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Pediatrics Emergency Operations Plan
Ramon E. Gist, MD FAAP SUNY Downstate Medical Center Assistant Professor of Pediatrics Acting Director, Pediatric Critical Care Medicine
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Objectives Hospital Incident Command Structure All-Hazards Planning
Departmental Emergency Operations Plan Pediatric Inpatient Surge Plan Pediatric Inpatient Evacuation Plan
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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
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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
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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
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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
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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
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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)
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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
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What are the chances?? Shelter in Place Surge Capacity Evacuation
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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
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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
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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
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Pediatric Inpatient Surge Plan
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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
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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
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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
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Evacuation
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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.
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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
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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
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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
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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
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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
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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
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QUESTIONS?????
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