Nursing Home. Emergency Management Program Manual

Transcription

1 Nursing Hme Emergency Management Prgram Manual

2 Nursing Hme Emergency Management Plan Template

3 Disclaimer Statement The cntents f this Emergency Management Plan template are nt meant t be used as an all inclusive Emergency Management Plan fr a facility as written, but are meant fr use as a guideline and/r reference fr develping a cmprehensive facility specific emergency management manual. This template shuld underg a thrugh review by yur Emergency Planning Cmmittee and be edited t include agency specific infrmatin, data, plicies and prcedures. If yu wuld like assistance with this template, please cntact the Center fr Strategic Health Innvatin (CSHI) and the University f Suth Alabama. Yu may call , r Carl Taylr David Wallace Carlyn Rss Heather Maurer Tammy Pastr cwtaylr@usuthal.edu dwallace@usuthal.edu carlynrss@usuthal.edu maurer.heather@gmail.cm tpastr@usuthal.edu Center fr Strategic Health Innvatin

4 References 1. Rules f Alabama State Bard f Health, Alabama Department f Health, Chapter , Nursing Facilities, May 2005 retrieved frm 2. Department f Health and Human Services, Office f Inspectr General, Nursing Hme Emergency Preparedness and Respnse During Recent Hurricanes, August 2006 retrieved frm pdf 3. Agency fr Healthcare Research and Quality, US Department f Health and Human Services, Nursing Hmes in Public Health Emergencies, May 2007 retrieved frm 4. American Jurnal f Public Health, Prviding Shelter t Nursing Hme Evacuees in Disasters: Lessns Frm Hurricane Katrina, July 2008 retrieved frm 5. Natinal Lng Term Care Ombudsman Resurce Center, Federal Nursing Hme Refrm Act frm the Omnibus Budget Recnciliatin Act f 1987 (OBRA 87 SUMMARY), retrieved frm Nursing- Hme- Refrm- Act 6. * Califrnia Primary Care Assciatin, Clinic Emergency Operatins Plan dcuments EOP: - (Revised fr Nursing Hme use). 7. * Cmmunity Health Care Assciatin f New Yrk State (CHCANYS), Cmmunity Health Center Emergency Management Plan, Editin. Retrieved frm: Emergency _ ManagementManual.pdf - (Revised fr Nursing Hme use).

5 Sectin: INTRODUCTION: INDEX TABLE OF CONTENTS Prcedure #: Page: 1 f 2 Table f Cntents 1. General Infrmatin Plicy and Primary Objectives Purpse and Scpe Activatin f Emergency Management Plan General Hazard Vulnerability Analysis Key Persnnel Cmmunity Crdinatin 2. Ntificatin Telephne List Duties External Disaster Key Persnnel Phne/Pager Ntificatin Supprt Services Checklist 3. Cntinuity f Operatins Gals & Planning Elements Emergency Generatr Staff Vlunteer Staff Vlunteer Staff Registratin/Credentialing Frm Staffing Requirements fr Sheltering in Place and evacuatin 4.4 Staff Family Members (1 f the 25 elements) 5. Incident Cmmand System Activatin Of Incident Cmmand System EOC Activatin Criteria And Setup Directin and Cntrl 6. Hazard Vulnerability Analysis (HVA) HVA General Determinatin Of Ptential Risk Mitigatin, Preparedness, Respnse & Recvery Incident Actin Plan Actin Plan Develpment Actin Plan frm Cmmunicatins/IT Redundancy Of Cmmunicatin Systems Public Infrmatin Officer. Nursing Hme Emergency Plan Template

6 Sectin: INTRODUCTION: INDEX TABLE OF CONTENTS Prcedure #: Page: 2 f 2 Table f Cntents 9. Facility Checklist General Facilities Checklist Management Of Envirnment Shelter in Place (* this sectin can either be a separate prcedure in the plan r an annex dcument) 10.1 Decisin Criteria 10.2 Specific Resident needs 10.3 Securing the facility 10.4 Emergency pwer 10.5 Water Supply 10.6 Staffing *** 10.7 Medicatin 10.8 Serving as hst facility 11. Prvisins fr Evacuatin (* this sectin can either be a separate prcedure in the plan r an annex dcument) 11.1 Transprtatin Cntract 11.2 Evacuatin Prcedures 11.3 Hst Facility Agreement 11.4 Fd Supply 11.5 Medicatins 11.6 Transfer f Medical Recrds 11.7 Staffing 11.8 Resident Persnal Belnging 11.9 Re-entry Water Supply Evacuatin Rute 12. Annexes Evacuatin General... * Can be separate prcedure r annex Evacuatin Flds... * Can be separate prcedure r annex Surge Hspital Snw/Ice Emergency Internal Disaster Plan: Fire Weapns f Mass Destructin Cmmunicable Disease Nursing Hme Emergency Plan Template

7 Sectin: 1 GENERAL INFORMATION POLICY AND PRIMARY OBJECTIVES OF DISASTER PLANNING Prcedure #: 1.1 Page: 1 f 1 POLICY AND PRIMARY OBJECTIVES OF DISASTER PLANNING POLICY: (Facility Name) shall establish and maintain an emergency management plan t facilitate apprpriate respnse t internal and external disasters. The staff shall be trained t respnd t the incident in accrdance with guidance prvided in this plan. Disaster drills will be cnducted (number f times) t test and evaluate the plan. PURPOSE: 1) T ensure efficient utilizatin f lcal health resurces s that they will nt be verwhelmed during initial disaster relief when emergency medical care and first aid are needed fr casualties. 2) T prvide fr expansin f services thrugh discharge, transfer arrangement and crdinatin/cnsultatin with lcal civil authrities and lcal reginal and state representatives and ther agencies. 3) T prvide prfessinal care fr disaster victims immediately upn their arrival at the Nursing Hme r frm internal disaster situatins. 4) T effectively utilize available resurces and supplies. 5) T preserve the health and endurance f persnnel fr the duratin f the disaster and its aftermath. EMERGENCY MANAGEMENT PLAN DEVELOPMENT: NIMS and JC standards have been the criteria used in develping this plan. Lcal civil/health authrities have cntributed t the plan including: Plice, Fire, EMS, DOH, Hspitals.

8 Sectin: 1 GENERAL INFORMATION PURPOSE AND SCOPE OF DISASTER PLANNING Prcedure #: 1.2 Page: 1 f 3 PROCEDURE: EMERGENCY MANAGEMENT PLAN EDUCATION 1. All emplyees will be educated n the Emergency Management Plan (when). 2. Managers will ensure that new staff members are educated n their specific departmental respnsibilities during a disaster. 3. Managers will prvide (frequency) in-service fr all staff. NURSING HOME RESPONSE ROLES AND REQUIREMENTS Emergency Rles Requirements Internal Emergencies: Prtect residents/ccupants and visitrs, staff. Prtect facilities, vital equipment and recrds. Generally requires planning, training and exercises. Als requires internal culture where safety and preparedness are given high pririty. Specific Requirements include: Emergency Plans Training/Drills/Exercises Emergency/Evacuatin Signage Business Cntinuity Plans Security Internal cmmunicatins Staff ntificatin and recall Emergency prcedures distributed thrughut the Nursing Hme Mass Casualty Care Sufficient staff t manage resident/ccupant surge Triage capability ALS capability Hlding Agreements with receiving hspitals r ther nursing hmes Integratin f Nursing Hme int medical respnse System Receptin and Triage Respnse plan During disasters, Nursing Hme may becme Staff recall prcedure pints f cnvergence fr injured, infected, wrried, r dislcated cmmunity members. Depending n the emergency and availability f Prcedures t btain utside additinal assistance vlunteers, assistance frm cunty ther medical resurces, Nursing Hme may nt Crwd management be able t handle all f the presenting cnditins. Lcatin f shelters Minimum Nursing Hme rle will likely be triage, Receptin area reprting, stabilizatin, and hlding until transprt Triage tags can be arranged. Triage training

9 Receptin f Hspital Overflw In disasters, hspitals may be verwhelmed with ill and injured requiring high levels f care, while at the same time facing cnvergence frm patients with minr injuries r the wrried well. Nursing Hme may be requested t handle patients with minr injuries t relieve the pressure n the hspital. Maintaining Onging Rutine Patient Care Nrmal Levels and Extended Surge The cmmunity s need fr rutine medical care may cntinue fllwing a disaster. Mental Health Services Nursing Hme can expect the cnvergence f the wrried well fllwing a disaster. Requirements abve fr mass casualty care. Prir agreement that defines: Circumstances fr implementatin Types f patients that will be accepted Resurce/staff supprt prvided by hspital Patient infrmatin/medical recrds Liability releases Nursing Hmes shuld prepare t maintain their service capacity thrugh prtectin f equipment, critical supplies and medicatins, and persnnel. Requirements include: Cntinuity f Operatins Plan Prcedures t augment resurces In areas subject t frequent pwer utages, Nursing Hmes shuld cnsider adding generatrs t ensure peratinal capacity & safeguard ther utilities Disaster mental health training fr Nursing Hme Staff/licensed mental health staff Internal r external mental health team External surce f trained persnnel t augment respnse Bi-Agent Initial Identificatin and Rapid Reprting Nursing Hme may be the early warning system fr a bi-agent utbreak. Nursing Hme staff shuld lk fr unusual symptms r ther signs f use f BT agents. Rapid reprting is critical. Unusual event may be a single case r multiple cases with the same symptms. Staff Prtectin Prvide prtectin t staff in event f presence suspected infectius agents Mass Prphylaxis Nursing Hme may be requested t participate in mass prphylaxis managed by the lcal health department at Pint f Distributin (POD). Nursing Hme participatin culd include requesting Nursing Hme staff t supprt mass inculatins at ther sites. Infectius disease mnitring prcedures and prtcls Prcedures fr reprting t cunty and state health department Evidence Kits Training Adherence t standard, drplet, and/r airbrne precautins as apprpriate Training Infectius disease prcedures Reprting prcedures Availability f staff wh can vlunteer Prcedures fr determining when Nursing Hme staff can vlunteer

10 Hazardus Material Respnse Nursing Hmes near majr transprtatin rutes, distant frm hspitals, r with emergency medical capabilities may be called upn t treat injured patients wh have been cntaminated by a hazardus material. Generally, in urban areas, Nursing Hmes will nt be required t be hazardus material respnders. Risk Cmmunicatins Nursing Hmes are ften imprtant cnduits f health infrmatin fr the cmmunities they serve. Patients, staff and cmmunity members may lk t the Nursing Hmes fr answers t their questins abut an emergency. Prvide Vlunteer Staff Nursing Hmes may be requested t prvide staff t deliver health services at shelters, fr mass prphylaxis r at ther respnse sites. Prtective equipment Decntaminatin prcedures/capability/equipment Reprting prcedures Waste hlding cntainer Cmmunicatins link with ADPH, EMA and Lcal Department f Public Health Prcedures fr cmmunicating with patients staff and cmmunity (in languages spken in the cmmunity) Backup staff Plicy fr receiving requests, plling staff, and releasing staff fr nn-nursing Hmes duties Plicy n release f staff fr vlunteer duty Receive Vlunteer Prviders/Teams Receptin prcedures Credential/backgrund checks Lgistic supprt Cmmunity Preparedness Educatinal material in apprpriate languages Educatrs/vlunteers Educatin at schls and faith-based rganizatins in cmmunity Sheltering Hlding area Prtectin frm weather Bedding Medical supplies Pharmaceuticals fr cmmn cnditins (insulin, etc.)

11 Sectin: 1 POLICY: GENERAL INFORMATION ACTIVATION OF EMERGENCY MANAGEMENT PLAN Prcedure #: 1.3 Page: 1 f 1 PURPOSE: THE NURSING HOME has a frmal activatin and terminatin f ur Emergency Management Plan. T ensure prper activatin and terminatin f this disaster plan. PROCEDURE: 1. Initial ntificatin via AIMS, ALERT, telephne, media (TV, radi, etc.). 2. Ntificatin t (whm) t call CEO/AOC. 3. Activatin/terminatin f this plan shall be by the CEO/Incident Cmmander. 4. As per CEO, PRE-ALERT CODE activatin/terminatin r ACTIVATION CODE will be paged. ALERT: 5. All members f the Emergency Management (ICS) Team will reprt t the Cmmand Pst. 6. All staff cntinues nrmal peratins until ntified. 7. Initializatin f Call Back Staff List by peratr. STAFF NOTIFICATION: All persns ntified will be prvided the same, shrt briefing f the events at hand, including: What is the event What is it threatening (staff, prperty, cmmunicatins, data, fiscal peratins, envirnment, general public) What is being dne and by whm (activatin f Emergency Management Cmmittee, Cmmand Pst, recvery actins) 8. If Cde incident meets disaster criteria and necessitates activatin f entire plan all n duty shuld activate and functin accrding t emergency management plan. 9. The Incident Cmmand may direct that utside agencies be ntified (Fire, EMS, etc.). 10. Deactivatin Cde Clear t be indicated by Incident Cmmander.

12 ectin: 1 GENERAL INFORMATION Cmmunity Crdinatin Prcedure #: 1.4 Page: 1 f 1 POLICY AND PRIMARY OBJECTIVES OF COMMUNITY COORDINATION POLICY: (Facility Name) shall wrk t integrate the facility int the cmmunity by crdinating with lcal authrities and lcal resurces needed t facilitate effective and efficient disaster preparedness planning and respnse. PURPOSE: 1) T ensure that all participants in disaster respnse understand their rles, respnsibilities and capabilities during the Nursing Hme s Emergency Management Prgram develpment and disaster respnse. 2) At a minimum, the fllwing agencies shuld be invlved in the cllabratin and crdinatin regarding the Nursing Hmes disaster preparedness and respnse fr the mutual benefit f the Nursing Hme facility and the lcal cmmunity: a. Lcal Department f Public Health Emergency Preparedness Crdinatr b. EMA c. LEPC d. Lcal Hspitals e. Lcal Ambulance cmpanies f. Fire and Rescue g. Lcal plice h. Other lng term care facilities

13 Sectin: 2 NOTIFICATION TELEPHONE LIST- DUTIES EXTERNAL DISASTER Prcedure #: 2. 1 Page: 1 f 1 POLICY: In a disaster the Nursing Hme will have a system t annunce the disaster and apprpriately ntify the staff. PURPOSE: T ensure cmmand will activate disaster ntificatin and staff ntificatin in a disaster. PROCEDURE: 1. The Incident Cmmander will call the switchbard t annunce CODE EXTERNAL r EXTERNAL CODE. 2. Switchbard is t annunce CODE EXTERNAL r EXTERNAL CODE with the lcatin via the verhead paging system and ver the pcket pagers t the Emergency Management Team. EMERGENCY MANAGEMENT TEAM RESPONDS TO COMMAND POST CEO Nursing Hme Administratr Medical Directr Directr f Security Plant Operatins Directr Chairman f the Emergency Management Cmmittee IT 3. Switchbard is t initiate the fllwing call list fr external disasters. 4. Cmmunicatins will dispatch an peratr t the cmmand pst t cver the Infrmatin Phne. 5. If the situatin is cleared, the switchbard will be ntified by the Administratr in charge and an peratr will annunce, CODE EXTERNAL CLEAR. Cmmunity Health Center Emergency Management Plan Template

14 Sectin: 2 NOTIFICATION KEY PERSONNEL PHONE/PAGER NOTIFICATION Prcedure #: 2. 2 Page: 1 f 1 KEY PERSONNEL MASTER LIST NOTE: Operatr t cntact via phne r pcket pager system. Persnnel Phne/Pager #. 1. CEO ( ) - 2. Administratr-On-Call ( ) Medical Directr ( ) Chairman f Disaster Cmmittee ( ) Security Directr ( ) - 6. Directr f Infrmatin Technlgy ( ) Directr f Plant Operatins ( ) - 8. ( ) ( ) - Cmmunity Health Center Emergency Management Plan Template

15 Sectin: 2 NOTIFICATION Supprt Services Checklist TELEPHONE LIST- DUTIES EXTERNAL DISASTER Prcedure #: 2. 3 Page: 1 f 1 BASIC NURSING HOME SUPPORT SERVICES LIST DATE OF LAST UPDATE: UPDATED BY: EMS Prvider Fire Service Plice Lcal Hspital DOH Cntact List: Vendrs / Funding Surces / Cmmunity Liaisns Telephne (999) Cntact Persn Gas r Prpane Telephne Equipment Prvider Equipment Repair Service Prvider Infrmatin Technlgy Admin EHR Supprt Medical Supply and Equipment Vendr Vendr Repair Repair Maintenance **Cmplete/Revise t keep CURRENT

16 Sectin: 3 CONTINUITY OF OPERATIONS GOALS AND PLANNING ELEMENTS Prcedure #: 3. 1 Page: 1 f 2 POLICY: It is the plicy f (Facility Name) t maintain service delivery r restre services as rapidly as pssible fllwing an emergency that disrupts thse services. As sn as the safety f Resident/ccupants, visitrs, and staff has been assured, the Nursing Hme will give pririty t prviding r ensuring Resident/ccupant access t health care. PURPOSE: T increase (Facility Name) ability t maintain r rapidly restre essential services fllwing a disaster. PROCEDURE: The (Facility Name) will take the fllwing actins t ensure: 1. Resident/ccupant, visitr and persnnel safety: a. Develp, train n and practice a plan fr respnding t internal emergencies and evacuating Nursing Hme staff, Resident/ccupants and visitrs when the facility is threatened. 2. Cntinuus perfrmance r rapid restratin f the Nursing Hme s essential services during an emergency: a. Develp plans t btain needed medical supplies, equipment and persnnel. Identify a backup site r make prvisins t transfer services t a nearby prvider. 3. Prtectin f medical recrds: a. T the extent pssible, prtect medical recrds frm fire, damage, theft and public expsure. If the Nursing Hme is evacuated, prvide security t ensure privacy and safety f medical recrds. 4. Prtectin f vital recrds, data and sensitive infrmatin: a. Ensure ffsite back-up f financial and ther data. b. Stre cpies f critical legal and financial dcuments in an ffsite lcatin. c. Prtect financial recrds, passwrds, credit cards, prvider numbers and ther sensitive financial infrmatin. d. Update plans fr addressing interruptin f cmputer prcessing capability. e. Maintain a cntact list f vendrs wh can supply replacement equipment. f. Prtect infrmatin technlgy assets frm theft, virus attacks and unauthrized intrusin. 5. Prtectin f medical and business equipment: a. Cmpile a cmplete list f equipment serial numbers, dates f purchase and csts. Prvide list t the CFO and stre a cpy ffsite. b. Prtect cmputer equipment against theft thrugh use f security devices. c. Use surge prtectrs t prtect equipment against electrical spikes. d. Secure equipment and/r elevate equipment as apprpriate during time f fld risk and water main break issues. e. Place fire extinguishers near critical equipment, train staff in their use, and inspect accrding t manufacturer s recmmendatins.

17 Sectin: 3 CONTINUITY OF OPERATIONS GOALS AND PLANNING ELEMENTS Prcedure #: 3. 1 Page: 2 f 2 1. Relcatin f services: (Facility Name) will take the fllwing steps, as feasible and apprpriate, t prepare fr an event that makes the primary Nursing Hme facility unusable (Facility Name) will: a. Identify a back-up facility fr cntinuatin f Nursing Hme health services, if pssible. b. Establish agreements with nearby health facilities t accept referrals f Nursing Hme patients. c. Establish agreements with nearby health facilities t allw Nursing Hme staff t see Nursing Hme patients at these alternate facilities. d. Identify a back-up site fr cntinuatin f Nursing Hme business functins and emergency management activities. The current back-up site is [lcatin]. 2. Restratin f utilities: (Facility Name) will: a. Maintain cntact list f utility emergency numbers. b. Ensure availability f phne and phne line that d nt rely n functining electricity service. c. Request pririty status fr maintenance and restratin f telephne service frm lcal telephne service prvider.

18 Sectin: 3 CONTINUITY OF OPERATIONS EMERGENCY GENERATOR Prcedure #: 3. 2 Page: 1 f 1 (Facility Name) will btain and install an emergency generatr t ensure its ability t cntinue peratins in the event f an emergency that creates pwer utages. (Facility Name) will btain assistance frm lcal utilities r vendrs. Specific steps include: Inventry essential equipment and systems that will need cntinuus pwer. Determine the maximum length f time the Nursing Hme will perate n emergency pwer (i.e., is emergency pwer primarily fr shrt term utages r fr extended peratins). Determine pwer utput needs. Select fuel preference: prpane r diesel. Determine lcatin f nearest supplies f selected fuels that can be accessed in an emergency. Select, purchase and install generatr. Perfrm recmmended peridic maintenance. Run mnthly generatr start-up tests.

19 Sectin: 4 STAFF VOLUNTEER STAFF Prcedure #: 4.1 Page: 1 f 2 POLICY: It is the plicy f (Facility Name) t permit the Chief Executive Officer, Medical Directr, r their designee(s), t grant disaster privileges n a case-by-case basis when the Nursing Hme s emergency management plan is activated and the Nursing Hme is unable t handle immediate patient care needs. This plicy utlines (Facility Name) Nursing Hme s plan t accept vlunteer practitiners and t prcess the credentials f thse practitiners wh d nt currently pssess medical staff privileges t practice at (Facility Name). PURPOSE: The purpse f this plicy is t utline the prcess fr granting disaster privileges t licensed independent practitiners (LIPs) during the time when the Nursing Hme s emergency management plan is activated and the Nursing Hme is unable t handle immediate patient care needs. RESPONSIBILITY: The CEO, Medical Directr and Directr f Nursing are respnsible fr granting disaster privileges in accrdance with this plicy. PROCEDURE: When the Nursing Hme s emergency management plan has been activated, the Nursing Hme will utilize the fllwing prcess fr any LIP wh is nt n the medical staff f (Facility Name) and wh presents his/her self as a vlunteer t render services: 1. The practitiner will be directed t, where he/she must present any ne f the fllwing, prir t the granting f disaster privileges: a. a current hspital pht identificatin card; r b. a current license t practice and a valid picture identificatin card issued by a state, federal, r c. regulatry agency; r identificatin indicating that the individual is a member f the Medical Reserve Crps (MRC); r d. identificatin indicating that the individual has been granted authrity t render patient care, treatment, and services in disaster circumstances (such authrity having been granted by a federal, state, r municipal entity); r e. Presentatin by current Nursing Hme staff member(s) with persnal knwledge regarding the LIP s identity. 2. Once a practitiner btains apprval fr disaster privileges, (Facility Name) will issue apprpriate identificatin. The practitiner will then reprt t and practice under the auspices f the directr f the department t which he/she is assigned.

20 Sectin: 4 STAFF VOLUNTEER STAFF Prcedure #: 4. 1 Page: 2 f 2 1. The medical staff will begin the verificatin prcess f the credentials and privileges f individuals wh receive disaster privileges as sn as the immediate situatin is under cntrl. The verificatin prcess is identical t the prcess established under the medical staff bylaws fr granting temprary privileges t meet an imprtant patient care need, and is a high pririty. 2. All disaster privileges will immediately terminate nce the emergency management plan is n lnger activated. Hwever, the Nursing Hme may chse t terminate disaster privileges prir t that time. The practitiner must return the temprary ID card t Security. 3. The medical staff will maintain a list f all vlunteer practitiners wh received disaster privileges during the emergency management/disaster event.

21 Sectin: 4 STAFF VOLUNTEER STAFF REGISTRATION/CREDENTIALING Prcedure #: 4.2 Page: 1 f 1 Nursing Hme Emergency Management Plan Sectin 4.2

22 Sectin: 1 GENERAL INFORMATION Staffing Requirements fr Sheltering in Place and Evacuatin Prcedure #: 4.3 Page: 1 f 1 Staff Family Members POLICY: PURPOSE: Shuld be develped accrding t HVA results and anticipated needs.

23 Sectin: 1 POLICY: GENERAL INFORMATION Staff Family Members Staff Family Members Prcedure #: 4.4 Page: 1 f 1 PURPOSE: This was ne f the 25 suggested required elements- making a plicy regarding staff family members. There are prs and cns t this ne. If there is a plicy fr allwing family members wuld have t calculate fd, water etc fr the extra head cunt in the facility

24 Sectin: 5 Plicy: In time f Activatin f the Emergency Management Plan, the Incident Cmmand Structure will be activated. Purpse: T ensure crdinated effrt using the Natinal Incident Management System(NIMS) terminlgy and rganizatinal structure. Prcedure: INCIDENT COMMAND SYSTEM ACTIVATION OF INCIDENT COMMAND SYSTEM Prcedure #: 5.1 Page: 1 f 2 1. The Nursing Hme Operatr t annunce ATTENTION ALL PERSONNEL, CODE. 2. Incident Cmmander, Sectin Chiefs and Key IC persnnel reprt t the Cmmand Pst (r call- in if ff- site) within minutes. 3. All Nursing Hme persnnel will reprt t, r check in with their departments and wait fr infrmatin and instructins. 4. Security persnnel will begin a facility assessment and determine the level f security necessary. 5. The IC will initiate the Incident Cmmand Management by Objectives prcess see schematic belw. 6. Sectin Chiefs and Key IC persnnel develp initial strategy t respnd t the event. An Incident Actin Plan (IAP) is develped and the first IAP time perid is set. *See Sectin 7:IAP 7. Sectin Chiefs and Key IC persnnel return t their wrkstatins and carry ut IAP strategy. 8. IC sets next IC/IAP briefing and the time fr the secnd IAP time perid t begin.

25 Sample Incident Cmmand Structure:

26 Sectin: 5 INCIDENT COMMAND SYSTEM EOC ACTIVATION CRITERIA AND SETUP Prcedure #: 5.2 Page: 1 f 1 POLICY: PURPOSE: PROCEDURE: T ensure a Cmmand Pst is functinal whenever an event ccurs which will threaten staff health and safety and/r will interrupt peratins. T ensure that the Nursing Hme Emergency Management Cmmittee (EMC) activates a Cmmand Pst in a timely manner as needed. T ensure that the apprpriate Cmmand Pst staffs are directed t perfrm set up s that the Cmmand Pst will be ready. T ensure that the crrect Cmmand Pst is activated, t ensure habitability and the safety f EMC staff. Steps in this prcess are suggested in an rder. Each situatin is different, which may require skipping steps because f the impact f actual events. Check the bx when cmpleted. Make decisin abut Cmmand Pst activatin, lcatin and apprpriate staffing. Assign staff t set up an Cmmand Pst. Ensure security is present t ensure safety f persnnel, habitability, and secure peratins. If nt all EMC staff are activated, ensure all ther EMC staff are made aware f when Cmmand Pst is being activated in case they are called fr service. Cntact peratinal area medical directr and ther key stakehlders abut the Cmmand Pst activatin and prvide cntact phne numbers nce the Cmmand Pst is peratinal (ready t functin). Ensure that external safety, parking, and access is apprpriate fr the Cmmand Pst peratin. Direct the Safety Officer t cntinue habitability assessments, especially in highly variable and dangerus cnditins (flds, fires, hazmat, civil disturbance, earthquake, etc.) Ensure that security is established at the entrance t the Cmmand Pst and then establish a sign-in prcess in rder t verify wh has arrived and when.

27 Sectin: 6 HAZARD VULNERABILITY ANALYSIS (HVA) HAZARD VULNERABILITY ANALYSIS- GENERAL Prcedure #: 6.1 Page: 1 f 1 HAZARD VULNERABILITY ANALYSIS (HVA) POLICY: The Nursing Hme will cnduct an annual HVA. PURPOSE: T evaluate all hazards, their risk f actual ccurrence, and the impact n life, prperty and business if the hazard ccurred. PROCEDURE: 1. Determine prbability and impact f hazard Prbability and impact are ranked: Lw Rare Mderate Unusual High High Ptential r Have Experienced Risk = Prbability x Severity f impact n life, prperty and business 2. Address mitigatin, preparedness, respnse, and recvery fr these hazards 3. Fr high risk/high impact hazards, develp individual incident actin plans

28 Sectin: 6 HAZARD VULNERABILITY ANALYSIS (HVA) DETERMINATION OF POTENTIAL RISK OF THE HAZARD OCCURING Prcedure #: 6.2 Page: 1 f 1 Hazard Vulnerability Analysis Disaster Management DETERMINATION OF POTENTIAL RISK OF THE HAZARD OCCURRING HAZARD LOW MODERATE HIGH Natural Disasters Ice/Snw/Blizzards Flding Earthquakes Fire Outbreak/Epidemic Resurce/Utility Disasters Lss f Pwer/Electric/Generatr IT Failure Lss f Water Fuel Shrtage Fire- Internal Medical Gas Shutdwn Staff Unavailability Mass Casualty Accidents Bus Accidents Train Accidents Airplane Accidents Hstage Situatin Industrial Accidents Fires Chemical Hazmat Weapns f Mass Destructin Chemical Weapns Bilgical Weapns Nuclear Weapns Radilgical Weapns High Explsive Devices Bmb Threat

29 Sectin: 6 HAZARD VULNERABILITY ANALYSIS (HVA) MITIGATION, PREPAREDNESS, RESPONSE AND RECOVERY POLICY: After cnducting an annual Hazard Vulnerability Analysis (HVA), we will determine the apprpriate level f mitigatin, preparedness, respnse and recvery. TYPES OF RISK EXAMPLES: Prcedure #: 6.3 Page: 1 f 2 1. Natural Disasters- Mitigatin: The Nursing Hme is nt in a fld plain, r earthquake prne area. Therefre we have nt taken any special precautins. In case f a blizzard, we have develped a snw emergency plicy. Preparedness: See snw emergency plicy. (Incident Actin Plan) Respnse: We wuld activate ur external disaster plan and prepare the Nursing Hme t receive multiple casualties. Recvery: This wuld be determined by the incident cmmander. 2. Utility Disasters- Mitigatin: The Nursing Hme has taken steps t prvide fr redundant capabilities f ur telephne system. We have emergency generatrs t pwer all f ur missin critical patient systems. Preparedness: We test ur generatrs and telephne switch n an nging basis. We have distributed prtable radis t all patient care areas fr use during a telephne failure. We als maintain a supply f bttled water at all times. Respnse: We wuld activate ur internal disaster plan. Recvery: The incident cmmander wuld authrize the apprpriate steps and resurces necessary t return the Nursing Hme t ur full level f functining. 3. Mass Casualty Incidents- Mitigatin: We as a Nursing Hme cannt take any special precautins t prevent such an incident. Preparedness: We participate with the surrunding cmmunities in cnducting drills. During these drills we als cnduct a test f ur Nursing Hme Disaster Plan. Respnse: We wuld activate ur external disaster plan. Recvery: The incident cmmander wuld authrize the use f Nursing Hme resurces t assist the cmmunity in their recvery effrts. If the extent f the incident required that we altered varius departmental schedules, the incident cmmander wuld determine when the schedule culd be resumed.

30 Sectin: 6 HAZARD VULNERABILITY ANALYSIS (HVA) MITIGATION, PREPAREDNESS, RESPONSE AND RECOVERY Prcedure #: 6.3 Page: 2 f 2 4. Industrial Accidents- Mitigatin: We as a Nursing Hme cannt take any special precautins t prevent such an incident. Preparedness: We participate with the surrunding cmmunities in cnducting drills. We have trained staff in the use f PPE and decntaminatin prcedures. Respnse: We wuld activate ur external disaster plan and set up ur decntaminatin tents and equipment if required. Recvery: The incident cmmander wuld authrize the use f Nursing Hme resurces t assist the cmmunity in their recvery effrts. If the extent f the incident required that we altered varius departmental schedules, the incident cmmander wuld determine when the schedule culd be resumed. 5. Weapns f Mass Destructin- Mitigatin: We have taken multiple steps t prtect the Nursing Hme. Staff is being trained in early detectin t ensure that the Nursing Hme is nt cntaminated. We have heightened the awareness f the security and ther staff as t ptential risks and threats t the Nursing Hme Preparedness: We have purchased additinal decntaminatin tents and equipment and persnal prtectin equipment fr the staff. We are training the apprpriate staff in the use f equipment. We have instituted the Emergency Incident Cmmand System and are training the apprpriate management and center staff. We have prvided training fr the medical staff in the diagnsis and treatment f patients affected by bilgical weapns. Respnse: The Nursing Hme wuld activate ur external disaster plan well as CODE BROWN (t set up the decntaminatin tents and lck dwn the Nursing Hme). Recvery: The incident cmmander wuld authrize the apprpriate steps and resurces necessary t return the Nursing Hme t ur full level f functining.

31 Sectin: 7 POLICY: INCIDENT ACTION PLAN ACTION PLAN DEVELOPMENT Prcedure #: 7.1 Page: 1 f 1 Incident Actin Planning is an essential part f the Incident Cmmand System. Actin planning is an effective management tl invlving tw essential items: A prcess t identify bjectives, pririties and assignments related t emergency respnse r recvery actins. Plans which dcument the pririties, bjectives, tasks and persnnel assignments assciated with meeting the bjectives. PURPOSE: T develp an Incident Actin Plan based n Hazard Vulnerability Analysis, drills and exercises. The prcedures and frms in this sectin prvide a radmap fr the use f this imprtant respnse tl. Even in the perid immediately fllwing a disaster, it is imprtant t establish and cmmunicate clear pririties and t track the cmpletin f pririty bjectives. At this pint, actin plans can be verbal and cver very shrt (e.g., twhur) time perids. In later phases f the respnse, written actin plans fr lnger time perids prvide effective tls fr ensuring that all respnders are addressing the rganizatin s pririty tasks. PROCEDURE: Incident Actin Planning Prcedures: Incident Actin planning is based n the use f an peratinal perid. The length f the peratinal perid fr the Incident Actin Plan is determined by first establishing a set f bjectives and pririty actins that need t be perfrmed and then establishing a reasnable time frame fr accmplishing thse actins. Generally, the actins requiring the lngest time perid will define the length f the peratinal perid. Typically, peratinal perids at the beginning f an emergency are shrt, smetimes nly a few hurs. As the emergency prgresses, peratinal perids may be lnger, but shuld nt exceed twenty-fur hurs. Operatinal perids shuld nt be cnfused with staffing patterns r shift change perids. They may be the same, but need nt be. The initial Incident Actin Plan shuld nt be cmplex r create a time-cnsuming prcess. The Incident Actin Plan shuld generally cver the fllwing elements: Listing f bjectives t be accmplished (shuld be measurable). Statement f current pririties related t bjectives. Statement f strategy t achieve the bjectives. (Identify if there is mre than ne way t accmplish the bjective and which way is preferred.) Assignments and actins necessary t implement the strategy. Operatinal perid designatin the time frame necessary t accmplish the actins. Organizatinal elements t be activated t supprt the assignments. (Als, later Incident Actin Plans may list rganizatinal elements that will be activated during r at the end f the perid.) Lgistical r ther technical supprt required. Fcus f the Incident Actin Plan: The fcus f the Incident Actin Plan shuld be n Nursing Hme issues. The plan sets verall bjectives fr the Nursing Hme s Incident Actin Plan. Prperly prepared, the Incident Actin Plan becmes an essential input t the develpment f Incident Actin Plans by ther rganizatins. *Refer back t Sectin 5 - ICS

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33 Sectin: 7 INCIDENT ACTION PLAN FORMS Prcedure #: 7.2 Page: 1 f 1 INCIDENT ACTION PLAN FORM

34 Sectin: 8 COMMUNICATIONS/IT REDUNDANCY OF COMMUNICATION SYSTEMS Prcedure #: 8.1 Page: 1 f 2 RISK COMMUNICATION AND HEALTH INFORMATION DISSEMINATION Which are addressed in the agency s emergency respnse/crisis cmmunicatin plan? (check all that apply) i. Messenger An agency staff member and at least ne alternate assigned the rle and respnsibility f Public Infrmatin Officer (PIO) Lines f authrity and respnsibilities fr the public infrmatin team Wrk and relief scheduling fr public infrmatin team t maintain 24 hur per day peratins (2-3 wrk shifts per day) fr at least several days Identificatin f persns t act as spkespersns n public health issues during an emergency fr multiple audiences and frmats (spkespersns representing different ethnic grups, media spkespersns, cmmunity meetings speakers, etc.) ii. Cmmand and Cntrl Verificatin (accuracy/apprpriateness) and clearance/apprval prcedures fr infrmatin that will be released t respnse partners, media, and public Crdinatin with public infrmatin fficials frm partner rganizatins t ensure message cnsistency Liaisn between agency and Cmmand Pst Briefings with agency directr, Cmmand Pst, and higher headquarters t update and advise n infrmatin intended fr release, incident-specific plicy, science, and situatin. iii. Creating G-Kits t enable rapid, mbile respnse by public infrmatin fficers that includes: Laptp cmputer capable f cnnecting t Internet/ CD-ROM with elements f crisis cmmunicatin plan (emergency cntact infrmatin, preprepared materials, medical management infrmatin, manuals, backgrund infrmatin, etc.) Prtable printer Cellphne r satellite phne, pager, wireless iv. Media Infrmatin Triage f media requests and inquiries Respnse t media requests (e.g., daily press cnferences, website updates) Lcatins, equipment, and supplies fr press cnferences Prductin f media advisries, press releases, fact-sheets, b-rll Mnitring media thrugh envirnmental and trend analysis (e.g., clipping service, mnitring news cverage) t determine messages needed, misinfrmatin t be crrected, media cncerns, and media interest during crisis v. Direct Public Infrmatin Assessing existing telephne capacity t determine the need fr additinal lines during an emergency Respnse t public wh request infrmatin directly frm the agency by telephne (e.g., htline), in writing, r by Timeliness and accuracy f public website infrmatin Public advertising f agency cntact infrmatin Mnitring public thrugh envirnmental and trend analysis t determine messages needed, misinfrmatin t be crrected, public cncerns, and public interest during crisis

35 Sectin: 8 COMMUNICATIONS/IT REDUNDANCY OF COMMUNICATION SYSTEMS Prcedure #: 8.1 Page: 2 f 2 Examples f Cmmunicatin Systems Effective in an Emergency Having Multiple, Redundant Systems Is the Mst Effective Way t Ensure Cmmunicatin: Inter-center cmmunicatins systems. Fax machines hked up t run n emergency pwer fr backup cmmunicatins and use f bradcast faxes. Emergency management mbile cmmand vehicles. Physical runners t cmmunicate needs. Accessing ffice functins frm ffsite via secure Web technlgy. Setting up mass dial-up Internet Service Prvider accunts fr lcal health agencies having truble accessing Internet. High-speed wireless Internet netwrks. Wireless Lcal Area Netwrk (LAN). Satellite reach-back cmmunicatins. Blackberry r ther PDA/handheld wireless devices prviding mbile, cntinuus access. Web sites set up t cmmunicate with emplyees. Health Prvider Netwrk (HPN)/Health Alert Netwrk (HAN), a Web-based system fr infectius disease reprting and fr syndrmic surveillance r ther centralized infrmatin surces fr health care prviders, by fax, , Web site r htline. Amateur radi and walkie-talkie 5-mile radis/mbile radis. Integrated Services Digital Netwrk (ISDN), a dial-up cnnectin that can be used fr vide cnferencing. Large signs indicating functin (e.g., Pharmacy, Triage) t shw lcatin fr peple needing assistance r bringing in supplies. Cmmunity-wide, centralized patient lcatr systems. 800 MHz radis s respnders can mnitr emergency peratins. Videcnferencing. Develping frums fr tw-way cmmunicatins with the public. Pre-event jint planning, training and practice, nt nly t establish rles, but t create relatinships between stakehlders, respnders, and media t facilitate cmmunicatin during the emergency. Triaging telephne calls. Redundancy in everything frm cable lines t having pagers frm multiple cmpanies. Invlving the news media early and cnsistently in the cmmunicatin prcess. Develping dual uses fr emergency respnse systems s that systems with rare emergency use are exercised thrugh sme alternative, rutine use. This als prtects capacity thrugh bm and bust funding cycles. Pre-event develpment f an infrmatin stckpile in multiple frmats. Repeater may be necessary t cmmunicate ver lng distances.

36 Sectin: 8 Cmmunicatins IT PUBLIC INFORMATION OFFICER Prcedure #: 8.2 Page: 1 f 1 THE PUBLIC INFORMATION 1. Cntrls all utging infrmatin t the OFFICER media. [Name, Usual Jb Title] 2. Arranges press statements fr release t the public/media. 3. Assumes respnsibility fr taking pictures and btaining releases. 4. Ntifies and utilizes the expertise f the designated medical spkespersn fr medical reprts which are t be given t the media. 5. Crdinates infrmatin apprpriate with all external agencies (such as DOH). PUBLICATION RELATIONS CODE INTERNAL The switchbard will cntact the Public Infrmatin Officer by telephne r lng-range pager. 1. The Public Infrmatin Officer will respnd t the cmmand pst t determine the nature f the cde. 2. Determine need fr media area with phnes and fd/cffee. 3. With the Media Relatins Center ready fr peratin, the department will call the cmmand pst fr a preliminary reprt fr release t the press (i.e., the nature f the disaster and initial reprt f the extent f injuries). This initial statement will be released t the media. Names and numbers will be taken and the department will return phne calls after mre infrmatin is btained. 4. Emplyees may nt speak t the media withut the permissin f the Public Infrmatin Officer. 5. If needed, a decisin will be made by the CEO/Incident Cmmander abut whether reprters may be taken t the scene f the disaster r int the Center.

37 Sectin: 9 FACILITY CHECKLIST GENERAL FACILITIES CHECKLIST Prcedure #: 9.1 Page: 1 f 1 POLICY: T ensure that the envirnment and utilities are cntinually assessed fr functinality. PURPOSE: T minimize/prevent any hazard caused by an unsafe envirnment r unsafe equipment. PROCEDURE: Utilize: 1. Hazard surveillance risk assessment Operatinal status reprt.

38 Sectin: 9 FACILITY CHECKLIST MANAGEMENT OF ENVIRONMENT HAZARD SURVEILLANCE RISK ASSESSMENT REPORT FORM Hazard Surveillance Risk Assessment Reprt Frm Prcedure #: 9.2 Page: 1 f 3 Date: Building: Prgram Safety Management Security Management Hazardus Materials and Waste Management Hazard Surveillance / Risk Assessment Item 1. Are grunds clean and free f hazards? 2. Are flrs clean, dry, in gd repair and free f bstructin? 3. Are mechanisms fr access (i.e. ramps, handrails, dr pening mechanisms, etc.) peratinal? 4. Is the parking area free f pthles r ther hazards? SUBTOTALS 1. Are drs functining and lcked as apprpriate? 2. Are medical recrds centrally lcated and accessible ONLY t authrized persnnel? 3. Are alarms functining, tested, and maintained in accrdance with manufacturers specificatins? 4. Are systems/mechanisms in place t quickly ntify fficials r ther staff quickly in the event f a security related prblem? SUBTOTALS 1. Are OSHA Hazard Cmmunicatin and Expsure Cntrl dcuments available? 2. Have all bihazard and txic substances present been identified? 3. Are MSDS sheets quickly available fr all identified txic substances? 4. Are all waste cntaminated with bld/bdy fluid cnsidered and handled as infectius? Cmments PROGRAM TOTAL: PROGRAM TOTAL:

39 Emergency Preparedness Life Safety Management Medical Equipment Management 5. Are sharps cntainers puncture resistant and in accrdance with required safety standards? 6. Are sharps and dispsable syringes placed in apprved sharps cntainers? 7. Are all engineering, persnal prtective equipment and wrkplace cntrls in effect? SUBTOTALS 1. Is there an updated disaster plan in the department? 2. Has a nn-fire related emergency drill been perfrmed in the past six mnths? 3. Is staff aware f at least three different types f ptential nn-fire emergencies and their rle in eliminating r reducing the risk t patients, staff and prperty? 4. Is staff aware f the primary and secndary exits frm the facility? SUBTOTALS 1. Is the evacuatin plan psted and can staff demnstrate knwledge f the plan? 2. Are fire extinguishers lcated in accrdance with NFPA standards? 3. Are fire extinguishers inspected mnthly and dcumented n/near the extinguisher? 4. Are smke/fire alarm systems functining, tested, and maintained in accrdance with manufacturers specificatins? 5. Are exit hallways well lit and bstacle free? 6. Is emergency exit lighting peratinal and tested in accrdance with NFPA standards? 7. Are fire/smke drs perating effectively? 8. N smking plicies are in effect and signs are psted apprpriately? SUBTOTALS 1. Is there a unique inventry f all medical equipment in the facility? 2. Are all equipment evaluated and priritized prir t use? 3. Has all equipment been tested/maintained accrding t manufacturers specificatins? 4. Are maintenance recrds cmplete, are they capable f tracking the maintenance histry f a particular piece f equipment, and d they recrd the results f bth electrical safety as well as calibratin, as apprpriate? 5. Are systems/mechanisms in place t respnd apprpriately t a medical equipment failure? PROGRAM TOTAL: PROGRAM TOTAL: PROGRAM TOTAL:

40 SUBTOTALS PROGRAM TOTAL: Utility Management 1. Are the lights, emergency lights, and pwer plugs peratinal and in wrking rder? 2. Des the water/sewage system appear t be wrking prperly and has the water quality been tested within the past year? 3. Is the telephne system peratinal? 4. Has the HVAC system been inspected in accrdance with manufacturers specificatins and have the filters been checked quarterly? Infectin Cntrl Mnitring Issues Other Key Safety Mnitring Issues SCORING LEGEND: 5. Are fire suppressin (sprinkler) systems checked at least nce a year, r as apprpriate by a qualified individual? 6. Are shut-ffs fr all utility systems clearly marked and accessible fr all staff in the event f an emergency? 7. Are systems/mechanisms in place t respnd in the event f a failure f any utility system? SUBTOTALS 1. Is all staff utilizing Universal Precautins (i.e. utilizing apprpriate PPE, handwashing, etc.) in the perfrmance f their jb duties? 2. Are cleaning slutins secured, mixed, and utilized apprpriately thrughut the facility? 3. Are ptentially infectius patients aggressively identified and prcessed in a manner which wuld minimize the risk f infectin f staff and ther patients? 4. Can staff intelligently describe their rle in infectin cntrl within the rganizatin? SUBTOTALS 1. Are Utility Rms lcked, clean, and clear f debris? 2. Are Strage Rms secure, clean, and free f flammable? 3. Are Emergency Carts present, as apprpriate, fully stcked and checked per schedule? 4. Are all medicatins, including samples, secured and accunted fr by lt number? SUBTOTALS OVERALL ASSESSMENT TOTALS PROGRAM TOTAL: PROGRAM TOTAL: PROGRAM TOTAL: TOTAL 1= Outstanding 2= Gd 3= Satisfactry 4= Marginal 5= Unsatisfactry Inspectin cnducted by: Reprts Nted: Safety Officer Date:

41 Sectin: 10 ANNEX Shelter In Place: GENERAL Prcedure #: 10.0 Page: 1 f POLICY: PURPOSE: The Sheltering Plan shuld describe where the residents r patients will be transprted. The receiving facility shuld be apprpriate fr the level f care required fr the patients r residents being evacuated. It shuld include as an attachment any cntract, memrandum f agreement, r transfer agreement the facility has with a receiving facility. The sheltering plan shuld include: a. Sleeping plan b. Feeding plan c. Medicatin plan d. Accmmdatins fr relcated staff e. Number f relcated patients/residents that can be accmmdated at each receiving facility RESPONSIBILITY: Decisin Making Criteria fr Sheltering in Place: A. Need t utline hw the decisin t shelter in place is derived versus evacuatin Cmmunicatin f Shelter in Place A. This Shelter in Place plan is based n the premise that an event has ccurred, causing the Nursing Hme t be in a Cde mde. If this is nt the situatin, Cde must be initiated prir t evacuatin, t establish the Cmmand Center/CP (Cmmand Pst). B. Ntify 911, ADPH & EMA f Shelter in Place Decisin PROCEDURE: Decisin t Shelter-in-Place versus Evacuatin 1. The staff persn, wh identifies an internal hazard r wh is ntified f an external hazard, is respnsible t ntify the huse supervisr immediately. 2. Shelter-in-place is the preferred ptin, unless the decisin is made by the huse supervisr t evacuate, cnsidering the circumstances f the incident. a. The healthcare facility is t initiate its Emergency Management Plan and perate under the Incident Cmmand System3. b. The healthcare facility Incident Cmmand will assess the need fr the diversin f incming patients. (Hspital) 911 (dispatch) is t be ntified by the Liaisn Officer,if patients are t be diverted. (Healthcare facility) The apprpriate referralfacilities/agencies are t be ntified that

42 admissins are t be canceled. The healthcare facility Liaisn Officer is als t ntify the EOC, if activated. 3. The decisin t shelter-in-place r evacuate is t be made in cnsultatin with the respnse agency Incident Cmmander and als Unified Cmmand, if established, e.g. the lcal Emergency Management Directr, Fire Department, Law Enfrcement, Public Health, EMS, Human Services and thers, as apprpriate. a. If there is n respnse agency Incident Cmmander, healthcare facility Incident Cmmand is t d all that is necessary t prtect the life and safety f its patients, staff and visitrs. Hspital Incident Cmmand is t ntify 911 (dispatch) f its decisin.. b. Prir t the actual need t shelter-in-place r evacuate, the healthcare facility is t cnsult with the lcal Emergency Management Directr, Fire Department, Law Enfrcement, Public Health, EMS, Human Services and thers, as apprpriate s that these agencies are aware f and are in agreement with this plan and its prcedures Nte: A healthcare facility may decide t bth evacuate parts f the facility and als shelter-inplace in anther part f the facility. Part B: Decisin t Shelter-in-Place 1. The healthcare facility Incident Cmmand is t make an assessment whether the healthcare facility faces an internal r external hazard r bth. 2. If the decisin is made t shelter-in-place due t an internal and/r external envirnmental hazard4, the healthcare facility Incident Cmmand will ntify lcal authrities by calling 911 (dispatch), if apprpriate, and will make an assessment fr the need t initiate envirnmental engineering interventins. The primary decisins are: a. The decisins n hw t prtect patients, staff and visitrs by mvement t a mre secure area will be made by healthcare facility Incident Cmmand in cllabratin with the respnse agency Incident Cmmander r Unified Cmmand, as apprpriate. b. The decisins n hw t prtect the building will be made by healthcare facility Incident Cmmand, based n the knwn hazards and their effects n the building and its inhabitants in cllabratin with the respnse agency Incident Cmmander r Unified Cmmand, as apprpriate. 3. The healthcare facility is t initiate a prcess t secure the building (lckdwn). 4. The Staff is t be advised t stay within the building and t advise all patients and visitrs t stay within the building until further ntice. 5. If shelter-in-place is expected t last fr mre than 24 hurs, the healthcare facility Incident Cmmand is t infrm all departments that all resurces are t be cnserved. Fr example: (the fllwing list is nt meant t be inclusive) a. This is the Incident Cmmand System Branch that puts carries ut all activities related t the management f the incident. (Operatins) b. establish a patient management plan, including identifying the current census, the cancellatin f elective admissins and prcedures, etc.; establish a wrkfrce plan, including a plan t address staff needs fr the expected duratin f the shelter-inplace (Planning). c. establish cmmunicatins and a back-up cmmunicatins plan with the lcal Emergency Management, Fire Department, Law Enfrcement,