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Emergency Operations PLan - Managing Patient Clinical and Support Activities

CLINICAL ACTIVITIES
Bluffton Regional Medical Center has a policy on the clinical activities for the treatment of patients during an emergency.  These activities include triage, scheduling, assessment, treatment, and discharge.

Bluffton Regional Medical Center will evacuate when the environment cannot support care, treatment and services. (See also EM.02.02.03.9-10). Follow the evacuation plan evacuation routes.

SPECIAL PATIENTS
The Bluffton Regional Medical Center has a policy on the clinical activities for providing treatment of special patients during an emergency.  These patients include pediatrics, geriatrics, and disabled.  This may also include patients with serious chronic conditions such as mental health or addiction.

PERSONAL HYGIENE AND SANITATION REQUIREMENTS
The alternative means to personal hygiene can be baby wipes, personal wipes, or alcohol-based rubs.  Family can also be used to clean the patient during emergencies.  The alternative means to sanitation, if toilets are inoperable, is kitty litter, bags in toilet, or bucket brigade.  Limit changes of bed linen to those patients who have gross soiling from draining wounds, catheters, etc.
Environmental Services use of water will be curtailed to the extent of one change of water per day for mopping except in surgery, delivery rooms, and isolation areas.  The hospital has a means for an emergency water connection.  The Plant Operation department will coordinate the connection in coordination with a water supplier and contractor, if necessary.

MENTAL HEALTH SERVICES
During an emergency, the organization will provide mental health services to the appropriate patient.  The staff may use patient registration and triage information, and medical records to determine this population and the appropriate services required.  The Social Services Department  will be responsible for tracking these patients receiving these services during the emergency.  Any of these services provided to the organization's patient will be documented in the patient's records.  The staff will assess the processes used to manage the mental health services during the emergency exercises or actual events, and revise the policies, procedures and Emergency Response Plans as deemed necessary.  The critique of the services will be reviewed by the Environment of Care Committee and appropriate medical staff before modifying the emergency services.

MORTUARY SERVICES
In the event of an emergency involving deceased patients, the organization will contact the local medical examiner for the appropriate clearance and procedures.  Arrangements with Medical Examiner have been made and a transport refrigeration truck will be dispatched to the hospital and located near the loading dock. Bodies will be appropriately tagged and housed in the refrigeration truck until positive ID and the claiming process have been instituted. Those contaminated deaths will deemed un-releasable to family until appropriate decontamination of bodies as taken place. This process will be handled by the local county coroner's office. Contaminated bodies will be taken to the designated area until the refrigeration truck arrives.  The Medical Examiner's office will be notified when the refrigerated trailer is full or the disaster has been cleared.  Refer to the organization's policy on deceased patients during an emergency.

CARING FOR MASS CASUALTIES
Bluffton Regional Medical Center has designated treatment areas for mass casualty triage, decontamination and other major emergency situations. Treatment areas are identified below:

PATIENT TRACKING: INTERNAL AND EXTERNAL
For the departments that will be receiving disaster patients such as the Emergency Room and patient care units, they will have patient trackers assigned to track the patients entering and leaving the areas.  That information will be given to the Patient Tracking Manager who will track all the patients within the facility during disaster.  The form to use for patient tracking will be the HICS 254 – Disaster Victim Patient Tracking Form.

If patients are evacuated, the process should be the same except for the forms.  The individual patient tracking for evacuation will be the HICS 260 – Patient Evacuation Tracking Form.  When more than two are being evacuated, the HICS 255 – Master Patient Evacuation Tracking Form should be used to gain a master copy of all those that were evacuated.

According to the facilities MOU; MAC; or third-party information such as Web EOC, American Red Cross database, or fax in tracking information, information will be maintained for the regional tracking methods.  In some of these methods, there may be the possibility of families gaining access to this information to find their loved ones.

BUSINESS CONTINUITY/DISASTER RECOVERY PLAN
Bluffton Regional Medical Center has a Business Continuity/Disaster Recovery Plan for its information systems.  For electronic systems, the plan includes plans for unscheduled interruptions, including end user training with downtime instructions, contingency plans for operational interruptions, plans for minimal interruptions as well as a result of scheduled downtime, an emergency service plan, a backup system, either electronic or manual, or data retrieval, including retrieval from storage, and information presently in the operating system , retrieval of data in the event of a system interruption and the backup of data. The plan is tested periodically to ensure the business interruption backup techniques are effective, and is implemented when information systems are interrupted.  Bluffton Regional Medical Center Information Systems department has specific policies and procedures to support the Business Continuity and Disaster Recovery Plan.  Administration reviews and approves the policies that support the plan.

INFLUX OR MANAGEMENT OF INFECTIOUS PATIENTS
Bluffton Regional Medical Center prepares to respond to an influx, or the risk of an influx, of infectious patients, and determines its response to an influx or the risk of an influx of infectious patients.  Bluffton Regional Medical Center has a plan for managing an ongoing influx of potentially infectious patients over an extended period.  Under the direction of the Infection Control Practitioner, the hospital performs the following functions including, how long it will keep abreast of current information about the emergence of epidemics or new infections that may result in the hospital activating its response, how it will disseminate critical information to staff and other key practitioners, how the facility will identify resources in the community through local, state, and or federal public health systems for obtaining additional information.  The Infection Control Practitioner manages the functions described through the Infection Control Plan.  The Infection Control Plan is reviewed by Bluffton Regional Medical Center Administration and the Medical Staff.

PATIENT FLOW
Leadership, including the Medical Staff plan to identify and mitigate impediments to efficient patient flow throughout the hospital. Leadership assesses patient flow issues within the hospital, the impact on patient safety and plan to mitigate that impact.  Planning encompasses the delivery of appropriate and adequate care to admitted patients who must be held in temporary bed locations.  Leadership and the Medical Staff share accountability to develop processes that support efficient patient flow.  Planning includes the delivery of adequate care, treatment, and services to non-admitted patient that are placed in overflow locations.  Specific indicators are used to measure components of the patient flow process and address available supply of patient bed space, efficiency of patient care, treatment and service areas, safety of patient care, treatment and service areas, and support service processes that impact patient flow.  Indicator results are available to those individuals who are accountable for processes that support patient flow. Indicator reports are reported to Leadership on a regular basis to support planning. The hospital improves inefficient or unsafe processes identified by Leadership as essential to the efficient movement of patients through the hospital.  Criteria are defined to guide decisions about initiating diversion.  Bluffton Regional Medical Center Leadership reviews all patient flow processes regularly with the clinical department heads and the Medical Staff.

GRANTING DISASTER PRIVILEGES FOR VOLUNTEER LICENSED PRACTITIONERS
Disaster privileges may be granted only when the Emergency Operations Plan has been activated in response to a disaster and the hospital is unable to handle the immediate patient needs.

The medical staff identifies in its bylaws the individuals responsible for granting disaster privileges to volunteer licensed independent practitioners. See policy EM.02.02.13 for more information.

GRANTING DISASTER PRIVILEGES FOR VOLUNTEER PRACTITIONERS WHO ARE NOT LICENSED INDEPENDENT PRACTITIONERS
During disasters, Bluffton Regional Medical Center may assign disaster responsibilities to volunteer practitioners who are not licensed independent practitioners, but who are required by law and regulation to have a license, certification, or registration.

Disaster privileges may be granted only when the Emergency Operations Plan has been activated in response to a disaster and the hospital is unable to handle the immediate patient needs.  The same standards appliy to volunteer practitioners who are not licensed independent practitioners as those who are volunteer licensed independent practitioner. See policies EM.02.02.13 and EM.02.02.15.

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