PLAN: EXTERNAL/INTERNAL DISASTER ESTABLISHED GUIDELINES: An All Hazards procedural process to respond to a Disaster. CODE ANNOUNCED: CODE D ACTIVATOR OF CODE: OBJECTIVE: Emergency Department Attending Physician, Charge Nurse and Administrator (Nurse Supv. if off-hours). Render emergency care to disaster victims. IMPLEMENTATION OF PLAN: A: GENERAL: 1. If code D is due to Nuclear, Biological or Chemical (NBC) contamination, NBC supplemental plan (page 6)is also implemented. 2. Hospital radios switched to Security Channel. 3. In accordance with the Medical Staff Bylaws, in an emergency, any practitioner, including also those not currently appointed to the Medical Staff, may be permitted by the Senior Vice President for Medical Affairs (SRVPMA) or designee, acting as designee for the Chief Executive Officer, to exercise clinical privileges to the extent permitted by his/her license upon presentation of current Georgia licensure. To the extent possible, the Medical Staff Office will confirm licensure prior to granting of such privileges. During a disaster, the CEO, SRVPMA, or designee, may grant disaster privileges to any practitioner not currently appointed to the Medical Staff if the organization is unable to handle the immediate patient needs in accordance with the process and criteria as outlined in the Medical Staff Bylaws. 4. Volunteer practitioners may be permitted to perform their professional duties during a disaster to the extent permitted by his/her license provided: a. The organization is unable to meet immediate patient needs with available regular staff; b. Practitioners are approved for patient care by Hospital Administration at the command center; c. Volunteers provide a current license, certification, or registration and a valid picture identification; d. Volunteer practitioners are properly identified by a temporary identification badge; e. The volunteer is properly supervised while performing professional duties; f. Primary source verification of license is conducted within 72 hours of the practitioner presenting; and g. A decision is made within 72 hours related to the continuation of the disaster responsibilities initially assigned. B: SPECIFIC FOR DEPARTMENTS SWITCHBOARD EMERGENCY DEPARTMENT NURSE SUPERVISOR ADMINISTRATION (BI 2006) 1. Announce Code D x 3, repeating every 15 minutes until all clear. 2. Notify Administrator on Call. 3. Notify the following departments/personnel: Safety Officer Security Public relations. Patient/Family Services Nurse Supervisor 1. Obtain portable radio from ICC 2. Attending Physician and Charge Nurse will make personnel assignments to designated areas. 3. Charge Nurse and Attending 4. Physician will communicate with Nurse Supervisor via portable radio or phone. 5. One Emergency Department Secretary to coordinate activities with Charge Nurse. Nurse Supervisor 1. Proceed to the ICC to pick up radio and communicate with ED attending and Charge Nurse. 2. Establish Command Center in Nursing Administration Conference Room (unless V.P. present). 1. VP or designee will Be Incident Commander. Until Administration Arrives (off-hours), NS will be Incident Commander. 2. Report to Command Center (BI2006). 1
SWITCHBOARD (CONTINUED) Plant Operations Human Resources Psychiatry Set up phones in Command Center, small Auditoria, CMC auditorium, and Personnel Pool Including power fail phones. Set up other Phones as available. PERSONNEL POOL (BI3079 Amphitheatre) 1. Human Resources is in charge of pool and to distribute staff as needed. 2. Obtain portable radio from The ICC 3. Sign-in all staff reporting to personnel pool. 4. Immediately send 10 staff members (blue security vest) to the ED for assignment from Security Supervisor/ 5. Immediately send 6 pool members to stand by in the ED or ACC decon area if Code D- NBC (for runners, etc.) 6. Issue orange vest to each staff member and green to Physicians. 7. Keep in constant contact with ICC and ED Charge Nurse. NURSING DEPARTMENTS (Medical, Surgical & CCU) 1. Charge Nurse to designate staff to go to the Personnel Pool. (At least one Nurse and one Phlebotomy trained Care Assistant preferred.) 2. Staff to remain in Personnel Pool until released by Pool Supervisor. EMERGENCY DEPARTMENT (CONTINUED) 6. Trauma First Responder Cart. (Disaster Cart) available in the Emergency Department will be taken to the incident site, if appropriate and set up a triage site. 7. Existing (prior to disaster) patients in the ED will be moved at the discretion of the ED Attending and/or ED Charge Nurse. PATENT/FAMILY SERVICE (CMC Auditorium Room- Fax 1-5196) 1. Obtain portable radio from the ICC 2. Report to CMC Auditorium Room to set up Family area 3. Assist taking relatives of the victims to the CMC Auditorium Room. 4. Maintain radio communication with the Command Center. 5. Work in conjunction with Dietary to coordinate food, drinks, etc for families of victims and staff. 6. Member of Pastoral Care reports to family area. 7. Member of Social Services reports to family area. 8. Member of Psychiatry reports to family area. OTHER DEPARTMENT CLINICAL 1. Each Director/Department Head for Pulmonary Care, Laboratory, Admitting, Pharmacy, ED registration will deploy staff to all treatment areas. Send all extra staff to personnel pool who will remain until discharged. NURSE SUPERVISOR (CONTINUED) 3. A Nursing Office Secretary will make calls to designated personnel, if on offshift, Nurse Supervisor to assign someone to make calls. SECURITY/SAFETY 1. Will be posted at: Emergency Department Entrance ICC (issue radios and control entry) Ambulance Entrance West Entrance Main Entrance Family Medicine South Entrance CMC Entrance Small Auditoria to assist Public Relations 2. Unlock the Code D cabinet in BI3079 3. Control people flow in Emergency Department area. 4. Member from Campus Public Safety will report to ICC ALL OTHER DEPARTMENTS 1. Send all available staff to Personnel Pool when code D is announced. 2. All staff remains until released by charge person. ADMINISTRATION (BI 2006) (CONT.) 4. Obtain radio from the ICC. 5. Establish communication with Personnel Pool, Media Center, Family Area and Emergency Department. 6. Incident Command will assign a liaison to the ED to facilitate communication. RADIOLOGY (x3746) 1. Obtain portable radio from the ICC 2. X-ray Technician will report to Personnel Pool. Assign 1 Tech to ED. 3. Department will prepare area for receiving victims. 4. Communicate via portable radio with Command Center. 5. Will handle transports to and from Family Medicine (Minimal Care Area). PUBLIC RELATIONS 1. Obtain portable radio from the ICC. 2. Set up area in small Auditoria 3. Communicate with Command Center. 4. Will be the official spokesperson for the Hospital. 5. Work closely with Security to ensure the Media stays in one place. 2
PHYSICIAN/RESIDENT STAFF OPERATING ROOM HUMAN RESOURCES PATIENT ACCESS 1. Surgeons and anesthesiologists, both faculty and 1. Follow Department Plan. 1. Operate/Manage Personnel 1. One Supervisor and two house staff, should assemble in the operating room 2. Coordinate with Command Center. Pool in BI 3079 registrars will report to the area and the respective chiefs of surgery or designee (amphitheatre) Emergency Department. should have a sign in list, adults to the adult 2. Supervisor will report to the ED operating rooms and CMC staff to Children s. Charge Nurse. 2. Intensivists should report to their respective intensive care units. For example in the CMC, the 3. Registrar reports to ICC to assist neonatologists would go to the NICU and the Peds with IDX. Critical Care physicians to the PICU. A similar 4. Pre-assigned registration action should occur on the adult side and the senior intensivists in the units present should develop a packages will be obtained from the Trauma First Responder cart sign-in list so that the command center can be told (Disaster Cart). who is present. 5. Bracelet/tag from the package 3. Faculty physicians who are attending on in-patient will be applied by the registrar units, including house staff, should go immediately on the patient and the package to the in-patient unit to which they are assigned, determine the number of physicians present and be will be tucked under the corner prepared to report to Command Center. of the patient s stretcher (these 4. ED personnel including faculty and house staff packages must remain with should report to the ED and sign in, the number the patient at all times). present should be determined by chief of ED or designee and reported to the Command Center. 5. All other medical personnel should proceed to the 4 th floor amphitheater and sign in. There the Chief of Medicine for the CMC and the Chief of Medicine for the MC should report to the Command Center whom is present and assist in making decisions as to where medical personnel are sent. COMMUNITY AND VOLUNTEER RESOURCES 1. Have volunteers available to Report to the Personnel Pool. Transportation department will report to ED/ACC and facilitate patient transportation. REVISED: July 2008 REVIEWED: 3
COMMAND CENTER BI 2006 (Pathology Conference) External/Internal Disaster/CODE D LOCATIONS AND RESPONSIBILITIES PERSONNEL POOL BI 3079 MEDIA CENTER Small Auditoria FAMILY WAITING AREA CMC Auditorium Main number: 706.721.6200 FAX 706.721.1042 Main number: 706.721.1539 Main number: Main Number: 706.721.1541 Administration: Will either be incident commander or appoint designee. (NS during off-hours until Administrator arrives). Assigns someone to direct Personnel Pool operations. Establish HICS Obtain radio from the ICC Coordinate with all areas Arrange patient transfers if needed. Monitor disaster. Radio Call Sign= Command Center Leader obtains Personnel Pool Instruction booklet from cabinet: Responsibilities: Enlist at least two more staff members to assist leader. Man disaster phone. Sign in all reporting staff (log sheets in book). Issue vest to all reporting staff. Vests: 1. Blue for Security (those assigned to supplement security) sends 10 immediately to ED to get instructions from Security personnel. 2. Green for Doctors only. 3. Orange for all other staff. Send staff as requested from ED and other areas (runners, bring equipment, etc). Obtain radio from the ICC Collect all vests when disaster or drill is over Give sign in sheets to Safety Director along with a brief written critique. Radio Call Sign= Labor Pool Public Relations or designee to staff. Obtain radio from ICC Communicates with ED and Command Center. Sole source of media information. Radio Call Sign= Media Center Family Services staff to direct activities. Obtain radio from the ICC Radio Call Sign= Family Center 4
EXPECTANT CARE AREA MINIMAL TREATMENT AREA DELAYED TREATMENT AREA IMMEDIATE TREATMENT AREA TRIAGE TREATMENT AREA EDOU (Emergency Family Medicine CMC ED General ED ED Staff Department Clinic Observation Unit) ED Staff but may ED Staff Kept in general Family Medicine require ED area. If the EDOU Staff (may Staff augmented augmentation community require addition of 1 by nursing staff from other shower is used or 2 personnel) units nursing units for mass decon that will be a triage area and the secondary triage area would be the ambulance bay. The ambulance bay can be used for primary triage as it currently is for mass casualty. Radio Call Sign= Radio Call Sign= Radio Call Sign= Radio Call Sign= Expectant Minimal Delayed Immediate FACILITIES TRANSPORTATION PASTORAL CARE PSYCHIATRY SOCIAL SERVICES Send one person to Family Medicine to operate/manage elevators. 1. Transport supervisor reports to ICC for vest and then reports to ED (or ACC deck if Code D- NBC) to manage victim movement. 1. Sends one pastor to family area. 1. Sends one therapist to family area. 1. Sends one social worker to family area and others to personnel pool. MORGUE Morgue Refrigerator Vehicles 5
PLAN: EXTERNAL DIASTER NBC Master Disaster Plan Supplement ESTABLISHED GUIDELINES: CODE ANNOUNCED: ACTIVATOR OF CODE: OBJECTIVE: A procedural process to respond to a Disaster involving Nuclear, Biological or Chemical event. Code D- NBC Emergency Department Attending Physician, Charge Nurse and Administrator (NS if off-hours). Render emergency care to a large number of disaster victims IMPLEMENTATION OF PLAN: A. General 1. All entrances will be closed (locked down) to the public/personnel. 2. If Code D is due to Nuclear, Biologic, or Chemical Mass Casualty Incident, the Nurse Supervisor, Emergency Department Attending Physician and the Administrative Director of the Emergency Department will be notified. B. It is the responsibility of the Emergency Department Attending Physician to ensure the safety of all hospital personnel working in the area of the Emergency Department during a NBC Disaster. If the at Attending Physician determines that the situation is unsafe for any person he/she is empowered to make necessary changes in protocol or practice to protect the hospital staff and patients. SWITCHBOARD EMERGENCY DEPARTMENT EMERGENCY DEPARTMENT EMERGENCY DEPARTMENT 1. Announce Code D NBC (3) times and every 15 minutes until informed to discontinue by Nurse Supervisor 2. Complete all duties listed for Code D 3. Notify the of Chief of Medical Staff, Emergency Dept. Director, Medical Director of ED,PICU Attending On Call, Hospitalist On Call. 4. Deliver completed Call/Response List to Command Center. ATTENDING Obtain portable radio from ICC 2. Arrange for immediate consultation with the Nurse Supervisor. 3. Arrange for ASAP telephone consultation with the Administrative Director of the Emergency Dept. and the Chief of the Medical staff. 4. Review the Action Plan for NBC Disasters and discuss the action plan with present members of the medical staff from the Emergency Dept. 5. Direct the Emergency Dept. Charge Nurse to evaluate current staffing, patient census and review the NBC Disaster Plan. SECRETARY 1. Notify the following hospital Personnel of the NBC Disaster Status: O R Supervisor, Charge Nurse for PICU, CICU, NICU, 3 South, 3 East, 3 NE, 2 East, 2 North and 3 North Units, Lab Sup., Pharmacy Sup., Chief Resident. 2. Initiate the Emergency Dept. Medical Staff notification protocol for the notification of ED Attending Physicians and ED Nursing staff. CHARGE NURSE 1. Confirm current staffing with the Emergency Dept. Attending Physician. 2. Confirm current Emergency Dept. patient census. 3. Make personnel assignment to designated areas. 4. Review Action Manual for NBC Disaster management. 5. Discuss staff safety and initial triage consideration with the Emergency Dept. Attending Physician. 6. Rapidly assess the Emergency Dept. staff for unacceptable levels of anxiety/stress and make adjustments in staffing as needed. 6
SECURITY PHYSICAIN/RESIDENT STAFF LABORATORY/PULMONARY FACILITES 1. Assume predetermined posts per Security protocols. 2. If the risk of contamination is determined to exist, all access to the hospital will be stopped with the exception of the Emergency Dept. main entrance. 3. Discuss the possibility of biologic, chemical, or nuclear contamination or casualties with the Emergency Dept Attending Physician and ED Charge nurse. 4. Notify the Director of Security of the NBC Disaster Status. Follow regular Code D reporting assignments 1. One phlebotomist will report to Emergency Dept. for assignment. 2. One Pulmonary technician will report to the Emergency Dept. for assignment. 3. Inventory blood supply and communicate to ICC 1. Set up and Activate decontamination Site in ACC deck 2. Report to Personnel Pool. PHARMACY 1. Pharmacist picks up bio-terrorism drugs and reports to the ED Charge person when NBC is announced. DECONTAMINATION TEAM 1. Report to staging area. 2. Setup all Decon equipment & supplies. 3. Prepare for victims. Revised: July 2008 7
EMERGENCY MANAGEMENT PROGRAM CODE SIGNAL D PATIENT CARE CAPACITY Date: Current Census: Time: Unit: Beds Available: Potential Discharges: NUMBER OF STAFF MEMBERS: 1. Nursing Manager 2. Assistant Nurse Manager 3. Charge Nurse 4. Registered Nurses 5. Licensed Practical Nurses 6. Patient Care Technicians 7. Unit Clerks 8. Desk Operations Specialists 9. Administrative Assistants 10. Environmental Service Technicians 11. Other: SIGNATURE & TITLE OF PERSON PREPARING REPORT: ADDITIONAL COMMENTS: This form is not intended to be a part of the medical record. Rev. 6/08 8