Welcome to ZZ Chatham Hospital

Code "D" - External

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PURPOSE:
To provide for the emergency care and management of a large number of casualties resulting from an external disaster. Provisions are made for the emergency conversion of facilities and treatment areas of casualty care.
Outlined in the plan are the duties and responsibilities of all hospital departments and employees. The plan complies with Joint Commission Standards.

PLAN DEVELOPMENT AND COORDINATION:
Chatham Hospital is responsible for the development of a working external disaster plan in cooperation with the Administrator, Medical Staff, Department of Nursing and other departments within the hospital. The plan will be shared with the following area authorities and agencies:

UNC Hospitals
Siler City Police Department
Chatham County Sheriff's Department
EMS Services – FirstHealth and Volunteer Services
SunBridge Health Care
Chatham County Emergency Management
Chatham County Health Department

DISASTER NOTIFICATION AND PLAN IMPLEMENTATION:
Whoever receives notification of a disaster occurring outside the hospital (usually the hospital operator, volunteer or Admissions Clerk) will transfer the call to the following: ED Director, Clinical Supervisor, ED Charge Nurse or ED Physician for the following information to be obtained:

The estimated number of casualties

Type of disaster (chemical, biological, etc.)

The location

Estimated time of arrival

Name and phone number of informant

Informant verified

The ED Director, Clinical Supervisor, ED Charge Nurse or ED Physician will confirm the disaster call and initiate the disaster alert if deemed necessary. They will page the following hospital wide:

“Code ‘D'–external” (Announced three times)

The individual who paged the Code will then contact the Administrator on-call and ED Director.

Administrator on-call (after hours/weekends) will call the other Administrators

The Registration Supervisor will be responsible for obtaining monthly a current listing of the following emergency contact information:

Department Director's Roster (from Administrative Secretary)

Personnel Roster (from each Department Director)

Hospital Telephone Numbers (from Administrative Secretary)

Hospital Referral Listing

Beeper Numbers (from Administrative Secretary)

Physician Numbers

The Administrative Secretary will maintain a current Department Director's Roster. Each Department Director will maintain a current Personnel Roster.

The Admissions Supervisor will provide Admissions and the ED with updated emergency contact information on a monthly basis.

ACTIVITY DIRECTION AND COORDINATION:
During a disaster, the ED Staff Physician (or the Chief of Staff) will direct care and treatment of patients. Physicians will report to the Labor Pool in the large conference room for assignments by Incident Command.

Proposed assignment and treatment areas designated in this plan may be modified by the ED Physician (or the Chief of Staff) as conditions warrant during a disaster.

The Clinical Supervisor (or ED Charge RN if no Supervisor is in house) will man the Command Center in the ED until the CNO (or on-call Administrator) arrives. Command will then be assumed by the CNO/on-call Administrator, and the Command Center will be moved to Conference Room #366 (Small Conference Room).

The Incident Commander will delegate staff to contact Department Directors and medical staff not on-site and during off-hours/weekends. These calls should be initiated from a different extension than the Command Center to keep these lines open. Department Directors will be given the following information:

The estimated number of casualties

Type of disaster (chemical, biological, etc.)

The location

Estimated time of arrival

Department Directors or designees will direct activities in their areas of responsibility, with specific disaster duties carried out as specified in this plan. Department Directors will maintain a current call roster A current call roster will also be kept in the Admissions area.

HEADQUARTERS OF DISASTER OPERATIONS:
The Staff Physician on duty in the Emergency Room will direct medical care from the Emergency Room until he/she delegates this role to another willing physician. The Chief of Staff or Staff Physician on-call for the ED will be directed by the on-duty physician, unless command is relinquished to one of them.

The Triage station will be the Emergency Entrance to ED, Triage Room and surrounding areas, as needed.

Upon determination of the external disaster, the initial Command Center will be located in the ED until sufficient support staff arrives to relocate the Command Center to Conference Room #366 (Small Conference Room).

MOBILIZATION, FACILITY, AND CONVERSION ACTIVITIES:
To facilitate reception and care of casualties, the following will be initiated upon notification and confirmation of a disaster.

All patients (except immediate Urgent) and families will be cleared from the Emergency Department by the Registration Clerk after consultation with the ED Nursing Staff (Charge RN or Clinical Supervisor if available; otherwise staff RN or ED physician).

All outpatient procedures in progress will be completed and other outpatient procedures will be rescheduled.

Maintenance personnel (or security guard after hours) will lock all entrances to the hospital except for the ED area and one will remain at the main entrance to direct families and one will remain at the employee entrance to admit hospital personnel. All personnel should present their identification badge in order to enter during a disaster. This will be an initial security measure until law enforcement officials arrive to aid (see security section). Once officials arrive, they will secure points and control access to the hospital.

At the discretion of the ED Charge Nurse, the Clinical Supervisor or a designee, Nursing and other personnel will staff and supply the Triage and other treatment and reception areas in preparation for reception of casualties. (See Departmental Responsibilities and Duties).

Two-way radios (located in ED) will be used to facilitate communication between the Command Center and the ED.

All mobile units may be asked to discontinue services and remove unit.

RECEPTION AND MANAGEMENT OF CASUALTIES:
Casualties will be brought by ambulance to the Chatham Hospital Emergency Department via the ED entrance, which will serve as the reception area for initial triage and classification of casualties.  When feasible, triage and classification will be done outside the doors of the ED. Minimal treatment and delayed victims will be routed through the ED waiting room and to the Minimal and Delayed Treatment areas.

This is a guide.  Actual staffing will be based upon the anticipated number and severity of casualties. Excessive staff will be instructed to return to the labor pool. Please check with the Command Center to see if you or your treatment area is still necessary.

Victims will be transported to the appropriate area based on the following CLASSIFICATIONS:

DISASTER SITE TRIAGE

Location – Scene of Disaster

Staff

Done by EMS personnel. There will be no Chatham Hospital personnel reporting to the disaster scene, unless requested by the EOC. In the event that the EOC requests hospital personnel, response will be initiated through communication between the EOC and the Incident Commander. The Incident Commander will then make personnel selection

HOSPITAL TRIAGE AREA

Location – Entrance to the Emergency Department, Triage room and surrounding areas (as needed). Ambulances should move away from the ED bay as soon as their patients are brought into the ED rather than remaining there until the paramedics complete their paperwork. Non-critical patients should be unloaded from ambulances some distance from the ED bay, so as not to block the bay to other ambulances with more critical patients.

Staff

Triage Physician (Chief of Staff or designee)

1 Nurse

Extra Admissions Clerk or Business Office Personnel with disaster tags

Stretcher Bearers or ED NA

The preliminary triage classification, and tagging of victims will take place. Victims will be transported to the appropriate area based upon their classification, utilizing the tagging system of black, red, yellow and green.

TREATMENT AREAS:

MINIMAL TREATMENT AREA

Location – PACU

Staff

To be determined by the ED Director/Charge RN or Clinical Supervisor. Extra staff will report to the Command Center for relocation.

1 Physician

1 RN

1 LPN or RN

1 Transport Aide or ED NA

1 Medical Records/Business Office Clerk

Persons with minor injuries will receive treatment here. After treatment, the majority of minimal treatment patients will be discharged.

DELAYED TREATMENT AREA

Location – PACU and ED

Staff

To be determined by the ED Manager/Charge RN or Clinical Supervisor. Extra staff will report to the Labor Pool for relocation.

1-3 Physicians

2 RN's

1 LPN or RN

1-2 Transport Aides

Those patients whose injuries require attention not of an immediate nature (i.e. simple fractures) will be sent to this area. Upon treatment, these patients will be transferred to the appropriate area in the hospital or discharged.

IMMEDIATE TREATMENT

Location – Hospital Emergency Department,

Staff

To be determined by the ED Director/Charge RN or Clinical Supervisor. Extra staff will report to the Labor Pool for relocation.

Emergency Room:
1-3 Physicians
2-4 RN's
1-2 Respiratory Therapists
1-3 Transport Aides (as needed)

Those patients requiring short, simple immediate lifesaving surgical procedures will have these done in the Emergency Department. Upon termination of emergency procedure, the patients will be reclassified and transferred to the appropriate area.

TEMPORARY MANAGEMENT OF DOA's AND VICTIMS WHO EXPIRE

Location – Mammogram Room

Staff

1 Medical Records Person

1 Transport Aide

The Incident Commander will designate personnel to record the names of all deaths and DOA's.

SPECIAL CONSIDERATIONS:

Discharge and Transfer of Hospital Inpatients

If hospital space is needed for the care of injured disaster victims, the Physician in Charge will direct Staff Physicians to discharge inpatients that do not require skilled care (i.e. patients admitted for elective surgical procedures or for diagnostic studies, as appropriate). If necessary, inpatients requiring institutional care may be transferred to other facilities as appropriate. Copies of appropriate documents (and medications if needed) should accompany these patients.

Transfer of Casualty Patients to Other Facilities

Casualty patients requiring transfer to other facilities for special care (i.e. orthopedics, neurosurgery, etc.) will be transferred via ambulance as soon as possible. Ambulance services and Rescue Squads in surrounding communities may be called in to assist if necessary. Appropriate documents or copies (history and physical, treatment records, etc.) and medications should accompany transferred victims.

RECEPTION AND MANAGEMENT OF FRIENDS AND RELATIVES OF THE INJURED:
Relatives and friends of the injured will be directed to the Atrium or designated location as arranged by command staff.  The Incident Commander will designate personnel to communicate with families.

SECURITY:
The Incident Commander will designate personnel to contact any outside resources. As an initial security measure until law enforcement officials arrive, maintenance personnel (or security guard after hours) will lock all entrances to the hospital, except for the Emergency Room area.

The employee entrance will be used for hospital employees only. Only patients are to enter through the Emergency Room.

Vehicle traffic control can be accomplished by sealing off the hospital grounds at the entrances from Progress Boulevard by law enforcement.

The employee parking lot will be kept clear of unauthorized vehicles by law enforcement.

COMMUNICATIONS:
Telephone communications will be the first line in contacting employees, agencies, etc.  Local radio stations may be used as a supplemental method of notifying hospital personnel to report to the hospital.

Chatham County Communications at 919-542-2911 will be used to contact area agencies, authorities, and hospitals and for communication with Triage teams. In case of breakdown of conventional communications, this system will be the primary communication system.

If hospital telephone lines are dead, pay phones in the ED and ICU waiting areas may be utilized, as well as personal cell phones.

PRESS AND PUBLIC INFORMATION CENTER:
A summary of casualties will be forwarded from the Emergency Department to the Incident Commander.  No identification of casualties will be released to the public from the hospital unless directed through the Incident Commander.  Communication between the Incident Commander and the Public Information Officer will be established and coordination of all information will go between these two.

DEPARTMENTAL RESPONSIBILITIES AND DUTIES:
This section covers individual departmental responsibilities in addition to those mentioned in the basic plan.  These are expected initial duties and will be further determined through incident command.

ADMINISTRATOR (CFO acts for Administrator in his/her absence)

Administrator – Reports to the command center. After hours, CEO will contact Administrative Secretary.

Administrative Secretary – Reports to the Command Center. All incoming messages and will be maintained by the secretary.

The Incident Commander will log on to Fast Command for action plans.

BUSINESS OFFICE

Department Director or designee reports to the Command Center for assignment.

Department Director contacts the personnel not on duty required to manage their functions of the disaster as directed by the Incident Commander.

Call-back staff report to the Command Center.

CARDIOPULMONARY

Department Director or designee reports to the Command Center for assignment.

Department Director contacts the personnel not on duty required to manage their functions of the disaster.

Call-back staff report to the Command Center.

Prepare additional equipment and supplies and take to the immediate treatment areas (ED).

Through the Command Center, two therapists will be assigned to the Immediate Treatment Area. Other therapists are assigned as conditions warrant.

The primary responsibilities are airway management, oxygen delivery, suction monitoring and intubations.

CASE MANAGER

Reports to the Command center for assignment.

EMERGENCY DEPARTMENT STAFF

Staff prepares area for reception of disaster victims.

The Emergency Dept. should be locked to control traffic and extra personnel. (This will also control contamination/exposure – dependent upon disaster.)

ED Director/Charge Nurse will be the acting leader of the Command Center until sufficient administrative / command staff arrives to relocate to the Conference Room.

ED Director/Charge Nurse will remain in the ED, assisting with triage and patient care.

ED Director/Charge Nurse will communicate with the Command Center and scene of the disaster.

HOSPITAL AUXILIARY

On duty auxiliary will report to the Command Center for assignment.

HOUSEKEEPING

Department Director or designee reports to the Command Center for assignment.

Department Director contacts the personnel not on duty required to manage their functions of the disaster as directed by the Incident Commander.

Call-back staff report to the Command Center for assignment.

Housekeeping is to insure that adequate linen is available at all treatment and care areas. Director assigns personnel to stock and maintain the supply in treatment and care areas.

HUMAN RESOURCES DIRECTOR

Reports to the Command Center.

Contacts auxiliary personnel as directed.

IMAGING

Department Director or designee reports to the Command Center for assignment.

Department Director contacts the personnel not on duty required to manage their functions of the disaster as directed by the Incident Commander.

Call-back staff report to the Command center for assignment

Department personnel will transport all patients to and from the department.

The Director of Imaging may request nursing personnel monitor patients in the Imaging area, if necessary. If additional nurses are needed, they should contact the Command Center.

Inpatient procedures should be completed, if possible, and the patients returned to their rooms. Outpatients in the waiting room should be informed of the potential wait and rescheduled, if possible.

The Mammogram Room should be set up for the Temporary Holding for DOAs.

INFORMATION TECHNOLOGY (IT)

Ensure laptop computer availability and function in the Command Center (Small Conference Room).

All staff will report to the Command Center.

Staff will be responsible for duties necessary to ensure computers and communications are maintained, as determined by the Command Center.

INTERPRETERS

Department Director or designee reports to the Command Center for assignment.

Department Director contacts the personnel not on duty required to manage their functions of the disaster as directed by the Incident Commander.

On-call staff report to the Command Center for assignment.

Staff will translate as needed.

LABORATORY

Department Director or designee reports to the Command Center for assignment.

Department Director contacts the personnel not on duty required to manage their functions of the disaster as directed by the Incident Commander.

Call-back staff report to Command Center for assignment.

Outpatients in the lab and / or waiting room area should be informed of the potential wait and rescheduled if possible.

The Laboratory personnel will assume their assigned responsibilities, which will be determined through communication between the Lab Director and the Command Center Leader.

Chief Technologist – coordinator of Lab Services

Tech #1 – Phlebotomy & Hematology (MLT)

Tech #2 – Chemistry & Bacteriology (MT)

Tech #3 – Phlebotomy & Hematology (MLT)

Tech #4 – Urinalysis & Report Transfer (Lab Assist)

Tech #5 – Blood Banking (MT)

MAINTENANCE / SECURITY

Department Director or designee reports to the Command Center for assignment.

Department Director contacts the personnel not on duty required to manage their functions of the disaster as directed by the Incident Commander.

On-call staff report to the Command Center for assignment.

Maintenance / Security Personnel initially lock all entrances to the hospital, except for the ED area until security personnel arrive. Maintenance personnel (or Security Guard) will remain at employee entrance to admit hospital personnel and at the main entrance to direct traffic until security personnel arrive.

Maintenance Director and personnel are responsible for maintaining power and keeping all equipment operational. One person should report to the Energy Plant to assure the maintenance of power during this time.

MATERIAL MANAGEMENT

Department Director or designee reports to the Command Center for assignment.

Department Director contacts the personnel not on duty required to manage their functions of the disaster as directed by the Incident Commander.

On-call staff report to the Command Center for assignment

Responsibility shall include stocking triage areas with additional supplies according to departmental disaster plan.

Department shall be responsible for furnishing supplies for restocking as communicated by the Command Center by request of ED personnel.

MEDICAL RECORDS

Department Director or designee reports to the Command Center for assignment.

Department Director contacts the personnel not on duty required to manage their functions of the disaster as directed by the Incident Commander.

Call-back staff report to the Command Center for assignment.

One person may be assigned to the Temporary Holding Area of DOAs (Mammogram room) to maintain a list of the dead.

NURSING PERSONNEL (Med/Surg, ICU, and Employee Health Nurse)

Department Director or designee reports to the Command Center for assignment.

Department Director contacts the personnel not on duty required to manage their functions of the disaster as directed by the Incident commander.

On-call staff report to the Command Center for assignment.

Staff will assist in ED Treatment Areas as needed, as determined by Incident Commander.

NUTRITIONAL SERVICES

Department Director or designee reports to the Command Center for assignment.

Department Director contacts the personnel not on duty required to manage their functions of the disaster as directed by the Incident Commander.

Call-back staff report to the Command Center for assignment.

PHARMACY

Department Director or designee reports to the Command Center for assignment.

Department Director contacts the personnel not on duty required to manage their functions of the disaster as directed by the Incident Commander.

On-call staff report to the Command Center for assignment.

PHYSICAL THERAPY (Diabetes Education, Cardiac Rehab, Risk Management, And all other, Unspecified Personnel)

Department Director contacts the personnel not on duty required to manage their functions of the disaster as directed by the Incident Commander.

On-call staff report to the Command Center for assignment.

REGISTRATION

Registration clerk will be responsible for making the initial calls: Administrator on-call (after-hours/weekends) (Administrator on-call will call the other Administrators), ED Director, Chief of Staff.

If after-hours or weekends, then will be responsible for screening incoming calls and forwarding them appropriately.

On-call staff report to the Command Center for assignment.

SURGICAL SERVICES

Department Director or designee reports to the Command Center for assignment.

Department Director contacts the personnel not on duty required to manage their functions of the disaster as directed by the Incident Commander

On-call staff report to the Command Center for assignment.

All elective surgery will be cancelled until further notice from the Surgical Services Director/Surgeon.

Recovery

The Incident Commander is responsible for terminated emergency management processes and initiating the recovery process.

Employee Health and Human Resources will coordinate a staff incident stress debriefing and any follow-on counseling.

The President will coordinate resumption of any curtailed services.

A facility damage assessment will be conducted by the * Maintenance Department and schedule repair work prior to reoccupying damaged areas of the hospital.

The Financial Chief will prepare and process all authorized claims.

The Incident Commander will schedule a debriefing and conduct a critique of the response.

All supplies, drugs, water, food, linen and fuel will be replenished.

SUGGESTED RESPONSIBILITIES FOR CIVIL AUTHORITIES IN A DISASTER SITUATION INVOLVING CHATHAM HOSPITAL, INC.

Chatham County Emergency Management (EOC) – Should be one of the first persons contacted in the event of a large or prolonged event requiring outside resources.  Will coordinate the allocation of necessary outside resources (i.e. – law enforcement. EMS, SMAT; decon teams etc).

Siler City Police – Traffic control of roads surrounding hospital.  Security at all entrances to the hospital.

Sheriff's Department – Traffic control on roads leading to hospital.  Assist Siler City Police Department in security.

Pittsboro Police Department – Control of traffic and emergency vehicles going from Chatham Hospital to UNC.

N.C. Highway Patrol – Control of traffic. Emergency transportation of blood and drugs.

City Manager – Coordinates traffic control and communications.

National Guard – If necessary, aid in security and traffic control. May be used to assist in patient transport to or within the hospital.

Fire Department – Will probably be at the disaster scene. Could be used if necessary, for security and traffic control (only in extreme circumstances).

Siler City Care and Rehab – Administrator prepares to take patients discharged from hospital and not able to go home. Nursing and other personnel could be temporarily loaned to the hospital, if possible.

Mental Health Center – Crisis intervention and supportive therapy for victims, families and friends, and identification of individuals with long-term needs.

US Patent Numbers 7,720,998 B2, 7,836,207