partners
If several agencies are involved the PIO will coordinate with them to form/join a “Joint Information Center (JIC). Information released to the community will come from the JIC as a single, consistent message.

E. Communicating with Patients and Families
To ensure communication with patients and their families is consistent and timely policy and protocols have been established for communication activities prior to and during an emergency.

  1. Planning Activities
    The organization shares activities related to preparedness as needed. Activities can include identification of rescheduling of operations, alternative service locations, collaboration with vendors and other partners demonstrating readiness (typically seen with pending inclement weather events), patient family education, responsibilities during the event (if altered), and other information as appropriate.
  2. Response and Recovery Activities
    A Family Care Center will be established to provide information and support to patients’ family. The Family Care Center may be a coordinated with campus and jurisdictional partners.
    If a family member is not present, members of the “Patient Family Assistance” unit will contact the patient’s family with location of child and brief status information (as cleared by Incident Commander and Medical Officer).
  3. The Family Care Center staff will utilize VA 211 for family reunification assistance.

F. Communicating with Vendors of Essential Supplies, Services and Equipment
All department leadership is responsible for ensuring adequate resource capability. Select departments (Materials Management/Supply Chain, Engineering, Pharmacy, Nutrition Services, Safety and Security, Risk Management, Environmental Services) establish multi modes of communication with vendors, contractors and consultants. These essential service/resource provide primary and secondary contacts and discuss disaster capability with department leadership. (Vendors, contractors and consultants provide specific services before, during and after an emergency event).

G. Communication with other Healthcare Organizations
Communicating with other healthcare organizations occurs through multiple modes (see above resource lists).

  1. During an emergency a regional partner may contact the Regional Healthcare Coordinating Center (757-243-2134) to request an alert or initiate an alert through VHASS Alerting. The RHCC staff will issue a web based alert to regional healthcare contacts providing event information, request updating of facility capability and initiate resource assistance, or patient tracking.
  2. An event board will be created for partners to track event status and communicate with the RHCC, regional and State partners.
  3. The “HCC Command Box” has spreadsheet of critical contacts for regional healthcare partners, community stakeholders, and essential organizational staff.

H. Communicating about Patients to Third Parties
The “Health Insurance Portability Act (HIPPA)” regulates the use and disclosure of protected health information (PHI). There are purposes under the law for which organizations are permitted to disclose a patient’s health information to third parties without the consent or authorization of the patient/family. All information released will be approved or managed through the Medical Records Specialist. Any questions regarding the disclosure of patient information should be directed to them. The most likely scenarios include:

  • Other healthcare organizations for purpose of treatment after discharge/transfer.
  • Public Health for the prevention and control of disease, reporting of abuse or neglect, and death.
  • Law Enforcement for purposes under certain conditions such as reporting of certain types of physical injuries, locating persons, and reporting and investigating crimes.
  • VA211 for family reunification

I. Communication Redundancy
The organization maintains multi modes of communication in the event of failure of one or many. (Reference Internal and External Communication) Back up communication equipment and system(s) are tested routinely and prior to a known disaster, such asinclement weather or potential high risk event such as a large scale gathering.

J. Use of Common Language 
In order to ensure mass communication of critical safety information and effective information sharing amongst responding agencies or patients/visitors the organization supports common language alerting. The following common language emergency alerts are used: (**For further guidelines on initiating common language alerts refer to Hospital of Office Building, Urgent Care Safety Reference Charts.)


K. Crisis Communication
Every attempt is made to ensure that the PIO is the voice of the hospital however in some cases the PIO may be unavailable in person, and unable to be contacted. The following guidelines have been established for non-public relations staff that may have to assume the PIO function. A command team member will be designated as spokesperson. All information released must be cleared by the Incident Commander and be clear, conscious, mission focused and provides limited information.

  1. Introduction
    1. Provide a statement of concern “CHKDHS is concerned about the impact of the event on the children of the community and is providing...”
      b. Enforce CHKDHS commitment and intent to provide essential medical care
  2. Key Messages
    1. Simple talking points; maximum of three (3) key points
    2. Provide information to support key talking points
  3. Conclusion
    1. End the statement by summarizing the intent of the message, provides clarification
  4. Tips
    1. Do not go before media without rehearsing
    2. DO NO HARM-Words have consequences, select carefully
    3. Use empathy-focus on informing and not impressing.
    4. Use common language not medical jargon.
    5. Do NOT reassure or minimize impact.
    6. Acknowledge fears.
    7. Don’t get angry with media -you lose credibility.
    8. Don’t speculate or guess-if you don’t know say so, “It is too early in response to determine, or I will try to have the information for you later.”
    9. Use as an opportunity to drive home key response objectives such as “Remain calm, contact Public Health, Do not report to hospital unless you need medical care, provide alternative care sites etc...”

The amount and location of resources, including pharmaceutical, nutritional, medical supplies, linen, fuel, medical gases, and other essential items is evaluated annually and prior to known disaster events (inclement weather) to determine the organizations ability to sustain essential safe services (for up to 96 hours). If 96 hours cannot be sustained either through inventory, vendor procurement, or critical resource process the organization may need to limit, relocate or cease services.

A. Obtaining Resources-Staged Process (Hospital based resource capability)

  1. Stage One: During the initial phase of emergency response impacted departments will utilize department stock resources, evaluate supply needs, and obtain supplies through normal process. Each department/service within the organization is encouraged to develop a site specific “Emergency Tool Kit” stock with immediate resource needs. This aids in the immediate requisitions placed on the Supply Unit (Materials Management).
  2. Departments will institute measures to conserve resources by maximizing utilization, and minimizing waste. Areas not impacted by the event will attempt to maintain operations with supplies on hand. This will enhance allocation of resources to impacted areas.
  3. Once Logistic Section Chief is established resource requests will be processed through Logistics.
  4. Materials Management/Supply Chain, Nutrition, Pharmacy, and Sterile Processing will monitor inventory through normal processes and programs during all stages of the event and report resource status to Logistics (frequency of reporting is event dependent).
  5. Stage Two: Upon awareness of potential actual resource shortages department leadership will:
    1. Initiate replenishment through primary vendors.
    2. Reallocate supplies from areas not impacted.
    3. Contact alternative vendors.
    4. Maintain documentation of emergency supply procurement and reallocation on Resource Accounting Record.
  6. Stage Three: Emergency Cache
    To aid Supply Chain and to address specific disaster response a dedicated EM cache exists. Contents of the inventory are based upon HVA risks and history.
    1. This cache is inventoried and evaluated for quality at a minimum annually. **Items with expirations dates are noted on the inventory.
    2. The inventory chart is available with Emergency Management and the HCC reference book.


B. Resource Assistance Beyond Hospital Process (Stage Four)
During this fourth stage the Director of Emergency Management will be contacted to aid resource procurement and sharing, beyond typical measures. The following resource request options are available.

Campus Partners-SNGH, EVMS, Central Baptist Church

  • Medical supplies
  • Police and public safety assistance and supplies
  • Sheltering for staff, dependents, patient families

Norfolk WebEOC WebEOC situational awareness message or 911

  • Norfolk Local Emergency Planning Committee (LEPC) (ESF 8) and other members of the LEPC.
  • 911 and speak to shift supervisor

Eastern Virginia Healthcare Coalition (EVHC)
Regional Healthcare Coordination Center (RHCC) - 757-243-2134

  • If resource needs exceed the capability at the regional level the RHCC will initiate MOU’s with other RHCCs throughout the State.
  • VDH monitors regional capabilities and can assist by engaging the Virginia Department of Emergency Management (VDEM) as needed.

Federal Assistance
If needs exceed the level of the Commonwealth, Virginia Department of Emergency Management (VDEM) will assist by engaging Federal partners through:

  • Jurisdictional Emergency Operations Center request to VDEM.
  • Virginia Department of Health Emergency Operations Center request to VDEM.


C. Critical Resource Shortage-Stage Five
Disaster events with actual or potential resource shortage will initiate a Critical Resource Vulnerability Analysis (CRVA). This process involves establishing a “Critical Resource Specialty Team”

  1. The team can consist of:
    • Command Staff: Incident Commander, Public Information Officer, Liaison Officer, Safety Officer, Medical/Technical Specialist (Medical, Bio-Ethics, Risk)
    • Operations Section Chief
    • Supply Chain
    • Finance (Procurement)
    • Infection Prevention and Control
    • Occupational Health (event dependent)
    • Bio-Med (event dependent)
    • Pharmacy (event dependent)
    • Others identified at the time
  2. The process involves:
    • Incident Command upon notification from Supply Chain of a critical resource shortage will request a CRVA evaluating the impact of the shortage on safety and services.
    • Initiate resource control measures through reallocation to areas of greatest need, and institute alternative procedures accepted by the team.
    • Contact tertiary vendors for resource procurement.
    • Contact Emergency Management for resource procurement assistance.
    • Look beyond normal supply chains to alternative vendors.
    • Establish crosswalk of supplies that can be safely substituted and present to the Critical Resources Specialty Team for approval.
    • Look to experts within the State (Virginia Department of Health), Federal, and CDC, for analysis and recommendations of potential alternative resources, standards, and guidance on ethical, legal decision making.
  3. All venues of resource acquisition will be exhausted; if assistance is not available further actions as deemed appropriate will be taken. If the capability to provide essential care is determined unsafe, the Incident Commander will inform the Chief Operation Officer (or their designee) and other options will be evaluated including:
    • Relocation of services to alternative areas
    • As a last resort evacuation


D. Strategic National Stockpile (SNS)
The Strategic National Stockpile (SNS) is managed by the Virginia Department of Health.
Local requests from hospitals are made by the hospital Incident Commander to the jurisdictional authority-Norfolk EOC.

E. Developing a “Go Pack”
Staff are educated and trained on the need to develop a personal “Go Kit” to aid in resource conservation and to facilitate personal comfort during Shelter In Place events. The hospital makes every effort to ensure adequate resource capability for patients, and staff, however during emergency events resources may become scarce and replenishment can be difficult.

F. Sharing Resources with Other Healthcare Organizations
As a partner of the Eastern Virginia Medical Campus (EVMC), and Eastern Virginia Healthcare Coalition (EVHC) campus partners or other hospitals within the coalition (and State) may request resource assistance. CHKD within capability will support these requests:

  1. Resource requests from regional partners typically occur through the Virginia Healthcare Alerting Status System (VHASS). This system is monitored by Emergency Management and Nursing Operations.
  2. The requesting facility is responsible for obtaining and returning (if applicable) the resource.
  3. Resources shared with another facility should be documented on the HICS 257-Resource Accounting Record for tracking and reimbursement purposes.

G. Transporting of Resources to Alternate Care Locations
In order to maintain essential pediatric healthcare to the community the Incident Command team may have to initiate essential pediatric care services in alternative areas within the building or to other locations. Location of services is based upon the impact to the hospital or surrounding infrastructure. Resources (Staff, equipment, linen, pharmaceutical, nutrition, utility, medical gases etc.…) must be adequate at the receiving site, or sent with the patient.

  1. Essential service department leadership will work the incident management team on assessing site capability and ensuring adequate resource on hand. Transporting can be arranged within departments of hospital courier.
    1. Supply Chain will develop and deliver carts of essential equipment based on event type and surge projection.
    2. Pharmacy will ensure medication availability and data integration with Electronic Medical Record (EMR) ensuring staff may obtain medication in timely fashion.
    3. Environmental Services will oversee linen and other environment objectives.
    4. Engineering will oversee utility availability and resiliency.

I. Evacuation
Escalation of a significant emergency event can, as a last resort, lead to partial or full evacuation. Mitigation and preparedness activities identify risk events that may require identification of alternative care areas within the hospital, or other locations. During the planning stage of patient evacuation the Command Team will contact the Regional Healthcare Coordination Center (RHCC) for evacuation planning, response and recovery resource assistance. This includes aid in obtaining transport vehicles and receiving facilities. Resources such as staff, equipment, medical durable and non-durable supplies, pharmaceuticals and others may be transported with patients to receiving facilities. (Reference: EmerMgt-02 Shelterin Place Evacuation Plan and appendices)

A disaster or emergency event due to the nature of public reaction requires expansion of normal safety and security initiatives; this includes integration with campus partners. At any time safety of staff is threatened, response objectives will cease, staff will return to the hospital (or healthcare center) and lockdown will be initiated by Security.

A. Internal Security
Security coordinates operations with campus partners (EVMS Police and Public Safety and SNGH Safety and Security). Security Officers conduct internal security operations including surveillance, perimeter control, integration with first responders, and access control up to facility lockdown. Resources include:

Badging
All people (above the second floor, at all times must have a badge). Visitor Management System - During an emergency event visitor access may be revised/restricted based on IC/Safety Officer directive. 

Access Control
Infrastructure supports automated access control to entryways.
Various levels of controlled access based upon IC and Safety Officer directive.

“See Something, Say Something”
All staff is responsible for ensuring safety. Atypical observations should be reported to Safety and Security Command or 911.

Safety Reference Charts
Strategically located throughout organization and site specific, Safety Reference Charts provide guidance on immediate emergency actions.

Duress Buttons
Duress or panic buttons are strategically placed throughout the organization locations based upon risk assessment.

Camera and Recording System
Cameras are strategically placed throughout the hospital, campus and other locations, providing centralized and remote viewing and recording.

Campus Phone
Phone line within Security Command Center linking EVMS Public Safety and Sentara Safety and Security.


B. Access Control
Tasked with maintaining access control the Security Branch Director will oversee objectives necessary to restrict movement of persons into and out of the hospital.
The Incident Commander and/or Safety Officer may initiate controlled access up to lockdown based upon safety of staff and patients. Ingress and egress will be controlled protecting threats from entering the facility and protecting people from exiting to a high threat situation. The IC in conjunction with the Security Branch Director will determine when to clear controlled access. (Reference SEC-04 Controlled Access) Layers of controlled access include:

  1. Controlled Access: Entry to any access door will be by badge only. Patients and visitors will be permitted entry to main access routes: Emergency Department and Main Lobby. These areas are under direct observation by Security staff.
  2. Partial Lockdown: Badge access to certain doors only (Emergency Room, Raleigh Garage, Main Entrance, Ambulance Entry)
  3. Total Lockdown-Badges will not let you in-except Emergency Room.


C. Controlling Movement Within the Building
Movement of people throughout the facility may be controlled based on potential or actual risk.

  1. Surge presents heightened security risks that can impede operations. In order to mitigate issues the Incident Commander may establish staging areas for family waiting, patient triage and treatment. These areas are event dependent and will be supported with additional resources and oversight.
    1. Posting of Security or other staff that receives just in time training to aid in patient flow or escorting of patients/family to appropriate areas.
    2. Establishment of the environment with bilingual signs, barriers, stanchions, color coded tape and concierge may be utilized to aid in crowd control.
    3. Institute overhead alert: “Security Alert-heightened security…informing building occupants of area to avoid.


D. Vehicular Control
The Security Branch Director will integrate with EVMS Police and Public Safety and other partners to implement vehicular traffic flow control ensuring optimal access to first responders (EMS, police, and fire) and patients seeking care.

  1. EVMS Police will take the lead integrated vehicular control plans with jurisdictional and State law enforcement resources.
  2. Barriers, stanchions and tape will be deployed to aid in optimizing flow.


E. Coordinating with Responding Resources
In the event of an internal or external event that requires security resources greater than what the organization has available, Eastern Virginia Medical School Police and/or jurisdictional police will be called to assist. External agency integration takes on a Unified Command structure with the responding agencies integrating operations for best outcome. Unified Command occurs through:

  1. The Security Branch Director with assistance of the Liaison and Safety Officers will work closely with the responding agencies in order to ensure needs/obligations of healthcare objectives are met.
  2. During a large scale event, in order to facilitate communications with respondingpolice EVMS Police will take the lead in communicating with community responders and sharing that information within the organizational HCC.
  3. Events impacting one campus partner will impact all; Sentara Safety and Security will be notified of events occurring at CHKD through Rave Alert, or via the Security Command Center “Bat Phone”.


F. Management of Regulated and Hazardous Material Wastes During Emergency Events
Vendor, contractors provide normal operation waste management services; during known potential disaster events services are contacted for pre-event pickup. Alternative storage areas have been identified in the event the environment does not support rapid recovery and resumption of normal pickup services after the event.
For an unplanned event when needs exceed safe storage and primary and backup vendors are not capable of pickup, designated alternative storage areas will be implemented. These areas will have controlled access, posting of risks and shared with staff.


G. Management of Hazardous Materials
Ideally casualties arriving to the hospital will be free of contamination from hazardous agents. First Responders work diligently to ensure casualty decontamination prior to transport. However, situations can occur where contaminated casualties spontaneously present to the hospital seeking medical care.

  1. Every attempt will be made to control secondary contamination of hazardous materials to other patients and staff while providing services to the arriving contaminated patients.
  2. Communication of operations for medical care of contaminated casualties is crucial.
    Staff should alert leadership of arrival of contaminated patients to the hospital and:
    1. Not come in direct contact with casualties, remain greater than three (3) feet, upwind from them.
    2. Security will assess the situation and assist staff by instituting required controlled access. Mass contamination events may require partial lockdown in order to maintain safe, resilient services.
    3. Direct patients to outside safe area, providing simple instructions and reassurance that every measure is being taken to ensure their well-being as staff prepare the “Emergency Treatment Area”.
      (Reference “EmerMgt-06 External Hazardous Material Event)

A. Assignment of Staff
During a disaster all personnel are considered essential and all departments may be requested to assist with event management.

  1. Upon initial awareness of an event the Nursing Administrative Supervisor will ensure adequate staffing of appropriate skillset is available. The Administrative Nursing Supervisor will:
    1. Evaluate staff in area to determine capability/needs.
    2. Ensure leadership of area is aware of the event.
    3. Evaluate resource availability in other areas that may assist.
  2. Overall responsibility for staffing decision lies with the Incident Commander. IC will direct Operations to implement adequate staffing patterns based upon event impact. During the preparedness/response and recovery stages staff may be required to:
    1. Alter their schedule on short notice.
    2. Report early or stay for extended periods.
    3. Cancel vacations or days off.


B. Developing and Managing Response and Recovery Staffing Teams Pre-Event Preparedness
Department leadership should discuss with staff upon hire, during annual review, and at department meetings their commitment as employees of a healthcare organization.
Include discussions on: Disaster staffing processes with potential altering of scheduling, Shelter In Place (SIP), the department’s emergency plan and emergency tool kit, their personnel emergency plan, and “Go Pack”. (See Annex: Emergency Staffing Information and Preparing the Go-Pack)

  1. Emergent event staffing exemption may be granted upon department director discretion. Exemption from an assignment does not guarantee that schedules will not be altered to accommodate needs. To be exempt employees must meet at least one of the following criteria:
    1. The employee is the sole primary provider for an immediate family member who cannot evacuate or care for themselves and there is no other family or friend who can care for the individual.
    2. If both parents work for the organization, one employee will be exempt to care for the children.
    3. The employee is a member of National Guard or other civilian and military service and is activated.
    4. Other extenuating circumstances will be addressed on a case by case basis.


C. Response and Recovery
Upon activation of the Emergency Operations Plan (EOP) the Incident Commander (IC) will direct department leadership to implement objectives needed to meet patient care needs. Department Leadership may be directed to:

  1. Reassign staff to alternative work areas with similar clinical care required, and similar duties. Staff that is reassigned to another area should receive:
    1. Preceptor to provide area orientation and any “just in time” training
    2. Event briefing including safety, objectives and department leadership information.
  2. Staff recall may be required in order to meet event needs.
    1. Each department is responsible for maintaining a process for effective recall.
    2. Staff recalled will report to their department for specific assignment.
    3. As staff is recalled they will replace personnel at tasks they are best qualified to perform. Branch Directors will consistently evaluate assignments for effectiveness. Staff is rotated as soon as appropriate for rest and recovery.
    4. Individuals directly involved with operations in high impact areas may not be able to perform as routine. Shift hours will be adjusted to meet the needs of the situation and staff capability.
  3. Staff may be assigned to “Response” or “Recovery” operational periods. Objectives for each team are event specific but may include:
    1. Early arrival prior to onset of hazards
    2. Remaining after shift, extending shifts
    3. Sheltering In Place for extended period
    4. Assisting with resource capability by providing a “Go Pack”
    5. Changes in schedule or assignments


D. Licensed Independent Practioners (LIP) Role and Responsibility
The role of Licensed Independent Practitioners (LIP) is delineated in CHKDHS Professional Staff By-Laws. “All practitioners will be expected to participate, as needed, in the event of a mass casualty, in accordance with the “Emergency Operations Plan”. All practitioners on the Professional Staff specifically agree to allow movement, discharge or change of treatment of their patients by the appropriate authorities in case of a mass casualty”
LIP participate in mitigation, preparedness, response and recovery activities including:

  • Development and revision of the Emergency Operations Plan
  • Performance Improvement review
  • Exercise Planning
  • After Action Report/Improvement Plan Matrices development and review
  • Participation in workshops, exercises and drills
  • Education and training


E. Volunteer Management
Disaster privileges may be granted for licensed independent practitioners (LIP) and healthcare providers who are required by law to be licensed (RN, LPN, Clinicians) that may volunteer their services during a declared disaster, when the Emergency Operations Plan has been activated. All volunteers who are granted temporary privileges will be assigned a preceptor to oversee the individual’s performance.
Approved volunteers will receive:

  • Organization badge identifying them as an approved volunteer. Badges will be identifiable from other hospital volunteer program badges by placement of “red dot”.
  • Environment of Care “just in time training”` reviewing applicable hazards/risks and safety objectives.
  • Safety Reference Chart applicable to area volunteering
  • Recent Incident Action Plan and pertinent Incident Management Team member names/contact information.


F. Volunteer Screening Process

  1. Volunteer Licensed Independent Practioners, who are not members of the professional staff, may be granted disaster privileges by the Executive Medical Director, or highest ranking member of the Medical Staff available. Granting disaster privileges is discretionary based upon available information regarding the extent of the disaster, staffing capabilities, number and type of injuries anticipated. Specialty Specific Privileges may be grant to the volunteer LIP only after receiving a valid government issued photo identification issue by a State of Federal agency and a second verifying source of at least one of the following:
    1. A current Medical Center phone ID card that clearly identifies professional designation.
    2. A current medical license to practice and a valid photo ID issued by a State, Federal or regulatory agency.
    3. ID that certifies the individual is a member of a disaster medical assistance team (DMAT), or Medical Reserve Corp (MRC), or Emergency System for Advance Registration of Volunteer Health professionals (ESAAR-VHR) or other recognized State, or Federal organizations or groups.
    4. ID that certifies a State, Federal or municipal entity has granted the individual the authority to administer patient care under emergency circumstances.
    5. Presentation by a current Medical Center or Medical Staff member who can vouch for the practitioner’s identify and who possesses personal knowledge regarding the volunteer’s ability to act as a Licensed Practitioner during a disaster; or
    6. Primary source verification of the license obtained by the Medical Center.
  2. Volunteer Non Licensed Independent Practitioner - Volunteers (RN, LPN, Clinician, Paramedics etc.) that arrive to the hospital to assist in response will require verification of licensure and capability as outlined in policy H6109.
    1. Emergent staffing privileges are assigned only during a disaster when the EOP is activated and there is substantial need for assistance.
    2. The qualifications and competency must be validated by:
      • Verification of licensure, certification or registration
      • Oversight of the care, treatment and services provided by appropriate CHKDHS personnel.
  3. Verification will begin by requesting a valid government issue photo identification by a State or Federal agency and at least one of the following:
    1. ID identifying them as a member of a Federalized disaster medical assistance team (DMAT) or Medical Reserve Corp (MRC).
    2. Valid photo hospital identification card which identifies professional designation
    3. Identification by a current hospital staff member who possesses personal knowledge regarding the volunteer practitioner’s qualification.
    4. ID indicating that person has the authority to render care in an emergency situation.

(Reference Hospital/Corporate Policies Assigning Emergency Responsibilities to Volunteer Practitioner H6109)


G. Roles and Responsibilities During Emergency Operations Plan Activation

Standby Operations

Staff Responsibilities: 
Maintain awareness, monitor reliable sources of information. Avoid passing rumors and unsubstantiated information.
Incident Management Team: 
Activate EOP- establish incident management team based on current objectives. Evaluate essential service preparedness. Complete Quick Start Incident Action Plan.
Department Level: 
Heightened awareness, evaluate department preparedness and continue normal operations, until directed otherwise.

Staff Responsibilities: Report suspicious activity or safety risks to security.
Incident Management Team: Heightened surveillance of credible sources. Coordinate information sharing and response with campus, jurisdictional and other stakeholders.
Department Level: Evaluate resource readiness, pull “Emergency Tool Kit” contact Supply Chain for additional supplies

Staff Responsibilities: Prepare for altered scheduling, check your home, dependents, and “Go Kit”
Incident Management Team: Institute heightened Safety and Security Objectives based on needs. Evaluate potential infrastructure issues-(utilities, environment, patient care needs)
Department Level: Plug essential equipment into emergency power, check emergency phone line (if available). Relocate perishables to refrigerator with emergency power.

Staff Responsibilities: Review specific departmental response responsibilities for disaster preparedness, response and recovery.
Incident Management Team: Ensure adequate resource availability. Contact vendors for additional supply procurement. (96 hr. capability)
Department Level: Prepare staff for altered schedules, response time, SIP, potential hazards and safety objectives

Staff Responsibilities: Keep cell phones fully charged, gas tanks full, family informed, and “Go Pack” ready
Incident Management Team: Establish event support areas: Rest and Recovery, Waste Management, Resource Staging etc.
Department Level: Evaluate clinic appointments, patient volume (potential transfers, discharges)


Response and Recovery Stage Operations
Staff Responsibilities: Take care of yourself, heightened safety and security monitoring. Report suspicious activity.
Incident Management Team: Ensure safe and resilient essential services. Establish Operational Briefings and provide up to date Incident Action Plan, flex IMT to meet needs of event, ensure rest and recovery of staff.
Department Level: Follow chain of command, monitor compliance with event objectives. Provide clear, concise event objectives to staff.

Staff Responsibilities: Expect strict access, display badge. Approach and question or report to Safety and Security persons without ID badge
Incident Management Team: Evaluate need for access control for safety of all building occupants
Department Level: Ensure adequate staffing, oversee staff safety and provide for rest and recovery.

Staff Responsibilities: While traveling carry CHKD identification badge. Police may implement access control to certain areas and require proof of employment.
Incident Management Team: Ensure critical communication to internal and external stakeholders.
Department Level: Maintain resource control and tracking; report capabilities as directed. Ensure resources are not inappropriately used

Staff Responsibilities: Maintain chain of command and formal communication. Report to only one supervisor for event directives.
Incident Management Team: Be prepared to institute mutual aid with campus partners, regional hospitals, and community partners.

Staff Responsibilities: Monitor health system intranet, internet, media, radios, emergency phone line (8-7787) for event information.
Incident Management Team: Monitor resource management through Logistics. Report resource capability and needs to vendors, jurisdictional EOC’s, and vendors. RHCC,


H. Departmental Responsibilities
The Emergency Operations Plan is an overarching document; individual departments are responsible for developing, training and implementing guidelines specific to their area.

  1. Plans should be documented on a Departmental Emergency Response Plan.
    This document is utilized as a guideline for staff, outlining critical initial responsibilities, key contact information and resource capability.
    Each department should prepare to expand its function to support overall needs.
    Mitigation and preparedness objectives should address priority risk event impact on their specific safety and operations. Emergency Management assists as needed and reviews with department leadership their ability to:
    1. Expanded functions - to provide treatment for large numbers of injured persons, regardless of time of day, weather, interruption to utility services and other problems
    2. Relocate work area and related functions - in whole or in part, if damaged or destroyed. This includes planning for obtaining substitute equipment and supplies, and loss of routine utility services.
    3. Function self-sufficiently for 96 hours - at maximum census, if possible with no access to “normal” supply replenishment. This requires contingency planning, stock piling of critical medical, pharmaceutical, nutritional materials, a system for rationing supplies, where feasible to a greater degree than normal and listing redundant resource contacts.
    4. Variable staffing objectives - To maintain essential services, recall of employees off duty and integration of staff from other areas and/or volunteers that have been credentialed through Labor Pool into medical objectives.


I. Staff and Licensed Independent Practioners Needs
Leadership recognizes the burden placed on healthcare staff during emergency events.
Staff safety and well-being is a core objective. Strategies include:

  • Disaster Preparedness Education and Training - personal, home, dependents including pets, work and alternative driving directions during flooding events.
  • Consistent, reliable, timely event information during all stages
  • Incident Stress management before, during and after an event through the Employee Assistance Program and Chaplaincy Program.
  • Catastrophic loss assistance through the “Employee Crisis Assistance” fund
  • Ensuring staff rest and recovery by providing event based staffing patterns.
    Some events by nature have heightened stress physically and psychosocially.
    Length of work shifts is dependent on those factors.
  • The organization provides Shelter in Place areas for sleep and recovery, or information sharing (media updates, entertainment, and family communication assistance) for all staff (including licensed independent practioners).
  • Every attempt is made to provide nutrition and other basic resources needed during their SIP assignment. However disasters can place restrictions/limitations on resource availability therefore staff is taught to have a “Go Pack” available and ready for deployment. (Staff restricted to the facility by Incident Command will be compensated according to policy).
    1. Dependent Care
      Emergency Management education and training supports staff preparedness for dependent care. It is recognized that the hospital is not the best place for dependents to seek shelter. However it some situations dependent care may need to be provided. Staff unable to report to work due to dependent issues should immediately inform their departmental leadership of the need:
      1. The hospital has identified areas within the building to establish the “Dependent Care Area” - this area will provide safe sleep accommodations and basic resource needs - hygiene, sanitation, and information sharing.
      2. To assist with resource availability, dependents must supply their own 96 hour “go pack”.
      3. Upon arrival to the hospital, dependents will be registered and receive an ID bracelet with their name, age, family members name, contact phone number and out of area contact number.
      4. For their safety dependents will be restricted to designated areas ONLY.
        Areas are reviewed upon registration.
    2. Pet Care
      It is recognized that due to the environment and lessons learned from historical events hospital sheltering of pets is not the best option for their safety. Employees are assisted by information shared during orientation and annual refresher training. Staff should:
      1. Check with co-workers who are not Sheltering in Place, family and friends who are able to provide care
      2. Discuss with jurisdictional emergency managers, kennels, shelters, and personal veterinarian

(Reference: Appendix-Staff Pet Care)

During an emergency the organization will provide alternative means for providing essential utility systems as identified in the Utility Management Program policies and procedures. Utility systems are tested according to regulatory standards set forth by guiding agencies or manufactures and reported to the Environment of Care Safety Committee.

A. Gap Analysis
Periodically Emergency Management oversees the performance of a Gap Analysis, reviewing utility systems and other essential resources and services, 96 hour capability with limited to no community assistance.

  1. Primary, secondary and tertiary contractors/vendors are identified by essential department leadership. Department leadership discusses vendor capability to respond prior to and during disasters that impacts operations.
  2. Through established relationships and MOU’s assistance may be obtained from campus, jurisdictional, regional and State resources and partners through Emergency Management and Engineering leadership processes.

B. Risk Assessments
Periodically Utility risk assessments are performed when potential/actual risks are identified during system interruptions or exercises. These documents are shared with the Environment of Care Safety Committee and Performance Improvement.

C. Alternative Means Are Identified For:

  • Electrical Power 
    • Vendor, contractor relationship for rapid resolution.
    • Tested plan for response and recovery to an event.
  • Back Up Power
    • Vendor, contractor relationship for rapid resolution.
    • Redundant, resilient response and recovery plan including layers of tested generator system-essential equipment is plugged into “red outlets”.
    • Engineering has capability to direct electrical flow to select areas based upon IC directive.
    • Robust fuel resource.
  • Water
    • Vendor, contractor relationship for rapid resolution and supply replenishment.
    • Robust emergency cache-potable and non-potable water is reviewed for at a minimum annually for adequacy.
    • Bladders, bags and barrels may be filled prior to, or during some events.
    • During an event water conservation plans will be initiated. Staff is instructed to assist in resource availability by supplying personal water supply for 72 hours. (Go-Pack instructions to bring 5 gal container of water during Shelter In Place events)
    • Tested plan for response and recovery to an event
  • Hygiene and Sanitation
    • Resource cache of hygiene and sanitation products including disposable hygiene kits, sanitation kits and alternative sanitation processes for waste management.
    • Vendor contact for “Port-a-Johns, Kitty Litter and waste bags.
  • Fuel
    • Vendor relationship for maintaining robust supply, tanks are maintained and monitored in order to support generator operations.
    • Vehicles: Fuel tanks are refueled during preparedness stage.
    • Tested plan for response and recovery to an event.
  • Medical gas
    • Vendor relationship for ensuring adequate supply
    • Redundant, resilient response and recovery plan to an event
    • Medical gas emergent cache
  • Vacuum Systems
    • Contractor relationship for rapid resolution
    • Tested redundant and resilient capability with effective resources and implementation plans for response and recovery to an event
  • Heating and Cooling
    • Vendor, contractor relationship for rapid resolution
    • Tested redundant and resilient plan for response and recovery to an event
    • Emergency response resources cache (portable units, fans etc.)
  • Air Handlers
    • Air intake, flow and release can be controlled dependent on event needs.
    • Vendor, contractor relationship for rapid resolution.
  • Elevators
    • Contractor relation for timely resolution
    • Select elevator(s) on emergency power
  • IT/IS
    • Redundant interoperability modes have been established and periodically tested.
    • Data storage-Health and business critical information storage and recovery has been established and exercised. Critical data systems are backed by generator.

Pediatric care by nature comes with intrinsic needs that escalate during emergency events. Children respond to disasters differently due to physiological and psychosocial reasons including:

  • Body Size-Body surface area and the ratio of organ size to body mass
  • Age and emotional development
  • Services rendered will include the family
  • Language barriers due to age or other barriers
  • Unidentifiable pediatric casualties, no legal guardian and family reunification


A. Key Surge Management Steps:

  1. Assessment: Situational awareness and validation of event impact on safety and services. Capability assessment evaluate current resource capability vs. needs.
  2. Pre-hospital integration: Monitor pre-hospital communications with Transport Officer on scene and coordinating hospital (if established) or Regional Healthcare Coordinating Center (if activated). Determine potential influx number and needs, share through chain of command.
  3. Triage-(below)
  4. Treatment-(below)
  5. Disposition-(below)


B. Management of Patient Care During Emergencies, including Scheduling, Triage, 
Treatment, Admission, Transfer and Discharge
CHKD has policies that address patient care. During emergencies additional objectives will be directed by the Incident Commander.
Upon notification of a medical disaster the Nursing Administrative Supervisor, Administrator on Call and Daily Safety Officer will assess staffing and hospital capacity, and determine the need to activate the Emergency Operations Plan based upon safety and services impact.

  1. Activation of Command Staff, Operations, Planning and Logistics:
    1. Determine primary areas of impact; activate incident management team. (Command, Operations, Planning and Logistics). Institute immediate response objectives in impacted areas - send staff and resources; ensure safety and continuity of essential care.
    2. Scheduling: Evaluate the need to suspend, reschedule or terminate surgical, medical and/or imaging procedures. Non emergent and urgent services may be suspended during heightened surge operations in order to meet the needs of casualties.
    3. Assign the Medical Care Branch Director to address disaster patients reporting to the ED and hospital bed capacity. The following unit leaders may be activated to assist:
      • Casualty Care Unit Leader - Address influx of casualties to ED.
      • Inpatient Unit Leader - Address in-house bed availability.
      • Outpatient Unit Leader - Space and staff for alternative patient care.
      • Clinical Support Unit Leader - Address support service needs such as Imaging, Respiratory, Pharmacy, Patient Registration.
  2. Staff recall may be implemented with resources deployed to areas of impact.
  3. Departments will complete a “Department Status Report” and email to “HICS@chkd.org” providing information on department capability/needs.
  4. Reverse Triage may be implemented by Medical staff; evaluating all current ED and hospital patients for disposition-discharge, transfer to other area for continued care.
  5. Mass Casualty Incidents that stress hospital capability and/or impose demand for sustained services may require resource assistance from:

Agency: EVMS Police and Public Safety
Role: 
Vehicular, Crowd Control, hospital access control

Agency: Sentara Norfolk General Hospital
Role: 
Equipment, supplies and safety integration

Agency: Norfolk Emergency Operations Center
Role: 
Public Safety and Security, Metropolitan Medical Response System assistance

Agency: Regional Healthcare Coordination Center
Role: 
Resource Assistance, Patient Tracking-VHASS website


C. Triage
Casualties arriving to the hospital may have received primary triage from First Responders. They should have around their wrist a Commonwealth Triage Tag. Secondary triage will occur by ED staff upon arrival to the hospital. Normal operations will continue until needs exceed capability. Establish casualty reception area under ED ambulance bay - ensure adequate transportation resources and staff to support rapid Triage (START, jumpSTART), and movement to appropriate staging or treatment area. Consider:

  1. Area: Location dependent on number of casualties presenting and environmental conditions. Triage casualties from the event should be separate of daily patient influx and be cleared defined by resources available. Alternative triage locations can be colored coded (Red, Yellow, Green) for quick visualization of activity within the area. This aids in resource management (staffing, security, supplies etc.…).
  2. Resources: Barriers, stanchions, tapes (red, yellow, green), DQE MasCache (Emergency Management cache), triage “fanny packs” with triage tape. These resources are part of the EM Cache and are available through Emergency Management (or their designee) and Security.
  3. Process: Simple Triage with classification based upon quick patient assessment:
    1. Worried Well - See with 240 minutes
    2. Green - Stable walking wounded (see within 120 minutes)
    3. Yellow - See within 60-120 minutes
    4. Red - See immediately due to ineffective airway, volume, consciousness, significant open wounds.

1. Casualty/Patient Treatment
The treatment area will be reversed triaged by ED attending and charge nurse. ED patients will be discharged (if medically stable), relocated to alternative care area within hospital, or admitted.

  1. Area: Triaged Red and Yellow casualties will remain in the ED. The Trauma Bays are designated as “Red” treatment areas, the Monitored Bed Unit as “Yellow” treatment area and Sedation Unit may be utilized as “Green” area. (if needed)
  2. Resources: As above, color coded identifiers (Red, Yellow, Green). Staff will be divided amongst these areas and designated as red, yellow staff.

2. Patient Tracking
Patient Registration and Tracking encompasses pre-hospital to final disposition and is a function of Operations and Planning Sections. HICS 254 Disaster Victim Patient Tracking Form will be utilized.

  1. VA 211 and VHASS Patient Tracking Resource - The hospital will provide disposition data to official entities as requested for family reunification, legal and public health initiatives during a Mass Casualty Incident (MCI). All information released must abide by HIPPA regulations for information sharing during disasters.
    1. During an MCI some patients may request that their information not be provided to Family Assistance Centers or the organization determines it is in the patient’s best interest to not be included in the list of victims provided to the Family Assistance Center.
      1. The organization will mark the record “Confidential”.
      2. If marked “confidential” no users shall be able to view the PHI associated with the record. All users with the appropriate permission will however be able to view the De-Identified Data associated with the record.
  2. Quick Book Registration may be utilized to process large volumes of casualties.
  3. Casualties received to the hospital with a VA Disaster Triage tag will have a label removed from the tag and attached to the hospital’s registration paper work and entered into the electronic medical record.
    1. If the label is not available the number must be hand written on the registration paper work or entered in the electronic medical record (EMR).
    2. All patients will receive a CHKD arm band with the hospital medical record number and a sticker from the VA Disaster Tag.
  4. For unidentifiable casualties a photo will be taken, descriptive data including estimated age, sex, skin color, hair, eye color, approximate height, weight, and distinguishing characteristics, will be recorded and turned over to the Family Care Center staff to process with external resources aiding in family reunification.

3. Patient Placement
Patient Placement utilizes the bed tracking system (Teletracker®). In the event of system failure, downtime procedures will be utilized.

  1. All departments upon activation of the Emergency Operations Plan will update Teletracker. If the system is unavailable submit a Departmental Status Report identifying clean, dirty, upcoming beds and patients that are capable of being discharged or transferred to another area.
  2. Bed placement is based on:
    1. Isolation to prevent expansion (negative pressure rooms or cohorting)
    2. Safety and security needs - Alias names, high visibility rooms etc.…
  3. Establishment of alternative areas - If needs exceed capabilities Incident Command will direct Operations and Planning to evaluate space capabilities and needs.

4. Surge Considerations

  1. Unaccompanied Minors and Family Reunification
    Unidentifiable and unaccompanied casualties arriving to the hospital require special considerations.
    1. The Incident Commander may establish a Family Care Center (FCC). The FCC is overseen by the Patient and Family Assistance Branch Director and is tasked with facilitating reunification of casualties with legal guardian.
      Location: Sixth Floor Conference Room
    2. The FCC is staffed by employees with skills in psychosocial needs including Social Work, Chaplains, Patient Advocate and Child Life. FCC resource considerations include:
      • Safety and Security
      • Medical Records Specialist staff: Uniting children with families requires sharing of private health care information to external agents and people looking for family.
      • Tracking Forms Unaccompanied minors upon arrival to the hospital will be documented on the Disaster Patient Tracking Form 254; this form along with a photo of the casualty will be shared with the FCC staff. Photographs will be securely displayed.
    3. Minors may not be discharged to anyone until guardianship is proven.
    4. The Family Care Center may become a joint service of campus partners.
  2. Alternative Care Areas
    Due to structural design not all areas of the hospital may be impacted by a disaster, this supports the movement of patients to other areas (nearest safe zone) for continued medical operations. If the hospital is significantly impaired as a result of a disaster the organization may relocate services to alternative locations within the system. Areas for consideration include:
    • Emergency Department alternative screening/treatment area-Sedation Unit. Last resort: Therapy Gym for stable patients.
    • Inpatient Beds- All opened beds, 3C, 7H, Same Day Surgery, PACU, TCU.
  3. Personal Hygiene
    1. Linen shortages may be managed by limiting changing of linen to what is necessary and limiting showers.
    2. Alternative hygiene can be achieved by DQE Personal Hygiene Kits, baby wipes, and alcohol based rubs.
  4. Sanitation
    1. Needs may be addressed by Sani-bags, vendor acquisition of porta-johns, kitty litter.
    2. Alternative environmental cleaning and usage of water will be implemented with staff addressing primary patient care areas only.
  5. Mental Health
    During an emergency the organization will provide mental health services to the patients and families through Social Work and if needed Behavioral Health. Ongoing assistance beyond the immediate medical stabilization is paramount and is addressed through multi health system services.
  6. Mortuary Services
    If the event involves deceased patients, CHKD will contact Norfolk Office of the Chief Medical Examiner for appropriate clearance and procedures.
    **Refer to EmerMgt-08 Mass Fatality Management for further guidance.


F. Emergency Medical Treatment and Active Labor Act (EMTALA) 
The Emergency Medical Treatment and Active Labor Act governs when and how a patient may be refused treatment or transferred from one hospital to another when he is in an unstable medical condition. All EMATLA rules must be complied with during emergent/disaster events unless waived through Federal acts. All casualties arriving to the hospital will receive medical screening and disposition per EMTALA rules and regulations, and Federal directives. 


G. Biological or Chemical Contamination/Exposure
The hospital has the capability for small to moderate size incident decontamination, using FiberTect dry decontamination system or a shower system (with temperature controlled water)

  1. Patients who may have been contaminated/exposed or history of travel to endemic area (Reporting with symptoms of atypical for region, or season) should be immediately isolated and the Director of Infection Prevention and Control notified.
  2. Patients who may have been contaminated/exposed to hazardous materials presenting with complaints of contamination should be isolated from others, clothing removed and wiped down with Fast Grab decon kit. These patients, for their safety and others may be required to remain outside of the hospital for decontamination.
  3. Symptoms of Concern and Requires Immediate Isolation Outdoors and Decontamination include: Significant respiratory distress, nausea, vomiting, diarrhea, tearing, dilatation of eyes, seizures, burning/blistering of skin, bright red skin and high oxygen saturations with complaints of shortness of breath.
  4. Stable patients presenting with contamination to radiological material should be decontaminated outside of the hospital. Unstable patients with radiological material contamination should be immediately brought into the hospital for medical stabilization and then decontaminated.
  5. Immediately contact Emergency Management. (Reference EmerMgt-06 External Hazardous Material Events)


H. Department Considerations to Support Surge and Clinical Activities During Disasters

Nursing Administrative Officer

  1. Assume Incident Command until relieved
  2. Ensure safety of all building occupants and evaluate impact on services
  3. Deploy resources to impact areas
  4. Identify Scribe to document actions
  5. Identify assistant to manage phones calls

Daily Safety Officer

  1. Determine need to activate Emergency Operations Plan
  2. Assume Incident Commander and establish initial objectives, incident management team and initiate first Incident Action Plan

Emergency Management

  1. Institute mass notification as needed
  2. Integrate with internal and external subject matter resources

Safety and Security

  1. Institute heightened security interventions, access control, and camera recall
  2. Integrate with campus partners (EVMS Police and Sentara Norfolk General Security)

Operations

  1. Initiate initial objectives-ensure adequate resources to impact areas.
  2. Activate job functions as needed in order to ensure essential patient care to inpatients and casualties

Emergency Department

  1. Activate Casualty Care Unit Leader and team; disburse job functions, and vests
    Brief team on situation
  2. Consider need for alternative triage and casualty flow

Surgery

  1. OR cases in progress will continue. Do not start further cases until cleared through Operations or Command

Respiratory Therapy

  1. Prioritize RT patients and send additional resources to area of impact
  2. Inventory critical resources including Ventilators and other support equipment and supplies

Laboratory

  1. Resource inventory-blood/blood products
  2. Integrate State lab for specimen requirements (if applicable)

Radiology/Imaging

  1. Current appointments will be triaged for potential rescheduling if directed by IC

Materials Management

  1. Monitor inventory for resource reallocation (resources should be designated for areas of maximum impact)
  2. Integrate with Planning and Finance for resource procurement, initiate vendor contacts. Document on ICS Forms
  3. Assist in establishment of Resource Staging Area if necessary

Pharmacy

  1. Inventory critical resources
  2. Integrate with Emergency Management for SNS deployment

Patient Registration

  1. Evaluate need to realign staffing to support area of influx
  2. Establish alternative Quick Book registration
  3. DOCUMENT DISASTER TRIAGE TAG number with hospital registration

Social Work, Patient Advocates, Language Services, Chaplain, Child Life

  1. Prepare to address both patient/family psychosocial concerns and staff and their family concerns
  2. Evaluate need to establish hospital or campus Family Care Center

Nutrition

  1. Consider need for additional supplies or alternative meal plans
  2. Evaluate capability of providing meals to staff Sheltering in Place
  3. Develop plan for nourishment cart for Family Care Center and other alternative staging areas

Call Center

  1. Institute emergent phone line as directed by IC
  2. Integrate with PIO for common messages

Physician Practices and Clinics

  1. Outpatient services within hospital triage present client schedule for potential need to reschedule appointments if directed by IC. Inventory resources for potential reallocation
  2. Office buildings (healthcare center and surgical centers) may be impacted by emergency events based upon IC directive including absorbing services performed by other locations


I. Integration to Enhance Resilient Healthcare Services
The following regional, State and Federal partners can assist the organization in maintaining essential pediatric healthcare services.

  1. The Eastern Virginia Healthcare Coalition (EVHC) - Regional Healthcare Coordinating Center (RHCC) assistance with event coordination, patient tracking, resource management and evacuation. The RHCC links with the Virginia Department of Health and other State RHCCs. The RHCC can assist with:
  2. The Hampton Roads Metropolitan Medical Response System (HRMMRS) - Assistance with mass casualty management including triage, and decontamination.
  3. The National Disaster Management System (NDMS) - The organization is a NDMS partner and upon alert/activation provides bed availability information to the local NDMS Federal Coordinating Center for potential surge. NDMS can also assist with mass evacuation.


J. Evacuation
Evacuation of the hospital is not anticipated in most cases, as the risks to patients are great during movement. Evacuation should only be considered as a last resort. The hospital has been designed and built to “defend in place” and policies and preparedness supports “Shelter In Place”. Plans have been established and exercised for varying degrees of evacuation based upon risks (partial, vertical, horizontal, and full). Only when multiple failures exist would complete or partial evacuation be considered.
The Incident Commander and Chief Operating Officer will advise the health system President (and Board) of the criticality of the situation and request implementation of the evacuation objectives. (Reference: EmerMgt-02 Evacuation, Shelter In Place Plan)

  1. The Incident Commander will contact the Regional Healthcare Coordinating Center, campus partners, and Norfolk Emergency Operations Center to inform of decision and activation of resource assistance through pre-established MOU’s.
  2. The Norfolk Emergency Operations Center will assist with jurisdictional event coordination. ESF 8 will be contacted and other public and private partners including: police, fire/EMS, Norfolk Airport, public utilities and others. Additional resource assistance will be channeled to State (and Federal) partners.
  3. A Unified Command will be established with organizational staff responsible for safe essential pediatric healthcare. The RHCC will assist with resource integration and patient tracking.


K. Technology Dependent Home Care Clients
Technology dependent clients in the community integrate with “Care Connection for Children (CCC)” program. This program is part of a statewide system of services that help families coordinate community resources with medical expertise. Many children rely on stable utility management that can be compromised during and after disaster events.

  1. Technology dependent families are encouraged to develop robust emergency plans including:
    1. Registering with jurisdictional emergency management and utility providers.
    2. Having a plan to evacuate out of the area when recommended by authorities.
  2. Children who fail to evacuate may require refuge in the hospital and will be sheltered in an area that has security, and utilities. One guardian will stay with the child and be responsible for their care. Families
  3. must:
    1. Supplying a “go pack” for child and themselves; this pack will include all necessary resources to maintain child and guardian for 96 hours.
    2. Shelter needs are overseen by CHKDHS staff. If medical conditions warrants medical intervention; child will be seen in Emergency Department.

Demobilization objectives should be considered shortly after response. Actions Include:

Incident Commander - Establish and oversee restoration of services

  • Institute Recovery Incident Management team mid cycle of response. (see below).
  • Assess situation and determine when normal daily operations must be instituted.
  • Send out mass notification alerting of demobilization to internal and external stakeholders
  • Ensure documentation of event impact is gathered and forward to appropriate internal and external departments for financial and legal object

Safety Officer: Oversee safe demobilization processes, including staff psychosocial support and family needs
Liaison: Notify stakeholders of demobilization and operational status
PIO: Continue to work with media, patients and families and staff for information sharing.
Operations: Institute and confirm facility readiness for normal operations.
Planning: Ensure appropriate archiving of documentation
Logistics: Inventory supplies and work with vendors to replenish
Finance: Compile response and recovery costs and expenditures and submit to organization and jurisdictional Emergency Management (FEMA reimbursement)

The organization has mechanisms in place to restore the operational capabilities of the facility to pre-disaster levels. Once the disaster is over, the Damage Assessment Team overseen by the Safety Officer will begin assessing the damage to the facility and surrounding environment. The team will:

  • Perform Facility Status Assessment taking pictures/videos of damage to the buildings, grounds, equipment, including off-campus structures. Secure unsafe buildings as necessary.
  • Evaluate safety and services capability based upon Facility Status Assessment findings. Initiate alternative vendors/contracts, resource, utility, staffing, communication, operations plans as needed in order to provide essential services to community children and their families.
  • Contract with architects and engineers to determine if the building(s) are safe.
  • Coordinate staff support programs as needed. Including Shelter In Place Response and Recovery staffing teams. Assist with dependent (families, pets) needs within capability. Ensure rest and recovery of staff, monitor for psychosocial needs.
  • Prioritize restoration of essential utility. Contact vendors for resumption of service recovery times.
  • Inventory equipment and supplies for damage and determine if additional supplies are needed. Initiate contact with vendors for resupply capabilities. If necessary initiate alternative vendor supplier critical resource plans. Pictures/videos will be taken of damaged supplies and equipment for insurance purposes. Damaged supplies and equipment will be retained until released by Risk Management.
  • Contact stakeholders update on Operations capabilities - including Norfolk Emergency Operations, Eastern Region Healthcare Coordinating Center, and campus partners. Work with insurance companies to ensure claims reimbursement.
  • Incident Action Plan should reflect situational awareness, safety briefing, alternative resources, services, utility plans and equipment in usage.
  • Notify the community through available communication modes what services the organization will be providing and where they will be provided in the event the services are relocated.

Incident Command will remain in contact with the Chief Operating Officer (or designee) updating on recovery objectives, resumption of normal services and repatriation of clients. Multi initiatives occur during this stage, requiring establishment of Recovery Incident Management Team:

  • Administrative Specialist for Patient Care Services and Ambulatory - Oversee inpatient and outpatient services.
  • Risk - Notify regulatory agencies of progress on resumption of services and inspections.
  • Medical Specialist - Professional staff resumption of services.
  • Infrastructure - Restoration of spaces, utility management and essential life safety systems.
  • Logistic - Supplies and equipment.
  • Infection Prevention and Control Specialist - Building environment, air quality oversight
  • Security Specialist - Camera monitoring systems, life safety systems, access control.
  • Employee Health and Well Being - Staff and family psychosocial objectives.
  • Emergency Management Specialist - Integration with partners.
  • Patient Tracking and Family Reunification - Dedicated to long term concerns with child reunification, integrate with Regional Healthcare Coordinating Center and Family Reunification Center.
  • Medical Records Specialists and IT/IS Specialist - EMR and other essential database capability.
  • Transportation Specialist - Work with agencies on repatriation of clients when deemed ready.



Purpose:
The purpose of this plan is to provide guidance on managing mass casualty incidents (MCI) when safety and services may be significantly impacted due to high volume patient presentation, or the need for atypical resources. To respond and recover effectively staff must:

  1. Recognize the incident in its early stages and.
  2. Activate the Emergency Operations Plan (EOP), Mass Casualty Incident Annex and other supporting guidelines.
  3. Implement Hospital Incident Command System, assigning an Incident Management Team.
  4. Provide adequate support for critical functions (Safety, Clinical, Communication, Resource, and Infrastructure) to meet the needs of the event.
  5. Adequately prepare for consequence management associated with MCIs.

Scope:
This plan is all hazards therefore it may be used for any type of mass casualty incident (MCI).

Assumptions:

  • The incident is not exclusive to the ED and will impact multiple services.
  • During the initial 15 minutes response will be performed by staff on duty, using existing equipment and supplies.
  • Less seriously injured casualties who self-transport arrive before those who are most seriously injured. This population can be resource demanding for safety and services.
  • Casualty volume can be estimated by utilizing the CDC “Mass Casualty Predictor Model”. “Total Expected Casualties=Number of Casualties Arriving in the First Hour Doubled”.
  • Casualties arrive in waves with 80% arriving in 90 minutes. The first wave arrives 15-30 minutes and is typically stable/green. The second wave, arriving within an hour is transported by EMS and triaged Red and Yellow. Casualties arriving may include a large volume of unidentified and unaccompanied minors. The following table offers a perspective on the number of casualties per acuity level.




Peninsula Emergency Medical System (PEMS) and Tidewater Emergency Medical System (TEMS)Regional Medical Control & Protocols

  1. The EMS Incident Commander on scene will immediately inform the closest emergency department, providing the following:
    • The nature or apparent cause of the event (risk of contamination).
    • The estimated number of injured.
    • Expected time to first patients transported.
  2. The closest ED may accept medical control and become the “Coordinating Emergency Department “ or transfer to another facility (typically a trauma care center).
    • The initial “Coordinating Emergency Department” cannot transfer coordinating role to another facility unless EMS confirms communication with that ED.
  3. Within the “Coordinating Emergency Department”, an Emergency Department physician will serve as incident “Medical Control”.
    • EMS will request to follow the “Regional Medical Protocols” permitting EMS providers to perform skills approved for their level of certification.
    • Normal EMS to hospital communication suspends; EMS will communicate with the “Coordinating ED”, who is responsible with sharing information to other EDs.
    • EMS from outside the region will adhere to patient protocols of their agency.


EMS Transport Group Supervisor Report

  1. EMS “Transport Group Supervisor” will notify the “Coordinating ED” when ambulances depart the scene and provide the following for each transport:
    • EMS agency, ambulance number and destination hospital
    • Patient triage tag number(s) and color of each casualty
    • Age and gender of each casualty
    • Nature of injuries
    • Estimate time of arrival
  2. The EMS Transport Group Supervisor will initiate casualty distribution to area hospitals based upon the “Initial MCI Patient Distribution Table” located within the HRMCI-Guide. (see Supporting Document: HR-MCI Guide “MCI Patient To Hospital Distribution and Transport Tool”)


Communication From Scene-Radio Channels
800 MHz mutual aid channels are routinely utilized. During a MCI Statewide VHF frequencies including the following may be used:

  • 155.400MHz - HEAR radio used between ambulances and hospitals.
  • 155.205MHz - Used between incoming EMS units and Staging Officer (on scene)


Patient Tracking
After all patients have been transported from the scene the “Transportation Group Supervisor” will contact the “Coordinating Emergency Department” to obtain patient tracking data.


Coordinating Emergency Department Communication to Area Hospitals

(See: Supporting Document: Emergency Department MCI Alert Procedure for Coordinating ED)

  1. The Coordinating ED will contact area hospitals via radio (or by monitoring of VHASS) and provide event information - type, projected number of casualties, potential contamination. (See following pages: “Emergency Department MCI Alert Procedure” and “Emergency Supporting Documents: Department/Hospital Emergency Situation Report”.)
  2. The Coordinating ED will prepare final patient tracking report for on scene EMS.
    • Receiving hospitals should enter casualties from the event into VHASS Patient Tracking and be prepared to provide the “Coordinating ED” with final patient disposition data.
  3. The Coordinating ED may contact the “Regional Healthcare Coordinating Center (RHCC)” to request assistance with event coordination and resource management.
    • The RHCC will coordinate regional and statewide resource assistance.

ACTIVATION

Awareness of a mass casualty incident (MCI) may come to the hospital in any one of numerous formats:

  • Notification from EMS, or “Coordinating Emergency Department”.
  • “Walking Wounded” arriving at the ED/hospital.
  • Atypical first responder radio chatter.
  • Media Alerts - “breaking news”.

Authorization to Activate
When it is apparent that casualty surge, due to volume or atypical needs, will challenge normal operations the Nursing Administrative Supervisor in consultation with the Emergency Department Physician and Charge Nurse will activate the Emergency Operations Plan (EOP) and All Hazard Mass Casualty Incident (MCI) Annex.
Upon activation of the EOP/MCI Annex the Nursing Administrative Supervisor will immediately:

  1. Notify the Daily Safety Officer, or their designee who will then assume Incident Command.
  2. Notify the Director of Emergency Management, or their designee who will initiate the mass notification Rave Alert process to “MCI” list.


NOTIFICATION

Notification Process:

  1. Rave Alert: To “MCI” list provides initial situational awareness, needs and location of initial planning meeting.
    • Incident Commander provides message to Emergency Management
  2. Overhead Announcement:
    • “Facility Alert” - MCI, all departments implement departmental emergency response plan.”
  3. Rave Alert: To “Group Management Plus” provide type of incident, projected influx, security level (Access Control), and needs (staffing/other resource).
    • Incident Command provides message to Emergency Management
  4. External Partners: (SNGH Emergency Management, SNGH Security and EVMS Emergency Management is included in “Group Management Plus”)
    • Liaison Officer will ensure following are contacted:

Emergency Department Response

  1. Upon activation of MCI annex the Emergency Department Charge Nurse will assume the Casualty Care Unit Leader role and assign roles to ED staff, distribute “Disaster Supply Kits”, and ensure MCI casualty care areas (Triage, Red, Yellow and Green Treatment Areas) are established.
  2. Roles and responsibilities:



Hospital Incident Command System

  1. Incident Command will assess the situation and determine initial event management objectives: (Access Control, deploy resources to area of need, initial communication).
  2. Through Rave Alert - “Group Management Plus” department leadership will be provided an estimate of staffing needs. Clinical and essential support departments (Lab, Imaging, Pharmacy, Respiratory Therapy, all Inpatient Clinical, Supply Chain, Security, Social Work, Behavioral Health, Chaplain, Child Life, Patient Advocates, Public Relations, Environmental Services, Engineering, Professional Staff) should initiate their staff recall process obtaining:
    • Staff who can immediately respond.
    • Staff who can relieve staff at the next operational period.
  3. Roles and Responsibilities:

Trauma Program

  1. Upon awareness initiate routine response and expand operations as needed and directed by Incident Command.
  2. Assist Emergency Department triage and treatment facilitating patient movement utilizing the triage criteria.

Daily Position Title: Medical Director 
MCI Responsibility: 
Trauma Surgeon-Medical Specialist
Location: Surgery/ED/Hospital Command Center

Daily Position Title: Program Manager
MCI Responsibility:
Trauma Program Oversight
Location: ED

Department Response

  1. Departments implement their “Departmental Emergency Response Plan” and complete a “Departmental Status Report” providing Incident Command current capability information.
  2. Department management will follow IC directive by:
    • Implementing call back plans as needed addressing: staff who can immediately respond and those who can relieve staff at the next operational period.
    • Evaluate supplies and request additional or prepare to share with impacted area(s).
  3. Roles and responsibilities:



Blood Bank
The need for blood products is often overestimated with less than 5% of patients requiring services; however those individuals typically require multi units. Most frequent blood group O.


Supplies (Medical Supplies, Medication, Equipment)

  1. Supplies will be quickly depleted; Logistics (Supply chain/Materials Management) is responsible for initiating contact with Treatment Area Leaders in all impacted areas to evaluate supply
    capability.
  2. MCI supply packs, carts, and DQE Cache are available for select treatment areas. Additional supplies should be obtained by Supply Chain/Materials Management with assistance from Finance.
  3. If supplies become scarce contact Emergency Management to initiate critical resource plans and Memorandum of Understanding (MOU’s) with campus, jurisdictional and regional partners.


Space

  1. MCI management requires alternative patient care and family waiting areas in order to meet the surge demand. The hospital has designated locations for triage, treatment, and family care (see Supporting Documents: Casualty Care Areas, Family Care Center).
  2. Infrastructure considerations in establishing areas can be found on the following tables.

Community Integration

The Liaison Officer will maintain community integration ensuring organizational needs for optimal pediatric care is prioritized and met. Relationships include:

  • Virginia Healthcare Alerting Status System (VHASS) - Regional and State resource coordination and assistance, including patient tracking.
  • Norfolk WebEOC- Norfolk Emergency Operations Public Safety, Public Health and infrastructure support.
  • Private and Government Liaisons assisting with disaster relief and family reunification.


Safety and Security Assessment and Controlled Access

  1. Implement access control as directed by Incident Command. Typically “Partial Lockdown” of all perimeter doors is implemented with staff, patients and visitors directed toward three monitored entrances (Raleigh garage staff entrance, Main Lobby, Emergency, and Ambulance).
  2. Implement “Visitor Screening” process at designated entrances.
  3. Integrate with EVMS Police for traffic and crowd control, prioritizing EMS, and staff access. Cones, barriers, and signs can be used to direct points of ingress and egress, staging, and parking.
  4. Complete the Safety Analysis (HICS Form 215A) - Identifying unsafe conditions and reporting to the Incident Commander for correction.


Casualty to Casualty Blood Exposure
Casualty to casualty blood exposure and traumatic implantation of bone or other biologic material that is alien to the wounded person is likely. Testing of wounded persons is not recommended. Infection Prevention and Control can provide assistance in assessing exposure risk.


Patient Tracking

  1. Patient tracking is a function of the HICS Planning Section-Patient Tracking. This section oversees casualty tracking from arrival to final disposition.
  2. Casualties arriving from the scene or self-referring will be documented by the Patient Tracking support staff on a “HICS Form 254 Disaster Patient Tracking”.
    • Documentation includes - “Virginia Triage Tag” number; this number must be entered into CHKD EMR. It is critical that all casualties be tracked on paper and within EMR by hospital medical record number and “Virginia Triage Tag”.
    • Casualty disposition (OR, admitted, discharged/transferred) will be tracked within the ED by Patient Tracking support staff.
  3. The Patient Tracking support staff will regularly share “HICS Form 254” with the Situation Unit Leader who will ensure entry of casualty information into the VHASS Patient Tracking database. 
    • Routinely the Situation Unit Leader will run a copy of the “HICS Form 254” to the Family Care Center.


Patient and Family Psychosocial Care (Reference Family Care Center section)

  1. Due to potential large volume of family seeking information and reunification Incident Command may opt to restrict visitor access to immediate family only.
  2. Persons who are injured are not victims; they are survivors with unique needs in the present and future. A Family Care Center supports patients and families and provides:
    • A secure, private area for sharing information to families.
    • Assistance with searching for missing members, linking with community resources.
    • Calming and healing-crisis counseling and mental health referrals.
    • Protection from media.
    • Shelter unattended children until families or other arrangements can be made.
  3. Incident Command will direct the establishment of the Family Care Center in the Sixth Floor Conference room, staffed by Social Work, Behavioral Health, Chaplains, Child Life, and support staff.


Crisis Communication
Coordination of all communication is the responsibility of Incident Command aided by the Public Information Officer (PIO). Information provided has significant impact on safety, services and potentially the image of the organization.

  1. Activation of the Crisis Communication Plan will assist in effective messaging for staff, patients, families, media and community.
  2. All requests for information should be forward to the PIO.


HIPPA Rules for MCIs
Patient Health Information (PHI) can be shared under the following circumstances:

  • Treatment:
    Covered entities (which include hospitals) may disclose, without a patient’s authorization, PHI about the individual as necessary to treat the patient or to treat a different patient. Treatment includes the coordination of healthcare and related services by one or more healthcare providers and others, consultation between providers, providing follow up information to an initial provider, and the referral of patients for treatment.
  • Public Health Activities:
    For ensuring public health and safety to a public health authority that is authorized by law to collect or receive information for the purpose of preventing or controlling disease, injury or disability.
  • Disclosure to Family, friends and others involved in an individual’s care and for notification (family reunification):
    A covered entity may share PHI with a patient’s family, or others identified by the patient as involved in the patient’s care. A covered entity may also share information about a patient as necessary to identify, locate, and notify family members, or anyone else responsible for the patient’s care, of the patient’s location, general condition, or death. This may include notifying family members and other (police, public at large, disaster relief organizations such as American Red Cross). Every attempt should be made for permission; if the individual is incapacitated covered entities may share information if deemed in best interest of the patient.

Minimum Necessary: For most disclosures, a covered entity must make reasonable efforts to limit the information disclosed to that which is the “minimum necessary” to accomplish the purpose. Minimum necessary requirements do not apply to disclosures to health care providers for treatment purposes.


Infection Prevention and Control
Extremely high risk of blood borne pathogen exposure during an MCI requiring scrupulous donning and doffing of PPE. A MCI involving casualties with communicable illness may require modifications of standard infection prevention practice. Infection Prevention and Control must be immediately contacted.


Expectant and Mass Fatality Considerations

  1. Deceased victims fall under the direction of the Office of Chief Medical Examiner (OCME). By law bodies, remains and effects of the decreased, and instruments or weapons related to the death will be left in place until permission is granted by the ME (or their designee) unless there are hazards present. Lifesaving activities should not be hampered or confusion created by the needs of law enforcement or OCME.
  2. Space for expectant patients (Palliative Care) should be identified. This should be a private, quiet space respecting the unique psychosocial and pain management needs of this population.
  3. Due to the volume of decedents morgue capability may be quickly exceeded. Alternative human remains storage process may be implemented. (Reference EmerMgt-08 Mass Fatality Plan)


Evidence Collection

  1. Any object (or part of an object) indicating that a crime has occurred or establishing a link between victim and perpetrator is physical evidence and needs to be protected. Physical evidence includes such items as clothing, hairs, fibers, stains, bullets, objects, physical injuries, and laboratory specimens.
  2. Staff, within capability - without interfering in patient stabilization should ensure chain of custody policy and procedures are followed. Reference: Policy C4109 (Maintenance of the Legal “Chain of Custody” of Evidence)
    • Package all evidence separately. Use appropriate packaging for each type of evidence.
    • All packages used to collect evidence are to be sealed and labeled with the date, time, patient’s name (or disaster triage tag number), description and source of material.

Packaging Type: Paper bags or envelopes
Uses: 
Biological material (plants, blood, semen, etc.) submit to law enforcement as soon as possible (inform of wet status). Placing blood soaked, wet evidence in plastic bags can degrade the sample, quickly.

Packaging Type: Plastic bags or Ziploc
Uses: 
Non-biological materials

Packaging Type: Metal cans
Uses: 
Arson evidence

Packaging Type: Glass vials
Uses: 
Liquid drug samples, syringe contents

Packaging Type: Post-It Notes
Uses: 
Small pieces of trace evidence, hairs, fibers, drug residue. Use a Post-It note by placing the trace evidence on the adhesive and folding the Post-It in.

3. Sealing - A proper seal ensures that evidence has not been altered, or compromised. A good seal is tamper proof and is detectable if tampered with. The person packaging the evidence should initial and date across the seal. Do not use staples, binder clips, paper clips, masking or scotch tape.


Stress Management
Most individuals will demonstrate “normal” stress reactions that may persist for several days or weeks after a disaster. Approximately 1/3 may develop severe stress reactions that place them at risk for acute anxiety syndromes in the immediate post-event period and in the days to weeks afterward. Occupational Health and Employee Assistance Program (EAP) may provide assistance.


Service Animals

  1. Patients with service animals should not be separated from their service animal. The Americans with Disabilities Act (ADA) for Title II (State and local government services) and Title III (public accommodations and commercial facilities) of 9/15/2010 defines service animals as dogs that are trained to do work or perform tasks for people with disabilities. The work or task must be directly related to the person’s disability.
  2. When it’s not clear what service an animal provides, you can legally ask only two questions:
    • Is this a service animal required because of a disability?
    • What work or task has it been trained to perform?
  3. Owners cannot be required to provide medical documentation, special identification or proof of animal training, or to demonstrate their animals’ abilities.
  4. Service animals must be allowed to accompany people with disabilities in all areas of the facility where the public is normally allowed to go. However it may be appropriate to exclude a service animal from operating rooms where the sterile environment may be compromised.
  5. Service animals must be under control at all times, leashed or tethered, unless these devices interfere with the service animal work/task.

***Public Safety working dogs are not “Service Animals”. These dogs include police, detection, search and rescue dogs. They provide critical services during incidents, working side by side with their handler. Patients arriving to the hospital may have a Public Safety working dog with them. In these situations typically the agency the handler works with has a process of securing the canine, ask the handler. Emergency Management has a list of potential agencies that utilize public safety working K9s. As a last resort contact the jurisdictions Emergency Operations Center, police or animal shelter.


Evacuation
If a healthcare facility is to be evacuated CHKD may provide short-term or extended care within capability. In situations where a campus partner requires assistance each facilities Hospital Incident Commander and team will form a unified command along with EVMS and other regional agencies (RHCC, other hospitals in region, transportation assets including jurisdictional EMS, and private patient transport services) to aid in safe, successful operations. Communication for these types of events would initially be between requesting and receiving organization administration, and may expand to Norfolk EOC, or the Regional Healthcare Coordination Center (RHCC).


DEMOBILIZATION AND RECOVERY STAGE

The trigger for deactivation of the MCI Plan will depend largely on the type of incident and the resources required and available including:

  • The incident is over and no additional incident related patients are appearing.
  • The hospital can manage care of patients without alteration in normal daily operations.
  • Safe, resilient services have become compromised.
  1. Authority to deactivate the plan lies with the Incident Commander.
  2. Notification of Deactivation: Same as activation
  3. HICS Form 221 Demobilization provides a full checklist of deactivation operations. Demobilization should include gathering of all complete paperwork, disseminating final messages or incident
    summaries to staff (including LIP), media, patient and family briefings, notifying proper agencies, completing inventory of remaining equipment and supplies, and completing a Facility Status Assessment and safety check.



Triage Area

Location: External ED, under the awning and EMS drop-off, entryway.

Resource Needs:

  • Staff:
    •  Clinical
      • Registered Nurse (1:10 projected arrivals)
      • ED Tech (1:10 projected arrivals)
    • Support Staff Within This Area:
      • Security (1:20 or event dependent)
      • EVMS Police
  • Equipment
    • Stretchers (4)
    • Wheelchairs (6)
    • Triage Tags (Pack of 50)
    • Triage Supply Pack Grey (color coded tape, bandages, scissors, tape, ace wraps, splints, flashlights)
  • Communication
    • Signs - Triage Area, Visitor Screening In Progress - No weapons permitted, Patient Registration
    • Bull Horn
    • Language Services staff and/or resource


Goal: To sort and rapidly identify the most critical patients from the total injured.


Process:

  1. ED Charge Nurse Will:
    1. Identify Triage Area staff:
      1. RN
      2. ED Tech
    2. Pull “Triage Treatment Area Disaster Pack” (Gray pack)
    3. Pull and issue “Triage Treatment Area” vests to team
  2. Institute MCI disaster triage - Simple Triage and Rapid Treatment (START) and JumpSTART (pediatric version) are utilized to sort and prioritize casualty care. Triage tags/color coded ribbon is used to identify acuity levels of casualties.
  3. Casualties arriving to the hospital may have been triaged on scene and tagged with a “Virginia Triage Tag” (Sample follows). Upon arrival to the hospital these patients should receive secondary triage to determine if there was a change in status.
  4. All ambulatory patients are moved away from the rest of the injured and are given a “green”designation.
    1. State: “If you can hear me, move this way”.
    2. Bullhorns may be used to amplify directions. Gestures are helpful for hearing impaired, and those that speak a different language.
  5. A rapid less than one (1) minute screening of each remaining person is conducted by clinical staff. Screening parameters: Respiratory Status, Perfusion, and Mental Status.
    1. Children less than 8 years of age triage using “JumpStart” which provides for repositioning of the airway to determine spontaneous respiratory effort, palpating for a pulse, and 5 rescue breaths prior to determining “Black” acuity level.
    2. Only the simplest of interventions are performed within the “Triage Area” (Airway opening, tourniquet or bandage application)

Patient Access Area

Location: Patient Access occurs in two locations.

  • EMS Arrivals: Ambulance staff corridor.
  • Self-Referrals: Within the ED, routine registration area.


Resource Needs:

  • Staff:
    • Patient Access (1:6 projected arrivals)
    • Security (1:20 projected arrivals)
    • MCI-Casualty Tracking Leader and staff
  • Equipment:
    • Patient Access Disaster Supply Bin-Blue
    • Downtime Registration Forms
    • HICS Form 254: Disaster Patient Tracking
    • Computers on Wheels
  • Communication:
    • Signs- Patient Registration Area
    • Language Services or resources
    • FRS Radio: Utilized to speak with Casualty Care team.


Goal: Registration of all event casualties.

Process:

  1. Patient Registration (Access) leadership will:
    1. Prepare “Patient Access Areas” at:
      1. Main ED Entrance
      2. Ambulance staff corridor
    2. Identify a minimum of two staff members for each area and issue “Patient Access Blue Vests”.
    3. Complete “Departmental Status Report” and deliver to the Hospital Command Center.
  2. Patient Access staff will ensure ALL casualties arriving via EMS transport or self-referral will be quick registered within First Net or as a last resort on downtime forms. Each casualty registered must be tracked by both hospital medical record and the “Virginia Triage Tag number (if available)”.
    1. Each tag has a pull off label that can be placed on downtime.
    2. Both the hospital and Virginia Triage Tag number will be placed within EMR when time warrants.
  3. Patient Tracking: The Incident Command and “Patient Tracking” Unit Leader will assign two individuals to work with Patient Access and the ED Casualty Care Unit Leader. These individuals are responsible for documenting every casualty on HICS Form 254 Disaster Patient Tracking Form.
    1. Every 30 minutes the form should be copied and delivered to the “Patient Tracking Unit Leader” in the Hospital Command Center. Information may be entered into the VHASS Patient Tracking database.
    2. The original HICS Form 254 should remain with the Casualty Care Unit Leader and be used to provide the “Coordinating ED” with final patient tracking data.
    3. Casualty disposition within the ED will be tracked by the Patient Tracking Staff (OR, Imaging, Admit/Discharge)

Red Treatment Area

Location: Emergency Department Trauma Rooms; after stabilization patients may be moved to adjacent treatment rooms.


Resource Needs:

  • Staff
    • Clinical
      • Red Team Attending
      • Red Team RN (1:2)
      • Red Team Respiratory Therapist
      • Red Team ED Tech
      • Red Team Resident
    • Support Staff
      • Security - (1:10 People - includes casualties and family at bedside).
      • Social Work - Within Emergency Department Waiting Area, Red & Yellow Treatment Areas, and Family Care Center. (1:10 People including casualties and family at bedside)
      • Chaplain - Within Family Care Center and one assigned to Red & Yellow Treatment Areas.
      • PIO team member - Within Casualty Care Area
      • EVMS Police - Within the Emergency Department Waiting Area, and Red, Yellow Treatment Areas (2).
      • MCI Casualty Tracking Leader (1:10) with additional casualties consider additional staff to assist in maintaining “HICS Form 254 Disaster Patient Tracking Form”.
  • Equipment:
    • Red Treatment Area Disaster Supply Bags or carts.
    • Red Tape - Place on back of isolation gown and label with name/role.
  • Communication:
    • Language Services and resources.



Goal: Immediate care and stabilization of the critically injured.


Process: Casualties tagged “Red” will receive immediate medical screening and stabilization by the “Red Treatment Area” staff.

Yellow Treatment Area

Location: ED, segregate triaged MCI patients within Monitor Bed Unit.


Resource Needs:

  • Staff
    • Clinical
      • Yellow Team Attending
      • Yellow Team RN (1:4)
      • Yellow Team Respiratory Therapist
      • Yellow Team ED Tech
      • Yellow Team Resident
    • Support Staff
      • Security - Within the ED Red & Yellow Treatment areas (1:10 People-includes casualties and family at bedside).
      • Social Work - Assigned to ED Waiting Area, and Red & Yellow Treatment areas (1:10 People including casualties and family at bedside)
      • Chaplain - Within ED Waiting Area and Red & Yellow Treatment Area.
      • PIO team member within Casualty Care Area
      • EVMS Police - Within the Emergency Department Waiting Area (assist with Visitor Screening), and Red, Yellow Treatment Areas (2).
      • MCI Casualty Tracking Leader - Within ED Red & yellow Treatment areas (1:10)
        additional casualties consider additional staff to assist in maintaining HICS Form 254 Disaster Patient Tracking Form.
  • Equipment:
    • Yellow Treatment Area Disaster Supply Pack
    • Yellow Tape - Place on back of isolation gown and label with name/role of staff member.
  • Utilities: All power, medical gases, suction, communication, IT/IS, pyxis
  • Communication:
    • Language services


Goal: Provide medical care within 2-4 hours.


Process: Requires intervention within two to four hours; these casualties will receive continuous oversight for changes in status. Injuries may become life-threatening if ignored, but can wait until “Red” tags are treated.

Green Treatment Area

Location: Space permitting ED, segregated from Red, and Yellow Treatment Area. Alternative: Sedation Unit.


Resource Needs:

  • Staff:
    • Clinical
      • Green Team Fellow/Chief Resident/Third Year Resident
      • Green Team RN (1:6)
      • Green Team ED Tech (1:10)
      • Green Team Resident
    • Support Staff
      • Security - Within the Green Treatment areas (1:10 People-includes casualties and family at bedside).
      • Social Work - Assigned to ED Waiting Area
      • Chaplain - Within ED Waiting Area
      • PIO team member within Casualty Care Area
      • EVMS Police - Within the Emergency Department Waiting Area (assist with Visitor Screening)
      • MCI Casualty Tracking Leader-Within ED
    • Equipment
      • Green Disaster Supply Pack
      • Chairs for patients and one family member
      • Medical Supply Cart-basic urgent care dressings, bandages, splints
    • Utilities: All power, phones, computers
    • Communication: Language services, Cyracam phone


Goal: To provide medical care to “Green” tag casualties; typically after “Red” and “Yellow” tag casualties or when resources available. Care may be delayed for greater than 4 hours.


Process: General stable and ambulatory (“walking wounded”) these casualties may wait for medical care, but will receive oversight for changes in condition.

Family Care ED Waiting Room

Location:

  • ED Waiting Room
  • Alternative: Admitting Waiting Room (MCI Alternative Care Area for “Green” minor care)


Resource Needs:

  • Staff:
    • Social Worker
    • Chaplain
    • Security
  • Equipment:
    • Chairs
  • Utilities: Power
  • Communication: Language Services, Television, Phones for family members


Goal: To provide a safe area for MCI yellow and green patients and family members to await medical screening, care and disposition.


Process: Treated as normal operations waiting room with special attention to information sharing, safety, and emotional support. Area should be segregated away from media intrusion.

Family Care Center (FCC)

Location: Sixth Floor Conference Room with overflow and staff work area in Sixth Floor Classroom


Resource Needs:

  • Staff:
    • Social Work
    • Behavioral Health
    • Child Life
    • Administrative Support Staff
    • Security
    • PIO
  • Equipment and Supplies:
    • Purple Disaster Bin
    • Nourishments
    • Computers
    • Television
    • Toys
    • Blankets
  • Utilities: All power, phones, computers
  • Communication: Language services, Cyracam phone


Goal: Casualty and family support, assist jurisdictional agencies with family reunification.


Process:

Establish:

  • Reception Area - Families register and receive assistance showing them to waiting area or directly to Information Desk.
  • Information Desks - Consistently updated with current patient tracking information providing families information on their dependent. Information desks are spaced for privacy.
  • Safe Child Area - Provide oversight for children of families or those unaccompanied from MCI but medically cleared by ED.
  • Photo Identification Area - Secure, private area for family members lacking confirmed information on missing child when it is highly probable that the child is among the casualties. Photos are posted for families to identify their missing member. At this stage the need for support is greatest and requires sensitive and careful intervention.
  • Consultation Areas - Private, quiet rooms for family that expresses extreme stress reactions.


Family Care Center - Disaster Response
When needed the FCC must be able to open and operate as soon as possible. The following steps can be implemented during activation, operation and demobilization.

  1. Activate the FCC
    Staff: FCC Coordinator, PIO, Security, Admin Support Staff, Social Work, Behavior Health, Child Life, Chaplains.
    Forms: Mass Casualty Plan - FCC Section
    Resources: Supply Pack, Vests, privacy screens, photo boards and easels
    • Establish the space - see layout
    • Place signs in critical areas
    • Fill roles - initiate recall and establish shifts
    • Begin services
  2. Provide Services
    • Reception
    • Family Waiting Area with computer support for families to search VA 211 and other resources
    • Information Desks - Obtain patient information and determine likelihood that patient is within hospital. Escort family member to Photo Identification Area if necessary.
    • Safe Child Area - Reassure family that child can safely stay in this area. Escort child toarea and register with Child Life staff.
    • Nourishment - Refreshments and fluids
    • Photo Identification Area - Secure, private screened area. All family members must be escorted to and from this area.
  3. Family Interaction
    • Keep families updated with most current and accurate information
    • Accompany families to and from Photo Identification Area
    • Assign families to Social Worker, intercede with media requests. When transferring services to another Social Worker - introduce this individual to the family and let them know when they will see you again.
  4. Worker Support
    • Ensure rest, relaxation and basic needs are met.
    • Facilitate stress management immediate needs and ongoing care as needed.
  5. Demobilize
    1. When service demand is diminished transfer needs to normal daily operations.
    2. Facilitate community intervention/consults as needed.
    3. Ensure families have contact methods for staff they worked with.
    4. Provide assistance in any way possible to community Family Assistance Center.

Visitor Screening Area

Location: Visitor Screening areas should be established at point of entries; primarily ED and potentially front entrance.


Resource Needs:

  • Staff:
    • Security
    • EVMS Police
    • Language Services
  • Equipment and Supplies:
    • Golden Visitor Screening Bin
    • Tables
    • Stanchions
    • Signs
  • Utilities: All power, phone
  • Communication: Language services, Cyracam phone


Goal: Safe secure environment for staff, patients and family


Process:

  1. Establish the environment:
    • Pedestrian flow can be controlled by establishment of stanchions channeling patients and family toward the Visitor Screening Area.
    • Signs informing patients and family of the Visitor Screening process should be posted in main access areas. Signs will provide brief explanation: “For the safety of patients, visitors and staff Security will interview all Visitors, and inspection all packages”.
    • Set up tables close to entrance door for Security staff to stand behind.
  2. Validate four major elements:
    • Validation of the visit: Is the visit valid? Do they have an immediate family member that is in the ED/hospital?
    • Verification of Identity: Who is the person seeking access and can they prove that they are who they say they are?
    • Screening for Contraband: Disaster event management requires Security to screen for weapons or other items that could potentially harm building occupants.
    • Control of Access to Appropriate Area: Patients and 1 parent should be channeled toward appropriate Patient Access registration desk. Immediate family should be directed to the ED Waiting area.
  3. Security will courteously, without interrupting patient flow, interview patients and family for reason to be at hospital. Patients and one family member will be channeled to Patient Access area.
    Other immediate family members will have packages inspected for contraband and directed to ED Waiting area.




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