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Memorial Hospital of Converse County - DISASTER PLAN Policy and Procedure Section 1 - OBJECTIVES This plan is intended to establish procedures for receiving injured persons in the event of a disaster outside the hospital, and/or for relocation of patients to medical care facilities should complete Hospital evacuation be required. In general, the possibility of the Hospital receiving more casualties than the facility can adequately handle as determined by the Emergency Department staff shall be considered as constituting a disaster of sufficient scope to warrant placing this plan into effect. Deviation from placing the plan in full effect may be done at any time at the discretion of the Emergency Department physician on-duty. In the event of the need for evacuation of the Hospital premises or any part thereof, the disaster plan shall be placed in effect to such extent as deemed necessary in the opinion of the CEO or Medical Disaster Chief. It should be emphasized that if the situation appears to warrant decisive and prompt action, the person in charge of the Hospital (CEO), Safety Director or key medical staff members (Chief of Staff, E.R. Physician) is authorized to place this plan, or any portion thereof, into effect without seeking other authority or opinion. A. Personnel All Hospital personnel and physicians are asked to report to the Hospital upon hearing of the disaster. 1. Medical Staff All available physicians will be notified utilizing the local answering services. Assignments are found in the Disaster Plan Information and Assignments for Medical Staff supplement to this plan. 2. Hospital Staff All Hospital staff personnel are subject to recall and special assignments. 3. Outside Agencies Outside agencies may be contacted for assistance at the discretion of the Administrator or his representative. 4. Utilization Normal operations in all areas are subject to cancellation dependent on numbers of casualties received. 5. Employee Families Employees may bring their families and services will be provided. B. Traffic Emergency vehicles should bring patients to the Emergency Entrance utilizing Center Street and exit on Oak Street. Walking wounded and others will be directed to the ER entrance for triage and assignment. Maintenance shall be responsible for determining traffic control needs on the Hospital premises. C. Departmental Responsibilities 1. All departments shall be responsible for developing and maintaining a recall system for calling employees back to work in case of disaster. These rosters should be reviewed monthly to keep as current as possible. See DISASTER CALL TREES.doc 2. Department Managers shall be responsible for implementation of the department recall plan under disaster notification. If there is no phone communications, the command center will designate someone to go to employees' houses to pick up personnel and bring them in for emergency duty. 3. Individual departmental protocols are listed later in this plan. 4. Maintenance Department Head will be responsible for placing two (2) tables near the Hospital Main Entrance upon notification of a disaster. 5. Business Office personnel will assign 1 to 2 registration personnel (Office) at the Main Entrance tables. NOTE: No individual is to be permitted past the registration table unless they are properly identified. D. Elevators In the event of power failure, the North elevator will continue to operate on emergency power and under the direction of an elevator operator if deemed necessary. Employees will use stairs to the maximum extent possible in going to and from areas. Elevator use priority shall be as follows: 1. Emergency responding personnel for transporting patients 2. Surgery 3. Central Service supplies delivery 4. Dietary and linen delivery 5. Soiled linen and trash removal 6. Dead bodies E. Patient Transfers Some injured patients may require transfer to a special care facility. A list of Hospitals with which transfer agreements have been made is on file in the Administrator's Office. Patients will be transferred to outside facilities only on a physician's directive. The Disaster Command Group will assist in transportation and transfer arrangements upon request from the referring physician. F. Evacuation 1. Should a situation exist which necessitates evacuation of part or all of the Hospital, the same general implementation plan shall be followed. 2. The Command Center and opinion of the Chief of Staff or his representative shall be considered in arriving at the decision. The final decision will be determined by the Command Center leader. a. Primary evacuation shall be to the Converse County Courthouse. Secondary evacuation shall be to the Wyoming Law Enforcement academy Section 2 - COMMAND CENTER A. The disaster Command Center will be located in the Maintenance Department office; Hospital extensions: 1140, 1141, 1142 B. The disaster Command Group is composed of the following individuals: 1. Hospital Administrator, Ext. 1140 2. Safety Director, Ext. 1141 3. Vice President of Patient Care, Ext. 1142 C. When the Disaster Plan is initiated, the first person on the above team who arrives at the Disaster Control Center will coordinate all disaster operations until he or she feels the responsibility can be turned over to someone higher on the list without loss continuity. D. The duties of the Operations Director shall be: 1. To affect the Disaster Plan and to order it's deactivation. 2. To determine the need to coordinate information with: a. Civil Defense Director. b. Law Enforcement. c. Coroner. d. Douglas Ministerial Association Representatives and Solution for Life. 3. To appoint a person whose duty is to physically verify that each department is actively recalling their department, and relay any assistance needed to the Operations Director/Command Group 4. Decide on recommendations from the Directors/Department Managers that staffing procedures are necessary, e.g., 12hour shift 5. Assign personnel as needed to proceed to areas of urgent need. 6. The Chief of the Medical Staff shall be responsible for all medical decisions. When it is necessary to make an immediate decision, either professional or administrative, the Hospital Administrator, Chief of Staff or the Operations Director shall have the authority to make such decisions. E. CEO or Vice President of Patient Care will determine information to be given to the media. 1. A person shall be appointed to act as Liaison to the media. 2. News media personal will not be allowed into the healthcare facility. 3. Cameras will not be allowed in or used inside the facility. F. A person will be assigned to call key personnel who have not arrived. They will also arrange for personnel pickup if needed. see DISASTER CALL TREES.doc Section 3--PERSONNEL RECALL see DISASTER CALL TREES All personnel recalled should use the main entrance, where a computer list with photo of employees will be used to verify that only hospital employees will be admitted. A. Responding staff may bring families: 1. Childcare services will be provided and employees will be informed where children are to be taken. 2. Adult family members may be used as volunteers and will be located in the cafeteria. B. Communication Policies 1. No personal calls will be permitted from Hospital telephones. 2. Incoming personal calls shall not be accepted. 3. Incoming calls to the Command Center should be held to those essential to avoid jamming available lines. 4. Requests for lab work should be ordered by computer, when possible, to the laboratory to keep phone lines open. Section 4 - MEDICAL STAFF A. The internal flow of casualties must be strictly controlled to prevent delay in caring for the coming patients. Patients will be received in the Triage Area and will flow to Treatment Areas after being tagged by Triage Physicians. Flow from the Emergency Treatment Areas will be to the north elevators to the assigned nursing division. Flow of the Minor Injuries will be to the Outpatient Services area. B. Triage (Receiving and Sorting) 1. Medical Staff will report to E.R. and be assigned as designated by the Triage Officer. The assignments will be directed by the medical chief of staff 2. Triage shall occur in the E.R. just beyond both doors from ambulance entry. All casualties will be received through the ambulance entry. 3. Each patient not already tagged, will be tagged with a disaster tag at the Triage area. This is the responsibility of the admissions personnel assigned to triage disaster victims. THE TAG IS TO REMAIN ATTACHED TO THE PATIENT UNTIL REMOVED AT THE TIME OF DISMISSAL. Triage doctors will write on the disaster tag any instructions concerning each casualty and will direct them to one of the treatment units. a. One of the numbered pieces of the tag should be removed from the disaster tag and placed inthe plastic bag with clothes and valuable for identification (See Appendix A). 4. Also, each casualty is to be listed on the Disaster Casualty List Form (Appendix B). One copy of the List is to be sent to the Control Group and one copy to the Information Center. The original Disaster Casualty List is to be kept in the Triage Area – this will be Admitting's copy and should be retained by them until proper admitting records can be completed following the disaster. 5. The Triage doctors will evaluate the casualties as they are received in the Receiving Area and they will classify the patients according to severity and place each patient in the following categories: a. Casualty Categories 1) GREEN-Minor Injuries, minimal treatment, small lacerations, contusions, closed fractures of small bones, and other relatively minor injuries. Treatment will be provided in Thunder Basin Orthopedics clinic; patients will be escorted immediately to Thunder Basin Orthopedics clinic for treatment, after triage and logged in patient roster. 2) YELLOW-Delay Medical or surgical care; lacerations without bleeding closed fractures of major bones and second degree burns to 20% of the body surface. Prognosis Good. These patients are to be triaged and sent to Out Patient Surgery area. 3) RED-Urgent Need of medical or surgical care. Immediate treatment for hemorrhage from accessible site, sucking chest wound, open fractures, respiratory obstructions or distress. PROGNOSIS FAVORABLE WITH IMMEDIATE MEDICAL CARE. 4) BLACK-Dead Temporary morgue (shelled space). Section 5 - THIRD FLOOR NURSING A. ACTIVATION OF CODE DELTA 1. The Switchboard will announce Code Delta three (3) times once a disaster status has been activated. 2. The Switchboard will then notify 911 if they are not aware of the disaster. 3. The Switchboard then begins the on-call list while a designated person notifies Administration. B. WHO IS IN CHARGE 1. At the time of a CODE DELTA announcement, the Medical/Surgical Charge Nurse or Nurse Manager, upon their arrival on the unit, will be responsible for directing the unit. 2. All communication of discharges or admissions will be through this Charge Nurse/HUC. All requests for supplies or staffing will be directed through this Charge Nurse. C. INITIAL ACTIVITY 1. The Charge Nurse will initiate a list of patients for potential discharge or transfer to collaborate with the designated Discharge Physician 2. The Charge Nurse will determine the number of staff needed and ensure that the disaster call list has been initiated, determine number of staff available to come in when needed and how often staff need to be rotated. 3. The Charge Nurse will delegate staff to handle discharges. Discharge documentation will be completed traditionally – utilize center stairwell or north elevator 4. The Charge Nurse will delegate staff to: a. Prepare blocks of rooms for admission of disaster victims; b. Check rooms for complete units: BP cuffs, IV poles, oxygen, suctions, etc; c. Check floor stock for adequate supplies: linens, warmed blankets/fluids, IV pumps, wheelchairs, medical supplies, medications, IV supplies, etc. D. PERSONNEL ARRIVAL 1. Report to Charge Nurse at the Nurse's Desk on 3rd floor. 2. The Charge Nurse will delegate team members block assignments. E. RECEIVING PATIENTS TO 3RD FLOOR 1. Each staff member will function according to each person's job description. 2. Volunteers assigned to each area will be utilized for paperwork, reporting need of supplies to Charge Nurse, acting as a runner for supplies and hand carrying lab, x-ray, and diet requests. 3. The Red Crash Cart will remain on the 3rd floor. A Code Team will be available as traditionally done. F. COMMUNICATION POLICIES 1. The Charge Nurse will contact the Command Center (Maintenance Dept, Extension 1140) for needed staff or equipment. Remember – personnel recalled should use the main entrance, front doors where a computer list of the employee's and their occupation will be maintained. Recalled personnel must be identified by means of the computer list, or personal recognition before their entrance will be authorized Remember: a. No personal calls will be permitted from Hospital telephones. b. Incoming personal calls shall not be accepted. c. Incoming calls to the Disaster Control center should be held to those essential to avoid jamming available lines. d. Requests for lab, x-ray, or respiratory therapy work should be entered by computer when possible to the lab, x-ray, or respiratory therapy departments to keep phone lines open. Section 6 - CARDIOPULMONARY A. On call Respiratory Therapist will respond immediately to a 777 page or a 999 page. B. The cardiopulmonary Manager/Respiratory Therapy Charge/Night Call Therapist will assume charge of the RT staff for the Event. C. The Respiratory Therapist on Scene will determine the number of RT staff members needed and will initiate the call tree. D. The Charge RT/Manager will notify the Receptionist of RT staffing needs. E. Depending on number of patients and need, E size Oxygen tanks w/carts will be brought to the staging area. F. All staff will report immediately to the ER Staging Area and RT Charge/Manager will delegate duties as follows: 1. Therapist will be assigned to Med/Surg to continue Inpatient care 2. Therapist will be assigned to the patients requiring breathing assistance/Intubation 3. Therapist will be assigned to do testing as time and manpower permit 4. Therapists may be assigned to other areas of the hospital as needed when above duties are covered G. All RT staff will have radios on for communication purposes. H. In the event that large quantities of Oxygen are needed, Airgas from Casper will respond immediately to our needs: 307-265-8410 (AFTER HOURS CALL: 307-660-5981 Viktor Strayer, Manager) Section 7 - LABORATORY A.PERSONNEL NOTIFICATION 1.Notification by telephone or trauma paging system: a.ER personnel will notify the technologist on-call (either by telephone or by activating the trauma paging system), who will notify the laboratory personnel as needed according to the telephone triage. b.Additional phlebotomists will be notified by laboratory personnel if necessary. c.Volunteers will be assigned by the Command Center if needed 2.Particulars must be known to identify the disaster to personnel: a.“Who, what, where, and when” questions need to be answered immediately to define the disaster. b.Clear and concise information should be given for all stages of communication. B.PERSONNEL ATTENDANCE 1.Available laboratory personnel will report to their duty area and perform laboratory services as needed. 2.Disaster situation will dictate where and how many personnel are needed. 3.Personnel will remain on duty until notified that the disaster is over. 4.If no laboratory services are required, personnel will assist as needed. 5.Laboratory personnel will KEEP CALM 6.Call the Command Center to repeat which personnel have not been contacted so the Command Center can continue to call them. C.PROCEDURE IN THE EVENT OF A DISASTER 1.Laboratory personnel will be dispersed as needed by the Laboratory Supervisor or Senior Technologist present. a.One (1) Phlebotomist will be dispatched to the ER. He/she will be sent to 3rd floor, OP Services, and/or Radiology as needed and available. b.Supplies necessary to take on the phlebotomy tray. One or more phlebotomy trays may be taken with the phlebotomist depending on the scope of the disaster: 1.)Syringes and needles 2.)Alcohol wipes and cotton balls 3.)Tubes suitable for the Trauma Panel and blood banking. 4.)Tourniquet(s) 5.)Marking pens 6.)Blood banking identification bands 7.)Gloves and infection control materials c.Patient Identification: 1.)Patients will be identified by the computer generated Medical Record number and/or the blood bank band number 2.)Laboratory requests will be entered in to the Hospital Information System by available personnel. Laboratory orders will be written on a clip board that will accompany the patient or on the ID tag attached to the patient. a.)In the event the Hospital/Laboratory Information System is not working, orders may be written on Laboratory slips. 3.)The phlebotomist will perform the venipuntures. The patients will be drawn in accordance with the “Trauma Panel” and proper phlebotomy technique. a.)The phlebotomist will initial the clipboard, label tubes with pertinent information:  Patient name and/or Medical Record number (and/or blood bank band number) Time drawn Date drawn Test(s) requested Physician/PAC Initials4.)Red blood banking bands will be put on the patient's wrists, or ankles as needed. THESE MAY NOT BE REMOVED!!! d.One person will be assigned as a Runner (this position may be filled by a volunteer): 1.)Keep supplies current 2.)Transport specimens, reports, supplies and/or orders between the laboratory and the disaster stations 3.)Transport blood and blood products 4.)Keep lines clear for communication. e.Technologists will work in their assigned department as much as possible: 1.)All orders will be entered into the Hospital Information System by available personnel. 2.Volunteers will be assigned by the Command Center: a.Transport specimens and/or act as Runners b.Transport results to various departments c.Call blood donors d.Screen blood donors e.Pick up blood/supplies f.Act as Phlebotomists if qualified. D.BLOOD BANK PROCEDURE 1.Technologist on duty will follow the blood bank procedure as listed on the Laboratory Disaster Inventory Sheet (see Appendix XX) a.Make a list of blood and components immediately available in the Laboratory Blood Bank b.Call Pharmacy (Extension #1128) for a list of blood expanders available (i.e., Dextran, Plasmanate, Albuminsol) c.Call Blood Services and inform them we have a disaster and request an inventory of blood and/of blood products available: 1.)Specify this is a disaster and request the fastest mode of transportation 2.)Stress that we need rapid attainment of blood and/or blood products (i.e., charter plane, highway patrol) 3.)Blood, blood products, typing sera, and additional supplies are also available from United Blood Services. Request these if needed 4.)Record what time they are shipping, what has been ordered, by what means of transportation, what time blood will arrive, and where it will arrive on the Laboratory Disaster Inventory Sheet. d.Call the Command Center (Extension #1140) and inform them on the arrival time of the blood and by what means of transportation 2.Technologists will give requests for blood transfusions top priority: a.According to the scope of the disaster, use the “Emergency Crossmatch” and “Emergency Release of Blood” procedures b.If time permits, cross matching will be done c.All paperwork connected with the disaster will be completed as per laboratory policy after the disaster d.Perform procedures in the order they are received, using Laboratory judgment to prioritize work accordingly. e.If additional supplies are needed, contact Wyoming Medical Center (307-577-2365). E.PROCEDURE IN THE EVENT THAT UNITED BLOOD SERVICES CANNOT SUPPLY US WITH NEEDED SUPPLY OF BLOOD AND/OR BLOOD PRODUCTS 1.United Blood Services inventory is such that this should not occur: a.Units available 2 hours from here in Cheyenne b.Units available in Casper c.Over 200 facilities from which to draw supplies d.UBS now can draw on units from Billings, Montana, as well. 2.UBS would be responsible for supplying MHCC with required blood products. F.PROCEDURE IN THE EVENT OF A POWER FAILURE 1.Emergency Power: a.The following sockets are on emergency power: Blood Bank—Red socket on South wall Freezer—Red socket on the East wall Hematology—Sockets on the South end of the counter Microbiology—None. Use extension cords to provide power to essential equipment Break Room—None Chemistry—sockets on the South end of the counterb.The orange sockets are dedicated lines and are not on emergency power c.Emergency Lights: Main Lab—Six lights in middle A drop light is provided for G.PROCEDURE IN THE EVENT OF LOSS OF WATER 1.For laboratory procedures, sterile bottled distilled water will be used. 2.Personnel will conserve on drinking water and use of toilet facilities. 3.A five-gallon container of distilled water will be stored in Central Supply H.PROCEDURE IN THEEVENT OF RELOCATION 1.Use the posted lists to pack necessary supplies to go to the new location. 2.Equipment can be moved provided there is power at the new location. 3.Instruments would be moved by Laboratory personnel and maintenance 4.Blood and/or blood products will be packages in insulated containers suitable for short-term storage 5.Close door and windows in the Laboratory. 6.Turn off gas and electrical instruments 7.Seal flammable liquids. 8.Remove any patients in the Laboratory 9.Cooperate with other departments in helping to transport patients. Laboratory Disaster Check Sheet Section 8 - CARE OF THE DEAD A. If a casualty is obviously dead upon arrival, the body should be unloaded here. The Triage Officer should pronounce the casualty dead, and the body taken to the location of the temporary morgue which shall be the shelled space, and shall be accessed through surgery hallway. B. Casualties that expire after they are here in the Hospital will be taken to a temporary morgue established in the Hospital. The morgue will be under the direction of the County Coroner. C. Valuables are not to be removed from the bodies. Protection of the valuables for the deceased shall be maintained by the Security Force. D. Bodies are to be placed so that the faces may be plainly seen for identification. E. After identification and release by the Coroner, bodies may be removed by private Morticians. The families of the deceased must designate their choice of Mortician. Complete records must be kept on the disposition of the dead, and the Mortician must sign for each body that he removes. The disaster tags must be removed by personnel from Admitting before the body is removed by the Mortician. F. A Security Guard should be assigned to this area. G. Bodies may only leave the morgue after they are released by the County Coroner. If back-up is needed, contact: Platte County Funeral Chapel ---------------- 322-2384 Converse Funeral Chapel (Gorman)--------- 358-3843 Section 9 - RADIOLOGY 1.All Radiology employees must maintain a current Radiology Department Employee Emergency Call Tree at their home. 2.All Radiology personnel are subject to recall and special assignments during a disaster. 3.Normal operations in all areas are subject to cancellation dependant on the number of casualties. 4.Employees should enter on 1st floor through main entrance where a computer list and a photo I.D. will be used to verify that only hospital employees are admitted. 5.Employees may bring family members with them during a disaster if necessary. 6.Adult family members can be used as volunteers if necessary and can get assignments near command center (Maintenance area). 7. On-Call Radiology employees carrying pagers will respond immediately to pages 777 or 999. 8. In the event of a disaster, the technologists on duty or, if after hours, on-call for the radiology department will be contacted by ER personnel. 9.These employees will immediately contact the radiologist, R.P.A., and department manager and implement the department call-tree. 10.X-Ray equipment, CT Scanner, and Ultrasound Machines should be turned on and warmed up and portable X-Ray Machines should be taken to ER. 11.The department manager, or if not available, designee, will be responsible for executing duties as outlined on the department disaster job action sheet (posted at tech computer workstation). 12.Radiology personnel will make themselves available to help in other areas until such time that Radiology Procedures are ordered and remain to help in radiology or other areas as needed. 13.During a disaster, all carts not being used, should be taken to the Materials Department for supply distribution. 14. During emergencies, employees and volunteers are to use stairs to the maximum extent leaving elevators for patient transport and supply delivery. 15.In case of power outages, the IS department should be contacted to reboot server if needed to get radiology equipment operational. If there is a power outage and there is no one on site from I.S., contact the on-call I.S. employee. The plate reader, viewer, portable units, C-arm, ultrasound units, and Dry Pix unit will remain operational, but PACS will not. 16.The network cable from the Radiology work area viewing station should be connected directly to the Dry Pix film printer to enable film image reproduction for possible patient transfers. 17.During a power outage, Radiologic images will be available for viewing from the Radiology Department workstation. 18.Phone lines should remain open, no personal phone calls should be made from hospital phones. Section 10 - SECURITY The Facilities Security shall coordinate security to include traffic control, all Hospital entrances, and all entrances within the Hospital. Additional personnel to assist in this function will be requested from the Command Center. Security will be provided by the hospital Maintenance and Environmental Services Departments. A call will be made to the Sheriff's Office/Douglas Police Department if additional support is needed. In the event the local law enforcement cannot provide adequate security, the WLEA shall be contacted and law enforcement staff from the agency may be considered for security. A. Maintain security and control traffic, allowing only authorized personnel* in at the following locations: 1. Main Entrance – 1st floor B. Check off authorized personnel on master employee list, which can be obtained from the Business Office or Human Resources. Section 11 - BUSINESS OFFICE During a disaster, the Business Office will be responsible for handling the incoming telephone calls and collecting patient information from the 2nd floor. A. The first person to arrive at the Business Office will be responsible for calling in all personnel using the Call Tree Lists. This individual will be in charge of the Business Office until the Business Office Manager arrives. B. The second individual that arrives will be responsible for establishing the patient information station in the Main Entrance Lobby. C. The Business Office will be responsible for a master employee list with addresses and phone numbers to assist with calling in personnel and assisting security with authorization of personnel. A pool of other professional personnel that may be available in the community will be made available to the Command Center by the Business Office. D. Employees will be informed where child care has been set up for their children. E. The individual that collects the information from the 2nd floor will be responsible for this going to the Business Office every hour. 1. This information will be brought to the Business Office and sorted. 2. The first group will contain the information on the patients that are going to be admitted to the Hospital. 3. The information for the out-patients will be organized in alphabetic order. The information that we have from the patient tag will serve as the only information type of a situation, the information will be very limited and our normal procedure for signed papers along with detailed information will need to be set aside. F. The following positions will be (if they can come in) responsible for: Receptionist - Handling the switchboard Admissions Staff - Help with the incoming calls and answer questions Administrative Assistant - Runner for Administrator Admissions Supervisor - Help with all patient discharges and/or help in E.R. with triage Collections Staff - Will be Runner for Business Office Business Office Manager - Will help coordinate the other areas that are needed and fill-in where needed Patient Account Representatives - Will help coordinate the other areas and/or be available for another Department Section 12 - PHARMACY A. Call Pharmacist and/or Back-Up Pharmacist/Pharmacy Techs Joy Johnson R.Ph. - 358-2464 Tanisha Dexter - 359-1117 Safeway Pharmacy - 358-1706 Frontier Pharmacy - 358-5077 Pamida Pharmacy - 358-3386 B. Immediately update all emergency drugs and supplies from E.R., upon request (refer to list in Pharmacy and the E.R. and 3rd Floor). C. Pharmacy and Lab will be notified immediately the possible need for blood expanders. United Blood Services (Casper) - 307-237-2328, (Cheyenne) - 800-456-7057 D. Volunteers may act as Runners and deliver drugs to areas as needed. E. Monitor supplies routinely throughout the disaster: 1. Wyoming Medical Center in Casper will supply us with emergency drugs if they are not involved in a disaster. This is confirmed by letter on file in the disaster file. Wyoming Medical Center - 307/577-7201 or 800/822-7201 Wyoming Medical Center Emergency - 307/577-2222 Wyoming Medical Center Pharmacy - 307/577-2131 Cardinal Wholesaler - 1-800-678-7889 or 1-800-548-0510 Life Flight – Casper (800/442-2222) Section 13--MAINTENANCE If a disaster is called because of interrupted utilities; gas, electrical power, and water or if a disaster is called because of severely cold weather; tornado or flooding, the following steps will be exercised: Our Call Tree: Person on-call will be paged, and in turn, call the alternate. 1. First maintenance man at the Hospital needs to check operation of plant. 2. Call Control Center (Ext. 1141) and tell them condition of plant and utilities. 3. If water services are interrupted, emergency supplies are available in Laundry to be distributed as follows by the Maintenance and Environmental persons available: a. Dietary (2 drinking water) b. O.R. (1 non-potable) c. O. P. (1 non-potable) d. 3rd Floor (2 drinking water, 2 non-potable) e. X-Ray (1 non-potable) f. Mechanical Building (1 tank) g. 1st Floor Bathrooms (1 non-potable) If a disaster or mini-disaster is called due to a bus/car wreck, fire or other such similar incident where loss of utilities are not experienced, then the following steps will be exercised: 1. The Maintenance/housekeeping persons will lock all outside doors and stand by the ambulance door directing traffic to E.R. admissions until a Law Enforcement Officer can take over this duty. 2. Assist in moving equipment and setting up emergency areas, morgues, etc. 3. Will set-up decontamination area under E.R. canopy if needed. The following is a list of places that will assist MHCC if a disaster is called: COMPANY Kinder-Morgan SERVICE Natural Gas TELEPHONE 1-888-449-7539 COMPANY Link Oil SERVICE Heating Oil, Diesel TELEPHONE 307-358-2383 358-6129; 359-1635; 351-0135 COMPANY Culligan Water SERVICE Potable Water TELEPHONE 307-358-2891; 359-3233 COMPANY City of Douglas (Adminitrator) TELEPHONE 307-358-3462 COMPANY City of Douglas Public Works TELEPHONE 307-358-9750 COMPANY Rocky Mountain Power SERVICE Electricity TELEPHONE 1-888-221-7070; 1-877-548-3768 Section 14 - PHYSICAL THERAPY A. Physical Therapy staff will respond to any disaster called in the community. If phones are operational, Chuck Mangus will be called; he then will call in the remainder of the staff. B. All staff members responding to a disaster will bring a functional flashlight from home. Family members will be allowed into the building to volunteer their services. C. First person to arrive secures the following after unlocking the area: 1. Light Sources Needed: Could function with 2 flashlights; need to light main treatment area 2. Water - Need drum of water with a bucket. Heated water is not necessary. 3. Casting Supplies (secure from Central Supply). Need on hand; sandbags, immobilizers, cast materials. D. Volunteers will assist with positioning, holding lights, transporting patients to next area. Volunteers can be found at the Command Center. E. Physical Therapy staff will assist in immobilization of extremities in the Emergency Department and 3rd floor. Staffing of these areas by P.T. will be delegated by the therapist in charge for that day. F. Once stabilized, patient to be transferred to floor or to the hallway past Purchasing. G. Stabilize all neck, spinal injuries first; then compound factures. Section 15 - ENVIRONMENTAL SERVICES A. Upon arrival to hospital, the staff will assume these responsibilities: 1.The first person to arrive will go to the ER to assist with ER operations, cleaning spills, clearing equipment, gathering laundry, etc. as the situation dictates. 2.Second person to arrive will man the 1st floor front door and direct persons to the cafeteria area. Under no circumstances will persons other than staff be allowed on the 2nd floor until the physicians request family consultation and only then will they be allowed to go to the 2nd floor waiting area. This station will be maintained until Law Enforcement arrives and releases the Environmental person. 3.Third person arriving will assume laundry/linen duties to facilitate needs of the staff. NOTE: Upon arrival to the laundry area, all available linen will be divided between ER and 3rd floor. These will be taken to each area with the white laundry tubs. Laundry will be accomplished as needed. In the event that more laundry facilities are needed, contact: Clay Street Laundry (Rick Marler) - 358-8085 or 358-9338 In the event that we need more linen, contact: Michael Manor - 358-3397 Wyoming Law Enforcement Academy - 358-3617 4.Fourth person arriving will act in any capacity that Command Center deems necessary. B. When the situation arises, a person from Environmental Services (Building Maintenance if available) will assist in setting up or moving equipment in conjunction with Maintenance person(s). C. When a Code Delta (Disaster) is activated, the person on duty will do the following: 1. Call Environmental Manager or on-call person. During working hours, person on-call will initiate the Call Tree. During non-working hours, Maintenance will initiate the Call Tree. 2. Start phone tree by calling first person on this list; if no answer, go on to the next name. When the all Tree, calling the remainder of the staff. After the individual calls are made, a call will be made to Memorial Hospital of Converse County to notify the number of persons that can be available. 3. Lock ER East door, Cafeteria, and all first floor doors other than Main Entrance. 4. The initial call will convey the disaster as such; a drill or disaster. Person who continues the Call Tree will let the phone ring at least 4 times for each person. Disaster drills will be prefaced with the acknowledgement, “This is a Disaster Drill – if it had been real, could you have come in?” Section 16--MATERIALS MANAGEMENT A.The Materials Management Department will need 2 or 3 volunteers to help distribute supplies. 1.Volunteers will be issued large quantities of med/surg supplies to be taken care of where needed. 2.Supplies will be issued out by writing them all down in the sign out book. B.All carts shall be collected and taken to the Materials Management Department to be stacked with emergency supplies as needed. 1.Carts and boxes will be used by volunteers for convenience sake C.Wyoming Medical Center I Sasper, Wyoming will be our emergency supplier if they are not involved in a disaster. Wyoming Medical Center - 1-307-577-7201 Section 17--HEALTH INFORMATION MANAGEMENT A. In case of disaster, the telephone tree calling system will be implemented immediately. Each employee is given a copy of the telephone tree to take home with them. There is also a copy of the tree in the Green Disaster Manual in the Health Information Management Department which is kept on the wall across from the reception desk. B. Once called, employees are to respond immediately and will report directly to the Health Information Management Department. As help is needed, we will be contacted. Section 18 - DIETARY Once the Disaster Plan is activated, the department will initiate the following: A. Procedure 1.Between 5:00am and 7:00pm the following steps will be taken: a.Dietary personnel will report to work as scheduled with additional staff recalled as the Dietary Manger sees fit with regards to the state of the emergency. (Dietary Call Tree/Scheduling Policy) b.Vendors will be notified by the Dietary Manger as to the requisition of additional supplies. Sysco Food Services of Montana 406.247.1110, 407.247.1136, 307.277.8911 Douglas Grocery 307.358.3446 Sara Lee (Earthgrains Bread) 307.256.8170, 307.262.9118 Safeway 307.358.3446 c.Dietary Staff will begin ration counts and preparation of disaster meals. d.Patient meals will be served as close as possible and feasible to normal operating meal times. All patients on restricted diets will continue to be served according to restrictions and times, with diabetic patients receiving all nutritionally deemed necessary meals and snacks at the normal operating times in accordance with ration levels. Patients on regular diets and diets as tolerated will be served based on nutritional needs, food supply and the current plan for rationing the food supply. A sample menu is below: Breakfast: Scrambled eggs (16 oz), three (3) bacon slices, two (2) slices of toast. Lunch/dinner: Lunch meat sandwich, bag of chips, small side salad and/or 7.5 oz can of soup. All patients will be removed from room service e.Disposable plates, bowls, forks, knife, spoons, cups and napkins will be used for all meals. f.The Cafeteria will offer meals to the staff according to supply counts and general nature of the Disaster. 2.Between 7:00pm and 5:00am the following steps will be taken: a.The switchboard will notify the Dietary Manger, who will activate the Dietary Call Tree, recalling staff as needed and modifying scheduling applications of the staff while informing them of the situation. b.All scheduled employees will report to the kitchen. c.Steps above (A. b. through f.) will be taken B.In case of power failure: 1.Traffic will be limited to all the food storage areas, no unnecessary entry or opening of doors. 2.The outdoor grill will be lit in order to prepare many entrees for the day, based on supply. 3.Coffee and hot water will be dispensed into a hot storage container, air-pots. 4.Perishable food will be used first, dairy and items which were on the menu for that day, followed by any items that have a twelve (12) hour shelf-life, defrosted meat, followed in sequence by an eighteen (18) hour shelf-life, twenty-four (24) hour, thirty-six (36) hour. 5.Chafing dishes will be used with lit sterno fuel to keep cooked food at or above the mandatory temperature of 145 degrees F. The only other application is to heat soup from cold, preserved or canned state. 6.Battery powered flashlights and lanterns will be dispensed by the Dietary Manager for use throughout the kitchen area. C.Emergency water Supply (Emergency Water Service Maintenance Procedure) 1.All water bottles will be counted and moved to dry storage for centralized pick up if needed. D.Evacuation (Upon notification by the command center) 1.Money will be removed from the two (2) cash drawers and placed in the safe; safe will then be locked and checked for security. 2.All patient diet cards, sheets, printouts, and medical/nutritional assessments in Dietary's immediate possession will be taken with the Dietary Aid on duty and, or the Dietary Manager. Section 19--EMERGENCY DEPARTMENT A. In case of disaster, the telephone tree from the E.R. and on-call personnel will be implemented immediately. This list is found in the E.R. Policy/Procedure. B. All doctors will be notified as well if not already in the Hospital. C. The on-duty nurse in the E.R. will assume the role of triage nurse using the protocol of the E.R. Policy/Procedure, “Triage of Emergency Patients. As the E.R. staff arrives, one nurse is designated as the triage nurse (the on-duty nurse may continue in this capacity if not needed elsewhere). D. E.R. personnel will inform in-house personnel responding to the E.R. on the nature of the disaster. E. One nurse will be assigned to one or two patients by the E.R. triage nurse. He/she will also keep track of his/her patient's whereabouts, i.e., when the patient went to x-ray and when returned, when lab was drawn and when results return. A chart will be kept on the patient's gurney which pertains to patient's name and number, lab, x-ray, and R.T. orders. F. The Admissions Clerk on 2nd floor shall be used Monday – Friday from 0730 to 1530 hours. That person will be delegated by the E.R. triage nurse if 2nd floor Admissions Clerk is not available. Duties will include telephone and radio communication and any paperwork which needs to be completed at the E.R. desk. G. No attempt will be made by disaster area personnel to separate valuables from clothing. All (clothing and valuables) items removed from casualties shall be placed in the plastic bags normally kept in the emergency area for this purpose. Section 20--SURGERY / ANESTHESIA A. ER HUC to call O.R./Anesthesia on-call. B. OR will call in other O.R. staff using disaster call tree. C. Identify self at front door with MHCC name pin or safety pin on the collar. D. R.N.'s report to the O.R. E. O.R. Techs report to the O.R. Nurse in the O.R. F. Depending on type of disaster, nurse will determine units needs and assign staff accordingly. G. In the event we would need additional anesthetists/anesthesiologists, our in-house anesthetist will make the decision and direct others to call for outside help. Section 21 - INFORMATION SYSTEMS In the event of a disruption of essential services from a source beyond our control, we have made the following provisions: A. In the event of a power or communication loss, please notify the Information Systems Department immediately. The Information Systems Department will start at the top of the call tree and notify its department members appropriately. B. In the event of a power loss, our internal power generation system will provide power to the telephone communication system within the Hospital. C. In the event of a power loss, we have been assured that our out-going calls will go through. Cell phones may be used in some areas, however, due to the manner in which cellular phones work, it is likely that in a wide-spread power outage they may not work. There are four (4) hand-held radios in Maintenance that will be retrieved and distributed by Information Systems to Infection Control, E.R., Information Systems, and the Lab. D. In the event of phone switch failure; there are phone lines that do not go through the switchboard; E.R. at 358-2754 and the Ambulance at 358-9279. E.There is one emergency radio within the Hospital that can access the local Hospital frequency; mutual aid frequency (police, fire, highway patrol), as well as the ambulance frequency. This radio will be placed in the E.R. F. During a power loss of communication loss, there should be no personal use of telephone or computers whether incoming or out-going. G. After a power loss or communication loss, after each station is started back-up, if there are any irregularities, notify the Information Systems Department via Footprints. H. All Information Systems related equipment, including phones; computers and fax machines have been tested to be compliant. Should anyone find a failure, please notify the Information Systems Department via Footprints for assistance or replacement. Section 22 - PERFORMANCE IMPROVEMENT A. The following areas will follow this plan in the event of a disaster: 1.Director of PI will initially report to the Command Center, and then will assist as needed in Liaison and Infection Control. PI Director will observe for risk issues. 2. Infection Control Coordinator will report to Director of PI; will monitor and assist in an infectious /hazardous disaster, otherwise will be assigned where needed. IC will track types of ER patients on a (HEICS)-IC Tracking Form (IC form) for reporting to the Command Center. 3. PI Coordinator will report to Director of PI; PI Coordinator will be assigned where needed. 4. Customer Service will report to Director of PI. B. Incident Commander may override all previous assignments. C. See Fire Drill Policy/Procedure for announcement protocol. D. In the event of a Tornado, personnel will assist as needed if patients are to be moved. Section 23--WELLNESS A. In the event of a disaster, the following area will: 1. Wellness/Occupational Health: a. All fulltime Wellness staff will report to Central Command b. Wellness will staff the Liaison Officer position as identified in the HEICS. B. Incident Commander may override all previous assignments. C. See Fire Drill Policy/Procedure for announcement protocol. Other numbers that may be needed by Liaison Converse County Public Health - 358-2536 State Health Officer - 307-777-7656 All Hazards Response Program (WDH) - 888-996-9104 Responsible for early detection and rapid response to biological or chemical events, infectious disease outbreaks, hazard materials spills and natural disasters. Section 24 - CLERGY and SOLUTIONS FOR LIFE A. Clergy and Solutions for Life will be directed at the Main Entrance registration table to remain in the Hospital's cafeteria area only. 1. Clergy and Solutions For Life staff will assist in comforting family members on an as-needed basis. (Solutions For Life telephone: 358-5329, contact: Stacie Thoma) 2. Unless otherwise requested by the Command Center Coordinator or their designee, the Clergy and Solutions For Life staff should not attempt to leave the cafeteria area in order to obtain information for the victims' family, volunteers, other Clergy or Solutions for Life staff or media. 3. The Douglas Ministerial Association will be called until one is reached. The person contacted will assume responsibility for notifying the remainder of the clergy. Church United Methodist Church Church phone 358-3616 Alternate phone 358-0775 Church St James catholic Church Church phone 358-2338 Alternate phone 358-8326 Church Congregational Church Church phone 358-2580 Church First Baptist Church Church phone 358-3724 Alternate phone 358-5414 Church First Methodist Church phone 358-0775 Church Christ Episcopal Church Church phone 358-5609 B. Updates will be verbally shared with the family, volunteers, clergy, and Solutions For Life staff by a designated person, as necessary. 1. Information related will be updates on the patient's condition if appropriate. 2. Clergy and Solutions For Life staff are to retain any and all information about patient's family members or patient name (if they are told by a family member) confidential and are not to share it with concerned volunteers, other families, media or other persons located in the cafeteria area. C. Dietary department will provide coffee, tea, cookies, and/or soup, as available, for the families at no charge. D. Wellness/Marketing department is the designated Liaison under HEICS and will be responsible for the following: 1. Making certain all clergy and Solutions For Life staff are in assigned areas and aware of responsibilities. 2. Obtaining verbal or written updates/information from the Command Center Coordinator or designate, to share frequently with family, volunteers, clergy, and Solutions For Life Staff (those located within the Hospital's Cafeteria area). Section 25--AMATEUR RADIO The following is a list of Converse County Amateur Radio Operators in the Douglas area, who can be called upon in the event of an emergency in which communications by normal means are lost. Communications may be re-established through Amateur Radio to within county designations, state and federal agencies or private parties, should the need arise: Douglas Call List (in alphabetical order with capacity) 1. Erickson, Kent - N7PTO - 624 VanBuren Home Phone: 358-2090 Work Phone: 358-5190 Amateur License: Advanced Equipment Capability: VHF 2M FM, Mobile, Fixed HT Emergency Power: Battery 2. France, Diane - N7GSW - 719 S. 10th Street Home Phone: 358-2867 Work Phone: 358-2122 Amateur License: Technician Equipment Capability: VHF 2M FM, Mobile, Fixed HT Emergency Power: Generator and Battery 3. France, Keith - N7OGT - 719 S. 10th Street Home Phone: 358-2867 Amateur License: Advanced Equipment Capability: VHF 2M FM, Mobile, Fixed HT Emergency Power: Generator and Battery 4. Kilmer, Rick - 7KOH - 1901 Madora Avenue Home Phone: 358-5126 Work Phone: 358-6811 Amateur License: Technician Equipment Capability: VHF 2M FM, Mobile, Fixed HT Emergency Power: 5. Leonard, Ed - KB7ZJS - 415 S. 5th Street Home Phone: 358-2485 Amateur License: Technician Equipment Capability: VHF 2M FM, Mobile, Fixed HT Emergency Power: Battery 6. Smith, Gordon - KB7QIN - 318 N. 4th Street RACES Coordinator Home Phone: 358-3309 Work Phone: 358-5515 Amateur License: General Equipment Capability: VHF 2M FM, Mobile, Fixed HT, UHG 70CM FM, Mobile, Fixed HT, HF SSB, Mobile, Fixed Emergency Power: Generator and Battery 7. Dan Arnold - NG7L Home Phone: 358-0369 8. Bill Thompson - KIOIN Home phone: 359-2660 9. Frank Prochaska - WAOZZU Home Phone: 358-4249 This list is provided by Daine France of the Converse County Amateur Radio Club, 10/08. |
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