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Emergency Operations Plan

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Emergency Operations Plan

Table of Contents

Section Title Policy Number

Introduction / Policy and Objectives / 1.01
Purpose and Scope / 1.02
Definitions / 1.03
Mitigation / Hazard Vulnerability Assessment / 2.01
Management of Environmental Safety Survey / 2.02
Structural Hazard Mitigation / 2.03
Nonstructural Hazard Mitigation / 2.04
Insurance / 2.05
Preparedness / Incident Command System / 3.01
Activation of Incident Command / 3.02
Emergency Operations Center / 3.03
Action Plan Development / 3.04
Training and Exercises / 3.05
Response / Incident Action Planning: All Hazard Approach / 4.01
Alerts and Notifications / 4.02
Incident Action Planning: Surge / 4.03
Incident Action Planning: Fire-Internal / 4.04
Incident Action Planning: Weapons of Mass Destruction / 4.05
Incident Action Planning: Communicable Diseases / 4.06
Incident Action Planning: Radiation / 4.07
Incident Action Planning: Workplace Violence / 4.08
Incident Action Planning: Evacuation / 4.09
Incident Action Planning: Infant/Child Abductions / 4.10
Incident Action Planning: Shelter in Place / 4.11
Volunteer Management / 4.12
Staff and Patient Tracking / 4.13
Recovery / Restoration of Services / 5.01
Documentation / 5.02
Psychological Needs of Patients/Staff / 5.03
Appendix A / Hazard Vulnerability Assessment
Appendix B / Management of Environmental Hazard Survey
Appendix C / Structural Mitigation Survey
Appendix D / Nonstructural Mitigation Survey
Appendix E / Job Action Sheets
Appendix F / Incident Action Plan Form
Appendix G / Emergency Contact Information
Appendix H / Evacuation Plans
Appendix I / Staff and Patient Tracking
Appendix J / Evacuation Briefing Instructions
Appendix K / After Action Report

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Emergency Operations Plan

Introduction

Subject: Policy and Objectives

Policy No.: 1.01

POLICY:

The CLINIC shall establish and maintain an Emergency Operations Plan that supports an appropriate response to internal and external disasters. The staff shall be trained torespond to incidents in accordance with guidance provided in the plan. Disaster drillswill be conducted at least twice a year to test and evaluate the plan.

PURPOSE:

1) To ensure efficient utilization of resources to avoid overwhelm during initial disaster relief when emergency medical care and first aid areneeded.

2) To provide for expansion of services through discharge, transfer arrangement andcoordination/consultation with local civil authorities and local regional and staterepresentatives and other agencies.

3) To provide professional care for disaster victims immediately upon their arrival at the Clinic or from internal disaster situations.

4) To effectively utilize available resources and supplies.

5) To preserve the health and endurance of personnel for the duration of the disaster andits aftermath.

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Emergency Operations Plan

Introduction

Subject: Purpose and Scope

Policy No.: 1.02

POLICY:

The CLINICwill utilize the Emergency Operations Plan to guide actions during the event of a manmade or natural disaster. The Clinic will ensure that:

All employees are educated on the Emergency Operations Plan at orientation.
Employees are educated on their specific responsibilities during a disaster.
Yearly in-services are provided to all staff.

PROCEDURES:

TheCLINICwill educate staff regarding the following emergency roles and responsibilities:

Responsibilities / Requirements
Internal Emergencies
Protect patients and visitors, staff.
Protect facilities, vital equipment and records. / Generally requires planning, training and
exercises. Also requires internal culture where
safety and preparedness are given high
priority. Specific Requirements include:
• Emergency Plans
• Training/Drills/Exercises
• Emergency/Evacuation Signage
• Business Continuity Plans
• Security
• Internal communications
• Staff notification and recall
• Emergency procedures distributed
throughout the clinic
Mass Casualty Care / • Sufficient staff to manage patient surge
• Triage capability
• Agreements with receiving hospitals
• Integration of clinic into medical response
system
Reception and Triage / During disasters, Clinic may become point
of convergence for injured, infected, worried,
or dislocated community members.
Depending on the emergency and availability
of other medical resources, Clinics may not be
able to handle all of the presenting conditions.
Minimum Clinic role will likely be triage,
reporting, stabilization, and holding until transport arrives
• Response plan
• Staff recall procedure
• Procedures to obtain outside additional
assistance – volunteers, assistance from
county
• Crowd management
• Location of shelters
• Reception area
• Triage tags
• Triage training
Reception of Hospital Overflow / In disasters, hospitals may be overwhelmed
with ill and injured requiring high levels of
care, while at the same time facing
convergence from patients with minor injuries
or the worried well.
Clinic may be requested to handle people
with minor injuries to relieve the pressure on
the hospital.
Requirements above for mass casualty care.
Prior agreement that defines:
• Circumstances for implementation
• Types of patients that will be accepted
• Resource/staff support provided by hospital
• Patient information/medical records
• Liability releases
Maintaining Ongoing Routine Patient Care
– Normal Levels and Extended Surge / The community’s need for routine medical
care may continue following a disaster.
Clinic should prepare to maintain their
service capacity through protection of
equipment, critical supplies and medications,
and personnel. Requirements include:
• Continuity of Operations Plan
• Procedures to augment resources
• In areas subject to frequent power outages,
clinics should consider adding generators
to ensure operational capacity
Mental Health Services / Clinic can expect the convergence of the
“worried well” following a disaster.
• Disaster mental health training for
clinicians/licensed mental health staff
• Internal or external mental health team
• External source of trained personnel to
augment response
Bioterrorism Agent Initial Identification and
Rapid Reporting / Clinic may be the “early warning system” for
a bioterrorism outbreak. Clinicians should look
for unusual symptoms or other signs of use of
BT agents. Rapid reporting is critical.
Unusual event may be a single case or
multiple cases with the same symptoms.
• Infectious disease monitoring procedures
and protocols
• Procedures for reporting to county and
state health department
• Evidence Kits
• Training
Staff Protection / Provide protection to staff in event of presence suspected Bioterrorism agent.
• Adherence to standard, droplet, and/or
airborne precautions as appropriate
• Training
• Infectious disease procedures
• Reporting procedures
Mass Prophylaxis / Clinic may be requested to participate in
mass prophylaxis managed by the local health
department as Point of Distribution (POD).
Clinic participation could include requesting
staff to support mass inoculations at
other sites.
• Availability of staff who can volunteer
• Procedures for determining when Clinic staff
can volunteer
Emergency Roles Requirements
Hazardous Material Response / Clinic near major transportation routes,
distant from hospitals, or with emergency
medical capabilities may be called upon to
treat injured patients who have been
contaminated by a hazardous material.
• Protective equipment
• Decontamination
procedures/capability/equipment
• Reporting procedures
• Waste holding containers
Risk Communications / Clinics are often important conduits of health
information for the community.
Patients, staff and community members may
look to the Clinic for answers to their questions
about a bioterrorist attack or other emergency.
• Communications link with County and State OES.
• Procedures for communicating with patients
staff and community (in languages spoken
in the community)
Provide Volunteer Staff / Clinics may be requested to provide staff to
deliver health services at shelters, for mass
prophylaxis or at other response sites.
• Backup staff
• Policy for receiving requests, polling staff,
and releasing staff for non-clinic duties
• Policy on release of staff for volunteer duty
Receive Volunteer Providers/Teams / • Reception procedures
• Credential/background checks
• Logistic support
Community Preparedness / • Educational material in appropriate
languages
• Educators/volunteers
• Education at schools and faith-based
organizations in community
Sheltering / • Holding area
• Protection from weather
• Bedding
• Medical supplies
• Pharmaceuticals for common conditions
(insulin, etc.)

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Emergency Operations Plan

Introduction

Subject: Definitions

Policy No.: 1.03

POLICY:

The CLINICwill adopt standardized terminology to facilitate communication during a manmade or natural disaster.

PROCEDURES:

CLINICstaff will adopt the following definitions in relation to disaster preparedness and response:

ALTERNATE SITES/FACILITIES:

Locations other than the primary facility where clinic operations will continue during an emergency.

BOMB THREAT:

Call received at the medical centerthreatening damage to patients, staff

and property.

CASUALTY:

One who is injured or killed in anaccident.

CODE RED:

FIRE: Procedures staff should follow toprotect patients, staff, visitors,

themselves and property from aconfirmed or suspected fire.

CODE BLUE:

MEDICAL EMERGENCY: Facilitate thearrival of equipment and specializedpersonnel to the location of an adult

medical emergency. Provide life support and emergency care.

CODE PINK:

INFANT/CHILD ABDUCTION: Activateresponse to protect infants and children

from removal by unauthorized persons, and identify the physical descriptions

and actions of someone attempting tokidnap an infant from the medical

facility.

CODE GRAY:

COMBATIVE ASSAULT PERSON:Activate facility and staff response when

staff are confronted by anabusive/assaultive person.

CODE GREEN:

BOMB THREAT: Activate response to abomb threat or the discovery of asuspicious package.

CODE SILVER:

PERSON WITH WEAPONS ORHOSTAGE: Activate facility and staff

response to event in which staffmembers are confronted by: personsbrandishing a weapon or who have taken hostages in the medical facility.

CODE YELLOW:

HAZARDOUS MATERIALS SPILL:Identify unsafe exposure conditions,

safely evacuate an area and protectothers form exposure due to a

hazardous materials spill release.Perform procedures to be taken in

response to a minor or major spill.

CODE ORANGE:

ACTIVATES ICS—INTERNAL DISASTER/EXTERNAL DISASTER: Term which indicates a disaster, eitherinternal or external, is in progress and requires or may require significantsupport from several departments inorder to continue patient care; activatesresponse and identifies the initiation of the ICS.

CODE BLACK:

POWER BLACKOUT: Activate responseto a rolling power failure.

CODE BROWN:

Term which indicates adisaster that is chemical, biological, radiological, or nuclear in nature; such adisaster may be thought to involve weapons of mass destruction. SpecialDecontamination Tents may be set up outside the Clinic (if available) and theSecurity may limit access.

CODE WHITE:

EVACUATION: Evacuation of the facilityis necessary; activates evacuationprocedure.

CONTINUITY OF OPERATIONS (COOP):

Plans and actions necessary to continue essential business functions and services and ensure continuation of decision making even though primary facilities are unavailable due to emergencies.

DELAYED CARE AREA:

An area which receives, evaluates,treats and provides disposition for allcasualties without serious or lifethreateninginjuries.

DISASTER (GENERAL):

An unusual occurrence involvingpersons requiring extraordinarycoordination of personnel andequipment and the interruption of

routine activity. Disasters are classifiedas:INTERNAL or EXTERNAL

DISASTER DRILL:

A pre-planned exercise that enables policy, procedure,and performance testing.

DISASTER TAG (METTAG):

A triage tag which is placed on casualty victims in thefield which provides sufficient information fortransportation/treatment priorities.

EMERGENCYOPERATIONSCENTER (EOC):

The location at which management can coordinate clinic activities during an emergency. It is managed using the Incident Command System (ICS). The EOC may be established in the primary clinic facility or at an alternate site.

EMERGENCY PREPAREDNESS COMMITTEE (EPC):

The Emergency Preparedness Committee guides the development and maintenance of the clinic’s emergency management program and development of its emergency operations plan.

EMERGENCY RESPONSE TEAM (ERT) :

The Emergency Response Team (ERT) consists of the clinic staff who will fill the core positions of the EmergencyOperationsCenter(EOC) and manage the clinic’s emergency response.

ESSENTIAL FUNCTIONS (EF) :

Essential functions and services are those that implement the clinic’s core mission and goals. The extended loss of these functions, following an emergency, would create a threat to life/safety, or irreversible damage to the clinic, its staff or its stakeholders.

EVACUATION:

The movement of individuals away from a dangerousarea to a place of comparative safety. Evacuations canbe classified as:

A. Partial

B. Lateral

C. Downward

D. Total

EXTERNAL DISASTER:

An occurrence in the community that overwhelmsresources.

EXTERNAL DISASTER –STAGE II:

A mass casualty incident involving nuclear, biological orchemical weapons or a terrorist attack:At this stage, if possible, the Clinic would set up theportable decontamination showers in their designated area outside the Clinic, as well as the triage tents. Allincoming victims would be decontaminated as indicated.

HAZARDOUS MATERIALS:

Any substance that is toxic to human and environmentallife.

HAZARD MITIGATION:

Measures taken by a facility to lessen the severity or impact a potential disaster or emergency may have on its operation. Hazard mitigation can be divided into two categories.

• Structural Mitigation. Reinforcing, bracing, anchoring, bolting, strengthening or replacing any portion of a building that may become damaged and cause injury, including exterior walls, exterior doors, exterior windows, foundation, and roof.

• Nonstructural Mitigation: Reducing the threat to safety posed by the effects of earthquakes on nonstructural elements. Examples of nonstructural elements include: light fixtures, gas cylinders, HazMat containers, desktop equipment, unsecured bookcases and other furniture.

HAZARD VULNERABILITY ANALYSIS:

Hazard vulnerability analysis identifies ways to minimize losses in a disaster considering emergencies that may occur within the facility as well as external to the facility in the surrounding community.

INCIDENT COMMAND SYSTEM (ICS):

A temporary management system used to manage and coordinate clinic activities during an emergency. ICS is designed facilitate decision-making in an emergency environment.

MEDICAL HEALTH OPERATIONAL AREA COORDINATOR (MHOAC):

The position in the Standardized Emergency Operations System (SEMS) responsible for all disaster medical and health operations in an operational area. The MHOAC is stationed in the CountyEOCand is frequently, but not always, the County Health Officer or designee. During the response to disasters, the MHOAC is the Operational Area contact point for requests for medical and health resources including personnel, supplies and equipment, pharmaceuticals, and medical transport.

MULTI-HAZARD APPROACH:

A multi-hazard approach to disaster planning evaluates all threats including the impacts from all natural and man-made disasters, including technological threats, terrorism, and a state of war.

OPERATIONAL AREA (OA):

An intermediate level of the State emergency organization, consisting of a county and all political subdivisions within the county area. Clinics and other health facilities will coordinate their disaster response with the Medical Health

Operational Area Coordinator (MHOAC).

PHASES OF EMERGENCY MANAGEMENT:

Mitigation - Pre-event planning and actions which aim to lessen the effects of potential disaster.

Preparedness – Actions taken in advance of an emergency to prepare the organization for response.

Response - Activities to address the immediate and short-term effects of an emergency or disaster. Response includes immediate actions to save lives, protect property and meet basic human needs.

Recovery - Activities that occur following a response to a disaster that are designed to help an organization and community return to a pre-disaster level of function.

STANDARD OPERATING PROCEDURES (SOP):

Pre-established procedures that guide how an organization and its staff perform certain tasks. SOPs are used routinely for day to day operations and response to emergency situations. SOPs are often presented in the form of checklists or job action sheets.

STANDARDIZED EMERGENCY MANAGEMENT SYSTEM (SEMS):

SEMS is the mandatory system established by Government Code Section 8607(a) for managing the response of government agencies to multi-agency and multi-jurisdiction emergencies in California. SEMS incorporates the use of the Incident Command System.

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Emergency Operations Plan

Mitigation

Subject: Hazard Vulnerability Assessment

Policy No.: 2.01

POLICY:

The CLINICwill conduct a Hazard Vulnerability Assessment on an annual basis for each Clinic site.

PROCEDURES:

The CLINICwill utilize a standard evaluation tool to assess all hazards, their risk of actual occurrence and their impact on life, property and business if the hazard occurred.
Risk will be assessed based upon the Probability x Severity of Impact on life, property and business.
The Consequences of the Impact will be measured as follows:

0=N/A / Negligible / Minor injuries, minimal quality of life impact, shutdown of critical facilities and services for 24 hours or less, less than 10 percent of property is severely damaged.
1=Low / Limited / Some injuries, complete shutdown of critical facilities for more than one week, more than 10 percent of property severely damaged.
2=Moderate / Critical / Multiple severe injuries, complete shutdown of critical facilities for at least 2 weeks, more than 25 percent of property is severely damaged.
3=High / Catastrophic / Multiple deaths, complete shutdown of facilities for at least 30 days or more, more than 50 percent of property severely damaged.

The Frequency of Occurrences will be measured as follows:

0=N/A / Highly Unlikely / Little to no probability in next 100 years.
1=Low / Possible / Between 1 and 100 percent probability in next year or at least one change in next 100 years.
2=Moderate / Likely / Between 10 and 100 percent probability in next year, or at least one change in next 10 years.
3=High / Highly Likely / Near 100 percent probability in next year.

The Clinic will address mitigation, response and recovery for any potential hazard.
A copy of the Hazard Vulnerability Assessment(s) will be included in Appendix A.

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Emergency Operations Plan

Mitigation

Subject: Management of Environmental Safety Survey

Policy No.: 2.02

POLICY:

The CLINICwill conduct a Management of Environmental Safety Survey on a quarterly basis.

PROCEDURES:

The CLINICwill utilize a standard evaluation tool to assess the environmental safety of each Clinic Site.
Each assessment will include Safety Management, Security Management, Hazardous Materials and Waste Management, Emergency Preparedness Management, Life Safety Management, Medical Equipment Management, Utility Management, Infection Control Monitoring Issues.
The Clinic will create a correction action plan to address any potential hazards that are identified during the Environmental Safety Survey.
Environmental Safety Survey(s), and any associated corrective action plans, will be included in Appendix B.

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