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)
(ENTER HAZARD)
(ENTER HAZARD)
(ENTER HAZARD)
(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, Events Accidents, Terrorist Attacks, School Shootings)
•
•
•
•
•
(ENTER HAZARD)
(ENTER HAZARD)
(ENTER HAZARD)
(ENTER HAZARD)
(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
(ENTER ITEM)
(ENTER ITEM)
(ENTER ITEM)
(ENTER ITEM)
(ENTER ITEM)
STORAGE SITE
(ENTER SITE)
(ENTER SITE)
(ENTER SITE)
(ENTER SITE)
(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)
(ENTER NAME)
(ENTER NAME)
(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)
• (ENTER FACILITY)
• (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
Tax returns
Corporation documents
Insurance policies
Medical Degrees/Diplomas
(LIST OTHER DOCUMENTS)
(ENTER SITE)
(ENTER SITE)
(ENTER SITE)
(ENTER SITE)
(ENTER SITE)
(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 that we 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
ITEM
BP CUFFS
AMOUNT
(TREATMENT ROOM)
1 EACH SIZE
STETHOSCOPES (TREATMENT ROOM)
3
OTOSCOPES (OFFICE)
1
OPTHALMOSCOPE (OFFICE)
1
TONGUE BLADES
1 BOX
OTOSCOPE SPECULA
1 BOX EACH SIZE
THERMOMETERS
2 DIGITALS
PROBE COVERS
2 BOXES
PRESCRIPTION PADS
2
CLINICAL NOTES
30
PAPER BILLS
30
GLOVES
1 BOX EACH SIZE
MASKS
1 BOX
DISPOSABLE PPE GOWNS
6
SCALE
1
ALCOHOL WIPES
1 BOX
SANITIZERS/SURFACE CLEANERS
2 BOTTLES
HAND GELS
3 BOTTLES
EAR CURRETTES
1 BOX
TAPE MEASURE
2
WOUNDS/LACERATION BOX
ITEM
AMOUNT
4X4 UNSTERILE
2 PACKAGES
4X4 STERILE
1 BOX
KLING GAUZE
1 PACKAGE EACH 3”, 4”
KERLIX
1 PACKAGE
TELFA
1 BOX
BETADINE
1 BOTTLE
SHUR-CLENS
1 BOX
STERILE GLOVES
1 BOX EACH SIZE 7 AND 7 1/2
SUTURE KITS DISPOSABLE
3
STAPLERS
4
DERMABOND
1 BOX
STERISTRIPS
1 BOX EACH SMALL, LARGE
NEOSPORIN
2 TUBES
STERILE FORCEPS
2
SPLINTER FORCEPS
2
RAZOR DISPOSABLE
2
SCAPLES
1 BOX EACH #10, #11
SYRINGES
1 BOX EACH 1,3,6CC
NEEDLES
1 BOX EACH 27,25,23,GAUGE
SHARPS CONTAINER
1 LARGE
LIDOCAINE 1%
1 BOTTLE
RESPIRATORY BOX
ITEM
AMOUNT
NEBULIZERS
2
MASKS AND TUBING
1 BOX
ALBUTEROL AMPULES
1 BOX
RACEMIC EPINEPHRINE
1 Vial
SALINE AMPULES
1 BOX
OXYGEN PORTABLE
1 TANK
ALBUTEROL MDI
2 INHALERS
AEROCHAMBER MASKS
2
ORTHO BOX
ITEM
AMOUNT
SOFT CASTING
1 EACH SIZE
ACE WRAPS
2 OF EACH SIZE
FINGER SPLINTS
ASSORTMENT
PREWRAP
1 EACH SIZE
ADHESIVE TAPE
2 ROLLS EACH SIZE
SLINGS
1 EACH SIZE
BOOTS
1 EACH SIZE
EYE BOX
ITEM
AMOUNT
EYE WASH
1 BOTTLE
FLUORESCEIN STAIN STRIPS
1 BOX
ANAESTHETIC TOPICAL (REFRIGERATOR)
1 BOTTLE
Q TIPS
1 BOX
BLACK LIGHT
1 UNIT
2X2 S
1 PACKAGE
EYE PATCHES
1 BOX
PAPER TAPE
1 ROLL
LABORATORY BOX
ITEM
AMOUNT
TIMER
2
STREP SCREENS
1 BOX
URINE DIPS
1 CONTAINER
URINE DIP MACINE (OPTIONAL)
1 UNIT
PREGNANCY TESTS
1 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)
Secondary Person Responsible: (ENTER NAME)
Person with 24-hour access: (ENTER NAME)
Phone: (ENTER #)
Phone: (ENTER #)
Phone: (ENTER#)
What to do if a power failure occurs, the refrigerator door was left open, the temperature
was too cold, and the refrigerator plug was pulled or any other situation which would
cause improper storage conditions:
1.
2.
3.
4.
5.
Close the door and/or plug in the refrigerator/freezer.
Record the current temperature of the refrigerator/freezer.
Store the vaccines at appropriate temperatures. Make sure that the
refrigerator/freezer is working properly or move the vaccines to a unit that is.
Do not automatically throw out the affected vaccine.
Collect essential data on the reverse side of this sheet and notify the state
health department.
Call all manufacturers of affected vaccine(s) and ask to speak to medical.
INFORMATION FOR MANUFACTURERS(S) OF AFFECTED VACCINE(S):
Vaccine and Lot #
Expiration Date
Amount of Vaccine
Vaccine Manufacturer Information
Manufacturer
Telephone Number
Sanofi Pasteur
Merck
GlaxoSmithKline
Wyeth
Novartis
Med Immune
State Immunization Program
1-800-822-2463
1-800-609-4618
1-888-825-524
1-800-999-9384
1-800-244-7668
1-877-633-4411
(ENTER NUMBER)
What to do if a power failure occurs and it is determined it will last more than 2 hours:
1. In this instance the vaccines will need to be transported to another facility with the
capability of proper storage.
2. Immediately remove most but not all of the coolant packs from the freezer to allow
for partial thawing (conditioning).
3. Before transporting, call the back-up location site to ensure that they can accept the
vaccines.
#1. Location & Contact’s Name
__________________________________Ph #__________________
#2. Location & Contact’s Name
__________________________________Ph #__________________
4. Procedure for placing vaccines in transport coolers
Coolant packs are stored in the basement refrigerator and should be “conditioned”
before using with refrigerated vaccines. If completely frozen coolant packs are used
with refrigerated vaccines they can cause permanent damage. Leave some coolant
packs in the freezers for transport of frozen vaccines. Transport refrigerated
vaccines and frozen vaccines separately.
1.1.
1.2.
1.3.
1.4.
1.5.
1.6.
Place vaccines in cardboard boxes and place on bottom of cooler
Put a layer of Bubble-wrap around the boxes
Place conditioned coolant packs around the vaccines
Place a layer of Bubble-wrap on top of vaccines
Place a layer of coolant packs on top
Close the lid.
Procedure for packing frozen vaccines in transport coolers:
Same as above, but use frozen coolant packs.
If the vaccines will be in the transport containers more than an hour they will need to
have temperature monitored hourly. This may be done with portable thermometers.
5. Transport vaccines as soon as possible to back-up facilities.
DO NOT PLACE IN THE TRUNKS OF CARS