The nation has been in high-alert

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1 Avian Flu: Planning for Pandemic Surge Population By Aruna Vadgama, R.N., MPA, CSP, CPHQ, COHN-S, CPE, SRN The nation has been in high-alert mode for the last several years. As a result, systems for managing safety and security in public places have changed. The goal of instituting the screening system is to prevent outcomes that could impact local and national security and safety. The systems for managing travelers surge are continually reviewed and revised to ensure effectiveness. Likewise, community first responders, in collaboration with hospitals and other healthcare organizations, have been challenged to design systems for managing surge to enhance their capacity or to provide healthcare services. In the planning phase, healthcare organizations have learned that although they may have a surge management plan, they may have to consider contingencies when executing their plan. In recent years, healthcare institutions have had to learn how to treat and manage surge. After the catastrophes of Sept. 11, 2001, and the 2005 hurricane season, the healthcare community quickly mobilized to provide care to thousands of people. In Houston, TX, the sports arena and other public halls were rapidly redesigned to house hurricane victims. Many people forced to take shelter required medical care. Many Houstonians volunteered to provide healthcare in these public places. Additionally, healthcare providers from throughout the U.S. helped manage the surge. Government oversight institutions were criticized for not developing effective rapid response plans for managing surge. OSHA requires employers to develop emergency response plans. In recent years, the Joint Commission has revised the Leadership and the Environment of Care standards that require healthcare organizations accredited by the Joint Commission to develop surge plans. Surge Hospitals Hurricane Katrina flooded many Gulf Coast healthcare facilities and devastated the greater New Orleans healthcare facilities and other buildings in the region. This forced many healthcare organizations to set up temporary facilities called surge hospitals in public buildings such as shuttered retail stores, athletic arenas and veterinary hospitals. These facilities were designed to treat a surge in the number of patients needing contained triage, healthcare treatment and services sometimes even surgical interventions. These temporary facilities were established to serve as a stopgap measure to provide necessary medical care until healthcare facilities could reopen. The severity of damage among the greater New Orleans healthcare facilities raised questions concerning the nation s lack of planning for managing similar emergencies or catastrophes that could result from weapons of mass destruction. Healthcare oversight agencies have developed plans that can be tailored to meet individual healthcare planning needs. The Joint Commission, the U.S. Department of Health and Human Services (DHHS) and some states have provided funding and emergency equipment for planning, building and operating effective surge hospitals. The Agency for Healthcare Research and Quality (AHRQ), a branch of DHHS, has developed guidelines on using closed hospitals to expand surge capacity in an emergency. The agency recommends the following events when surge plan execution is warranted: 1) community mass-casualty events; 2) cases where quarantines must be instituted to guard against transmission of an infectious agent or communicable disease and/or controlling occupational or community exposure to radioactive agents, chemicals or such weapons of mass destruction. Any institution contemplating the use of a closed hospital to expand surge capacity should ideally engage in advance planning to thoroughly assess the facility, although it must be acknowledged that in many cases, the urgency of a situation often calls for swifter action. The best approach might be for an existing hospital or other healthcare organization to acquire the shuttered hospital as a satellite of the medical center so that patient services, such as the pharmacy and laboratory, can be extended to the satellite. Whether the site is a shuttered hospital or a closed hospital ward, the first staff to enter the facility should be an environmental crew which will clean the facility to ensure that the water, air and general environment are sanitary and adequate for their intended use. Effective Elements of the Surge Plan The plan should meet the minimum regulatory requirements of the Joint Commission Infection Control, IC 6.10 and provide a means to expand care capabilities in the event of an increased demand of contaminated or possibly infectious surge patients. Hospital ABC has a plan for managing a large volume of patients who may require healthcare treatment and services due to contamination, weapons of mass destruction or a natural or manmade disaster. This plan should be developed in collaboration with local, state and federal agencies and area and regional healthcare facilities. It should include facility capacity and treatment locations, supplies, equipment, diagnostic testing communication, safety and security, staffing and recovery, disposition and care of the mass catastrophe victims and contaminated or possibly infectious patients. Hospital ABC should use elements of the HICS system to respond to an increase in patient volume, including mass catastrophe victims and contaminated or possibly infectious patients. In the event this plan is executed, Hospital ABC s emergency planning guidelines provide for alternate treatment sites, cancellation of elective procedures, early discharge, emergency credentialing for additional staff and staff and family plans. Each area is addressed under HICS positions listed under the four chiefs-planning, finance, operations and logistics. Universal precautions are used for handling all patients. Disposable PPE kits are stored in the emergency storage locked cabinets. Contact, droplet or airborne precautions are followed when indicated for patients. Increased patient numbers should not negate the use of proper protective gear for staff. Additional or updated safeguards should be developed and implemented based on specific events. Hospital ABC continued on page 4 HealthBeat / 3

2 Pandemic Surge continued from page 3 should be in constant contact with the local emergency planning coordinator. Emergency management for additional information may come from the Centers for Disease Control and Prevention (CDC) or from state and local health departments. 4 / Vol. 6 No. 3 Hospital ABC Surge Plan Hospital ABC is an acute care hospital located in Any Town, USA. The hospital is licensed for 212 beds and has approximately 700 employees, 38 physicians and 110 volunteers. Licensed beds include intensive care unit (ICU), coronary care, medical/surgical, psychiatric rehabilitation service unit, behavioral health, obstetrics and nursery and sub-acute. Other services include basic emergency, social services, nuclear medicine, radiation therapy, speech pathology, outpatient services, respiratory care, physical therapy and occupational therapy and radiology, and gastroenterology laboratory and operating room. There are six operating rooms in the surgery department, one obstetrical surgical room in labor and delivery, and two in the GI lab. The emergency department has 12 designated, monitored beds. ICU has 10 beds. All rooms are single private rooms with monitors. The labor and delivery/obstetrics unit has 13 beds, all private rooms. This area does not share airflow with other parts of the hospital, and it could be designated for nonacute patients who need negativepressure isolation. Medical/surgical has 31 beds and all are monitor-capable. One room is private with 26 beds in shared rooms. The psychiatric rehabilitation service unit has 29 beds (three private rooms, 29 beds in shared rooms). Sub-acute has 29 beds (three private rooms, 26 beds in shared rooms). The psychiatric unit has 26 beds, all in shared rooms. All emergency department nurses are competent in age-appropriate care and are pediatric advanced life support (PALS)- certified. Pediatric patients who require admission are transported to the Children s Hospital. If transport is unavailable, pediatric patients are cared for within the hospital s capacity. Hospital ABC does not have a burn unit. Severely burned patients are stabilized and transferred to university-affiliated hospital burn units. If the transfer is not possible, the patient may be cared for in a single room using protective contact precautions. Hospital ABC is not a designated trauma center. The emergency department routinely handles nondesignated multiple trauma victims and nonpenetrating traumatic full arrests. The local emergency response policy is that designated traumas are transported to the trauma hospital, but the emergency department is aware that when trauma centers are overwhelmed and if they are on diversion trauma, cases may be transported to Hospital ABC. The hospital is not a neurosurgical receiving center but may/may not have a neurosurgeon on staff. Hospital ABC has a large auditorium, and there are two physician-occupied office buildings. When Code Triage Internal or External is announced, the HICS process begins, and the incident commander determines shelter in place. Alternate Treatment Sites Alternate treatment sites depend on the size and nature of the incident and include: emergency department beds; use of 1 to 12 person tents; three 80-person tents; pre- and post-anesthesia care units; GI lab; same-day surgery; and obstetrics. The auditorium will be able to house 30 to 50 cots to manage surge. If necessary, physician office buildings may be used to manage surge. Isolation Rooms The emergency department has one negative-pressure isolation room. Patients suspected of requiring negative-pressure isolation as inpatients are to be transported to a negative-pressure isolation room as soon as possible. In the interim, patients are placed in the two negative airflow emergency department rooms. Hospital ABC s ICU has one negativepressure room. Medical/surgical has ome negative-pressure room. A HEPA filter is available for an additional private room, but it should not be used for longterm occupancy by a patient requiring airborne precautions. If the number of isolation patients continues to increase, the incident commander along with the safety officer and engineering department, will identify the appropriate area to house these patients, taking into account air handling, the number of patients, access and CDC recommendations. Areas that could be used for this are obstetrics and maternity. Increased Isolation Capabilities Hospital ABC adheres to isolation guidelines as listed in the Infection Control Manual but recognizes that additional measures may be needed to accommodate isolation needs for an increased contagious patient population. Infection control is available 24/7 through the PBX operator or via pager. Patients in existing negative-pressure isolation rooms are assessed by infection control or the house supervisor with infection control consultation as necessary. Patients not requiring isolation are transferred to a standard room. All in-patient beds are located in double rooms at SCMC, but the potential for grouping patients with the same organism/diagnosis in one room with the approval of infection control or the infectious disease physician may be obtained during a mass-casualty/pandemic event. Caring for people in their own homes is an important source of surge capacity, and it may be a particularly attractive alternative in the event of a biological attack with an infectious agent. CDC, social services, home health and the Public Health Department can be used for recommendations during a mass-casualty/pandemic event.

3 Individual patient rooms can be converted to negative-pressure rooms by: 1) using a large HEPA filter unit (located in Central Services); 2) connecting the HEPA exhaust tubing out the patient window (window to be replaced with plywood plastic); 3) blocking or HEPA-filtering normal rooms exhaust, which returns air to the hospital circulation; or 4) renting a large construction HEPA filter unit. Rooms should be tested for negative pressure by using smoke or tell-tail (thin strip of paper that shows the direction of air flow) testing. Decontamination Hospital ABC has an outdoor shower and holding tank outside the emergency department at the ambulance receiving area. Hospital ABC has a self-contained decontamination trailer that can be moved to a central location as directed. It can be attached to the trailer hitch on the hospital truck and brought to an appropriate location. Hospital ABC also maintains hoses with connectors for a fire hydrant hookup. Victim Tracking Hospital ABC uses the HICS victim-tracking system, which captures victims names, triage tag numbers, location, admission and discharge that is shared with the command post and local community response team for dissemination to appropriate agencies such as the American Red Cross. Health Insurance Portability and Accountability Act (HIPAA) guidelines are followed to maintain patient privacy. Special Needs Population Hospital ABC recognizes several categories of special-needs victims such as juveniles, the elderly, nonambulatory persons, persons with sensory impairments and persons with language barriers. Translation service is available 24 hours a day through AT&T translation services. CDC bioterrorism information written for children and other groups is available for use at Hospital ABC also has a direct-dial TDD phone number. Critical Infrastructure Hospital ABC recognizes that power, water, electricity, nutritional supplies and information services are integral parts of continuation of care. The hospital developed a 72-hour contingency plan to maintain operations until local, state and federal resources can be accessed. Food: Dietary has a 3-day disaster menu designed for 1,000 people of three meals per day (3,000 meals). The menu requires no equipment other than a can opener for serving. In addition, there are 30 cases of Mainstay MRE-style meals in the disaster trailer. Electricity: Hospital ABC has two diesel-powered generators for the hospital and plant and three gasoline-powered mini Honda generators. The hospital s generators can run for 4 days on a full tank of underground diesel fuel. The hospital maintains a medical office building with Dixie Diesel for additional fuel if necessary during an emergency. Water: The hospital has gallons of water onsite, and 1,500 gallons of water maintained in the disaster supply closet located on the loading dock. Toilets/Sewer: The hospital has a mobile unit with which to provide six portable toilets. In the event they are unavailable, the plan will include bagging toilets. Medical Gas: The hospital has bulk oxygen with a 7-day supply. The hospital has adequate T cylinder supplies of nitrous oxide and nitrogen for 72 hours. Information Services: Information services has an extensive plan of action for a computer outage designed in 1999 for Y2K. (Information services has one computer on red power located in the emergency room only.) Equipment and supplies: Hospital ABC maintains a limited cache of medications and supplies. Disaster Supplies Hospital ABC maintains emergency response supplies in the environmentally controlled disaster trailer, the 40-yard container and the self-contained bioterrorism decontamination trailer. Each department also maintains a departmental disaster kit. Supplies in the containers include tents, cots, first aid, bandaging and suture supplies. Water supplies are maintained in the disaster supply closet located on the loading dock. Food is maintained in the food service department, and a complete list of Definitions Surge capacity is the ability to expand care capabilities in response to a sudden or more prolonged demand. Surge capacity includes all aspects of providing care for patients and employees during this period of increased demand. Planning includes alternate treatment sites, security decontamination facilities, increased isolation, equipment and supplies, including PPE. Hospital incident command systems (HICS) are designed to manage a rapid influx of patients from a variety of causes. Assigned roles, community integration and common nomenclature decrease confusion and facilitate preparedness. All-hazards planning is an integrated planning approach to all emergencies, whether they are accidents, natural disasters or terrorist-related, while sustaining critical hospital operations, protecting staff, restoring needed functions and protecting the environment. food menus is contained in the department s policy and procedure manual. The menu will depend on the disaster. Pharmaceuticals The pharmacy maintains an emergency supply of pharmaceutical supplies on site. Emergency pharmaceutical supplies are intended to initiate treatment or prophylactic average for approximately 24 to 48 hours until county or federal supplies are received. A non-hospital-owned pharmacy is located onsite to lend supplies in the event of a disaster. The county has three MMRS cities and associated caches in Global County. The nearest stockpile is at QQQ Station 6 on Euclid and can be transported to Hospital ABC by trailer as needed. The supply includes antibiotics for 10,0000 biological victims and 1,000 chemical victims. The county EMS has an extensive stockpile of medications and supplies located within the county with its own transportation that will be delivered to Hospital ABC as needed. The cities of Global County are UASI recipients, and related supplies are available to all county cities as needed. Agreements are in place with drug suppliers and with sister and local hospitals to bring additional supplies if needed. National stockpile is available within 12 hours of request for push-packs and 24 hours for tailored vendor-managed inventory. Hospital ABC has a first-responder mass prophylaxis plan that addresses the ability to rapidly prophylaxis hospital personnel, first responders and their immediate families when recommended by local, state or federal authorities. continued on page 6 HealthBeat / 5

4 Pandemic Surge continued from page 5 Recognizing that information sheets will likely be rapidly outdated in an event, CDC information guidelines will be posted for professionals, the general public and children. These information guidelines are available in many languages based on population need. Respiratory Care Services On-duty respiratory care personnel will be contacted to evaluate the following options to obtain additional ventilators: 2 Bennett 7200A Volume Ventilators in house; 2 Bird Mark 7A pressure ventilators; 2 Bird Mark 10 pressure ventilators; 2 Achieve long-term backup ventilators; rental companies for required needs; single-use disposable automatic resuscitator; bag-valve hyperinflation system (manual ventilation/assist); request equipment from sister local hospitals. In the event that a single-use disposable automatic resuscitator is needed, a request for additional equipment will be submitted to the community emergency response center. There are six anesthesia machines available in the surgery department and one located in obstetrics. There are two arterial blood gas machines. The blood gas machines are located in the Respiratory Care Department s pulmonary laboratory respiratory care services and can perform arterial blood gas and hemoglobin. Rental equipment is available from Radiometer. In addition to Hospital ABC staff, available respiratory care staffing agencies are American Mobile Health, Associated Health, DialMEd, Maxim, MSN, Mediscan, NRT, QRS and RCSN and STAT. Cardiology Cardiology has six EKG machines (two in cardiology, one in the emergency department) as well as three cardiac echo machines. Laboratory Testing Hospital ABC s laboratory is located in the main hospital building. The laboratory is rated bio-safety level 2 and is capable 6 / Vol. 6 No. 3 of disease testing. Specimens for certain diseases, such as reportable diseases and other bioterrorism or unusual/unknown samples, are packaged and sent to the appropriate county, state or federal laboratory for processing. Hospital ABC s laboratory complies with all local, state and federal reporting guidelines. A blood drawing station is located in the main hospital. Nursing units have blood glucose meters and blood drawing supplies. Blood for transfusion services is available from the American Red Cross. Communication & Notification External Communication Hospital ABC adheres to Public Health Department mandates with MMR reporting guidelines, which regulate infectious disease reporting. These guidelines are in place on a daily basis and will continue independent of the number of patients involved. ReddiNet is the 900-MHz secure microwave radio and website system that forms a major component of Orange County s emergency management communications system. ReddiNet s real-time data can include hospital diversion, public health alerts and law enforcement updates. Examples are recommendations for PPE, appropriate safety-oriented actions taken by hospital personnel for letter handling and suggested treatment protocols and dosage specifications. ReddiNet is located in the emergency department. Hospital ABC s emergency department and emergency admitting staff monitors ReddiNet 24 hours a day and reports answers to queries for all types of incidents. The county uses ReddiNet to monitor infectious disease outbreaks. In addition to daily ReddiNet use, Hospital ABC participates in the county s quarterly ReddiNet testing for all paramedic-receiving centers to ensure proper use and reporting. ReddiNet is used between hospitals and the county emergency medical services, while HAM radio operators are used among local hospitals and local vendors for medical and pharmaceutical supplies. HAM operators communicate with RACES as the hospital s alternate communication method with law enforcement. Walkie-talkies may be used between the incident command post, emergency department, security, alternate treatment sites and other involved departments depending on the event scenario. Hand-carried messages may be used between hospital departments. In addition, the hospital s intranet may be used to communicate within the hospital and sister hospitals. Overhead voice pages may be used within the hospital. Alphanumeric pagers may be used for the management team. Landline telephones and personal cell phones may be used as well. 800-MHz radios may be used to communicate with police, fire and the county. Hospital ABC is part of the California Alert Network (CAHAN) and receives graded alerts from the state on health information and new or potential threats. The Federal Coordinating Center s (FCC) website aids in communications between NDMS non-federal hospitals, transporting agencies and the FCC. This secure website allows for online bed capacity reporting and patient information, condition and updates. It also assists with the hospital billing process. Internal Communication HICS role is to provide job action sheets that address organized and coordinated internal and external communications. The communications unit leader is directed to establish and record coordinated communication through specific position assignments. Daily methods of internal communication include: pager, fax, ReddiNet, , hospital intranet, walkie-talkies, interoffice mail, landline telephone, cell phone, disaster call tree, overhead paging and some of the nurse call systems. The infection control coordinator has access to CDC, the National Center for Infectious Diseases, Travelers Health, Emerging Infectious Diseases Journal, Morbidity and Mortality Weekly Report, the Infectious Disease Society of America, Association for Professionals in Infection Control and Epidemiology, Infection Control and Hospital Epidemiology, the Journal of the Society for Healthcare Epidemiology of America and Society for Healthcare Epidemiology of America. The hospital receives regular reports from the Orange County Terrorism Early Warning Group (OCTEWG) and participates in OCTEWG s policy development and reporting structure. Hospital ABC meets regularly with

5 city, county, state and federal partners to develop relations and keep current with ongoing and new information. Committee participation includes: Orange County Yellow Net Disaster Group; Orange County Sheriff s Department Terrorism Early Warning Group Hospital Advisory Committee; Orange County Emergency Managers Committee; Regional Paramedic Advisory Committee; County Paramedic Advisory Committee; National Disaster Medical System/ Federal Coordinating Center/Patient Receiving Area Advisory Committee. Employee/Personnel Safety Protection of the Environment Hospital ABC practices daily security procedures, including visitor/vendor restriction procedures, limited access, photo identification and post-security personnel, to provide a more secure daily environment and to lessen the impact when a full emergency lockdown is initiated. The transition to shelter-in-place is greatly reduced, as fewer entries/exits must be secured. The director of plant operations/facilities via the Security Department is responsible for securing the facility and gaining crowd control. HICS command staff use other disciplines within the hospital or community to temporarily staff security positions in an overwhelming event. The local police department is contacted as needed, but Hospital ABC recognizes that local law enforcement may or may not be a viable option due to district population and scene specifics. Personnel/Family Plans Standard precautions are implemented on all patients. Masks and splash shields are considered for any type of event with traumatic injuries and the potential for body fluid exposure. Infection control policies are to be followed in all events. Infection control, through public health and other outside resources, identifies agents in contamination events and identifies the proper level of protective equipment needs. Updates are provided as additional information is received. Hospital ABC refers to the county s mass prophylaxis plans to address local first responders, including hospital staff and their immediate families. Personnel Protection HICS command staff provides for reassignment of personnel in a disaster response. The labor pool, planning and operations chiefs and administrative staff plan, assign and regulate personnel to maximize staff in a disaster. All department managers maintain a disaster call tree. Activation of disaster call-back is at the discretion of the incident commander. Identification of qualifications of required personnel during an emergency. The medical staff office is responsible for contacting physicians if needed during an emergency. Human resources verify provisional credentials of professional staff. The medical staff office, per medical staff policy, grants physicians emergency privileges following the emergency credentialing policy. Employees and their families require provisions and planning to ensure that their needs are met. We encourage employees to bring their families with them in the event of a disaster. Needs include the following: Memo of understanding with hotels/ motels or other appropriate facilities in close proximity to the hospital for staff boarding as needed; dependent care (both child and elder care); telephone access for personal calls; staff and family member mental health services; food, rest and relief. Hospital ABC recognizes that staff debriefing recommendations are currently in flux and will use critical incident stress debriefing as recommended by authorities, including the county EMS and public health offices and CDC. Provisions for staff needs are also addressed in the HICS job action sheets. Additional regional, state and federal mental heath resources can be accessed through the county EMS. An additional source of personnel is the National Disaster Medical System (NDMS). The Office of Homeland Security administers NDMS. NDMS teams include nearly 8,000 volunteer healthcare professionals from around the country who have been organized into general and specialty teams to help local communities respond to a disaster. Expected response is 72 hours from request. Four teams specialize in responding to an incident caused by a chemical or bioterrorism attack. There are also burn teams, mental health teams and disaster mortuary teams that can assist in a masscasualty event. NDMS teams are a federal asset and must be requested by the state. The first step in obtaining assistance from NDMS is to contact county emergency medical services. Local authorities will contact state EMS who will then contact the Federal Emergency Management Agency and Homeland Security. Staffing, Quarantine & Emergency Credentialing Hospital healthcare providers, staff and ancillary employees who are able to work respond to their specific units and handle their staff assignments as designated by their immediate supervisor, who takes general directions from the HICS incident commander. The disaster call-back tree for staff is used only when the incident commander deems appropriate after collaborating with Hospital ABC s infection control practitioner and department chair and the county Public Health Department. Designated isolation areas have specific staff members assigned and tracked for that location. Assigned staff members for isolated patients are designated as appropriate per the infection control practitioner s direction in collaboration with the direct supervisor of the clinical unit. Refer to infection control policies and procedures for use of protective isolation equipment. Recovery Hospital ABC recognizes that recovery starts at the beginning of an incident and has HICS personnel assigned to that function. The following activities should be ongoing: 1) monitoring of mental health care needs in emergency response personnel; 2) monitoring of air quality performed by the South Coast Air Quality Management District; 3) monitoring of soil and water quality is assigned to private vendors post-decontamination procedures at the recommendation of the Laguna Beach Fire Department and the Orange County Fire continued on page 20 HealthBeat / 7

6 Pandemic Surge continued from page 7 Authorities Hazardous Materials Team; 4) vector control is at the discretion of the Orange County Vector Control; Environmental decontamination is assigned to private vendors post-decontamination procedures at the recommendation of the local fire department and the county First Aid s Hazardous Material Team. Continuation of Healthcare for the Community In a massive disaster, many chronically and acutely ill patients could lose access to their physicians or settings where they usually receive care or obtain medications. In the wake of an emergency, hospitals may cancel scheduled surgeries and defer other planned diagnostic, therapeutic and rehabilitative activities. If the need for emergency response is sustained, every option is exercised for the transfer and treatment of patients in various settings and at various levels of care: alternate treatment sites; early discharge; cancellation of elective procedures; transfers; Attention to Fire Alarm Data continued from page 14 annual incidents. It is more difficult to quantify the impact felt or the money saved in fewer interruptions for patients, visitors and staff due to a reduction in fire alarms at Mayo Clinic. NDMS/FCC transport; and supplemental staffing/emergency credentialing. Disposition of Human Remains The mortuary is located in the main hospital on the loading dock. The refrigerator holds up to four bodies on a cart. Extra body bags are available. Hospital ABC has limited morgue space and recognizes that in a large-scale event with mass fatalities, the coroner may be unable to accommodate the high volume of bodies. In the event that a location for bodies is needed, the pathologist will choose sites depending on the number of bodies, the contamination or the infectious disease. Sites also depend on access, environmental temperature and shared airflow. Documentation, chain-ofevidence and information-release policies will be followed. Hospital ABC uses disaster mortuary response teams as needed when federally activated. Conclusion All healthcare professionals are challenged to develop plans for managing emergencies that include dealing with surge population in case of site-specific surge or local or state catastrophic events. The article is designed to help readers design their own surge planning guidelines or policy. Its guidance mirrors a small standalone community hospital surge plan. Readers can tailor plans to meet their organizational and geographic needs. It is essential to collaborate with local, state and federal emergency management agencies. Aruna Vadgama, R.N., M.P.A., CSP, CPHQ, CPE, COHN-S, is Administrator of the Healthcare Practice Specialty. She has more than 17 years experience as a healthcare executive and recently joined the South Coast Medical Center in Laguna Beach, CA, where she will direct the department of quality and risk management services. Conclusion If you are experiencing a frustrating level of fire alarms in your organization, remember that depending on your organization s size, these alarms may not be completely eliminated. However, by keeping accurate records, identifying causes and educating staff and contractors, you can minimize false alarms. The best friend you make in this effort could well be your local fire department. American Society of Safety Engineers Healthcare Practice Specialty 1800 East Oakton Street Des Plaines, Illinois PRESORT STD US POSTAGE PAID PERMIT NO. 401 DES PLAINES, IL Terry Schoonover, CSP, is a safety coordinator at Mayo Clinic in Rochester, MN. He formerly served as the security director and safety officer for Franciscan Skemp Healthcare in La Crosse, WI. Schoonover is a consultant and resource in life safety, fire and emergency preparedness plans and procedures. He holds a bachelor s and master s degree in management, both from the University of St. Thomas. An ASSE member since 1998, he can be reached at schoonover.terry@mayo.edu.