1. OSHA Training Institute 1 Evacuation Issues: Institutional Planning OSHA Training Institute – Region IX University of California, San Diego (UCSD) - Extension

2. OSHA Training Institute2 Purpose To describe the critical issues that need to be addressed in the pre- planning and active stages of healthcare facility evacuation.

3. OSHA Training Institute3 Reality We are at risk!  OSHPD-CA: As of 2001, 48% hosp buildings at risk for structural failure Evacuating staff occurs w/ the evacuation of patients Some plans provide for staff to follow pts to receiving hospitals Personal safety is of primary importance

4. OSHA Training Institute4 Phases of a Disaster Pictorial from disasterhelp.gov Planning (Preparedness) Response Recovery Mitigation

5. OSHA Training Institute5 Planning Phase: EAP Emergency Action Plan: Evacuation  Potential emergencies  How to activate  When to evacuate  Employee responsibilities  Chain of Command  Emergency exits and routes, fire alarm pulls and fire extinguishers  Final destination of employees and patients Mutual Aid agreements with other facilities Alternative care sites

6. OSHA Training Institute6 Planning Phase: Training Training using the EAP for evacuation  Knowledge of how to use evacuation devices  Knowledge of manual movement techniques  Knowledge of evacuation staging areas  Knowledge of responsibilities under HICS, for evac roles of the ICC participants Update/upgrade physical plant to achieve EAP requirements

7. OSHA Training Institute7 Response Phase: Evacuation Safety Situation assessment Activation of evacuation Security Communication Physical movement of employees and patients  Staging in a “Safe Area”  Accountability Transport of evacuees off site Destination of evacuees

8. OSHA Training Institute8 Response Phase: Evacuation Safety Before you move… Evaluate potential threats immediately around you Know your evacuation routes & alternatives Assist other staff and patients with safe egress Assess potential threats outside prior to leaving building

9. OSHA Training Institute9 Response Phase: Evacuation Hazards Falling objects Dark hallways, debris Aftershocks Fires Explosion from flammable gases Water, risk of electrocution

10. OSHA Training Institute10 Response Phase: Other Concerns Lifting injuries Biohazards Helicopter Safety  Proper approach Make eye contact with pilot or loadmaster Avoid vertical tail rotor, inclines  Eye, ear protection  No loose articles

11. OSHA Training Institute11 Response Phase: Situation Assessment Establish command post to coordinate evacuation Activation of an “internal disaster”  WHO? Nursing Supervisor Administrator on-call  HOW? PA system? Pagers? Flashing lights, alarms? Security?

12. OSHA Training Institute12 Response Phase: Situation Assessment Location of Incident Areas of the facility affected Potential areas to become involved  Define an evacuation zone-away from threats

13. OSHA Training Institute13 Response Phase: Situation Assessment Infrastructure Assessment Damage to structures, roads, emergency facilities  Including ingress/egress roads to facility  Emergency provider access Damage to neighboring areas/facilities  Fire risk  Hazmat risk  Walk in patients from incident

14. OSHA Training Institute14 Response Phase: Activation of Evacuation Conditions that require immediate evacuation Area in need of controlled evacuation Special needs employees or patient groups Weather conditions

15. OSHA Training Institute15 Response Phase: Situation Assessment Number of casualties Direction and movement of evacuees Location of staging area(s) Emergency assistance required Ingress/egress routes for emergency vehicles

16. OSHA Training Institute16 Response Phase: Staff Communication Regularly scheduled briefings Handheld radios, phones, etc Computer disaster dashboards Plan for the relocation of patients back into your facility

17. OSHA Training Institute17 Response Phase: Security Establish perimeter security to prevent entry of people into facility  Unsafe environment  Walking wounded, worried well, injured Establish interior security for staff and patients  May have separate safety personnel Most will need EXTRA security personnel

18. OSHA Training Institute18 Response Phase: Physical Movement Staff safety first in setting of evacuating patients  Safe methods of lifting, moving pts  Individual worker safety (universal precautions, back/other injuries, environmental hazards)

19. OSHA Training Institute19 Response Phase: Physical Movement Develop movement control procedures Continual assessment of evacuation “Safe Areas” Manpower pool (Augustine 2005)  Reserve of staff members  Await assignments in safe area of site  Social & pastoral support for staff & patients

20. OSHA Training Institute20 Recovery Phase: Destination of Evacuees Individual calls to surrounding hospitals  MOAs in pre-incident planning County EOC/MOC Depends on number of patients to be evacuated, if EOC unavailable  Provisions for independent transfer arrangements  Backup plan if cannot transfer pts

21. OSHA Training Institute21 Response Phase: Destination of Evacuees If nowhere to transport patients, consider: Field hospitals Alternative care sites  Now required by The Joint Commission for disaster plan  Clinics, nursing homes  Schools  Churches

22. OSHA Training Institute22 Response Phase: Destination of Evacuees Alternative care sites/surge  Expect patients to be presenting to your facility while you are trying to evacuate  Need care site for care of all types of patients, including critically ill/injured No hospital on “Diversion”

23. OSHA Training Institute23 Response Phase: Destination of Evacuees Augustine 2005 Transferred with medications and chart Bed patients sent to ED for triage & transport out  Sent to alternative care site with staff RN & other personnel from manpower pool Ambulatory patients sent to safe holding area

24. OSHA Training Institute24 Response Phase : Transportation of Evacuees Immediate vs Delayed Evacuation  Fire or other imminent danger, power outages, flooding  Immediate  Structural but stable damage  Delayed Immediate requires use of anything available  Buses, hospital vans, personal cars, trams  Ambulances will likely be tied up in a multi-site incident

25. OSHA Training Institute25 Recovery Phase: Mass Care & Shelter Need for staff shelters  Including psych support Care & shelter multi-jurisdictional agreements Mutual aid for accepting patients into other facilities Establish procedure to communicate with staff once they are evacuated

26. OSHA Training Institute26 Recovery Phase: Post-Event Injuries More injuries occur in the clean-up phase of many disasters than during the event itself, especially those involving wind or blast  Chain-saw accidents while clearing downed trees and branches  CO-poisoning from inappropriate use of gas-powered washers, generators, or pumps used too close to windows,in closed spaces (such as parking garages), or indoors Downed tree, U. of Guam, after Super Typhoon Pongsona

27. OSHA Training Institute27 Mitigation Phase: Mitigation steps based on exercise hotwash or After Action Report/Recommendations following real event Includes corrective measures  Examples: prevent employee injuries, bottlenecks in evacuation routes, possible structural changes in facilities, reinforcement of non-structural hazards Might include augmentation of evacuation assets Part of “The Disaster Cycle”

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29. OSHA Training Institute29 Summary PLAN to be PREPARED  Emergency Action Plan  Training  Physical Plant Preparation RESPOND SAFELY RECOVER  Once the facility if evacuated, move off-site MITIGATE

30. OSHA Training Institute30 References Augustine J, Schoettmer J. Evacuation of a rural community hospital: Lessons Learned from an unplanned event. 2005. Disaster Management and Response. 3:68-72. California Office of Emergency Services. The ABCs of Post-earthquake evacuation: A checklist for school administrators and faculty. California Office of Emergency Services. Legal Guidelines for Flood Evacuation. 1997.

31. OSHA Training Institute31 References Federal Emergency Management Association’s Guide for All-hazard Emergency Operations Planning. State and Federal Local Guide. 1996. General Accounting Office Report 03-924. Hospital preparedness: most urban hospitals have emergency plans but lack certain capacities for bioterrorism, General Accounting Office Report 03-924, August 2003. Hospital preparedness: most urban hospitals have emergency plans but lack certain capacities for bioterrorism Pesik N, Keim ME, Iserson KV. Terrorism and the Ethics of Emergency Medical Care. Annals of Emergency Medicine. 2001. 37:642–646.

32. OSHA Training Institute32 References Norcross ED, et al. Impact of a major hurricane on surgical services in a university hospital. Am Surg 59(1):28-33, 1993. Rubin JN, Recurring Pitfalls in Hospital Preparedness and Response. Homeland Security Journal, January, 2004 Sarpy S, Warren C, Kaplan S, Bradley J, Howe R. Simulating Public Health Response to a Severe Acute Respiratory Syndrome (SARS) Event: A comprehensive and systematic approach to designing, implementing, and evaluating a tabletop exercise. Journal of Public Health Management Practice. 2005. S75-S82.

33. OSHA Training Institute33 References Schultz CH, Koenig KL, Auf der Heide E: Benchmarking for hospital evacuation: A critical data collection tool. Prehosp Disast Med 2005;20(5): 331–342. Schultz CH, Koenig KL, Lewis RJ. “Implications of Hospital Evacuation After the Northridge, California Earthquake,” New England Journal of Medicine, vol. 348, no. 13, 3 April 2003, pp. 1349–1355. US Dept of Labor: OSHA. General industry (29 CFR 1910) requirements for emergency response and preparedness. www.osha.govwww.osha.gov US Dept of Labor: OSHA. Evacuation Plans and Procedures. www.osha.gov/SLTC/etools/evacuation/evac.html www.osha.gov/SLTC/etools/evacuation/evac.html

34. OSHA Training Institute34 References US Dept of Labor: OSHA. Emergency Preparedness and response: Safety and Health Guides. http://www.osha.gov/SLTC/emergencypreparedness/guid es/index.html http://www.osha.gov/SLTC/emergencypreparedness/guid es/index.html US Dept of Labor: OSHA. Evacuation planning matrix. “Matrix to provide employers with planning considerations and on-line resources that may help employers reduce their vulnerability to a terrorist act or the impact of a terrorist release.” www.osha.gov/dep/evacmatrix/index.html www.osha.gov/dep/evacmatrix/index.html