Hospital Emergency Management

The safety officer wrote the disaster plan! What am I supposed to do?

Hospital emergency management has changed over the past few years...
Until recently, hospitals planned response to mass casualty disasters (Alert 1), fire, and a few natural disasters (tornado, earthquake) that could impact the facility.

UK Hospital Hazard Vulnerability Analysis

Now hospitals conduct an annual hazard vulnerability analysis and come up with a list of emergencies that looks like this
This list takes into account probability impact on institution institutional preparedness

Event Mass Casualty Incident (Hazmat) Hostage Situation Civil Disturbance Bomb Threat Earthquake Hazmat Exposure, Internal Mass Casualty Incident (Trauma) Terrorism, Biological Terrorism, Chemical HVAC Failure Information Systems Failure Communications Failure Tornado Unavailability of Supplies Mass Casualty Incident (Medical) Infant Abduction Fire, Internal Ice Storm Temperature Extremes Epidemic Hazmat Exposure, External Generator Failure Electrical Failure Medical Gas Failure Labor Action Severe Thunderstorm Drought Medical Vacuum Failure Flood, Internal Blizzard Sewer Failure Fuel Shortage Steam Failure VIP Situation Structural Damage Water Failure Snow Fall Forensic Admission Fire Alarm Failure Wild Fire Flood, External Transportation Failure

2002 Rating 30 30 30 30 30 30 30 30 30 30 28 20 20 20 20 20 20 18 16 15 15 10 10 10 9 9 8 8 8 6 4 4 4 4 4 4 3 3 2 1 1 1

Emergency Management has evolved beyond response planning. It includes:

Mitigation Preparedness Response and Recovery

Because of the numbers and kinds of emergencies that can impact a hospital, most begin planning with a basic infrastructure...
Incident Commander
Safety Officer Security Officer

Public Information Officer

Liaison Officer

Logistics Chief

Planning Chief

Finance Chief

Operations Chief

JCAHO and NFPA 99 require an all-hazards incident command structure that...

Can be coordinated with the command system in the community Uses the same terminology as the community ICS Is flexible enough to allow activation and deactivation of components, based on the specific event

Both JCAHO and NFPA also require a structure that explicitly allows for the management of...
Patient care Staff/family support Logistics of critical supplies Media Security

Hospital Emergency Incident Command System HEICS

Incident Commander Public Information Officer Safety and Security Officer Liaison Officer

Logistics Chief

Planning Chief

Finance Chief

Operations Chief

Facilities Unit Leader

Situation-Status Unit Leader Labor Pool Unit Leader

Time Unit Leader Procurement Unit Leader

Medical Care Director

Ancillary Services Director

Human Services Director

Damage Assessment and Control Officer Sanitation Systems Officer

Medical Staff Director

Laboratory Unit Leader

Staff Support Unit Leader Psychological Support Unit Leader

Medical Staff Unit Leader

Nursing Unit Leader

Claims Unit Leader

Cost Unit Leader

In-Patient Areas Supervisor

Treatment Areas Supervisor

Radiology Unit Leader

Communications Unit Leader

Transportation Unit Leader

Surgical Services Unit Leader

Patient Tracking Officer Maternal Child Unit Leader Critical Care Unit Leader General Nursing Care Unit Leader Out Patient Services Unit Leader

Triage Unit Leader

Immediate Treatment Unit Leader Delayed Treatment Unit Leader Minor Treatment Unit Leader Discharge Unit Leader

Pharmacy Unit Leader

Cardiopulomonary Unit Leader

Dependent Care Unit Leader

Materials Supply Unit Leader

Nutritional Supply Unit Leader

Patient Information Officer

Morgue Unit Leader

What is HEICS?
An all-hazards command structure A universal link with outside resources

HEICS provides...
A dependable chain of command Improved communication through common language Flexibility Prioritization of tasks Organized documentation system Effective mutual aid planning
The Fayette County Healthcare Emergency Planning Committee has adopted HEICS. As a result, all acute care hospitals will begin using the HEICS structure.

HEICS Tools
Organization chart Job Action Sheets Forms

Basic Units of HEICS Organization

Incident Commander Section Chiefs Directors Unit Leaders Officers

PI Officer Safety Officer Security Officer Liaison = Command Center

Five sectionsone mission...

To respond to the emergency at hand.

Command Center Logistics Planning Finance Operations

Defines the mission and ensures its completion.

Command Center

Provides for a working environment and adequate materials to meet the overall medical objective.

Logistics

Determines and provides for the continuance of each medical objective. Prompts and drives all HEICS officers to develop short- and long-range action plans.

Planning

Provides funding for present medical objective and stresses facility-wide documentation to maximize financial recovery and reduction of liability.

Finance

Carries out the medical objective to the best of the hospitals ability.

Operations

University of Kentucky Hospital Emergency Incident Command System HEICS

Incident Commander Joseph Claypool Administrator-on-call Public Information Officer PR-on-call Liaison Officer Tomi Ross

Safety Officer Tomi Ross Sharon Berry

Security Officer Joseph Frye Jeff Shutt

Logistics Chief David Allen Sandra Chambers

Planning Chief Sandra Chambers Jim Zembrodt

Finance Chief Murray Clark Larry Moore

Operations Chief Ann Smith Karen Stefaniak

Facilities Unit Leader Ed McClure

Situation-Status Unit Leader Vicky Bradley

Time Unit Leader

Medical Care Director HOA

Ancillary Services Director Ann Smith Barb Atkins

Human Services Director Carol Barnett

Damage Assessment and Control Officer Leo Foster

Labor Pool Unit Leader James Patterson Margaret Longhurst Medical Staff Unit Leader Jan Williams

Procurement Unit Leader

Medical Staff Director Kevin Nelson

Laboratory Unit Leader Barb Bush Teresa Eickhorn

Treatment Areas Supervisor Colleen Swartz Paul Ferrell Radiology Unit Leader Sheryl Abercrombie Kevin Connelly Pharmacy Unit Leader John Armitstead

Staff Support Unit Leader Karen Graham

Sanitation Systems Officer Matt Mueller

Claims Unit Leader

In-Patient Areas Supervisor Kathleen Kopser

Psychological Support Unit Leader Donna Farrar

Communications Unit Leader Jan Bates James Wellman

Nursing Unit Leader Pat Powers Shane Stratton

Cost Unit Leader

Surgical Services Unit Leader Trish Seabolt Triage Unit Leader Patty Sturt

Dependent Care Unit Leader Bonnie Thornton

Transportation Unit Leader Joe Mallek

Patient Tracking Officer Jodie Martin Harold Miles Patient Information Officer Carol Dickey Lin Dudik

Maternal Child Unit Leader Gwen Moreland Critical Care Unit Leader
Dennis Szczygielski

Immediate Treatment Unit Leader Linda Holtzclaw Delayed Treatment Unit Leader

Cardiopulomonary Unit Leader Barb Atkins Bryan Collins

Materials Supply Unit Leader Mary Skeen

John Burton General Nursing Care Unit Leader Gayle Plank Minor Treatment Unit Leader

Nutritional Supply Unit Leader Floyd Drexler

Out Patient Services Unit Leader Trina Van Guilder

Discharge Unit Leader Bev Hanson-Tucker Morgue Unit Leader Barb Bush

Job Action Sheets

Your disaster response job descriptions Tell you
What you are going to do When you are going to do it To whom you are going to report it after you have done it.
Universal titles and missions allow emergency responders from a variety of agencies to communicate.

HEICS Forms
Used with job assignments Can be altered in any way necessary
Documentation = $$$

The Language of Emergency Management

 To specific disaster plans

(to reflect HEICS structure)

Emergency code names

(to make consistent with other hospitals and emergency responders)

JCAHO Emergency Management standards

Medical Care Director

The Operations Chief will require written plans for:
Establishing an Operations Section Center, including locations and staffing Assessing staffing, supply, equipment needs in patient care settings. Emergency inpatient discharge. (See Nursing Unit Leader.) Communicating with patient care areas. (See Communications Unit Leader.)

Advance planning for

Medical Staff Director

The Operations Chief will require written plans for: Establishing a physician labor pool. (See Medical Staff Unit Leader.) Credentialing volunteer medical staff. (See Medical Staff Unit Leader.) Assessing physician staffing needs and assigning physicians.

Advance planning for

In-Patient Areas
The Operations Chief will require written plans for: Assessing inpatients for early discharge. (See Nursing Staff Unit Leader.) Establishing alternate inpatient care sites within the facility. Assessing staffing, supply, equipment needs in patient care settings.

Advance planning for

Treatment Areas
The Operations Chief will require written plans for:
Establishing emergency treatment areas, including location and staffing. Assessing staffing, supply, and equipment needs in treatment areas. (See Medical Care Director.) Assessing security needs in treatment areas. Moving patients through treatment areas to discharge or admission.(See Transportation Leader.)

Advance planning for

Ancillary Services
The Operations Chief will require written plans for:
Inventorying available blood supply. Evaluating ancillary services capacity to perform services required by emergency. Tracking patients to ensure results reporting. (See Patient Tracking Officer.) Assessing staffing, supply, and equipment needs.)

Advance planning for

Human Services
The Operations Chief will require written plans for:
Establishing Human Services Center, including location and staffing. Implementing emergency discharge procedures. (See Nursing Staff Unit Leader.) Establishing staff rest, nutrition, and sleeping areas, including location and staffing. Keeping staff updated regarding emergency status. (See Situation-Status Unit Leader.) Establishing staff psychological support and debriefing areas, including location and staffing. Establishing a dependent care area, including location and staffing. Identifying dependents. Assessing materials and supply needs.

Advance planning for

Situation-Status Unit
The Planning Chief will require written plans: Maintenance and recovery of computer systems Security of medical records

Advance planning for

Advance planning for

Labor Pool

The Planning Chief will require written plans for:

Establishing the labor pool, including location and staffing Registration and credentialing of volunteer staff

Advance Planning for

Critical Supplies
The logistics section chief will require a written plan and procedures for procuring, handling, and distributing...

Logistics of

Pharmaceuticals Medical supplies Food supplies Linen Water Critical Equipment

Communications
Logistics
The logistics section chief will require a written plan and procedures for communicating with In addition, the chief will require an... Other areas/departments within hospital Other facilities External agencies Alternative communications plan for all major communication systems

Advance planning for

Transportation
Logistics
The logistics section chief will require a written plan and procedures for transportation of... Patients Staff Equipment to or from other facilities Staff to and from hospital during bad weather Critical supplies

Advance planning for

Medical Staff Unit

The Planning Chief will require written plans for:

Advance planning for

Establishing a physician labor pool, including location and staffing Registration and credentialing of volunteer medical staff

Advance planning for

Nursing Unit
The Planning Chief will require written plans for:

Emergency Inpatient discharge Patient Tracking Release of Patient Information Recalling Nursing Staff