Disaster Plan for (Enter Name of Practice)

DISASTER PLAN FOR (ENTER NAME OF PRACTICE)

DATE OF LAST REVIEW (ENTER DATE)

1)HAZARD VULNERABILITY ASSESSMENT

The first step in developing the office disaster plan is to determine what the possible disasters your office may be subject to. They should be listed in order of likelihood. Thinking about these various scenarios is beneficial in determining your planning decisions. For example if flooding is the highest likelihood for disasters in your area storing expensive supplies in the basement may not be a good idea. However, if you are in “Tornado Alley” storage of expensive equipment there may make perfect sense.

The following have been determined to be potential disaster situations for our office: (Some examples: Power Outages, Winter Storms, Tornados, Hurricanes, Pandemics, Floods, Fire, On-site Shooter)

•(ENTER HAZARD)

The following have been determined to be community disasters that may affect the office services but not directly affect our ability to provide services at our current location

(Some examples: Winter storms,Tornados,Pandemics,Floods,Industrial Accidents, EventsAccidents, Terrorist Attacks, School Shootings)

•(ENTER HAZARD)

2) OFFICE MATERIAL AND DISASTER KITS

During some disasters you may not be able to see patients in your current office setting.

In these situations you will need to have available essential supplies to allow you to continue seeing your patients. It is recommended that you have available 72 hours of these essential supplies. One way to accomplish this is through the use of portable disaster kits. Any easily transposable container is best to use. Examples would be plastic storage bins or luggage with wheels. How extensive the supplies are depends on your practice and its needs. You may feel you need multiple containers. A separate “Go Bag” or “Go Kit” that is pre filled and can be quickly grabbed if given some warning is a good place to start. If you pre-fill kits with supplies remember to check periodically for expiration dates. (Examples of some supplies that you might consider are included in APPENDIX A). Remember to include materials to record patient care. Also, include materials for billing purposes.

In the event our practice is forced to provide services to our patients at locations other than our office we will use the following to transport supplies.

(ENTER CONTAINER TYPE)

These will be located in (ENTER LOCATION HERE)

A list of the office supplies for each container is included in (ENTER SITE)

3)ESSENTIAL SUPPLIES AND EQUIPMENT

Each office has a number of high valued pieces of equipment that would be very costly if they were damaged or lost. Because of this when possible the practice should store the equipment in safest location possible to provide better protection. The practice should make a list of these items.

The practice has supplies and equipment that are especially valuable. The names and storage locations are listed below

ITEM STORAGE SITE

(ENTER ITEM)(ENTER SITE)

Disaster situations may occur during regular office hours. In some instances there may be time to move some equipment to safer locations. REMEMBER:The first and most important concern is safety of patients and staff and not equipment.Your practice should have an Office Evacuation Plan that describes your protocols.The Evacuation Plan can include guidelines for movement of equipment when feasible.

A list of vendors should be kept, with appropriate safeguards for recovery, for replacement or repair of equipment should it be necessary. Make sure you have appropriate backups of the information.

The list of vendors for repair or replacement of equipment is located:

(ENTER LOCATION)

Backup of these files can be found:

(ENTER LOCATION)

4)FACILITY MANAGEMENT/ ALTERNATE SITES

In certain disaster situations, office staff may be able to mitigate damage to the facility.

Shutting off utilities such as water may prevent significant damage to equipment and the offices structure. A staff member (for example the business/office manager) should be designated to be in charge of management of the facility during the disaster. In larger buildings this may not be an option and the following may not be applicable. If your practice leases office space contact the owners and discuss how they will handle disaster situations.

In order to help mitigate damage to the building whenever possible and appropriate, water, electrical, and gas shut offs should be undertaken. Remember: Staff safety is our first and foremost concern so no staff member should undertake this if there is a chance of injury.

Water shut off valve is located:(ENTER LOCATION)

Electrical Breakers are located:(ENTER LOCATION)

Gas shut off valve is located: (ENTER LOCATION)

Management of the facility during disaster situations including assigning mitigation duties will be the responsibility of:

(ENTER NAME)

If they are not available then:

(ENTER NAME) will assume this responsibility.

The following companies are to be used for repair services for our facility.

•(ENTER NAME)

Contact numbers are located in phone book and in the (ENTER LOCATION).

Damage to the facility may make use of the building impossible for an indeterminate amount of time. Prior arrangements with nearby facilities should be undertaken to allow your practice to continue to provide services to your patients.

If our facility is damaged or otherwise made unusable the office has made arrangements with the following facilities to allow the practice to provide services at their location on a temporary basis:

•(ENTER FACILITY)

Contact numbers and information are located: (ENTER LOCATION)

In some instances especially if the disaster is of a large magnitude even the use of other facilities may be impossible. In these cases consideration of other sites such as large trailers or even large tents should be explored.

In the event we cannot use these facilities we have made arrangements with(ENTER NAME)for us to provide patient services.

Contact numbers and information are located:

(ENTER LOCATION)

Generators are an option your practice may choose to employ. These can be portable or attached to the building. Generators attached to your building may allow you to practice, although probably in a limited fashion, in your facility in certain situations such as power outages. Portable generators can be useful if the practice is forced to use an outdoor location. If your practice uses generators someone on the staff will need to be responsible for their usage and obtaining fuel.

Our office has available generators for usage. The following individual is responsible for usage and obtaining fuel when usage is deemed necessary.

(ENTER NAME)

5)RECORDS AND OFFICE FILES

One advantage of the switch to electronic medical records is this makes storage and backup of records easier. Paper charts make protection of these records especially difficult in disaster situations. Loss of medical records can be especially damaging and may have some legal ramifications. If your office is still using paper medical records you need to explore how you can provide the best protection from loss or disclosure.

The office medical records are electronic and are stored: (ENTER SITE)

Backups are performed daily.

Backups are located off site at: (ENTER LOCATION)

Billing files are kept: (ENTER SITE)

Backups are located off site at: (ENTER LOCATION)

The following list of other business documents is located:

Bank statements (ENTER SITE)

Tax returns(ENTER SITE)

Corporation documents(ENTER SITE)

Insurancepolicies(ENTER SITE)

Medical Degrees/Diplomas(ENTER SITE)

(LIST OTHER DOCUMENTS)(ENTER SITE)

Recovery of these documents will be the responsibility of: (ENTER NAME)

In the event that he/she is unavailable then (ENTER NAME)can access these documents.

6)INSURANCE COVERAGE

Insurance coverage should include vaccines, property, and equipment. Make sure you are aware of the limitations of coverage as some disasters may not be covered.Photos or videos of property and equipment are recommended. Insurance policies, contact information and photos should be stored electronically. Policies and coverage should be reviewed yearly.

The practice has insurance policies covering the following

Vaccines

Property

Equipment

Business interruption

(LIST OTHER POLICIES)

The policies are stored at: (LIST SITE)

The policies were last reviewed on: (ENTER DATE HERE)

7) EDUCATION AND TRAINING

An old adage is we perform like we train. If your practice is to be successful handling a disaster, staff education and training exercises are necessary. Training provides many benefits. Staff will have a better understanding of their roles. They can provide excellent input and make your plan better. Finally, it will promote team building and help the staff buy into the plan.

The practice will have staff training at least yearly on the following: (ENTER DAY)

This training will include, but not be limited to:

Review of the Plan document

Organizational command structure

Evacuation procedures

Staff responsibilities

Phone tree and communications protocols

Location of essential materials using maps to help identify

HR issues including pay and benefits

Discussion period including input from staff and Q&A

8) VACCINE DISASTER PROTOCOLS

If your practice administers vaccines you have a significant financial investment in the vaccines. In the event of a disaster most likely power will be interrupted to the facility thus putting your vaccines in peril. Each practice that has vaccines on site needs a separate Vaccine Recovery Plan. An example of a Vaccine Recovery Plan can be found in Appendix B

If there is a power failure the first step is to keep the units doors closed. This will allow a short time to decide whether or not to institute the facility’s Emergency Vaccine Plan. This plan, which can be found (ENTER LOCATION), will set up the protocol to transport vaccine safely to an alternate site while maintaining the cold chain. Here are some key points to remember.

We can only store the vaccines in a specified location with the proper storage equipment (Not someone's home). We have made contact with (ENTER LOCATION) about storing our vaccines should the need arise and they have agreed to this. (ENTER NAME) should contact them once the decision has been made to transport the vaccines.

Some key factors to remember during use of the Vaccine Recovery Plan:

•Use only appropriate transport containers.

•Coolant packs should be “conditioned”before using with refrigerated vaccines

•The CDC does not recommend the use of dry ice.

•Portable temperature probes are needed to monitor maintenance of the cold chain.

•Never put the containers in the trunks of vehicles when transporting. The temperature swings in trunks is too great to assure the cold chain.

•Monitor temperatures hourly.

If questions arise contact the State Immunization Program or the vaccine manufacturers.

Transportation of varicella vaccine poses some different circumstances. The vaccine is kept frozen and is very fragile. We can transport in a cooler, but the vaccine then must be used within 72 hours and cannot be refrozen.

9) COMMUNICATIONS

Following a disaster one of the biggest problems is communications. Usual methods of communication will probably be unavailable. Plan on whom you need to communicate with, what messages you need to pass on and how you will do this. While phones may be down texting may still be possible and is one way to contact staff. Having a preset “Calling Tree” is the most efficient way to contact staff. Consider other social media means to contact patients and the public. Messages for patients should be thought out and coordinated.

During a disaster communications with our staff, patients and the public is crucial. (ENTER NAME) will be in charge of overseeing our communications.

Staff: Because of the likelihood of disruption of cell towers during a disaster telephone communication most likely will not be an option. However, frequently texting is still available. The staff should use text messages if they are unable to uses telephone services. Contact will follow our “Calling Tree”.

Patients: Re-establishing telephone services should be the first priority. Again this may not be available for an extended period of time so other methods such as social media should be considered. News outlets (TV and Radio) may also be helpful especially for contact information and locations and times of services.

Public: Hospitals and law enforcement agencies may also need to be contacted concerning status. These entities may also ask for the facility for assistance with community medical services.

Information and messages thatwe communicate to our patients will be coordinated by

(ENTER NAME)

10) OTHER ATTACHED PLANS

There needs to be a number of ancillary plans that are part of the practices disaster management. These include evacuation of the building, taking cover, and infection control. Your practice may already have these plans written and in place. Training drills should include these additional plans.

Our practice has the following plans that are included in our disaster protocols

•Evacuation

•Take Cover

•Infection Control

They can be found at the end of this document.

11) ORGANIZATIONAL CHART

During disasters most communities have in place Incident Command Structure. This predetermines who will be in charge and making what decisions. Your practice should also have some form of an organizational structure in place. It may involve only a few individuals depending on the size of your practice, but it will be helpful to have some type of predetermined decision making structure in place.

In the case of a disaster our practice will set up the following organizational plan:

(ENTER PLAN HERE)

APPENDIX A

EXAMPLES DISASTER EQUIPMENT BOXES

DISASTER GO BOX

ITEMAMOUNT

BP CUFFS(TREATMENT ROOM)1 EACH SIZE

STETHOSCOPES (TREATMENT ROOM)3

OTOSCOPES (OFFICE)1

OPTHALMOSCOPE (OFFICE)1

TONGUE BLADES1 BOX

OTOSCOPE SPECULA1 BOX EACH SIZE

THERMOMETERS2 DIGITALS

PROBE COVERS2 BOXES

PRESCRIPTION PADS2

CLINICAL NOTES30

PAPER BILLS30

GLOVES1 BOX EACH SIZE

MASKS1 BOX

DISPOSABLE PPE GOWNS6

SCALE1

ALCOHOL WIPES1 BOX

SANITIZERS/SURFACE CLEANERS2 BOTTLES

HAND GELS3 BOTTLES

EAR CURRETTES1 BOX

TAPE MEASURE2

WOUNDS/LACERATION BOX

ITEMAMOUNT

4X4 UNSTERILE2 PACKAGES

4X4 STERILE1 BOX

KLING GAUZE1 PACKAGE EACH 3”, 4”

KERLIX1 PACKAGE

TELFA1 BOX

BETADINE1 BOTTLE

SHUR-CLENS1 BOX

STERILE GLOVES1 BOX EACH SIZE 7 AND 7 1/2

SUTURE KITS DISPOSABLE3

STAPLERS4

DERMABOND1 BOX

STERISTRIPS1 BOX EACH SMALL, LARGE

NEOSPORIN 2 TUBES

STERILE FORCEPS2

SPLINTER FORCEPS2

RAZOR DISPOSABLE2

SCAPLES1 BOX EACH #10, #11

SYRINGES1 BOX EACH 1,3,6CC

NEEDLES1 BOX EACH 27,25,23,GAUGE

SHARPS CONTAINER1 LARGE

LIDOCAINE 1%1 BOTTLE

RESPIRATORY BOX

ITEMAMOUNT

NEBULIZERS2

MASKS AND TUBING1 BOX

ALBUTEROL AMPULES 1 BOX

RACEMIC EPINEPHRINE1 Vial

SALINE AMPULES1 BOX

OXYGEN PORTABLE1 TANK

ALBUTEROL MDI2 INHALERS

AEROCHAMBER MASKS2

ORTHO BOX

ITEMAMOUNT

SOFT CASTING1 EACH SIZE

ACE WRAPS2 OF EACH SIZE

FINGER SPLINTSASSORTMENT

PREWRAP1 EACH SIZE

ADHESIVE TAPE2 ROLLS EACH SIZE

SLINGS1 EACH SIZE

BOOTS1 EACH SIZE

EYE BOX

ITEMAMOUNT

EYE WASH1 BOTTLE

FLUORESCEIN STAIN STRIPS1 BOX

ANAESTHETIC TOPICAL (REFRIGERATOR) 1 BOTTLE

Q TIPS1 BOX

BLACK LIGHT1 UNIT

2X2 S 1 PACKAGE

EYE PATCHES1 BOX

PAPER TAPE 1 ROLL

LABORATORY BOX

ITEMAMOUNT

TIMER2

STREP SCREENS1 BOX

URINE DIPS1 CONTAINER

URINE DIP MACINE (OPTIONAL)1 UNIT

PREGNANCY TESTS1 BOX

RAPID FLU TESTS (SEASONAL)1 BOX

APPENDIX B

VACCINE POWER OUTAGE PLAN TEMPLATE

Vaccines are fragile biological products. They are very sensitive to two factors: light and temperature. If vaccines are not carefully managed and protected from these elements then they can lose potency. The effect of this is that the patient may not develop an adequate immune response. Therefore vaccines that are exposed to improper temperatures or light cannot be used. This results in wastage of the vaccine and the significant costs incurred from this. If a patient has inadvertently received a vaccine that has not been stored adequately they need to have the immunization repeated.

Proper storage of vaccines requires special refrigerator and freezer units. These units require power to maintain the appropriate conditions. Thus power outages must be addressed immediately in order to maintain the cold chain.

If there is a power failure the first step is to keep the units doors closed. This will allow a short time (2 hours) to decide whether or not to institute the facility’s Emergency Retrieval Plan. See below

(ENTER NAME HERE) has agreed to store our immunizations should the need arise. The name of the contact is listed in the Emergency Retrieval Plan document

Use only appropriate transport containers. These are stored (ENTER SITE)

Insulation materials are stored (ENTER SITE)

Frozen coolant packs are located (ENTER SITE)

The CDC does not recommend the use of dry ice.

Portable temperature probes are needed to monitor maintenance of the cold chain.

Never put the containers in the trunks of vehicles when transporting. The temperature swings in trunks is too great to assure the cold chain.

Monitor temperatures hourly.

If questions arise contact the State Immunization Program or the vaccine manufacturers.

Transportation of varicella vaccine poses some different circumstances. The vaccine is kept frozen and is very fragile. Therefore the CDC recommends transport in a portable freezer unit. If this is not available you can transport in refrigerator unit temperatures but the vaccine then must be used within 72 hours and cannot be refrozen.

VACCINE STORAGE AND EMERGENCY RESPONSE PLAN

Post on outside of refrigerator for all staff

Primary Person Responsible: (ENTER NAME)Phone:(ENTER #)

Secondary Person Responsible: (ENTER NAME)Phone:(ENTER #)