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To provide resilient health care during emergency events when conditions are less than ideal, and services are most critical.
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.
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.
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.
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:
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.
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.
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.
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.
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.
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.
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.
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:
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.
C. Persons Responsible for Plan Activation
The following individuals have the authority to initiate the Emergency Operations Plan.
Daily Safety Officer-Vice President
Administrator on Call-Director of Patient Care Services
Nursing Administrative Supervisors
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:
B. Department Leadership will:
C. Staff will:
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.
KEY JOB FUNCTIONS
(REFERENCE JOB ACTION SHEETS AVAILABLE IN HCC COMMAND BOX)
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)
Ensures health and safety of building occupants and environment.
(Crosswalk: organization Safety Officer, Emergency Management, Infection Control, Occupational Health-event dependent)
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.
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)
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)
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)
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.
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.
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).
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:
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.
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)
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
Norfolk WebEOC WebEOC situational awareness message or 911
Eastern Virginia Healthcare Coalition (EVHC)
Regional Healthcare Coordination Center (RHCC) - 757-243-2134
If needs exceed the level of the Commonwealth, Virginia Department of Emergency Management (VDEM) will assist by engaging Federal partners through:
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”
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:
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.
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:
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.
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 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.
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:
C. Controlling Movement Within the Building
Movement of people throughout the facility may be controlled based on potential or actual risk.
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.
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:
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.
A. Assignment of Staff
During a disaster all personnel are considered essential and all departments may be requested to assist with event management.
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)
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:
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:
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:
F. Volunteer Screening Process
(Reference Hospital/Corporate Policies Assigning Emergency Responsibilities to Volunteer Practitioner H6109)
G. Roles and Responsibilities During Emergency Operations Plan Activation
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.
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:
(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.
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:
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:
A. Key Surge Management Steps:
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.
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
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. 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.
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.
3. Patient Placement
Patient Placement utilizes the bed tracking system (Teletracker®). In the event of system failure, downtime procedures will be utilized.
4. Surge Considerations
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)
H. Department Considerations to Support Surge and Clinical Activities During Disasters
Nursing Administrative Officer
Daily Safety Officer
Safety and Security
Social Work, Patient Advocates, Language Services, Chaplain, Child Life
Physician Practices and Clinics
I. Integration to Enhance Resilient Healthcare Services
The following regional, State and Federal partners can assist the organization in maintaining essential pediatric healthcare services.
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)
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.
Demobilization objectives should be considered shortly after response. Actions Include:
Incident Commander - Establish and oversee restoration of services
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:
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:
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:
This plan is all hazards therefore it may be used for any type of mass casualty incident (MCI).
Peninsula Emergency Medical System (PEMS) and Tidewater Emergency Medical System (TEMS)Regional Medical Control & Protocols
EMS Transport Group Supervisor Report
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:
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)
Awareness of a mass casualty incident (MCI) may come to the hospital in any one of numerous formats:
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:
Emergency Department Response
Hospital Incident Command System
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
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)
The Liaison Officer will maintain community integration ensuring organizational needs for optimal pediatric care is prioritized and met. Relationships include:
Safety and Security Assessment and Controlled Access
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 and Family Psychosocial Care (Reference Family Care Center section)
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.
HIPPA Rules for MCIs
Patient Health Information (PHI) can be shared under the following circumstances:
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
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.
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.
***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.
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:
Location: External ED, under the awning and EMS drop-off, entryway.
Goal: To sort and rapidly identify the most critical patients from the total injured.
Patient Access Area
Location: Patient Access occurs in two locations.
Goal: Registration of all event casualties.
Red Treatment Area
Location: Emergency Department Trauma Rooms; after stabilization patients may be moved to adjacent treatment rooms.
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.
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.
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
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
Goal: Casualty and family support, assist jurisdictional agencies with family reunification.
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.
Visitor Screening Area
Location: Visitor Screening areas should be established at point of entries; primarily ED and potentially front entrance.
Goal: Safe secure environment for staff, patients and family