E M E R G E N C Y O P E R A T I O N A L (DI S A S T E R )PLAN ( E O P )

E M E R G E N C Y O P E R A T I O N A L (DI S A S T E R )PLAN ( E O P ) Title: KING SAUD UNIVERSITY HOSPITALS (King Khalid University Hospital and King Abdul Aziz University Hospital ) Committee: EMERGENCY MANAGEMENT Issue Date: MAY 2002 Prepared/Revised by: Date: EMERGENCY OPERATIONAL (DISASTER) PLAN (EOP) Reviewed by: Date: Revision Date MAY 2005 Effective Date MAY 2010 Due for Revision on: Authorized by: Date: Dr. Zohair Ahmed Al Aseri Chairman, Department of Emergency Medicine Co-Chairman Emergency Management Committee Authorized by: Date: Dr. Farheen Shaikh Policy and Procedure Review Committee Authorized by: Date: Dr. Badr Al Jabri KKUH-Medical Director Authorized by: Date: Dr. Abdul Rahman Al Muammar KAUH Medical Director Approved by: Date: Dr. Ayman Abdo Vice Dean for Quality Dr. Abdulaziz Al Saif Vice Dean for Hospitals Chairman of Emergency Management Committee Prof. Mussaad Al Salman Dean College of Medicine and Supervisor for University Hospitals 1

E M E R G E N C Y O P E R A T I O N A L (D I S A S T E R ) P L A N ( E O P ) Table of Content Content Page Purpose 3 Introduction 4 Activation Of Response 5 Command Authority 7 Communication 11 Level Of Activation 14 Emergency Codes 16 External Emergency Plan 17 Utility Failure Code Gray 19 Fire Code Red 22 Alert 4- Evacuation 24 Cardio Pulmonary Resuscitation-Code Blue 28 Disruptive Behavior-Code White 29 Bomb Threat-Code Orange 32 The Emergency Operation Plan Of Safety And Security Department 37 Dem Disaster Response 39 Disaster Plan- Blood Bank 43 Incident Respond Guides (IRG) 44 Bomb Threat 45 Alert 4 Evacuation, Complete Or Partial Facility 49 Fire 53 Hazardous Material Spill (Code Brown) 58 Code Green (DEM Overcrowding) 61 Hostage / Barricade 65 Infant / Child Abduction (Code Pink) 68 Internal Flooding 71 Loss of Heating / Ventilation/ Air Conditioning (HVAC) 75 Loss of Power 79 Loss of Water 83 Severe Weather 87 Appendix 1 Command Center 91 Appendix 2 Emergency Codes 92 Appendix 3 Triage Algorithms 93 Appendix 4 Mettag 95 Appendix 5 Call List 100 Appendix 6 Job Action Sheet (JAS) 111 2

Emergency (Disaster) Operations Plan (EOP): Purpose Hospitals confront a myriad of operational and fiscal challenges on a daily basis. To effectively manage emergencies, whether external (e.g., fires, sever weather) or internal (e.g., child abductions, utility failure), KKUH must invest the time and necessary funds to ensure adequate preparations are in place. Hospital Emergency Incident Command System (HEICS) and Emergency (Disaster) Operations Plan (EOP) serve as an important emergency management foundation for this institute. We recognized the value and importance of using an incident management system, not only in emergency situations but also in daily operations, preplanned events, and nonemergent situations. We believe this Emergency (Disaster) Operations Plan (EOP) and the accompanying materials can play a major role in advancing KKUH preparedness while providing needed local, state, and national standardization of hospital emergency response and recovery. We believe the new Hospital Incident Command System has built upon the benefits and successes of the original Disaster Plan and provides our hospital with tools needed to advance their emergency preparedness and response capability both individually and as a member of the broader response community. This Emergency (Disaster) Operations Plan (EOP) is intended to explain in a clear and concise manner the critical components of the Hospital Incident Command System (HICS) as well as the suggested manner for using the accompanying materials. The primary beneficiaries of HICS will be physicians, nurses, hospital administrators, department chairman, and other personnel in hospitals who will assume command roles during an incident. Students preparing for a career in medicine, nursing, and hospital administration, whose education should include understanding hospital emergency preparedness principles and practices, will also find the material useful. The reader should find the short-paragraph and bulleted-information format helpful in quickly understanding and applying vitally important tenets of response planning, incident command, and effective response. A copy of the KKUH Emergency Plan shall be available within each unit/department for all staff to read. It is the responsibility of Chairmen/units heads to ensure that all staff being oriented and assure continuous training for all staff toward emergency preparedness plan. Since all staff employed by KKUH involved with patient care should be trained in techniques for the safe evacuation of patients from their area. A list of code red associate (wardens) and emergency floor plans should be centered prominently in all work areas. Evacuation blanket/sheet should be available in all clinical areas. 3

INTRODUCTION There are two types of emergencies that may impact on this hospital Internal and External Emergencies. Internal Emergencies involve only the hospital and its capabilities that may be reduced. External Emergencies will usually be sited outside the hospital and the hospital s capabilities may remain intact. INTERNAL EMERGENCIES Internal emergencies are any incidents which threaten the safety of the physical structure of the hospital, staff, patients and visitors and which may also reduce the capacity of the hospital to function normally. In most cases, staff in departments and units will be responsible for their own initial response. EXTERNAL EMERGENCIES KKUH will resume Incident Command for all emergencies within King Saud University. KKUH will participate with other facility in order to provide emergency medical care during emergencies outside the University Medical City. External emergencies are managed as a part of an overall plan. HOSPITAL EMERGENCY STATUS Whenever the internal or external emergency plan is activated, the hospital will be considered to be in EMERGENCY STATUS with specific command responsibilities to facilitate resource allocation. 4

ACTIVATION OF RESPONSE KSUHS response to an incident begins with recognition that an untoward incident could happen (advance warning) or has happened (post-incident warning) that may disrupt normal business operations. Advance warning information may come from several sources. The Chairman of DEM or the Consultant on duty must be contacted during the initial emergency notification call. If possible, the call reporting the emergency should be transferred through to the Consultant in DEM, so he/she is able to obtain a full appreciation of the situation. If the call cannot be transferred through, the Telecommunications Operator must ascertain all related details regarding the emergency, and those details should be relayed to the Chairman of DEM or the Consultant on duty. Chairman of DEM or the Consultant on duty shall advise the Telecommunications Operator of one of the four principle responses: Alert 0 - NO RESPONSE Do nothing further at this time. Alert 1 -STANDBY STATUS A warning notice, and the incident command group should be contacted and advised of the emergency, and a brief report of the situation provided; or Alert 2 - EMERGENCY STATUS Activate The Partial call-in list contacted, according to Incident Commander. all parties advised of the emergency, given a brief report of the situation and directed to initiate their response immediately. Alert 3- EMERGENCY STATUS Activate The full call-in list contacted, all parties advised of the emergency, given a brief report of the situation and directed to initiate their response immediately. Alert 4- EVACUATION Activate the total evacuation process. Important information to obtain as soon as possible should include but not be limited to: Type of incident, including specific hazard/agent, if known Location of incident Number and types of injuries Special actions being taken (e.g., decontamination, transporting persons on buses) Estimated time of arrival of first-arriving red crescent units 5

Initiation of Disaster Notification All key personnel on the Initial Disaster Notification (Appedinx1) will be notified accordingly during initial disaster notification, those personnel and the disaster code number-8888-should notify the appropriate personnel under their command of the alert status for the response (appendix 5). All subsequent staff will be called in by using a cascade system, where the primary contacts call in other personnel as required. Telecommunication Operators shall obtain from the Incident Command Centre: Instructions for dealing with inquiries from: o Emergency response services o Other Hospitals o Relatives, etc., inquiring about persons involved in the emergency incident Offers from volunteers Name of PIO from the Dean Office to whom all media enquiries should be directed. The primary communications will be through the switchboard. The Emergency number will be according to Emergency Codes System (appendix2) REMEMBER Communication capacity will be severely taxed during the emergency, so restrict calls to critical matters do not phone for an update. SWITCHBOARD Emergency hot line is 953 The Telecommunications Operator will be crucial in assisting with the appropriate response to any emergency. Notification of the emergency, and its status, may be received first by either the Department of Emergency Medicine (DEM) or the Telecommunications Operator. 6

Command Authority GENERAL DEM (Team Leader) and/or the ADON-DEM (after working hours the Nursing Supervisor) will have the authority to activate the disaster plan and initiate the disaster notification. They will immediately consult with the DEM Chairman/designee. The Incident Commander will have the authority to move to any alert phases according to the level of emergency. In a sudden rush of casualties to DEM before the arrival of the Incident commander, the Emergency Team Leader will have the authority to activate the disaster response. During Disaster announcement every member of the KKUH staff shall follow the job action Sheet (JAS) assigned to his/her. (Appendix 6) If an emergency requires a response from Civil Defense, Police, Fire or other professional response agencies, they will assume command to the service the render and will liaise with the Hospital Command Centre to forward information and the use of hospital resources when required. COMMAND CENTREE LOCATION: 0 LEVEL, Conference Room DEM For major emergencies, the Command Centre will be established in the College Board Room, this room contains: o Telephone services on dedicated outside lines to facilitate communication in the event of hospital communications failure or overload. o Internal telephones o A complete set of Emergency Plans and associated documentations o Site Maps and Whiteboard o A Fax Machine o A rotated stock of torches, stationery and materials appropriate to the need o An AM/FM band radio battery operated The COMMAND CENTREE will operate upon the announcement of alert 1,2 or 3. by Command Member In the event the Incident Command Centre in DEM conference room, level 0 cannot be utilized the Incident Command Centre will be established in the College Board Room. PERSONNEL COMMAND CENTREE For the purpose of all Emergency Plans in this document, the following defines the Hospital Emergency Incident Command System (Appendix 1) that will decide on the management of the emergency and the activation of resources. The Incident Commander will be in charge of the total response and the other members of the team will coordinate with him. For each designated role in the plan, the responsible officer will be the most senior officer from each group on site and available at the time. INCIDENT COMMAND TEAM Incident Commander (Chairman-DEM) Members Liaison Officer (Medical Director) PIO Dean Office IT Branch Director Medical/Technical Specialist(s) Safety & Security Director Exec. Director of Services Medical Director Director of Nursing Exec. Dir. Of Patient Affairs 7

DUTIES COMMAND TEAM When informed of an incident by the Incident Commander/ DEM Consultant/ Telecommunications Operator, find out the: Nature of incident Time and place By whom reported Move to the Command Centre and initiate action to control initial minor problems. Liaise with the Director, Safety and Security Services Department, and Manager, Security Services in the area (using Safety and Security Services radio if necessary) to establish if the incident is under control or if additional staff is required. Ensure the appropriate response for the type of incident that is being followed: Establish communications with the Civil Defense, KSU Fire Services - 955-and/or Police as required Obtain additional staff resources as required and oversee any evacuation deemed necessary. Determine if the incident will be brought under control quickly or is likely to escalate to a larger incident. If the incident is being effectively managed and likely to be brought to a prompt conclusion, ensure all patients are safely accommodated, evaluate the final impact of the incident and advise respective senior staff of the events. Where the incident is escalating or is likely to be protracted, the Command Team should ensure that all designated personnel are on site. INCIDENT COMMAND TEAM Incident Commander (Chairman-DEM) Members Liaison Officer (Medical Director) PIO Dean Office IT Branch Director Medical/Technical Specialist(s) Safety & Security Director Exec. Director of Services Medical Director Director of Nursing Exec. Dir. Of Patient Affairs 8

DUTIES OF INCIDENT COMMANDER (Chairman, DEM) 1. Initiate the activation phase 2. Supervision of the whole plan 3. Modification of the plan steps as necessary 4. Notify and mobilize additional support as necessary 5. Call more senior staff and officials as necessary 6. Communication with the disaster site 7. Formation and direction of medical teams to go to the scene 8. Coordination of disaster plan with outside agencies as appropriate a. Police b. Red Crescent c. Civil Defense d. Other Hospitals 9. Communication and coordination with all clinical and non-clinical departments 10. Make announcements as necessary 11. Terminate the disaster DUTIES OF THE MEDICAL DIRECTOR 1. Supervise the clinical care in all areas of the hospital including Department of Emergency Medicine 2. Make sure the plan is being carried out in the right manner 3. Call up the necessary medical specialists as needed 4. Assist in the areas where help is required 5. Monitor the number of patients admitted and their distribution in the surgical/ medical/ pediatric wards. These details are available from the disaster patient tracking form. 6. Allocate a clinician to reassess all patients for possible discharge to improve patient bed availability. 9

DUTIES OF THE EXECUTIVE DIRECTOR of SERVICES 1. Initiate the call in of his Associate directors and their teams 2. Liaise with the Associate Director, Support Services to ensure disaster plan and job action sheets are being carried out. DUTIES OF THE EXECUTIVE DIRECTOR of PATIENT AFFAIRES 1. Initiate the call in of his Associate directors and their teams 2. Liaise with the Associate Director, Patient Relations to ensure disaster plan and job action sheets are being carried out 3. Liaise with the Executive Director for Support Services to ensure disaster plan and job action sheets are being carried out 4. Allocate the Public Relations Officers to the DEM AOD 5. Allocate Patient Relations Officers to arrange together with security supervisor to keep property of injured patients safe DUTIES OF DIRECTOR OF NURSING 1. Initiate the call in of the relevant nursing departments 2. Direct Associate Directors of Nursing to commence their job action sheets 3. Allocate a Nursing Supervisor to the Physiotherapy department to control and delegate call in nursing staff. (nursing staff pool) 4. Initiate the commencement of the patient discharge area 5. Monitor that the disaster plan is being carried out in the right manner 7. Enhance nurse s assistance in discharging patient that clinically discharged to improve patient bed availability. 11

COMMUNICATION COMMAND CENTREE RADIO PROCEDURES Call 953. The relevant code name of the disaster response must be used at all times (e.g. Code Orange) DIRECT TELEPHONE NUMBER 1) 467 1362 2) 467 1372 3)469 761 4)469 1763 Fax 469 1764 COMMUNICATIONS ALTERNATIVE In the event that a malfunction of the switchboard occurs as a result of the emergency, a number of available alternative systems such as direct external telephones in Executive Offices, mobile telephones and two-way radio systems are available. CANCELLATION OF CODE After consultation with appropriate emergency services, the Incident Commander shall indicate ALL CLEAR and advise of subsequent action. It is important to observe that ALL CLEAR is given and followed by the emergency code corresponding to the emergency to which it relates. For example, where emergency color codes are used, in a fire Code Red. If the fire is extinguished prior to completion of evacuation then ALL CLEAR Code Red is given. DEBRIEF At the conclusion of the activity, a formal debrief and counseling sessions should be made available for all staff. The Head of Psychiatric Services will coordinate this after the emergency is over. WORKPLACE HEALTH AND SAFETY REQUIREMENTS If during the course of an Internal or External Emergency, either of the following occurs: o o SERIOUS BODILY INJURY: an injury that causes death or impairs a person to such an extent that as a consequence of the injury, the person becomes an overnight or longer stay patient in a hospital. DANGEROUS EVENT: an event at a workplace involving imminent risk of explosion, fire or serious bodily injury. The Safety and Security Services Department is to be immediately notified by pager through the switchboard. Before an area is re-entered, following an evacuation due to smoke or a fire, the Safety and Security Services Department is to be notified by pager through the switchboard to enable atmospheric monitoring to be conducted. 11

COMMUNICATION Role of the Department of Emergency Medicine 1. The Deputy Chairman of Emergency Medicine is to assume control of the Department of Emergency Medicine (DEM) if the chairman is not available ROLE: Direct the clearing of patients in the department Prepare for the reception of casualties into the department i. Communicate with Incident Command Centre ii. Organize site medical teams, equipment as required. Safety and Security Services staff will control access to the Department of Emergency Medicine. 2. Patients will be directed to an appropriate area on arrival by the Triage Officer (Emergency Department Team Leader). All patients will be identified, recorded and issued a disaster chart number. A Mettag (Appendix 4) will be attached to the patient if not already present. The number on the Mettag should be recorded with the disaster chart number on the patient tracking form. 3. The distribution of casualties within the emergency department will be according to their triage acuity (Appendix 3). All adult, ambulatory patients with minor injuries will be directed to Urgent Care Unit. All pediatric, ambulatory patients with minor injuries will be directed to the Pediatric Emergency Unit. 4. Following initial assessment and treatment, patients are transferred to appropriate areas of the hospital Wards. 5. For critically ill patients requiring intensive care: Surgical Intensive Care Unit (SICU) Medical Intensive Care Unit (MICU) Pediatric Intensive Care Unit (PICU) Coronary Care Unit (CCU) High dependency unit (HDU) beds to be converted to Intensive Care Unit (ICU) beds Ward 21B 4 beds Ward 25A 3 beds These beds will accommodate chronic patients in the related intensive care units so that the patients from the emergency department will be transferred to the appropriate ICU. The beds in ICU will be vacated by transferring patients to the HDU beds. If there are any patients in the HDU, they will be transferred to their corresponding ward. The HDU will serve as backup for any patients from ICU requiring minimal care. All ICU s should have designated chronically ill patients requiring minimal care who can be transferred to HDU as required. Heads of clinical areas should arrange to discharge patients from the wards. The discharged patients will be directed to Ward 35A. In this area, the discharge medications, clinic appointments and patient transport will be dealt with. A Patient Relations Officer will be placed here to assist with contacting patient s relatives if necessary. Discharged patients will use the elevator near ward 35A as their exit out of the hospital. 6. Evacuation of casualties by helicopter 12

The number of casualties to be evacuated by air from a major incident/ disaster should be established as soon as possible. Arrangements should be made to send KKUH ambulances to the university helipad. A staging point with medical/nursing support to be established adjacent to the heliport when resources permit. NOTE: If casualties are being transported in large numbers by helicopter, consideration should be given to request the assistance of the Red Crescent to transport casualties to KKUH Department of Emergency Medicine. 13

LEVEL OF ACTIVATION STANDY Alert1 When the decision is made to move to Standby Status pending possible activation of the External Medical Emergency Plan, the Emergency Department Consultant/Team Leader, will ensure that the following senior personnel are notified. Emergency Department Standby Hospital Standby Chairman Department of Emergency Medicine Emergency Department Consultant On-call Associate Director of Nursing, DEM Head Nurse, Emergency (Adult& Pediatric) ACTIVATION Alert 2, 3 1. When the decision to activate the external emergency plan has been made, the above senior personnel must be asked to come immediately to the Incident Command, Department of Emergency Medicine for briefing and to collect their job action sheets. They then have the responsibility of notifying and mobilizing the other key response personnel. 2. The Consultants on-call of Surgery, Medicine, Anesthesia and Orthopedics should report initially to the Chairman of Emergency Medicine or his designee for a briefing on the disaster. 3. The Trauma Team should initially report to the doctor s room in DEM for an initial briefing before entering the clinical area. 4. Security officers are responsible for immediately securing the entrances and perimeters of the emergency department (map 1) and for organizing the flow of ambulances to the emergency department triage area. 5. In the emergency department, patients waiting for admission or who are likely to require admission are to be sent directly to an allocated ward. Those patients who can be discharged should be discharged from the emergency department. Those patients with minor complaints should be asked to go to another hospital 6. Patients from KKUH wards will be transferred to KAUH, as a back-up in case more beds are needed than can be made available at KKUH. Patients with minor injuries may also be referred to KAUH if the need arises. The Deputy Director of Nursing (KKUH) can be contacted on 467-1620/1621, bleep 0059 or 1798 and the Director of Nursing (KAUH) on 477-5733, bleep 0879 for this arrangement to be initiated (agreement Plan in process with king Fahad Medical City) in order to reduce patient travel distance. 7. When necessary back up ambulances from KAUH can be utilized throe the Head Paramedic/designee. KKUH ambulance will be the person responsible for contacting KAUH on 478 6100 if the need arises. 8. All personnel who are called in to report for duty must have their hospital ID visible to be given entry to the hospital by the security officers. All staff should enter thorough the main entrance at the front of the hospital. 9. All DEM staff who are called in are to assemble in the Ortho Clinic to await further instructions and allocation of their duties. 10. All medical and nursing staff from other areas who have been called in should report to the Ortho Clinic to await further allocation of their duties. 14

11. Staff called in for other departments of the hospital should report to their designated areas 12. An information center staffed by Public Relations Officers will be established in the orthopedic female waiting room. Media representatives e.g. reporters, TV crews will not be permitted into any area on O Level. Security officers should direct all such representatives to the Dean Office, College of Medicine on the first floor. 13. Security should direct any people who come to volunteer either medical students or those wishing to give blood to the student cafeteria area. A Patient Relations Officer should be stationed there to assist as needed. NO STAFF OTHER THAN THOSE ISSUED WITH DISASTER PASSES ARE PERMITTED ACCESS TO THE DEPARTMENT EMERGENCY MEDICICNE. The underlying principle is early mobilization of key personnel in control of departments who will play a pivotal role in the hospital response. These key personnel are then responsible for contacting and mobilizing staff required for their own internal response as decided by each department. Each department has the responsibility to ensure that all their employees are familiar with the Hospital as well as the department disaster plan 15

EMERGENCY CODES Identification: To facilitate identification of and communication about the various types of emergency, particularly when using open communication such as a public address system and two-way radios, the following color codes have been developed. The Color Codes are based on a Standard for an Emergency Response for Health Care Facilities: Blue Yellow Brown Orange White Green Black Pink Gray Medical Emergency Missing Patient Toxic or Radiological Leak Bomb Threat Disruptive Behavior ED Overcrowding External Disaster Infant/Child Abduction Utility Failure 16

EXTERNAL EMERGENCY PLAN EXTERNAL DISASTER - CODE BLACK DEFINITION: An incident occurring outside the hospital, which causes casualties in such numbers and severity that would overwhelm the capabilities of existing clinical services. At KKUH, ten (10) or more injured casualties with potentially serious injuries constitute a DISASTER. A MAJOR INCIDENT will be activated if there are five (5) or more seriously injured casualties. CATEGORIES OF CASUALTY SEVERITY Explanation: The aim of the KKUH external emergency plan (Code Black) is to coordinate the hospital services to receive and optimally manage any influx of patients of such numbers that would otherwise overwhelm the capabilities of existing services. The external emergency plan for KKUH is activated in response to incidents, which temporarily increases the demands on the hospital emergency patient handling capacity above the normal level, and/or requires on-site clinical teams to undertake assessments and assign priorities to the treatment and evacuation of the victims. This plan seeks to ready the hospital to receive patients within 30 minutes of notification of an external disaster. PRINCIPLES The following principles are based on three (3) phases: Acts to dispatch teams to the pre-hospital site Acts to sort the Emergency Department resources Acts to sort the hospital resources The principles underlying this plan are: Immediate assessment of likely demands on current services and activation when a potentially overwhelming demand is confirmed. Central command and coordination of the hospital response, with best possible communication to the incident site, other emergency response agencies, and other responding health care facilities Managing the response within normal operational protocols wherever possible, and only implementing special procedures where the demand is excessive. Activation of key hospital personnel, who will use their professional skill and expertise to provide an appropriate response guided by Job Action sheets which provide prompts/reminders for necessary activities that differ from normal daily practice. Progressive build up of response (Key staff activate additional staff as required) to match the demand arising from the incident. Careful management of the response to ensure that the operation of the hospital addresses the continuing demands of existing patients as well as incident victims, both in the short and long term. Accurate documentation of treatment as well as casualty movements. 17

Progressive integration of incident victims into the mainstream of hospital routine, although in the first few days there may be a need to allocate an appropriately staffed separate ward to cope with the numbers involved. Addressing not only the physical but also the psychological and emotional needs of victims and their families, as well as those of KKUH staff participating in the response. Detailed debriefing and assessment after the event to review the effectiveness of the response and to identify where improvement is required to better future responses. Ongoing training and periodic drills for key hospital staff to ensure an effective and appropriate response when the plan is activated. NOTIFICATION Notification is most likely to come from Red Crescent, Civil Defense or Police via a call to the Department of Emergency Medicine. The person receiving the call notifying an external disaster should record the following information: Time of notification Who is calling and their contact telephone number Description of disaster Location of disaster Number and type of persons injured and severity of injuries Any other information available The person taking the call must immediately notify the Consultant on duty in the Emergency Department, who will then notify those who have authority to activate the External Medical Emergency Plan (Code Black). AUTHORITY TO ACTIVATE The decision to move to Standby Status and/or activate the External Emergency Plan will be made by the Incident Commander. 18

UTILITY FAILURE CODE GRAY Dial 953, state Code Gray, the location and the nature of the emergency If necessary, move people to a safe area Follow the instructions of the Senior Safety & Security Officer or authorized person in charge Prepare to evacuate if instructed by the Senior Safety & Security Officer or authorized person in charge. EXPLANATION Internal Emergencies are any incidents that threaten the safety of the physical structure of the hospital, staff, patients, and visitors and which may also reduce the capacity of the hospital to function normally. Such incidents include: Explosion Natural Disaster (Earthquakes) Engineering failures (burst water mains, loss of electricity, gas leak, etc.) Impacts on buildings or grounds (aircraft, etc.) Incidents in the immediate surrounds of the hospital (Chemical spills with noxious vapors affecting people) The Internal Emergencies that are most likely to occur in the hospital will be of short duration and low intensity. Staff in the affected area, will manage such emergencies with provision for coordination by the most senior medical, nursing, and security staff actually on site at the time of the incident. These staff will constitute the Command Group. However, some emergencies will increase to a serious nature, and others will have a long time frame. In these situations, an Incident Command, staffed by senior hospital personnel, will be established to manage the hospital activities and liaise with external Emergency Services. These incidents will require the systematic evacuation of patients and others from all or part of the hospital. To address these needs, the plan has specific instructions for each incident category and the systematic evacuation of the building. When any of these incidents happen, the hospital is in EMERGENCY STATUS, and this affects allocation of personnel, command responsibilities, etc. PRINCIPLES OF EMERGENCY RESPONSE The basic principles of managing the response to an internal emergency are: Removal of people from danger as quickly as possible. Prevent other people unknowingly coming into a danger area Minimize the damage to the physical structure of the hospital Maintain the hospital function and re-establish services There are specific sections of this plan addressing major emergency categories. All staff must be familiar with the appropriate initial action for each emergency. It is important that there are effective management processes that can be implemented rapidly and that personnel and facility risks/danger are minimized. STAFF OBLIGATIONS INTERNAL EMERGENCY During the initial phase of an emergency, all staff will be under the direction of the Director, Safety and Security Services and the Senior Staff Member on duty in the affected area. If necessary, the Command Team will be formed and assume responsibility for managing the response. In major incidents an Incident Command Team will be established and these personnel assume control. In the event of a major internal emergency, where there has been significant damage to hospital property and casualties among patients and staff, there will be a reverse flow of patients. This means the casualties (staff, patients) will be taken 19

from wards to the Department of Emergency Medicine for treatment and transferred to another health facility for care. The underlying principle of the plan is that as far as possible staff will be doing their normal job. However, all staff may be required to assist in activities not normally part of their duties. While the EMERGENCY STATUS exists for the hospital, staff will be expected to undertake any allocated tasks for which they are physically capable position descriptions and duty statements are suspended for the duration of the emergency. Staff off-duty should not come to the hospital until the starting time of their normal shift and they should not telephone the hospital as this places a higher demand on the telephone services. In situations where off duty staff are called to assist in making the hospital safe or to evacuate patients, all staff are expected to return promptly to duty if called. It is the responsibility of managers/supervisors to ensure: That up-to-date call in lists are maintained That the Switchboard is informed of changes as necessary It is the responsibility of employees to: Be aware that their names are on the call in lists Be aware of their obligations if called Regularly exercise their roles in such emergencies Know where to report to in evacuation. There is an obligation for all off duty staff to return to duty when requested in an emergency and to assist as required by the Incident Command Team. Staff returning to duty must ensure them WEAR THEIR HOSPITAL STAFF ID BADGE, so they will have their usual freedom of movement around the hospital. COMMUNICATION In the normal course of events the hospital telephone system will be used, but there are back-up systems in the form of Safety and Security two-way radios and hand carried messages TRAFFIC CONTROL / PARKING Pedestrian Non-Evacuation Traffic Safety and Security Services staff shall ensure that all non-essential people do not enter the hospital grounds. If the emergency is major, Police should assist in the control of people traffic. Vehicular Traffic While the hospital is in Emergency Status, only emergency response vehicles will gain access to KKUH. Media vehicles will not gain access. All vehicles on site and not involved in the emergency but which may interfere with the management of the emergency, must be removed by their owners. If this cannot be managed, then, on the authority of the Command Team, a towing contractor can be called to remove the vehicles. Illegal Occupancy KKUH may become a target for illegal intruders. In the event of the above incident occurring the Senior Safety and Security Officer on duty will: Notify the Police and request assistance Ensure appropriate Emergency Services have been alerted. Notify the Director, Safety & Security Services Department. 21

Initiate action to restrict: a. Entrance to the building b. Illegal occupants gaining entry, and c. Contact between the illegal occupants and the hospital occupants. For the duration of the incident, the Senior Security Officer will utilize all available officers to assist with the control of pedestrians / traffic and to liaise with the relevant Emergency Services. 21

ACTION ON DISCOVERY OF FIRE FIRE - CODE RED DO NOT PANIC as panic may cause more serious injuries than that caused by the fire. Alert staff near to the fire to remove patients from the immediate area. REMOVE or RESCUE people from the immediate area. ALERT others of the presence of the fire by: o Verbally telling others in the immediate area o Activating the nearest break glass alarm (manual call point) o Contacting the emergency operator on extension 953 on any internal telephone. State your name and the exact location and the nature of the fire. CONFINE by closing doors and windows. This will provide occupants with additional time to evacuate EXTINGUISH the fire if: o It is safe to do so o You have someone with you o You have previously used a Fire Extinguisher TURN OFF ALL SERVICES Any decision to withdraw patient life support systems for the duration of the evacuation rests with the Medical Director. The decision to turn off the main oxygen supply to a building would be made by the Chief Fire Officer in conjunction with the Chief of Staff / Vice Dean. Lifts are not to be used in a fire emergency unless authorized by a Fire Officer. Save records (without personal risk) The procedures and equipment discussed below relate to the initial response to the fire emergency. Standard procedures will normally have a Safety and Security Officer at the site of a fire alarm in 2 minutes. The Civil Defense can be expected on site within 15 minutes. REPORTING A FIRE Remove all people from immediate danger Investigate any trace of smoke or burning smell Contact Safety and Security Services when the source of the smoke or smell cannot be identified. Dial 953 Tell your name and classification (e.g. Staff Nurse) Location of the fire, what is burning and if patients are being evacuated Activate any manual alarms in the vicinity use a hard object to break glass alarms. Do not shout or panic, this may cause confusion Where possible isolate any oxygen outlets by closing the shut off valve Remove oxygen cylinders from the area COMMAND RESPONSIBILITY For the initial response to a fire emergency, the senior staff member present is in command. If your position takes you to a number of wards and units each day, you do not have to know each area s fire plan, but you should understand the basic principles and be prepared to work under the direction of a fire marshal or the senior nursing staff member present at the time of the initial response. You may be asked to guide ambulant (walking) patients from the ward, allowing nursing staff to deal with non-ambulant (bedridden) patients. FIRE FIGHTING EQUIPMENT 22

Know the location and use of the fire fighting equipment in your area. All areas of the hospital have fire hoses and portable fire extinguishers. The location of the fire fighting equipment is shown on the evacuation plan displayed in your area. Use of the wrong fire extinguishers can make the situation worse. Water based equipment used on fires involving energized electrical equipment can result in electrocution. Furthermore, water from a hose or extinguisher applied to burning flammable liquids will spread the fire. FIRE EXTINGUISHERS Fire extinguishers are mounted on brackets either on the wall or in fire hose cupboards depending upon the hospital location. Make certain that you are familiar with the action required. Know how to activate the fire extinguishers in your area. Free the fire extinguisher from the bracket Balance the weight of the fire extinguisher Release the safety pin Squeeze the trigger or lever. Hold and direct the hose if necessary FIRE HOSES Located throughout the building are hose reels, which are similar to large garden hoses. DO NOT USE fire hoses if: Live electrical circuits are in area of the fire Flammable liquids are the source of the fire Procedure for using Fire Hoses Turn on the hose at the valve attached directly to the hose reel (in some cases this also releases the hose from a clamp). The hose is still turned off at the nozzle. Drag the hose to the scene of the fire Turn the nozzle in the direction as indicated on the nozzle. Play the stream of water on the fire. If hose nozzles are fitted with an upright lever, pull or push the lever to activate the hose. Following the completion of the fire emergency, the message CODE RED, ALL CLEAR will be given by the incident commander. Evacuation If evacuation from the area or building is required see CODE ALERT 4 23

Alert 4 - EVACUATION Do not panic or shout as this may cause panic in others. An orderly response will save more people. Under no circumstances should lifts be used in a fire related evacuation unless directed by the Fire authorities. Remove people from the immediate danger area e.g. a room containing the fire or alleged to contain a bomb. Evacuate people in the following order: o Ambulant (walking) o Semi-Ambulant (support when walking\0 o Non-Ambulant (bedridden) Move people adjacent (sideways) to a safe area if possible, or go down using fire stairs to another level below. The best choice is to move adjacent (sideways) through smoke doors on the same level. PROGRESSIVE EVACUATION OF THE BUILDING When evacuation requires movement outside the building, personnel will move via their directed route to the designated assembly area (via fire stairs) GENERAL Evacuation involves the movement of patients, staff and other people within or from the hospital in a rapid and as safe a manner as possible. ASSESSING THE SITUATION Before the decision to evacuate is made, a senior staff member present in the area should assess the situation at the time, in relation to the: Seriousness of the fire threat to human safety Proximity of hazards which may be relevant to the situation; and The nature and type of patients in the area AUTHORITY TO EVACUATE The authority to order evacuation of an area shall be with the Fire Marshal or senior staff member present in the area at the time. Responsibility for the evacuation should be given to the incident commander who would act on his/her own initiative. Staff such as medical officers, nursing staff, or engineers if present may provide advice. The decision for which patients are for immediate evacuation should be made by the nurse-in-charge or medical officer (or both). The Fire Services will assume control on their arrival. STAGES IN EVACUATION Evacuation should be conducted in three distinct stages according to the severity of the emergency. STAGE 1 REMOVAL OF PEOPLE FROM THE IMMEDIATE DANGER AREA. Patients and other people in the immediate area, and if necessary on the whole floor will need to be assembled a safe distance from the cause of the emergency. In the case of fire and smoke, once the area has been evacuated, doors should be closed to localize the fire and smoke. 24

STAGE 2 - STAGE 3- REMOVAL TO A SAFE AREA Should the seriousness of the situation warrant further evacuation, patients should be moved through the fire and/or smoke doors/exits to safe areas. This may be to an adjoining ward protected by fire and smoke doors on the same floor level or to another floor level. When evacuating a complete floor, patients should generally be moved to a floor on a lower level of the occupied building. COMPLETE EVACUATION OF A BUILDING Evacuation of the entire building will require all available staff to assist in the movement of the patients to a safe place. STAGES IN EVACUATION 1. Away from immediate danger 2. To safe area beyond fire or smoke doors 3. Complete evacuation of the building An evacuation plan should be displayed in your area. Evacuation should be by using exit routes as indicated on that plan. It is important that all staff are familiar with evacuation plans for their own work area. EXIT ROUTES The presence of fire or smoke (or both) in an emergency situation may govern the choice of evacuation routes and prohibit the use of nearby exits, in which case the nearest accessible exit should be used. For this purpose, prior knowledge of the building layout by staff is very important. Fire Marshals play a vital role in the education of staff and in controlling any necessary evacuations. LIFTS Lifts shall not be used in a fire emergency unless authorized by the fire service officers. Electric power may fail or be switched off causing people to be trapped in a lift. The lift shaft could act as a chimney and thus contribute to the spread of fire, heat and smoke to other parts of the building. Fire isolated stairs; fire escapes and other safe routes should be used. EVACUATION OF STAFF AND PATIENTS For the purpose of evacuation it is desirable to sub-divide patients into three groups taking into account the type of patients present: GROUP 1 - Ambulatory patients who require only a staff member to guide or direct them to a place of safety. GROUP 2 - Semi-ambulant patients, requiring minimal assistance GROUP 3 - Non-ambulant patients who have to be physically moved or carried. Once people have been removed from immediate danger it is generally recommended that Group 1 be moved first, then Group 2, and finally Group 3. ASSEMBLY AREAS In the event of a major fire/emergency, patients, visitors and staff will be advised of the required assembly area within the hospital grounds. It is desirable to wrap a blanket around each patient. A blanket provides protection from radiated heat if required. NOTE: It must be stressed that the first responsibility of the staff in proximity to the fire/ emergency is to remove patients from the immediate danger area. Staff must be familiar with all exits and exit routes to facilitate the quickest movement of patients. 25

ROOM CHECK / RECORD COLLECTION When all patients have been removed from the danger area, a staff member should check that the area is clear. Provided no risk is involved, staff lists and patients records should be collected at this time. FIRE EXIT MONITORS A staff member should be positioned to prevent other people entering the danger area by alternative entrances, provided no risk is involved and the person nominated can be spared. A head count should also be conducted once the evacuation is complete. Staff and patients must be instructed to stay in the evacuation area, until advised they can leave, to enable an accurate head count to be made. The senior staff member or designee should report to the Fire Service Officer or Senior Safety and Security Services Officer present to indicate if anyone is missing after having conducted a staff and patient check. FACTORS FOR CONSIDERATION Factors that must be considered in the emergency handling of patients include: The nature of the emergency The weight and condition of the patient The strength, skill and training of the rescuer(s) The height of the bed The availability of resources both human and material Correct lifting techniques should be observed at all times. When using a blanket to drag a patient, it should be grasped and pulled from the end near the patient s feet. The beds of intensive care patients may be wheeled to safety if the situation permits. Do not obstruct corridors, doorways, and stair entrances with beds or bedding. AMBULATORY PATIENTS Ambulatory patients should be taken in a group to a safe area. A responsible person must be given control to minimize panic and ensure that all are accounted for. Ambulatory patients and visitors can be used to assist in the orderly removal of other ambulatory patients. WHEELCHAIR PATIENTS If the need for wheelchairs is acute, patients who have reached a safe area should vacate their chairs so that other patients may be evacuated. Do not obstruct corridors, doorways and stairs with wheelchairs NON-AMBULATORY PATIENTS Non-ambulatory patients may be carried on stretchers, blankets or specially designed equipment, e.g. evacuation sheets. They may also be moved by emergency removal techniques such as: Blanket drag Swing carry Fore and aft carry Other improvised techniques to suit the situation. PATIENT CARE FOLLOWING EVACUATION After patients and staff are evacuated the all clear may be given. Patient care will probably require an extraordinary effort by staff until such time as the patients can be returned to their ward, found alternative accommodation within the hospital or transported to another hospital. 26

SISTER WARDS An evacuation that has patients being placed outside of a building will, in addition to subjecting the patient to the weather conditions at the time, effectively reduce the following: Medical air and gas Suction Communication Medical support It is therefore strongly recommended that all patient care areas develop a sister ward protocol with at least two other wards/clinics that would be able to look after patients in the event of an evacuation. Each ward would be required to provide as much as possible, similar medical functions that the patients were receiving prior to the evacuation. This process would be reciprocal and should be confirmed on a regular basis. 27

CARDIO PULMONARY RESUSCITATION CODE BLUE 1. Commence basic life support and call for assistance 2. Dial 7-1234, state the Code Blue and the location 3. Continue resuscitation with CPR, use of bag-valve mask and AED (if available) until the arrival of the Cardiac Arrest Team MEDICAL EMERGENCY NON CARDIAC ARREST This process applies to situations where the patient is not experiencing a cardiac arrest but where clinical staff believes that the patient requires medical attention urgently (i.e. within 10 30 minutes). Guidelines for following this process include: Airway threatened Breathing unexpected change in respiratory rate. Under 5 or over 36. Circulation unexpected change in pulse rate. Under 40 or over 140 Drop in Systolic BP under 90 Unexpected significant bleeding Nervous System sudden loss of consciousness. Aggression. Prolonged or repeated seizure activity. Other any patient whom you are seriously concerned about. Procedure: Dial 6. Notify switchboard as to which is the primary treating team for the patient and ask to have them paged urgently or the be paged urgently by the ward staff. 28

DISRUPTIVE BEHAVIOR CODE WHITE Definition: Armed or unarmed persons threatening to injure others or cause injury to themselves. This procedure is the initial response to a personal threat that may arise from an armed or unarmed person confronting staff or others in a violent or threatening manner or where a person threatens to commit suicide. Once Safety and Security Services, Police or other professional response groups arrive, they will assume command. WARNING! UNDER NO CIRCUMSTANCES SHOULD STAFF, PATIENTS OR VISITORS PLACE THEMSELVES IN FURTHER DANGER. Whenever there are unlawful demands for hospital property (Money, drugs, equipment, etc.) with threats of violence, the property should be handed over without question. ARMED CONFRONTATION Obey the offender s instructions, Keep calm and be observant. Do only what you are told and nothing more Do not volunteer any information Stay out of danger if not directly involved Leave the building if it is safe to do so Raise the alarm Dial 953 with details of the: o Location o Nature of incident o Person reporting The switchboard operator should announce CODE WHITE then notify Safety and Security. Safety and Security Services on arrival at the scene will inform the switchboard operator of the situation to be relayed to the Police. Carefully observe any vehicle used by the offender(s) taking particular note of its registration number, type and color and number of occupants and their descriptions. Observe the offender(s) as much as possible. In particular, note the speech, mannerisms, clothing, scars or any other distinguishing features. Record these observations as quickly as possible after the event, as the police will want individual descriptions of what happened, not influenced by others. Keep other people out of the area and Centre Safety and Security Services staff at entrances to stop people from entering into the area. Do not move or take anything from the area until the police have checked for fingerprints and other clues. Ask all witnesses to remain until the police arrive. Explain to the witnesses that their view of what happened, however brief, could provide vital information when put together with other evidence. All members of the media must be excluded from the Hospital and all media contact will be made through the Public Relations Office. Should injuries occur, only attempt to assist where there is no risk to yourself and the offender consents? Do not place more people in danger. Explanation In the hospital environment, personal threats can take many forms, and therefore a specific response cannot be detailed. However, the basic principles that should always be addressed are: o Remove as many people from the danger and prevent other people from getting into danger o Always carry out the demands of the offender exactly nothing more, nothing less. 29

o o If hospital property is demanded, it should always be handed over. Do not try to be a hero Aims of the Plan Saving of life Minimum disruption to the patients, staff, visitors and the running of the hospital Where possible, protection of assets. RAISING THE ALARM In most cases involving personal threat, the person directly involved with the offender will not be in a position to raise the alarm. In such cases, the staff member must try to draw the attention of other persons to the situation, without placing any person at risk. Each work area should develop a code that indicates that an individual is under threat. The alarm should be raised by dialing 953 and advising the switchboard of the nature of the incident, the number of people involved, the location of the incident and who is reporting the incident. The operator will immediately notify Safety and Security Services and the Police. Medical Team The Department of Emergency Medicine will be informed by the switchboard operator and placed on Alert 1 -STANDBY STATUS in the event of injuries. Minimizing People Involved Every effort should be made to minimize the number of people involved or potentially involved in a personal threat situation. All people who are not directly under threat should leave the area if safe to do so. Outside the threat area, security should be Centered to ensure that other people do not become involved in the incident. The unexpected arrival of other people may panic the offender into rash action, or increase the number of people at risk. ARMED HOLD UP Armed hold up is the most likely personal threat, and this could be for cash, drugs or some other item. In all cases, the persons in contact with the offender should be as agreeable as possible, while trying to signal to other staff to raise the alarm. DRUGS HOLD UP The pharmacies and every clinical area are potential sites for unlawful demands for drugs. Where possible, you should tell the offender that the demanded drugs are not held in the area or that the key to the storage cupboard is unavailable. If the threats become more menacing, then every effort should be made to meet the offender s demands. If there are genuine reasons to be unable to meet the demands, such as not having the key to drug cupboards, then explain the procedure used to access the drugs and why you are unable to access them. For any type of hold up, try to keep a mental note of the property taken, and as soon as the threat is removed, write down the list of stolen property. It is also important that nothing is touched and only essential people enter the area until the Police are on the site, so that fingerprints and other evidence is maintained intact HOSTAGE The hostage may be a patient, staff member or a visitor. The reasons for taking such a hostage can be several, but could include: demands for money or drugs; demands for action or inaction regarding the treatment of an individual (this may or may not be the offender); some political motivation, retribution for some real or perceived wrong; a domestic matter. The major concerns should be to minimize the number of hostages and to minimize the risk to each. 31

People who can, should immediately leave the threat area. The offender s instructions should be carried out as closely as possible. Because of the likely lengthy nature of this category of personnel threat, a Command Centre would be established to manage liaison between the Police, Hospital staff, and the threat area. The locations will depend upon the site of the threat, and all communication should be relayed through the switchboard. Twoway radio communication should be used only out of earshot of the hostage taker(s). It is important that there is a clear understanding of the nature of the demands including the reasons for the event and the expectations of the offender. This information must be relayed to the Command Centre by Senior Safety and Security Services Officer. Once Police and other professional response groups are on site, they will assume control. This response may be armed so staff will need to be aware of the risks not only from the offender, but also Police, and should immediately obey any instructions. If you are in a location that is low risk, stay there until the situation is resolved. When the situation is resolved, there will be an announcement CODE WHITE ALL CLEAR. At that time, it is safe to resume normal activities. IRRATIONAL PERSON When an irrational person undertakes a campaign of damage against staff and/or the environment of the hospital, there is essentially an unmanageable situation. The first concern should be to move as many people away from the expected path of the offender and the violence. If these people cannot escape from the area, they should minimize their exposure by moving behind furniture, etc., which will isolate them from the offender. The alarm should be raised by dialing 953. The switchboard operator will contact Safety and Security Services and the Police. All personnel who are able should leave the threatened area as quickly as possible. If possible, staff should exit one by one, not in groups to minimize target opportunities. Once Police and other professional response groups are at the hospital, they will assume control. 31

BOMB THREAT CODE ORANGE This procedure is this hospital s response to a bomb threat. Once Police, Civil Defense and other professional response groups arrive, they will work with staff of the hospital to assess the level and nature of the threat. A bomb threat will usually be received by phone or in the mail. Do not panic but treat the threat as genuine. Phone Threat Record all available information given by the person on the telephone. DO NOT HANG UP AFTER CALL UNTIL INSTRUCTIONS ARE GIVEN. Mail Threat Suspicious Parcel Do not touch. Remove all people from the area. Written Threat Envelope and correspondence should be kept, do not handle further. Place in a plastic bag if possible to assist in fingerprinting, Centre marks, etc. Dial 953; state CODE ORANGE and location (use another internal phone if threat is by phone). Follow instructions of the Senior Safety and Security Services Officer or Police. Prepare to evacuate in accordance with the Evacuation Plan ALERT 4. Assist by visual search of your work area look for unusual parcels, objects, etc. NOT normally in your work area. If object found: Do not touch Report find by dialing 953 on internal telephone Keep clear BOMB / ARSON THREAT CHECKLIST Any indication that a bomb or improvised explosive device has been planted must be regarded as genuine and the bomb/arson protocol implemented. If such threats are genuine and the device is activated resulting in an explosion and/or fire, then the Fire Plan Code Red, Code Gray and Alert 4 will be implemented. Bomb threats may be specific or non-specific as follows: SPECIFIC THREAT The caller provides more detailed information which could include statements describing the device, why it was placed, its location, the time of activation and other details. Although less common, the specific threat is more credible. NON-SPECIFIC THREAT The caller may make a simple statement to the effect that a device has been placed. Generally, very little, if any additional detail is said before the caller ends the conversation. The non-specific threat is more common but neither type of threat should be immediately discredited without investigation. Every threat should be treated as genuine until proven otherwise. INITIAL RESPONSE The staff member receiving the threat must gain as much information as possible and document it immediately. Details that should be gained include: The location of the bomb or other device and in what it is contained. When the device is set to be activated The reason for the threat Any identifying characteristics of the caller which might be available, including: Location 32

Identity Age Sex Accent or speech impediment Background sounds e.g. aircraft, etc. Immediately after the phone call, or during the phone call, another staff member must try to contact the switchboard on 953 and advise them of the threat and they will initiate the appropriate protocol for CODE ORANGE. It is best if you can raise the alarm while keeping the caller on the phone as long as possible to enable a phone trace and action the CODE ORANGE protocol earlier than the caller would anticipate. NOTIFICATION The staff member receiving the call must immediately contact the switchboard operator on 953. The switch immediately contacts the Director, Safety and Security Services Department IN HOURS OR AFTER HOURS. The Duty Senior Safety and Security Services Officer will immediately contact the staff member who received the call or information. The Director, Safety and Security Services or the Senior Safety and Security Services Officer will contact the Police. The Police will contact other emergency services as necessary. The Security Officer will then delegate the Safety and Security Officers to inform staff within close proximity to the Code Orange Area. EVALUATION Following an analysis of the information received, the Director or Senior Safety and Security Services Officer shall make the decision whether to institute one of the three possible actions, as follows: Search without evacuation Evacuate and search Evacuate (without search) SWITCHBOARD / SAFETY & SECURITY SERVICES Ensure that radio transmitters including two-way radios and mobile telephones are not used within 30 meters of the suspect bomb location. (This action reduces the risk of setting off the detonators, etc. by radio emission). SEARCH The aim of the search is to identify any object which is not normally found in an area or location, or for which an owner is not readily identifiable or becomes suspect for any other reason e.g. suspiciously labeled (similar to that described in the threat), unusual size, shape, sound and presence of pieces of tape, wire, string or explosive wrappings. If any suspect object is found, the Safety and Security Officers shall ensure that it is not touched or moved, and that the area is kept clear. The Safety and Security Officer shall notify the Incident Commander immediately. NOTE: More than one suspect object may have been planted. The search may be made without evacuation or made after evacuation. 33

SEARCH WITHOUT EVACUATION If the decision is made to search without evacuation, Incident Commander shall execute the following: Alert all Security Officers and the Police of the situation, identifying the location, if known. If the location is unknown, state that it is unknown Delegate Security Officers to supervise and assist in the search for any objects. All Safety and Security Officers and members of staff within the area will search their immediate areas. A sticker should be placed on each sector of an area after a search has been completed to indicate that each area has been searched. This negates double searching and identifies area, which have been missed. If any suspect object is found, the Staff member will notify the Security Supervisor IMMEDIATELY. The Security supervisor will ensure that it is not touched or moved and that the area is kept clear. The Security Supervisor will notify the Police and switchboard operator IMMEDIATELY that a suspect object has been located. The Incident Commander will then notify the following officers: Dean Vice Dean for hospital affairs Medical Director Executive Director of Services Executive Director of Patients Affairs EVACUATION Implement ANNOUNCEMENT OF Alert 4- EVACUATION. Ensure all personal items are removed As soon as all persons are at the evacuation assembly point, all persons shall move to a secondary assembly area at least 100 meters distance from the building where the bomb is placed. Doors and windows should be opened as the building is evacuated to allow any explosive device to vent. Once evacuation has been completed no person should re-enter the building without the authority of the Police or Safety and Security Services Officer. PATIENT CARE AREAS: EVACUATION OPTION The following options need to be assessed by Senior Medical and Nursing Staff in consultation with the Director or Senior Safety & Security Services Officer: Total Evacuation Partial Evacuation TOTAL EVACUATION Immediate and total evacuation would seem to be the most appropriate response to any bomb threat. However, there are significant safeties factors associated with a bomb threat that may weigh against immediate evacuation. These are as follows: RISK INJURY As a general rule, the easiest area in which to plant an object is the shrubbery sometimes found outside a building, an adjoining car park, or in an area to which the public has the easiest access. Immediate evacuation through these areas may increase the injury risk. Car parks should not normally be used as assembly areas. The Security Supervisor should ensure that exit routes and assembly areas are searched for suspicious objects prior to any evacuation. 34

RESPONSE IMPAIRMENT Total evacuation will remove personnel who may be required to make a search. Panic. A sudden bomb threat evacuation may cause panic and unpredictable behavior, leading to unnecessary risk of injury. Patient Dependency. At least some of the patients in any area under bomb threat may be dependent upon life support equipment. Reduction in patient care. Although evacuation of patients to any assembly area may ensure their safety, repeated threats and evacuation could compromise patient care. The above factors may make total evacuation an undesirable response to the bomb threat. NOTE: Total and immediate evacuation, although risky, is the easy decision. After taking the easy way, the hard decision of when to return still has to be made. PARTIAL EVACUATION One alternative to total evacuation is partial evacuation. This response is particularly effective when the threat includes the specific or general location of the object or in those instances where a suspicious object has been located without prior warning. Partial evacuation can reduce risk of injury by evacuating ambulant patients, visitors and non-essential personnel. Staff essential to a search can remain, critical services can be continued and in cases of repeated threat, risk of injury is minimized. SEARCH AFTER EVACUATION If the decision is made to evacuate and search, the Security Supervisor should try to see that personal belongings are removed. Experts should check unidentified and unattended suspicious objects e.g. Police, and no attempt to remove such objects should be made. The following areas shall be searched in the order stated below: 1. Outside areas including evacuation assembly area 2. Building entrances and exits, and in particular evacuation routes. 3. Public areas within buildings 4. After external and public areas have been cleared, a search should be conducted beginning at the lowest levels and continuing upwards until every floor including the roof has been searched. 5. After a floor or room has been searched, it should be distinctively marked to avoid duplication of effort. If a device has been located, Police will establish a Command Centre. The following staff will be required at the Command Centre location: During Working Hours: Hospital Incident Commander Vice Dean Medical Director Deputy Director of Nursing Executive Directors Director, Safety & Security Department After Hours: The following officers will report to the Command Centre until replaced by more senior members of staff. Officers identified in During Working Hours will be notified of the incident by switchboard: Senior Safety & Security Officer DEM Team Leader Nursing Supervisor 35

At the conclusion of this stage, Police will advise when Code Orange is cancelled. Code Orange All Clear Telecommunications Operator will then advise all sections Stand down Safety and Security Services and Switchboard 36

THE EMERGENCY OPERATION PLAN OF SAFETY AND SECURITY DEPARTMENT OBJECTIVE To secure the site by scrutinizing everything entering to it and by making sure that alarm system and fire fighting means are available and in place; evacuation points, routes utilized, temporary collection and evacuation places are known; the readiness of site to receive ordinary and emergency cases is kept and maintained. THE MISSION The mission of Safety and Security Unit at College of Medicine and King Khalid University Hospital is presented in the following: 1) to prepare the site for receiving emergency cases at any time. 2) To make sure that all internal and external traffic areas leading to emergency exits and doors are clear. 3) To continuously make sure that all corridors are not blocked and free from any obstacles that may hinder or hamper evacuation. 4) To provide vigilance to all service sites, energy sources, and vital sites and prevent unauthorized personnel from entrance. 5) To spread awareness among staff, patients and watchers in respect of what they should know about: a. Siren tones b. Safety places that they can go to during an internal disaster c. Receiving instructions during emergency occurrence and not acting alone. d. Not approaching any suspicious items and reporting its presence. 6) To make sure that contact devices are properly working and urgent contact can be made with the Civil Defense Dept. 7) To make sure that the service tunnel is secure and periodic patrols are routed in and around it. 8) To schedule the working hours pro-rota to be every six hours in the field area. 9) To keep record of places from which necessary needed vehicles or machinery can be brought over in time of crisis such as fire break -out or building collapse. 10) When a disaster occurs, the most important acts of safety and security will be: a) To initiate immediate intervention with the purpose of accommodating the situation and lessening the disaster s effects. b) To request help from the parties concerned. c) To extinguish fires and prevent spreading of fires. d) To participate in the evacuation process. e) To carry out evacuation plan in the site and nearby sites that could be exposed to danger as result of the situation. 37

f) To prepare evacuation sites for affected people. g) To mobilize all potentials for confronting the situation. Mobilization to include mobilizing human resources, equipment and machinery. h) To safeguard and maintain discipline in the area (affected site, medical evacuation, support site, accommodation places). i) To account for losses and harms, and to conduct an investigation for establishing the cause of the internal disaster. j) To restore the situation to its normal status. THE PLAN OF RECEIVING CASES IN EMERGENCY 1. The casualties who are brought in by ambulances will enter through the southern entrance of the hospital. A security man at the entrance will direct the injured to the Emergency Triage Area at the main door (Ambulance Bay). 2. Security Officers will be allocated to all points of entry on 0 level from the Emergency Department to Primary Care Clinics (PCC). No persons other than those wearing disaster passes will be permitted entry to the Emergency Department and surrounding areas on 0 level. 3. An iron rail separating the E/entrance and the visit entrance (20) will be put in place so that the injured are separated from the discharged patients who leave their wards. A security man will guide the patients and their watchers to the exit. 4. A security man will be stationed in the covered parking lot in order to prevent private cars from parking in Ambulance Parking Area. 5. Additional security man will be stationed at the circle in order to guide the injured to the right place and to prevent at random parking, and to facilitate the entrance of the ambulances. 6. The exit route for inpatients from their wards will be through the southern entrance of the hospital and the emergency exits of the wards. A security man will be stationed and he will guide the inpatients and the watchers to the exit place. 38

DEM DISASTER RESPONSE ROLE OF THE DEPARTMENT of EMERGENCY MEDICINE The Chairman of the DEM is a Incident Commander and is responsible for initiating the appropriate response to the disaster that has been notified. The Chairman should follow his/her action sheet for the directions to be commenced. If the number of victims is 10 or less, the DEM doctors with the help of medical staff on-call (trauma team) will deal with the incident. The nurse-in-charge will ask for more nurses if required. If the number of victims is more than 10, the team leader of DEM will advise the in charge nurse to initiate the Code Black and commence an activated response. On arrival, the Chairman of DEM will assume control of the department. He/she is responsible to Direct the clearing of patients from the department. Patients waiting for admission/likely to need admission should be sent to the ward. Patients requiring an emergency intervention should be triaged as normal. Patients waiting in the waiting room should be directed to another hospital. If afterhours, the nursing supervisor should provide nursing staff until on-call staff arrives. For critically ill patients requiring intensive care SICU PICU CCU MICU NICU High dependency beds Ward 21B 4 beds Ward 25A 3 beds These beds will accommodate chronic patients in the related intensive care units so that the patients from the emergency department will be transferred to the appropriate ICU s. The beds in the ICU will be vacated by transferring patients to the HDU beds. If there are any patients in the HDU, they will be transferred to their corresponding ward. The HDU will serve as back up for any patients from ICU requiring minimal care. All ICU s should have designated chronically ill patients requiring minimal care who can be transferred to the HDU as required. Organize the department for the reception of patients. ORGANISATION OF THE DEPARTMENT During a disaster, the emergency department staff will continue to manage patients as normal in the appropriate assessment areas, the difference being the number of patients will be increased and not all investigations and treatment will be completed before the patient leaves the assessment area. This is to ensure a continuous flow of patients through the department during the disaster response. A senior doctor will be responsible for prioritization of investigations such as X-ray, CT scan. TRIAGE Triage area will be set up outside the main door in the Ambulance bay. All available stretchers and wheelchairs should be brought to this area. This area will be staffed by: An emergency physician A pediatric doctor 2 staff nurses 2 receptionists All available paramedics/emt s 39

Role of the doctors and nurses This staff will be responsible for allocating a triage category to the patient and disposal to an appropriate assessment area. They should check the Mettag that is attached to the patient for relevant information. If no Mettag is attached to the patient, then triage staff is responsible for attaching a tag. If a patient not involved in the disaster, but requiring emergency care arrives, they should be treated the same as a disaster patient and a Mettag should be attached to their person. The triage staff are also responsible for directing the patient to the appropriate assessment area (see diagram). Each team should consist of: 1 doctor 1 staff nurse 1 receptionist Role of the receptionists The receptionists are responsible for the documentation of all patients who arrive to the emergency department. The form that is used is the disaster patient tracking form. They should not remove the Mettag from the patient. They are responsible for keeping an accurate list of all patients who arrive either alive or dead. They must record the number of the Mettag with the number of the disaster chart that is allocated to the patient. They must also record the assessment area that the patient is sent to. This list should be kept by the reception staff and not given to anyone. The people who may require access to the list are either a patient relation officer or a public relations officer. Under no circumstances are they to remove the list from the department. Role of the paramedics The paramedics/emt who are available should assist in transferring the patients to the assessment areas. They must ensure that staff in the area know that a patient has arrived. They should return to the triage area as soon as possible. When the casualties are no longer being transported to the department, the paramedics/emt should be allocated throughout the department to assist with patient care/ transfer. Resuscitation Unit Function of the area: To resuscitate the critically ill/injured patients with life-threatening conditions that may require airway management/assisted ventilation This area should be staffed by 3 anesthetists 3 doctors 16 nurses (1 nurse per patient, 2 nurses as runners) Comprehensive care should be given to these patients until a decision is made about their transfer to ICU or operating room. Acute Care Unit Function of the area: To resuscitate the critically ill/injured patients with life-threatening conditions that do not need airway support. This area should be staffed by 1 emergency consultant 5 doctors 9 nurses (1 nurse per patient, 2 nurses as runners) Stabilizing care should be given to these patients until a decision is made about their transfer to the ward or operating room. 41

Stabilizing care should be given to these patients until a decision is made about their transfer to the ward or operating room. Some of these patients may be admitted to the ward prior to having investigations completed e.g. X-ray Fast track Room Function of the area: To treat the seriously ill/injured patients e.g. long bone fractures with hypotension, <15% burns. This area should be staffed by: 2 doctors 4 nurses 1 emergency consultant should move between Acute Care 1 and Consultation room. Stabilizing care should be given to these patients until a decision is made about their transfer to the ward or operating room. Some of these patients may be admitted to the ward prior to having investigations completed e.g. X-ray Urgent Care Unit Function of the area: To treat patients with minor injuries who are non-ambulatory e.g. multiple lacerations, fractures This area should be staffed by: 1 doctor 3 nurses All adult ambulatory patients with minor injuries should be directed to the Primary Care Clinics. PEDIATRIC PATIENTS Pediatric Emergency Consultant/Team Leader should direct the clearing of patients in the department. Patients waiting for admission/likely to need admission should be sent to the ward. Patients waiting in the waiting room should be re-triaged and those able to leave should be directed to another hospital. All pediatric patients from the disaster will be seen at the Triage area (ambulance bay). The triage staff will be responsible for applying a triage category to the patient and allocation to an assessment area. They should check the Mettag that is attached to the patient for relevant information. If no Mettag is attached to the patient, then the triage staff is responsible for attaching a tag to the patient. If a patient not involved in the disaster but requiring emergency care arrives, they should be treated the same as a disaster patient and a Mettag should be attached to their person. They are also responsible for directing the patient to the appropriate assessment area (see diagram). Observation area Function of the area: To resuscitate the critically ill/injured patients with life-threatening conditions that do not need airway support. This area should be staffed by 2 doctors 4 nurses (1 nurse as a runner) 41

Stabilizing care should be given to these patients until a decision is made about their transfer to the ward or operating room. POPD All pediatric ambulatory patients with minor injuries will be directed to the Pediatric Outpatient Clinic area. This area should be staffed by: 6 doctors 12 nurses DOCUMENTATION ALL CLINICAL AREAS It is critically important that accurate and timely documentation is kept during the period of the disaster response. All patients must have two identifying numbers one taken from the Mettag and the other from the disaster chart. These two numbers should be written on any and all documentation relating to the patient even when transferred from the emergency department. The correct identity of the patient will be matched with these numbers when the disaster response has been stood down and time can be taken to establish correct information. All ambulatory patients should have correct identification information taken before they are permitted to leave the hospital. 42

DISASTER PLAN BLOOD BANK 1. MAIN OBJECTIVES o To ensure that the necessary stock of blood and blood products is maintained throughout the emergency. o To ensure the policy of issuing blood in a major disaster is maintained. 2. MAINTENANCE OF THE NECESSARY STOCK OF BLOOD AND BLOOD PRODUCTS Suspending blood issue for non-emergency transfusions. Increasing stock to the desired level by: o Delivery from other hospitals o Emergency donor bleeding Policy for blood issue in a major disaster (same as of emergency transfusion but will be dictated by the color code of the patient: Red, Yellow, or Green). o Compatibility done wherever possible. o Attempt to determine ABO and Rh groups to allow issue of group specific blood. o Issue group O Rh+ve to boys and men, O Rh-ve to women (except if O-ve is not available). o FFP & PC: usually available in good stocks (PC reserved for those who receive massive transfusion. PPF reserved for burns), o The Disaster & Mettag No. should be used in the: Identification of casualties Labeling samples of blood, reports of X-matched blood units 3. EMERGENCY DONORS ROOMS o Provision of bigger space and personnel to man the extended donor area. o Blood bank 4 rooms plus Student Cafeteria area. o This area should be clearly sign posted; hospital security and Public Relations, KKUH Telephone Operator and local radio or TV station should know of it in advance. o The King Saud University student rooms (the Health Center 5th floor) may be used in extremes of need. o Specially labeled bags and tubes should be ready to allow collection of blood from about 100 donors. o The currently used Blood Transfusion Requisition Form will be employed. It will carry the Disaster No. & Mettag No. which is to be issued by DEM. o Extra personnel to man the emergency donor rooms will be recruited from: o Hematology personnel (both medical and technical) o Hospital Phlebotomy personnel (both males and females) o Other laboratory personnel, if needed. o Porters (at least 2) should be allocated to Blood Bank Copies of this document will be circulated to all departments concerned to make their staff aware of the proposed commitments to this disaster plan. P.S.: 43

INCIDENT RESPONSE GUIDES ( IRG) To assist the incident command staff to optimally react to the situation they are confronting, Incident Response Guides have been devised for external and internal scenarios. Each IRG lists fundamental decision considerations specific to managing that situation by timeframe. The IRGs are intended to complement the hospital EOP and provide a primer that will provide some directional assistance and a means of initially documenting the actions undertaken. 44

BOMB THREAT INCIDENT RESPONSE GUIDE Mission: To safely manage staff, patients, and visitors during a bomb threat or suspicious package situation. Directions Read this entire response guide and review incident management team chart Use this response guide as a checklist to ensure all tasks are addressed and completed Objectives Document all bomb threat information Immediate respond to the bomb threat when received or suspicious object is found Maintain security of the facility, consider lockdown and/or evacuation Control and inspect packages and materials entering critical areas for suspicious objects Maintain patient care services Ensure safety of the staff, patients, and visitors Immediate (Operational Period 0-2 Hours) COMMAND (Incident Commander): Activate Command staff and Section Chiefs as appropriate Consider the possibility of a dirty bomb and evaluate/prepare for secondary radiation, chemical, and/or biological contamination (Liaison Officer): Notify appropriate authorities of bomb threat and coordinate internal and external response agencies (e.g., law enforcement, bomb squad) Communicate with other healthcare facilities to determine: Situation status Surge capacity Patient transfer/bed availability Ability to loan needed equipment, supplies, medications, personnel, etc. COMMAND (Safety Officer): Consider immediate evacuation of areas if threat is identified. Monitor response activities to ensure safety of staff, patients, and responders. (Public Information Officer): Establish a media staging/briefing area and secure the media area to ensure media remain in designated areas. Conduct media briefings and situation updates. OPERATIONS Implement the bomb threat procedure. Secure the facility and stop visitors and others from entering the facility. Evacuate non-essential personnel out of the facility to a safe area. 45

Initiate and coordinate search activities to identify suspicious objects or suspicious activity. Liaison with responding and investigating law enforcement agencies Consider evacuation or relocation of patients. PLANNING Establish operational periods, incident objectives and Incident Action Plan, in collaboration with Incident Commander. Prepare to track patients and personnel. LOGISTICS If necessary, establish an external evacuation safe area. Prepare to implement patient tracking protocols. Prepare for possible transportation for evacuated patients. Account for all personnel currently in the facility. Provide staff information and mental health services, as appropriate. Intermediate (Operational Period 2-12 Hours) COMMAND (Incident Commander): Meet with Command Staff and Section Chiefs to evaluate the overall impact of incident on the facility. (PIO): Continue monitoring media reporting Develop briefings and updates for staff, patients and visitors (Safety Officer): Conduct ongoing analysis of existing response practices for health and safety issues related to staff, patients, and facility, and implement corrective actions to address. OPERATIONS Continue securing the hospital and grounds and restricting non-essential personnel from entering the building. Continue facility search procedures. Evacuate patients and staff, as indicated. Continue to liaison with law enforcement LOGISTICS Continue to support facility response by providing appropriate personnel or equipment. FINANCE/ADMINISTRATION Track expenses and lost revenues. Extended (Operational Period Beyond 12 Hours) COMMAND (Incident Commander): Implement patient, staff and visitor evacuation of the facility. Update and revise the Incident Action Plan. (PIO): Continue media briefings and situation updates. (Liaison Officer): 46

Continue updating local emergency management, fire and EMS of situation status and need to evacuate facility. (Safety Officer): Continue monitoring safety practices and oversee safe evacuation of the facility OPERATIONS Continue patient management activities and evacuation of the facility Oversee evacuation of the facility and transfer of patients to other hospitals Continue hospital and grounds security, deny entry to non-essential personnel PLANNING Implement patient and staff tracking during the evacuation Update and revise the Incident Action Plan LOGISTICS Continue to provide mental health support to staff and patients as needed FINANCE Continue to track response expenses Demobilization/System Recovery COMMAND (Incident Commander): Ensure local law enforcement/bomb squad issue an all clear for the facility. Oversee restoration of normal hospital operations (PIO): Conduct final media briefing providing situation status, appropriate patient information and termination of the incident. (Liaison Officer): Notify local emergency management, fire and EMS of termination of the incident. (Safety Officer): Oversee the safe return to normal operations and repatriation of patients OPERATIONS Restore patient care and management activities. Repatriate evacuated patients Re-establish visitation and non-essential services PLANNING Finalize the Incident Action Plan and demobilization plan. Compile a final report of the incident and hospital response and recovery operations Ensure appropriate archiving of incident documentation. Write after-action report and corrective action plan to include the following: Summary of actions taken Summary of the incident Actions that went well Area for improvement Recommendations for future response actions Recommendations for correction actions 47

LOGISTICS Provide debriefing and mental health support services for staff and patients. FINANCE/ADMINISTRATION Compile final response and recovery cost and expenditure summary and submit to the Incident Commander for approval. Documents and Tools Hospital Emergency Operations Plan Hospital Evacuation Plan Hospital Bomb Threat Procedure (telephone vs. suspicious object threat) Facility and Departmental Business Continuity Plans 48

(ALERT4) EVACUATION, COMPLETE OR PARTIAL FACILITY INCIDENT RESPONSE GUIDE Mission: To safely perform a complete or partial facility evacuation. Directions: Read this entire response guide and review incident management team chart. Use this response guide as a checklist to ensure all tasks are addressed and completed. Objectives: Maintain safety of patients, staff, visitors Maintain life support functions Conduct safe and rapid evacuation of the facility Plan for patient repatriation and restoration of services Immediate (Operational Period 0-2 Hours) COMMAND (Incident Commander): Activate the facility emergency operations plan and the Incident Command structure. Appoint Command Staff and Section Chiefs. Determine type of evacuation needed: Immediate vs. delayed Vertical, horizontal, complete Order the organized and timely evacuation of the facility (PIO): Conduct regular media briefings on situation status and appropriate patient information. Oversee patient family notifications of evacuation/transfer/early discharge (Liaison Officer): Notify and regularly communicate with local emergency management agency, Fire, EMS and law enforcement about facility status and evacuation order. (Safety Officer): Oversee the immediate stabilization of the facility and basement flooding Recommend areas for immediate evacuation to protect life Ensure the safe evacuation of patients, staff and visitors OPERATIONS: Implement emergency life support procedures to sustain critical services (i.e., power, water, communications) until evacuation can be accomplished. Determine type of evacuation needed, in conjunction with the Incident Commander: Immediate vs. delayed Vertical, horizontal, complete Implement planning for immediate evacuation of the facility. Prioritize patients/areas of the facility to be evacuated Prepare patient records, medications and valuables for transfer 49

Confirm the transfer and timeline with accepting hospitals, providing patient information as appropriate Discharge patients as appropriate Establish a safe area for holding patients until transferred. Ensure patient records, medications and belongings are transferred with the patient Secure the facility and restrict visitors and entry of non-essential personnel Activate business continuity plans and procedures Relocate hazardous materials from flooded areas to prevent area/facility contamination Coordinate ambulances, aero medical services, and other transportation Implement the evacuation plan and move patients and staff PLANNING: Track patients and personnel including evacuation location and receiving facility Establish operational periods, incident objectives and develop the Incident Action Plan in collaboration with the Incident Commander Ensure documentation of all actions and activities Intermediate (Operational Period 2-12 Hours) COMMAND: (Incident Commander): Notify hospital Board, Dean and other internal authorities of situation status and evacuation. (Liaison): Integration with external agencies, including healthcare facilities (PIO): Continue staff, patient, visitor and media briefings (Safety Officer): Conduct ongoing analysis of existing response practices for health and safety issues related to staff, patients, and facility, and implement corrective actions to address OPERATIONS: Ensure appropriate patient care and management during evacuation Continue facility security, traffic and crowd control Ensure family notification of patient transfer Continue facilitating discharges Continue to communicate patient information and status to receiving facilities PLANNING: Continue patient and personnel tracking and documentation Update and revise the Incident Action Plan Ensure complete documentation of activities, decisions and actions LOGISTICS: Supply supplemental staffing to key areas to facilitate evacuation Provide for staff food and water and rest periods Monitor facility damage and initiate repairs, as appropriate, as long as it does not hinder evacuation of the facility Initiate salvage operations of damaged areas and relocate equipment from evacuated areas to secure areas or to other facilities. FINANCE/ADMINISTRATION: Track costs and expenditures of response and evacuation 51

Track estimates of lost revenue due to evacuation of the facility Extended (Operational Period Beyond 12 Hours) COMMAND (Incident Commander): Meet with Command Staff and Section Chiefs to update evacuation progress and situation status. (Liaison Officer): Continue to update local emergency management, Fire, EMS and law enforcement officials on situation status and evacuation progress (Safety Officer): Continue ongoing evaluation of evacuation practices for health and safety issues related to staff, patients, and facility, and implement corrective actions. OPERATIONS: Ensure patient care and management for patients waiting evacuation Secure all evacuated areas, equipment, supplies and medications Continue business continuity and recovery actions PLANNING: Continue to track patients and staff locations Track materiel and equipment transferred to other hospitals Prepare a demobilization plan and deactivate HCC positions and staff when they are no longer necessary Discuss staff utilization and salary practices during evacuation and closure of the facility with Human Resources; provide information to employees when determined Continue to ensure documentation of actions, decisions and activities Update and revise the Incident Action Plan LOGISTICS: Maintain information technology security Support evacuation of supplies (medical, food, water, other equipment) Assess and secure utility systems FINANCE/ADMINISTRATION: Continue to track and report response costs and expenditures and lost revenue Demobilization/System Recovery COMMAND: (Incident Commander): Assess if criteria for partial or complete reopening of the facility is met, and order reopening and repatriation of patients Oversee restoration of normal hospital operations (PIO): Conduct final media briefing providing situation status, appropriate patient information and termination of the incident (Liaison Officer): Notify local emergency management, fire and EMS of termination of the incident and reopening of the facility (Safety Officer): Oversee the safe return to normal operations and repatriation of patients OPERATIONS Restore patient care and management activities 51

Repatriate evacuated patients Re-establish visitation and non-essential services PLANNING: Finalize the Incident Action Plan and demobilization plan Compile a final report of the incident and hospital response and recovery operations Ensure appropriate archiving of incident documentation Write after-action report and corrective action plan to include the following: Summary of actions taken Summary of the incident Actions that went well Area for improvement Recommendations for future response actions LOGISTICS: Implement and confirm facility cleaning and restoration, including: Structure Medical equipment certification Provide debriefing and mental health support services for staff and patients Inventory supplies, equipment, food, and water, and return to normal levels FINANCE/ADMINISTRATION: Compile final response and recovery cost and expenditure and estimated lost revenues summary and submit to the Incident Commander for approval Contact insurance carriers to assist in documentation of structural and infrastructure damage and initiate Documents and Tools: Hospital Emergency Operations Plan Patient Evacuation Plan Utility Failure Plans Facility and Departmental Business Continuity Plans 52

FIRE INCIDENT RESPONSE GUIDE Mission: To reduce the loss of life and property during an internal fire incident. Directions: Read this entire response guide and review incident management team chart Use this response guide as a checklist to ensure all tasks are addressed and completed Objectives: Confine the fire/reduce the spread of the fire Rescue and protect patients and staff Implement internal emergency management plan fire Implement partial/full evacuation Communicate situation to staff, patients, and the public Investigate and document incident details Immediate Actions (Operational Period 0-2 Hours): COMMAND: (Incident Commander): Activate the facility emergency operations plan and the Incident Command structure Appoint Command Staff and Section Chiefs Consider the formation of a unified command with hospital and fire officials Determine need for and type of evacuation (PIO): Establish a media staging area Conduct regular media briefings to update situation status and provide appropriate patient and employee information Oversee patient family notifications of incident and evacuation/relocation, if ordered COMMAND (Liaison Officer): Notify and regularly communicate with local emergency management agency, Fire, EMS and law enforcement about facility status Communicate with other healthcare facilities to determine: Situation status Surge capacity Patient transfer/bed availability Ability to loan needed equipment, supplies, medications, personnel, etc. (Safety Officer): Oversee the immediate stabilization of the facility Recommend areas for immediate evacuation or temporary relocation to protect staff and patients Monitor the condition of the facility during the event and immediately notify the Incident Commander of any situations that are an immediate threat to life or health OPERATIONS: Implement fire response plan and conduct extinguishment/rescue operations, if needed and/or if possible Evaluate need for evacuation or temporary relocation of nearby areas damaged from smoke or fire Evaluate safety of involved structure after obtaining damage assessment from emergency response agency (fire department) 53

Secure the facility and deny entry to non-essential and unauthorized personnel Establish alternate laboratory testing sites through other locations or contracted services Follow up on injured employees and patients and document condition PLANNING: Conduct an immediate count of hospital patients and their locations Initiate patient tracking procedures Account for on-duty staff by name and location Establish operational periods, incident objectives and develop Incident Action Plan, in collaboration with the Incident Commander LOGISTICS: Assist with facility damage assessment Perform salvage operations in damaged laboratory areas, if possible Ensure communications systems and IT/IS is functioning Initiate follow up and documentation on injured employees, and assist with notification of family members Call back additional staff to assist with operations and possible evacuation, as needed Intermediate (Operational Period 2-12 Hours) COMMAND (Incident Commander): Meet regularly with Command Staff and Section Chiefs to review overall impact of the fire on the facility and reevaluate the need for evacuation or temporary relocation of patient care area and services (Liaison): Continue to communicate with area hospitals and local emergency management to update on situation status and request assistance Establish the patient information center, in collaboration with the PIO (PIO): Continue briefings for staff, patients and the media Establish the patient information center, in collaboration with the Liaison Officer (Safety Officer): Conduct ongoing analysis of existing response practices for health and safety issues related to staff, patients, and facility, and implement corrective actions to address OPERATIONS: Continue patient care and management activities Relocate or evacuate patients from damaged/impacted areas, as appropriate Ensure notification of patient s families of incident and patient condition Continue to re-establish laboratory services Ensure critical infrastructure services to essential area Initiate facility clean up procedures Initiate facility repairs Continue facility security and secure all unsafe areas Ensure business continuity operations were not damaged and are fully functional PLANNING: Continue patient and personnel tracking Update and revise the Incident Action Plan Ensure documentation of actions, decisions and activities LOGISTICS: Continue salvage operations, as appropriate Provide mental health support for staff Provide for staff food, water and rest periods Continue to monitor condition of injured employees and report to Incident Commander 54

Order supplies and equipment as needed to facilitate patient care and recovery operations Arrange transportation for relocated or evacuated patients Assist with re-establishment of laboratory services through relocation or contracted services Continue to provide supplemental staffing, as needed FINANCE/ADMINISTRATION: Track response and recovery costs and expenditures, including estimates of lost revenue Initiate documentation and claims for injured employees and patients, if any Facilitate procurement of supplies, equipment, medications, contracted services and staff needed for effective response and recovery Extended (Operational Period Beyond 12 Hours) COMMAND: (Incident Commander): Meet with Command Staff and Section Chiefs to update situation status and patient relocation/evacuation progress (PIO): Continue to brief staff, patients, families and the media on the situation status and appropriate patient information Continue patient information center, as needed (Liaison Officer): Continue to update local emergency management, Fire, EMS and law enforcement officials on situation status and evacuation progress (Safety Officer): Continue ongoing evaluation of evacuation practices for health and safety issues related to staff, patients, and facility, and implement corrective actions OPERATIONS: Continue patient care and management activities Ensure safe patient relocation/evacuation, if necessary If patients are evacuated to other facilities, ensure patient records, medications and belongings are transferred with the patient Continue to assess facility damage and services Provide for food and water for patients, families and visitors Continue security of the facility and unsafe areas within the facility PLANNING: Plan for demobilization of incident and system recovery Update and revise the Incident Action Plan Ensure documentation of actions, decisions and activities Continue patient and personnel tracking LOGISTICS: Provide mental health support and debriefings to staff Continue to provide food, water and rest periods for staff Continue to monitor the condition of injured employees and report to the Incident Commander Replace or reorder damaged supplies and equipment to provide laboratory services as soon as possible Provide additional staffing as needed FINANCE/ADMINISTRATION: Continue to track and report response costs and expenditures and lost revenue Complete claims/risk management reports on injured employees or patients Demobilization/System Recovery: 55

COMMAND: (Incident Commander): Assess if criteria for partial or complete reopening of areas within the facility is met, and order reopening and repatriation of patients Oversee restoration of normal hospital operations Provide appreciation and recognition to solicited and non-solicited volunteers, staff, state and federal personnel that helped during the incident (PIO): Conduct final media briefing providing situation status, appropriate patient information and termination of the incident (Liaison Officer): Notify local emergency management, fire and EMS of termination of the incident and reopening of the facility (Safety Officer): Oversee the safe return to normal operations and repatriation of patients OPERATIONS: Restore patient care and management activities Repatriate evacuated patients Re-establish visitation and non-essential services Provide mental health support and information about community services to patients and families, as needed PLANNING: Finalize the Incident Action Plan and demobilization plan Prepare a summary of the status and location of patients. Disseminate to Command Staff and Section Chiefs and to other requesting agencies, as appropriate Compile a final report of the incident and hospital response and recovery operations Ensure appropriate archiving of incident documentation Write after-action report and improvement plan to include the following: Summary of actions taken Summary of the incident Actions that went well Area for improvement Future response actions Corrective actions LOGISTICS: Provide mental health support and conduct stress management debriefings, as needed Monitor health status of staff Restock and resupply equipment, medications, food and water and supplies to normal levels Itemize all damaged equipment and supplies and submit to Finance/Administration Section Return borrowed equipment after proper cleaning/disinfection Restore normal non-essential services (i.e., gift shop, etc.) FINANCE/ADMINISTRATION: Compile final response and recovery cost and expenditure and estimated lost revenues summary and submit to the Incident Commander for approval Contact insurance carriers to assist in documentation of structural and infrastructure damage and initiate Documents and Tools: Hospital Emergency Operations Plan 56

Fire Emergency Response Plan Hospital Patient Evacuation Plan Patient Tracking Form Hospital Damage Assessment Procedures Forms Job Action Sheets Hospital Organization Chart Facility and Departmental Business Continuity Plans Television/radio/internet to monitor news Telephone/cell phone/satellite phone/internet for communication 57

HAZARDOUS MATERIAL SPILL (CODE BROWN) INCIDENT RESPONSE GUIDE Mission: To effectively and efficiently manage a spill or leak involving hazardous material within the hospital. Directions: Read this entire response guide and review incident management team chart Use this response guide as a checklist to ensure all tasks are addressed and completed Objectives: Isolate the contaminated area Identify the hazardous material Patient triage and medical management Protection of patients, staff and visitors Immediate (Operational Period 0-2 Hours) & Intermediate (Operational Period 2-12 Hours) COMMAND: (Incident Commander): Establish Incident Command and activate PIO, Safety Officer, Liaison Officer and Operations and Logistics Section Chiefs Alert/notification of internal staff via overhead page (e.g., Code Orange: Internal) Activate and implement the hospital s Spill Response Team Establish Hospital Command Center (HCC) and assemble incident management team Activate the Medical/Technical Specialist Chemical to assess the incident Activate Medical Care, Infrastructure, HazMat, and Security Branch Director Establish operational periods and operational objectives (e.g., protecting life safety of existing personnel and patients, limit further spread/damage, provide decontamination, and account for all personnel and patients) (PIO): Establish a patient information center; coordinate with the Liaison Officer and local Emergency Management/Public Health/EMS COMMAND (Liaison): Communicate with other healthcare facilities to determine: Situation status Surge capacity Patient transfer/bed availability Ability to loan needed equipment, supplies, medications, personnel, etc. (Safety Officer): Conduct ongoing analysis of existing response practices for health and safety issues related to staff, patients, and facility, and implement corrective actions to address OPERATIONS: Ensure proper triage of symptomatic and non-symptomatic patients, staff, volunteers and others with possible exposure Initiate and maintain patient care and management activities Coordinate with the Security Officer, as necessary, to isolate the spill area Communicate with local emergency management to identify toxic chemicals Isolate the contaminated area Identify the hazardous material Provide situation report to IC including 58

Substance description and damage inflicted Response / clean-up plan including potential notification and activation of contracted Hazardous Materials spill response provider PLANNING: Establish operational periods and develop Incident Action Plan: Engage other hospital departments Share Incident Action Plan through Incident Commander with these areas Provide instructions on needed documentation including completion detail and deadlines Prepare and implement patient tracking protocols LOGISTICS: Monitor the health status staff who participated in decontamination activities and actively provide rehabilitation as necessary Anticipate an increased need for medical/surgical supplies, personal protective equipment, transporters, and personnel Extended (Operational Period Beyond 12 Hours) COMMAND (PIO): Continue patient information center, as necessary (Liaison): Obtain a summary of the status and location of all incident patients from the Patient Tracking Officer. Disseminate to public health/ems, local EOC, local Fire/HazMat Teams, or others as appropriate OPERATIONS: Continue spill clean up and decontamination of the laboratory Continue patient management activities Monitor environmental conditions/fumes and continue to control HVAC operations to limit or prevent spread LOGISTICS: Continue to monitor the health status of staff who were exposed to the fumes or who participated in decontamination activities Monitor, in collaboration with the Medical Care Branch Director, all patients who were exposed or may have been exposed to the fumes/chemical Ensure restoration or relocation of laboratory services FINANCE/ADMINISTRATION: Monitor and track all personnel time and response costs Track costs for outside resources assisting in response Prepare summary reports for the Incident Commander every 8 hours and as requested Demobilization/System Recovery COMMAND: (Incident Commander): Once notified of complete clean up and decontamination of the affected area(s), declare the emergency terminated and demobilize the HCC (PIO): Notify the media of the termination of the event, outcomes and other pertinent information (Safety Officer): Ensure safety of impacted area(s) and notify the IC of status 59

(Liaison): Notify local officials, Fire/HazMat teams and other hospitals of all clear status OPERATIONS: Complete clean up operations and assess decontamination Implement local hazmat protocols to follow up with the local/state/federal agencies as appropriate (e.g., EPA) PLANNING: Conduct after-action review with the following: Command personnel and Section Chiefs Laboratory Staff Spill Team Response Members Staff, patients and volunteers Write after-action report and corrective action plan to include the following: Summary of actions taken Summary of the incident Actions that went well Area for improvement Recommendations for future response actions Recommendations for correction actions LOGISTICS: Monitor the health status staff who participated in decontamination activities for an extended period Conduct stress management and after-action debriefings and meetings as necessary Inventory all HCC and hospital supplies and replenish as necessary and appropriate FINANCE/ADMINISTRATION: Compile expense reports and submit to Incident Commander and proper authorities for reimbursement Documents and Tools Hospital Emergency Operations Plan Hospital Spill Response Plan Hospital Decontamination Protocol Hospital Mass Casualty Incident Protocol Patient Tracking Form 61

CODE GREEN (DEM OVERCROWDING) HOSPITAL OVERLOAD INCIDENT RESPONSE GUIDE Mission: To safely manage periods of limited bed capacity, facilitate the timely admission of patients, and minimize holding time in the department of emergency medicine (DEM). Directions: Read this entire response guide and review incident management team chart Use this response guide as a checklist to ensure all tasks are addressed and completed Objectives: Maintain current census of ED and inpatients, number waiting to be seen, waiting for admission and pending discharges Activate alternate care sites Provide safe and appropriate patient care Communicate situation status regularly to patients, families, staff, other hospitals and local officials Evaluate diversion criteria and outpatient/urgent care clinic resources Immediate Actions (From Decision to Activate EOP to 2 Hours) COMMAND (Incident Commander): Activate Hospital Command Center, Command Staff and Section Chiefs, as appropriate Activate the Medical/Technical Specialists Hospital Administration, Clinic Administration, Medical Staff and Pediatric Care Establish the operational period, incident objectives and initial Incident Action Plan (PIO): Provide information to visitors and families regarding situation status and hospital measures to meet the demand Activate the media staging area and provide regular briefings and updates COMMAND: (Liaison Officer): Establish communications with the local Emergency Operations Center to report the activation of the Emergency Operations Plan/HCC, situation status and critical issues/needs Contact licensing authorities for potential need to alter staff/patient ratio s, as necessary Communicate with local EOC and Regional Hospital Coordination Center for local, regional and state bed availability Communicate with other healthcare facilities to determine: Situation status Surge capacity and capability Patient transfer/bed availability Ability to loan needed equipment, supplies, medications, personnel, etc. (Safety Officer): Ensure safety practices are being used Ensure that non-traditional areas used for patient care and other services are safe and hazard free OPERATIONS: Activate Branch Directors and Unit Leaders and brief on the current situation Activate the hospital s surge capacity plan Activate alternate care sites, as appropriate 61

Review all surgeries and outpatient appointments and procedures for cancellation and/or rescheduling Identify inpatients for early discharge or transfer to other facilities and direct staff to expedited discharges Establish a discharge area to free beds until patient can be transported Assess current staffing and project staffing needs/shortages for the next operational period and 24-48 out Ensure the rapid cleaning and turn-over of patient care beds and areas to expedite discharge and admission Ensure the use of appropriate personal protective equipment by staff and volunteers Consider extending outpatient hours to accommodate additional patient visits PLANNING: Establish operational periods, incident objectives and develop Incident Action Plan, in collaboration with the Incident Commander Institute patient, bed, personnel and materiel tracking and project needs for the next 24-48 hours LOGISTICS: Anticipate an increased need for supplies, equipment, medications and personnel and obtain resources as appropriate Ensure the operations of communication systems and IT/IS Assist the Operations Section with the establishment of alternate care sites Manage solicited and unsolicited volunteers Intermediate and Extended (Operational Period 2- greater than 12 Hours) COMMAND (Incident Commander): Communicate current hospital status to CEO, Board of Directors and other appropriate internal and external officials Regularly update and revise initial Incident Action Plan, in collaboration with Planning Section Consider deploying a Liaison Officer to the local EOC (PIO): Continue to provide information to visitors and families regarding situation status and hospital measures to meet the demand Provide regular staff situation status updates and information Continue to provide regular briefings and updates to the media Establish the patient information center, if appropriate, in conjunction with the Liaison Officer (Liaison Officer): Continue regular communications with the local Emergency Operations Center to report the hospital s situation status and critical issues/needs Continue to communicate with local EOC and Regional Hospital Coordination Center for local, regional and state bed availability Continue to communicate with and update other healthcare facilities regarding: Situation status Surge capacity and capability Patient transfer/bed availability Ability to loan needed equipment, supplies, medications, personnel, etc. (Safety Officer): Conduct ongoing analysis of existing response practices for health and safety issues related to staff, patients, and facility, and implement corrective actions to address 62

OPERATIONS: Continue patient care and management activities Assist with transportation of discharged/transferred patients to residences, skilled nursing facilities, alternate care sites, etc. Expedite discharge medication processing and dispensing Regularly reassess and reevaluate patients waiting for admission Continue to review scheduled/elective procedures and surgeries for cancellation or rescheduling Ensure the re-triage and observation of all patients waiting to be seen Continue or implement alternate care sites Consider need for and provision of alternate standards of care (austere care) and prioritization of resources PLANNING: Update and revise the Incident Action Plan and distribute to Command Staff and Section Chiefs Continue patient, bed, personnel and materiel tracking and reporting Ensure complete documentation of actions, decisions and activities Begin planning for demobilization and system recovery LOGISTICS: Continue to call in additional staff to supplement operations Continue to coordinate solicited and unsolicited volunteers Obtain needed supplies, equipment and medications to support patient care activities for a 72 hour period Provide for food, water and rest periods for staff Establish a dependent care area, as appropriate Ensure the rapid investigation and documentation of injuries or employees exposed to illness and provide appropriate follow up FINANCE/ADMINISTRATION: Facilitate procurement of needed supplies, equipment, medications and contractors to meet patient care and facility needs Track all costs and expenditures of the response and estimate lost revenues due to cancelled procedures/surgeries and other services Ensure the rapid investigation and documentation of injuries or employees exposed to illness and provide appropriate follow up Demobilization/System Recovery COMMAND (Incident Commander): Establish priorities for restoring normal operations using the hospital s continuity of operations and business plans Approve the demobilization plan and finalize the Incident Action Plan Provide appreciation and recognition to solicited and non-solicited volunteers, staff, state, and federal personnel that helped during the incident (Public Information Officer): Conduct final briefings for media, in cooperation with the JIC Close the patient information center, if activated (Liaison Officer): Communicate hospital status and final patient condition and location information to appropriate authorities (i.e., local and state public health, local EOC) (Safety Officer): Oversee the safe and effective restoration of normal services OPERATIONS: 63

Restore normal facility operations and visitation Provide mental health and information about community services for patients and families PLANNING: Compile all documentation and forms for archiving Write after-action report and improvement plan, including the following: Summary of actions taken Summary of the incident Actions that went well Area for improvement Recommendations for future response actions Recommendations for correction actions LOGISTICS: Conduct stress management and after-action debriefings and meetings for staff Monitor health status of staff exposed to infectious patients and provide appropriate medical and mental health follow up, as needed Restock all supplies and medications Restore/repair/replace broken equipment Return borrowed equipment after proper cleaning/disinfection Restore normal non-essential services (i.e., gift shop, etc.) FINANCE: Compile final response expense reports, submit to IC for approval and to appropriate authorities for reimbursement Documents and Tools: Emergency Operations Plan, including: Infectious Patient Surge Plan and Alternate Care Site Plan Mass Prophylaxis Plan Risk Communication Plan Hospital Security Plan Patient/staff/equipment tracking procedures Behavioral health support for staff/patients procedures Mass Fatalities Plan Infection Control Plan Employee Health Monitoring/Treatment Plan All other relevant protocols/guidelines relating to biological/infectious disease/mass casualty incidents Hospital Organization Chart Television/radio/internet to monitor news 64

HOSTAGE / BARRICADE INCIDENT RESPONSE GUIDE Mission: To safely manage a hostage or barricade situation. Directions: Read this entire response guide and review incident management team chart. Use this response guide as a checklist to ensure all tasks are addressed and completed. Objectives: Protect safety of staff, patients, and visitors Manage the media Coordinate with law enforcement and other external response agencies Provide for mental health support and stress debriefing/management services to patients, staff and families Immediate (Operational Period 0-2 Hours) COMMAND (Incident Commander): Notify law enforcement agencies of incident and provide details, as able Establish a unified command with law enforcement, upon arrival Safely evacuate the immediate area surrounding the unit, if possible or provide security to the nearby areas Determine need to activate Medical/Technical Specialist Risk Management, as appropriate (Public Information Officer): Establish a media staging area in a safe and secluded location Provide regular media briefings and situation status updates (Liaison Officer): Establish communication with area hospitals to notify of the incident and potential need for evacuation of patients (Safety Officer): Ensure the safety of patients, families, visitors and staff in non-impacted areas of the hospital Collaborate with law enforcement and hospital security staff on safe evacuation of nearby areas OPERATIONS: Suspend non-essential services Secure the facility and do not allow entrance or exit of people except essential personnel Evacuate the immediate area around the critical care unit, if safe to do so Consider and prepare for additional gunman or perpetrators Liaison with law enforcement and provide facility and utility drawings/schematics upon arrival Provide space and communications systems near the unit for law enforcement operations including negotiations Be prepared to maintain or shut off selective utility or HVAC systems upon the request of law enforcement Ensure continuation of patient care management activities in the hospital Institute ambulance diversion status; notify local EMS and ambulance providers Notify family members of hostages of the situation, including staff, families and visitors Prepare to render care to injured hostages and/or the perpetrator PLANNING: 65

Establish operational periods, incident objectives and develop Incident Action Plan, in collaboration with the Incident Commander and law enforcement Implement patient tracking LOGISTICS: Prepare for mental health support needs of hostages Provide mental health support for on-duty staff, patients and visitors, patients, family and staff Intermediate and Extended (Operational Period 2 to Greater than 12 Hours) COMMAND (Incident Commander): Assess the impact of the situation and response on the hospital; Update and revise the Incident Action Plan in conjunction with law enforcement and Planning Section Chief Establish a procedure, in conjunction with local law enforcement, to provide care for hostages, when released COMMAND (PIO): Continue to conduct regular media briefings as the incident evolves Establish a patient information center, if needed, in collaboration with Liaison Officer Continue to provide staff, patients and visitors with situation status updates and information (Liaison Officer): Continue to communicate with local officials to provide situation updates and hospital critical issues/needs (Safety Officer): Conduct ongoing analysis of existing response practices for health and safety issues related to staff, patients, and facility, and implement corrective actions to address OPERATIONS: Reassess evacuations and need for further evacuation Continue hospital/facility security and restriction of entry and exit except for essential personnel Continue to liaison with law enforcement and provide requested supplies and services Continue patient care and management operations Ensure documentation of actions, decisions and activities Provide ongoing victim family support PLANNING: Update and revise the Incident Action Plan Continue patient tracking, if needed Plan for demobilization and system recovery LOGISTICS: Continue to supply hostage support needs (water, medications, etc.) as directed by law enforcement Assess impact of ongoing incident on services FINANCE: Track costs and expenditures of response, including lost revenues Demobilization/System Recovery 66

COMMAND (Incident Commander): Ensure local law enforcement issues an all clear for the facility Oversee restoration of normal hospital operations Conduct immediate debriefing with law enforcement (PIO): Conduct final media briefing providing situation status, appropriate patient information and termination of the incident (Liaison Officer): Notify local emergency management, fire and EMS of termination of the incident (Safety Officer): Oversee the safe return to normal operations and repatriation/relocation of patients OPERATIONS Restore normal patient care operations Restore normal visitation and non-essential services Facilitate clean up and repair of the critical care unit and reopening Provide mental health support services to patients and patient s families Restore utilities to the unit, if needed Reunite hostages with family Immediately debrief staff hostages, as directed by law enforcement PLANNING Finalize the Incident Action Plan and demobilization plan Compile a final report of the incident and hospital response and recovery operations Ensure appropriate archiving of incident documentation Write after-action report and corrective action plan to include the following: Summary of actions taken Summary of the incident Actions that went well Area for improvement Recommendations for future response actions Recommendations for correction actions LOGISTICS Provide staff debriefing, mental health support and stress management services Continue providing support to hostages, as needed FINANCE/ADMINISTRATION Compile final response and recovery cost and expenditure summary and submit to the Incident Commander for approval Complete documentation and follow up of personnel injury and/or line of duty death as appropriate Documents and Tools Hospital Emergency Operations Plan Hospital Evacuation Pan Hospital Building and Utilities Plans Fatality Management Plan 67

INFANT/CHILD ABDUCTION (CODE PINK) INCIDENT RESPONSE GUIDE Mission: To manage and collaborate in the process of locating and recovering a lost or abducted infant or child. Directions Read this entire response guide and review incident management team chart Use this response guide as a checklist to ensure all tasks are addressed and completed Objectives: Confirm that an abduction has taken place Secure mother and staff involved with infant or child s care Activate the Infant/Child Abduction Response Plan Collaborate with law enforcement to recover the infant or child Provide mental health support services to the patient and staff Immediate (Operational Period 0-2 Hours) COMMAND (Incident Commander): Activate the Infant/Child Abduction Plan Notify law enforcement agencies of incident and provide details, as able Establish a unified command with law enforcement, upon arrival Activate appropriate Command Staff and Section Chiefs (Public Information Officer): Establish a media staging area Provide regular media briefings and situation status updates, releasing only information that has been approved by the hospital Incident Commander and law enforcement Provide informational bulletin for current patients to notify them of the incident and the measures initiated, as appropriate COMMAND (Liaison Officer): Notify and liaison with local government officials, as needed Call local law enforcement to initiate an Amber Alert Call the National Center for Missing and Exploited Children, 800-THE-LOST, for assistance in handling the ongoing investigation and crisis (Safety Officer): Ensure the safety of patients, families, visitors and staff during hospital search procedures OPERATIONS Secure the facility and deny access or exit. Search any persons exiting the facility, as appropriate Assign staff to conduct a floor-by-floor, door-by-door search of the facility Assign a liaison to coordinate with law enforcement/fbi Conduct staff and mother/family interviews to gather information and evidence, in conjunction with law enforcement Provide law enforcement with photos, footprints of child, etc., if available Provide additional information to staff and security about the abductor as information is available to facilitate internal search Provide mental health support to the patient and other family members 68

PLANNING Establish operational periods, incident objectives and develop the Incident Action Plan, in collaboration with the Incident Commander Intermediate and Extended (Operational Period 2- Greater than 12 Hours) COMMAND (Incident Commander): Update and revise the Incident Action Plan Ensure the continuation of normal hospital operations Activate Medical/Technical Specialist Risk Management to assist with response and documentation of incident Continue to brief key senior management on the situation Appropriately report incident to state, JCAHO and other regulatory agencies as a sentinel event (PIO): Continue regular media briefings and updates, in conjunction with law enforcement Provide situation status updates to hospital staff and patients (Liaison Officer): Update local officials and other agencies, as appropriate OPERATIONS If it is determined that abductor has left facility, consider releasing staff posted at doors to normal duties Continue to provide mental health support and physical care to the mother and family members Provide assurance and support to other new mothers or parents of children in the facility, regarding the safety of their infant/child Consider maintaining a visible security presence in the impacted department Re-register the mother under a fictitious name and move her room location to maintain privacy Ensure the continuation of normal patient care services and hospital operations Continue communications and collaboration with law enforcement Provide appropriate medical exam of infant/child, and unification with parents PLANNING Revise and/or complete Incident Action Plan LOGISTICS Provide mental health support and stress management services to department staff FINANCE/ADMINISTRATION Track costs and expenditures of response Demobilization/System Recovery COMMAND (Incident Commander): Oversee the hospital s return to normal operations Ensure continued liaison and communication with law enforcement (PIO): Conduct final media briefing providing situation status, appropriate patient information and termination of the incident (Liaison Officer): 69

Notify appropriate local officials of the termination of the incident OPERATIONS Restore normal operations and patient care services Restore normal visitation and non-essential services PLANNING Finalize the Incident Action Plan and demobilization plan Compile a final report of the incident and hospital response and recovery operations Ensure appropriate archiving of incident documentation Write after-action report and corrective action plan to include the following: Summary of actions taken Summary of the incident Actions that went well Area for improvement Recommendations for future response actions Recommendations for correction actions LOGISTICS Provide ongoing mental health support and stress management services for involved employees, as needed FINANCE/ADMINISTRATION Compile final response and recovery cost and expenditure summary and submit to the Incident Commander for approval Documents and Tools Emergency Operations Plan Hospital s Infant/Child Abduction Response Plan Secure surveillance media (tapes or other video) 71

INTERNAL FLOODING INCIDENT RESPONSE GUIDE Mission: To safely manage an internal flooding incident within a hospital. Directions: Read this entire response guide and review incident management team chart Use this response guide as a checklist to ensure all tasks are addressed and completed Objectives Prevent facility flooding Protect patients, staff and facility Ensure safe patient care and medical management Evacuate the facility (partial or complete) as needed Immediate (Operational Period 0-2 Hours) COMMAND (Incident Commander): Activate the facility Emergency Operations Plan Activate Command Staff and Section Chiefs, as appropriate (Liaison Officer): Notify local emergency management of situation and immediate actions Communicate with other healthcare facilities to determine: Situation status Surge capacity Patient transfer/bed availability Ability to loan needed equipment, supplies, medications, personnel, etc. (Public Information Officer): Inform staff, patients and families of situation and actions underway to prevent/limit flooding Prepare media staging area in a safe locations Conduct regular media briefings, in collaboration with the local EOC/Joint Information Center (Safety Officer): Conduct safety assessment of low lying flooded areas and assess risks and impacts to patients, staff and facility OPERATIONS Activate the hospital s Internal Flooding Plan Ensure continuation of patient care and essential services Consider partial or complete evacuation of the facility, or relocation of patients and services into safe areas of the facility Ensure the operations of alternate power supplies (i.e., back up generators) Maintain communications systems, activate alternate communications systems, as needed Evaluate the flooded area(s) and identifying safety issues Institute measures to prevent flooding and protect facility resources, as appropriate Secure the facility and limit access and egress Implement business continuity planning and protection of patient records PLANNING Establish operational periods, incident objectives and develop the Incident Action Plan, in collaboration with the Incident Commander Implement patient and staff tracking, as appropriate 71

LOGISTICS Assess facility damage and project impacts of rising flood waters on the facility Maintain utilities and activate alternate systems as needed Intermediate (Operational Period 2-12 Hours) COMMAND (PIO): Establish a patient information center in coordination with the Liaison Officer to notify patient families of situation and patient locations (Liaison Officer): Notify local emergency management and EOC of situation status, critical needs and plans for evacuation, if appropriate OPERATIONS Continue essential patient care management and services Initiate clean up operations, as appropriate Reassess need for or prepare for evacuation Continue to maintain utilities Provide mental health support to patients and families, as needed Continue to secure the facility, including unsafe areas Activate business continuity plans, including protection of records and possible relocation of business functions PLANNING Continue patient and personnel tracking, as needed Update and revise the Incident Action Plan and distribute to Command Staff and Section Chiefs LOGISTICS Continue to evaluate facility integrity and safety of flooded areas Initiate clean up as appropriate FINANCE/ADMINISTRATION Track costs and expenditures and estimate cost of facility damage and lost revenue Initiate documentation of any injuries or facility damage Facilitate the procurement of supplies, equipment and medications and contracting for facility clean up or repair Extended (Operations/EOC Activation Beyond 12 Hours) COMMAND (Incident Commander): Update and revise the Incident Action Plan and prepare for demobilization Continue to update internal leaders on the situation status (PIO): Continue with briefings and situation updates with staff, patients and families Continue patient information center operations, in collaboration with Liaison Officer (Liaison Officer): Continue to notify local EOC of situation status Continue patient information center operations, in collaboration with PIO. (Safety): Continue to evaluate flooded areas and facility integrity for safety and take immediate corrective actions OPERATIONS 72

Continue essential patient care management and services Continue repair and clean up operations, as appropriate Continue evacuation of the facility, if implemented Ensure the transfer of patient s belongings, medications and records, when evacuated Continue to maintain utilities Continue to secure the facility, including unsafe areas Continue business continuity activities and relocation of business services, if appropriate Prepare for demobilization and system recovery PLANNING Revise and update the incident action plan Initiate demobilization plan and plan for system recovery LOGISTICS Provide supplemental staffing as needed Continue to evaluate facility damage and integrity and initiate clean up and repair activities FINANCE/ADMINISTRATION Continue to track costs and expenditures Continue to facilitate contracting for facility repair and clean up Demobilization/System Recovery COMMAND (Incident Commander): Determine hospital status and declare termination of the incident (Liaison Officer): Communicate final hospital status and termination of the incident to local EOC, area hospital and officials Assist with the repatriation of patients transferred (PIO): Conduct final media briefing and assist with updating staff, patients, families and others of the termination of the event (Safety Officer): Ensure facility safety and restoration of normal operations Ensure facility repairs are completed, in conjunction with the Operations and Logistics Sections OPERATIONS Restore normal patient care operations Ensure restoration of utilities and communications Complete a facility damage report, progress of repairs and estimated timelines for restoration of facility to pre-event condition PLANNING Complete a summary of operations, status, and current census Conduct after-action reviews and debriefings Develop the after-action report and improvement plan for approval by the Incident Commander LOGISTICS Restock supplies, equipment, medications, food and water Ensure communication and IT/IS operations return to normal Provide stress management and mental health support to staff 73

FINANCE/ADMINISTRATION Compile a final report of response and facility repair costs for approval by the Incident Commander Work with local, state, and federal emergency management to begin reimbursement procedures for cost expenditures related to the event Contact insurance carriers to assist in documentation of structural and infrastructure damage and initiate reimbursement and claims procedures Documents and Tools Hospital Emergency Operations Plan Hospital Evacuation Plan Flood Response Plan Utility Failure Plans Facility and Departmental Business Continuity Plans 74

LOSS OF HEATING/VENTILATION/AIR CONDITIONING (HVAC) INCIDENT RESPONSE GUIDE Mission: To safely manage the loss of HVAC within the hospital. Directions Read this entire response guide and review incident management team chart Use this response guide as a checklist to ensure all tasks are addressed and completed Objectives Identify the extent and duration of the loss of HVAC Protect patient, family, staff and facility Minimize the impact of the loss of HVAC on patients and staff and consider evacuations Communicate situation status and updates to staff, patients, visitors and facility Immediate (Operational Period 0-2 Hours) COMMAND (Incident Commander): Activate the facility Emergency Operations Plan Activate Command Staff and Section Chiefs, as appropriate (Liaison Officer): Notify local emergency management of situation and immediate actions Notify local EMS and ambulance providers about the situation and possible need to evacuate Communicate with other healthcare facilities to determine: Situation status Surge capacity Patient transfer/bed availability Ability to loan needed equipment, supplies, medications, personnel, etc. Contact the Regional Hospital Coordination Center, if exists, to notify about the situation and request assistance with patient evacuation destinations COMMAND (Public Information Officer): Inform staff, patients and families of situation and actions underway to cool the facility and protect life Prepare media staging area in a safe locations Conduct regular media briefings, in collaboration local emergency management, as appropriate (Safety Officer): Evaluate safety of patients, family, staff and facility and recommend protective and corrective actions to minimize hazards and risks OPERATIONS Assess patients for risk and prioritize care as appropriate Implement alternate cooling measures for the patients, perishable supplies and the facility Secure the facility and implement limited visitation policy Assess the HVAC system and prepare a plan and timeline for repair and restoration of service Ensure continuation of patient care and essential services Consider partial or complete evacuation of the facility, or relocation of patients and services within the facility Maintain communications systems and other utilities 75

PLANNING Establish operational periods, incident objectives and develop the Incident Action Plan, in collaboration with the Incident Commander Implement patient and personnel tracking, as appropriate LOGISTICS Assess HVAC system damage and project impacts of heat on the facility, equipment and perishables Maintain other utilities and activate alternate systems as needed Investigate and provide recommendations for rental of portable HVAC units Investigate and provide recommendations for rental of portable filtration such as HEPA units and temporary isolation capability Identify needed replacement air filters (e.g. HEPA) for HVAC system Provide for water, food and rest periods for staff Monitor staff for heat related injuries and provide appropriate follow up Obtain supplemental staffing, as needed Prepare for transportation of evacuated patients Intermediate and Extended (Operational Period 2 to Greater than 12 Hours) COMMAND (Incident Commander): Update and revise the Incident Action Plan and prepare for demobilization Continue to update internal officials on the situation status Monitor evacuation, if activated (PIO): Continue with briefings and situation updates with staff, patients and families Continue patient information center operations, in collaboration with Liaison Officer (Liaison Officer): Continue to notify local EOC of situation status, critical issues and request assistance, asneeded Continue patient information center operations, in collaboration with PIO Continue communications with area hospitals and facilitate patient transfers (Safety): Continue to evaluate facility operations for safety and hazards and take immediate corrective actions OPERATIONS Continue evaluation of patient and visitors for heat impacts and maintain cooling measures Cancel elective surgeries and procedures Prepare the staging area for patient transfer/evacuation Initiate ambulance diversion procedures Continue or implement patient evacuation Ensure the transfer of patient s belongings, medications and records upon evacuation Continue evaluation and provision of temporary HVAC systems and portable filtration units Ensure facility security and restricted visitation Ensure provision of water and food to patients, visitors and families Continue to maintain other utilities Monitor patients for adverse affects of heath and psychological stress Institute HVAC repairs and services Prepare demobilization and system recovery plan PLANNING Continue patient, bed and personnel tracking Update and revise the Incident Action Plan Plan for repatriation of patients 76

Prepare demobilization and system recovery plan Ensure documentation of actions, decisions and activities LOGISTICS Continue provision of portable HVAC units and filtration systems Continue to provide staff for patient care and evacuation Monitor staff for adverse affects of heath and psychological stress Monitor, report, follow up on and document staff or patient injuries Continue to provide transportation services for internal operations and patient evacuation FINANCE/ADMINISTRATION Continue to track costs and expenditures and lost revenue Continue to facilitate contracting for facility repair and clean up Demobilization/System Recovery: COMMAND (Incident Commander): Determine hospital status and declare restoration of HVAC services and termination of the incident (Liaison Officer): Communicate final hospital status and termination of the incident to local EOC, area hospital and officials Assist with the repatriation of patients transferred (PIO): Conduct final media briefing and assist with updating staff, patients, families and others of the termination of the event (Safety Officer): Ensure facility safety and restoration of normal operations Ensure facility repairs are completed, in conjunction with the Operations and Logistics Sections OPERATIONS Restore normal patient care operations Ensure restoration of HVAC services and negative pressure isolation rooms Repatriate evacuated patients Discontinue ambulance diversion and visitor limitations PLANNING Finalize the Incident Action Plan and demobilization plan Compile a final report of the incident and hospital response and recovery operations Ensure appropriate archiving of incident documentation Conduct after-action reviews and debriefing Write after-action report and corrective action plan for approval by the Incident Commander to include the following: Summary of actions taken Summary of the incident Actions that went well Area for improvement LOGISTICS Restock supplies, equipment, medications, food and water Ensure communication and IT/IS operations return to normal Replace all damaged or soiled air handling filters (e.g. HEPA) Provide stress management and mental health support to staff 77

FINANCE/ADMINISTRATION Compile a final report of response and facility repair costs for approval by the Incident Commander Contact insurance carriers to assist in documentation of structural and infrastructure damage and initiate reimbursement and claims procedures Documents and Tools Hospital Internal Utility Failure Plan Emergency Operations Plan Facility Evacuation Plan (as needed) 78

LOSS OF POWER INCIDENT RESPONSE GUIDE Mission: To safely manage the operations of the facility during a power outage and minimize time to restore service. Directions Read this entire response guide and review incident management team chart Use this response guide as a checklist to ensure all tasks are addressed and completed Objectives Maintain emergency power systems Maintain patient care management and safety Minimize impact on hospital operations and clinical services Evacuate patients to other facilities, if appropriate Communicate situation to staff, patients, the media and community officials Immediate (Operational Period 0-2 Hours) COMMAND (Incident Commander): Activate the facility Emergency Operations Plan Activate Command Staff and Section Chiefs, as appropriate (Liaison Officer): Notify local emergency management/eoc of hospital situation status and obtain incident information and estimated timelines for restoration of power Notify local EMS and ambulance providers about the situation and possible need to evacuate Communicate with other healthcare facilities to determine: Situation status Surge capacity Patient transfer/bed availability Ability to loan needed equipment, supplies, medications, personnel, etc. Contact the Regional Hospital Coordination Center, if exists, to notify about the situation and request assistance with patient evacuation destinations COMMAND (Public Information Officer): Inform staff, patients and families of situation and measures to provide power and protect life Prepare media staging area Conduct regular media briefings, in collaboration local emergency management, as appropriate (Safety Officer): Evaluate safety of patients, family, staff and facility and recommend protective and corrective actions to minimize hazards and risks OPERATIONS Evaluate the emergency power supply and appropriate usage within the facility Initiate power conservation measures Assess patients for risk and prioritize care and resources, as appropriate Secure the facility and implement limited visitation policy Ensure continuation of patient care and essential services Consider partial or complete evacuation of the facility, or relocation of patients and services within the facility 79

Maintain communications systems and other utilities and activate redundant (back up) systems, as appropriate Implement business continuity plans and protection of records PLANNING Establish operational periods, incident objectives and develop the Incident Action Plan, in collaboration with the Incident Commander Prepare for patient and personnel tracking in the event of evacuations Monitor weather conditions LOGISTICS Maintain other utilities and activate alternate systems as needed Investigate and provide recommendations for auxiliary power (i.e., battery powered lights,etc) Provide for water, food and rest periods for staff Obtain supplies to maintain functioning of emergency generators (i.e., fuel, parts, etc.) Obtain supplemental staffing, as needed Prepare for transportation of evacuated patients Validate and/or activate the backup communications systems Intermediate and Extended (Operational Period 2 to Greater than 12 Hours) COMMAND (Incident Commander): Update and revise the Incident Action Plan and prepare for demobilization Continue to update internal officials on the situation status Monitor evacuation, if activated (PIO): Continue with briefings and situation updates with staff, patients and families Continue patient information center operations, in collaboration with Liaison Officer (Liaison Officer): Continue to notify local EOC of situation status, critical issues and request assistance, as needed Continue to communicate with local utilities incident details and duration estimates Continue patient information center operations, in collaboration with PIO Continue communications with area hospitals and facilitate patient transfers : (Safety): Continue to evaluate facility operations for safety and hazards and take immediate corrective actions OPERATIONS Continue evaluation of patients and patient care Determine if any equipment can be taken off emergency power to minimize load on generators Cancel elective surgeries and procedures Prepare the staging area for patient transfer/evacuation Initiate ambulance diversion procedures Continue or implement patient evacuation Ensure the transfer of patient s belongings, medications and records upon evacuation Continue evaluation and provision of emergency power Ensure facility security and restricted visitation Ensure provision of water and food to patients, visitors and families Continue to maintain other utilities Monitor patients for adverse affects of heath and psychological stress Prepare demobilization and system recovery plan 81

PLANNING Continue patient, bed and personnel tracking Update and revise the Incident Action Plan Prepare the demobilization and system recovery plans Plan for repatriation of patients Ensure documentation of actions, decisions and activities LOGISTICS Contact vendors to schedule regular deliveries of fuel to maintain emergency power Contact vendors on availability of supplies and fresh food Continue provision of emergency power to critical areas Continue to provide staff for patient care and evacuation Monitor staff for adverse affects of heath and psychological stress Monitor, report, follow up on and document staff or patient injuries Continue to provide transportation services for internal operations and patient evacuation FINANCE/ADMINISTRATION Continue to track costs and expenditures and lost revenue Continue to facilitate contracting for emergency power and other services Demobilization/System Recovery COMMAND (Incident Commander): Determine hospital status and declare restoration of normal power and termination of the incident Notify state licensing, accreditation or regulatory agency of sentinel event (Liaison Officer): Communicate final hospital status and termination of the incident to local EOC, area hospitals and officials Assist with the repatriation of patients transferred (PIO): Conduct final media briefing and assist with updating staff, patients, families and others of the termination of the event (Safety Officer): Ensure facility safety and restoration of normal operations OPERATIONS Restore normal patient care operations Ensure restoration of power and services Repatriate evacuated patients Discontinue ambulance diversion and visitor limitations Ensure business continuity of operations and return to normal services PLANNING Finalize the Incident Action Plan and demobilization plan Compile a final report of the incident and hospital response and recovery operations Ensure appropriate archiving of incident documentation Conduct after-action reviews and debriefing Write after-action report and corrective action plan for approval by the Incident Commander to include the following: Summary of actions taken Summary of the incident Actions that went well Area for improvement Recommendations for future response actions LOGISTICS 81

Perform evaluation and preventative maintenance on emergency generators and ensure their readiness Restock supplies, equipment, medications, food and water Ensure communications and IT/IS operations return to normal FINANCE/ADMINISTRATION Compile a final report of response costs and expenditures and lost revenue for approval by the Incident Commander Contact insurance carriers to assist in documentation of structural and infrastructure damage and initiate reimbursement and claims procedures Documents and Tools Hospital Emergency Operations Plan Hospital Evacuation Plan Emergency Power Plans Emergency Communications Plans Facility and Departmental Business Continuity Plans 82

LOSS OF WATER INCIDENT RESPONSE GUIDE Mission: To effectively and efficiently manage the effects of a loss of water in the facility. Directions Read this entire response guide and review incident management team chart. Use this response guide as a checklist to ensure all tasks are addressed and completed. Objectives Conserve water and restore water supply Identify and obtain alternate sources of potable water Maintain patient care management Monitor heating and cooling systems Immediate (Operational Period 0-2 Hours) COMMAND (Incident Commander): Activate the facility Emergency Operations Plan Activate Command Staff and Section Chiefs, as appropriate Establish incident objectives and operational period (Liaison Officer): Notify local emergency management of hospital situation status, critical issues and timeline for water service repairs and restoration Notify the water utility and outside agencies of water loss and estimated time for water main repair and restoration of service Notify local EMS and ambulance providers about the situation and possible need to evacuate Communicate with other healthcare facilities to determine:. Situation status. Surge capacity. Patient transfer/bed availability. Ability to loan needed equipment, supplies, medications, personnel, etc.. Contact the Regional Hospital Coordination Center, if exists, to notify about the situation and request assistance with patient evacuation destinations COMMAND (Public Information Officer): Inform staff, patients and families of situation and measures to conserve water and protect life Prepare media staging area Conduct regular media briefings, in collaboration local emergency management, as appropriate (Safety Officer): Evaluate safety of patients, family, staff and facility and recommend protective and corrective actions to minimize hazards and risks OPERATIONS Determine loss of water impact on systems and patients Estimate potable and non-potable water usage and needs and collaborate with Logistics Section and Liaison Officer to obtain back up supplies 83

Access alternate sources of water to provide for fire suppression, HVAC system and other critical systems, as able Institute rationing of water, as appropriate Initiate water conservation measures Assess patients for risk and prioritize care and resources, as appropriate Monitor infection control practices Provide alternate toilet and hand washing facilities Secure the facility and implement limited visitation policy Ensure continuation of patient care and essential services Consider partial or complete evacuation of the facility, or relocation of patients and services within the facility Activate facility and impacted departmental business continuity plans PLANNING Establish operational periods, incident objective and develop the Incident Action Plan, in collaboration with the Incident Commander Prepare for patient and personnel tracking in the event of evacuations LOGISTICS Maintain other utilities and activate alternate systems as needed Investigate and provide recommendations for alternate water supplies, including potable water Assist with rationing water, as appropriate Obtain supplemental staffing, as needed Prepare for transportation of evacuated patients, if activated Oversee and conduct water main repairs and restoration of services Intermediate and Extended (Operational Period 2 hours to Greater than 12 Hours) COMMAND (Incident Commander): Update and revise the Incident Action Plan and prepare for demobilization Continue to update internal officials on the situation status Monitor evacuation (PIO): Continue with briefings and situation updates with staff, patients and families Continue patient information center operations, in collaboration with Liaison Officer Assist with notification of patient s families about situation and evacuation, if activated (Liaison Officer): Continue to notify local EOC of situation status, critical issues and request assistance, as needed Continue to communicate with local utilities incident details and duration estimates Continue patient information center operations, in collaboration with PIO Continue communications with area hospitals and facilitate patient transfers (Safety Officer): Continue to evaluate facility operations for safety and hazards and take immediate corrective actions OPERATIONS Continue evaluation of patients and patient care Cancel elective surgeries and procedures Prepare the staging area for patient transfer/evacuation Initiate ambulance diversion procedures Continue or implement patient evacuation Ensure the transfer of patient s belongings, medications and records upon evacuation Continue to ration water, especially potable water, as appropriate Maintain facility security and restricted visitation Continue to maintain other utilities 84

Monitor patients for adverse affects of heath and psychological stress Prepare demobilization and system recovery plan PLANNING Continue patient, bed and personnel tracking Update and revise the Incident Action Plan Prepare the demobilization and system recovery plans Plan for repatriation of patients Ensure documentation of actions, decisions and activities LOGISTICS Continue with nutritional, sanitation, and HVAC support and operations Contact vendors to provide emergency potable and non-potable water supplies and portable toilets Monitor the impact of the loss of water on critical areas Continue to provide staff for patient care and evacuation Monitor staff for adverse affects of heath and psychological stress Monitor, report, follow up on and document staff or patient injuries Continue to provide transportation services for internal operations and patient evacuation FINANCE/ADMINISTRATION Continue to track costs and expenditures and lost revenue Continue to facilitate contracting for emergency repairs and other services Demobilization/System Recovery COMMAND (Incident Commander): Determine hospital status and declare restoration of normal water services and termination of the incident Notify state licensing, accreditation or regulatory agency of sentinel event Provide appreciation and recognition to solicited and non-solicited volunteers and to state and federal personnel sent to help (Liaison Officer): Communicate final hospital status and termination of the incident to local EOC, area hospital and officials Assist with the repatriation of patients transferred (PIO): Conduct final media briefing and assist with updating staff, patients, families and others of the termination of the event (Safety Officer): Ensure facility safety and restoration of normal operations OPERATIONS Confirm water restoration plan with local water authority and complete bacteriological testing and final potable water safety verification Restore normal patient care operations Ensure restoration of water and other infrastructure (i.e., HVAC) Repatriate evacuated patients Discontinue ambulance diversion and visitor limitations PLANNING Finalize the Incident Action Plan and demobilization plan Compile a final report of the incident and hospital response and recovery operations Ensure appropriate archiving of incident documentation Conduct after-action reviews and debriefing Write after-action report and corrective action plan for approval by the Incident Commander to include the following: 85

Summary of actions taken Summary of the incident Actions that went well Area for improvement Recommendations for future response actions LOGISTICS Perform evaluation and preventative maintenance on emergency generators and ensure their readiness Restock supplies, equipment, medications, food and water Ensure communications and IT/IS operations return to normal Conduct stress management and after-action debriefings and meetings, as necessary FINANCE/ADMINISTRATION Compile a final report of response costs and expenditures and lost revenue for approval by the Incident Commander Contact insurance carriers to assist in documentation of structural and infrastructure damage and initiate reimbursement and claims procedures Documents and Tools Hospital Emergency Operations Plan Hospital Loss of Water Plan Hospital Loss of Sewer Plan Hospital Loss of HVAC Plan Facility and Departmental Business Continuity Plans 86

SEVERE WEATHER INCIDENT RESPONSE GUIDE Mission: To provide for the safety of patients, visitors, and staff during a severe weather emergency such as rain, flooding, etc. Directions: Read this entire response guide and review incident management team chart. Use this response guide as a checklist to ensure all tasks are addressed and completed. Objectives Implement Emergency Operations Plan and Severe Weather Emergency Response Plan Initiate facility hardening Protect patients, visitors, staff and facility Maintain patient care and medical management Restore normal operations as soon as feasible Immediate (Operational Period 0-2 Hours) COMMAND (Incident Commander): Activate the facility Emergency Operations Plan Activate Command Staff and Section Chiefs, as appropriate Establish incident objectives and operational period (Liaison Officer): Notify local emergency management of hospital situation status, critical issues and resource requests Notify local EMS and ambulance providers about the situation and possible need to evacuate or relocate patients Communicate with other healthcare facilities to determine: Situation status Surge capacity Patient transfer/bed availability Ability to loan needed equipment, supplies, medications, personnel, etc. Monitor weather conditions, structural integrity, and facility security COMMAND (Public Information Officer): Inform staff, patients and families of situation status and provide regular updates Prepare media staging area Conduct regular media briefings, in collaboration local emergency management, as appropriate (Safety Officer): Evaluate safety of patients, family, staff and facility and recommend protective and corrective actions to minimize hazards and risks OPERATIONS Assess patients for risk and prioritize care and resources, as appropriate Secure the facility and implement limited visitation policy Ensure continuation of patient care and essential services Prepare to implement emergency plans and procedures as needed (i.e., loss of power, water, HVAC, communications, etc.) Consider partial or complete evacuation of the facility, or relocation of patients and services within the facility Develop storm staffing plan and triggers for activation 87

Initiate facility hardening activities Designate an area(s) to accommodate community boarders including those who may be electrically dependent or have medical needs Distribute appropriate equipment throughout the facility (i.e. portable lights), as needed Determine timeline and criteria for discontinuation of non-essential services and procedures PLANNING Establish operational periods, incident objective and develop the Incident Action Plan, in collaboration with the Incident Commander Conduct a hospital census and identify potential discharges, in coordination with Operations Section Initiate tracking system for patients and arriving community boarders and visitors that will remain in the facility during the storm LOGISTICS Maintain utilities and communications and activate alternate systems as needed Obtain supplies, equipment, medications, food and water to sustain operations Obtain supplemental staffing, as needed Prepare for transportation of evacuated patients, if activated Intermediate and Extended (Operational Period 2 hours to Greater than 12 Hours) COMMAND (Incident Commander): Update and revise the Incident Action Plan and prepare for demobilization Continue to update internal officials on the situation status Monitor evacuation, if activated (PIO): Continue to monitor weather reports and conditions Continue with briefings and situation updates with staff, patients and families Continue patient information center operations, in collaboration with Liaison Officer Assist with notification of patient s families about situation and evacuation, if activated (Liaison Officer): Continue to notify local EOC of situation status, critical issues and request assistance, as needed Continue patient information center operations, in collaboration with PIO Continue communications with area hospitals and facilitate patient transfers, if activated (Safety Officer): Continue to evaluate facility operations for safety and hazards and take immediate corrective actions OPERATIONS Continue evaluation of patients and maintain patient care Cancel elective surgeries and procedures Prepare the staging area for patient transfer/evacuation Regularly perform facility damage assessments and initiate appropriate repairs Ensure the functioning of emergency generators and alternative power/light resources, if needed Initiate ambulance diversion procedures, if possible Continue or implement patient evacuation Ensure the transfer of patient s belongings, medications and records upon evacuation Maintain facility security and restricted visitation Continue to maintain utilities and communications 88

Monitor patients for adverse affects of heath and psychological stress Prepare for demobilization and system recovery PLANNING Continue patient, bed and personnel tracking Update and revise the Incident Action Plan Prepare the demobilization and system recovery plans Plan for repatriation of patients Ensure documentation of actions, decisions and activities LOGISTICS Continue evaluation of facility for damage and initiate repairs Continue to obtain needed supplies, equipment, medications, food and water Continue to provide staff for patient care and evacuation Monitor staff for adverse affects of heath and psychological stress Monitor, report, follow up on and document staff or patient injuries Continue to provide transportation services for internal operations and patient evacuation FINANCE/ADMINISTRATION Continue to track costs and expenditures and lost revenue Continue to facilitate contracting for emergency repairs and other services Demobilization/System Recovery COMMAND (Incident Commander): Determine hospital status and declare restoration of normal water services and termination of the incident Provide appreciation and recognition to solicited and non-solicited volunteers and to state and federal personnel sent to help (Liaison Officer): Communicate final hospital status and termination of the incident to local EOC, area hospital and officials Assist with the repatriation of patients transferred (PIO): Conduct final media briefing and assist with updating staff, patients, families and others of the termination of the event (Safety Officer): Ensure facility safety and restoration of normal operations OPERATIONS Restore normal patient care operations Ensure integrity of and/or restoration of utilities and communications Repatriate evacuated patients Discontinue ambulance diversion and visitor limitations PLANNING Finalize the Incident Action Plan and demobilization plan Compile a final report of the incident and hospital response and recovery operations Ensure appropriate archiving of incident documentation Conduct after-action reviews and debriefing Write after-action report and corrective action plan for approval by the Incident Commander to include the following: 89

Summary of actions taken Summary of the incident Actions that went well Area for improvement Recommendations for future response actions LOGISTICS Ensure facility repairs and restoration of utilities Restock supplies, equipment, medications, food and water Ensure communications and IT/IS operations return to normal Conduct stress management and after-action debriefings and meetings, as necessary FINANCE/ADMINISTRATION Compile a final report of response costs and expenditures and lost revenue for approval by the Incident Commander Contact insurance carriers to assist in documentation of structural and infrastructure damage and initiate reimbursement and claims procedures Documents and Tools Hospital Emergency Operations Plan Hospital Severe Weather Emergency Procedure Facility and Departmental Business Continuity Plans Television/radio to monitor weather Hospital Emergency Operations Plan Hospital Severe Weather Emergency Procedure Telephone/cell phone/radio/satellite phone/intranet for communication 91

Appendix1 (Command Team) 91

Appendix 2 (Emergency Codes) 92

Appendix 3 START Adult Triage Algorithm 93

Appendix 3 Jump START Pediatric Triage Algorithm 94

Appendix 4 Mettag 95

Appendix 5 Call List LIST OF INCEDENT COMMAND GROUP Name Position Bleep Office Fax Cell phone Prof. Mussad mohammed Alsalman Dr. Abdulaziz Abdullah Al-Saif Dr. Zohair Ahmed Al- Aseri Dr. Bader Bin Abdulrahman Al Jabri Mr. Mansour Saeed AlSuwaidan Mr. Hamdan Daham Alenezi Mr. Nasser Salash AL Thbaib Dr. Bader Bin Abdulrahman Al Jabri Mr. Mohammed Mofleh Dean 1316 70731 0505404073 Vice Dean for Hospital Affairs Incident Command (DEM Chairman) PIO Dean Office Liaison Officer (Medical Director) IT&C Branch Director Safety & Security Director Medical/Technical Specialist(s) Exec. Director of Services 0472 70546 2790 70544 72529 0500900750 2441 7-0874 7-1376 0555232711 70178 0505247802 4444 90101 9-1372 0556640995 1007 90400 9-1502 Medical Director 2441 7-0874 7-1376 0555232711 Director of Nursing 0059 9-0121 9-1148 9-1149 9-1128 0506200984 Mr. Motlaq Abdullah Alrasheed Exec. Dir. Of Patient Affairs Engr. Sayed Abdul Infrastructure Hafiz Hassanein Branch Director 0030 9-0299 9-1502 0507293425 Pro.Taj aldin Omar HazMat Branch Mlinbary Director 0786 7-1999 7-1746 0505417061 Mr. Ahmed Ali Security Branch Albashiri Director 1099 7-2469 91372 0557558582 Dr.Talal Daian AL Otaibi Supply Unit 2822 9-0134 9-1003 Dr. Zohair Bin Ahmad Al Aseri DEM 2790 71955 72529 0500900750 Mr. Sultan Al Rashid PCC 2772 90105 91474 0500414124 Dr. Mohammed Deputy Medical Ibrahim Almajid Director 2598 7-0778 7-1410 0500291291 Prof. Hana Ahmad Habib LABORATORY 0806 70881 72366 0504138199 Dr. Abdulmoneam Al Othman BLOOD BANK 1314 71314 71317 -- Dr. Ayed Mohammed Al Shamrani PHARMACY 1357 70882 71908 0504216978 96

Dr. Abdullah Dohayan Al Dohyan SURGERY 1312 71575 79493 0505477103 Prof. Ahmad Abdulrahim Turkstani ANESTHESIA 1045 71597 79364 -- Dr. Fawaz Fahad Al Jasir ORTHOPEDIC 1974 70871 79436 0555441161 Dr. Nizar Naqshbandi RADIOLOGY 2174 7199 71746 0503218878 Dr. Abdulaziz Hamad Al Zeer CRITICAL CARE 0196 79840 79461 0504410525 Prof. Mohammed Abdulaziz Al Sahger PSYCHIATRY 1134 71717 72571 0503762273 Mrs. Sara Al Banyan Central Supply Sterilization 1511 71053 0503110049 Mr. Haytam Mosleh ADON -DEM 2045 9-9188 0509442473 Ms. Rosely Varghese ADON- SURGERY 0056 7-1682 0535227590 Ms. Mhardiya Al Fad ADON- Medicine 0108 7-1209 0500950368 Ms. Maggie Taiwo ADON- OBGYNE 0189 7-1207 0502867474 Ms. Neda Salcedo ADON- OR 0115 7-1056 7-9161 0565132757 Physician's Name Dr. Abdulla Mohammed Ahmed Al-Sakka Dr. Abdulmoniem Mohammed Al- Mubarak Dr. Ahad Alhassan Saud Abdulaziz LIST OF ADULT EMERGENCY PHYSICIANS ADULT ER STAFF Computer Number Bleep Number Home Phone Mobile 14282 2587 4914105 0505416067 74074 3483 293-4249 0500820182 33861 0011 4704984 0552018681 Dr. Ahmad Fathy Al-maghrabi 75157 2851 4560039 0551245568 Dr. Ahmed Abdullah Bin Obaid 33779 1854 4566046 0557777756 Dr. Abdulaziz Sulaiman Al- Mehlisi 32757 0860 2329568 0555677701 Dr. Ala'a Eldeen Al-Jundi 72027 2332 4612536 0501807020 Dr. Ala'a Mostafa Sultan 71122 1904 4535960 0507850344 Dr. Asa'ad Sulaiman Mohammed Hamza Al Shuja'a Dr. Ammar Abdulkader El Sammra Dr. Adel Abdullah Obaid Al- Tamimi 14987 3482 ------ 0566699841 75181 2852 228-4973 0509424793 0546464573 19252 2251 2692392 0504877949 97

Dr. Adel Mohammed El Hardallo 77999 0414 ----- 0534624786 Dr. Bandar Youssef Al-Eissa 31996 0952 1878780 0555409299 Dr. Fahad Ibrahim Abuguyan 33785 1723 2269093 0555123944 Dr. Fawaz Abdulrahman Al- Tuwaijri Dr. Hossam Aldin Hassan Abdulrazik 22452 2883 4933554 0555046222 65978 0084 4212515 0509900593 Dr. Hani Ali Al Ibrahim 19564 2215 2634114 0506863412 Dr. Jalal El-Noor Yousif 67061 0845 2075022 0509425845 Dr. Khalid Abdelkarim Gabralla Hamed 77664 8818 ------ 0594111383 Dr. Majed Alawe Al Otaibi 34370 2564 4918459 0500114884 Dr. Mohammed Moustafa Izzideen 69966 2090 2075124 0506282167 Dr. Mohammed Owais Suriya 71117 1866 4682850 0509245053 Dr. Mohammed Shoukry Ibrahim Ahmed 70415 2016 2150062 0556080220 Dr. Mohammed Ahmed El Zubair 68871 2081 4044667 0506445749 Dr. Mohammed Mahamoud Mohammed Abdulrahim 76763 0627 ----- 0590052976 Dr. Mohammed Khalid Al-Ageel 32117 2770 4542557 0503225060 Dr. Mohammed Shami Al-Zahri 26585 3699 4866660 4854300 0557070703 Dr. Mushtaq Moh'd Ghulam Jilani 70114 2091 2934597 0568137763 Dr. Neda'a Mohammed Romaili 33995 1989 2624886 0507486314 Dr. Abdulaziz Dawas Al-Dawas 26369 3113 248-7160 0504222189 Dr. Abdulmajeed bin Mubarad 22805 2949 436-8039 0555449424 Dr. Bayan Abdullah Hassan Abdulbaqi 22868 2975 4664635 0504816557 Dr. Bashayer Al-Mahdi Al-Bogami 34081 8087 ----- 0503700074 Dr. Fatimah Saif Alibrahim 31647 1236 4760404 0503186158 Dr. Hanan Saad Al Zeer 24504 2340 4352488 0504485513 Dr. Mohammad Mosleh Al Gehani 30445 1061 48283553 0542135454 98

Dr. Mohannad Fahad Al Eeban 33919 8080 ------- 0504417952 Dr. Rakan Saleh Al Rasheed 23596 2506 2492250 0504250370 Dr. Yasser Abdulkarim Alaska 26368 2727 4505012 0555484463 Dr. Tariq Abdulrahman Jaber Al Thobaiti Physician's Name Dr. Abdulrahim Mahmoud Aljaraddah 20695 1478 2071033 0503350872 PEDIATRIC STAFF Computer Number Bleep Number Home Phone Mobile 70587 0088 279-2486 0504190367 Dr. Abdulshaheed Khan 72940 2965 ------ 0569100785 Dr. Adel Hassan M. Suleiman 71669 2071 N/A 0509774050 Dr. Hashim Mohammed Bin Salleeh 14529 2963 207-6007 0505203575 Dr. Lina Abdulaziz Al Bakry 21305 2434 ------ 05044515401 Dr. Mahmoud Mahmed Al Hag Ibrahim 67148 0271 450-9863 0502130641 Dr. Manal Eltoum Hassan Abou 66878 0067 468-2844 0507965044 Dr. Mohammed Abdulaziz Al Othman 19383 2794 ------ 0569760270 Dr. Mohammed Masirul Haque 69379 0048 484-4378 0502914263 Dr. Mohey Eldin Mahmoud Ismail Dowidar Dr. Moutaz Mohammed Kudaimi 68129 1523 402-5133 0503196836 69651 1524 281-4030 0503459115 Dr. Mudasir Mushtaq Ahmad 76282 1649 ------ 0535934219 Dr. Nazik Abdulaziz Al Bawardi 27222 2767 4709023 0506278883 Dr. Saleh Abdullah Al Tamimi 12885 2125 485-5905 0503442810 Dr. Sayed Ahmed Ammer 77725 2031 ---- 0502288455 Dr. Tahani Awad Al Ahmadi 25063 0261 468-2157 0505314996 Dr. Uzma Yasmeen Majed Kashif 77465 482-7202 056-917-4630 Dr. Varky Ashok 0560400552 Dr. Yasmeen Ahmed Sayed 65031 0604 468-2170 0506987319 99

IT Staff Staff Name Tel. Bleep Mansour Saad M. Al-Swaidan (IT Director) 7-0159 NA Khawla Al Harbi (IT Deputy Director) 7-9429 0996 Fairzia A. Lim( Administration) 7-0178 2952 Suha Ayoub( Administration) 7-2538 0760 Help Desk 9-1515 0808 Khalil Ibrahim Joudah (Supervisor) 7-9285 NA Imran Abdulrahman 7-1115 2953 Mohammed Sujath Ali 7-1424 0311 Raheemuddin Mohd. Saleem 7-9412 0995 Sari alsayed Mohd. Mofleh 9-1526 0148 Yahya Zakaria Sultan 9-1526 0709 Nelson Raul Patacsil 9-1526 0748 Salman Khalid Baksh 7-9430 0992 Majid Jazi Al Mutairi 7-9430 0390 Mohammed Shafeeq ur Rahman 7-1623 0273 Kamran Ahmed Khan 7-9432 0389 Abdulrazzak Pannam Kutil 9-9237 NA Mohammed Feroz Kamaruddin 7-1907 NA Mohammed Yakub Ali 7-9434 NA Warda Mohammed Bawazeer 7-2532 NA Najwa Abdulhaq Merriki 7-9295 NA Meshael Mubtil Al Otaibi 7-1906 NA Wasim Khalil Ali 7-0658 3384 Ramy Mohammed Mustafa 9-1523 NA Mohd. Mahmoud Mohd. Farghali 9-1523 NA Mohd. Mamdouh Abdulaziz 9-1523 NA 111

Ghada Nasser AlBakr 7-9042 NA Amro Mohammed Fekry 9-9236 3380 Ibrahem Ahmed Al Bajjaly 79927 NA Mustafa Majed Yamak 9-9238 NA Mohammed Aamir AbdulQayyum 7-1964 0349 Syed Afzal Ali 7-2613 3381 Mohammed Abdulnaim Aqter 7-1547 1173 Al Ameen Mohammed Khair 7-9433 NA Mohammed Abdullah Ali 7-9433 NA Khalid Abdullah Al Enizi 7-9413 NA Surgery Department GASTRO-INTESTINAL SURGERY GENERAL SURGERY LAST NAME M. NAME FIRST NAME Degree/Position FRCSC, Associate Professor & 1 Al-Naami Yahya Mohammed 2 Al- Dohayan Dohayan Abdullah Al- Bin 3 Tameem Mubarak COLORECTAL SURGERY Mohsin 1 Al-Obaid Abdulaziz Omar 2 Zubaidi Mohammed Ahmad 3 Al-Khayal Abdulmalik Khayal 4 El-Faroug Yousif Omer COMP. # PAGER OFFICE MOBILE HOME TEL Consultant 19985 2344 7-9417 0505756338 208-8477 FRCSGlas, Professor & Consultant, Chairman D/S 4630 1312 7-1580 0505477103 485-3379 Professor & Consultant General surgeon 1492 0505444036 249-1998 FRCSC, Asst. Prof.Cons Colorectal & Min. Inv Sur 13098 2903 9-5277 0500003071 207-0490 FRCSC, Asstistant Prof. & HEAD of G.S. 15369 2735 9-0804 0558293231 210-5169 FRCSC, FRCSC (Colorectal) A/Cons Colorectal Surgeon 16720 3444 9-0813 0555457003 454-2371 FRCS, Asst. Prof & Consultant 70125 0265 7-9165 0506459061 483-3580 ENDOCRINE/BREAST & ENDOCRINE SURGERY 1 Al-Shehri Yahya Mohammed 2 Al-Saif Abdullah Abdulaziz 3 Abdulkareem Abdullatif Amal 4 Gamal Aldin Ahmed Khairy Professor & Consultant General surgeon 28953 3529 7-0482 0505754117 468-0338 FRCS, FRACS, Asst. Prof. & Cons. Breast/ Endocrine Surg. 5216 0472 7-2503 0505409148 468-2873 American Board, Asst. Professor & Consultant 13993 0662 7-1137 0505203228 493-3408 FRCS, Assoc. Prof & Consultant 65333 2059 7-1586 0504586560 480-4725 111

VASCULAR SURGERY HEPATO-BILIARY SURGERY 1 Al-Saif Abdullah Faisal Al- 2 Qahtani Hadi Hamad HEPATO-BILIARY SURGERY 1 Safdar Mufti Mohammed 2 Anjum Nawaz Muhammad 468-2058 455-9116 3 Bokhari Abdullah Areej El- 4 Sayed Saad Magdy 5 Al-Enazi Abdullah Naif 6 Al-Alawi Salamah Khalil FRCSC, Asst. Prof. Cons Hep.- Pancreato Bil & Transplant Surgery 13068 3060 7-2541 567777288 General & Hepato biliary surgery 34113 2138 0554412324 FCPS, Senior Registrar 73634 2341 7-1474 567777288 FCPS, Senior Registrar 73523 3065 7-1474 0553490692 Saudi Board of General Surgery, Senior Registrar 18851 2099 7-1730 0505321298 FRCSI, Senior Registrar 70586 1658 7-1541 0530864560 General Surgery, Senior Registrar 2930 0505281314 General Surgery, Senior Registrar 76580 2130 0569496591 461-6062 480-0265 468-2670 PLASTIC SURGERY LAST NAME M. NAME FIRST NAME DEGREE/POSITION COMP. # BLEEP OFFICE MOBILE MD, FRCSC, Associate Professor, 1 Al-Jabri A'rahman Badr Head & Consultant 12166 2441 9-5273 0555232711 Al- FRCSC, FACS, Professor of Surgery & 2 Salman Mohammed Mussaad Consultant 3651 1316 7-1847 0505404073 Al- MD, MSc, FRCSC, Assoc. Professor & Omran A'rahman Mohammed Consultant 11899 2992 9-5272 0556885887 3 4 Iqbal Shikh Kaisor FRCS, Consultant Vascular Surgeon 68424 0366 7-2683 0507434432 5 Al-Nasr Mahmoud Tawfiq FRCS, Sr. Registrar 70474 1034 7-2683 0502810766 Al- Tuwaijri A'rahman Talal MB;BS, Sr. Registrar 17248 2400 7-2683 0505461649 6 7 Batheeb Abo Bakr Nabil FRCSI, Sr. Registrar 72487 1910 7-2683 0503197750 MB; Bch, SB of Gen. Surg. Fellow, 8 Zoghby Ahmed Kamal Vascular Surgery 2684 7-2683 0550556282 9 AlToijry Hamad Abdulmajeed MBBS, Demonstrator 25584 3617 0504141252 Al- Sheikh Omar Sultan MBBS, Demonstrator 24257 0252 0555356635 10 Home Tel 456-4126 493-1438 464-7681 468-2878 263-6959 481-8886 04 8461599 263-0212 112

Home Tel. NGH 4633 239-5602 275-7827 430-3087 480-5509 470-0544 470-9871 496-3357 LAST NAME M. NAME FIRST NAME DEGREE/POSITION COMP. # BLEEP OFFICE MOBILE FRCSC, Professor, Head & 1 Al-Qattan Manaa Mohammed Consultant 4555 0368 7-9481 0505274885 FRCSGlas, Assist. Professor & 2 Hassanain Mahjoub Jamaleldin Consultant 3397 0374 7-9386 0505417488 Al- Jordanian Board, Acting Consultant Shanawani Nawras Bisher Surgeon 17009 1789 9-0794 0505480950 3 4 Al-Zahrani Jaman Khalid Saudi Board of Plastic Surgery 16767 1917 0504226605 MRCS & Arab Board in GS, Sr. 5 Keyyali Essam Mohammed Registrar 70091 2015 7-1735 0508401571 6 Zeidan Ibrahim Mohammed FRCS, Sr. Registrar 72808 2659 7-1735 0507386268 7 A'Hamid Mahmoud Mokhtar MRCSEng, Registrar 74407 3639 7-1735 0559537517 8 Al-Arfaj A'Hamid Nawarah MB;BS, Registrar, Plastic Surgery 16624 2008 0554455142 9 Al-Humsi Riyadh Taghreed MB;BS, Resident, Plastic Surgery 20750 2542 0505150803 9 Al-Ghamdi Gormulla Hisham MB;BS, Demonstrator, Plastic Surgery 32373 1024 0504583466 Adult UROLOGY LAST NAME M. NAME FIRST NAME DEGREE/POSITION COMP. # BLEEP OFFICE MOBILE FRCSC, FACS, Assoc. Professor, 1 Rabah Manthar Danny Head & Consultant 12847 2554 7-2502 0500025806 FRCSEd, Professor of Urology & 2 Talic Fouad Riyadh Andrology 6007 0834 7-1591 0505440016 FRCSEng, Associate Professor & 3 El-Faqih Rashid Salah Consultant 3800 0550 7-1574 0556663430 FRCSC, Asst. Professor & 4 Alomar Abdulaziz Mohammad Consultant 12787 2544 7-9244 0500873796 Arahman 5 Bin Saleh Abd. Saleh FRCSC, Asst. Prof. & Consultant 14422 3620 9-0785 0502100034 6 Al-Turaifi El-Gaili Abdulmonem FRCS, Consultant Urologist 67147 0846 7-1473 0508997292 Home Tel. 201-2739 453-1467 468-3822 275-4905 207-4647 206-4003 Pediatric LAST NAME M. NAME FIRST NAME DEGREE/POSITION COMP. # BLEEP OFFICE MOBILE FRCSI, Assoc. Professor & Cons. 1 Fouda Neel Ali Khalid Pediatric Urologist 7221 1221 7-2561 0505183109 2 Al-Hazmi Hammad Ayed Hamdan Asst. Professor & Cons. Pediatric Urologist 18080 1996 9-0784 0555023263 Home Tel. 463-3429 454-9630 REGISTRARS & SENIOR REGISTRARS/RESIDENT LAST NAME M. NAME FIRST NAME DEGREE/POSITION COMP. # BLEEP OFFICE MOBILE Home Tel. 1 Sallem Abdallah Mahmoud FRCS, Senior Registrar, Pedia Urology 71927 2147 7-1473 0501394811 225-1295 2 Gomha Bahaaeddin Abdulmoneim Masters in Urology, Senior Registrar, Pedia Urology 74447 3651 7-1472 0503041778 456-6582 3 Mohamad Mohamad Ahmad MBSc, Masters Degree in Urology, Sr. Registrar, Pedia Urol. 77722 1928 7-1474 0566884656 4 Seida Atia, Atwa Mohammed FRCS, Registrar Urodynamics 71100 1547 7-1473 0502496240 215-2501 5 Abou Mustafa Abdullah Nebal Arab Board, Registrar, Adult Urol. 75329 2210 7-1473 0500692962 207-1736 6 Ahmed Siddique Tauheed M.S. Registrar 73245 2977 7-1473 0509440778 2051327 7 Adwan Ahmad Ayman Registrar 72862 2615 7-1473 0508262805 205-1327 8 AlThunayan Mohammed Abdulaziz MB;BS Resident 22732 2988 7-1473 0505244400 113

THORACIC SURGERY 1 LAST NAME M. NAME FIRST NAME Al- Nassar Abdulaziz Sami 2 Hajjar Mohammed Waseem 3 Kim Joon Dae DEGREE/POSITION COMP. # BLEEP OFFICE MOBILE MD, FRCSC, Asst Prof. & Head Consultant Thoracic surgeon 14728 1200 9-0143 0541499198 FRCS, Asst. Professor & Consultant Gen Thoracic 68937 1285 7-1994 0507240914 MD, Asst. Professor & Consultant Gen Thoracic 75215 2865 7-1538 0557814539 Home Tel. 248-9839 468-2324 415-7648 468-2344 488-6244 4 Rahhal Mahmoud Salah FRCS,.Registrar, General Thoracic 74030 3469 7-2259 0554701763 El- 5 Akeed Nageeb Ahmad MD, Registrar, General Thoracic 75230 1037 7-2259 0564979002 6 Ahmed Chaudary Iftikhar FCPS, Registrar, General Thoracic 76576 1469 7-2259 0546170453 NEUROSURGERY LAST NAME M. NAME FIRST NAME 1 Al-Habib Fayez Amro 2 Jamjoom Alabedeen Zain 3 El-Watidy Mohammed Sherif 4 El-Gamal Eldin Ali Essam DEGREE/POSITION COMP. # BLEEP OFFICE MOBILE FRCSC, Asst. Prof. & Consultant Neurosurgeon 15121 2641 9-0816 0506661582 FACHARZT, Professor, Head & Consultant Neurosurgeon 5343 0395 7-1678 0505480054 FRCS, Professor & Consultant Neurosurgeon 70066 1384 7-1680 0503187544 FRCS, Asst. Professor & Consultant Neurosurgeon 71715 2252 7-1273 0502989526 5 Malik Hussain Safdar FCPS, Senior Registrar 72232 2374 7-2594 0500708918 Abdel 6 Ahmed Raouf Aly MS, Registrar 71562 2038 7-2594 0509182098 7 Zakaria Mohammed Amr MS., Registrar 71755 1987 7-2594 0501839524 8 Zaidi Ghalib Syed FCPS Neurosurgery, Registrar 73740 2792 7-2594 0564517121 Home Tel. 488-7814 256-2366 468-0200 468-0300 279-1393 463-2167 293-5384 483-3971 114

PEDIATRIC SURGERY LAST NAME M. NAME FIRST NAME DEGREE/POSITION COMP. # BLEEP OFFICE MOBILE Home Tel. 1 Al-Jazaeri Hassan Ayman FRCSC, Asst. Professor & Consultant 14008 0811 9-0812 0565994455 435-2881 2 Al-Bassam Ahmed Abdulrahman FRCSEd, Professor & Head & Consultant 5564 0089 7-0865 0505233242 453-1029 3 Al-Qahtani Robiaan Aayed FRCSC, Assoc. Professor & Consultant 9881 1959 7-1593 0507475363 455-3788 4 Al-Zahem Mohammed A'rahman FRCSC, Asst. Professor & Consultant 12334 2743 7-1859 0554123320 426-3084 5 Mallick Mohammad Saquib FRCS, Assoc. Professor & Consultant 69876 1378 7-1733 0507419577 468-2444 6 Gado Mohammed Abdulmonem FRCS, Senior Registrar 66666 0587 7-9131 0504249362 468-2788 7 Al-Sayed Hamdy Osama MD, FRCSEd, Senior Registrar 73518 3062 7-9131 050906758 486-1211 8 Aziz Asher Muhammad MRCSI, Senior Registrar 76157 0912 7-9131 0544284938 9 Al-Shehri Fadl Abdullah MB BS; Demonstrator 26005 3679 7-9131 0500611122 10 Fallatah Mohd Amein Amnah MB;BS; Gen. Surgery Specialist, Fellow 3021 0505872114 38032599 GENERAL SURGERY - RMC LAST NAME M. NAME FIRST NAME DEGREE/POSITION COMP. # BLEEP OFFICE MOBILE 1 Alam Kurshid Mohammed FRCS, Professor of Surgery 56282 0201 7-9166 0501839507 Bin FRCS, Assoc. Professor of 2 Al-Salamah Mohamed Saleh Surgery 12907 0191 4359999 1243 0555221269 FRCS, Assoc. Professor of 3 Al-Aqeely Bin Hamed Mohammed Surgery 4657 0296 7-1472 0505485810 FRCS, Consultant General 4 Bismar A'Rahman Hayan Surgeon 66600 0372 1283/1210 0507908644 5 Gul Home Tel. 468-2556 421-1774 402-9516 419-6698 Malik Mushtaq Rahman FRCS, Senior Registrar 71771 2048 1283/1210 05012567431 4889454 6 Ibrar Hussein Mohammed FRCS, Senior Registrar 72658 2406 1283/1210 7 Anzari Uddin Fraz FRCS, Senior Registrar 72682 2549 1283/1210 0558256064 8 Abdullah Yaqoob Muhammad FCPS, FRCS, Senior Registrar 73972 1283/1210 0558254370 4681293 DEMONSTRATORS LAST NAME M. NAME FIRST NAME DEGREE/POSITION COMP. # BLEEP OFFICE MOBILE MBBS, Demonstrator, Vascular 1 AlToijry Hamad Abdulmajeed Surgery 25584 3617 0504141252 2 Al-Buraikan Adnan Ahmed MB;BS, Demonstrator - G.S. 25508 3605 0504169213 3 Al-Subaie Saud Hamad MB;BS, Demonstrator - G.S. 25513 3604 0502494949 4 Bin Drees Khalid Hind MB;BS, Demonstrator - G.S. 26663 3900 0504221868 5 Al-Qahtanij Mansour Saad MB;BS, Demonstrator - G.S. 24232 0267 0504786646 6 Al-Turaiki Abdullah Thamer MB;BS, Demonstrator - G.S. 25808 3603 05554449780 MB BS; Demonstrator, Pediatric 7 Al-Shehri Fadl Abdullah Surgery 26005 3679 0500611122 MB;BS, Demonstrator - 8 Al-Mutairi Sallem Fawaz Neurosurgery 0901 0559446060 MB;BS, Demonstrator, Plastic 9 Al-Ghamdi Gormulla Hisham Surgery 32373 1024 0504583466 Home Tel. 263-0212 248-8441 425-6986 233-7624 115

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