Putting the FUN back in
Emergency Preparedness:
A FUNctional Guide to
Readiness
Anne Hargrave-Thomas, RN, BSN, MBA
CEO, OakLeaf Surgical Hospital, Eau Claire, Wisconsin
LoAnn Vande Leest, RN, MBA-H, CNOR, CASC
CEO, Northwest Michigan Surgery Center
Margaret G Acker, RN, MSN, CASC
Administrator, Southwest Surgical Center
Objectives
Recognize components needed in an
Emergency Preparedness Plan.
 Discuss development of policies for
an Emergency Preparedness Plan.
 Compare and Contrast differences
between an Emergency Preparedness
Plan and Emergency Operations Plan.

Joplin Tornado
Oklahoma Tornado
Earthquakes, Floods and
Snow
Mass Shooting - Colorado
9/11
§416.41(c) Standard



(1) The ASC must maintain a written disaster
preparedness plan that provides for the
emergency care of patients, staff and others in the
facility in the event of fire, natural disaster,
functional failure of equipment, or other
unexpected events or circumstances that are likely
to threaten the health and safety of those in the
ASC.
(2) The ASC coordinates the plan with State and
local authorities, as appropriate.
(3) The ASC conducts drills, at least annually, to
test the plan’s effectiveness. The ASC must
complete a written evaluation of each drill and
promptly implement any corrections to the plan.
Emergency Operations Plan vs.
Emergency Preparedness Plan
Are there differences?
Emergency Operations Plan
A plan to assess and minimize
emergency risks and to develop.
coordinate, manage and evaluate
activities during actual or potential
emergency/disaster situations.
Emergency Preparedness
Plan
A plan that will guide and direct the
facility in the event of an internal or
external emergency or disaster.
Emergency Management Plan
and Emergency Preparedness
Plan
EMP A plan to assess
EPP and minimize
A plan that will guide
emergency risks
and direct the facility
and to develop.
in the event of an
coordinate, manage
internal or external
and evaluate
emergency or
activities during
disaster.
actual or potential
emergency/disaster
situations.
Emergency Management
Detail of EMP
Purpose
 Objective
 Authority
 Drills
 Mitigation
 Response
 Recovery

Detail - EMP
HVA List
 Incident Command
 Plan Activation
 Plan implementation/Staff duties
 Security
 Disaster Classifications
 Identifying and assigning personnel

Detail - EMP
Patient management
 Evacuation
 Utilities
 Communication/ Contact Lists
 Education/Training
 Associated Policies
 Job Descriptions
 Forms

Hazard Vulnerability
Analysis

Every facility should be doing a
Hazard Vulnerability Analysis
This provides the information you
need to develop or improve your EPP.
 Every area and facility is different for
internal and external emergencies.
 Completed annually.

Emergency Preparedness
Plan
Emergency Preparedness
Plan - Questions
How to determine what you need in
your EPP?
 What should every Emergency
Preparedness Plan have?
 What are your state requirements?

CMS – Disaster
Preparedness Plan
(Rev.56, Issued: 12-30-09,
Effective/Implementation: 12-30-09)
 §416.41(c) Standard: Disaster
Preparedness Plan

Most Important Component
Policies and Procedures
 Policies and Procedures
 Policies and Procedures

Policies - EPP

What do you need in your policies?



Purpose
Policy
Procedure
• Describe in detail the procedure you want followed
in this policy.
• Follow normal governing body approval process
• Educate your staff
• Evaluate the plan
Policies - EPP
Forms
 Define during and after business
hours in your procedures.

Usual Cast of Characters
Cardiac Arrest: Patient/Visitor
 Fire plan (Fire Safety)
 Security Alert, Building Threat: Bomb
 Severe Weather: Inclement Weather
 Missing Person Plan (safety &
security)
 Utilities Plan
 Hazardous Waste Plan

Are we missing anything?
Changes in Culture…
Items we should now be thinking about:
Mass Casualty Incident Plan
 Active Shooter
 Cyber Attacks
 Pandemic Influenza

Emergency
Preparedness/Management

EMP’s help the facility assess their
vulnerabilities/weaknesses in order to
develop, manage and evaluate the
activities used during an emergency.

EPP defines and guides the facility
and its staff through emergencies or
disasters.
Useful Links
http://www.michigan.gov/michiganprepares
http://training.fema.gov/IS/NIMS.aspx
Putting the FUN back in
Emergency Preparedness:
A FUNctional Guide to
Readiness
LoAnn Vande Leest, RN, MBA-H, CNOR, CASC
CEO
Northwest Michigan Surgery Center
Traverse City, MI
Preparedness
Developing plans to address how the
ASC will meet the needs of patients,
staff and others present in various
emergency situations.
 Based on HVA – policies are
established to manage incidents most
likely to occur.

Policies
 Bomb
Threat
 Chemical Spill
 Evacuation/Lockdown
 Internal Flooding/Water Damage
 Loss of Fire Alarm System
 Mitigation of Transmission of Influenza
 Severe Weather
 Utilities Systems Failure
Policies – Common Terms

Incident Commander (IC)


The highest level personnel on duty at
the time of the incident is the
commander
Unified Command

Occurs when fire or police arrive on
scene
Bomb Threat

Receiving a bomb threat
 Standardized form by each phone in the facility
for use by the person receiving the call (on thumb
drive)
 Determine whether your phone system allows
each phone to display the last originating call
number – if not, the recording sheet should have
a line to record the number on the display
 Get the attention of a co-worker to notify IC
 Gather as much information as possible using the
questions on the form
 Listen for background noises during the call.
Bomb Threat
 Staff
Response
Don’t turn on/off any lights – use
flashlights if necessary
 Don’t use cell phones, two-way radios, or
other cellular transmitting equipment
 Don’t touch or move anything unusual or
suspicious
 Look for anything you can’t immediately
identify
 Hurt locker clip

Bomb Threat

Supervisor Response
If the threat is for a specific area, note
that and start the search in that area
 If it is a general threat, staff should
search the areas they normally work
in first – as they would recognize
something different/out of place.
 Only the responding authority can
issue and “all clear”

Bomb Threat Drill
May be most effective to drill per area
 Assure that area supervisors know a
drill will occur
 Have a script for the “bomber” to use,
calling in from an outside number
 Debrief after the drill and discuss what
could have made the response more
effective

Chemical Spill
Differentiate from Incidental Spill
 AKA – Hazardous Material
Emergency
 Hazardous Material – any substance
to which exposure would result/may
result in adverse effects to the health
or safety of an individual
 Requires a specialized response by
trained staff to abate the situation

Chemical Spill
 Train
staff on what types of chemical,
housed in the facility, would be
considered hazardous
 Keep a copy of the policy, in a plastic
sleeve, in the location of the chemicals
identified
 If possible/reasonable, have personnel
trained in clean up / abatement
 Note in procedure which chemicals are
appropriate for in house personnel and
which require fire department / hazmat
assistance.
Chemical Spill
 In
the event of a hazardous chemical
spill:
 Use
Checklist
 Notify staff
 Notify authorities
 Establish perimeter
 Take immediate action as directed
 All clear by IC only
Shelter in Place and
Evacuation
 Shelter
in place is the preferred option
 Decision to SIP or Evacuate is made in
consultation with the IC/UC
 Decision may include evacuation of part
of the facility while another part shelters
in place
 A safe zone will be determined – this is
a place outside of the building, far
enough away from the hazard, where
pick up for discharge home or transport
to another facility occurs
Shelter in Place
Decision may be made related to
internal and/or external hazard
 IC initiates process to secure the
building (lockdown)
 Staff/patients/visitors are advised to
stay within the building until further
notice

Evacuation
 Multiple

types of evacuation
Incident Site
• From room/area to room/area

Horizontal
• From area (i.e. smoke compartment) to area

Vertical
• From floor to floor

Complete
• Sequence will be determined by IC
Evacuation
 Considerations




Patient’s chart, meds, ID accompany patient
during evacuation
A master list of all patients with
documentation of discharge home, move to
safe zone, or transfer to hospital noted
If going to the safe zone, staff should stay
with patient until discharged or transported
To the extent possible, turn off and unplug all
equipment, turn off all medical gases, and
close all doors
Internal Flooding/Water
Damage
 IC

Notified – plan put in action
Determine continuity/clean-up/damage
assessment/recovery
 Staff
response
Assure all staff, patients, visitors are
accounted for and put in safe locations.
 Secure the affected area so no one enters
 Protect electronic equipment as much as
possible
 Utilize waste baskets/other receptacles to
catch water

Loss of Fire Alarm System
Implement “fire watch” procedures
 < 4 hours



Assure everyone knows – overhead
page
>4 hours
Fire Watch patrol assigned (walk the
facility continually
 Inspects all rooms – including locked
equipment/store rooms

Influenza Mitigation

Eliminate sources of infection
Postpone elective visits/procedures
for those with confirmed influenza until
they are no longer infectious
 Deny entry to those wishing to
accompany patients if there is a
suspicion/confirmation of influenza
 Train staff to stay at home if ill

Influenza Mitigation

Implement Engineering Controls
Liberal installation of hand sanitizers
 Use closed suctioning systems for
airway suction
 Ensure effective general ventilation
 Ensure thorough environmental
surface hygiene

Influenza Mitigation
 Administrative
Controls
Vaccinate workforce
 Implement respiratory hygiene/cough
etiquette programs (signage at
appropriate reading level, in appropriate
languages)
 Screen personnel and visitors for signs
and symptoms of infection
 Tissues/masks/hand sanitizers available
in waiting areas

Severe Weather
 Staff
Response
Who will receive the initial notification
from NWS
 Overhead announcement
 Account for all patients/visitors/staff
 If Tornado activity – advise to stay away
from windows
 Close blinds, curtains, shades and privacy
curtains
 Move patients and visitors to safe areas

Utilities Systems Failure

Computer systems
HIPAA plan for access of EHR
 Use of paper documentation


Electrical power failure
Assure all life safety equipment is on
red outlets
 Assure med refrigerators are on red
outlets
 Use flashlights as needed

Utilities Systems Failure
 Generator
 Use
Failure
flashlights
 Switch to battery powered monitoring
devices
 Portable oxygen
 Alternate location for refrigerated meds
 Institute fire watch
 Use personal cell phones and runners
to pass messages
8 Step Exercise Design Model
Each is based on needs assessment
 Must have a specific scope that
answers who, what, when, where and
how
 Clear purpose – why are we doing it,
what do we want to accomplish
 SMART Objectives with observable
actions

 Simple, Measurable, Achievable,
Realistic, Task-Oriented
8 Steps (continued)
Written narrative to set the scenario
with sufficient detail
 Identify major and detailed events
 Identify what staff is expected to do
based on objectives
 Write messages (to move scenario
along)

After Action Report

Write an AAR (example on thumb
drive)
Identify recommendations for
improvements (corrective actions)
 Make corrective actions measureable
and specific
 Test them at the next exercise

Regional Emergencies
Michigan is divided into 8 regions
 Volunteer Registry
 https://www.mivolunteerregistry.org/

Region 1 Coordinator
5020 Northwind Ste. 104
East Lansing, MI 48823
Office: 517-324-4404
Fax: 517-324-4406
Email: [email protected]
www.d1rmrc.org
Region 2N Coordinator
1000 W. University Drive, Suite
203
Rochester, MI 48307
Office: 248-759-4748
Fax: 248-759-4751
Email: [email protected]
www.region2north.com
Region 2S Coordinator
6754 Brandt Street
Romulus, MI. 48174
Office: 734-728-7674
Fax: 734-902-6000
Email: [email protected]
http://portal.2south.org
Region 3 Coordinator
1600 N. Michigan Ave., Rm 411
Saginaw, MI 48602
Office: 989-758-3712
Fax: 989-758-3714
Email: [email protected]
http://www.region3hpn.org/index.php
Region 5 Coordinator
1000 Oakland Dr.
Kalamazoo, MI 49008
Office: 269-337-6549
Fax: 269-337-6475
Email: [email protected]
www.5dmrc.org
Region 6 Coordinator
1675 Leahy Street, Ste 308B
Muskegon, MI 49442
Office: 231-728-1967
Fax: 231-728-1644
Email: [email protected]
www.miregion6.org
Region 7 Coordinator
2464 Silver Fox Trail, Suite A
Gaylord, MI 49735
Office: 989-731-4975
Email: [email protected]
www.MIregion7.com
Region 8 Coordinator
420 W. Magnetic Street
Marquette, MI 48955
Office: 906-225-7745
Fax: 906-225-3038
Email: [email protected]
www.reg8.org
http://www.michigan.gov/documents/mdch/regional_bt_contacts_map_321591_7.pdf
QUESTIONS