EMERGENCY MANAGEMENT PLAN



EMERGENCY MANAGEMENT PLAN

I. EXECUTIVE SUMMARY 2

II. INTRODUCTION 3

A. Basic information 3

B. Mission Statement 4

C. Purpose 4

D. Scope 4

III. HAZARD ANALYSIS 4

IV. CONCEPT OF OPERATIONS 5

A. Direction and Control and Mitigation 5

B. Receiving timely information and alerting people 6

C. Evacuation for external and internal disaster 7

D. Re-entry 8

E. Sheltering 9

V. INFORMATION, TRAINING, AND EXERCISE 9

VI. APPENDICES 9

A. Emergency Contact and Phone Information 10

B. Transfer Agreement with Hospital 11

C. Evacuation Route Maps 12

D. Support Material 13

1. Fire Marshal Inspection Report 13

2. Disaster & Fire Plan 14

3. Facility Floor Plan and Location of Knox Box 15

E. PLAN APPROVALS 16

F. Executive Summary of Local Coordination 17

EXECUTIVE SUMMARY

BRIEFLY describe how this plan includes integration and collaboration of the following entities within the regional plan:

Coordination with local and state health jurisdictions.

The Surgery Center will not participate in community wide disasters since the Center is not equipped or staffed to provide emergency patient care. The Surgery Center has notified the local emergency management planning office.

Coordination with local and state emergency management jurisdictions.

The Surgery Center will not participate in disasters that are community wide. The Surgery Center is not staffed or equipped to provide unplanned medical care. The Surgery Center has notified the local emergency management planning office.

Coordination with a local Disaster Planning Committee, if applicable.

The Surgery Center will not participate in disasters that are community wide. The Surgery Center is not staffed or equipped to provide unplanned medical care. The Surgery Center has notified the local organization and/or committee that manages local disaster planning.

Coordination between and among hospitals.

The Surgery Center will not participate in disasters that are community wide. The Surgery Center is not staffed or equipped to provide unplanned medical care. The surgery center is located near Kincaid Hospital. In the event of an evacuation of the surgery center, patients who cannot be sent to their homes for recovery from outpatient surgery will be transferred to the hospital for recovery care. The Administrative Director will provide the Center’s Plan to the hospital’s emergency management department for review and coordination.

Coordination with community health clinics.

The Surgery Center will not have coordination with community health clinics. Patients will not be transferred to or received from a community health clinic.

Coordination with federal health facilities (VA, Military, etc.).

The Surgery Center will not have coordination with federal health facilities. Patients will not be transferred to or received from federal health facilities.

Coordination with local and regional Emergency Medical Service (EMS) .

The Surgery Center is located neat _____________ Hospital. In the event of the need to evacuate patients who need immediate surgical recovery care, the patient can be transferred by ambulance service, if that service is available, or my wheelchair or stretcher if necessary during a community-wide emergency when ambulance service is not readily available.

Coordination with local, county, and state law enforcement agencies.

The Surgery Center will not accept patients from other health care facilities or provide care for the general public. The Surgery Center is not staff or equipped for emergency medical care. Once the center patients are discharged, the Center staff may be asked to volunteer by reporting to the disaster site or the Center may respond by providing bandages or other supplies. This action is entirely voluntary and is based upon the extent of the emergency, availability of resources, and decision of the Center management.

INTRODUCTION

1 Basic information

1. ASC Name

1234 Street name

City, State 11111

Main Phone Number: 555-123-4567

Fax Number: 555-123-4567

Emergency Contact: Administrator

Emergency Contact Phone Number: 555- 123-4567

2. The Center was built in 1999 as a business construction, Type IV, Unprotected with automatic sprinkler system throughout. NFPA Construction type: Type II. Additional space and interior renovation occurred in 2003. The construction type remained the same.

3. Administrator:

Name:

Address:

City, State 11111

Phone: Phone cell:

Email Address:

Alternate Contact Person: Title:

Name

Address

City, State 11111

Phone: Phone cell:

Email Address:

4. Plan developed by: Mary Smith

5. Organizational Chart: Appendix ____

6. Emergency Contact Employee Call List: Attached Appendix ____

7. Floor Plan of Center: Knox Box, Fire Extinguishers noted: Appendix ___

8. Evacuation Routes: Map with two routes marked: Appendix ____

2 Mission Statement

The purpose of this emergency management plan is to provide guidance to the surgical center personnel on their expected duties when the center must be evacuated, when the center elects to close due to a warning of a potential disaster, and when the center must temporarily cease operations due to an internal or external safety issue.

The event of interruption of services can be caused by any unplanned occurrence, either natural or manmade.

3 Purpose

Through this document, employees will understand their role in internal and external disasters which are specific to their community and to the operating environment of the facility. The employee will understand that the surgical center does not provide services for emergencies and cannot remain open if an internal or external disaster should require increased emergency medical care in the community. The employee will understand that safety of any patient, staff member, and other individuals who are on the premises at the time of a major disruptive event is the main concern and protecting and directing them from potential harm is the duty of all employees

4 Scope

The Governing Body of the Center is responsible for establishing the plan, conveying plan to the Administrative Directive who is responsible to:

1. Conduct an annual evaluation of the plan and implement the plan

2. Document the education of staff regarding the plan including drills to carry out understanding and actionable conduct.

3. The plan will be submitted to State/Local authorities as required and coordinate adjusting the plan accordingly.

4. Administrative Director has the authority to make decisions during emergencies. The Medical Director or ___________ has the authority in the Administrator’s absence. See appendix __

HAZARD ANALYSIS

A. Because the ambulatory surgery center serves patients who elect to have outpatient surgery and procedures, the center can discontinue operations if a hazardous condition is forecasted or other potential hazardous situation occurs.

Only patients that can medically be admitted in the morning, have outpatient

surgery or a procedure, recover and be discharged on the same day are

candidates for services at the ambulatory surgery center. Patients who require

relatively minor surgery but have health conditions that impact the risk of the

procedure and of any anesthesia would not be scheduled at the ambulatory

surgery center.

The surgery center is vulnerable to hazards, natural and manmade that develop with little or no warning. A generator will provide back-up electrical service in case of a power outage. This generator operates for at least _____ hours, which provides adequate time to safely halt the procedure or complete any surgeries in progress when the public power service is not available to operate HVAC, equipment, and lighting sources. The Center has back up battery lighting systems in all operating rooms as a temporary source for lighting.

The ambulatory surgery center is located on Big Wide Avenue, a well-traveled east-west road. Parking for physicians, employees, visitors, and patients is next to the building. The center will rarely, if ever, be vulnerable to a transportation accident of hazardous spills due to its location on Big Wide Avenue, which is not the major east-west road, nor near the major north-south roads. There are no industries or fixed facilities in the area that would be at a high risk for explosions or chemical hazards.

B. The site-specific information follows:

1. Location map is attached. Appendix ____

2. There are two operating rooms, five procedure rooms, and 13 areas for pre-operative and post-operative patients. The maximum number of patients if all pre-operative/post-operative patients and all operating and procedure rooms were occupied will be twenty. The average number of patients on site is fifteen.

3. The center, located in Populated County, is located in Hurricane evacuation zone, Level E, which is evacuation in a Category 5 hurricane.

4. The Flood Insurance Rate Map shows the Center to be in flood zone C.

5. The center is not located near a railroad nor near an interstate highway.

6. There are no nuclear power plants within the 10 or 50 mile area.

CONCEPT OF OPERATIONS

1 Direction and Control and Mitigation

1. The Administrative Director is in charge. Alternate person is the Medical Director.

2. The ASC is staffed and equipped to handle routine, non-emergency care. Center will not be additionally staffed in case of emergencies. The ASC will accept only patients scheduled for a procedure who are not in an emergency situation. The Administrative Director or alternate person is responsible for deciding to close the center if an emergency situation dictates shutting down services. The center is normally open 7 a.m. to 5 p.m., Monday through Friday, and would not open during off hours in case of emergencies.

3. The operational and support roles for all ASC staff are described in the attached disaster/fire safety plan. This plan details their duties in case of fire and safety hazard, Internal/External disasters, medical emergencies, utility emergencies, terrorism, bomb threat or severe weather threats to the surgery center.

4. To ensure the following:

a) Water and food source will not be available because the ambulatory surgery center will not be open in event of a disaster. In the event of a community disaster with limited water and food supplies, the ASC would remain closed until normal water service occurs.

b) There is a diesel fuel powered generator which will provide emergency power up to_____ hours and has a diesel fuel capacity of _____ gallons.

5. The ASC will not participate in the community wide emergency management plan nor provide treatment for mass casualties during an emergency.

6. Patients in the center at the time of an external or internal emergency will be treated as described in the disaster/fire safety plan. Generally, no new procedures will be started and all procedures occurring at the time of the emergency will be completed as safely as possible. Staff will remain on site until patients are either discharged to their own homes or transferred for post-operative care to a hospital.

2 Receiving timely information and alerting people

1. An emergency radio will be turned on and placed in an area that is staffed whenever there is a patient in the facility. Warnings will be received through the emergency radio.

2. The center does not have a 24 hour contact number. When the center is closed, the emergency contacts are as listed in the Introduction.

3. The Administrator and alternate, with their respective telephone numbers, are listed in the introduction. The Administrator also keeps a list of all personnel/physicians, their emails and their phone numbers at her/his place of residence to call employees/physicians if necessary to advise them the center will be closed due to an emergency. During normal business hours, notification would be made by using the internal intercom and paging system or face to face communication.

4. No staff will be expected to report to work during an internal or external emergency. During an emergency, the health care services would be cancelled and any underway would be completed and the patients would be discharged.

5. Once a warning of a potential disaster or severe weather is received when the center is open, an announcement over the intercom will be made to employees, patients, and their doctors to advise of the warning. When the center is open for business and the impending threat occurs during normal hours of operation, the patients who are having surgery or procedure will receive ending treatment. As soon as all patients can be safely discharged, the employees will be sent home. If the situation arises that employees are unable to leave facility, rudimentary supplies will be available such as water, snacks, linens for rest (disaster pack). If the center is not open, the administrator will notify employees, patients, and their doctors of any decision to close the center for the day when a severe weather /pending disaster warning provides time to plan for this, such as in the case of a hurricane.

6. A list of employees and physicians with cellular phones will be kept and calls made to those with cellular phones. The one alternative solution to cellular phone or regular telephone notification may be by personal internet emails if battery powered systems are functioning. Employees, patients, and doctors are located throughout the area and attempts to contact them at their home addresses by traveling in a car could endanger the messenger.

7. The center is located near Kindred Hospital. If patients should need transfer to the hospital for post surgical care, the patient can be transported to Kindred Hospital by ambulance if ambulance service is available or by wheelchair or stretcher if ambulance services is not available due to extensive community needs. Patients can also be transferred via cars to other local nearby hospitals. Normally, the patients can be discharged and return to their own homes.

8. Responsible adults and/or family members waiting at the center for patients to be discharged will be notified in person if the patient is being transferred to a hospital. If the responsible adult and/or family member(s) of the patient is not at the center, the responsible adults and/or family member will be contacted by telephone to advise of the transfer. The hospital will be notified if the responsible adults and/or family member(s) have been contacted.

3 Evacuation for external and internal disaster

1. The disaster/fire plan which is attached provides information about the policies, roles, and responsibilities and procedures for the discharge or transfer of patients.

2. The individual responsible for implementing the discharge and evacuation procedures is the Administrative Director or the alternate.

3. In most cases the patient is ambulatory or can be moved about via wheel chair or by walking. If the patient can be discharged to home, that discharge will occur as quickly as possible. If the patient needs further observation and nursing care, the patient will be transferred to a hospital via ambulance service if ambulance service is available. Due to the proximity of the surgery center to Kindred Hospital, patients could be transported by staff via wheel chair or stretcher if necessary.

4. In the event of an internal disaster, the patients and employees will be evacuated if necessary. There will not be an attempt to save records or supplies since doing so could hamper the duties of fire and safety professionals. In the event of an external disaster, the center will not remain open. Only medical records for the patients being transferred to a hospital will be transported with the patients. All other supplies and records will remain in the surgery center.

5. A copy of the transfer agreement with Kindred Hospital is attached. However, it is most likely that all patients can be discharged to their homes.

6. See the street map attached that identifies primary and secondary external evacuation routes in Appendix C. See building floor plan in the fire and disaster plan in Appendix D.

7. Since some hazardous situations are forecasted and warning systems enable ample time to determine that the ambulatory surgery center business should cease. Therefore, in case of a hurricane, no patients will be in the center. For other emergencies, a patient can be transferred to the closest hospital within 5 minutes. If the center is completely full with all operating rooms and all pre and post operative beds full, there is a maximum of twenty patients that would need transferred. It is highly unlikely that all twenty eight patients would require transfer since a significant number of cases at the surgery center will be procedures in which the patients leave the center by walking to outside transportation. However, even if twenty patients needed to be evacuated, the complete evacuation of the building would take less than 15 minutes.

8. The ambulatory surgery center staff will not accompany patients transferred. Only those patients who are not fully recovered from their procedure who are in need of professional medical monitoring and patient care would be transported. In that case, the ambulance staff would be responsible for any care during transport.

9. A patient’s family member/or responsible adult would be in the facility waiting room and would be instructed of any transfer, the method of transfer, and the location of the receiving facility.

10. At the order to evacuate, the registration clerk will get a list of patients admitted and in the building. The clerk will check off the names of the patients when each is removed from the building and will note their disposition to home or transfer to a hospital. Patients will be considered discharged at the time of relocation.

11. If an immediate evacuation were necessary and the patient cannot be discharged home, the ASC would call for transportation and notify the hospital.

4 Re-entry

1. The Administrative Director is responsible for gaining authorized re-entry into the building. The State/Local authorities have the responsibility, in coordination with the Administrator and the jurisdictional building official, to ensure that the facility is structurally sound. If the facility is damaged during a disaster, State/Local authorities will be consulted to determine structural soundness and will coordinate with the local building official to ensure adherence to all applicable building codes.

2. The administrator will confer with the architects, structural engineers, and building maintenance personnel/local authorities to ensure the building is structurally sound.

3. Water damage to building will require additional electrical, structural, and cleaning inspections.

5 Sheltering

This facility will not shelter individuals from other evacuating facilities.

INFORMATION, TRAINING, AND EXERCISE

A. All employees receive training at new hire orientation and annually.

B. All employees are trained at orientation by a facility manager. Fire drills are held once a quarter. External and internal (other than fire) disaster drills are held once every six months. Annually, there is a complete inservice with a video and fire extinguisher handling training. All employees participate in drills. Results of drills are used for educational sessions. Employees will be crossed trained on related responsibilities to promote safety/reliability of having employees available to handle important tasks.

C. New employees must receive training within 30 days of employment.

D. Fire drills are held quarterly. External disaster drills and internal disaster drills other than fire drills are held semi-annually.

E. All drills are critiqued. See form in the attached disaster/fire plan. The critique is used for educational purposes and to refine the plan.

F. Organizations should remain informed with of periodically visiting websites such as the United States Disaster Safety site () Loss Reduction at ().

APPENDICES

A. Roster of Employees and Companies with key disaster related roles.

1. See attached list by positions of all staff with disaster related roles.

2. See attached list of companies, contact person, telephone numbers, emails addresses, and addresses of emergency service providers such as transportation, emergency power, generator fuel, police, fire, Red Cross, etc.

B. Agreements and Understandings

1. Copies of agreements for transfer to a hospital are attached.

C. Evacuation Route Map .

D. Support Material

1. Latest fire marshal inspection

2. Fire and disaster plan

3. Floor Plan of Center, noting Knox box

E. Plan Approvals

F. Executive Summary of Local Coordination

1 Emergency Contact and Phone Information

1. Staff with disaster related roles: Insert Facility Roster as Prepared Listing all pertinent information:

Key personnel:

Administrator: ____________________________Contact: _(813) 123-4567

Address: ___________________________

2. Alternate: _________________________________Contact: (813) 123-3456

Address: __________________________

Alternate: _________________________________Contact: (813) 654 4321

2. Emergency Service Providers:

Emergency power is supplied by a generator. Fuel is kept to a level to provide up to one and a half hours of power. This time exceeds the time required to evacuate all patients. Therefore, there is no need for additional fuel or water.

Contact Numbers:

Carson City Police

Emergency 911

Non-emergency 274-5760

Carson City Fire Rescue

Emergency 911

Non-emergency 274-7015

Emergency Management Office 276-2385

American Red Cross 348-4820

Power Company 456-7890

Generator Fuel 987-6543

Filtration Specialists, (727) 547-1959

Water Company 123-4567

Generator Maintenance 321-6547

Diesel Energy Systems Inc. (727) 539-9979

2 Transfer Agreement with Hospital

The agreement with Kindred/ Vencor Hospital.

3 Evacuation Route Maps

The ABC Surgery Center is located near Kindred Hospital. The surgery center is located one block south of the Kindred Hospital. An ambulance driver would leave the center and turn onto Big Wide Avenue. Then turn east onto Little Street and left into the Kindred Hospital entrance. Or an ambulance drive would leave the center and turn left directly onto Little Street and then left into the Kindred Hospital entrance.

See the following street map, for the location of the surgery center, Kindred Hospital and Bigger General Hospital. (Appendix C.1.A)

Also see the floor plan of the ambulatory surgery center. (Appendix C.1.B)

4 Support Material

1 Fire Marshal Inspection Report

2 Disaster & Fire Plan

3 Facility Floor Plan and Location of Knox Box

6 PLAN APPROVALS

Facility Governing Board _____________________________

Signature and Date: _____________________________

Medical Director: _____________________________

Signature and Date: _____________________________

Facility Administrator: _____________________________

Signature and Date: _____________________________

Local Health Department Emergency Response Coordinator:

District:____________

Date: ________________________________________________

Signature:________________________________________________

County Emergency Manager:__________________________________________

Date: _____________________________

Signature: _____________________________

Date: _____________________________

Signature: _____________________________

Director, Office of Emergency Planning and Response, State of ______________

Date: _____________________________

Signature: _____________________________

7 Executive Summary of Local Coordination

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download