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External and Internal Disaster Plans

Policy:  
It is the policy of Mahaska Health Partnership to provide excellent healthcare services, a healing environment, and community service to the people of its service area.  Consistent with this mission, the Board of Directors, Medical staff and Administration will provide ongoing support for the emergency management procedures described in this plan.

Disaster Plan:
The external and internal disaster plan of Mahaska Health Partnership (MHP) is a well-developed community-based emergency service plan, which provides evaluation and treatment to all injured or ill individuals who come to the hospital.  MHP provides all levels of care, from comprehensive, to first aid, to referral.  For further information refer to the Scope of Practice of Emergency Care.  MHP will follow the Hospital Emergency Incident Command System (HEICS).

A serious external disaster will be classified as any situation involving a number of victims with attendant medical problems, the number being sufficient to overtax the facility and/or staff which are available.   An internal disaster is any situation within the hospital that interrupts its proper functioning.  (Fire, explosion, prolonged power outage, water problems, etc.)

The Ambulance will be called by the 911/Law Enforcement Center, the ambulance staff will get an estimate of the number of casualties, extent of injuries and expected time of arrival. This information will be communicated back to the ER staff.  To notify in-house personnel an announcement will be made Code D three times overhead. (Secure Code D will be announced overhead when the disaster is over). If extra staff is needed, the CEO, Administrator on call, or Nursing Supervisor will assess the situation and determine who needs to be called from the call lists. Call lists A, B, C, D and E are available on line under disaster preparednessand on the Fastcommand site.

Authority and Direction of Plan:
It is the responsibility of Mahaska Health Partnership to preserve life and treat patients before, during, and after a disaster.  MHP has the responsibility to use a consistent and uniform incident management system to prepare for, respond to, and recover from these hazards, regardless of the scale or complexity.  Mahaska Health Partnership and its associated departments will utilize the processes, protocols, and procedures established through the National Incident Management System (NIMS) and the Hospital Emergency Incident Command System (HEICS).  The NIMS standardizes incident management for all hazards across all levels of government.  The NIMS structure is based on the Incident Command System (ICS) and the Unified Command System (UCS) for command and management of emergency responses.  Mahaska County operates under this system.  Mahaska Health Partnership will cooperate under this provision.

Hospital Emergency Command System: 
All job roles will be available on the Fastcommand site and in the Disaster cabinet in the EOC

Incident Commander
Organizes and directs the Emergency Operations Center (EOC) and all positions through an ICS structure
Gives overall direction to the operation
Authorizes hospital Evacuation

Safety/ Security Officer
Monitors the situation for safety related issues
Reinforces scene safety and makes reports on incidents
Establishes a security command area and works closely with them

Liaison Officer
Functions as the incident contact person for representatives from other agencies
Communicates into and out of the hospital

Public Information Officer
Provides concise and pertinent information to the media
Provides scheduled briefings to the media and or public
Contact person for all media agencies
Works closely with PIOs from other agencies and hospitals

Finance Chief
Responsible for all financial activity and accounting
Time unit
Procurement unit
Claims unit
Cost unit

Finance Mission-
Provide funding for present medical objective and stress facility-wide documentation in order to maximize financial recovery and reduction of liability.

Logistics Chief
Facilities unit
Communications unit
Transportation unit
Materials supply unit
Nutritional supply unit

Logistics mission -
Provides a hospitable environment and materials to meet the overall medical objectives

Planning Chief
Situation status unit
Labor pool
Medical staff unit
Nursing unit
Patient tracking officer
Patient information officer

Planning mission -
Determine and provide for the continuance of each medical objective; planning section personnel prompt and drive all HEICS officers to develop long and short range plans.

Operations Chief
Medical staff director
In-patient areas director
Assure treatment of in-patients and manage the in-patient care areas
Provide for a controlled patient discharge
Treatment area supervisor
Initiate and supervise the patient triage process
Assure treatment of casualties according to triage categories and manage treatment areas
Provides for a controlled patient discharge
Supervise morgue service
Laboratory unit leader
Maintain laboratory services, blood and blood products at appropriate levels
Prioritize and manage the activity of the laboratory staff
Radiology unit leader
Maintain radiology and other diagnostic imaging services at appropriate levels
Pharmacy unit leader
Ensure the availability of emergency, incident specific, pharmaceutical and pharmacy supplies
Cardiopulmonary unit leader
Provides the highest level of cardiopulmonary services at levels sufficient to meet the emergency incident needs
Human Services Director Discharge Planner
Organize, direct, and supervise those services associated with the social and psychological needs of the patients, staff, and their respective families
Assist with discharge planning.

Medical Officer
Organize and direct the overall delivery of medical care in all areas of the hospital
Labor pool unit leader
Collect and inventory available staff and volunteers at a central point
Receive requests and assign available staff as needed
Maintain adequate numbers of both medical and non-medical personnel
Assist in the maintenance of staff morale

On scene, Ambulance personnel are responsible for the assignment of medical personnel and overall professional care of patients.  Admittance of casualties will be through the ambulance entrance.  Tagging equipment will be in the ER/Ambulance area.  A completed tag will be tied to the wrist or ankle of each patient.  Emergency stations will be set up as follows: 

1.Triage Located in Ambulance Garage or other designated area.

2.Immediate Care (life-threatening) Located in ER

3.Delayed Care (life-threatening, but will survive 2-4 
hours) Located in physical therapy or PACU

4.First Aid Team Located in the physical therapy area.

5.Surgical suite will be reserved for surgeries.

6.DOAs will be sent to the a designated area in the hospital.  No body will be removed from this area until Permit for removal of body, duly authenticated by the medical examiner, is delivered to the person in charge. ( see policy on Hospital Post Mortem and Mass Fatality Management)

7.Family members of victims will be housed in the dining room or the education center depending on how large an area is needed.  This area may be designated by the EOC. Clergy and Red Cross should be available for this area.

8.Press will be directed to the board room or a designated area where PR Director or PIO will assume responsibility for Release of Information.

9.   ECA/B is to be the Emergency Operation Center. (EOC)

Assignment of On-Duty Staff:
A.An adequate number of nursing staff will remain at in-house patient areas to care for those patients.

B.At triage area, a nurse will be assigned to each patient and will stay with that patient until 1:1 care is no longer needed. 

C.Nursing staff will be assigned to triage area, immediate care area, delayed care area, and first aid area.

Off-Duty Staff: 
All employees coming to the hospital will report to the front desk or other designated area.  An employee will be designated to log in personnel and their position as they arrive.  That person will ask for identification. The ID card must be shown for admission and then worn during the time of the disaster. When employees are signed in they will report to their respective departments or as assigned by the labor pool chief.

Notification of Necessary Persons and Agencies:
The key lists are available on the intranet or fastcommand sites.

A Disaster Call list will be maintained by the Admitting Department.

Calls may be placed to surrounding areas, at the discretion of the incident commander or   medical officer for extra physicians, anesthetists, and nurses.  These people may not be familiar with the hospital, so take this into consideration. A procedure for credentialing of medical staff will be maintained by the medical staff liaison officer. 

For quick relaying of messages for supplies, equipment, etc., outside the hospital;
Radios cell phones or ham radio operators may be utilized. An internet system for communication with other agencies may also be utilized.

Mass Casualty/ Prolonged surge in demand:
A prolonged surge in demand is described as a mass casualty scenario lasting longer than a few days.  When this scenario exists the Disaster Coordinator will contact Mahaska Emergency Management Services to coordinate delivery of supplies and equipment that may be needed to facilitate such an incident. The Disaster Coordinator may also have to limit or ration food, water, and power to essential areas.  Temporary shelter for MHP employees may also have to be provided. 

See job assignments and emergency contact numbers for supplies, utilities and alternative transportation such as 4 wheelers, snowmobiles etcin the locked cabinet in ECA/B.
These will also be available on line.