Medical Clinic

Emergency Operations

Template

This document will help your clinic prepare for emergencies of many different kinds

small and large, local, regional and national, including both medical and natural disaster events.

Emergency Operations Plan Template

Table of Contents

Preface………………………………………………………………………………………3

Introduction………………………………………………………………………………….4

Command Structure………………………………………………………………………..5

Mitigation…………………………………………………………………………………….6

Preparedness……………………………………………………………………………….8

Response…………………………………………………………………………………..15

Recovery……………………………………………………………………………………22

PREFACE

How to Use This Template

The purpose of this template is to assist El Paso and Teller county outpatient clinics with development and maintenance of an emergency management program to guide their response to all emergencies, regardless of cause. Please review, use and modify these for your circumstances.

The template emphasizes coordination with government emergency management agencies. Clinics will need to coordinate their emergency preparedness, response and recovery activities with the El Paso and Teller county Emergency Response System’s medical and health response; and for coordinating requests of medical resources from outside the local area

El Paso and Teller counties, respective health departments, and local cities have adopted a standardized emergency management system that has helped to create consistency among government agencies in their approach to emergency management.

The template takes an “all-hazards” approach ensuring applicability to plans for both natural and man-made disasters. The organization is around the four phases of emergency management – mitigation, preparedness, response, and recovery – and provides a systematic approach to development and implementation of the clinic’s emergency management program.

The template requires an active implementation effort. We recommend that the leadership of clinics initiating the development of their emergency management program:

1. Read this template.

2. Appoint an emergency preparedness committee (EPC) to manage the development and maintenance of an emergency management program.

3. Set priorities and create a work plan for developing plans and preparing staff and organization for emergency response. (All provisions of the template do not have to be implemented simultaneously.)

4. Recognize the importance of training, drills, and keeping plan information up-to-date.

The template is written in black, blue and green font. The green font alerts you to information that needs to be filled in that is specific to your clinic. Blue font alerts you to descriptive information, instructions, or advice. Once you have tailored the template to your clinic’s need, you should not have any blue or green font remaining in your document.
INTRODUCTION

Purpose

The purpose of the <Name of Clinic> Emergency Operations Plan (EOP) is to establish a basic emergency program to provide a timely, integrated, and coordinated response to the wide range of natural and man made events that may disrupt normal operations and require preplanned response to internal and external disasters. The Emergency Operations Plan is an “all-hazards” plan that will guide <Name of Clinic> response to any type of a disaster or emergency.

The objectives of the emergency management program include:

· protecting patients, visitors, and staff safety

· providing prompt and efficient medical care

· establishing a clear chain of command

· maintaining and restoring essential services as quickly as possible

· protecting clinic property, facilities, and equipment

Local vs. Widespread Emergencies

· Local emergencies are disasters with effects limited to a relatively small area. In local emergencies, other health facilities and resources will be relatively unaffected and remain viable options for sending assistance or receiving patients from the disaster area.

· An External Disaster is an event that occurs in the community. Examples include earthquakes, floods, fires, hazardous materials releases or terrorist events. An external disaster may directly impact the clinic facility and its ability to operate.

· In widespread emergencies, nearby medical resources are likely to be impacted and therefore less likely to be able to offer assistance to the clinic. Hospitals may also have a higher response priority than clinics for re-supply and other response assistance.

Policy

· <Name of Clinic> will be prepared to respond to a natural or man-made emergency in a manner that protects its patients, visitors, and staff, and that is coordinated with a community-wide response to a large-scale disaster.

· All employees will know and be prepared to be part of a team to provide the best possible emergency care in any situation. Each supervisor at each level of the organization will ensure that employees are aware of their responsibilities.

· The <Name of Clinic> will work in close coordination with the El Paso and Teller counties’ Public Health Emergency Operations Center and other local emergency officials, agencies and health care providers to ensure a community-wide coordinated response to disasters.

Who’s In Charge?

Under the county and city’s Emergency Operations Plan, there will be a Medical and Health Branch Director which will direct the medical response when needed. The Medical and Health Branch Director will operate Emergency Support Function #8 which includes public health, mental health, and environmental health. Dependent upon the type of emergency or disaster, such as an infectious disease outbreak or an earthquake, this operative section may perform a joint lead or supportive role.

COMMAND STRUCTURE

<Name of Clinic> Incident Command Structure
In order to coordinate with the County Emergency Response system, <Name of Clinic> has adopted the Incident Command Structure as the management structure to be used in an emergency.

The following roles will be filled by the listed persons:

Incident Commander: <_NAME HERE_____________>

Incident Commander (backup) : <_NAME HERE_____________>

Liaison: <_NAME HERE_____________>

Liaison (backup) : <_NAME HERE_____________>

Under ICS, the clinic’s overall response is directed by an Incident Manager. The Liaison officer is responsible for coordination with other agencies and with County Incident Command

Incident Command System (ICS) is a standardized management system used by government agencies and hospitals in emergencies. There are many resources that describe the Incident Command System (ICS) for Emergency Operations (See Appendix)

In order to coordinate with the county Emergency Response system, your clinic needs:

· a definite single person and a back up to be in charge (an Incident Manager)

· someone to be the main outside communicator, and a back up (Liaison)

We recommend if clinic size indicates, the clinic adopt an Emergency Management Operational Structure to clearly define roles and responsibilities and quickly mobilize response resources. Incident Command System is a standardized management system used by government agencies and hospitals in emergencies.

Under ICS, the clinic’s overall response is directed by an Incident Manager. A capable senior manager should serve in that role. (Physicians should be reserved as advisors and care delivery clinicians.)

Also important for your clinic’s coordination with the community’s overall response is a Liaison officer, who is responsible for communication and coordination with other agencies and with county Incident Command.

See Appendix for an expanded organization chart and example of staff assignment to Emergency Response Team positions.

MITIGATION

Introduction

The purpose of this section of the <Name of Clinic> plan is to address the perceived areas of vulnerability within the organization, to identify important hazards and take steps to lessen those hazards or reduce their potential impact on the clinic.

[If you are doing what OSHA requires, your safety person is well-positioned to enact necessary mitigation steps. (A higher-level Emergency Planning Group will need to energize additional necessary preparedness actions- see Preparedness, next section.)]

Mitigation activities may occur both before and following a disaster.

Hazard Vulnerability Analysis

As part of its risk management program, <Name of Clinic> will also conduct a Management of Environment safety survey of its facilities at least quarterly and a Hazard Vulnerability Analysis every 1-2 years.

(See the Kaiser HVA excel file. Our project assistant will schedule a time at your office to do the first assessment. Your EMP should address the main risk identified at the completion of this project.)

Hazard Mitigation

<Name of Clinic> will undertake mitigation or retrofitting measures before disasters to lessen the severity or impact a potential disaster may have on its operation.

[Refer to Appendix for a checklist of structural and non-structural hazard mitigation recommendations for specific hazards.]

Risk Assessment

Insurance Coverage

<Name of Clinic> will review insurance coverage for relocation, loss of data, supplies and equipment, and structural and nonstructural damage to the facility, as well as coverage for floods or earthquakes.

Whether it's free disaster relief or a charged service doesn’t really make a difference to the policy being in place. The difference will be in type of services provided, during a disaster, compared to the usual clinic practice. In an emergency setting you may be providing expanded services not anticipated in your usual rating. If you are charging fees for services it is intended that those services be within the course and scope of your rated specialty. Good Samaritan coverage is intended for services provided without compensation or the expectation of compensation.”

Review the following and make list of contacts (Appendix):

· Property insurance

· Liability insurance,

· Business interruption insurance

· Life, Disability, and Workers compensation policies.

· Is any type of an umbrella policy needed based on the risk implied or shown from the HVA?

Clinic Emergency Response Roles

<Name of Clinic> may play a variety of roles in responding to disasters including providing emergency medical care and expanding primary care services to meet increased community needs. <Name of Clinic> will also be asked to distribute important public information.

Clinic roles may be constrained by limited resources and technical capability and by the impact of the disaster on the clinic facility.

The clinic, not the emergency management community, needs to decide on the response roles it will prepare to perform following a disaster and describe those roles in this section. This decision will involve input from clinic management and staff, the clinic board of directors, the community, and government emergency management officials. Be sure to share this information with the emergency management community (e.g. local health department and county office of emergency management) so that they will know what to expect from the clinic.

Your clinic may a variety of roles in responding to a disaster including, but not limited to:

· Providing emergency medical care

· Providing temporary shelter

· Expanding primary care services to disaster victims and serving as a conduit for information dissemination to affected communities

· Closing clinics in order to move staff to other clinic facilities or to the local hospital

The following wording is an example of <Name of Clinic> Emergency Management Plan.

1. During an emergency <Name of Clinic> will consider taking the following roles if appropriate:

a. If possible, <Name of Clinic> will continue to see its regular patients with priority to those impacted by the emergency.

b. When the number of patients effected by the emergency exceeds the availability of same-day-appointments (refer to the section on surge capacity) <Name of Clinic> will:

1) Cancel non-emergency appointments

2) Consider schedule changes to increase hours

3) Consider increasing the number of staff by using the dental staff

4) Consider increasing the number of staff by the use of qualified volunteers

c. If the emergency is community-wide <Name of Clinic> will consider becoming a triage center in support of the (Name of Hospital (s)) hospital and working with the El Paso or Teller county health department and the El Paso or Teller County Office of Emergency Preparedness.

2. <Name of Clinic> working with the El Paso or Teller county health department and will consider the following to determine if its facilities should continue operation or close:

a. Availability of medications/vaccines locally or through the Strategic National Stockpile (SNS)

b. Integrity of the facilities

c. Ability to access facilities

d. Security

e. Availability of support staff

f. Availability of medical staff

g. The need to consolidate staff at a particular location

h. Ability to provide uncompromised care under the CDC altered standards of care specifications, if appropriate

i. Adequate supplies for staff, e.g. water, food

j. Availability of power and other utilities

k. Orders from authorities

Preparedness

Introduction

<Name of Clinic> has established an Emergency Preparedness Committee (EPC) with the authority to energize necessary preparedness action and to develop/update emergency plans and procedures, assure training, and conduct drills (see below for more about this committee.)

Integration with Community-wide Response

<Name of Clinic> will coordinate its response to community-wide disasters with the overall medical and health response directed by the County or City Emergency Operations Center.

[See Appendix for list of agencies and individuals who should be contacted in emergencies.]

Response authority - clinic personnel will cooperate fully with Emergency Medical Services and law enforcement personnel when they respond to emergencies at the clinic. This may include providing information about the location of hazardous materials or following instructions to evacuate and close the clinic.

Command post - the <Name of Clinic> will identify a location for an emergency responder command & coordinating center.

Acquiring Resources

<Name of Clinic> will develop procedures for augmenting supplies, equipment and personnel from a variety of sources. Assistance may be coordinated through the following channels:

· Prior agreements with vendors for emergency re-supply

· Stockpiles of medical supplies and pharmaceuticals anticipated to be required in an emergency response

· From other clinics, hospitals or health care providers with established Memorandums of Understanding (MOU’s).

· Medical and Health Branch Director under the county or city Emergency Operations Center

Roles / Responsibilities

The <Name of Clinic> Emergency Preparedness Committee will coordinate the development and maintenance of the Emergency Operations Plan; and provides for ongoing training for clinic staff.

[The EPC should include such staff as the safety manager, facility manager and senior representatives from administration and health care staff. Part of the EPC role may be assigned to existing committees of the clinic, such as the Infection Control or Safety Committee.]

The Emergency Preparedness Committee will appoint teams and perform the following tasks:

· Develop procedures for light search and rescue - Appoint and train a light search and rescue team to ensure all rooms are empty and all staff, patients, and visitors leave the premises when the clinic is evacuated. If required and safe, this team will perform additional search and rescue tasks that do not entail using equipment or disturbing collapsed structures.

· Assign staff emergency management duties and responsibilities

· Activate the clinic’s emergency response

· Direct the overall response to the disaster/emergency

· Develop the criteria for and direct the evacuation of staff, patients and visitors when indicated

· Ensure the clinic takes necessary steps to avoid interruption of essential functions and services or to restore them as rapidly as possible

· Ensure a hazard vulnerability assessment is performed periodically, every 1-2 years.

All clinic staff has emergency and disaster response responsibilities. In addition, all staff is required to:

· Familiarize themselves with evacuation procedures and routes for their areas [See Appendix]

· Become familiar with basic emergency response procedures for fire, HAZMAT and other emergencies [See Appendix]

· Understand their roles and responsibilities in <Name of Clinic> plans for response to and recovery from disasters

· All staff will also be encouraged to prepare family and home for consequences of disasters [See Appendix]

Initial Communications and Notifications

<Name of Clinic> Staff Call List

The clinic will compile and maintain an internal contact list that will include the following information for all staff: name, position title, home phone, cell phone, pager numbers, and preferred method of contact during off hours. [See Appendix.]

(The Staff Call List will contain sensitive contact information and should be treated confidentially.)

The list of staff phone numbers should be kept offsite as well as onsite by key employees and at key locations, and may be provided to the clinic’s answering service.

<Name of Clinic> will also develop an email and/or a paging group for employees to facilitate rapid staff contact. The clinic may distribute emergency contact information for key staff to keep information readily accessible. [See Appendix .]

External Notification

<Name of Clinic> will compile and maintain an external contact list of phone/fax numbers and/or e-contact information of emergency response agencies, key vendors, stakeholders, insurance companies, and resources.

[Appendix lists routine and emergency contact numbers for basic support services for clinic operations (e.g., utilities, repair services, etc.)

Appendix lists contact information for use in response to disasters (e.g., government response entities of national (FEMA, CDC), state, city, and county, county and state health departments, hospitals and clinics, etc.)]

Primary Communications Methods

The clinic has compiled a list of communication equipment available for use in an emergency.

[Refer to Appendix for a list of communication equipment available]

Other alternate communications tools include:

· FAX, Pagers, Cell Phone, Internet/Email, Public Pay Phones, and Voice Messaging.

[Learn to use your cell phones’ text messaging capacity; include instructions in your communications procedures. Also keep compatible cell-phone chargers at clinic and fully charged back up batteries]

· A working television and battery-operated radio in the clinic emergency operations area in order to remain up-to-date on official government announcements and other information during a disaster. County and city law enforcement channels: Radio:_______ and Television:________.

· Internet access: http://www.cdphe.state.co.us/epr/han.html – CDC’s Health Alert Network through the Colorado Department of Public Health and Environment.

Clinic Evacuation Plan

<Name of Clinic> will:

Develop an evacuation plan for all staff and clientele in the event of an emergency.

[Confirm your OSHA-required evacuation plan See Appendix ]

Develop plans to obtain needed medical supplies, equipment and personnel. [Appendix]
Plan for protection of medical records:

To the extent possible, the clinic will protect medical records from fire, damage, theft and public exposure. If the clinic is evacuated, security will be provided to ensure privacy and safety of medical records, and protection of vital records, data and sensitive information.

Ensure offsite back-up of financial and other data.
- The clinic will store copies of critical legal and financial documents in an offsite location
- Measures will be taken to protect financial records, passwords, credit cards, provider numbers and other sensitive financial information [Write them down, make copies of the information, and store it off-site.]
- Plans will be developed for addressing interruption of computer processing capability
- A contact list of vendors who can supply replacement equipment will be maintained [Appendix]

Protect information technology assets from theft, virus attacks and unauthorized intrusion.

Protect medical and business equipment. Necessary steps shall include:

Compiling a complete list of equipment serial numbers, dates of purchase and costs and storing a copy of this information offsite
Protecting computer equipment against theft through use of security devices
Using surge protectors to protect equipment against electrical spikes
Securing equipment to floors and walls to prevent movement during earthquakes
Placing fire extinguishers near critical equipment, training staff in their use, and inspecting according to manufacturer’s recommendations

Maintain contact list of utility emergency numbers. [See Appendix]
Ensure availability of phones and phone lines that do not rely on functioning electricity service.
Request priority status for maintenance and restoration of telephone service from local telephone service provider. Contact provider and request priority status for the reason that your clinic will be providing medical care in the event of an emergency.

Clinic Patient Surge Preparedness

Surge capacity requires clinic resources to deliver medical care under situations which exceed normal capacity.

Surge Functions may require areas in which patients may be triaged, managed, vaccinated, decontaminated, or simply located; available personnel of all types; necessary medications, supplies and equipment.

Normal clinic capacity could be exceeded during any type of emergency for reasons that include the following:

· Random spikes in numbers of presenting patients

· Seasonal or other cyclical spikes (e.g., school required immunizations, flu epidemics, etc..

· Convergence of ill, injured, or worried well resulting from disasters

Events that create patient surge may also reduce clinic resources through exhaustion of supplies and pharmaceuticals and reduced staff availability. Staff may be directly impacted by the emergency, unable to reach the clinic or required to meet commitments at other health facilities.

Basic Office Medical Surge Strategies

<Name of Clinic> will consider the following medical office surge strategies and, if feasible, develop specific implementing response plans.

Modification of routine operations:

Delay and/or deferral of routine office visits (e.g., cancel annual physical)
Extension of office hours (opening earlier, remaining open later)
Modification of office hours to segregate and concentrate influenza-related (or other highly infectious respiratory illness) patients to defined time slots in order to minimize secondary disease spread
Implement more flexible human resources strategies to accommodate needs of staff
Implement mutual aid agreements/understandings with other medical offices, including cross-staffing arrangements, designating one clinic as the “flu” clinic, the availability of non-primary care physicians and staff to assist, etc
Identify methods to frequently update the command center regarding the status of the clinic and the ability to receive new patients
Plan for managing a staffing shortage within the organization due to illness in personnel or their family members

Patient flow and site planning

<Name of Clinic> clinical staff will:

· Periodically review patient flow and identify areas on clinic grounds that can be converted to triage sites, patient isolation areas, and decontamination or treatment areas.

§ Sites should be selected based on patterns of access, airflow and ventilation, availability of adequate plumbing and waste disposal, and patient holding capacity

§ Triage and isolation areas will be accessible to emergency vehicles and to patients

§ Triage, decontamination and isolation sites should have controlled access

· Plan for the following surge strategies for an infectious disease emergency (Pandemic Illness) triage:

§ Identify persons who might have communicable illness

§ Separate them from others to reduce the risk of disease transmission, and

§ Identify the type of care they require (i.e., home care or hospitalization)

· Develop a strategy for triage, diagnosis, and isolation of possible infectious patients. The following triage mechanisms may be considered:

§ Using phone triage to identify patients who need emergency care vs. those who can be seen in your medical office or other non-urgent facility

§ Assigning separate waiting areas and a separate triage evaluation area for persons with infectious symptoms

§ Assigning a “triage coordinator” to manage patient flow, including deferring or referring patients who do not require emergency care

§ Reviewing procedures for the clinical evaluation of patients to facilitate efficient and appropriate disposition of patients

§ Reviewing admission procedures and streamline them as needed to limit the number of patient encounters in the office (e.g., direct admission to an examination room for infectious patients)

Disaster Medical Resources

Personnel

<Name of Clinic> will rely primarily on its existing staff for response to emergencies and will, therefore, take the following measures to estimate staff availability for emergency response:

· Identify clinical staff with conflicting practice commitments

· Identify staff with distance and other barriers that limit their ability to report to the clinic

· Identify staff that are likely to be able to respond rapidly to the clinic

<Name of Clinic> will take steps to facilitate response by its staff when their homes and families may be impacted by an emergency. These steps will include:

· Incorporating disaster preparedness information into the clinic’s normal communications and education programs for staff and patients, including home and family preparedness [See Appendix for guidelines.]

· Identifying childcare resources that are likely to remain available following a disaster, including possible on-site child care

Pharmaceuticals / Medical Supplies / Medical Equipment

· <Name of Clinic> will determine the level of medical supplies and pharmaceuticals it is prudent and possible to stockpile. Given limited resources, the clinic will stockpile only those items it is highly likely to need immediately in a response or in its day-to-day operations. All stored items should be rotated to the extent possible.

· The <Name of Clinic> will identify primary and secondary sources of essential medical supplies and pharmaceuticals and develop estimates of the expected time required for re-supply in a disaster environment.

Strategic National Stockpile (SNS)

· In an infectious disease emergency event, if mass quantities of pharmaceuticals are needed then the county will request mobilization and delivery of the Strategic National Stockpile (SNS) through the county or city’s Emergency Operations Center and the State of Colorado. The CDC has established the Strategic National Stockpile program as a repository of antibiotics, chemical antidotes, life support medications, IV administration sets, airway maintenance supplies including ventilators, and other medical/surgical supplies. The SNS is designed to supplement and re‑supply state and local public health and medical response teams in the event of a biological and/or chemical terrorism incident anywhere in the U.S. If required and delivered, the city or county’s Emergency Medical Operations Center will administer and distribute the stockpile.

Personal Protective Equipment (PPE):

· <Name of Clinic> will take measures to protect its staff from exposure to infectious agents and hazardous materials. Clinic health care workers will have access to and be trained on the use of personal protective equipment. <Name of Clinic> will obtain and maintain a minimum of <insert number> complete sets of PPE. (See Appendix for levels of PPE)

· The recommended PPE for clinic personnel is at a minimum, well-fitted N95 HEPA masks, and covering gowns, gloves and booties. (TYVEK Coverall with hood and booties, with TYVEK booties, face shield, and Nitrile Gloves.)

· The Emergency Planning Committee will designate clinical staff that is to receive PPE when a patient with a suspected infectious agent is present.

· Protective equipment is located in <location in clinic>, and will be accessed by <position of person> or <position of person> when a patient with a suspected infectious disease presents.

Training

All employees and new employees should attend periodic training and updates on emergency preparedness, including elements of this plan. Employee essential knowledge and skills include:

· The location and operation of fire extinguishers

· The location of fire alarm stations and how to shut off fire alarms

· How to notify clinic staff regarding an emergency

· How to dial 911(access the Emergency Response System) in the event of any emergency

· How to assist patients and staff in the evacuation of the premises

· Location and use of oxygen (licensed staff)

· Location and use of medical emergency equipment (medical staff and staff trained on AED)

· How emergency codes are called in the clinic and appropriate initial actions

· Actions to be taken during fire and other emergency drills

· Employment expectations regarding attending work during in emergency

Clinician Infectious Disease Emergency Training

· All physician and nursing staff will receive documented training on procedures to treat and respond to patients infected with an infectious disease. (Such training is easily appended to meet required OSHA training in Blood Borne Pathogens and infectious disease. Possible training available thru CDC website: http://www.cdc.gov/ncidod/dhqp/bp.html.) Training should include:

1. Information about most likely agents

2. Possible behavioral responses of patients

3. Infection control practices, including:

a. Use of and location of Personal Protective Equipment

b. Reporting requirements

c. Patient management

d. Behavioral responses of patients to biological and chemical agents and to medical emergencies

e. Roles and responsibilities in an infectious disease emergency

Drills and Exercises

<Name of Clinic> will rehearse this disaster plan periodically. All drills shall include an after-action debriefing and report evaluating the drill or exercise. Effective exercises may include one or more of the following response issues in their scenarios:

· Clinic evacuation

· Infectious disease emergencies

· Mental health response

· Coordination with government emergency responders

· Continuity of operations

· Expanding clinic surge capacity

Evaluation

The effectiveness of the administration of this plan can be evaluated following plan activation during actual emergencies or exercises. Staff knowledge and responsibilities may be critiqued by the Emergency Preparedness Committee (EPC) and reported to the clinic Executive Director.

Based on the after-action evaluation, the clinic Emergency Preparedness Committee could develop recommendations for:

· Additional training and exercises

· Changes in disaster policies and procedures/Plan updates and revisions

· Acquisition of additional resources

· Enhanced coordination with response agencies

Plan Development and Maintenance

The Emergency Preparedness Committee (EPC) will review and update this plan at least annually and following any emergency or drills, or following changes such as remodeling, construction, installation of new equipment, and changes in key personnel. When these events occur, the Emergency Preparedness Committee could review and update the Plan to ensure:

Evacuation routes are reviewed and updated
Emergency response duties are assigned to new personnel, if needed
The locations of key supplies, hazardous materials, etc. are updated
Vendors, repair services and other key information for newly installed equipment are incorporated into the plan