1. Pediatrics Emergency Operations Plan
Ramon E. Gist, MD FAAP
SUNY Downstate Medical Center
Assistant Professor of Pediatrics
Acting Director, Pediatric Critical Care Medicine

2. Objectives Hospital Incident Command Structure All-Hazards Planning
Departmental Emergency Operations Plan
Pediatric Inpatient Surge Plan
Pediatric Inpatient Evacuation Plan

3. Hospital Incident Command Structure
Mandated by HSPD-5 & TJC
Establishes a consistent framework for disaster management across organizations
Operates on the following principles
Life Safety
Incident Stability
Property Conservation
Develops and executes an Incident Action Plan when disasters occur

7. Emergency Operations Planning
All-Hazards Planning
“Planning, development, and implementation of all emergency functions necessary to prepare for, respond to, and recover from emergencies and disasters caused by all threats, whether natural, technological, or manmade.”
Hazard Vulnerability Analysis

8. Emergency Operations Planning
Disaster planning that utilizes an All Hazards approach and utilizes HICS embodies the core tenets of emergency preparedness:
Mitigation
Preparation
Response
Recovery

9. Emergency Operations Planning
Once plan is activated, the communication department will activate the disaster bells
“Code D”
Emergency Operations Center (EOC)/Incident Command Center (ICC)
Hospital Administration Area Conference Room ground floor
Department of Pediatrics Pediatric Command Center
4th Floor, Morris Steiner Memorial Library

10. Pediatric Emergency Operations Plan
Department of Pediatrics Command Structure
Department of Pediatrics Medical Officer
Appointed by departmental leadership
Leads and Coordinates Departmental Response
Activates departmental plan to the extent needed to manage the disaster
Activates attending call down list with Division Directors
Maintains contact with Hospital EOC
Maintains communications with chief residents and all units regarding census, patient discharges, and staff present

11. Pediatrics Emergency Operations Plan
Department of Pediatrics Command Structure
Department of Pediatrics Medical Officer may need to
Establish Pediatric Command Center
Establish a Pediatric Overflow Area in Suite D managed by Director of Ambulatory services or designee
For stable pediatric victims who require short observation prior to discharge
Establish a Pediatric Safe Area in Child Life Area and appointing Safe Area Coordinator (ie Child Life Services or Social Worker)

12. Pediatric Emergency Operations Plan
Department of Pediatrics Command Structure
Chief Residents
Activate Resident Call Down list
Assign residents to areas of need
Establish sleep/rest periods for a sustained response
Maintain communication between inpatient units and Inpatient Director/Pediatric Command Center

13. What are the chances??
Shelter in Place
Surge Capacity
Evacuation

14. Pediatric Inpatient Surge Plan
Regular Inpatient Capacity
17 floor beds
6 with oxygen delivery capability
3 isolation rooms, 2 with anterooms
7 Step Down Beds
All are capable of continuous cardiopulmonary monitoring and mechanical ventilation
4 of the 7 beds are capable of dialysis
5 PICU Beds
All are capable of continuous cardiopulmonary monitoring, mechanical ventilation, and dialysis
Contains 1 isolation room, no anteroom

15. Pediatric Inpatient Surge Plan
Clinical services not within our usual scope of practice
Neurosurgery
Trauma Surgery
CT Surgery
Burn
During a disaster, we may have to care for patients with these issues until they can be transferred

16. Pediatric Inpatient Surge Plan
At critical threshold of surge capacity, institutions may implement:
Rapid Discharge Protocols
Treat and Release/Refer Protocols
Transfer non-acute admissions to LTC facilities
Institute home care plans
Important for General Pediatricians with patients who have chronic needs or are dependent upon medical technology

17. Pediatric Inpatient Surge Plan

18. Pediatric Inpatient Surge Plan
Where are the pediatric surge areas??
NS 41
Current Ultrasound Area
Can accommodate 8 patients who do not require oxygen or continuous cardiopulmonary monitoring
Suite N
Can accommodate 3-4 disaster victims who require brief observation prior to discharge
4th floor Pediatric Clinic Area and Child Life Area
Can serve as a family reunification area for patients who are waiting to be discharged

19. Pediatric Inpatient Surge Plan
Surge Plan Overview
All beds PICU and Step Down Units will be prepared to manage critically ill patients
Floor beds with oxygen sources will be prepared to deal with the most stable Step Down status patients
NS 41 will be prepared to manage stable disaster victims or the most stable floor patients
Suite N will be prepared to serve as an observation area for disaster victims
4th floor Child Life and Pediatric Clinic Areas will serve as a family reunification area

20. Pediatric Inpatient Surge Plan
What is our surge capacity plan?
Initiate Rapid Discharges to home or family reunification area (4th floor clinic areas or Child Life area)
Any patient in the PICU or Step Down who does not require continuous cardiopulmonary monitoring CAN be transferred to the floor
The floor beds with oxygen sources CAN be reserved for the most stable step down status patients (whether inpatient or disaster victim)
Use NS 41 beds AFTER regular floor bed capacity is exceeded
Use Suite N for short observations of disaster victims

21. Evacuation

22. Evacuation General Principles: Level of Evacuation
Definition
Shelter in Place
Patients stay where they are as preparations are made to mitigate against the impending threat
Horizontal Evacuation
Involves moving patients to an area of refuge in an adjacent smoke/fire zone
Vertical Evacuation
Involves the complete evacuation of a specific floor in the hospital
Full Evacuation
This level involves a complete evacuation of the facility, and is used only as a last resort.

23. Evacuation General Principles: Types of Evacuation
Evacuation Model
Definition
Geographic Model
Evacuation of units at greatest risk
Resource Model
Evacuation of units based upon available resources
i.e. Evacuating hospital top to bottom if elevator is in use and bottom to top it stairs are used
Acuity Model
Evacuation of units takes place top to bottom or bottom to top, but prioritizes patients based upon acuity
Patients in immediate danger
Ambulatory patients
Non-ambulatory patients
ICU patients

24. Evacuation General Principles: Time Frames
Evacuation Time Frame
Definition
Immediate
-No time for preparation
-Evacuate now!!!!!
Rapid
-1-2 hour preparation,
-Evacuate in 4-6 hrs
Gradual
-Advanced Notice Given
-Prepare and evacuate over days
Prepare Only
-Prepare to evacuate
-Do not move patients

25. Evacuation General Principles: Patient Prioritization
Evacuation Time Frame
Evacuation Model
Immediate
Acuity Model
Rapid
Resource Model
Gradual
Geographic Model
-THIS IS ONLY A GUIDELINE!!!!!
-no EVAC model works equally well for all scenarios!!!!!
-A SITUATION MAY CALL FOR THE USE OF MORE THAN ONE MODEL SIMULTANEOUSLY!!!!!!
i.e. A hospital is evacuating top to bottom with ambulatory patients leaving first vis-à-vis the acuity model. ALS EMS becomes available. Critical care patients become the priority vis-à-vis the resource model

28. Evacuation Process: Clinical Units
Senior nurse or designee serves as Evacuation Unit Leader
Evacuation Unit Leader conveys the following:
The situation requiring evacuation
Amount of time available to prepare for transport
How patients will be transported
Location of the Assembly Point and Discharge Site
Elevator and/or stair assignments for evacuation
Role Assignment and Job Action Sheet Distribution
Ie Communications, Patient Record preparation

29. Evacuation Process: Clinical Units
Role of physicians
Work with nurses to
Prioritize patients for evacuation based upon clinical status.
Review and limit medications and clinical interventions to those which are essential and life sustaining
Writing/printing a summary of the patient’s inpatient course and treatment plan
Giving report to receiving clinicians at the receiving hospital (when possible)
Clinicians should not arrange their own patient transfers with other institutions, this is done through the incident command patient destination team

30. Patient Information
Complaint
Procedures/Tmt.
Age:________
Ped. Weight _________
Female:
Male:
DNR: Y N
Vital Signs
Time:
B/P________
HR ________
RR ________
T ________
Pulse Ox ______
FS__________
Decubiti: Y N
Isolation: Y N
Explain________________________________________
Mental Status:
Oriented X2 X3
Restraints: Y N
Fall Risk:
None Low High
ADL: Independent
Dependent
Diet: Regular Other
Transport:
Chief Complaint
_______________________________________________
_______________________________________________ DX:___________________________________________ ______________________________________________
Past Med. HX __________________________________
______________________________________________
Allergic: Y N To:
ID/ Allergy Band applied: Y N
Medications/Next Needed:_______________________
_____________________________________________ _____________________________________________
Admitted: Y N
To:___________________________________________
Adm.MD:______________________________________
Telemetry: Y N
Disabilities/Equipment: None Cane Walker Wheelchair Dentures Prosthesis-Type__________________________
Other__________________________________________
Patient Destination______________________________
Signature/Time: _________________________________
Original Chart Sent: Y N
Family Notified: Y N
Comments/Last Actions__________________________
O2%
Ventilator
CMV
FiO2
Heplock: Y N
Cardiac Monitor: Y N
Oxygen: Y N
Suction: Y N
CXR Y N
CT Y N
EKG: Y N
Heplock Y N
Foley Y N
IV Fluid:
________________________________________________
IVPB: Y N
________________________
Blood Transfusion: Y N
First: Y Second: Y
Notes: __________________
__________________
____________________
____________________ Nurse’s Name (Print)
Signature

32. QUESTIONS?????