Second National Emergency Management Summit Presented by: Scott Aronson, MS Principal Full Building Evacuation

Evacuation From a Healthcare Facility Is the EXCEPTION, Not the Rule

It Could Be More Dangerous

However, “Just in Case”  2007 CA Wildfires  2006 MA and NY hospitals & nursing homes  2005 Hurricanes Katrina & Rita  2004 Florida Hurricanes

Preplanned Methodology  Prepare patients within units / departments  Move to an internal Holding Area  Transport from the Holding Area to receiving facilities, or discharge

Key Components of the Plan  Activation of FBE Plan – Staff Awareness  Activation of a Labor Pool  Establishment of Internal Holding Areas  Coordination of Transportation (internal & external)  Patient Preparation on Units  Evacuation Path of Travel  Determination of Receiving Sites  Patient Tracking (internal and external)

Decision Making  Full Building Evacuation or Internal “Surge/Relocation”  Should staff call-backs go into effect (remember staff burnout)?  Are we transporting directly to EMS transports or can internal Holding Areas be utilized to stabilize and track?  Is this a regional incident or are we going to have local and state assets supporting us?  Is the building infrastructure impacted (earthquake, flooding, internal explosion, no power)  How does this affect means of travel? Vertical?  Are area healthcare facilities prepared for a surge? Was this initial thinking just completed without Incident Command in place?

Patient Preparation – On Unit  Complete top portion of the Patient Evacuation Tracking Form  Department-specific Plan should include:  Package chart (including MAR, face sheet & nursing notes) – customized for unique records in depts. – i.e. baby chart  Package with personal belongings (i.e. glasses, dentures, hearing aids, etc.)  Evacuation Stairs and Elevators specific to the unit  Medications and Supplies that MUST go  Special Considerations:  Intra-aortic Balloon Pump Patient  Ventricular Assist Device Patient  Non-ambulatory Bariatric Patient  Special Precautions  Staff to Patient Ratio (suicide risk; aggressive/violent; complex equipment)

Holding Areas PATIENT ACUITY LEVEL HOLDING AREA LOCATION PATIENT PICK-UP LOCATION Red (High Acuity) PACU ASU Entrance Yellow (Mid Acuity) ED ED Ambulance Bay Green (Low Acuity) Cardiac Rehab North Entrance Behavioral Stay on Unit and go direct to Transport (Back-up is Outpatient Gym) Main Lobby Entrance  Holding Areas cleared prior to evacuation initiating

Police Roadblock Route 8 Bus Staging – Blessed Sacrament Church - Roberts Street Ambulance Staging – Opticom Parking Lot - Grand Ave. Red Holding Pick-up Green Holding Pick-up Yellow Holding Pick-up Behavioral Holding Pick- up

Priority of Evacuation  Consider:  Ambulatory  Non-ambulatory, low to mid acuity (stable)  Non-ambulatory, high acuity/high intensity  Non-ambulatory, unstable high acuity/high intensity/non-ambulatory bariatric  Consider (Behavioral Health):  Low Risk  High Risk - Suicidal  High Risk – Aggressive  Consider bypassing the Holding Area with those that should not be mixed with the general population

Once a Unit is Evacuated  Once evacuation of the unit / department is completed  Check unit / department to ensure evacuation is complete – YELLOW TAGS  Account for all staff  Direct all staff to report to the Labor Pool (or they may be leaving with patients)  Report evacuation status to the Command Center and the Holding Area  Deliver Patient Destination form to Command Center