Montgomery Memorial Hospital Policy and Procedure Page 47 of 47
Title: MMH Code Triage: Disaster / Emergency Preparedness Plan
/ FirstHealth Montgomery Memorial Hospital Policy and Procedure / Page 1 of 47Title:
/ Code Triage: Disaster / Emergency Preparedness Plan / Policy
Number:
Originating
Department: / Safety Committee / Affected
Department: / All Departments
Department
Director Approval: / Original Date: / 06/1994 / Administration
Approval:
Revised Date: / 08/2008
Review Date: / 11/1999
Montgomery Memorial Hospital Policy and Procedure Page 47 of 47
Title: MMH Code Triage: Disaster / Emergency Preparedness Plan
I. PURPOSE & GENERAL HOSPITAL RESPONSIBILITIES
The purpose of FirstHealth Montgomery Memorial Hospital’s Mass Casualty Emergency Preparedness Plan CODE TRIAGE (“Disaster Plan”) is to provide hospital personnel and medical staff members with guidelines in the event of:
o Internal Disaster
o External Disaster
o Influx, or the risk of influx of infectious patients
o National Disaster Medical System (NDMS) activation
This plan outlines staff responsibilities necessary for the effective care of mass casualties.
FH MMH’s overall responsibilities in the event of a mass casualty situation are:
o Receive casualties
o Coordinate and administer casualty care and treatment
o Notification of next-of-kin regarding casualties received at the hospital
o Continue to provide for the care of non-casualty patients
II. DECISION TO IMPLEMENT PLAN/GUIDELINES FOR ADDITIONAL NURSING PERSONNEL
A) The decision to implement the full plan, or any part of it, will rest with the Director of Nursing/designee, in conjunction with the Emergency Department Physician and Emergency Department Unit Supervisor. Consultation with the Administrator/Administrative staff member on call may be sought as deemed necessary.
The Director of Nursing/designee will assume the role of Disaster Coordinator. Duties and responsibilities are outlined herein (see Section IV).
The 2nd floor nurse’s station will be used as the “Disaster Coordination Area.”
B) The Disaster Coordinator (in conjunction with ED physician and Unit Supervisors) will also determine the capacity of victims that the facility is prepared to treat and relay this to EMS field personnel.
Factors affecting this decision include:
o Acuity of victims
o Available staff/anticipated available staff
III. PLAN ACTIVATION
A) Information concerning a potential external disaster/mass casualty situation is normally received through pre-hospital EMS mechanisms.
1) If call comes in through the Emergency Department, (8:00 a.m. – 4:30 p.m.) staff receiving message should immediately notify:
o Director of Nursing/designee
o Emergency Department Physician and Emergency Department Unit Supervisor
2) If call comes in to the Switchboard Operator (or ED Registration Office after 4:30 p.m.), staff receiving message should immediately notify:
o Emergency Department Unit Supervisor on duty
o Emergency Department Physician and Nurse(s)
B) Once a decision regarding activation of the plan has been made, the Disaster Coordinator will instruct either the Switchboard Operator or other appropriate staff member to announce the following message over the intercom system:
“CODE Triage, Emergency Department” (Repeat announcement 3 times initially)
(Wait approximately one minute and repeat 3 times again)
C) Switchboard Operator (or ED Registration Office staff between hours of 10:00 p.m. and 8:00 a.m.) should then immediately begin telephoning personnel from telephone tree (see Attachment A).
D) ED Registration Office staff (or staff member assigned to Disaster Coordination Area after hours) should immediately begin telephoning the on-call medical staff members (per telephone tree, Attachment A); the Disaster Coordinator will advise regarding the need to contact medical staff members not on call.
E) Each department director is responsible for developing and implementing an internal telephone tree system for their area and ensuring that a current, complete copy is either posted in the department or is available to staff at all times.
After one staff member in a given area is contacted and informed of “Code Triage”, they are responsible for further departmental notifications as per instructions in department-specific plan.
IV. RESPONSIBILITIES/DUTIES OF DISASTER COORDINATOR
A) Confer with Emergency Department Physician, Nurse(s) (and Director of Nursing/designee and/or Administrator/ Adm. personnel on-call if indicated) regarding activation of the plan.
B) Assign in-house staff member to remain in the Disaster Coordination Area (DCA) for the purposes of:
o Securing in-house staff members to lock/guard the following hospital entrances/exits (if “Code Triage” is called during off-hours or when a sufficient number of Maintenance/Security is not available:)
- Main entrance
- South end ground floor entrance (near Administration offices)
- Emergency Department
- Employee Entrance (near Cafeteria). (This staff member will be responsible for signing in employees as they arrive)
- Outpatient Entrance
o Securing laptop from PACU.
o Contacting/calling persons listed on telephone tree (Attachment A) for notification by Disaster Coordinator or designee
o Contacting/calling in additional nursing personnel as per instructions of Disaster Coordinator
o Assigning staff members to various patient care areas as they arrive at the hospital. See staffing plan (Section IX) and Attachment B for staff assignment roster.
o Issue PPE and Code Triage area identification tags to assigned clinical staff.
o Secure 2-way radios for communication: (6) in Disaster Coordination Cabinet (keys are in ED Acudose and the night cabinet) and (6) on Acute Care Unit.
C) Advise ED Registration Clerk (or staff member assigned to Disaster Coordination Area) of the need to contact medical staff members in addition to those on call and follow up with clerk/designee regarding response from medical staff members.
D) Advise PACU staff to clear the area of patients (if possible) in anticipation of casualty arrival(s).
E) Advise PT staff to clear the area of patients in anticipation of casualty arrival(s).
F) Assign staff to take all available stretchers and wheelchairs to the OR/Lab hallway and to the Decon Area also if it is a Decon situation.
G) Send staff member to Purchasing to obtain initial supplies for Yellow Care (Delayed) and Green Care (First Aid) areas (if these have not been brought to the units by Purchasing staff).
H) Remain in the general area of the Emergency Department as much as possible, utilizing “message runners” to relay and receive information from other areas.
I) Assist in maintaining liaison with EMS and providing guidance as needed to field units and command center.
J) Make medical staff assignments as medical staff members arrive.
K) Consider preparations for reducing patient populations (e.g., discharge of less critically ill patients) in order to facilitate potential admissions.
L) Provide direction and control for hospital staff during emergencies, coordinating transportation of casualties and medical resources to healthcare facilities.
M) If necessary, dispatch triage medical staff teams to disaster site as requested.
N) Identify facilities within MMH (and assist as necessary in identifying facilities outside MMH) that could be expanded into emergency treatment areas if necessary and assist in ensuring the provision of medical care to any relocated persons at shelters and/or congregate care/reception centers.
O) Assist as necessary in the provision of medical care in the hazard areas and provision of medical care and preventative medical treatment of essential workers and injured persons.
P) Arrange for the restocking of medical supplies and equipment during the “recovery phase.”
V. EQUIPMENT/DISASTER BOX DISTRIBUTION
A) ED Registration Clerk (or designee if this office is not staffed) will take the “Disaster Box” (containing logs, records, etc.) from ED BO to the Triage Area and set it up for use. (Box is located in 3rd drawer of yellow filing cabinet).
B) Storeroom/Purchasing Department will be opened immediately upon arrival of personnel familiar with the department and deliver supplies as needed.
C) Pharmacy facilities will be opened immediately upon arrival of personnel familiar with the department.
D) Equipment and medication requests should be phoned or sent by messenger to patient care areas. In a disaster situation, it will not be necessary for the patient care unit to fill out requisitions. Purchasing and Pharmacy will be accountable for supplies and drugs dispensed.
VI. GENERAL INSTRUCTIONS FOR STAFF
A) Employees should not report to the hospital unless contacted by telephone.
Exception to this would be if phone communications were interrupted. In this case, a radio and/or television (local and/or regional) message will be broadcast that all employees should report to the hospital.
B) Upon arrival to the hospital, all employees (EXCEPT MEDICAL STAFF MEMBERS) are to enter the building through the entrance by the Food & Nutrition Department (near Cafeteria).
Medical Staff members are the only persons permitted to enter through the Emergency Department.
Staff should be prepared to show their pictured hospital identification badges and will be signed in by the staff member stationed at the door.
DO NOT BADGE IN! Call back hours will be calculated based upon the sign-in roster maintained at the staff entrance. In order to ensure that staff receive reimbursement for responding to the situation, they must enter through the appropriate door and be signed in.
C) All employees are expected to utilize PPE and follow all routine infection policies/procedures.
* PPE and Care Area tags will be given to clinical personnel at the Disaster Coordination Area.
D) Nursing personnel are to report to the Disaster Coordination Area (DCA) immediately upon arrival to the hospital for patient care area assignment.
E) All other staff are to report to their department immediately upon arrival to the hospital.
Each department shall have available an outline of what functions the department is responsible for during a mass/casualty disaster situation so that staff can proceed with specific duties as they arrive.
Personnel not needed in their “home department” should be instructed to report to the DCA for assignment in an alternate area.
F) All employees are to remain on-duty until released by their immediate supervisor.
VII. MEDICAL STAFF RESPONSIBILITIES
A) All medical staff members in the hospital should report to the Emergency Department.
B) Assignment will be made by the Disaster Coordinator, in coordination with the on-duty ED physician.
C) Medical staff assignments are:
o Triage Area: 1 (if no medical staff member available, ED RN will be assigned here)
o Red Care (Urgent) - ED: 3 (including ED physician)
o Yellow Care (Delayed) - PACU: 1 (will report to Green Care (First-Aid) when patients in
Yellow Care are stabilized)
VIII. CASUALTY ROUTING AND HANDLING
A) FIELD TRIAGE: Field triage will be performed by EMS/rescue personnel. In general, patients will be transported to MMH with transfers to other facilities as conditions warrant and circumstances permit.
B) MMH TRIAGE: All patients will be brought to the ambulance area at the Emergency Department. Triage will be performed as ambulances are unloaded.
Note: Hazardous material decontamination will be accomplished before arrival.
*If patient arrives that needs decontamination, the patient will be directed/escorted to the loading dock.
If a medical staff member is available, the Disaster Coordinator will assign him/her to triage. In the absence of a medical staff member, an Emergency Department Registered Nurse will be assigned to perform triage duties.
C) TRIAGE CLASSIFICATIONS AND ROUTING: Every casualty will be triaged according to the following classifications and routed to the appropriate area as follows:
o RED CARE: Patients requiring life-saving measures and/or immediate evaluation
o Patients will be taken directly into the Emergency Department
o YELLOW CARE: Patients whose injuries may eventually produce systemic decline and those in need of close monitoring but not immediate treatment
o Patients will be taken to the PACU (Recovery Room) via the ED corridor; PACU will
have been cleared of patients for this purpose
o Once these patients are evaluated and stabilized, disposition (admission, transfer,
etc.) will be upon the order of the medical staff member attending the patient
o GREEN CARE: Ambulatory patients with minor injuries requiring minimal treatment
o Patients will be taken to the Rehab Svcs. Department via the ED corridor; Rehab
Svcs. Dept. will have been cleared of patients for this purpose
o These patients will be treated in the Rehab Svcs. Dept. as medical staff members
become available
IX. DESIRED STAFFING FOR DISASTER AREAS
TRIAGE AREA (ED Loading Dock): 1 medical staff member (if available) (if not available, ED RN is
to be assigned to this duty)
2 nurses (1 RN and 1 LPN)
2 secretaries
3 transporters
RED CARE (Emergency Dept.): 3 medical staff members (including ED physician)
5 nurses (4 RN s and 1 LPN)
4 CNAs
2-3 secretaries/transporters
YELLOW CARE (PACU): 1 medical staff member (this provider will report to the First Aid area
when patients in Delayed Care are stabilized)
3 nurses (1 RN and 2 LPN s, or 2 RN s and 1 LPN)
2 CNAs
1 secretary/transporter
GREEN CARE (Rehab Svcs. Dept.): 1 medical staff member (same as assigned to Delayed Care)
2 nurses
2 CNAs
1 secretary/transporter
IF PATIENT CARE AREAS NEED ADDITIONAL HELP, THEY SHOULD INFORM THE DISASTER COORDINATOR BY TELEPHONE (EXT. 5127 or EXT. 5260) OR BY MESSENGER!
A) All information related to the treatment of each patient will be recorded on the patient’s individual Disaster ED record as per normal procedure.
B) Any tests ordered are to be documented (by nursing personnel or medical staff members) on the forms included in the disaster chart.
C) Triage secretaries’ responsibilities: (See also, Attachment T, REGISTRATION, EMERGENCY DEPARTMENT - SECRETARIAL)
o Assign numbered charts to each victim
o Document on triage disaster log:
o Name (if available) or brief description
o Time
o Triage classification (Red, Yellow, Green)
o Initiate pre-assembled ED record; document name (if available) or brief description, triage classification and time.
o Place arm band (with name, if available) on patient before they leave the triage area; if band cannot be placed on wrist, it may be placed on ankle.
D) Secretarial Responsibilities -- RED CARE, YELLOW CARE and GREEN CARE: (See also, Attachment T, NURSING SERVICE - EMERGENCY DEPARTMENT, SECRETARIAL)
o Obtain name (if not already available), address, next-of-kin and phone numbers as soon as feasible.
o If it is not possible to obtain above information, document this on ED record.
o Once this information is obtained (or documented that it cannot be obtained), pull the appropriate copy of the record and place in the basket marked “Information Center” in the ED Business Office.