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Evacuation of Facility


MITIGATION:
Activities the hospital undertakes to prevent the occurrence of an emergency or minimize the potential adverse effect one may have on its operations.  (i.e., Installation of stand by or redundant equipment, training, etc.)

An Internal Disaster causing a total loss of normal operations thus producing an inability to provide a safe environment of care will result in the implementation of the Emergency Evacuation Plan.  
Types of Internal Disasters producing an unsafe environment include but are not limited to:
fire and/or smoke
loss of utilities and/or medical gases
structural damage
chemical/radiation contamination

PREPAREDNESS:
Activities the hospital undertakes to support and enhance response to a disaster / emergency.  (i. e., plan-writing, employee education, preparation with outside agencies, acquiring and maintaining critical supplies)

1. Activation of the Emergency Evacuation Plan
     a. Decision to implement the Emergency Evacuation Plan will be made by the Incident Commander, the Fire Department Battalion Chief or Safety Officer.  
     b.Interim Emergency Operations Center will be established to facilitate and control the evacuation of the hospital.
        1. Location will be designated by the Incident Commander.
     c. Emergency Operations Center staff will consist of:
          1. Incident Commander
          2. Medical Division Leader
          3. Nursing Sector Leader
          4. Resource Management Leader
          5. Emergency Department Sector Leader
          6. Security Sector Leader
          7. Emergency Preparedness/Safety Director
          8. Other Sector Leaders as required
     d. Evacuation of the building will be according to a triage system that provides an orderly and safe evacuation. 
     1. Emergency Operations Center staff, in conjunction with the appropriate city services, will determine the extent of evacuation and the specific evacuation operations.
          e. Other Department Heads will report to their departments and await further instructions from the Emergency Operations Center (EOC).

2. Responsibilities
     a. Emergency Operations Center will coordinate all activities:
          1. designate triage points for the patients, visitors, and employees
          2. arrange any necessary patient transfers to area hospitals
          3. procure any needed outside assistance
          4. Media coverage.
     b. Medical Division Leader or designee will prioritize evacuation and implement plans of action.
     c. Nursing Sector:
          1.Sector Leaders or Nursing Administrative Coordinator will have the primary responsibility for evacuating the patients.
          1. Advise the Emergency Operations Center of any additional manpower, equipment, or supplies necessary for the evacuation of patients.
     2. Emergency Sector Leader will:
          1. Coordinate the patient care activities at patient triage points
          2.Be responsible for the procurement of any necessary medications, supplies, or equipment.
     d. Respiratory Care Sector Leader:  For patients requiring artificial breathing, Respiratory Care personnel are to assist the Nursing staff in providing oxygen and ventilation to patients.  
          1. Respiratory Care Sector Leader will coordinate the efforts.
     e. Engineering Sector:
          1. Shut off utility control valves or switches as required
          2. Medical gases will not be shut off without:
               1. Consultation with the Nursing and Respiratory Care                2. Confirmation from the Emergency Operations Center.
     f. Security Sector: 
          1. Provide traffic control by sealing off entrances and exits of the effected building(s)
          2. Sealing campus roadways as directed by the Emergency Operations Center and/or Law Enforcement.


RESPONSE
Activities the hospital undertakes to respond to disruptive events. The actions are designed to help reduce casualties, the impact on operations, damage, and to speed recovery. (ie: control, warnings, evacuations, etc.)

3. Evacuation procedure
     a. Emergency Operations Center, in conjunction with the appropriate city service official shall authorize all evacuations of areas of the facilities or the total facility.
     b. Notification
          1. Medical consultation will be sought prior to moving patients, except for those patients in immediate danger.
          2. Emergency Operations Center and/or Incident Commander will notify the PBX Operator to announce “Operation Evacuation” - followed by the area(s) to be evacuated.
          3. Emergency Operations Center will contact all 24 hour departments and request that the appropriate management/Supervisory personnel be contacted.
     c. Types of Evacuation
          1. Partial - removal of one or more patients from an area of danger.
          2. Horizontal - lateral movement of patients to a safe location between fire compartments on the same floor.
          3. Vertical - downward movement of patients to a safe area at least two floors below the floor of the fire.
          4. Total - evacuation of all floors and movement of all patients to a place of safety outside the building.
     d. Evacuation priorities:
          1. patients located on the disaster floor are evacuated first
          2. patients on the floor immediately above and below the disaster floor are evacuated
          3. second and third floors above the fire floor are evacuated
          4. Remaining floors are evacuated as directed by the Emergency Operation Center and/or the Fire Department Battalion Chief.
          e. Unit evacuation - Supervisor and/or Charge Nurse will perform the following:
          1. Triage
               1. identify which patients should be evacuated first
               2. what type of additional assistance is needed.
          2. Keep visitors in the rooms if there is a partial evacuation; otherwise, see that visitors are evacuated with patients.
          3. Employees assisting in evacuation must be aware of the nearest exists to safety.  
               1. Reference the Fire/Evacuation Routes posted on each wall by the elevators and Nurses station. 
          4. As conditions may prevent use of some exits, the evacuation routes must be chosen at the site, when the disaster occurs.  
               1. Note that horizontal evacuation into another wing on the same floor is the preferred choice.
          5. When vertical evacuation is ordered, use fire exit stairwells indicated on the posted fire evacuation route.  
               1. As a general rule, elevators are not used during a fire emergency. 
               2. Administrator On-Call may direct the elevators to be key operated by Engineering and Security.

1. Hospital Evacuation
     A. Should complete evacuation become necessary, patients will be evacuated in the following order:   
          1. Patients nearest the fire
          2. Ambulatory patients
          3. Non-ambulatory patients, in order of least critical to the most critical.
     B. Control of movement
          1. All personnel in the hospital at the time will remain on duty and function under the direction of their Supervisor.
          2. Any persons away from their duty station will return immediately and report to their Supervisor for instruction.
          3. Personnel are to remain in their assigned area unless directed elsewhere by the Incident Commander or the Fire Department.
          4. Keep visitors with patients.
          5. Personnel are to circulate among patients to reassure them.
          6. Do not attempt to remove patients until ordered to do so.
     C. Patient removal 
          1. In evacuation of non-ambulatory patients, the number of beds used to move them must be held to a minimum in order to avoid congestion in safe areas.
               a. The preferred method of movement will be the Stryker Evacuation Chairs 
                    1) Each unit will have an evacuation chair in a visible location. 
                    2) Chairs will be moved to the first location of evacuation and moved from floor to floor until evacuation is complete
          2. Other types of evacuation techniques:
               a. Side-by-side assist
                    1) Patients needing limited assistance
               b. Rear-approach assist
                    1) Potentially uncooperative patients
                    2) Psychiatric or senile patients
               c. Ankle roll
                    1) Patient found on the floor
                    2) Hip roll
                    3) Patient found on the floor (heavy individuals)
               d. Slide
                    1) Low bed position
                    2) Bed-fire situation
                    3) Any-weight patient
                    4) Smoke-filled room
               e. Hip carry
1) Abdominal surgery patients 
               f. Pack strap carry
                    1) Broken legs
                    2) Cerebrovascular injuries
                    3) Narrow or burning doorways
                    4) Obstructed areas 
               g. Swing Carry
                    1) Any-weight patient
                    2) Removal in stairwells
                    3) Removal on fire escapes 
               h. Extremity carry
                    1) Any-weight patient
                    2) Fast removal of many patients
                    3) Exiting through narrow or obstructed doorways
                    4) Exiting through fire areas  
               i. Four-rescuer or blanket carry
                    1) Patient with spinal problems
                    2) Traction patients
                    3) Recent surgery
                    4) Special medical problems.
          3. All life saving equipment will be moved with the patients, if possible.
          4. Decisions to move oxygen tanks and tents will be based on patient needs.
               a. Respiratory Care personnel will maintain portable O2 and assist in transport of these patients.
     D. General information
          1. The first consideration must be saving lives; property is secondary.
          2. Remain calm.  Fear, panic and smoke cause more deaths and serious injury then actual contact with flames.
          3. In severe smoke, put a wet towel over nose and mouth and keep as close to the floor as possible.
     4. Establishment of a Field Hospital by EOC 
          a. Medical Center Hospital Emergency Management team will assess locations on the Medical Center campus and throughout the community that could e used as patient care space in the event the normal patient care space is rendered unusable for any reason.
          b. Priority will be given to using alternate areas on the campus.
          c. Second level priority will be given to using space in other hospitals in the community.
          d. Third level priority will be given to using other health care facilities such as nursing homes.
          e. The lowest priority will be given to using public or commercial buildings due to the need for transporting an extensive array of equipment and a large number of staff to the site to enable use as a patient care space..
          f. Activate transportation plan by notifying:
               1. Emergency Medical Services (EMS)
               2. Private ambulances services
               3. Ector County Independent School District Bus Barn for deployment of school buses.
               4. EZ Rider Bus Service
          g. Notify the appropriate suppliers to deliver immediately to designated facilities:
               1. medical gas supplies
               2. pharmaceutical and medical supplies
               3. food and water
               4. laundry
               5. Refrigeration truck for a temporary morgue.
          h. Transport patients to Field Hospital or alternate care site.
          i. Implement departmental operations in the Field Hospital(s).
          j. Activate Local, State, and Federal Emergency Response Plans.

RECOVERY
Activities hospital Center undertakes to return the facility to complete business operations.  Short-term actions assess damage and return vital life-support operations to minimum operating standards.  Long term focuses on returning all hospital operations back to normal or an improved state of affairs.

     1. Following evacuation of an area or the facility, re-entry will be prohibited until a complete inspection has been completed by the Authority Having Jurisdiction of the incident. 

     2. Once re-entry has been granted, emotional debriefing of staff will occur, if applicable. Hospital chaplains and Social Services will be available to assist.

     3. Staff debriefing will occur to discuss the process and develop after action plans. 

     4. An evaluation of response will be performed to ensure proper response was achieved. Follow up of after action plans will be done to outline improvements needed.