Welcome to Bluffton Regional Medical Center

Emergency Operations Plan - Intiation Activities

PLAN INITIATION
To facilitate the orderly initiation of the response to an emergency, the following steps of the Emergency Operations Plan will be initiated.

1.Information received by the Bluffton Regional Medical Center concerning an external emergency facing the community or an internal emergency involving the function of the Hospital will be passed directly to the person in charge of the facility at the time- CEO ,House Supervisor or designee.

2.When notified of a potential disaster, the person in charge of the hospital, Emergency Department (ED) Physician, and ED Charge Nurse will:

Evaluate the issues such as location of incident (internal, external), the distance from the Bluffton Regional Medical Center, the scope of the incident (single individual, mass casualty, or malicious attack), and weather conditions (seasonal and current).

Discuss the operations pertaining to the conversion of the hospital to disaster status.

Plan care of casualty and non-casualty patients arriving in the Emergency Department during a disaster.

Will evaluate the information concerning this emergency and determine if initiation of the Emergency Operation Plan (EOP) is warranted.  Two of the three are required to initiate the EOP.

1.Once it has been determined to activate the EOP, the individual who takes the role of Incident Commander will notify the hospital, staff, and executives as soon as possible.

Incident Phases

1.Phase I – when notified by EMS and/or other sources of an incident with multiple casualties or a small incident with no casualties that occurred within the facility.
Situation that most likely can be managed with the staff already on duty.
Staff should remain on duty and review their department specific procedures to be prepared to respond to the next level if situation requires an upgrade.
The person in charge of Nursing will have a bed count and expected discharges ready to report.
The Hospital Command Center (HCC) may be set up and only selected departments notified.

2.Phase II – patients are received and some support from the Emergency Department will be required and/or the affected area may need some support.
Situation may require additional staff to be called into the hospital.
All staff will remain on duty and follow their procedures.
The HCC will be set up to coordinate disaster operations.

3.Phase III – large numbers of patients are received and/or significant issues have occurred and the need for extensive support will be addressed.

The HCC will be set up to coordinate disaster operations.
This major event will require mobilization of most aspects of the Hospital Incident Command System in the EOP, including department callback procedure and planning for staff relief over an extended period of time.

2.The plan may be called All Clear for the disaster situation while the recovery efforts continue until the hospital is back to normal operations.

HOSPITAL COMMAND CENTER

1.1.The HCC will be set up immediately in the Administrative Board Room at Phase II and III situations and may be set up at the discretion of the Incident Commander for the Phase I of a disaster.  The phone number for the Command Center is 2106.  If the Administrative Board Room is not available, an alternate site has been designated as  the Communications Office.  The phone number for the alternate Command Center is 5030.  This decision will be made by the Incident Commander, and the location will be announced overhead.

2.The HCC will be established by the Incident Commander. The following is the order of authority in the role of Incident Commander:

a.CEO
b.COO
c.CNO
d.CFO
e.SECURITY DIRECTOR

3.The Command Center staff report to the Command Center including Public Information Officer, Safety Officer, Liaison Officer, and administrative support for phones and documentation.

NOTE: The Medical/Technical Specialist would respond only if needed in a specific disaster event such as infectious disease like smallpox.

4.Deployment of Command Center Supplies
Supplies and materials for use in the Command Center shall be deployed upon the decision to implement the Command Center.  The table below shows locations of supplies and the positions responsible for bringing the supplies to the Command Center.

INCIDENT COMMANDER
Incident Commander will organize and direct the HCC and give overall direction for hospital operations and, if needed, authorize evacuation.

The command function manages the incident, which includes establishing the strategic objectives of the operation ordering and releasing resources. During normal business hours, the incident commander is normally the CEO. During non-business hours, the nursing supervisor will serve as Incident Commander until they are relieved by the CEO, Administrator-on-Call or another administrator.

Hospital administrative staff and other assigned personnel will support the Incident Commander.

Role of the Incident Commander:

a)Direct overall emergency operations for the hospital
b)Activate the HCC and initiate the appropriate emergency operating procedures
c)Appoint HCC staff in the HICS configuration and supervise their activities
d)Act upon information received from any source in a timely & effective fashion
e)Communicate internally and externally.

4. SAFETY & SECURITY OFFICER
The Safety & Security Officer is responsible for the coordination of all security measures. The Safety Officer will assist and ensure that the emergency management plan is implemented and identify any hazards and unsafe conditions.

The Incident Commander will assign the position of Safety & Security Officer. It is recommended that the Director of Security, Public Safety, Safety Officer, or another individual familiar with the hospital Security Management Plan fill the position.

5. 1.PUBLIC INFORMATION OFFICER
The Public Information Officer is responsible for the coordination of all outside media communications. Public Information Officer (PIO) will provide information to the news media. The PIO will also oversee the Media Center.  The Incident Commander will assign the position of Public Information Officer. It is recommended that an employee of Public Relations fill the position, or another individual experienced in communications.  The Public Information Officer will release any/all information to the press. During a mass casualty event involving more than one hospital:
The Public Information Officer, as agreed upon in the MOU agreement, communicates with the Public Information Officer at the scene or other agreed upon facility to ensure only one person is designated to speak with the media concerning the medical response.  Information will be provided to the Joint Public Information Officer who will speak on behalf of participating hospitals to assure consistent messages and flow of information.

1.Administrative support will provide phone and documentation support along with receiving various information/tracking lists and messages.

2.The Section Chiefs for Operations, Planning, Finance, and Logistics will establish their functions indicated by the Incident Commander. They will then report to their designated meeting place to receive further instructions.

3.The Incident Commander, or Liaison Officer, initiates communication with local emergency response groups as needed.

4.The proper Incident Command Structure identification apparel is issued to the Command Center Staff and Section Chiefs.

5.The Director of Security deploys the Bluffton Regional Medical Center's Security Force to the appropriate location as designated in preparation for securing the facility (lock-down), if necessary.  Should additional security assistance be required, staff may be deputized as security officers, or a security service may be employed.

6.The proper identification is worn by the Security Force to distinguish the Force from local law enforcement officials.

7.The Public Information Officer communicates to local Media needed information concerning the emergency, including instruction for walk-in victims and route for emergency vehicles and services.

8.Once the type of the emergency is determined, the appropriate Emergency Response Plan will be initiated.

Emergency Initiation Process

HOSPITAL INCIDENT COMMAND SYSTEM (HICS)
The hospital has implemented the Hospital Incident Command Structure (HICS) developed by the Emergency Medical Services Authority (EMSA) of California as a revision from the previous Hospital Emergency Incident Command System (HEICS).

HICS is an incident management system based on the Incident Command System (ICS) that assists hospitals in improving their emergency management planning, response, and recovery capabilities for unplanned and planned events. HICS is consistent with ICS and the National Incident Management System (NIMS) principles. The new HICS has been restructured to be consistent with ICS and NIMS principles and will provide greater flexibility/adaptability for the hospital setting (NIMS Element 2).

Operations Section
The Operations Section conducts the tactical operations (e.g., patient care, clean up) to carry out the plan using defined objectives and directing all needed resources. Many incidents that are likely to occur involve injured or ill patients. The Operations Section will be responsible for managing the tactical objectives outlined by the Incident Commander. A subject level expert in the health care emergency service will be required for this position. A potential individual for this role may be the CNO (or someone familiar with the hospital disaster policy).

The Operations section is typically the largest in terms of resources to marshal and coordinate. To maintain a manageable span of control and streamline the organizational management, Branches, Divisions, and Units are implemented as needed. The degree to which command positions are activated depends on the situational needs and the availability of qualified command officers.

Planning Section
The Planning Section collects and evaluates information for decision support, maintains resource status information, prepares documents, and maintains documentation for incident reports. It will also be responsible for preparing status reports, displaying various types of information, and developing the Incident Action Plan (IAP). The effectiveness of the Planning Section has a direct impact on the availability of information needed for the critical, strategic decision-making done by the Incident Commander and the other General Staff positions.

The Incident Commander will assign the position of Planning Section Chief, which can be filled by the Director of Quality and Regulatory Compliance, Administrator On-Call, etc. A senior representative from the Medical Staff, Information Systems, and Admitting Departments should support the Planning Sector Chief.

Logistics Section
The Logistics Section provides support, resources, and other essential services to meet the operational objectives set by Incident Command.  The Director of Facilities or an individual with knowledge of the building structure, utilities, material resources, etc would be appropriate for this role.

For the hospital to respond effectively to the demands associated with a disaster, support requirements will be coordinated by the Logistics Section. These responsibilities include acquiring resources from internal and external sources using standard and emergency acquisition procedures and requests to the local EOC or the RHCC. Each resource request from an area in the hospital should be reported to the Logistics Section using pre-identified ordering procedures outlined in the EOP. When requesting resources from outside sources, it will be important that the hospital specify exactly what its need is and not try to identify how that need can be met: that will be done at the local EOC or RHCC. In addition, it is important for the hospital to know how the requests are to be made (electronically, fax, phone).

Finance Section
The Finance/Administration Section monitors costs related to the incident while providing accounting, procurement, time recording, and cost analyses. The Incident Commander will assign the position of Finance Sector Chief. It is recommended that the position be filled by the CFO, Controller or another individual experienced in fiscal operations.

The costs associated with the response must be accounted for from the outset of the incident. These costs can come from multiple sources such as overtime; loss of revenue-generating activities; and repair, replacement, and/or rebuild expenses. Daily financial reporting requirements are likely to be modified and, in select situations, new requirements outlined by state and federal officials.
Preplanning efforts should identify what state and federal financial aid documents must be completed for receiving reimbursement. In addition to patient costs being tracked, vendor expenses, mutual aid financial remuneration, and personnel claims must also be accounted for and processed. The Finance/ Administration Section coordinates personnel time (Time Unit), orders items and initiates contracts (Procurement Unit), arranges personnel-related payments and Workers' Compensation (Compensation/Claims Unit), and tracks response and recovery costs and payment of invoices (Cost Unit).

STAFF RESPONSE
1.All Staff on duty will report to their departments and STAND-BY (i. e., being ready, willing and able to perform assigned duties) for further instruction.

2.Staff away from their department or duty station, who cannot report physically to the department, will communicate with the department and identify their current location and status of activity.

3.1.Patient care activities being conducted away from the department, such as radiology, surgery, etc, will continue until a point of completion is reached.

4.The patient and staff will return to the appropriate area as soon as possible or receive instructions to secure the patient in an ancillary location if necessary.

5.The Staff will notify their Department Heads of the location of the patient and staff member.

6.Staff will continue their designated, patient care activities in preparation for response to the directions provided by the Command Center.

7.All staff requesting to go off duty must obtain the approval of their Department Heads.  The Department Heads may not give this approval without prior clearance from the Incident Commander.  Staff must not leave their workstations until relief has arrived or until dismissed by the Department Heads.

DEPARTMENTAL RESPONSE
1.Each Department Head, for both clinical and non-clinical operations, will assess the status of their Staff to maintain normal operation.

2.Each Department Head, or designee, will identify available resources, such as beds, personnel, and equipment, which could be allocated to the emergency response.

3.The Department Head will STAND-BY with information on status of department.

4.The Department Head will provide information to the Command Center staff or Incident Command Section Leader when requested.

5.When the departments receive the notification of the specific emergency, the Department Heads will initiate the appropriate departmental response plan for the emergency.

6.The Department Heads will report any problems or concerns to the appropriate Section Leader or the Command Center staff.

7.No department should reduce its hours of operation without prior approval from the CEO.

Ongoing Communication with Staff
During the event, the staff and department heads will receive instructions and information from the Section Chiefs or Command Staff. This information could come be relayed via a meeting, a written form sent by email, or by a runner. Additional meetings will be setup to disseminate information throughout the emergency until the “All Clear.”

US Patent Numbers 7,720,998 B2, 7,836,207