Download EMERGENCY PREPAREDNESS PLAN Policy #: 02-04

EMERGENCY PREPAREDNESS PLAN
Policy #: 02-04-014
Reviewed/Updated: 09/01/2014, 10/14//2015
Table of Contents
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I.
Introduction
A.
Purpose
B.
Policy
C.
Scope
D.
Key Terms
II.
Phases of Emergency Management
A.
Mitigation
1.
Hazard Vulnerability Analysis
2.
Hazard Mitigation
3.
Risk Assessment
4.
Insurance Coverage
5.
Emergency Response Roles
B.
Preparedness
1.
Emergency Operations Plan
2.
Standardized Emergency Management System
3.
Integration with Community Response
4.
Coordination w/ Government Response Agencies
5.
Coordination w/ Emergency Responders
6.
Limitations
7.
Acquiring Resources
8.
Roles/Responsibilities
9.
Initial Communications and Notifications
10.
Continuity of Operations
11.
Clinic Patient Surge Preparedness
12.
Disaster Medical Resources
13.
Mental Health Disaster
14.
Public Info/Risk Communications
15.
Training, Exercises and Plan Maintenance
16.
Plan Development and Maintenance
C.
Response
1.
Response Priorities
2.
Alert, Warning & Notification
3.
Response Activation and Initial Actions
4.
Emergency Management Organization
5.
Emergency Operations Center (EOC) Operations
6.
Medical Care
7.
Acquiring Response Resources
8.
Communications
9.
Public Information/Crisis Communications
10.
Security
11.
Mental Health Response
12.
Volunteer/Donation Management
13.
Response to Internal Emergencies
14.
Response to External Emergencies
D.
Recovery
1.
Introduction
2.
Documentation
3.
Inventory Damage and Loss
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4.
5.
6.
7.
8.
9.
Lost Revenue through Disruption of Services
Cost/Loss Recovery Sources
Psychological Needs of Staff and Patients
Restoration of Services
After-Action Report
Staff Support
54
Appendix A: Emergency Management Acronyms
56
Appendix B: Emergency Management Glossary
64
Appendix C: Mitigation Tool – Clinic Hazard and Vulnerability Analysis
70
Appendix D: Management of Environment/Hazard Surveillance & Risk Assessment Report Form
73
Appendix E: Structural and Nonstructural Hazard Mitigation Checklist
75
Appendix F: Response Roles & Requirements
78
Appendix G: Emergency Response Team – PATHS Day-to-Day Organizational Chart
79
Appendix H: Emergency Response Team – Position Assignments
80
Appendix I: Emergency Response Team Organization Chart
81
Appendix J: Training & Exercises
91
Appendix K: Disaster Contact List
92
Appendix L: Health Care Alternate and Referral Facility Locations
93
95
96
99
100
101
102
103
105
Appendix M: Emergency Procedures
a.
Fire Related Emergency
b.
Medical Related Emergencies
c.
Bomb Threat
d.
Suspect Package
e.
Power Outages
f.
Gas Leak or Chemical Spill
g.
Environmental Emergencies
h.
Personal Threat
i.
Natural Disasters
106
107
108
109
110
111
112
Appendix N: Emergency Floor Plans
a.
Danville – Ground Floor/Basement
b.
Danville – First Floor
c.
Danville – Second Floor
d.
Martinsville
e.
Chatham Facility Floor Plan
f.
Boydton – Ground Floor/Basement
g.
Boydton – First Floor
113
114
115
116
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118
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Appendix O: Job Action Sheets
a.
Incident Manager (IM)
b.
Public Information Officer (PIO)
c.
Operations Section Chief
d.
Division/Group Supervisor
e.
Planning Section Chief
f.
Logistics Section Chief
g.
Finance/Administration Section Chief
121
Appendix P: Home Emergency Preparedness Guide
127
Appendix Q: Damage Check List
131
Appendix R: Emergency Codes
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I.
INTRODUCTION
A.
Purpose: The purpose of the PATHS’ Emergency Preparedness Plan (EPP) is
to establish a basic emergency program to provide timely, integrated, and
coordinated response to the wide range of natural and manmade events that
may disrupt normal operations and require preplanned response to internal and
external disasters.
The objectives of the emergency management program include:
B.
1.
To provide maximum safety and protection from injury for patients,
visitors, and staff.
2.
To attend promptly and efficiently to all individuals requiring medical
attention in an emergency situation.
3.
To provide a logical and flexible chain of command to ensure maximum
use of resources.
4.
To maintain and restore essential services as quickly as possible
following an emergency incident or disaster.
5.
To protect clinic property, facilities, and equipment.
6.
To satisfy all applicable regulatory and accreditation requirements.
Policy: PATHS will be prepared to respond to a natural or man-made disaster,
suspected case of bioterrorism or other emergency in a manner that protects the
health and safety of its patients, visitors, and staff, and that is coordinated with a
community-wide response to a large-scale disaster.
All employees will know and be prepared to fulfill their duties and responsibilities
as part of a team effort to provide the best possible emergency care in any
situation. Each supervisor at each level of the organization will ensure that
employees are aware of their responsibilities.
PATHS will work in close coordination with the State Medical Health Operational
Area Coordinator (MHOAC) and other local emergency officials, agencies and
health care providers to ensure a community-wide coordinated response to
disasters.
C.
Scope: Within the context of this plan, a disaster is any emergency event which
overwhelms or threatens to overwhelm the routine capabilities of any facility.
This all-hazards EOP describes an emergency management program designed
to respond to natural and man-made disasters, including technological,
hazardous material, and terrorist events.
This plan describes the policies and procedures PATHS will follow to mitigate,
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prepare for, respond to, and recover from the effects of emergencies.
D.
Key Terms: Refer to “Appendix A - Emergency Management Acronyms” and
“Appendix B - Emergency Management Glossary” for a list of acronyms and
more extensive glossary, respectively. The following terms are used frequently
throughout this document.
1.
ALTERNATE SITES/FACILITIES: Locations other than the primary
facility where operations will continue during an emergency.
2.
CONTINUITY OF OPERATIONS (COOP): Plans and actions necessary
to continue essential business functions and services and ensure
continuation of decision making even though primary facilities are
unavailable due to emergencies.
3.
EMERGENCY OPERATIONS CENTER (EOC): The location at which
management can coordinate clinic activities during an emergency. It is
managed using the Incident Command System (ICS). The EOC may be
established in the primary facility or at an alternate site.
4.
EMERGENCY PREPAREDNESS COMMITTEE (EPC): The Emergency
Preparedness Committee guides the development and maintenance of
the organization’s emergency management program and development of
its emergency operations plan.
5.
EMERGENCY RESPONSE TEAM (ERT): The Emergency Response
Team (ERT) consists of the clinic staff who will fill the core positions of
the Emergency Operations Center (EOC) and manage the clinic’s
emergency response.
6.
ESSENTIAL FUNCTIONS (EF): Essential functions and services are
those that implement the clinic’s core mission and goals. The extended
loss of these functions, following an emergency, would create a threat to
life/safety, or irreversible damage to the facility, its staff or its
stakeholders.
7.
HAZARD MITIGATION: Measures taken by a facility to lessen the
severity or impact a potential disaster or emergency may have on its
operation. Hazard mitigation can be divided into two categories.
a)
Structural Mitigation. Reinforcing, bracing, anchoring, bolting,
strengthening or replacing any portion of a building that may
become damaged and cause injury, including exterior walls,
exterior doors, exterior windows, foundation, and roof.
b)
Nonstructural Mitigation: Reducing the threat to safety posed by
the effects of earthquakes on nonstructural elements. Examples of
nonstructural elements include: light fixtures, gas cylinders,
hazmat containers, desktop equipment, unsecured bookcases and
other furniture.
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II.
8.
HAZARD VULNERABILITY ANALYSIS: Hazard vulnerability analysis
identifies ways to minimize losses in a disaster, considering internal and
external emergencies to the facility and the surrounding community.
9.
INCIDENT COMMAND SYSTEM (ICS): A temporary management
system used to manage and coordinate clinic activities during an
emergency. ICS is designed to facilitate decision-making in an
emergency environment.
10.
MEDICAL HEALTH OPERATIONAL AREA COORDINATOR (MHOAC):
The position in the Standardized Emergency Operations System (SEMS)
responsible for all disaster medical and health operations in an
operational area. The MHOAC is stationed in the County EOC and is
frequently, but not always, the County Health Officer or designee. During
the response to disasters, the MHOAC is the Operational Area contact
point for requests for medical and health resources including personnel,
supplies and equipment, pharmaceuticals, and medical transport.
11.
MULTI-HAZARD APPROACH: A multi-hazard approach to disaster
planning evaluates all threats including the impacts from all natural and
man-made disasters, including technological threats, terrorism, and a
state of war.
12.
OPERATIONAL AREA (OA): An intermediate level of a state emergency
organization, consisting of a county and all political subdivisions within the
county area. Clinics and other health facilities will coordinate their
disaster response with the State Medical Health Operational Area
Coordinator (MHOAC).
PHASES OF EMERGENCY MANAGEMENT: Emergency management involves work
to be completed under four separate, yet integrated processes: Mitigation (Pre-event
planning and actions which aim to lessen the effects of potential disaster), Preparedness
(Actions taken in advance of an emergency to prepare the organization for response.),
and Response (Activities to address the immediate and short-term effects of an
emergency or disaster. Response includes immediate actions to save lives, protect
property and meet basic human needs), and Recovery (Activities that occur following a
response to a disaster that are designed to help an organization and community return
to a pre-disaster level of function).
A.
Mitigation: PATHS will undertake risk assessment and hazard mitigation
activities to lessen the severity and impact of a potential emergency. Mitigation
begins by identifying potential emergencies (hazards) that may affect the
organization's operations or the demand for its services. This will be followed by
development of a strategy to strengthen the perceived areas of vulnerability
within the organization.
During the mitigation phase, PATHS’ Safety Officer and staff will identify internal
and external hazards and take steps to reduce the level of threat they pose by
mitigating those hazards or reducing their potential impact on the clinic. The
areas of vulnerability that cannot be strengthened sufficiently are then addressed
in emergency plans.
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Mitigation activities may occur both before and following a disaster.
1.
Hazard Vulnerability Analysis: PATHS will conduct a hazard
vulnerability analysis to identify hazards and the direct and indirect effect
these hazards may have on the organization. This will provide information
needed by the organization to minimize losses in a disaster.
“Appendix C - Clinic Hazard and Vulnerability Analysis” provides a tool for
estimating and ranking the probability of occurrence and potential severity
of various events. This assessment should be performed every three to
five years.
As part of its risk management program, PATHS Safety Officer will also
conduct a Management of Environment safety survey of its facilities at
least quarterly. “Appendix D: Hazard Surveillance / Assessment Form Hazard Vulnerability Assessment Tool” provides a tool for conducting that
survey, ranking problems and setting priorities for remediation. This
ongoing remediation contributes to reducing the overall vulnerability of the
clinic to various hazards. The tool provided in Appendix D.2 should be
modified, if necessary, to address problems associated with hazards
identified through the hazard vulnerability assessment.
2.
Hazard Mitigation: PATHS will undertake hazard mitigation or
retrofitting measures to lessen the severity or impact a potential disaster
may have on its operation. These measures are taken prior to disasters to
minimize the damage to the facility.
Refer to “Appendix E - Structural and Non-Structural Hazard Mitigation
Checklists”, for a checklist of structural and non-structural hazard
mitigation recommendations for specific hazards.
3.
Risk Assessment: PATHS will assess the risks identified in its Hazard
Vulnerability Assessment that could not be eliminated or satisfactorily
mitigated through its hazard mitigation program and determine their
likelihood of occurrence and the severity of their consequences. This
assessment of remaining risks will help to define the emergency response
role the clinic adopts for itself and the preparation required to meet that
role.
4.
Insurance Coverage: PATHS’ Director of Human Resources will meet
with insurance carriers to review all insurance policies and assess the
facility’s coverage for relocation to another site, loss of supplies and
equipment, and structural and nonstructural damage to the facility.
The Director of Human Resources will assess facility coverage for floods
or earthquakes. If coverage is absent or inadequate, the organization will
evaluate if it is financially sound to acquire it. Facilities located in special
flood hazard areas must have flood insurance to be eligible for disaster
assistance.
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5.
Emergency Response Roles: PATHS may play a variety of roles in
responding to disasters including providing emergency medical care,
providing temporary shelter and expanding primary care services to meet
increased community needs created by damage to other health facilities.
PATHS may also provide mental health services to disaster victims and
serve as a conduit for information dissemination to affected communities.
However, facilities are not equipped to respond definitively to all
disasters. Clinic roles may be constrained by limited resources and
technical capability and by the impact of the disaster on the clinic facility.
Refer to “Appendix F – Response Roles and Requirements” for a list of
potential roles and the planning and preparedness requirements for
meeting those roles.
As a part of its mitigation program, PATHS will identify the response roles
it will perform following a disaster. This decision will involve input from
clinic management and staff, the Board of Directors, the community and
government emergency officials. Based on the findings of the risk
assessment, PATHS will take the following steps to define the disaster
response roles for which it should prepare:
B.
a)
Assess the pre-disaster medical care environment and the role the
organization performs in providing health services.
b)
Assess clinic resources including availability of staff to respond
and ability of the clinic to survive intact.
c)
Discuss potential response roles and findings of risk assessment
with Medical Health Operational Area Coordinator or Office of
Emergency Services.
d)
Obtain community input.
e)
Obtain input from staff, especially the Medical Staff, Site
Managers, Safety Officer, and Chief Operating Officer.
f)
Present recommendations to the Board of Directors for ratification.
Preparedness: Preparedness activities build organization capacity to manage
the effects of emergencies should one occur. During this phase, PATHS’ Safety
Officer, Chief Executive Officer, Emergency Preparedness Committee (EPC) and
staff will develop plans and operational capabilities to improve the effectiveness
of the clinic’s response to emergencies. Specifically, the clinic will: Develop /
update emergency plans and procedures, including the Emergency Operations
Plan; Develop and update agreements with other community health care
providers and with civil authorities; Train emergency response personnel; and
Conduct drills and exercises.
1.
Emergency Operations Plan: PATHS’ Emergency Operations Plan is
an “all-hazards” plan that will guide PATHS response to any type of a
disaster or emergency.
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2.
Standardized Emergency Management System (SEMS): PATHS has
incorporated the principles of SEMS into its Emergency Operations Plan
to ensure maximum compatibility with local government response plans
and procedures.
SEMS incorporates the Incident Command System (ICS) which provides
an efficient tool for the management of emergency operations. SEMS/ICS
is designed to be adaptable to any emergency or incident. The system
expands in a rapid and logical manner from an initial response to a major
incident call-out. When organizational needs dictate, the system also
contracts just as rapidly.
These components of SEMS / ICS are incorporated or referenced in this
EPP: Common terminology; Modular organization; Unified Command;
Action Planning; Manageable Span-of-Control; and Multi-Agency and
Inter-Agency Coordination.
PATHS interfaces with SEMS through the Medical Health Operational
Area Coordinator (MHOAC), who is usually the county health officer.
SEMS operates at the following levels of government:
a)
State - Statewide resource coordination integrated with federal
agencies.
b)
Regional - Manages and coordinates information and resources
amongst operational areas.
c)
Operational Area – Manages and coordinates all local
governments within the geographic boundary of a county.
d)
Local - County, city or special district.
e)
Field - On-scene responders.
3.
Integration with Community-wide Response: PATHS will notify the
local MHOAC of any emergency impacting clinic operations and will
coordinate its response to community-wide disasters with the overall
medical and health response of the Operational Area. See “Appendix K Disaster Contact List” for list of agencies and individuals, including the
MHOAC, who should be contacted in emergencies.
4.
Coordination with Government Response Agencies: To the extent
possible, PATHS will ensure that its response is coordinated with the
decisions and actions of the MHOAC and other health care agencies
involved in the response. To ensure coordination, clinic staff will:
a)
In coordination with the organization’s Consortium, meet with the
MHOAC to define the organization’s role in the emergency
response system. Determine which response roles are expected
by officials and which are beyond the system’s response needs or
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the clinic’s response capabilities. See “Appendix F - Response
Roles and Requirements” for a list of potential clinic roles.
5.
b)
Participate in planning, training and exercises sponsored by
medical and health agencies.
c)
Develop reporting and communications procedures to ensure
integration with Operational Area response.
d)
Define procedures for requesting and obtaining medical resources
and for evacuating / transporting patients.
e)
During a response, report the status and resource needs of the
clinic and obtain or provide assistance in support of the
community-wide response.
Coordination with Emergency Responders:
a)
Emergency services availability: During an area-wide disaster,
fire, EMS and law emergency services may not be able to respond
to emergencies at the clinic.
b)
Response authority: PATHS’ staff will cooperate fully with EMS
and law enforcement personnel when they respond to
emergencies at any facility. This may include providing
information about the location of hazardous materials or following
instructions to evacuate and close the facility.
c)
Command post: PATHS has identified a recommended location
for an emergency responder command post for coordinating the
response to an emergency at each facility. The location of the
primary command post and an alternate are listed in “Appendix L
– Health Care Alternate and Referral Facility Locations”.
d)
Coordination with other Medical Facilities: PATHS recognizes that
it may need to rely on other health care facilities, especially those
nearby, in responding to a disaster to augment its capacity to
meet patient care needs. PATHS will review existing formal and
informal arrangements with health facilities to explore expanding
their provisions to cover disaster response conditions. The
organization will also seek to establish agreements with relevant
facilities where no agreement currently exists. PATHS views
these agreements as reciprocal and will also explore opportunities
to provide support to these facilities if conditions allow.
Examples of potential disaster related arrangements with nearby
hospitals include:
(1)
Referral / diversion of patients to nearby hospitals,
especially patients that require a higher level of care than
PATHS can provide.
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(2)
6.
7.
8.
Acceptance of diverted patients from hospitals to increase
their capacity to care for seriously ill and injured.
Limitations: During an area-wide disaster in which the Operational Area
has opened its EOC, patient transfers and access to ambulances may
need to be coordinated through the MHOAC, overriding other
agreements. Developing arrangements for receipt or diversion/referral of
disaster victims requires careful and detailed planning including:
a)
Alert and notification;
b)
Sharing of medical information;
c)
Patient tracking; and
d)
Contingencies that impact ability of either party to meet the terms
of the agreement.
Acquiring Resources: PATHS will develop procedures for augmenting
supplies, equipment and personnel from a variety of sources. Assistance
may be coordinated through the following channels:
a)
Prior agreements with vendors for emergency re-supply;
b)
Stockpiles of medical supplies and pharmaceuticals that may be
required to be required in an emergency response;
c)
Medical Health Operational Area Coordinator (MHOAC)
assistance to clinics.
d)
From other clinics, hospitals or health care providers.
Roles / Responsibilities:
a)
PATHS’ Chief Executive Officer, or designee, is responsible for
the development of the EPP and for directing the response to
emergencies. Specific responsibilities include:
(1)
Execute (oversee) the development and implementation of
the disaster plan;
(2)
Appoint an Emergency Preparedness Committee (EPC) to
coordinate the development and maintenance of PATHS’
Emergency Operations Plan and provide for ongoing
training for all staff.
The EPC should include the Chief Operations Officer,
Information Technology Director, Safety Officer, Facility
Maintenance Engineer, and the Director of Administrative
Operations. The EPC role may be assigned to an existing
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committee of the clinic, such as the Continuous Quality
Improvement (CQI) Committee.
b)
c)
(3)
Assign staff emergency management duties and
responsibilities. Appoint the Emergency Response Team
(ERT). See “Appendix G – PATHS Day-To-Day Org
Chart”, “Appendix H – Emergency Response Team
Position Assignments” and “Appendix I - Emergency
Response Team Organization Chart”.
(4)
Ensure staff is trained to perform emergency roles. See
“Appendix J - Training And Exercises”.
(5)
Ensure that drills and exercises are conducted semiannually and records are maintained. See “Appendix J Training and Exercises”.
(6)
Evaluate the disaster program annually and update as
needed including a description of how, when and who will
perform the activity.
(7)
Activate the clinic’s emergency response.
(8)
Direct the overall response to the disaster/emergency.
(9)
Develop the criteria for and direct the evacuation of staff,
patients and visitors when indicated.
(10)
Ensure the organization takes necessary steps to avoid
interruption of essential functions and services or to restore
them as rapidly as possible.
(11)
Ensure a hazard vulnerability assessment is performed
periodically.
Chief Operations Officer, or designee will:
(1)
Serve as leader, co-leader, or member of the emergency
response team (ERT).
(2)
Identify alternates and successors if unavailable or if
response requires 24 hour operation.
(3)
Contact local health department to determine local system
for bioterrorism updates and monitors for updates.
Medical Director, or designee will:
(1)
Provide clinicians with updates from the CDC and local
Health Department on standards for the detection,
diagnosis, and treatment of chemical and bioterrorism
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agents.
d)
e)
f)
(2)
Ensure the continuity of care and maintenance of medical
management of all patients in the care of the organization
during a disaster.
(3)
Assign clinical staff to medical response roles (triage,
treatment, decontamination, etc.)
(4)
Determine disaster response clinical staffing needs in
cooperation with the Director of Administrative Operations.
Director of Administrative Operations will:
(1)
Serve as a member of the ERT.
(2)
Monitor CDC for bioterrorism updates.
(3)
Provide clinicians with updates from the CDC and NHD of
standards or the detection, diagnosis, and treatment of
chemical and bioterrorism agents.
(4)
Determine the disaster response clinical staffing needs in
cooperation with the Medical Director.
(5)
Perform other duties delegated by the PATHS’ Chief
Executive Officer, Chief Operations Officer or Safety
Officer consistent with training and scope of practice.
The Safety Officer will: Appoint teams and develop procedures for
the following response tasks:
(1)
Light search and rescue: Appoint and train a light search
and rescue team to ensure all rooms are empty and all
staff, patients, and visitors leave the premises when the
facility is evacuated. If required and safe, this team will
perform additional search and rescue tasks that do not
entail using equipment or disturbing collapsed structures.
(2)
Damage Assessment: Appoint and train a damage
assessment team on each shift to evaluate items on the
“Damage Assessment Checklist” (see Appendix Q).
Supply the teams with hard hats, work gloves, flashlights,
clipboards, tape, cameras, film and videotape, if possible.
All PATHS’ Staff:
(1)
All PATHS’ staff members have emergency and disaster
response responsibilities. The job descriptions of all staff
positions will include the following language: “Participates
in all safety programs which may include assignment to an
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emergency response team.”
(2)
Additional specific response duties may also be included
for staff with appropriate skills and responsibilities.
(3)
In addition, all staff are required to:
(4)
9.
(a)
Familiarize themselves with evacuation procedures
and routes for their areas. See “Appendix M Emergency Procedures” and “Appendix N – Facility
Floor Plans”.
(b)
Become familiar with basic emergency response
procedures for fire, HAZMAT and other
emergencies.
(c)
Understand their roles and responsibilities in
PATHS’ plans for response to and recovery from
disasters. See “Appendix O – Job Action Sheets”.
(d)
Participate in training and exercises. These
exercises are intended to practice emergency
response activities and improve readiness. See
“Appendix J - Training And Exercises”.
All staff will also be encouraged to:
(a)
Make suggestions to their supervisor or the
Emergency Preparedness Committee on how to
improve organizational preparedness.
(b)
Prepare family and home for consequences of
disasters. See “Appendix P – Home Emergency
Preparedness Guide” for guidelines.
Initial Communications and Notifications:
a)
PATHS Staff Call List: PATHS’ Safety Officer will compile and
maintain an internal contact list that will include the following
information for all staff: name, position title, home phone, cell
phone, and preferred method of contact during off hours. The
Staff Call List contains sensitive contact information and will be
treated confidentially. The list of staff phone numbers will be kept
offsite as well as onsite by key employees and at key locations.
The phone list will be provided to the organization’s contracted
answering service.
PATHS’ Director of Information Technology will develop an email
group to facilitate rapid staff contact.
b)
External Notification: The Safety Officer will compile and maintain
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an external contact list of phone numbers of emergency response
agencies, key vendors, stakeholders, and resources.
c)
Primary Communications Methods: The primary means of
emergency communication is the local telephone system. If
telephones fail, staff will notify the telephone provider by any
means available including: telephones in another area of the
facility, cell phones, or e-mail.
(1)
PATHS has installed standard telephone jacks that bypass
the electronic phone system. These jacks are used for fax
machines and for telephones that do not require electricity
to operate.
(2)
Other alternate communications tools include:
(3)
10.
(a)
FAX, Cell Phones, Internet/Email, and Voice
Messaging.
(b)
If telephone and radio communications are
unavailable, runners will be assigned to take
messages to and from the facility and appropriate
agencies rendering assistance.
The clinic EOC will monitor television and radio broadcasts
to remain up-to-date on official government
announcements and other information during a disaster.
Continuity of Operations: It is PATHS’ policy to maintain service
delivery or restore services as rapidly as possible following an emergency
that disrupts those services. As soon as the safety of patients, visitors,
and staff has been assured, the organization will give priority to providing
or ensuring patient access to health care.
a)
Continuity of Operations Goals and Planning Elements: The
organization will take the following actions to increase its ability to
maintain or rapidly restore essential services following a disaster
to ensure:
(1)
Patient, visitor and personnel safety: Develop, train on
and practice a plan for responding to internal emergencies
and evacuating clinic staff, patients and visitors when the
facility is threatened. See “Appendix M – Emergency
Procedures” and “Appendix N – Emergency Floor Plans”.
(2)
Continuous performance or rapid restoration of the
organization’s essential services during an emergency
(3)
Develop plans to obtain needed medical supplies,
equipment and personnel. See “Appendix K – Disaster
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Contact List”. Identify a backup site or make provisions to
transfer services to a nearby provider. See “Appendix L.1
– Health Care Alternate and Referral Facilities”.
b)
Protection of medical records: To the extent possible, protect
medical records from fire, damage, theft and public exposure. If a
facility is evacuated, provide security to ensure privacy and safety
of medical records.
c)
Protection of vital records, data and sensitive information:
d)
e)
(1)
Ensure offsite back-up of financial and other data.
(2)
Store copies of critical legal and financial documents in an
offsite location.
(3)
Protect financial records, passwords, credit cards, provider
numbers and other sensitive financial information.
(4)
Update plans for addressing interruption of computer
processing capability.
(5)
Maintain a contact list of vendors who can supply
replacement equipment.
(6)
Protect information technology assets from theft, virus
attacks and unauthorized intrusion.
Protect medical and business equipment:
(1)
Compile a complete list of equipment serial numbers,
dates of purchase and costs. Provide list to the Director of
Finance and store a copy offsite.
(2)
Protect computer equipment against theft through use of
security devices.
(3)
Use surge protectors to protect equipment against
electrical spikes.
(4)
Secure equipment to floors and walls to prevent movement
during earthquakes.
(5)
Place fire extinguishers near critical equipment, train staff
in their use, and inspect according to manufacturer’s
recommendations.
Relocation of services: PATHS will take the following steps, as
feasible and appropriate, to prepare for an event that makes the
primary clinic facility unusable. PATHS will:
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f)
11.
(1)
Identify a back-up facility for continuation of clinic health
services, if possible. See “Appendix L – Health Care
Alternate and Referral Facility Locations” for location of
back-up facility.
(2)
Establish agreements with nearby health facilities to accept
referrals of clinic patients.
(3)
Establish agreements with nearby health facilities to allow
clinic staff to see clinic patients at these alternate facilities.
(4)
Identify a back-up site for continuation of clinic business
functions and emergency management activities. See
“Appendix L – Health Care Alternate and Referral Facility
Locations” for location.
Restoration of utilities: PATHS will:
(1)
Maintain a contact list of utility emergency numbers.
(2)
Ensure availability of phones and phone lines that do not
rely on functioning electrical service.
(3)
Request priority status for maintenance and restoration of
telephone service from local telephone service provider.
(4)
PATHS will strive to obtain emergency generators at each
facility to ensure its ability to continue operations in the
event of an emergency that creates power outages.
(5)
PATHS will obtain assistance from local utilities or
vendors. Specific steps include:
(a)
Inventory essential equipment and systems that will
need continuous power.
(b)
Determine the maximum length of time the clinic
will operate on emergency power (i.e., is
emergency power primarily for short term outages
or for extended operations)
(c)
Determine power output needs.
(d)
Determine location of nearest supplies of selected
fuels that can be accessed in an emergency.
(e)
Perform recommended periodic maintenance.
(f)
Run monthly generator start-up tests.
Clinic Patient Surge Preparedness: Surge capacity encompasses
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PATHS’ resources required to deliver health care under situations which
exceed normal capacity including potential available space in which
patients may be triaged, managed, vaccinated, decontaminated, or simply
located; available personnel of all types; necessary medications, supplies
and equipment; and even the legal capacity to exceed authorized care
capacity.
a)
Normal clinic capacity could be exceeded during any type of
emergency for reasons that include the following:
(1)
Random spikes in numbers of presenting patients.
(2)
Seasonal or other cyclical spikes (e.g., school required
immunizations, flu epidemics, etc.).
(3)
Convergence of ill or injured resulting from disasters.
(4)
Psychogenic convergence that results from emergencies.
(5)
A combination of any of the above.
b)
Events that create patient surge may also reduce clinic resources
through exhaustion of supplies and pharmaceuticals and reduced
staff availability. Staff may be directly impacted by the
emergency, unable to reach the clinic or required to meet
commitments at other health facilities.
c)
PATHS’ Medical Director and Director of Administrative
Operations, and other staff with responsibility for emergency
preparedness will review provisions of Operational Area
emergency plans that describe:
d)
(1)
How the surge capacity of the health system will be
increased.
(2)
Patient transportation policies and procedures for
bioterrorism and other major disasters.
(3)
Procedures for augmenting medical care resources at sites
of medical care including Operational Area plans for
accessing and distributing the contents of the National
Pharmaceutical Stockpile.
The Medical Director and Director of Administrative Operations
will develop a surveillance process to provide early indications of
potential for patient surge that may result from an infectious
disease outbreak, bioterrorist attack, or release of a hazardous
material. Staff will monitor:
(1)
Appointment patterns.
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e)
f)
g)
(2)
Walk-in utilization patterns.
(3)
News reports about flu and other pandemics.
(4)
Signs of bioterrorism attacks.
(5)
Past utilization experience to identify cyclical variations in
utilization.
Patient flow and site planning: PATHS’ Medical Director and
Director of Administrative Operations will:
(1)
Periodically review patient flow and identify areas on
facility grounds that can be converted to triage sites and
patient isolation areas.
(2)
Evaluate the appropriateness of the use of break rooms
and other spaces for patient holding, decontamination or
treatment areas.
(3)
Designate sites available for isolating victims of a chemical
or bioterrorist attack. Sites should be selected in
coordination with the site managers based on patterns of
airflow and ventilation, availability of adequate plumbing
and waste disposal, and patient holding capacity.
(4)
Ensure triage and isolation areas are accessible to
emergency vehicles and to patients.
(5)
Triage, decontamination and isolation sites should have
controlled access.
PATHS will also take the following actions to increase surge
capacity:
(1)
Store blankets and other items required for holding and
sheltering patients while they await transfer.
(2)
Establish reciprocal referral agreements with nearby clinics
and hospitals.
(3)
Survey staff to develop estimates of the likely number of
clinical and non-clinical staff able to respond during
operating hours and off hours for each day of the week.
The estimates will take into account distance, potential
barriers and competing responsibilities (hospital practice,
other clinics, etc.).
PATHS may be also be able to refer/divert patients to other
nearby sites if a site is damaged or overwhelmed, or could obtain
space and support from other health care providers nearby.
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12.
Disaster Medical Resources
a)
b)
c)
Personnel: PATHS will rely primarily on its existing staff for
response to emergencies and will, therefore, take the following
measures to estimate staff availability for emergency response:
(1)
Identify clinical staff with conflicting practice commitments.
(2)
Identify staff with distance and other barriers that limit their
ability to report to the site.
(3)
Identify staff who are likely to be able to respond rapidly to
the site.
(4)
Develop a roster of bi-lingual staff by language.
(5)
Promote staff home emergency preparedness and to
encourage staff to identify childcare resources that are
likely to remain open following a disaster. See “Appendix
P – Home Emergency Preparedness Guide”.
Pharmaceuticals / Medical Supplies / Medical Equipment:
(1)
PATHS will determine the amount of medical supplies and
pharmaceuticals that is prudent and possible to stockpile.
Given limited resources, the organization will stockpile only
those items it is highly likely to need immediately in a
response or in its day-to-day operations. All stored items
will be rotated to the extent possible.
(2)
PATHS will identify primary and secondary sources of
essential medical supplies and pharmaceuticals and
develop estimates of the expected time required for
resupply in a disaster environment.
National Pharmaceutical Stockpile: In a bioterrorist event, if mass
quantities of pharmaceuticals are needed then the county will
request mobilization and delivery of the National Pharmaceutical
Stockpile through the State of Virginia. The CDC has established
the National Pharmaceutical Stockpile (NPS) program as a
repository of antibiotics, chemical antidotes, life support
medications, IV administration sets, airway maintenance supplies
including ventilators, and other medical/surgical supplies. The
Virginia Department of Health and the Governor's Office of
Emergency Services are the lead state agencies for obtaining
access to the NPS. The NPS is designed to supplement and
re-supply state and local public health and medical response
teams in the event of a biological and/or chemical terrorism
incident anywhere in the U.S.
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It is not anticipated that healthcare facilities will be directly
involved with the distribution of NPS assets. However,
organizational leadership should be informed of local level plans
and what role, if any, they might be expected to play in the
distribution of assets to the community.
d)
13.
Personal Protective Equipment (PPE):
(1)
PATHS will take measures to protect its staff from
exposure to infectious agents and hazardous materials.
Health care workers will have access to and be trained on
the use of personal protective equipment. PATHS will
obtain and maintain an adequate supply of complete sets
of PPE at each site.
(2)
All clinical support staff members receive training on the
proper use of PPE during new employee orientation, and
whenever there are changes made to PPE design.
Training Records will reflect the nature of training each
employee receives in the proper use of PPE.
(3)
The Medical Director and Director of Administrative
Operations will designate clinical staff members who are to
receive PPE when a patient with a suspected infectious
agent is present. Licensed medical personnel and support
personnel assigned to respond to care for victims of
weapons of mass destruction will be assigned PPE.
(4)
Protective equipment is located in nursing storage at each
site, and will be accessed by the individual site manager or
designee when a patient with a suspected infectious
disease presents.
Mental Health Disaster:
a)
Following a bioterrorism event, or other major disaster, anxiety
and alarm can be expected from infected patients, their families,
healthcare workers, and the worried well. Psychological
responses may include anger, fear, panic, unrealistic concerns
about infection, fear of contagion, paranoia, and social isolation.
When available, mental health workers (psychiatrists,
psychologists, social workers, and clergy) can be deployed to help
manage the mental health needs of patients and families.
b)
PATHS’ Chief Operations Officer will establish a mental health
disaster program and appoint a clinic Disaster Mental Health
Coordinator who will be the Director of Behavioral Health, or other
licensed mental health professional. (If the clinic has no
behavioral health professionals available, the Medical Director
may choose a staff person to identify and coordinate with external
mental health resources.)
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c)
The scope of mental health services PATHS can perform depends
in large part on the availability of licensed mental health providers
at the clinic during the response to disasters.
d)
Mental Health Preparedness: The Behavioral Health Director,
Medical Director, and Director of Administrative Operations (and
Disaster Mental Health Coordinator, if applicable), in coordination
with Emergency Preparedness Committee, will develop and
exercise plans and procedures for implementing the disaster
mental health program during an emergency. Specific
preparedness tasks for the Mental Health Coordinator or designee
may include:
(1)
Develop an internal clinic mental health disaster response
plan.
(2)
Serve as a member of the Emergency Preparedness
Committee and the Emergency Response Team.
(3)
Promote mental health preparedness through clinician and
staff training and exercises to test mental health response.
Promote training of clinicians in the basics of disaster
mental health intervention, especially if there is a site that
does not employ a licensed mental health professional.
(4)
Establish a mental health response team. Develop mental
health team member callback lists and alert and
notification procedures for off-hour activation.
(5)
Coordinate with local jurisdiction and Operational Area
(county) to identify community resources and define
procedures for accessing those resources in an
emergency.
(6)
Develop and maintain a resource list of community mental
health resources (County Mental Health Agency, American
Red Cross, clergy, community mental health providers,
etc.) that could augment the response of the clinic’s mental
team. Establish MOUs when possible.
(7)
Identify mental health disaster communications needs.
(8)
Work with the clinic PIO to develop information (brochures,
PSAs, etc.) that could be used in a response.
(9)
Acquire and maintain the following resources that will be
stored with other disaster supplies in a container labeled
“Mental Health Supplies”
(10)
Contact information for clinic disaster mental health team
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and other mental health resources updated annually.
14.
(11)
A master copy of one or more brochures providing
information about typical survivor responses to a disaster
or critical incident with clinic or mental health agency
contact phone numbers.
(12)
A supply of brochure copies available for immediate use.
(13)
Culturally appropriate brochures in the languages of the
organization’s target populations.
(14)
A basic office supply "go-box" with pens, paper clips, tape,
note pads, etc. available to go with staff to work sites.
(15)
Paper, crayons and other items for children.
(16)
Cell phone or calling cards available for staff to use.
(17)
Disaster forms to document contacts.
(18)
Copies of a local resource directory and an agency
directory to facilitate referrals.
Public Information / Risk Communications:
a)
The Chief Executive Officer, or designee, will appoint a Public
Information Officer (PIO) to coordinate the release of information
internally and externally to media and community. The PIO will
develop a Disaster Public Information Plan to guide clinic
information dissemination and response to media and community
inquiries following the disaster. This plan will include:
(1)
Provisions for coordination with the Operational Area
Public Information Officer during an emergency to ensure
availability of up-to-date information and consistency of
released information. It will address the information needs
of the organization’s various “publics” that need to be
considered when providing information. These
stakeholders include community, patients, staff, volunteers
and other interested parties.
(2)
Explanation of how the following information is gathered,
verified, coordinated with the PIO, and communicated to
communities served by the clinic and other stakeholders:
(a)
The nature and status of the emergency.
(b)
Appropriate actions for protection, seeking health
care services, and obtaining needed information.
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(c)
(3)
b)
15.
The status of the organization’s facilities and its
ability to deliver services.
Provisions for employee meetings, internal informational
publications, press releases and other programs intended
to disseminate accurate information regarding the event
and its impact as well as deal with misinformation.
PATHS will incorporate disaster preparedness information into its
normal communications and education programs for staff and
patients including:
(1)
Home and family preparedness. See “Appendix P – Home
Emergency Preparedness Guide” for guidelines.
(2)
Information on facility emergency preparedness activities.
(3)
Information dissemination channels for these activities
include newsletters, pamphlets, health education and inservice education classes, and internet postings.
Training, Exercises and Plan Maintenance
a)
Training (See “Appendix J - Training and Exercises” for general
guidelines.)
(1)
Employee Orientation: All employees will learn the
following information from their new employee orientation
or subsequent safety training. This checklist will also be
used to design facility-wide drills to test clinic emergency
response capabilities. All employees must attend annual
training and updates on emergency preparedness,
including elements of this plan. Employee essential
knowledge and skills include:
(a)
The location and operation of fire extinguishers.
(b)
The location of fire alarm stations and how to shut
off fire alarms.
(c)
How to page a fire.
(d)
How to dial 911 in the event of a fire.
(e)
How to assist patients and staff in the evacuation of
the premises.
(f)
Location and use of oxygen (licensed staff).
(g)
Location and use of medical emergency equipment
(medical staff and staff trained on AED).
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(h)
(2)
Clinician Bioterrorism Training:
(a)
(b)
(c)
(3)
Actions to be taken during fire and other
emergency drills.
All medical and clinical support staff will receive
documented training on procedures to treat and
respond to patients infected with a bioterrorism
agent. Training will include:
(i)
Recognition of potential epidemic or
bioterrorism events.
(ii)
Information about most likely agents,
including possible behavioral responses of
patients.
(iii)
Infection control practices.
(iv)
Use of Personal Protective Equipment.
(v)
Reporting requirements.
(vi)
Patient management.
(vii)
Behavioral responses of patients to
biological and chemical agents.
General staff training will include:
(i)
Roles and responsibilities in a bioterrorism
event.
(ii)
Information and skills required to perform
their assigned duties during the event.
(iii)
Awareness of the backup communications
systems used in a bioterrorism event.
(iv)
The location of and how to obtain supplies,
including Personal Protective Equipment
(PPE) during a bioterrorism event.
Clinicians and other staff will receive periodic
updates as new information becomes available.
Mental Health Team Training: PATHS’ Mental health team
members will receive training that promotes understanding
of the normal human response to disasters. The training
for the Mental Health Coordinator and other mental health
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professional team members will include delineating the
difference between traditional mental health therapy and
crisis counseling. Training will also address cultural
considerations of the service population and how they are
affected by disasters.
b)
c)
Drills and Exercises:
(1)
PATHS will rehearse this disaster plan at least annually.
All drills shall include an after-action debriefing and report
evaluating the drill or exercise. See “Appendix J - Training
and Exercises” for further guidance.
(2)
Exercises should include one or more of the following
response issues in their scenarios:
(a)
Clinic evacuation
(b)
Bioterrorism
(c)
Mental Health response
(d)
Coordination with government emergency
responders
(e)
Continuity of operations
(f)
Expanding clinic surge capacity
(3)
See “Appendix J - Training and Exercises” for a variety of
scenarios to test internal and external disasters and
disasters that require extensive community cooperation.
(4)
PATHS will participate in community drills that assess
communication, coordination, and the effectiveness of the
organization’s and the community's command structures.
Evaluation:
(1)
The effectiveness of the administration of this plan will be
evaluated following plan activation during actual
emergencies or exercises. Staff knowledge and
responsibilities will be critiqued by the Emergency
Preparedness Committee (EPC) and reported to the Chief
Executive Officer.
(2)
Based on the after-action evaluation, the Emergency
Preparedness Committee will develop a Corrective Action
Plan that includes recommendations for:
(a)
Additional training and exercises.
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16.
C.
(b)
Changes in disaster policies and procedures.
(c)
Plan updates and revisions.
(d)
Acquisition of additional resources.
(e)
Enhanced coordination with response agencies.
Plan Development and Maintenance:
a)
The Emergency Preparedness Committee (EPC) is responsible
for coordinating the development and implementation of a
comprehensive emergency preparedness program and this plan.
The EPC will review and update this plan at least annually. The
plan will also be reviewed following its activation in response to
any emergency, following exercises and other tests, as new
threats arise, or as changes in clinic and government policies and
procedures require.
b)
PATHS environment undergoes constant change including
remodeling, construction, installation of new equipment, and
changes in key personnel. When these events occur, the
Emergency Preparedness Committee will review and update the
PATHS’ EOP to ensure:
(1)
Evacuation routes are reviewed and updated. See
“Appendix M – Emergency Procedures”.
(2)
Emergency response duties are assigned to new
personnel, if needed.
(3)
The locations of key supplies, hazardous materials, etc.
are updated.
(4)
Vendors, repair services and other key information for
newly installed equipment are incorporated into the plan.
Response: During this phase, PATHS will mobilize the resources and take
actions required to manage its response to disasters.
1.
Response Priorities: PATHS has established the following disaster
response priorities:
a)
Ensure life safety – protect life and provide care for injured
patients, staff, and visitors.
b)
Contain hazards to facilitate the protection of life.
c)
Protect critical infrastructure, facilities, vital records and other
data.
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d)
Resume the delivery of patient care.
e)
Support the overall community response.
f)
Restore essential services/utilities.
g)
Provide crisis information to the public.
2.
Alert, Warning and Notification: Upon receipt of an alert from the
MHOAC or other credible sources the Chief Executive Officer will notify
key managers, order the updating of phone lists, and the inspection of
protective equipment and supply, and pharmaceutical caches.
3.
Response Activation and Initial Actions: This plan may be activated in
response to events occurring within a facility or external to it. Any
employee or staff member who observes an incident or condition which
could result in a emergency condition should report it immediately to the
Safety Officer or his/her supervisor. Fires, serious injuries, threats of
violence and other serious emergencies should be reported to fire or
police by calling 9-1-1. All staff should initiate emergency response
actions consistent with the emergency response procedures outlined in
“Appendix M – Emergency Procedures”. If the emergency significantly
impacts clinic patient care capacity or the community served by the clinic,
the CEO will notify the MHOAC. This plan may also be activated by the
CEO, or designee, at the request of the MHOAC.
4.
Emergency Management Organization :
a)
PATHS will organize its emergency response structure to clearly
define roles and responsibilities and quickly mobilize response
resources. PATHS will use the Incident Command System (ICS)
to manage its response to disasters. ICS is a standardized
management system used by government agencies and hospitals
in emergencies. Under ICS, the clinic’s overall response is
directed by an Incident Manager. The CEO may serve in that role
or may appoint someone else to the position. See “Appendix I –
Emergency Response Team Organization Chart” for an expanded
organization chart and example of staff assignment to Emergency
Response Team positions.
b)
The Incident Manager overseas the command/management
function (command at the field level and management at all other
levels) is the function that provides overall emergency response
policy direction, oversight of emergency response planning and
operations, and coordination of responding staff and
organizational units.
c)
The management staff supporting the Incident Manager consists
of a public information officer, safety officer and security officer.
Liaison officers, who are responsible for coordination with other
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agencies, and legal counsel may also be added to the
management staff. (Management staff is sometimes referred to
as the Management or Command Section).
d)
e)
ICS employs four functional sections (operations, planning,
logistics, and finance) in its organizational structure. A detailed
description of staff roles and functions is included in “Appendix 0 –
Job Action Sheets”.
(1)
Operations Section — Coordinates all operations in
support of the emergency response and implements the
incident action plan for a defined operational period.
Medical care and mental health services are managed
through the Operations Section.
(2)
Planning and Intelligence Section — Collects, evaluates
and disseminates information, including damage
assessments; develops the incident action plan in
coordination with other functions; performs advanced
planning; and, documents the status of the clinic and its
response to the disaster.
(3)
Logistics Section — Provides facilities, services,
personnel, equipment and materials to support response
operations. The Logistics Section also manages
volunteers and the receipt of donations.
(4)
Finance and Administration Section — Tracks personnel
and other resource costs associated with response and
recovery, and provides administrative support to response
operations.
The Incident Command System has the following additional
characteristics:
(1)
Organization Flexibility - Modular Organization: The
specific functions that are activated and their relationship
to one another will depend upon the size and nature of the
incident. Only those functional elements that are required
to meet current objectives will be activated. A single
individual may perform multiple functional elements, e.g.,
safety and security or finance and logistics.
(2)
Management of Personnel - Hierarchy of Command and
Span-of-Control: Each activated function will have a
person in charge of it, but a supervisor may be in charge of
more than one functional element. Every individual will
have a supervisor, except the Incident Manager.
(3)
EOC Action Plans: Action Plans provide EOC and other
response personnel with knowledge of the objectives to be
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achieved and the steps required for their achievement.
They also provide a basis for measuring achievement of
objectives and overall response performance. The action
planning process should involve the EOC Incident
Manager, management staff and other EOC sections.
Action plans are developed for a specified operational
period which may range from a few hours to 24 hours. The
operational period is determined by first establishing a set
of priority actions that need to be performed. A reasonable
time frame is then established for accomplishing those
actions. The action plans need not be complex, but should
be sufficiently detailed to guide EOC elements in
implementing the priority actions.
5.
f)
EOC Staff Assignments: See “Appendix O - Job Action Sheets”
for position duties and responsibilities during an emergency.
Positions will be filled only as needed to meet the needs of the
response. Some overlap will occur to account for limited personnel
resources during an emergency, however all significant decisions
within the five primary functions of the Incident Command System
(ICS) will be made or delegated by the Incident Manager.
g)
ICS positions should be assigned to the most qualified available
and trained staff. Under emergency conditions, however, it may
not always be possible to appoint the most appropriate staff. In
that case the Incident Manager will be required to use best
judgment in making position appointments and specifying the
range of duties and authority those positions can exercise.
h)
Following are examples of potential position assignments of clinic
staff to ICS position. See “Appendix I - Emergency Response
Team Organization Chart” for example of how assignments can
be made.
(1)
Incident Manager – CEO, Chief Operating Officer (COO),
Medical Director
(2)
Operations Section Chief – Chief Operating Officer,
Medical Director, Administrative Operations Director
(3)
Planning / Intelligence Section Chief – COO
(4)
Logistics Section Chief – Administrative Services Director,
Human Resources Director
(5)
Finance / Administration Section Chief – Chief Financial
Officer (CFO), Chief Operating Officer (COO) or Finance
Director
Emergency Operations Center (EOC) Operations:
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6.
a)
The Emergency Operations Center will be located at the PATHS’
Danville location.
b)
In the event this site is obstructed or inoperable, a new location
will be chosen by the Incident Manager and ERT based on
environmental conditions.
c)
The EOC will be activated by the CEO, COO, Medical Director, or
other designated staff under the following circumstances:
(1)
One of PATHS’ facilities will be inoperable for more than
24 hours during its normal work week.
(2)
Coordination is required with the MHOAC or local medical
responders over an extended period of time.
(3)
PATHS requires augmentations of medical supplies,
pharmaceuticals or personnel.
(4)
PATHS needs to coordinate movement of patients to other
facilities through the Operational Area EOC.
(5)
Damage to the clinic or clinic operations is sufficient to
require management to set priorities for restoring clinic
services and manage the full restoration of clinic services
over an extended period of time.
(6)
Potential evacuation of a site.
(7)
Locally declared disaster with potential for illness or injury
in clinic service area.
d)
Required supplies include copies of this disaster plan, forms for
recording and managing information, frequently used telephone
numbers, marking pens, floor plans, and alternative
communications equipment. See “Appendix O - Job Action
Sheets”.
e)
The EOC will be deactivated by the Incident Manager when the
threat subsides, the response phase ends and recovery activities
can be performed at normal work stations.
Medical Care: It is PATHS’ policy that:
a)
The confidentiality of patient information remains important even
during emergency conditions. Staff will take feasible and
appropriate steps to ensure confidential information is protected.
b)
Due to legal liabilities, staff will never transport patients in private
vehicles under any circumstance. In a widespread emergency,
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the Operational Area will determine how and where to transport
victims through already established channels selected by the
county.
c)
Patients will be permitted to leave with family or friends ONLY
after they have signed a release form with the Medical Director or
designated clinic staff.
d)
Children will be allowed to leave only with parents, family
members or other adults who accompanied them to the site and
who provide confirming identification (e.g., driver’s license or other
government identification). If no appropriate adult is available,
staff will:
e)
(1)
Provide a safe supervised site for children away from
adults.
(2)
Attempt to contact each child’s family.
(3)
If contact is not possible, contact Child Protective Services
to provide temporary custodial supervision until a parent or
family member is located.
Medical Management: To the extent possible, patients injured
during an internal disaster will be given first aid by clinical staff. If
the circumstances do not permit treating patients at the site, they
will be referred to the nearest local emergency room unless their
injuries require immediate attention. “Appendix L – Health Care
Alternate and Referral Facility Locations” lists the alternate clinic
site and hospital and clinic referral facilities.
If immediate medical attention is required and it is not safe or
appropriate to refer the patient to the emergency room, 911 will be
called and the patient will be sent by ambulance to the nearest
emergency room. If 911 services are not available, a request for
medical transport will be conveyed to Medical Health Operational
Area Coordinator (MHOAC).
Visitors or volunteers who require medical evaluation or minor
treatment will be treated and referred to their physician or sent to
the hospital. Employees who need medical evaluation or minor
treatment will be treated and referred to their physician or sent to
the hospital.
As directed by the Medical Director or designee, clinical staff will
take the following actions:
(1)
Triage/First Aid: The clinic Medical Director or Site
Manager will establish a site for triage and first aid under
the direction of a physician. Triage decisions will be based
on the patient condition, clinic status, availability of staff
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and supplies and the availability of community resources.
The most likely location may be either the patient or the
staff parking lot. A nurse or physician will be assigned to
triage.
(2)
f)
g)
Assessing and administering medical attention: A
physician or nurse will assess victims for the need for
medical treatment. The medical care team will provide
medical services within the clinic’s capabilities and
resources.
Increase Surge Capacity: The CEO, Medical Director, or COO will
activate the clinic’s procedures for increasing surge capacity when
(1) civil authorities declare a bioterrorist emergency or other
disaster that affects the community or (2) clinic utilization or
anticipated utilization substantially exceeds clinic day-to-day
capacity with or without the occurrence of a disaster. PATHS will
take the following actions to increase clinic surge capacity:
(1)
Establish a communication link with MHOAC at the County
EOC
(2)
Periodically report clinic status, numbers of ill/injured, types
of presenting conditions and resource needs and other
information requested by the (MHOAC) in a format defined
by the Operational Area (OA).
(3)
Reduce patient demand by postponing / rescheduling nonessential visits. Cancel and reschedule non-essential
appointments.
(4)
Report status to facilities with which site has patient
referral reciprocity or to which patients may be referred.
Inform them of types of conditions that presenting patients
have. See “Appendix K – Disaster Contact List” for contact
information.
(5)
Refer patients to alternative facilities. Patients with
symptoms that indicate exposure to infectious, nerve, or
other toxic agents will be referred to the nearest hospital.
Triage procedures: PATHS will establish a triage in an area that
is clearly delineated, secured and with controlled access and exit.
(1)
If bioterrorism is suspected, all staff in the triage area will
wear Personal Protective Equipment (PPE).
(2)
All patients entering the triage area will be tagged and
registered.
(3)
Triage converging patients to immediate and delayed
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treatment categories.
7.
(4)
In response to suspected or verified bioterrorist attack,
isolate infected patients from other patients, especially if
suspected agent is human-to-human contagious or is
unknown. Use standard infection control standards at a
minimum.
(5)
Implement decontamination procedures as appropriate.
(6)
Arrange for transport of patients requiring higher levels of
care as rapidly as possible through 9-1-1 or MHOAC.
(7)
Direct uninjured yet anxious patients to the area
designated for counseling and information. Recognize that
some chemical and biological agents create symptoms that
manifest themselves behaviorally.
(8)
Provide written instructions for non-contagious patients
seen and discharged.
Acquiring Response Resources: The Logistics Section should
carefully monitor medical supplies and pharmaceuticals and request
augmentation of resources from MHOAC at the earliest sign that stocks
may become depleted. The clinic will maximize use of available
hospitals, other clinics and other external resource suppliers as is
feasible. EOC Request Process:
a)
In the response to a disaster, staff may require additional
personnel, supplies, or equipment or an executive decision
concerning the acquisition or disposition of a resource, or the
expenditure of funds. Requests for assistance will be transmitted
from the various areas of the clinic via existing lines of
communications to the EOC. The EOC will acknowledge the
receipt of the request and, immediately address the need from
current resources or incorporate the request into planning and
priority setting processes.
b)
The Logistics Section staff in the EOC may turn to external
vendors for the resources or the MHOAC.
c)
The MHOAC will seek resources to fill the request from within the
OA. If resources cannot be found and the request is high priority,
it will be submitted to Regional, State, and Federal response
levels until the requested resource can be obtained.
d)
Vendors: As information develops about current and future
resource needs, PATHS will consider contacting vendors of critical
supplies and equipment to alert them of pending needs and to
ascertain vendor capacity to meet those needs. PATHS
recognizes that in a major disaster, medical supply vendors may
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face competing demands that exceed their capacity. In that case,
request for assistance will be submitted to the MHOAC, who will
set resource allocation priorities.
e)
8.
Communications
a)
b)
c)
9.
Other Sites: PATHS will notify other sites with which it has mutual
assistance arrangements.
The Incident Manager will appoint a Communications Officer, who
may be the Communications Coordinator, who will work under the
Logistics Section and will use the clinic’s communications
resources to communicate with:
(1)
The Medical Health Operational Area Coordinator
(MHOAC).
(2)
Emergency response agencies.
(3)
Outside relief agencies.
(4)
Other healthcare facilities.
Contact Lists:
(1)
Telephone service providers and maintenance for the
organization’s internal telephone system, along with
utilities.
(2)
Staff contact telephone numbers.
(3)
Disaster response agency contact telephone numbers are
listed in “Appendix K – Disaster Contact List”.
Communication Procedures:
(1)
All external communications will be authorized by the
Incident Manager or designee unless emergency
conditions require immediate communications.
(2)
All outgoing and incoming messages will be recorded on
message forms or in notebooks.
(3)
All incoming messages will be shared with the EOC
Planning Section.
Public Information/Crisis Communications
a)
During a disaster response, all public information activities must
be coordinated with the Operational Area PIO.
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b)
c)
PATHS may perform the following public information / crisis
communications tasks coordinated by the clinic’s Public
Information Officer (PIO). See “Appendix O - Job Action Sheets”:
(1)
Conducting interviews with print and broadcast news
media.
(2)
Coordinating the dissemination of information to clinic staff,
community members, patients and other stakeholders.
(3)
Managing visits by VIPs.
Media Relations: In an emergency, the Public Information Officer
is designated as the media contact and will receive approval from
the Incident Manager or CEO prior to any interviews or media
releases.
Most media inquiries regarding a disaster will be managed by the
City or County. Media requests and responses regarding a
disaster should be coordinated through the Operational Area
Public Information Officer in the County EOC. It is critical that
information disseminated by the clinic be consistent with
information disseminated through the Operational Area PIO.
If PATHS receives a media inquiry, it will be handled by the
headquarters PIO.
d)
Community Relations:
(1)
The PIO will coordinate clinic release of information to the
community on the status of staff, family and friends.
Briefings will be held at a safe location away from the
designated assembly area to prevent further interruptions
with evacuation and treatment efforts.
(2)
The PIO will participate in media interviews and develop
communications strategies to keep patients and
community members informed of the situation at the clinic,
its operating status, and alternatives for receiving services.
(3)
The PIO should establish relationships with community
media, especially outlets that are preferred by communities
served by the clinic including non-English language
broadcast media, where appropriate.
(4)
In coordination with the Operational Area, the PIO can
provide information to the community that includes
recommended actions, protective measures, and locations
of various services and resources. Under some
circumstances, the PIO can request broadcast media to
broadcast a message specifically for the staff of the clinic
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to inform them of clinic operational status and expected
actions. Information should be disseminated in the
languages spoken in the communities served by the clinic.
10.
11.
e)
Communication with Staff: The PIO will coordinate the delivery of
information to staff through flyers, meetings, and conference calls.
Information provided can include clinic status, impact of the
disaster on the community, status of the overall response, and
clinic management decisions. The PIO will also be alert for the
spread of rumors among staff and will apply rumor control
procedures to curtail the spread of false information.
f)
The PIO will ensure that all public releases of information protect
patient confidentiality.
Security: The purpose of security will be to ensure unimpeded patient
care, staff safety, and continued operations. The Incident Manager will
appoint a Security Officer (see “Appendix O - Job Action Sheets”) who will
be responsible for ensuring the following security measures are
implemented:
a)
Security will be provided initially by existing security services or by
personnel under the direction of the Security Officer. Existing
security may be augmented by contract security personnel, law
enforcement, clinic staff or, if necessary, by volunteers.
b)
Checkpoints at building and parking lot entrances will be
established as needed to control traffic flow and ensure
unimpeded patient care, staff safety, and continued operations.
c)
Supervisors will ensure that all staff wears their ID badges at all
times. Security will issue temporary badges if needed.
d)
Security staff will use yellow tape to assist in crowd control, if
needed.
e)
The Security Officer will ensure that the facility is and remains
secured following an evacuation.
Mental Health Response:
a)
The Mental Health Coordinator will report to the Medical Director
position in the Operations Section of the clinic’s emergency
organization. When directed by the Incident Manager to activate
the clinic mental health response, the Mental Health Coordinator
will:
(1)
Assess the immediate and potential mental health needs
of clinic patients and staff, considering:
(a)
The presence of casualties.
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(b)
Magnitude and type of disaster.
(c)
Use or threat of weapons of mass destruction.
(d)
Level of uncertainty and rumors.
(e)
Employee anxiety levels.
(f)
Level of effectiveness of EOC operations.
(g)
Convergence of community members.
(h)
Patient levels of stress and anxiety.
(i)
Presence of children.
(j)
Cultural manifestations.
(2)
Request the EOC to notify the Operational Area of the
mental health response.
(3)
Communicate community mental health assessments to
Operational Area (county) and local jurisdiction contacts.
(4)
Determine need to: recall mental health staff to the clinic,
request the response of contract mental health clinicians,
or request mental health assistance from the MHOAC or
other sites. Establish communications and alert contract
and other mental health providers who may need to
support clinic’s mental health response. Coordinate with
other mental health service responders.
(5)
Establish site for mental health team operations.
(6)
Conduct ongoing monitoring of the mental health status of
employees and patients.
(7)
Establish procedures to refer employees or patients to
required mental health services beyond the scope that can
be delivered by the mental health team.
(8)
Document all mental health encounters with staff and
patients. Include information required for follow-up on
referrals. Maintain records of events, personnel time and
resource expenditures.
(9)
Coordinate any issuance of mental health information with
the Incident Manager or PIO.
(10)
Provide reports on the mental health status of clinic
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employees and patients. Report mental health team
actions and resource needs to the clinic EOC.
b)
12.
(11)
Activate procedures to receive and integrate incoming
mental health assistance.
(12)
Initiate recovery activities.
Response to psychological aspects of emergencies including
bioterrorism events: The following are some steps that can be
taken by clinicians and licensed mental health personnel to
mitigate and respond to the psychological impact of the disaster:
(1)
Communicate clear, concise information about the
infection, how it is transmitted, what treatment and
preventive options are currently available, when
prophylactic antibiotics, antitoxin serum or vaccines will be
available, and how prophylaxis or vaccination will be
distributed.
(2)
Provide counseling to the worried well and victims' family
members.
(3)
Give important tips to parents and caregivers such as:
(a)
It is normal to experience anxiety and fear during a
disaster.
(b)
Take care of yourself first. A parent who is calm in
an emergency will be able to take better care of a
child.
(c)
Watch for unusual behavior that may suggest your
child is having difficulty dealing with disturbing
events.
(d)
Limit television viewing of terrorist events or other
disasters and dispel any misconceptions or
misinformation.
(e)
Talk about the event with your child.
Volunteer / Donation Management: In a widespread emergency,
physicians and nurses may seek to volunteer at the clinic. The Logistics
Section will establish a Volunteer and Donations Reception Center. The
center’s location will be set-up in a safe location based on existing
disaster conditions away from the clinic treatment center.
All volunteers who arrive at the clinic will be sent to the Center for
verification of identity and credentials and to complete volunteer
registration forms. This center will provide for organization of the intake
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process.
The Center will also coordinate the receipt of donations. The Logistics
Section Chief will delegate the appropriate staff on site to handle this
task:
13.
a)
All donations will be documented and accounted for by the CFO or
delegated staff.
b)
The Medical Director and Director of Administrative Operations
will supervise distribution and disposal of donated medical
supplies, equipment and pharmaceuticals.
c)
All donations will be documented and acknowledged by the CFO
or designated staff prior to being handed over to the Medical
Director for disbursement.
Response to Internal Emergencies: An Internal Emergency is an event
that causes or threatens to cause physical damage and injury to the
clinic, personnel or patients. Examples are fire, explosion, hazardous
materials releases, violence or bomb threat. External events may also
create internal disasters. See “Appendix M – Emergency Procedures”.
The following procedures provide guidance for initial actions for internal
emergencies:
a)
If the event is a fire within the clinic, institute RACE:
R=
Remove patients and others from fire or smoke areas.
A=
Announce CODE RED (3 times) and Call 9-1-1
C=
Contain the smoke/fire by closing all doors to rooms and
corridors.
E=
Extinguish the fire if it is safe to do so. Evacuate the
facility if the fire cannot be extinguished.
b)
If the internal emergency is other than a fire, the person in charge
will determine if assistance from outside agencies is necessary.
Such notification will be done by calling 911.
c)
Notification of on-duty employees of an emergency event will be
made by calling the appropriate code, (shown in “Appendix R”
Appendix R), telling them of the situation or calling for help, as
appropriate. During the early stages of an emergency, information
about the event may be limited. If the emergency is internal to the
clinic, it is important to communicate with staff as soon as
possible.
d)
If the event requires outside assistance and the telephones are
not working, a person may be sent to the nearest working
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telephone, fire station or police department for assistance.
e)
PATHS will conduct an assessment of damage caused by the
disaster to determine if an area, room, or building can continue to
be used safely or is safe to re-enter following an evacuation.
Systematic damage assessments are indicated following an
earthquake, flood, explosion, hazardous material spill, fire or utility
failure. The facility may require three levels of evaluation:
Level 1 (a rapid evaluation to determine if the building is safe to
occupy), Level 2 (a detailed evaluation that will address structural
damage and utilities), or Level 3 (a structural/geological
assessment).
Depending on the event and the level of damage, fire or law
services may conduct a Level 1 or 2 assessment. If damage is
major, a consulting engineering evaluation, assessment by a
county engineer, and/or an inspection by the licensing agency
may be required before the facility can reopen for operations.
Following each level of evaluation, inspectors will classify and post
each building as: 1) Apparently OK for Occupancy; 2)
Questionable: Limited Entry; 3) Unsafe for any Occupancy. In
some cases, immediate repairs or interim measures may be
implemented to upgrade the level of safety and allow occupancy.
f)
PATHS will maintain a list of all hazardous materials and their
MSDSs, locations, and procedures for safe handling, containing
and neutralizing them. Each facility should keep this list in a
central location. A master copy will be kept by PATHS’ Safety
Officer.
All materials will have their contents clearly marked on the outside
of their containers. The location of the storage areas will be
indicated on the facility floor plan.
In the event of a hazardous material release inside the clinic, clinic
staff should:
(1)
Avoid attempting to handle spills or leaks themselves
unless they have been trained, have appropriate personal
protective equipment (PPE) and can safely and completely
respond. NOTE: Level C protection, or below, is not
acceptable for chemical emergency response.
(2)
Immediately report all spills or leaks to the Safety Officer or
designee.
(3)
Isolate area of spill and deny entry to building or area.
Initiate fire or hazmat cleanup notifications, as appropriate.
(4)
Obtain further instructions from the CEO, COO or Safety
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Officer, or refer to management guidance maintained at
the site.
g)
Evacuation:
(1)
(2)
A facility may be evacuated due to a fire or other
occurrence, threat, or order of the CEO, or designee.
Refer to PATHS’ Facility Evacuation Plan for complete
information. See “Appendix N – Emergency Floor Plans”.
The following instructions are communicated to staff:
(a)
All available staff members and other able bodied
persons should do everything possible to assist
personnel at the location of the fire or emergency in
the removal of patients.
(b)
Close all doors and windows.
(c)
Turn off all unnecessary electrical equipment, but
leave the lights on.
(d)
Evacuate the area/building and congregate at the
predetermined site. Evacuation routes are posted
throughout the clinic.
(e)
Patients, staff, and visitors should not be
readmitted to the clinic until cleared to do so by fire,
police, other emergency responders, or upon
permission of the Incident Manager.
(f)
Procedures for evacuation of patients.
Patients will be evacuated according to the following
priority order:
(a)
Persons in imminent danger.
(b)
Wheelchair patients.
(c)
Walking patients.
(3)
Staff should escort ambulatory patients to the nearest exit
and direct them to the congregation point. Wheelchairs will
be utilized to relocate wheelchair bound patients to a safe
place.
(4)
During an evacuation, a responsible person will be placed
with evacuees for reassurance and to prevent patients
from re-entering the dangerous area.
(5)
If safety permits, all rooms will be thoroughly searched by
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the Search and Rescue Team upon completion of
evacuation to ensure that all patients, visitors, and
employees have been evacuated.
(6)
When patients are removed from the facility, staff will
remain with them until they are able to safely leave or have
been transported to appropriate facility for their continued
care and safety. If patients evacuated from the facility are
unable to return home without assistance, the relatives of
patients evacuated from the facility will be notified of the
patient’s location and general condition by the staff as
soon as possible.
(7)
In case a partial or full facility evacuation is required, see
“Appendix M – Emergency Procedures” for general clinic
evacuation procedures. The following information should
be used to facilitate the evacuation:
(8)
(9)
(a)
Floor plan and map of exits with the building,
location of emergency equipment including fire
extinguishers, phones, fire route out of the building,
and first aid supplies. See “Appendix N –
Emergency Floor Plans”.
(b)
Know where and how to shut-off the utilities,
including emergency equipment, gas, electrical
timers, water, computers, heating, AC, compressor,
and telephones.
Following the occurrence of an internal or external disaster
or the receipt of a credible warning the CEO will decide the
operating status for that location. The decision will be
based on the results of the damage assessment, the
nature and severity of the disaster and other information
supplied by staff, emergency responders or inspectors.
The decision to evacuate, return to the facility and/or reopen the facility for partial or full operation depends on an
assessment of the following:
(a)
Extent of facility damage / operational status.
(b)
Status of utilities (e.g. water, sewer lines, gas and
electricity).
(c)
Presence and status of hazardous materials.
(d)
Condition of equipment and other resources.
(e)
Environmental hazards near the facility.
Extended site closure: If PATHS experiences major
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damage, loss of staffing, a dangerous response
environment or other problems that severely limit its ability
to meet patient needs, the CEO may suspend facility
operations until conditions change. If that decision is
made, staff will:
h)
(a)
If possible, ensure the site is secure.
(b)
Notify other staff of site status and require that they
remain available for return to work unless
permission is provided.
(c)
Notify the Medical Health Operational Area
Coordinator (MHOAC) of its change in status.
Request location of nearest source of medical
services.
(d)
Notify the Virginia Department of Health Services,
local field office or other appropriate licensing.
(e)
Notify the nearest hospital(s) and clinic(s) of the
change in operating status and intent to refer
patients to alternate sources of care.
(f)
Notify PATHS’ federal project officer at HRSA.
(g)
Place a sign on the facility that explains the
circumstances, indicates when the site intends to
reopen (if known), and location of nearest source of
medical services. See “Appendix L – Health Care
Alternate and Referral Facility Locations”.
(h)
If the environment is safe, staff will be stationed at
the site clinic entrance to answer patient questions
and make referrals.
(i)
Implement business recovery operations.
PATHS’ Response to Disaster Alert, Warning or Notification:
(1)
Disasters can occur both with and without warning. Upon
receipt of an alert from the MHOAC or other credible
sources the CEO, or designee, will notify key managers,
order the updating of phone lists, and the inspection of
protective equipment and supply and pharmaceutical
caches.
(2)
Depending upon the nature of the warning and the
potential impact of the emergency on the PATHS’ location,
the CEO, COO and Medical Director may decide to
evacuate the facility; suspend or curtail clinical operations;
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take actions to protect equipment, supplies and records;
move equipment and supplies to secondary sites; backup
and secure computer files; or other measures he/she may
find appropriate to reduce clinic, staff and patient risk.
(3)
i)
The CEO, or designee, will consider the following options,
depending on the nature, severity and immediacy of the
expected emergency:
(a)
Close and secure the facility until after the disaster
has occurred. Ensure patients and visitors can
return home safely.
(b)
Review plans and procedures. Update contact
information.
(c)
Check inventory of supplies and pharmaceuticals.
Augment as needed.
(d)
Ensure essential equipment is secured, computer
files backed-up and essential records stored offsite.
(e)
Notify the Operational Area, community members
and staff. Cancel scheduled appointments.
(f)
If time permits, encourage staff to return to their
homes.
(g)
If staff remains in the facility, take shelter as
appropriate for the expected disaster.
(h)
Ensure staff is informed of call-back procedures
and actions they should take if communications are
not available.
(i)
Take protective action appropriate for the
emergency.
(j)
Communicate status to the MHOAC.
Determining PATHS’ Response Role: If PATHS remains fully or
partially operational following a disaster, the CEO, COO, Medical
Director, and other members of the ERT will define the response
role the clinic will play. The appropriate response role for PATHS
will depend on the following factors:
(1)
The impact of the disaster on the PATHS’ location.
(2)
The level of personnel and other resources available for
response.
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14.
(3)
The pre-event medical care and other service capacity of
PATHS.
(4)
The medical care environment of the community both
before and after a disaster occurs as assessed by the
MHOAC (e.g., medical care demands may be reduced if
the 9-1-1 system and nearby hospitals are operational and
not overwhelmed).
(5)
The needs and response actions of residents of the
community served by PATHS (e.g., convergence to the
facility following disasters).
(6)
The priorities established by the PATHS’ CEO and Board
of Directors (e.g., to remain open if at all possible following
a disaster).
(7)
The degree of planning and preparedness of PATHS and
its staff.
Response to External Emergencies: An External Disaster is an event
that occurs in the community. Examples include earthquakes, floods,
fires, hazardous materials releases or terrorist events. An external
disaster may directly impact a facility and its ability to operate.
a)
b)
Local vs. Widespread Emergencies:
(1)
Local emergencies are disasters with effects limited to a
relatively small area. In local emergencies, other health
facilities and resources will be relatively unaffected and
remain viable options for sending assistance or receiving
patients from the disaster area.
(2)
In widespread emergencies, nearby medical resources are
likely to be impacted and therefore less likely to be able to
offer assistance to the facility. Hospitals may also have a
higher response priority than clinics for resupply and other
response assistance.
Weapons of Mass Destruction (WMD):
(1)
Preparations for an event involving weapons of mass
destruction - chemical, biological, nuclear, radiological, or
explosives (CBRNE) - should be based on existing
programs for handling hazardous materials. If staff
suspects an event involving CBRNE weapons has
occurred, they should:
(a)
Remain calm and isolate the victims to prevent
further contamination within the facility.
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(2)
c)
(b)
Contact the Medical Director, Site Manager, or
other appropriate clinician.
(c)
Secure personal protective equipment and wait for
instructions.
(d)
Comfort the victims.
(e)
Contact appropriate Operational Area authorities.
See “Appendix K – Disaster Contact List”.
Shelter-In-Place: Terrorist use of Weapons of Mass
Destruction may result in the release of radiation,
hazardous materials and biological agents in proximity to
the clinic. Shelter-In-Place may be the best strategy to
minimize risk of exposure to these agents.
Bioterrorism Response
(1)
PATHS’ Medical Director should immediately report to the
local health department those diseases that pose a
significant public health threat, such as agents of biological
terrorism.
(2)
PATHS will report diseases resulting from bioterrorist
agents, like other communicable and infectious diseases,
to the Health Department Epidemiologist at (804) 8648141.
(3)
PATHS’ response to a bioterrorism incident may be
initiated by the CEO or Medical Director due to:
(a)
The request of local civil authorities.
(b)
Government official notification of an outbreak
within or near the facility’s community.
(c)
Presentation of a patient with a suspected
exposure to a bioterrorist agent. In case of
presentation by a patient with suspected exposure
to a bioterrorist agent, PATHS will follow current
CDC response guidelines. Potential indicators of a
bioterrorism attack are:
(i)
Groups of people becoming ill around the
same time.
(ii)
Sudden increase of illness in previously
healthy individuals.
(iii)
Sudden increase in the following nonPage 46 of 132
specific illnesses:
(4)
(a)
Pneumonia, flu-like illness, or fever
with atypical features.
(b)
Bleeding disorders.
(c)
Unexplained rashes, and mucosal or
skin irritation, particularly in adults.
(d)
Neuromuscular illness, like muscle
weakness and paralysis.
(e)
Diarrhea.
(iv)
Simultaneous disease outbreaks in human
and animal or bird populations.
(v)
Unusual temporal or geographic clustering
of illness (for example, patients who
attended the same public event, live in the
same part of town, etc.).
Infection Control Practices for Patient Management:
(a)
PATHS will use Standard Precautions to manage
all patients, including symptomatic patients with
suspected or confirmed bioterrorism related
illnesses.
(b)
For certain diseases or syndromes (e.g., smallpox
and pneumonic plague), additional precautions may
be needed to reduce the likelihood for transmission.
(c)
In general, the transport and movement of patients
with bioterrorism related infections, as with patients
with any epidemiologically important infections
(e.g., pulmonary tuberculosis, chickenpox,
measles), should be limited to movement that is
essential to provide patient care, thus reducing the
opportunities for transmission of microorganisms
within healthcare facilities.
(d)
PATHS has in place adequate procedures for the
routine care, cleaning, and disinfection of
environmental surfaces, and other frequently
touched surfaces and equipment, and ensures that
these procedures are being followed.
(i)
Facility approved germicidal cleaning
agents are available in patient care areas to
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use for cleaning spills of contaminated
material and disinfecting noncritical
equipment.
(e)
(5)
(ii)
Used patient care equipment soiled or
potentially contaminated with blood, body
fluids, secretions, or excretions is handled in
a manner that prevents exposures to skin
and mucous membranes, avoids
contamination of clothing, and minimizes
the likelihood of transfer of microbes to
other patients and environments.
(iii)
PATHS has policies in place to ensure that
reusable equipment is not used for the care
of another patient until it has been
appropriately cleaned and reprocessed, and
to ensure that single use patient items are
appropriately discarded.
(iv)
Sterilization is required for all instruments or
equipment that enter normally sterile tissues
or through which blood flows.
(v)
Contaminated waste is sorted and
discarded in accordance with federal, state
and local regulations.
(vi)
Policies for the prevention of occupational
injury and exposure to blood borne
pathogens in accordance with Standard
Precautions and Universal Precautions are
in place.
If exposed skin comes in contact with an unknown
substance/powder, recommend washing with soap
and water only. If contamination is beyond the sites
capability, call 911. Local government, fire
departments and hospitals normally conduct
decontamination of patients and facilities exposed
to chemical agents.
Patient placement: In small-scale events, routine patient
placement and infection control practices should be
followed. However, when the number of patients
presenting to a healthcare facility is too large to allow
routine triage and isolation strategies (if required), it will be
necessary to apply practical alternatives. These may
include cohorting patients who present with similar
syndromes, i.e., grouping affected patients into a
designated section of a clinic or emergency department, or
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a designated ward or floor of a facility, or even setting up a
response center at a separate building.
(6)
Evidence collection:
(a)
PATHS will establish procedures for collecting and
preserving evidence in any suspected terrorist
attack. In the event of a suspected or actual
terrorist attack involving weapons of mass
destruction, a variety of responders, ranging from
health care providers to law enforcement and
federal authorities, will play a role in the
coordinated response. The identification of victims
as well as the collection of evidence will be a critical
step in these efforts.
(b)
The health care provider's first duty is to the
patient; however interoperability with other
response agencies is strongly encouraged.
(c)
The performance of evidence collection while
providing required patient decontamination, triage
and treatment should be reasonable for the
situation.
(d)
Information gathered from the victims and first
responders may aid in the epidemiological
investigation and ongoing surveillance.
(e)
It is imperative that individual healthcare providers
work with the local law enforcement agencies and
prosecutors in the development and customization
of these policies.
(f)
Evidence to be collected could include clothing,
suspicious packages, or other items that could
contain evidence of contamination. At a minimum:
(i)
PATHS has a supply of plastic bags,
marking pens, and ties to secure the bags.
(ii)
Each individual evidence bag will be labeled
with the patient's name, date of birth,
medical record number, date of collection
and site of collection.
(iii)
An inventory of valuables and articles will be
created that lists each item that is collected.
The list will be kept by the clinic and a copy
given to the patient.
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(iv)
(7)
The person responsible for the valuables
and articles will be identified and
documented. If possessions are to be
transported to the FBI or local law
enforcement agency, the facility will
document who received them, where they
were taken, and how they will be returned to
the owner.
Mass prophylaxis: PATHS encourages its clinicians to
participate in a mass prophylaxis program, if the disruption
to clinic operations would not negatively affect the health of
the community the organization serves.
Health care providers from other organizations throughout
the county could be called to volunteer to distribute
medication or provide vaccines in response to a
large-scale attack. Under this scenario, the County or City
would establish mass prophylaxis sites throughout their
jurisdiction. These sites would be large facilities such as
school gymnasiums or warehouses that can accommodate
large groups of people. These sites would require a large
number of healthcare providers to administer medications.
Since the county does not employ enough practitioners to
staff the sites, they will look to the private sector, including
PATHS, to adequately staff mass prophylaxis sites.
D.
Recovery:
1.
Introduction: Recovery actions begin almost concurrently with response
activities and are directed at restoring essential services and resuming
normal operations. Depending on the emergency's impact on the
organization, this phase may require a large amount of resources and
time to complete. This phase includes activities taken to assess, manage
and coordinate the recovery from an event as the situation returns to
normal. These activities include:
a)
Deactivation of emergency response: the Chief Executive Officer
or designee will call for deactivation of the emergency when the
clinic can return to normal or near normal services, procedures,
and staffing. Post-event assessment of the emergency response
will be conducted to determine the need for improvements.
b)
Establishment of an employee support system. Human resources
will coordinate referrals to employee assistance programs as
needed.
c)
Accounting for disaster-related expenses. The Finance Section
Chief will account for disaster related expenses. Documentation
will include: direct operating cost; costs from increased use; all
damage or destroyed equipment; replacement of capital
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equipment; and construction related expenses.
d)
Return to normal operations as rapidly as possible.
2.
Documentation: To continue providing the same efficient service as was
provided prior to the incident, PATHS will immediately begin gathering
complete documentation including photographs. Depending on the event,
it may be necessary to expedite resumption of health care services to
address unmet community medical needs.
3.
Inventory Damage and Loss: PATHS will document damage and
losses of equipment using a current and complete list of equipment serial
numbers, costs, and dates of inventory. One copy will be filed with the
Director of Finance and another copy in a secure offsite location.
4.
Lost Revenue through Disruption of Services: The Director of
Finance will work with the Finance Section to document all expenses
incurred from the disaster. An audit trail will be developed to assist with
qualifying for any Federal reimbursement or assistance available for costs
and losses incurred by the site as a result of the disaster.
5.
Cost / Loss Recovery Sources: Depending on the conditions and the
scale of the incident, PATHS will seek financial recovery resources in
accordance with the following:
a)
The eligibility of organization for federal reimbursement for
response costs and losses remains ambiguous. It may be
possible to gain reimbursement through county channels under
certain (largely untested) circumstances.
b)
Public Assistance (FEMA/OES) - After a disaster occurs and the
President has issued a Federal Disaster Declaration, assistance is
available to applicants through FEMA and the OES. The Small
Business Administration (SBA) provides physical disaster loans to
businesses for repairing or replacing disaster damages to property
owned by the business. Businesses and Non-profit organizations
of any size are eligible.
c)
Federal Grant - Following a presidential disaster declaration, the
Hazard Mitigation Grant Program (HMGP) is activated.
d)
A private, non-profit facility is eligible for emergency protective
measures (i.e., emergency access such as provision of shelters or
emergency care or provision of food, water, medicine, and other
essential needs), and may be eligible for permanent repair work
(i.e., repair or replacement of damaged elements restoring the
damaged facility):
(1)
pre-disaster design;
(2)
pre-disaster function; and/or
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(3)
e)
pre-disaster capacity.
Insurance Carriers – PATHS will file claims with its insurance
companies for damage to a facility. The facility will not receive
federal reimbursement for costs or losses that are reimbursed by
the insurance carrier. Eligible costs not covered by the insurance
carrier such as the insurance deductible may be reimbursable.
6.
Psychological Needs of Staff and Patients: Mental health needs of
patients and staff are likely to continue during the recovery phase. The
Mental Health Coordinator will continue to monitor for and respond to the
mental health needs of clinic staff and patients.
7.
Restoration of Services: PATHS will take the following steps to restore
services as rapidly as possible:
a)
If necessary, repair the facility or relocate services to a new or
temporary facility.
b)
Replace or repair damaged medical equipment.
c)
Expedite structural and licensing inspections required to re-open.
d)
Facilitate the return of medical care and other site staff to work.
e)
Replenish expended supplies and pharmaceuticals.
f)
Decontaminate equipment and facilities.
g)
Attend to the psychological needs of staff and community.
h)
Follow-up on rescheduled appointments.
8.
After-Action Report: PATHS will conduct after-action debriefings with
staff and participate in Operational Area after-action debriefings. The
organization will also produce an after-action report describing its
activities and corrective action plans including recommendations for
modifying the surge capacity expansion procedures, additional training
and improved coordination.
9.
Staff Support: The organization recognizes that staff and their families
are impacted by community-wide disasters. PATHS will assist staff in
their recovery efforts to the extent possible.
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Page 53 of 132
Appendix A: Emergency Management Acronyms
AAR
ARC
After Action Report
American Red Cross
BT
Bioterrorism
CFR
COG
COOP
CPR
Code of Federal Regulations
Continuity of Government
Continuity of Operations
Cardiopulmonary Resuscitation
DFO
Disaster Field Office
EAS
EOC
EPC
EPP
ERT
ESA
Emergency Alert System
Emergency Operations Center
Emergency Preparedness Committee
Emergency Preparedness Plan
Emergency Response Team
Emergency Services Act
FBI
FEMA
Federal Bureau of Investigation
Federal Emergency Management Agency
GIS
Geographic Information System
ICS
Incident Command System
JIC
Joint Information Center
MACS
MCS
MMAA
MOU
Multi-Agency Coordination System
Mass Care and Shelter
Master Mutual Aid Agreement
Memorandum of Understanding
NDAA
National Disaster Assistance Act
OA
OES
ORP
Operational Area
Office of Emergency Services
Operational Recovery Plan
PDA
PPE
PIO
Preliminary Damage Assessments
Personal Protective Equipment
Public Information Officer
REOC
RIMS
Regional Emergency Operations Center
Response Information Management System
SEMS
SEP
Standardized Emergency Management Systems
State Emergency Plan
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SITREP
SOC
SOP
SSCOT
Situation Status Report
State Operations Center
Standard Operating Procedures
State Strategic Committee on Terrorism
TSA
The Salvation Army
WMD
Weapons of Mass Destruction
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Appendix B: Emergency Management Glossary
A
Action Plan - Documented outline of specific projected activities to be accomplished within a
specified period of time to meet a defined need, goal or objective.
After-Action Report (AAR) - A narrative report that presents issues found during an incident
and recommendations on how those issues can be resolved.
Alternate Database/Records Access - The safekeeping of vital resources, facilities, and
records, and the ability to access such resources in the event that the emergency plan is put
into effect.
Alternate Facilities - An alternate work site that provides the capability to perform minimum
functions until normal operations can be resumed.
Advanced Life Support (ALS) - Procedures and techniques utilized by EMT-P, EMT-II, nursing
and physician personnel to stabilize critically sick and injured patients which exceed Basic Life
Support procedures
B
Basic Life Support (BLS) - Initial procedures in the care of a patient in cardiac and/or respiratory
arrest which may include the assessment of ABCs, opening the airway, artificial respiration and
CPR (cardio-pulmonary resuscitation) as needed to maintain life. Basic non-invasive first-aid
procedures and techniques utilized by most all trained medical personnel, including First
Responder, to stabilize critically sick and injured people
BLS Responder - Certified EMT-I or First Responder
Bioterrorism - The planned, unlawful use or threat of use, of biological weapons made from
living organisms with the intent of causing death or disease in humans, animals, or plants. The
goal of bio-terrorism is usually to create fear and/or intimidate governments or societies for
gaining political, religious, or ideological goals
C
Chemical Attack - The deliberate release of a toxic gas, liquid or solid that can poison people
and the environment
Command Post - Location where the administrative staff coordinates the other overall operations.
The Incident Commander remains here; other area chiefs assemble here regularly for debriefings
Crisis - exists when physical infrastructure is destroyed, political and social systems are
ruptured, and economic activity is seriously disrupted; population displacement grows quickly
and suffering increases, particularly among the aged, disabled, children and women. Such a
situation is often described as a "complex emergency".
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Crisis Relocation Plan (CRP) - The contingency planning designed to move populations from
high hazard areas to those of lower risk and to provide for their well being (i.e., congregate care
housing, feeding, fallout protection, etc.). Also frequently referred to as evacuation planning
D
Deceased - Fourth (last) priority in patient treatment according to the S.T.A.R.T. and other triage
systems.
Delayed Treatment - Second priority in patient treatment according to the S.T.A.R.T. and other
triage systems. These people require aid, but injuries are less severe. A hospitalized patient may
be categorized from "guarded" to "serious"; a patient requiring at least minimal hospital services.
Delegation of Authority - A statement provided to the Incident Manager by the Chief Executive
Officer delegating authority and assigning responsibility. The Delegation of Authority can
include objectives, priorities, expectations, constraints and other considerations or guidelines as
needed.
Disaster - A sudden calamitous emergency event bringing great damage loss or destruction.
E
Emergency - A condition of disaster or of extreme peril to the safety of persons and property
caused by such conditions as air pollution, fire, flood, hazardous material incident, storm,
epidemic, riot, drought, sudden and severe energy shortage, plant or animal infestations or
disease, the Governor’s warning of an earthquake or volcanic prediction, or an earthquake or
other conditions, other than conditions resulting from a labor controversy.
Emergency Medical Services Authority (EMSA) – Virginia’s agency responsible for coordinating
the State's medical response to a disaster.
Emergency Medical Services Agency, Local (LEMSA) - Local EMS agency responsible for
coordinating the local response of emergency medical resources.
Emergency Operations Center (EOC) - A location from which centralized emergency
management can be performed. The EOC is established by the clinic to coordinate the overall
organizational response and support to an emergency.
Emergency Operations Plan (EOP) - The plan that each organization has and maintains for
responding to hazards.
Emergency Response Team (ERT) - Staff and volunteers responsible for the operational
functions; such as medical, evacuation, communications, supply procurement, shelter, building
assessment and mental health services. Assignments are made by determining the needs and
skills of those reporting.
Exercise - Maneuver or simulated emergency condition involving planning, preparation, and
execution; carried out for the purpose of testing, evaluating, planning, developing, training,
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and/or demonstrating emergency management systems and individual components and
capabilities, to identify areas of strength and weakness for improvement of an emergency
operations plan.
F
Finance Section - One of the four primary functions found in all ICS organizations which is
responsible for all costs and financial considerations. The Section can include the Time Unit,
Claims Unit and Cost Unit.
First Responder - Personnel who have responsibility to initially respond to emergencies such as
fire fighter, police officers, Virginia State Police Officers, lifeguards, forestry personnel, ambulance
attendants, and other public service personnel. Virginia law requires such persons to have
completed a first-aid course and to be trained in cardiopulmonary resuscitation.
Flip Chart – A chart with several sheets hinged at the top; sheets can be flipped over to present
information sequentially.
H
Hazard Mitigation - A cost effective measure that will reduce the potential for damage to a
facility from a disaster event.
Hazard Mitigation Plan - The plan resulting from a systematic evaluation of the nature and
extent of vulnerability to the effects of natural hazards present in society that includes the
actions needed to minimize future vulnerability to hazards.
Hospital Emergency Incident Command System (HEICS) - A management program for
hospitals modeled after the Fire Service Plan; comprised of an organization chart with a clearly
delineated chain of command and a preordered job action sheet which assists the individual in
focusing upon his/her assigned position function.
I
Immediate Treatment - First level of patient priority according to the S.T.A.R.T. and other triage
systems. A patient who requires rapid assessment and medical intervention in order to increase
chances of survival. A hospitalized patient who may be classified from "serious" to "critical"
condition; requiring constant nursing care.
Incident Command System (ICS) - A flexible organizational structure which provides a basic
expandable system developed by the Fire Services to mitigate any size emergency situation. An
organization structure designed to improve emergency response operations; it originated with fire
service and is now adapted to many different types of agencies, including hospitals.
Incident Manager/Commander (IM/IC) - The individual who holds overall responsibility for
incident response and management.
Information Officer - A member of the Management Staff responsible for interfacing with the
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public and media or with other agencies requiring information directly from the incident. There
is only one Information Officer per incident. This position is also referred to as Public Affairs or
Public Information Officer in some disciplines. The individual at EOC level that has been
delegated the authority to prepare public information releases and to interact with the media.
In-Place Protection Plan (Formerly Community Shelter Plan) - A planning document which
includes a published map and emergency public information materials that enable a local
government to give people the answers to questions, "Where do I go for shelter?' and "What do
I do?" when the warning sounds. The IPP designates specific shelters to be used by people
working or living in specific areas of the community, thus allocating the people to the best
available fallout protection
L
Level 1 Disaster - A moderate to severe incident where local resources are adequate and
available, either on duty or by call-back.
Level 2 Disaster - A moderate to severe emergency where local resources are not adequate and
mutual aid may be required.
Level 3 Disaster - A major disaster where resources in or near the impacted areas are
overwhelmed and extensive mutual aid is required. A State of Emergency will be proclaimed and a
Presidential Declaration of an Emergency or a Major Disaster will be requested.
Liaison Officer - A member of the Management Staff responsible for coordinating with
representatives from cooperating and assisting agencies. The function may be done by a
Coordinator and/or within a Section reporting directly to the EOC Incident Manager.
Logistics - A working group responsible for coordinating the resources and activities associated
with relocation planning and deployment of operations and positions during an event. Person
responsible for the organization and direction of those operations associated with maintenance of
the physical environment, including adequate levels of food, shelter and supplies to support the
overall objectives.
Logistics Section - One of the five primary functions found at all SEMS levels. The Section
responsible for providing facilities, services and materials for the incident or at the EOC.
M
Management Staff - The Management Staff at the SEMS EOC level consists of the Information
Officer, Safety Officer, and Liaison Officer. They report directly to the EOC Incident Manager.
Medical Health Operational Area Coordinator (MHOAC) - The Medical Health Operational
Area Coordinator is responsible for coordinating all medical and health operations of the
Operational Area, including mutual aid, and is located in the County EOC.
Memorandum of Understanding - Agreement between or among government agencies,
community organizations, and other entities that define respective roles and responsibilities in
preparing for and responding to emergencies.
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Minor Treatment - Third priority of patient in the S.T.A.R.T. and other triage systems. A patient
requiring only simple, rudimentary first-aid. These patients are considered ambulatory. A
hospitalized patient may be considered minor if they are in "stable" condition and capable of being
treated and discharged.
Mitigation - Pre-event planning and actions which aim to lessen the effects of potential disaster.
O
Office of Emergency Services (OES) - Agency responsible for the overall coordination of
resources. OES can be a city, county, regional, or state level agency
Operations - Function in ICS organization responsible for coordination of medical personnel,
treatment and triage areas, social services and evacuation of patients.
Operational Period - The period of time scheduled for execution of a given set of operation
actions as specified in the EOC Action Plan. Operational Periods can be of various lengths,
although usually not over 24 hours.
Operations Section - One of the five primary functions found in all organizations managed by
the Incident Command System. The Section responsible for all tactical operations at the
incident, or for the coordination of operational activities at the EOC.
P
Packet Radio - A system of digital transmission of information via radio; information is typed into a
computer, transmitted via air waves in short bursts ("packets") and retrieved at the receiving end as
a typed document.
Personal Protective Equipment - The equipment and clothing required to mitigate the risk of
injury from or exposure to hazardous conditions encountered during the performance of duty. PPE
includes, but is not limited to: fire resistant clothing, hard hat, flight helmets, shroud, goggles,
gloves, respirators, hearing protection, and shelter.
Planning Section (Also referred to as Planning/Intelligence) - One of the four primary
functions found in all ICS organizations. Responsible for the collection, evaluation, and
dissemination of information related to the incident or an emergency, and for the preparation
and documentation of EOC Action Plans. The section also maintains information on the current
and forecast situation, and on the status of resources assigned to the incident. The Section
typically includes Situation, Resource, Documentation, Message, and Action Plan Units.
Plan Maintenance - Steps taken to ensure the plan is reviewed annually and updated
whenever major changes occur.
Preparedness - The preparedness phase involves activities taken in advance of an emergency
to ensure an effective response to the emergency, if it should occur.
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Primary Facility - The site of normal, day-to-day operations; the location where the employee
usually goes to work.
Public Information Officer - An official responsible for releasing information to the public and
other stakeholders, usually through the news media. (Also see Information Officer).
R
RACES/Radio Amateur Civil Emergency Service - One of several groups of amateur radio
operators commonly referred to as "HAM Radio Operators". RACES is designated by the FCC to
provide amateur communications assistance to federal, state and local government agencies in a
disaster.
Radiation Threat - The use of common explosives to spread radioactive materials over a
targeted area. Also known as a "dirty bomb," a radiation threat is not a nuclear blast, but rather
an explosion with localized radioactive contamination.
Recovery - Activities that occur following a response to a disaster that are designed to help an
organization and community return to a pre-disaster level of function. These activities usually
begin within days after the event and continue after the response activities cease. Recovery
includes government individual and public assistance programs which provide temporary
housing assistance, grants and loans to eligible individuals, businesses and government entities
to recover from the effects of a disaster.
Relocation Site - The site where all or designated employees will report for work if required to
move from the primary facility.
Response - Activities to address the immediate and short-term effects of an emergency or
disaster. Response includes immediate actions to save lives, protect property and meet basic
human needs.
Risk Communications - Communication of risks resulting from site operations and the
implications for the surrounding community. Organization risk communications include effective
processes for risk assessment & management, emergency preparedness, and community
dialogue.
S
Safety Officer - A member of the Management Staff within the EOC responsible for monitoring
and assessing safety hazards or unsafe situations, and for developing measures for ensuring
personnel safety.
Search and Rescue, Heavy - Rescue techniques for victims entombed by the partial or total
collapse of a structure, done by specially trained teams with mechanical or hydraulic equipment.
Search and Rescue, Light - Rescue techniques for victims trapped by non-structural contents,
even if structural damage has occurred, done by trained or non-trained teams (depending on
accompanying structural damage) using hand-held tools.
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Section - That organization level with responsibility for a major functional area at the EOC, e.g.,
Operations, Planning, Logistics, Finance.
"Shelter-in-Place" - The process of staying where you are and taking shelter, rather than trying
to evacuate.
Situation Report (SITREP) - A written, formatted report that provides a picture of the response
activities during a designated reporting period.
START - Acronym for Simple Triage and Rapid Treatment. Field triage system used that
allows field care personnel to triage patients into one of four categories within 60 seconds.
Staff Protection - Personal Protective Equipment – (See Personal Protective Equipment).
Staff Protection - Decontamination - Decontamination is the physical removal of harmful
substances from victims, equipment, and supplies of a HAZMAT or NBC attack. It should be
performed whenever there is a risk of secondary exposure from a hazardous substance. Failure
to adequately "decon" NBC victims could not only increase the number and severity of
casualties, but could also cripple medical response to a terrorist event. Various methods for
performing decontamination are available (such as mechanical removal, absorption,
degradation, and dilution), with dilution being the most applicable to the medical environment.
Standard Operating Procedures (SOPs) - A set of instructions having the force of a directive,
covering those features of operations which lend themselves to a definite or standardized
procedure. Standard operating procedures support an emergency plan by describing in detail
how a particular task will be carried out.
Standardized Emergency Management System (SEMS) - SEMS consists of five
organizational levels which are activated as necessary: Field Response, Local Government,
Operational Area, Region, and State.
Surge Capacity - In times of disaster so called excess capacity contributes to surge capacity
which provides the ability to care for large numbers of casualties. Surge capacity encompasses
potential available space in which patients may be triaged, managed, vaccinated,
decontaminated, or simply located; available personnel of all types; necessary medications,
supplies and equipment; and even the legal capacity to deliver health care under situations
which exceed authorized capacity.
T
Technological Hazard - Includes a range of hazards emanating from the manufacture,
transportation, and use of such substances as radioactive materials, chemicals, explosives,
flammables, agricultural pesticides, herbicides and disease agents; oil spills on land, coastal
waters or inland water systems; and debris from space.
Training and Exercise - These activities include: 1) efforts to educate/advise designated staff
on responsibilities, and on the existing plans; and 2), tests to demonstrate the viability and
interoperability of all plans
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Trauma Center Criteria – A method for deciding which patients need a trauma center, based on
the patient’s injuries, vital signs, mechanism of injury and the paramedic’s judgment.
Triage - It literally means "to sort"; commonly means prioritizing patients into categories according
to the severity of their condition. Patients requiring life-saving care are treated before those
requiring only first aid. The process of screening and classification of sick, wounded, or injured
persons to determine priority needs in order to ensure the efficient use of medical manpower,
equipment and facilities.
Triage, Expectant Category - A patient who requires more extensive resuscitation than available
resources will allow, but is still alive at that time; this category is used only in catastrophic disasters
where personnel and/or medical supplies are too limited to use standard resuscitation guidelines.
Triage Personnel - Trained individuals responsible for triaging patients and assigning them to
appropriate transportation or treatment areas.
Triage Tag - A tag used by triage personnel to identify and document the classification, or level, of
a patient's medical condition.
V
Vital Records & Systems - Records necessary to maintain operations during an emergency, to
recover full operations following an emergency, and to protect the legal rights and interests of
citizens and the Government. The two basic categories of vital records are emergency
operating records and rights and interests records.
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Appendix C: (Mitigation Tools) Clinic Hazard and Vulnerability Analysis
Instructions: Evaluate potential for event and response among the following categories using
the hazard specific scale. Assume each event incident occurs at the worst possible time (e.g.
during peak patient loads). Complete all worksheets, including Natural, Technological, Human
and Hazmat.

Issues to consider for probability include, but are not limited to:
o Known risk
o Historical data
o Manufacturer/vendor statistics

Issues to consider for response include, but are not limited to:
o Time to marshal an on-scene response
o Scope of response capability
o Historical evaluation of response success

Issues to consider for human impact include, but are not limited to:
o Potential for staff death or injury
o Potential for patient death or injury

Issues to consider for property impact include, but are not limited to:
o Cost to replace
o Cost to set up temporary replacement
o Cost to repair
o Time to recover

Issues to consider for business impact include, but are not limited to:
o Business interruption
o Employees unable to report to work
o Customers unable to reach facility
o Company in violation of contractual agreements
o Imposition of fines and penalties or legal costs
o Interruption of critical supplies
o Interruption of product distribution
o Reputation and public image
o Financial impact/burden

Issues to consider for preparedness include, but are not limited to:
o Frequency of drills
o Training status
o Insurance
o Availability of alternate sources for critical supplies/services

Issues to consider for internal resources include, but are not limited to:
o Types of supplies on hand/will they meet need?
o Volume of supplies on hand/will they meet need?
o Staff availability
o Coordination with MOB’s
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o
o

Availability of back-up systems
Internal resources’ ability to withstand disaster/survivability
Issues to consider for external resources include, but are not limited to:
o Types of agreements with local and state agencies
o Types of agreements with community agencies/drills
o Coordination with local and state agencies
o Coordination with proximal health care facilities
o Coordination with treatment specific facilities
o Community resources
Keeping this in mind, complete the assessment beginning on the next page.
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Facility Location: _________________________________ Completed by: ___________________________ Date: __ / __ / ____
Hazard and Vulnerability Assessment Tool Worksheet: NATURAL OCCURING EVENTS
A
Event
B
C
D
E
F
G
Probability
(Likelihood this
will occur)
Human Impact
(Possibility of
Death or injury)
Property
Impact
(Possibility of
physical losses
and damages)
Business
Impact
(Possibility of
Interruption in
Services)
Preparedness
(Amount of
Preplanning)
Internal
Response
(Likelihood of
immediate
availability of
resources)
0 = N/A
1 = Low
2 = Moderate
3 = High
0 = N/A
1 = Low
2 = Moderate
3 = High
0 = N/A
1 = Low
2 = Moderate
3 = High
0 = N/A
1 = Low
2 = Moderate
3 = High
0 = N/A
1 = Low
2 = Moderate
3 = High
0 = N/A
1 = Low
2 = Moderate
3 = High
H
External
Response
(Likelihood of
access to quick
community/
mutual aid staff
and supplies)
I
Total Risk
(Add columns
B – H)
0 = N/A
1 = Low
2 = Moderate
3 = High
Hurricane
Tornado
Severe
Thunderstorm
Snow Fall
Blizzard
Ice Storm
Earthquake
Temperature
Extremes
Drought
Flood,
External
Wild Fire
Landslide
Dam
Inundation
Volcano
Epidemic
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Facility Location: _________________________________ Completed by: ___________________________ Date: __ / __ / ____
Hazard and Vulnerability Assessment Tool Worksheet: TECHNOLOGIC EVENTS
A
Event
B
C
D
E
F
G
Probability
(Likelihood this
will occur)
Human Impact
(Possibility of
Death or injury)
Property
Impact
(Possibility of
physical losses
and damages)
Business
Impact
(Possibility of
Interruption in
Services)
Preparedness
(Amount of
Preplanning)
Internal
Response
(Likelihood of
immediate
availability of
resources)
0 = N/A
1 = Low
2 = Moderate
3 = High
0 = N/A
1 = Low
2 = Moderate
3 = High
0 = N/A
1 = Low
2 = Moderate
3 = High
0 = N/A
1 = Low
2 = Moderate
3 = High
0 = N/A
1 = Low
2 = Moderate
3 = High
0 = N/A
1 = Low
2 = Moderate
3 = High
H
External
Response
(Likelihood of
access to quick
community/
mutual aid staff
and supplies)
I
Total Risk
(Add columns
B – H)
0 = N/A
1 = Low
2 = Moderate
3 = High
Electrical Failure
Generator
Failure
Fuel Shortage
Natural Gas
Failure
Water Failure
Sewer Failure
Fire Alarm
Failure
Communications
Failure
HVAC Failure
IT Systems
Failure
Fire, Internal
Flood, Internal
Hazmat
Exposure
Supply Shortage
Structural
Damage
Page 67 of 132
Facility Location: _________________________________ Completed by: ___________________________ Date: __ / __ / ____
Hazard and Vulnerability Assessment Tool Worksheet: HUMAN RELATED EVENTS
A
Event
B
C
D
E
F
G
Probability
(Likelihood this
will occur)
Human
Impact
(Possibility of
Death or
injury)
Property
Impact
(Possibility of
physical losses
and damages)
Business
Impact
(Possibility of
Interruption in
Services)
Preparedness
(Amount of
Preplanning)
Internal
Response
(Likelihood of
immediate
availability of
resources)
0 = N/A
1 = Low
2 = Moderate
3 = High
0 = N/A
1 = Low
2 = Moderate
3 = High
0 = N/A
1 = Low
2 = Moderate
3 = High
0 = N/A
1 = Low
2 = Moderate
3 = High
0 = N/A
1 = Low
2 = Moderate
3 = High
0 = N/A
1 = Low
2 = Moderate
3 = High
H
External
Response
(Likelihood of
access to
quick
community/
mutual aid
staff and
supplies)
I
Total Risk
(Add columns
B – H)
0 = N/A
1 = Low
2 = Moderate
3 = High
Mass Casualty
(Trauma)
Mass Casualty
(Medical/Infectious)
Terrorism,
Biological
VIP Situation
Infant Abduction
Hostage Situation
Civil Disturbance
Labor Action
Forensic
Admission
Bomb Threat
Page 68 of 132
Facility Location: _________________________________ Completed by: ___________________________ Date: __ / __ / ____
Hazard and Vulnerability Assessment Tool Worksheet: EVENTS INVOLVING HAZARDOUS MATERIALS
A
Event
B
C
D
E
F
G
Probability
(Likelihood this
will occur)
Human
Impact
(Possibility of
Death or
injury)
Property
Impact
(Possibility of
physical losses
and damages)
Business
Impact
(Possibility of
Interruption in
Services)
Preparedness
(Amount of
Preplanning)
Internal
Response
(Likelihood of
immediate
availability of
resources)
0 = N/A
1 = Low
2 = Moderate
3 = High
0 = N/A
1 = Low
2 = Moderate
3 = High
0 = N/A
1 = Low
2 = Moderate
3 = High
0 = N/A
1 = Low
2 = Moderate
3 = High
0 = N/A
1 = Low
2 = Moderate
3 = High
0 = N/A
1 = Low
2 = Moderate
3 = High
H
External
Response
(Likelihood of
access to
quick
community/
mutual aid
staff and
supplies)
I
Total Risk
(Add columns
B – H)
0 = N/A
1 = Low
2 = Moderate
3 = High
Mass Casualty
(Hazmat, >=5
victims)
Mass Casualty
(Hazmat, < 5
victims)
Chemical
Exposure, External
Small-Medium
Sized Internal Spill
Large Internal Spill
Terrorism,
Chemical
Radiologic
Exposure, Internal
Radiologic
Exposure, External
Terrorism,
Radiologic
Page 69 of 132
Appendix D: Management of Environment/Hazard Surveillance & Risk Assessment
Report Form
Facility Location: _____________________________________________________________
Completed by: _________________________________ Date: __ / __ / ____
Program
Hazard Surveillance/Risk Assessment Item
Score (1 – 5)
(1 = Outstanding,
5 = Needs
Improvement)
Comments
1. Are grounds clean and free of hazards?
Safety
Security
Management
Hazardous
Materials &
Waste
Management
Emergency
Preparedness
Management
2. Are floors clean, dry, in good repair and free of
obstruction?
3. Are mechanisms for access (i.e., ramps,
handrails, door opening mechanisms, etc.)
operational?
4. Is the parking area free of potholes or other
hazards?
Program Total:
1. Are doors functioning and locked as
appropriate?
2. Are alarms functioning, tested, and maintained
in accordance with manufacturer’s specifications?
3. Are systems/mechanisms in place to quickly
notify officials or other staff quickly in the event of
a security related problem?
Program Total:
1. Are OSHA Hazard Communication and
Exposure Control Documents available?
2. Have all biohazard and toxic substances
present been identified?
3. Are MSDS sheets quickly available for all
identified toxic substances?
4. Are all waste contaminated with blood/body
fluid considered and handled as infectious?
5. Are sharps containers puncture resistant and
in accordance with required safety standards?
6. Are sharps and disposable syringes placed in
approved sharps containers?
7. Are all engineering, personal protective
equipment, and workplace controls in effect?
Program Total:
1. Is there an updated disaster plan in the
facility?
2. Has a non-fire related emergency drill been
performed in the past six months?
3. Is staff aware of at least three different types
of potential non-fire emergencies and their role in
eliminating or reducing the risk of patients, staff
and property?
4. Is staff aware of the primary and secondary
exits from the facility?
Program Total:
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Life Safety
Management
1. Is the evacuation plan posted and can staff
demonstrate knowledge of the plan?
2. Are fire extinguishers located in accordance
with NFPA standards?
3. Are fire extinguishers inspected monthly and
documented on/near the extinguisher?
4. Are smoke/fire alarm systems functioning,
tested and maintained in accordance with
manufacturer’s specifications?
5. Are exit hallways well lit and obstacle free?
6. Is emergency exit lighting operational and
tested in accordance with NFPA standards?
7. Are fire/smoke doors operating effectively?
Medical
Equipment
Management
Utility
Management
8. No smoking policies are in effect and signs are
posted appropriately?
Program Total:
1. Is there a unique inventory of all medical
equipment in the facility?
2. Has all equipment been tested/maintained
according to manufacturer’s specifications?
3. Are maintenance records complete, are they
capable of tracking the maintenance history of a
particular piece of equipment, and do they record
the results of both electrical safety as well as
calibration, as appropriate?
4. Are systems/mechanisms in place to respond
appropriately to a medical equipment failure?
Program Total:
1. Are the lights, emergency lights, and power
plugs operational and in working order?
2. Does the water/sewage system appear to be
working properly and has the water quality been
tested within the past year?
3. Is the telephone system operational?
4. Has the HVAC system been inspected in
accordance with manufacturer specifications and
have the filters been checked quarterly?
5. Are fire suppression (sprinkler) systems
checked at least once a year, or as appropriate
by a qualified individual?
6. Are shut-offs for all utility systems clearly
marked and accessible for all staff in the event of
an emergency?
7. Are systems/mechanisms in place to respond
in the nature of a failure of any utility system?
Program Total:
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Infection
Control &
Monitoring
Issues
Other Key
Safety
Monitoring
Issues
1. Is all staff utilitizing Universal Precautions (i.e.,
using PPE, hand washing, etc.) in the
performance of their job duties?
2. Are cleaning solutions secured, mixed and
utilized appropriately throughout the facility?
3. Are potentially “infectious agents” aggressively
identified and processed in a manner which
would minimize the risk of infection of staff and
other patients?
4. Can staff intelligently describe their role in
infection control within the organization?
Program Total:
1. Are utility rooms locked, clean and free of
debris?
2. Are storage rooms secure, clean, and free of
flammable objects?
3. Are emergency carts present, as appropriate,
fully stocked, and checked per schedule?
4. Are all medications, including samples,
secured and accounted for by lot number?
Program Total:
OVERALL ASSESSMENT TOTAL:
As PATHS’ Safety Officer, I have reviewed the findings of this audit and I am responsible for
seeing to it that any deficiencies are corrected as soon as possible, but at least before the next
inspection.
Safety Officer: __________________________________________
Date: __ / __ / ____
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Appendix E: Structural and Nonstructural Hazard Mitigation Checklist
Facility Location: _____________________________________________________________
Completed by: _________________________________ Date: __ / __ / ____
Structural Mitigation:
Structural Mitigation is reinforcing, bracing, anchoring, bolting, strengthening or replacing any
portion of the building that may become damaged and/or cause injury. For example:
 Exterior walls (e.g., use a wind resistant design for tornados or windstorms);
 Exterior doors (e.g., non-combustible materials for wildfires or urban fires);
 Exterior windows (e.g., use shutters or windows for tornados or windstorms);
 Foundation (e.g., brace, anchor or bolt the facility for earthquakes)
 Exterior columns/pilasters/corbels (e.g., steel or concrete columns)
 Roof (e.g., use non-combustible materials for wildfires or urban fires)
Check to certify that the facility is reasonably expected to withstand the following
disasters:

Earthquakes: Anchor/brace (mobile home) or bolt the facility to its foundation and
reinforce any portion of the exterior of the facility that may cause injury.

Floods and flashfloods: Elevate and reinforce the facility but ultimately avoid a floodplain
location.

Landslide and Mudflow: Build retaining walls on slopes. Build masonry walls to direct
the mudflow around the facility. Bolt the foundation and reinforce the walls of the facility.

Wildfire and Urban Fire: Use fire resistant materials (e.g., non-combustible roofing
materials

Tornado: Follow local building codes to use a wind resistant design for the facility.

Dam Failure: Reinforce and flood-proof the facility.
Nonstructural Hazard Mitigation:
Nonstructural hazard mitigation reduces the threat to safety posed by the efforts of earthquakes
on such nonstructural elements as building contents, internal utility systems, interior glass and
decorative architectural walls and ceilings. These actions involve identifying nonstructural
fixtures and equipment, which are vulnerable to an earthquake and which are either essential to
continued operations or a threat to public safety.
Nonstructural mitigation is:
 Retrofit: Refers to various methods for securing nonstructural items. Retrofitting
methods are bracing, securing, tying down (tethers or leashes), bolting, anchoring, etc.
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


Replace: Replacing the item with a new one that is resistant to the hazard.
Relocate: Moving items from a hazardous location to a non-hazardous one.
Backup Plan: If there is a concern that an essential service will be disrupted, provide for
the backup service.
Nonstructural mitigation includes all contents of the structure that do not contribute to its
structural integrity such as:
 Systems and elements which are essential to operations;
 Emergency power generating equipment, plumbing, HVAC;
 Fire protection systems including sprinklers and distribution lines, emergency water
tanks/reservoirs, etc.;
 Medical equipment (x-ray equipment, refrigeration units used to store pharmaceuticals,
etc.)
 Hazardous materials (chemicals restrained on shelves, containers stored on braced
storage rack or tall racks, gas tanks with flexible connections, gas tank legs anchored to
a concrete footing or slab).
 Non-essential elements whose failure could compromise facility operations, such as:
o Suspended lights and ceilings;
o Partitions;
o Interior doors;
o Furniture and contents (bookshelves, file cabinets, etc.);
Check to certify that the facility is reasonably prepared by having addressed the
following:

Light fixtures and other items that could fall are braced.

The top and bottom of compressed gas cylinders are secured with a safety chain.

Stored containers of hazardous materials are on braced storage racks, and tall stacks
are restrained (metal or wire guardrails, etc.).

All desktop equipment, such as computers, televisions, and printers are secured.

Shatter-resistant protective film or blinds are used on windows to prevent glass from
shattering onto people, or safety glass is installed.

All tall, unsecured furniture items are either anchored to the wall or to each other.

Heavy objects are hung away from workstations.

All large equipment (such as copiers or heavy machinery) is secured to the floor, or
tethered to the wall.

The main breaker or fuse box, and all utility meters, are elevated above the anticipated
flood level of the facility.
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Appendix F: Response Roles and Requirements
Emergency Roles
1. Internal Emergencies:
 Protect patients, visitors and staff
 Protect facilities and vital equipment
2. Mass Casualty Care:
3. Reception and Triage:
During disasters, PATHS’ sites may become
points of convergence for injured, infected,
worried, or dislocated community members.
Depending on the emergency and availability
of other medical resources, sites may not be
able to handle all of the presenting conditions.
Minimum site role will likely be triage,
reporting, stabilization, and holding until
transport can be arranged.
4. Reception of Hospital Overflow:
In disasters, hospitals may be overwhelmed
with ill and injured patients requiring high
levels of care, while at the same time facing
convergence from patients with minor injuries
or the worried well. Sites may be requested to
handle people with minor injuries to relieve the
pressure on the hospital.
Requirements
Generally requires planning, training and
exercise. Also requires internal culture where
safety and preparedness are given high
priorities. Specific requirements include:
 Emergency Plans
 Training/Drills/Exercises
 Emergency/Evacuation Signage
 Business Continuity Plans
 Security
 Internal Communications
 Staff notification and recall
 Emergency procedures distribution
 Sufficient staff to manage patient surge
 Triage capability
 ALS capability
 Holding
 Agreements with receiving hospitals
 Integration of a site into an operational
area medical response system
 Response plan
 Staff recall procedure
 Procedures to obtain outside additional
assistance (volunteers, assistance from
city/county, etc.)
 Crowd management
 Location of shelters
 Reception area
 Triage tags
 Triage training
 Medical supplies
Requirements above for mass casualty care,
and prior agreement that defines:
 Circumstances for implementation
 Types of patients that will be accepted
 Resource/staff support provided by the
hospital
 Patient information/medical records
 Liability releases
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5. Maintaining Ongoing & Routine Patient
Care (Normal levels and extended surge):
The community’s need for routine medical
care may continue following a disaster.
6. Mental Health Services:
Sites can expect the convergence of the
“worried well” following a disaster.
7. Bioterrorism Agent Initial Identification
and Rapid Reporting:
Sites may be the “early warning system” for a
bioterrorism outbreak. Providers should look
for unusual symptoms or other signs of use of
BT agents. Rapid reporting is critical.
Unusual events may include a single case, or
multiple cases with the same symptoms.
8. Staff Protection:
Provide protection to staff in event or presence
of Bioterrorism agent.
9. Mass Prophylaxis:
Sites may be requested to participate in mass
prophylaxis managed by the local health
department. Provider participation should
include requesting site staff to support mass
inoculations at other sites.
10. Hazardous Material Response:
Sites near major transportation routes, distant
from hospitals, or with emergency medical
capabilities, may be called upon to treat
injured patients who have been contaminated
by a hazardous material. Generally, in urban
areas, sites will not be required to be
hazardous material responders.
Sites should prepare to maintain their service
capacity through protection of equipment,
critical supplies, critical medications, and
personnel. Requirements include:
 Continuity of Operations Plan
 Procedures to augment resources in
areas subject to frequent power
outages, consider adding generators to
ensure operational capacity.
 Disaster mental health training for
clinicians/licensed mental health staff
 Internal or external mental health team
 External source of trained personnel to
augment response.
 Infectious disease monitoring
procedures and protocols.
 Zebra-Pack: If an infection is
suspected, the “Zebra-Pack” provides
information on precautions and initial
treatment.
 Procedures for reporting to county
health department.
 Evidence kits
 Training
 Adherence to standard precautions
 Level C PPE
 Training
 Infectious disease procedures
 Reporting procedures
 Availability of staff who can volunteer
 Procedures for determining when the
clinic staff can volunteer




Protective equipment
Decontamination
procedures/Capability/Equipment
Reporting procedures
Waste holding container
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11. Risk Communications:
Sites are often important conduits of health
information for the communities they serve.
Patients, staff and community members may
look to the site for answers to their questions
about a bioterrorist attack or other emergency.
12. Provide Volunteer Staff:
Sites may be requested to provide staff to
deliver medical services at shelters, for mass
prophylaxis, or at other response sites.





13. Receive Volunteer Staff (Providers,
teams, etc.):
14. Community Preparedness:
15. Sheltering:











Communications link with Operational
Area
Procedures for communication with
patients, staff and community (in
languages spoken in the community).
Back-up staff
Policy for receiving requests, polling
staff, and releasing staff for non-clinic
duties.
Policy on release of staff for volunteer
duty.
Reception procedures
Credentialing/Background checks
Logistic support
Educational materials
Educators/volunteers
Ability to organize/sponsor
“Neighborhood Emergency Response
Teams”
Holding area
Protection from the weather
Bedding
Medical Supplies
Pharmaceuticals for common
conditions (insulin, etc.)
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Appendix G: Emergency Response Team / PATHS Day-To-Day Organizational Chart
2015-2016 Organizational Chart
The day-to-day organizational chart provides a starting point for selection of staff to fill Emergency Response Team
(ERT) positions and to identify potential ERT backups and replacements
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Appendix H: Emergency Response Team / Position Assignments
Name
Day-to-Day Role
ERT Location
ERT Role
Page 79 of 132
Appendix I: Emergency Response Team Organization Chart
Incident Manager
Management Staff
Operations Section
Chief
Safety Officer
Planning Section
Chief
Medical Care
Director
Logistics Section
Chief
Finance Section
Chief
Situation/Status
Leader
Facility Leader
Team Leader
Patient Tracking
Leader
Communications
Leader
Procurement
Leader
Claims-Cost Leader
PIO
Triage Leader
Security Officer
Treatment Leader
Transportation
Leader
Liaisons
Mental Health
Coordinator
Materials Supply
Leader
Lab/Pharmacy
Leader
Dependent Care
Leader
Search and Rescue
Leader
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Appendix J: Training and Exercises
I.
Purpose: The purpose of this guide is to define a successful method for PATHS to
meet its emergency training needs. There are many reasons PATHS has chosen to provide
training for emergency staff. The training provided for members of the ERT has three primary
purposes, which are to:
II.
III.
A.
Know their role and responsibilities;
B.
Possess the skills and knowledge needed to perform respective functional
responsibilities; and
C.
Understand the disaster management processes to achieve effective
coordination and communications.
Desired Outcomes: There are three major outcomes PATHS expects from this
training. These are to ensure that:
A.
The emergency organization performs effectively in protecting health and safety,
property, and the environment;
B.
PATHS’ staff is prepared to work effectively with other emergency response and
recovery organizations, by appropriate and timely use of resources, and by
recovery of damages and operating costs, to the extent possible; and
C.
The emergency organization members can work in a safe manner to prevent
injury to themselves and others.
Curriculum Defined:
A.
B.
A curriculum defines the approaches to training and delivery methodologies,
which may include:
1.
Reading assignments,
2.
Briefings,
3.
Classroom instruction (with or without examinations),
4.
Videotape,
5.
Online instruction,
6.
Demonstration,
7.
Drill/Exercise
A curriculum also defines the types of training materials that will be used, which
may include:
Page 81 of 132
C.
IV.
V.
1.
Written materials (e.g., manuals, checklists, guides, graphics)
2.
Audio materials (e.g., compact discs)
3.
Audio/Visual materials (e.g., slide shows, movies)
A curriculum defines content and purpose for each training approach and the
materials. The contents are defined with specific:
1.
Goals
2.
Objectives (including knowledge and skill to be achieved)
3.
Materials needed (printed, A/V, testing devices, etc.)
4.
Location Requirements
5.
Prerequisites for the Participants
6.
List of Assigned Positions
7.
References (source of the curriculum content)
Legal Requirements
A.
Hazardous Materials Training: PATHS must decide what level of training is
appropriate for hazardous materials and bioterrorism events, including use of
personnel protective equipment. PATHS should identify the types of actions
expected of staff at a scene (especially in bio-hazard and chemical treatment
situations). Training decisions should be based on whether staff will be in the
vicinity of materials that are causing the event. References exist in OSHA 29
CFR 1910.120(q)
B.
General Safety Training: All PATHS’ staff members are required to have
general safety training and training in appropriate actions to take in an
emergency. Safety Team members are required to have additional training in
safe work practices, building evacuation, first-aid, fire safety, and CPR. PATHS
training personnel should work with the Safety Officer to integrate safety training
with disaster response training.
Curriculum Development Process
A.
Identification of the Organization: PATHS must first identify an Emergency
Response Team (ERT) roster. “Appendix G” provides the day-to-day
organization chart from which the Chief Executive Officer will identify staff to fill
the emergency management positions.
B.
Identification of Skill and Knowledge Needs by Position: The Chief
Executive Officer can use tools such as “Appendix H” and “Appendix I” to match
the staff to the positions based on their daily assignments, current skills, and
knowledge. This will help identify gaps that need to be addressed through
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training.
C.
Identification of Delivery Methodologies:
1.
The curriculum delivery methodologies must then be developed to match
the skill and knowledge needs that have been identified. The
methodologies may include:
a)
b)
Reading assignments: Reading assignments are appropriate
when the material is general in nature, timely, and requires
immediate attention (rather than waiting for the next training
cycle). A reading assignment should be accompanied with a
“read and sign” sheet to be returned to the Safety Officer. This
will be scanned into the employees file. These assignments can
include:
(1)
Revised sections of the Plan and SOPs that are relevant to
the readers
(2)
New laws or regulations that can immediately affect
emergency performance
(3)
Changes in emergency organization structure or
components
(4)
Changes in the EOC operations
(5)
Changes in assignment of key positions
(6)
Changes to the annual training assignments
Briefings in person in the office or at field locations: Briefings are
time intensive. They often involve fewer individuals than would be
featured in classroom presentations. Sometimes a briefing is for a
specific individual. There must be compelling reasons to hold
briefings. These can include:
(1)
Changes that require immediate awareness and change of
behavior
(2)
Warnings regarding impending threats to safety, health,
the environment, or property
(3)
Updates on current issues that can impact staff morale
(4)
Directives from the Operational Area or Chief Executive
Officer that require immediate attention
(5)
Updates on information that a member of the emergency
organization was not able to acquire because of a missed
training opportunity—this fulfills a legal requirement to
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keep everyone in the organization properly trained in
accordance with his/her assigned training curriculum
c)
Classroom instruction (with or without examinations): Classroom
instruction provides a formal environment for training and learning.
Most classroom training should be held at either the primary or
alternate EOC, when possible. For larger classes, or when the
emergency facilities are not available, the organization should
house classroom training. The Safety Officer should present most
training.
Some classroom instruction can be provided by specialized
training organizations. Some of these organizations can come
directly to PATHS’ sites. Other training organizations may require
staff to travel to another site. Training can be provided through
such diverse organizations as:
d)
(1)
Regional Healthcare Association
(2)
County / regional EMS Agencies and Offices of Emergency
Services
(3)
Hospitals
(4)
The Federal Emergency Management Agency (FEMA),
Emmetsburg, Maryland
(5)
The American Red Cross (ARC) (through numerous local
chapters)
(6)
Colleges and universities specializing in emergency
management courses
Videos:
(1)
(2)
Video-based training should include:
(a)
Overview of ICS
(b)
EOC facility layout and operations
(c)
Public Information
(d)
Other specific interests as noted by staff (specific
hazards, command and control, field operations,
mass care and shelter)
Videos should not be used to replace formal training
requirements such as classroom training, drills and
exercises.
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e)
Web-based presentations: PATHS can post emergency
management, self-guided training on its website for its own
emergency organization. This can include short video
presentations and PowerPoint slide shows. Other formal,
accredited courses can be taken online through FEMA’s website.
This training does not replace the required, formal PATHS
classroom, drill, or exercise activities.
f)
Demonstrations: Demonstrations develop skills for a limited
function. This helps staff perform properly in drills, exercises and
actual events. Typical demonstrations for PATHS might include:
g)
(1)
Communications use and protocols
(2)
Use of computers in the EOC, including e-mail and other
software
(3)
Use of fax machines and copiers (including electronic
faxing and scanning of documents)
(4)
Set up of the EOC or set up of a triage or isolation area
(5)
Tours of facilities (PATHS and others), hazards sites, and
equipment storage sites
Drills (unevaluated activities for developing skills):
(1)
The response phase of the emergency management plan
is tested twice a year, either in response to an actual
emergency or in planned drills. Drills are conducted at
least four months apart and no more than eight months
apart.
(2)
Testing includes participation in at least one communitywide practice drill yearly (where applicable) relevant to the
priority emergencies identified by the organization's hazard
vulnerability analysis, that assesses communication,
coordination, and the effectiveness of the organization's
and community's command structures.
(3)
PATHS follows FEMA’s definition of “drill” as a drill has the
following elements:
(a)
Single emergency response function
(b)
Single agency involvement
(c)
Often a field response component
(d)
Field evaluators and messaging is critical
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(e)
(4)
h)
Limit focus to ensure program is thoroughly
evaluated and improves
PATHS does not grade for achievement. Drills are lowstress activities for demonstrating skills after formal training
and/or demonstrations. Participants usually focus on a
single activity of recovery or response to limit the time
involved while increasing the value of the activity. PATHS
drills might include:
(a)
Plan and Procedures
(b)
Emergency Call Outs
(c)
Evacuation (fire/flood/bomb threat)
(d)
Emergency Operations
(e)
Emergency Techniques
(f)
Communications
(g)
Bomb Threat
(h)
Use of Forms
(i)
EOC Activation
(j)
Safety Operations
Exercises (evaluated activities for testing skills):
(1)
Exercises are evaluated activities that usually require
some element of realism and varying levels of stress. The
definitions of the types, as defined by FEMA, is:
(a)
Orientation Exercise: having the following elements
(often called a Walk-Through):
(i)
Informal
(ii)
No simulation
(iii)
Discussion of roles and responsibilities
(iv)
Review past cases and lessons learned
(v)
Introduction of policies, procedures, plans
and responsibilities
Page 86 of 132
(b)
(c)
(d)
(2)
Tabletop Exercises have the following elements:
(i)
Information discussion of simulated
emergency
(ii)
Messages to players, but no time pressures
(iii)
Low stress
(iv)
Initial evaluation of plans and procedures
(v)
Raise questions of coordination and
responsibility
Functional Exercises have the following elements:
(i)
Emergency simulation, timeline with
messages allowing player communications
(ii)
Policy and coordination tested...personnel
practice emergency response
(iii)
Stressful, realistic simulation
(iv)
Takes place in real time
(v)
Emphasizes emergency functions
(vi)
EOC is activated
a Full-Scale Exercise has the following elements:
(i)
Takes place in real time
(ii)
Employs real people and equipment
(iii)
Tests several emergency functions and
mixes field elements with response facilities
(iv)
Activate EOC
(v)
Produces high stress
Some form of exercise should be held at least every two
years, and more often as time and budgets allow. An offhours exercise should be performed every four years. A
weekend exercise should be performed every five years.
Some exercises (full-scale) can be very expensive and
require substantial staff time and resources for planning
and performance. All exercises should be followed by a
debriefing, or “hot wash,” with the participants. This should
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then be followed with a formal report.
2.
Combined, these elements can meet the required training needs. In
addition, there can be credit for training by performance during the
coming training cycle for all who performed in real emergency operations,
whether at PATHS or as assigned to other organizations and facilities as
a PATHS employee.
3.
Exercise Scenarios: The following scenarios may prove useful in
developing drills and exercises. These scenarios should be viewed as
starting points that can be adapted to reflect local conditions (for realism)
as well as local hazards and priorities.
a)
Major apartment fire occurs in the neighborhood: Fire trucks
arrive just as 200 people flee the apartment. The clinic is the
closest provider of health care in the neighborhood. Within 10
minutes 5 people enter the lobby of the clinic complaining of
smoke inhalation. They demand care. Within another 5 minutes
another 5 people arrive also requesting care. It is clear that
calling 911 and requesting EMS support will not be a sufficient
response. The Site Manager contacts a site Provider and decides
to begin to triage patients. The Site Manager contacts the Lt. in
charge of the first response and informs him that the site is
beginning triage efforts. What patients can the site provide care
for, what stabilization activities will the site begin and who gets
transported to the hospitals first?
b)
School Bus crash: Right in front of the site a school bus is rear
ended. Thirty children are on the bus. EMS arrives, but decides
that because of the weather all of the children should be brought
into the site. The EMT requests that a Provider evaluate the
patients since transport to the hospital will take up to 45 minutes.
What patients can the site provide care for, what stabilization
activities will the site begin and who gets transported to the
hospitals first?
c)
Bio-event: Beginning at 8:00 am today the phone is ringing off the
hook with worried parents calling because their kids are sick with
flu-like symptom, 104 degree temperatures and nausea. By
8:30AM, 20 children have been brought to the site with the same
symptoms. Mothers are unwilling to leave until their kids are
seen. It is clear that over the next several hours the number of
patients will continue to grow. How does the site determine which
patients are in need of immediate care, what they have been
exposed to what, and how does the site reorganize to evaluate
this tidal wave?
d)
Flood in the city: It has been raining for several days. The river
on the other side of town has begun to overflow its banks. A
number of elderly who live near the river have begun to come and
sit quietly in the site lobby. Right now there are about 30 people in
Page 88 of 132
the lobby. All of a sudden one slumps to the floor. Two others
begin to scream for help. 911 is called, but because of the
community emergency, the 911 operator informs the site that they
request the site Providers to handle the emergency.
e)
D.
Earthquake: At 10:10AM, a 6.5 earthquake rumbles through the
city. Roads are cut and commercial utilities are severed. Within
minutes, members of the community begin to arrive at the site with
both minor and major injuries. It is clear that the site will become
a place of care for the community members near the site.
Identification of Curriculum Content: Each of the core curricula (classroom
training, drills, exercises) will be consistent in their format for their type. The
classroom training materials should include both an instructor and a participant
manual for each course. The manuals need not be elaborate, but must be based
on a formal one-sheet lesson plan that includes the following contents:
1.
Topic
2.
Length of class
3.
Participant Prerequisites (if any)
4.
Emergency Organization Positions Required to Attend
5.
Location (if fixed)
6.
Instructor(s) name(s)
7.
Materials for presentation
8.
References
9.
Goal of Course
10.
Performance Objectives
E.
Assignment of Training Elements for Each Position: The formal training
should cover the topics in accordance with PATHS’ Emergency Plan SOPs and
ICS. These topics may change as new threats develop, as they did for nuclear
power plants, hazardous material spills, and terrorism.
F.
Development of a Training Delivery Schedule: PATHS’ Safety Officer will
develop a regular training schedule for the emergency management program.
With this completed, the organization will now know its needs, how to address
them, and how often to provide training to meet the skill and knowledge needs.
G.
Cost Analysis (Time and Budget): PATHS’ Director of Finance will develop a
formal method of planning for training costs each year. There may be changes
in the number of staff, the types of training, and the amounts of training each
year. The length of each course may also change as laws, regulations and
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lessons change. Most classroom subjects can be presented individually in one
hour or less, with the exception of specialized training such as ICS, CPR and
First Aid. Most drills will last two to three hours. Exercises last from a half-day to
a full day, depending on the type of exercise. Remember to consider staff time
for preparation and implementation of these activities. Also consider outsourcing
costs to outside training organizations and consultants.
H.
Evaluation of Training Effectiveness: Formal training requires evaluation.
PATHS’ Safety Officer will provide minimum evaluation instruments for each
formal classroom experience to ensure the objectives of the course have been
achieved. This also helps the instructors to revise course materials or training
modalities to ensure the effective use of staff time and costs. The same is true
for exercises, which by definition should always have some form of evaluation as
a formal record of the activity. Additional measurement devices are used after
exercises in the form of critiques, After Action Reports, and Corrective Action
Reports. External audits can also be used as a tool to evaluate the total training
curriculum effort.
I.
Maintaining Training Records: In all cases, a record must be kept of any
training methodology that was performed, including who received the information
and the results of any evaluation. Records of required training elements must be
kept with the individual’s personnel record.
J.
Program Maintenance and Schedule: Training programs are part of the 5-year
maintenance schedule for this emergency management program. The schedule
is as follows:
1. Redesign Emergency Plan
2. Redesign Primary EOC
3. Redesign Alternate EOC
4. Redesign Communications Systems
5. Redesign Budget Process
6. Perform Off-Hours Exercise
7. Perform Weekend Exercise
8. Develop New MOUs/Letters of Agreement
9. Audit Emergency Programs
10. Revise 5-year Plan
11. Revise Annual Plan
1
X
X
X
X
X
2
YEAR
3 4
X
X
5
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
X
Page 90 of 132
Appendix K: Disaster Contact List
Danville/Pittsylvania County
Contact
Police: Danville
Police: Pittsylvania County
Local Emergency Manager:
Danville
Local Emergency Manager:
Pittsylvania County
Health Department: Emergency
Coordinator
Health Department:
Epidemiologist
Danville Regional Medical
Center
Steve Dishman
Telephone
434-799-6510 (non-emergency)
434-432-7800
434-799-6535
James Davis
434-432-7920
Eric Clark
434-766-9822
434-770-9166 (cell)
434-766-9828
Email
Website
[email protected]
434-799-2100
Martinsville/Henry County
Contact
Police
Local Emergency Manager:
Henry County
Health Department:
Emergency Coordinator
Health Department:
Epidemiologist
Memorial Hospital of
Martinsville
Telephone
276-638-8751 (non-emergency)
276-634-4663
Email
276-638-2311 x145
276-732-1800 (cell)
276-638-2311 x129
276-732-8833 (cell)
276-666-7200
[email protected]
Email
Dave Martin
Telephone
704-336-7600 (non-emergency)
434-738-6815 x110
Agathe Hoffer-Schaefer
434-579-1674
Matthew Tatum, Public
Safety Dir.
Christopher Garrett
Sharon Ortiz-Garcia
Website
[email protected]
Mecklenburg County
Contact
Police
Health Department:
Emergency Coordinator
Health Department:
Epidemiologist
Community Memorial Hospital
Website
434-447-3151
Page 91 of 132
Appendix L: Health Care Alternate and Referral Facility Locations
PATHS Community Medical Center – Boydton
380 Washington St., Boydton, VA 27308
434-738-6420
PATHS Community Medical Center – Chatham
4 South Main Street, Chatham, VA 24531
434-432-4443
PATHS Community Medical Center – Danville
705 Main Street, Danville, VA 24541
434-791-4122
PATHS Community Medical Center – Martinsville
287 Commonwealth Blvd, Martinsville, VA 24112
276-632-2966
____________________________________________________________________________
DANVILLE/PITTSYLVANIA COUNTY:
 Danville Regional Medical Center
142 South Main Street, Danville, VA 24541
434-799-2100
MARTINSVILLE/HENRY COUNTY:
 Memorial Hospital of Martinsville
320 Hospital Drive, Martinsville, VA 24112
276-666-7200
MECKLENBURG COUNTY:
 Community Memorial Hospital
125 Buena Vista Circle, South Hill, VA 23970
434-447-3151
Page 92 of 132
Appendix M(a): Emergency Procedures
FIRE RELATED EMERGENCY
Page 93 of 132
Appendix M(a): Emergency Procedures
Page 94 of 132
Appendix M(b): Emergency Procedures
MEDICAL RELATED EMERGENCIES
DANGER:
Ensure that the area is safe for you,
others, and the patient.
Check for Response:
Ask name; Squeeze Shoulders.
Response “YES”:
Make comfortable and monitor response.
Response “NO”
SEND FOR HELP:
Dial 9-1-1 and state “AMBULANCE”
AIRWAY:
Check airway is clear by opening the
mouth; remove any foreign material,
clean
airway with fingers.
place in recovery position,
CHECK FOR BREATHING:
Look, listen, feel
Normal Breathing “YES”:
Place in recovery position; Monitor
Breathing
Appendix M(c): Emergency Procedures
Normal Breathing “NO”:
Start CPR
CPR:
30 Chest Compressions / 2 Breaths
BOMB THREAT
DEFIBRILLATION:
Apply defibrillator if available and follow
voice prompts
If you receive a bomb threat, do not use a mobile phone or set off the fire alarm – they may
Page 95 of 132
trigger an explosion.
Remain Calm:



Treat the call as genuine.
Attempt to prolong the conversation and DO NOT hang up.
Try to attract the attention of a second person to call 9-1-1.
Be attentive:



Note distinguishing background noises, music, traffic, etc.
Note voice characteristics.
Does caller indicate knowledge of the building?
Record:

Enter the details immediately on the “Bomb Threat Checklist” form on the next page.
Notify:


Dial 9-1-1 and state “BOMB THREAT”
Notify your Site Manager
Prepare:



To assist in the search, if requested.
To evacuate, if necessary.
To follow instructions of security, police and other emergency service personnel.
If Object Found:

DO NOT TOUCH IT! Report that you have found it. Open doors and windows where possible and evacuate the area, to reduce the
impact of an explosion.
Page 96 of 132
BOMB THREAT CHECKLIST
Remember to keep calm and do not hang up from the call.
Exact wording of the threat: _______________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Questions to ask:
1.
When is the bomb going to explode? ___________________________________
2.
Where did you put the bomb? ________________________________________
3.
When did you put it there? ___________________________________________
4.
What kind of bomb is it? _____________________________________________
5.
What will make the bomb explode? ____________________________________
6.
Why did you place the bomb? ________________________________________
7.
What is your name? ________________________________________________
Callers Voice:
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Accent:
Asian American English European Middle Eastern
Speech:
Fast
Slow
Voice:
Loud
Soft
Gender:
Male
Female
Impediment: Lisp
Stutter
Manner:
Calm
Emotional
Diction:
Clear
Muffled
Do you recognize the voice?
Yes
No
Other: ___________________________________________________________
Was the caller familiar with the building/area? Yes
No
Page 97 of 132
Threat Language:
11.
Well spoken:
Yes
No
12.
Incoherent:
Yes
No
13.
Taped:
Yes
No
14.
Abusive:
Yes
No
15.
Message read by caller:
Yes
No
16.
Other: ___________________________________________________________
Background Noises:
Voices

Music
Street Noises
Aircraft
House Noises
Machinery
Other: ____________________________________________________
Recipient of Phone Call:
Name:________________________________________________________________
Title: _____________________________ Date: ___ / ___ / ____ Time: __:__ (AM/PM)
Work Phone: (____) ____ - _____
Home Phone (____) ____ - _____
Signature: _____________________________________________________________
Page 98 of 132
Appendix M(d): Emergency Procedures
If you receive a Suspect Package:
STOP WHAT YOU ARE DOING AND PUT THE ITEM DOWN!
1.
Do not smell, touch, taste, shake or empty contents of the item or substance.
2.
Turn off any equipment that could disturb air flow (i.e., fans or air conditioning).
3.
Where there is a likelihood of contamination, remain in the area, but step away (approximately 2
meters) from the item or substance. Instruct other people in the vicinity to do the same.
4.
Dial 9-1-1, and state “SUSPECT PACKAGE”. Provide your name, location and as much detail
about the item as you can. DO not use a mobile phone in close proximity.
5.
If anyone is exposed to the substance, isolate the person and call for medical assistance.
6.
If possible, ask a co-worker who was not in the immediate area to notify the manager or person in
charge immediately who will arrange a temporary isolation of the area.
7.
Do not allow co-workers into the isolation area.
8.
Follow any further instructions from your manager, or other person in charge, until emergency
personnel arrive.
Page 99 of 132
Appendix M(e): Emergency Procedures
POWER OUTTAGES
Remain calm: Provide assistance to others if necessary.
During a power outage:
1.
Report the outage to Tara Riddle or Carmen Gee at 434-791-3630. Please note: During a power
outage, digital phone systems may not work. Please use a mobile phone instead.
2.
If evacuation is necessary, move cautiously. Lighted signs will indicate emergency exits.
3.
Remain with any immobile individuals who become stranded as a result of the outage. If
emergency assistance is required, dial 9-1-1.
4.
Keep all refrigerators and freezers closed during an outage and ensure staff is available to
monitor.
5.
Outage times are difficult to predict depending on the cause. This may take some time to identify.
Await further instructions from PATHS’ Administration.
Page 100 of 132
Appendix M(f): Emergency Procedures
GAS LEAK OR CHEMICAL SPILL
If it is a gas leak or chemical spill, DO NOT activate building alarms, use mobile phones,
hand-held radios, electronic equipment or light flammable material.
If a gas leak or chemical spill is affecting people in your area, immediately:
1.
REMOVE anyone in immediate danger only if it is safe to do so.

DO NOT allow other people in the area.

If anyone is exposed to a substance, set up an isolation area.

If available and only if it is safe to do so, put on personal protective equipment (PPE), observe, and support
the person until emergency responders arrive.

DO NOT put yourself at risk.
2.
ISOLATE the hazardous material by clearing the area, close the doors. If safe to do so, turn off isolation switches,
ventilation and machinery. DO NOT touch suspect materials.
3.
NOTIFY people in the area by shouting a warning. Pass the alarm by word of mouth.
4.
CONTAIN:

Do not risk contact with material or allow it to spread.

Do not smell, touch or taste it.

Close doors between you and the hazardous material.
Page 101 of 132
Appendix M(g): Emergency Procedures
ENVIRONMENTAL EMERGENCIES
An environmental emergency includes any accident, or potential for an incident of
uncontrolled discharge of a substance into water, air or land that harms or threatens to
harm the environment.
1.
REMAIN CALM. Don’t panic.
2.
REPORT:

Alert others in the area.

Report to your site manager

Report to PATHS’ Safety Officer.
3.
CONTAIN the emissions if safe and possible to do so (e.g., stopping valves, using temporary bunds or spill kits)
4.
EVACUATE:

Keep the area clear of people not directly responding to the emergency.

Prepare to evacuate, if required.
5.
CLEAN UP and rectify any damage when safe to do so. Expert assistance may be required.
6.
RECORD the incident on PATHS’ Incident Report Form available at http://splash.pathsinc.org.
Page 102 of 132
Appendix M(h): Emergency Procedures
PERSONAL THREAT
Threats to self or others may include harassment, assault, suicide, robbery or armed hold-ups.
1.
REMAIN CALM:


2.
Do not make sudden movements
DO NOT TAKE RISKS:




3.
Don’t panic or shout, avoid eye contact.
Hand over whatever is requested.
Do not do anything that may antagonize the offender.
Alert others around you if safe to do so.
Contain yourself in a secure area, by locking your office door, closing blinds and staying out of sight.
DO ONLY WHAT YOU ARE TOLD. Do not volunteer any other information.
4.
BE OBERSERVANT. Pay attention to the offender’s sex, height, voice, clothing, tattoos, jewelry, items touched, etc. Also note the type
of vehicle used for escape, license plate number if possible and last known direction.
5.
TELEPHONE:




Dial 9-1-1 and state “PERSONAL THREAT”
Stay on the line, and keep the line of communication open.
Give your name and site address.
Most importantly – REMAIN CALM.
6.
RECORD: Immediately complete a Personal Threat Report (next page) with the offender’s description, what they may have taken
(models and serial numbers), descriptions of any items they may have or any other relevant details.
7.
REPORT any aggressive, physical or verbal abuse, armed hold up/robberies and or suspicious activities to your Site Manager
immediately.
Page 103 of 132
PERSONAL THREAT REPORT
To be completed immediately after an incident. Try to be as descriptive as
possible. Use a separate form for each offending person’s description.
Threat details: __________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
OFFENDER’S DETAILS/DESCRIPTION
Any names or nicknames used: ____________________________________________
Male
Approximate age: ___________
Height: ______________
Female
Weight: __________
Complexion:
Fair
Fresh
Pale
Normal
Ruddy
Suntanned
Pimply
Dark
Hair:
Straight
Curly
Bald
Long
Thick
Short
Crew cut
Wavy
Facial:
Moustache
Glasses:
Yes
No
Build:
Thin
Medium
Stout
Small
Overweight
Obese
Posture:
Erect
Stooped
Slouchy
Walk:
Quick
Springy
Slow
Limp
Pigeon Toed
Hands:
Callused
Soft
Deformed fingers
Hairy
Nails missing
Voice:
Thick
Lisp
Accent
Stutter
Clear
Loud
Eyes:
Squinty
Intense Stare
Beard
Soft
(Use back of form for other comments.)
Page 104 of 132
Appendix M(i): Emergency Procedures
NATURAL DISASTERS
Remain calm, remove anyone from immediate danger if safe to do so.
1.
FLOODING:

If the building is in danger of being flooded, evacuate all staff, students, patients and visitors to a safe area unaffected by flooding.
Otherwise, do not evacuate unless instructed to do so.



2.
Switch off any electrical equipment and gas that could be affected by water, only if safe to do so.
Move any chemicals, documents, equipment and valuables to a safe area if time permits.
STORMS:






3.
Call PATHS’ Safety Officer.
Move all people away from windows.
Close all curtains, drapes and blinds.
Shelter in strongest part of the building (e.g., central corridors).
Stay clear of large areas with glass atriums.
Stay inside.
Report any storm damage to PATHS’ Safety Officer.
EARTHQUAKE:



If inside:
o
Stay inside.
o
Do not use elevators or stairs.
o
Take shelter in doorways, under desks, or down beside an internal wall.
o
Stay clear of large areas with glass atriums.
o
Keep away from windows or objects that could fall on you.
If outside:
o
Stay outside.
o
Take shelter clear of buildings, trees, power lines and other potential hazards.
When the earthquake stops:
o
Check for signs of fire, hazardous material spill or major structural damage.
o
Account for all staff, students, patients and visitors. Treat any minor injuries.
o
Do not evacuate unless area is immediately threatened or instructed to do so.
Page 105 of 132
Appendix N(a): Emergency Floor Plans
Danville Facility Floor Plan – Ground Floor/Basement
Page 106 of 132
Appendix N(b): Emergency Floor Plans
Danville Facility Floor Plan – First Floor
Page 107 of 132
Appendix N(c): Emergency Floor Plans
Danville Facility Floor Plan – Second Floor
Page 108 of 132
Appendix N(d): Emergency Floor Plans
Martinsville Facility Floor Plan
Page 109 of 132
Appendix N(e): Emergency Floor Plans
Chatham Facility Floor Plan
Page 110 of 132
Appendix N(f): Emergency Floor Plans
Boydton Facility Floor Plan – Ground Floor/Basement
Page 111 of 132
Appendix N(g): Emergency Floor Plans
Boydton Facility Floor Plan – First Floor
Page 112 of 132
Appendix O: Job Action Sheets
Job Action Sheets are tools for defining and performing specific emergency response functional
roles. The Job Action Sheets contained within this appendix are designed to assist PATHS’
staff during all hazards. They can easily be amended to fit the specific requirements of the
situation at hand.
The key elements are as follows:
1.
Position Title: The name of the Incident Command System (ICS) functional role. Note
that this generally is not the same as every day, non-emergency job titles.
2.
Supervisor: The official who maintains direct authority over the worker.
3.
Mission: The purpose of the role and a brief guiding principle for the responder to keep
in mind.
4.
Location: The place of operations.
5.
Immediate Actions: Tasks that must be completed first upon assuming the role or
coming on duty.
6.
Intermediate Actions: Tasks to be completed after the immediate tasks are addressed.
7.
Extended Actions: Tasks completed later or on an ongoing basis.
The following Job Action Sheets contain recommended actions that are reminders of activities
to take into consideration when fulfilling the assigned role.
Page 113 of 132
Appendix O(a): Job Action Sheets
INCIDENT MANAGER (IM)
Supervisor:
Chief Executive Officer (CEO)
Mission:
To organize and manage Command and General Staff; Coordinate and
report on organizational components; responsible for performing
emergency response operations.
Location:
PATHS’ Facility
Immediate Actions:









Read this entire Job Action Sheet.
Identify all Command Staff and Section Chiefs who are required for this response.
Construct an agency Incident Command System (ICS) Organizational Chart.
Develop and provide an initial incident briefing to all personnel staffing the ICS.
Distribute section packets to each position, which contain: Job Action Sheets and any
other relevant guides, forms, or templates. Refer all assigned personnel to the EON IMS
for additional material.
Provide direction in regards to activating the Incident Action Plan (IAP). Notify all
relevant internal and external personnel of activation level and reporting requirements.
Confer with Command Staff and Section Chiefs to develop an IAP for a defined period of
time, establishing priorities (Section Chiefs will communicate completed plan to
responsible emergency personnel).
Consider and assign responsibilities for communicating with agency organization
components and external agencies, as appropriate.
Assure that contact has been established and resource information shared with relevant
parties.
Intermediate Actions:



Schedule routine briefings with Section Chiefs and update the plan regarding the
continuance and/or termination of organizational emergency operations.
Participate in regularly scheduled situation/status briefings and teleconferences.
Maintain contact with all relevant agencies.
Extended Actions:



Observe all staff for status and signs of stress and provide regular rest periods.
At shift change, provide a briefing on past and ongoing organizational emergency
response activities to incoming staff. Provide additional detailed information to your
replacement, as required.
Plan for the possibility of extended operations.
Page 114 of 132
Appendix O(b): Job Action Sheets
PUBLIC INFORMATION OFFICER (PIO)
Supervisor:
Incident Manager (IM)
Mission:
To serve as a conduit of information between, and maintain regular
communications between all levels of the Emergency Management
Team. Provides information on any/all associated activities, concerns,
and requests related to incident information.
Location:
PATHS’ Facility
Immediate Actions:




Upon notification, report to Emergency Operations Center (EOC). Notify appropriate
staff of activation status and close out performance of all day-to-day activities.
Read this entire Job Action Sheet and review the Incident Command System (ICS)
organizational chart.
Obtain briefing from the Incident Manager (IM). Report this information to appropriate
communications staff.
Assist the Planning Section Chief with formulation of an Incident Action Plan (IAP).
Intermediate Actions:





Report on organizational and field public affairs and communications activities,
concerns, and scheduled press conferences.
Evaluation organizational strategy in support of the IAP and overall response efforts.
Assist in drafting press reports and media releases. Ensure that the IM and Section
Chiefs, as appropriate, review and approve all public information releases.
Assist in developing and posting public and industry messaging and guidance to the
organization’s web site.
Participate in regularly scheduled status briefings and teleconferences. Provide spot
reports to appropriate staff as necessary.
Extended Actions:


At shift change, provide a briefing on past and ongoing external affairs activities to
incoming staff. Provide additional detailed information to your replacement, as required.
Plan for the possibility of extended operations.
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Appendix O(c): Job Action Sheets
Operations Section Chief
Supervisor:
Incident Manager (IM)
Mission:
Coordinate and report on all activities from administration and the field.
Establish an organizational wide operating picture.
Location:
Emergency Operations Center (EOC)
Immediate Actions:





Upon notification, report to the EOC. Obtain packet containing Operations Section Job
Action Sheets.
Read this entire Job Action Sheet and review the Incident Command System (ICS)
organizational chart.
Obtain briefing from IM.
Notify staff of activation, as appropriate. Appoint Division/Group Supervisors and
distribute Job Action Sheets.
Assist the Planning Section Chief with the development of an Incident Action Plan (IAP).
Intermediate Actions:
 Routinely brief the IM and Planning Section Chief on the status of administration’s field
response operations.
 Participate in regularly scheduled situation/status briefings and teleconferences.
Extended Actions:
 At shift change, provide a briefing on past and ongoing agency and Operations Section
activities to your replacement, as required.
 Plan for the possibility of extended operations.
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Appendix O(d): Job Action Sheets
Division/Group Supervisor
Supervisor:
Operations Section Chief
Mission:
Organize and direct the activities of personnel assigned to a designated
division or functional group.
Location:
Emergency Operations Center (EOC) or normal work location
Immediate Actions:




Read this entire Job Action Sheet.
Review the Incident Action Plan (IAP). Provide information on the incident and
objectives to supporting staff, as appropriate.
Establish and maintain communications with other agencies, as appropriate.
If operating from your normal work location, provide contact information to the
Operations Section Chief.
Intermediate Actions:
 Issue mission assignments to, and monitor, the activities of Division/Group staff.
Maintain a log of all objectives and the staff assigned to associated tasks.
 Ascertain information on resources needed by Division/Group staff and arrange for
appropriate support.
 Monitor the progress and status of responding Division/Group staff and immediately
report any changes or issues that cannot be resolved to the Operations Section Chief.
 Participate in regularly scheduled situation/status briefings and teleconferences. Provide
spot reports to Division/Group staff, as necessary.
Extended Actions:
 At shift change, provide a briefing on past and ongoing agency and Division/Group
activities to your replacement, as required.
 Plan for the possibility of extended operations.
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Appendix O(e): Job Action Sheets
Planning Section Chief
Supervisor:
Incident Manager (IM)
Mission:
Collect, evaluate, and disseminate incident information to EOC and other
staff. Coordinate status reporting, monitor and display situational
information, and develop and update the Incident Action Plan (IAP).
Location:
Emergency Operations Center (EOC)
Immediate Actions:





Upon notification, report to the EOC.
Read this entire Job Action Sheet and review the Incident Command System (ICS)
organizational chart.
Obtain briefing from IM.
Notify supporting Unit staff and necessary technical specialists of activation, as
appropriate.
Confer with the IM and Operations Section Chief to develop an IAP.
Intermediate Actions:
 Issue mission assignments to support staff and technical specialists.
 Collect, interpret, and analyze information regarding the status of resources and
response activities. Update the IAP to reflect this information and distribute to the IM
and other staff, as necessary.
 Coordinate regularly scheduled situation/status briefings and teleconferences. Send
invitations, agendas, and other meeting materials to the IM and all other staff.
Extended Actions:
 At shift change, provide a briefing on past and ongoing organizational and Planning
Section activities to your replacement, as required.
 Plan for the possibility of extended operations.
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Appendix O(f): Job Action Sheets
Logistics Section Chief
Supervisor:
Incident Manager (IM)
Mission:
Organize, direct, and coordinate those operations associated with
maintenance of physical environment (facilities), security, and staff
deployment. Provide for adequate levels of equipment and supplies to
support all activities.
Location:
Emergency Operations Center (EOC)
Immediate Actions:






Upon notification, report to the EOC. Notify appropriate staff of activation status and
close out performance of all day-to-day activities.
Read this entire Job Action Sheet and review the Incident Command System (ICS)
organizational chart.
Obtain briefing from IM.
Notify supporting Unit staff and necessary technical specialists of activation, as
appropriate.
Assist the Planning Section Chief with the development of an Incident Action Plan (IAP).
Receive direction from the IM regarding current agency logistical services and support
needs.
Intermediate Actions:
 Monitor deployment of agency resources (staff, equipment, and supplies) in support of
field response operations.
 Provide facility management and security services support.
 Coordinate provision of headquarters information technology assistance, as necessary.
Ensure headquarters voice and data communications systems and equipment are
functioning properly.
 Inventory equipment and supplies and project needs based upon requests from the IM,
Operations Section, and/or Planning Section.
 Participate in regularly scheduled situation/status briefings and teleconferences, as
appropriate. Provide spot reports to appropriate staff, as necessary.
Extended Actions:
 At shift change, provide a briefing on past and ongoing organizational and Logistics
Section activities to your replacement, as required.
 Plan for the possibility of extended operations.
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Appendix O(g): Job Action Sheets
Finance/Administration Section Chief
Supervisor:
Incident Manager (IM)
Mission:
Serve as a conduit of information between the IM, and other responsible
staff, on all financial and human resource related matters. Monitor and
report on resource costs, procurement issues, and employee
compensation/claims.
Location:
Emergency Operations Center (EOC)
Immediate Actions:




Upon notification, report to the EOC. Notify appropriate staff of activation status and
close out performance of all day-to-day activities.
Read this entire Job Action Sheet and review the Incident Command System (ICS)
organizational chart.
Obtain briefing from IM. Report this information to appropriate staff.
Assist the Planning Section Chief with the development of an Incident Action Plan (IAP).
Intermediate Actions:
 Report on the anticipated or requested costs of field activities.
 Advise the IM of financial systems and human resource-related policies and procedures
as they apply to field response efforts.
 Assist in accounting, payment processing, financial reporting, travel, employee
relocation, payroll liaison, and financial systems related to the incident.
 Participate in regularly scheduled situation/status briefings and teleconferences. Provide
spot reports to appropriate staff, as necessary.
Extended Actions:
 At shift change, provide a briefing on past and ongoing financial/human resource related
activities to incoming staff. Provide additional detailed information to your replacement,
as required.
 Plan for the possibility of extended operations.
Page 120 of 132
Appendix P: Home Emergency Preparedness Guide
Even though no one actually knows when the next emergency might occur, it makes sense to
be prepared. Begin planning and communicating with family members now. Regardless of the
type of event -- ice storm, hurricane, blizzard, hazardous materials emergency, terrorist activity,
etc. -- there are things that you can do to minimize the effect on you and your family.
This Home Emergency Preparedness Guide is designed to help you plan for such an
emergency. Although it does not cover every conceivable emergency, it does offer information
and resources to help you plan for most home emergency situations.
____________________________________________________________________________
1.
Check on Relatives and Neighbors. During storms and other emergency events,
check to see how your relatives and neighbors are coping, especially senior citizens and
persons with disabilities. If possible, consider helping them plan or locate resources in
which to obtain assistance.
2.
Preparing Your Home for an Emergency. Planning for any emergency requires
considering all likely scenarios that could result when things that you rely on daily -- like
electricity, water, heat, air conditioning, telephone service and transportation -- are
disrupted or lost for a considerable amount of time. Consequently, you should plan on
having enough food, water and other essentials, to get you through the emergency. Most
emergency management planners suggest having enough supplies to last you and your
family for at least three to seven days. However, many things may impact your decision,
including storage space, special needs, and number of people in the household and
available resources.
3.
What To Include In Your Home Emergency Preparedness Kit: The six basic items
that should be stored in your home are water, food, first aid supplies, clothing and
bedding, tools and emergency supplies, and specialty items. Keep the items that you
would most likely need at home in one easy-to-carry container, such as a trash can,
camping backpack or duffel bag. Store it in a convenient place and put a smaller version
in your car. Keep items in airtight plastic bags. Remember to change the stored water
and rotate the food supplies every six months (place dates on containers). Check the
supplies and re-think your needs every year. Consult your physician or pharmacist about
storing prescription medications, and maintain a list of your prescriptions needs.
A.
Water: Store water in plastic containers or purchase bottled water, avoiding
using containers that will decompose or break, such as milk or glass bottles. Plan
for one gallon of water per person per day. Water should be stored in a cool, dark
place with the date labeled on the container. This is a good use for two liter soda
bottles; rinse clean and refill with tap water.
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B.
Food: Store a supply of three to seven days of nonperishable food per person.
Foods should require no refrigeration, preparation or cooking and little or no
water. Examples include: ready-to-eat canned meats, fruits and vegetables;
canned or boxed juices, milk and soup; condiments such as sugar, salt and
pepper; high-energy food like peanut butter, jelly, low-sodium crackers, granola
bars and trail mix; vitamins; foods for infants or persons on special diets; cookies,
hard candy, instant coffee and sweetened cereals. Bulk food items such as rice,
powdered milk, and grains can be stored for long periods of time. Some camping
and outdoor suppliers have available MREs (meals ready to eat) that store for
long periods and require no cooking. Remember to include utensils to open the
containers and eat the foods.
C.
First Aid Kit: Assemble a first-aid kit for your home and each vehicle. Items
should include: sterile adhesive bandages in assorted sizes, gauze pads,
hypoallergenic adhesive tape, triangular bandages, sterile roller bandages,
scissors, tweezers, needle, moistened towelettes, antiseptic, thermometer,
tongue blades, tube of petroleum jelly or other lubricant, safety pins, cleansing
soap (preferably waterless), eyewash, latex gloves, aspirin, anti-diarrheal
medication, activated charcoal (for poisoning), laxatives.
D.
Tools and Supplies: Keep the following items handy for all-around use: extra
batteries of assorted sizes (check shelf life before purchasing), paper cups,
plates and plastic utensils, battery operated radio, flashlight, battery powered
carbon monoxide and smoke detectors, cash, (include change) and/or traveler's
checks, non-electric can opener and utility knife, small ABC fire extinguisher;
pliers and other small tools you might need, waterproof matches, plastic storage
containers, signal flares, paper and pencil, needles and thread, and medicine
dropper. For sanitation, make sure you have a sufficient supply of the following:
toilet paper, soap and liquid detergent, feminine supplies, plastic garbage bags
with ties, disinfectant and household chlorine beach.
E.
Clothing and Bedding: If you have to utilize the emergency shelter, assemble
at least one or two complete changes of clothing per person, sturdy shoes or
work boots, rain gear, blankets or sleeping bags, sleeping pad, hat and gloves,
and thermal underwear (during cold weather)
F.
Specialty Items:
1.
For babies: formula, diapers, bottles, powdered milk and medication
2.
For adults: medications, prescriptions, denture needs, eye glasses
and/or contact lenses and related supplies
3.
For entertainment: games, books and several quiet toys for children
4.
Important Family Documents: wills, insurance policies, contracts, deeds,
passports, stocks and bonds, immunization records, important phone
numbers, credit card accounts, social security cards and other personal
family records. All should be stored in a safe and secure place.
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4.
Public Emergency Shelters: Your home is the safest place to be even during an
emergency. However when conditions warrant, your community may establish
community-based shelters for local residents. Normally, shelters are setup in public
schools, or other appropriate facilities where residents can seek refuge from the event.
Shelters to be opened will be designated based on the situation by Emergency
Management. Persons in need of shelter are asked to bring food (as outlined
previously), a change of clothing, bedding (blankets or sleeping bag and pad, bathing,
and sanitary supplies, pre-filled prescription and other medical needs, denture and eye
care materials and special dietary supplies or requirements. With the exception of guide
dogs, PETS ARE NOT PERMITTED IN THE SHELTERS. ALCOHOLIC BEVERAGES
AND SMOKING ARE NOT ALLOWED.
5.
What To Do For Pets in Emergencies: Emergency planning should include all
members of the family, including pets. If your family must re-locate to a shelter or other
site, confine your pet to a specific room in the house and provide plenty of food and
water to sustain the animal while you are away. If possible, arrange for someone to
board the animal, or locate a relative or friend who can check on its well being on a
regular basis. Put together a basic disaster kit for your pets, in case you must leave your
residence quickly. Recommended items would include:
6.
A.
An extra supply of pet food (for dogs a lower protein dog formula will produce
less stool, a benefit when kept indoors).
B.
Plenty of clean water.
C.
Bowls (disposable containers if you must leave your residence), can opener,
kitchen trash bags, bleach, disinfectant, blankets, towels, paper towels, and other
waste disposal supplies.
What To Do When Electrical Power is Lost: Disruption of electrical service can occur
as a result of many things, including lightning, high winds, ice and heavy snow, and
equipment failure. For the most part, service is normally restored within a short period.
However, major power outages can happen for extended periods from time to time.
When power is lost, you should:
A.
Check to see if your neighbors have power. It may be only in your home, a
blown fuse or a tripped circuit. If your neighbors are also without service, call
your local power company (see phone numbers). If you must go outside to
assess the situation, take a flashlight and watch for downed power lines that
could still be energized. If downed lines are located, don’t go near them or touch
anything that they may be in contact with. Report downed power lines
immediately.
B.
Turn off all major appliances. Leave just a couple of light switches on in the
home and the front porch light. When major appliances – refrigerators, electric
water heaters, air conditioners and pumps – are left on, they could overload
electric lines when power is restored causing a second outage.
C.
Refrigerators and freezers. Food can be kept cold enough for a day or two, if
the doors are kept closed. During the winter, you may be able to store some
items outside in a proper container. If temperatures are below freezing, it’s
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possible to freeze water outside in containers and place them inside your
refrigerator to help keep food cold. Try to consume perishable foods first. Some
partially frozen foods can be refrozen as long as they contain ice crystals or are
no warmer than 40 degrees Fahrenheit. Consider purchasing a thermometer for
both the refrigerator and freezer. Don’t refreeze meat, seafood, poultry, ice
cream, cream sauces or anything susceptible to spoilage. When in doubt…
throw it out!
D.
Flashlights or Battery-operated Lanterns -- should be used to illuminate the
home. Candles and kerosene lanterns are not recommended for lighting because
of the inherent fire safety hazards.
E.
Portable Emergency Generators – can be used to provide limited electrical
power during an outage. But, take care to ensure that they do not pose a threat
to you and your family. Never fuel or run a portable generator or store extra
fuel in the home or attached garage. Gas-powered generators pose a serious
fire and carbon monoxide threat. Never connect the generator directly to the
house electrical service, unless approval has been granted by the power
company and the generator is equipped with a double-throw transfer switch that
protects your equipment and prevents feedback on power lines. Always operate
according to the manufacturer’s instructions. For additional information on the
proper use of emergency generators, call your power company or the Town’s
electrical inspector.
F.
Water Systems and Waste Water Systems with Electric Pumps – such as
wells or sewer ejector pumps -- will not operate when the power is out. Alternate
sources of water and /or waste disposal will have to be used until power is
restored. However, home connected to the Town’s Water and Sewer system will
usually have service during power outages.
G.
Gas Appliances – may not work if the electricity is off because the equipment
may require electricity for ignition or valve operation.
H.
Water Heaters – that are drained to prevent damage from freezing, must have
their power circuit shut off as well. Failure to do so could result in loss of the
heating element when power is restored. Never turn on a water heater unless the
tank is full.
I.
Plumbing – can freeze when power is lost during cold weather periods. Drain
supply lines, water heaters, boilers and traps in drains of tubs, sinks, commodes,
washing machines and dishwashers. Special environmentally safe anti-freeze is
available to winterize drains. To avoid major flooding when temperatures rise,
you should also turn off supply lines to outside spigots. Leaving a cold water line
running (just slightly) may keep the supply line from freezing during a prolonged
period without heat.
J.
Life Support Equipment – required for family members who depend on these
devices (respirators, ventilators, oxygen equipment or other life-sustaining
devices) should be listed with the power company. If the power outage is not
widespread, power companies attempt to restore power to these homes first.
Regardless, you should have a contingency plan that always includes an
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alternate power source for the device and relocating the person.
K.
Trees – While power companies have a regularly scheduled program for
trimming trees away from power lines, they do not go on private property.
Consider this when planting and/or trimming trees on your property, and always
seek professional help in trimming limbs or branches that are close to power
lines.
L.
Keeping Warm- Select a single room in the home in which the entire family can
live; ideally a room, which gets sunlight during daylight hours. Use fireplaces and
wood-burning stoves with care and always supervise them when in use. Make
sure the fireplace is in proper working condition and has been inspected before
use. Wear layers of clothing, including sweaters and coats, which entraps warm
air and helps to maintain body heat for longer periods. For homes with natural
gas heaters, homeowners are reminded to keep meters and vents clear of ice
and snow.
M.
SAFETY NOTE – Never use gas ovens or stovetops to heat homes;
charcoal or propane grills should never be used inside the home. They
pose a serious threat of fire and the creation of poisonous carbon
monoxide. When removing ashes from the fireplace, make sure that the
ashes are cool, and are placed in a metal container outside and away from
the home.
7.
Keeping Updated on an Emergency: Getting information during an emergency
situation is vital, especially at the height of the event, when evacuation may be required.
Radio and television stations provide the quickest means to obtain information. If you
have electrical power and cable television, turn to the local access channel for frequent
updates. Have a battery-operated radio tuned to a local all-news or talk-radio station. In
situations requiring immediate action by residents, the Emergency Manager will transmit
messages over the cable television system. Have a family contingency communications
plan so relatives can contact you.
8.
Technology/Computer Contingency Planning: Every home and business should have
a Continuity and Contingency Operating Plan, which assumes that there may be
computer and embedded chip glitches. These plans provide a road map for ways to get
around problems should they occur.
A.
Financial and Personal Records: Keep all your financial records in order and
up-to-date. Bank statements, credit and debit cards, investment portfolios,
medical and prescription, insurance information, taxes and other records show
transactions related to your account may be susceptible to technology glitches.
Should a problem exist with any of these records because of a computer or
software problem, your records may be the sole source for validating the correct
information. Keep your documents and records in a safe place and preferably in
a container. If you leave your home for an extended period you can take the
documents with you, if necessary
B.
Travel: If you plan to travel, check to see how the community you are planning
to visit is prepared to deal with issues. If your plans include transportation by
airplane, train or ship, inquire about the carrier’s planning efforts, including
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contingency plans for alternate travel means should a problem develop. Also,
consider taking some extra cash or travelers checks (preferred) in case of
problems related to ATM machines and credit card verification systems.
C.
Testing Your Personal Computer: Your Personal Computer's (PC) hardware
and software may be vulnerable; with some planning and attention to detail, you
can protect yourself from technology disruptions.
Page 126 of 132
Appendix Q: Damage Assessment Checklist
It is essential to perform a damage assessment following an adverse event to help ensure the
safety of building occupants as well as prevent additional losses. This checklist has been
developed to guide assessments of damage immediately following adverse events like fire,
flood, severe weather, acts of violence or any other incident that may have potentially damaged
a facility.
The safety of the facility’s employees must be considered first and foremost. This assessment
shall not be completed if it is determined that a facility has been “severely damaged” and
conducting such an assessment may place the safety of an employee(s) in jeopardy.
____________________________________________________________________________
SITE INFORMATION:
Date of Incident: ___ / ___ / _____
Date of Assessment: ___ / ___ / _____
Name/Title of Person Completing Assessment: ______________________________________
Facility Name: ________________________________________________________________
Facility Address: ______________________________________________________________
Phone Number: (____) ____ - ______
General Impression of Damage:  None
 Minor
 Moderate
 Severe
 Total Loss
TYPE OF INCIDENT:
 Fire
 Power Failure
 Vandalism
 Explosion without Fire
 Natural Gas Failure
 Severe Weather
 Incident of Workplace Violence  HVAC Failure
 Civil Disturbance
 Internal Flooding
 Technology Failure
 Vehicle Striking Building
 External Flooding
 Criminal Activity
 Other Mechanical System Failure: ______________________________________________
 Other Striking the Building: ____________________________________________________
 Other: ____________________________________________________________________
Describe the incident in detail: ____________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Page 127 of 132
EXTERIOR PROPERTY ASSESSMENT: Check any that were damaged in the incident.
 Landscaping
 Freestanding Signs
 Parking Lot
 Outside Water Pipe Rupture
 Out-Buildings
 Light Poles
 Patios
 Downed Trees/Tree Limbs  Broken Glass on Ground
 Flagpole
 Driveways
 Outside Gas Leaks
 Damage to Entire Area
 Fences/Gates
 Vehicles
 Fire Hydrants
 Mailboxes
 Hazardous Materials
 Damage to Neighboring Buildings  Windows
 Generator Enclosure
 Doors
 Roof Structure
 Partial Structural Collapse
 Pipes on Building
 Penthouse
 Steeple
 Utility Transformers
 Balconies
 Light Fixtures
 Foundation
 Railings
 Exterior Walls
 Exterior Structural Damage
 Utility Control Boxes
 Canopies
 Soffits
 Wiring on Building
 Porches
 Complete Structural Collapse
 Blood, Body Fluids or other Biohazards Present
Describe damage to the exterior of the property in detail: _______________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
Page 128 of 132
INTERIOR ASSESSMENT: Check any that apply.
Building Assessment
 Fire Damage
 Smoke Damage
 Interior Contents Damage
 Interior Structural Damage   Water Damage
 Hazardous Materials
 Presence of Mold or Mildew Blood, Body Fluids, or other Biohazards Present
Interior Building Elements
 Ceilings
 Windows 
 Carpeting 
 Stairs
 Screen Doors

 Foyer/Entry Way/Vestibule 
 Basement 
 Ramps

 Elevator Shafts
 Circuit Breaker Boxes
 Fuse Boxes 
 Open/Exposed Wiring
 Floor boards
 Attic
 Interior Doors
 Wall coverings
 Window Screens
 Other Floor Coverings
 Elevator Cars
 Door Locks
 Electrical Outlets
 Computers/Servers
 Security System
 Fire Extinguishers
 Exit Doors
 Wall Structure
 Window Latches
 Floor Tile
 Stairwells
 Door Handles
 Graffiti
 Crawlspace
 PA System
 Railings
 Light Fixtures
 Electrical Switches
Fire Alarm System Components
 Control Panel
 Horn/Strobe Devices
 Battery Cabinet
 Smoke Detectors
 Annunciator Panels
 Pull Stations
Mechanical Equipment
 Boilers
 Sewer Pipes
 Furnaces
 Return Air Units
 Air Conditioning Units
 Pumps
 Elevator Equipment
 Hot Water Tanks
 Hot Water Heaters
 Condensers
 Incinerator

 Sump Pumps
 Emergency Generator
 Soil Stacks
 Gas Pipes
 Water Pipes
 Water Meter
Offices, Treatment Rooms, and Other Rooms
 Desks
 Fax Machines
 Paper Shredders
 Filing Cabinets
 Shelving
 Copy Machines
 Toilets
 Sinks
 Office Furniture
 Computers
 Other Office Equipment
 Plumbing Fixtures
Evidence of Theft or Missing Items
 Evidence of Burglary
 Evidence of Looting
 Missing Supplies
 Missing Equipment

 Missing Furniture
 Missing Appliances
 Missing Personal Items

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Appendix R: Emergency Codes
PATHS has adopted 8 standardized codes that will be used for all sites in cases of emergency:
1. Fire
Code Red
2. Medical Emergency
Code Blue
3. Abduction
Code Amber
4. Severe Weather
Code Gray
5. Mass Casualty
Code White
6. Security
Code Silver
7. Evacuation
Code Green
8. Bomb Threat
Code Black
Boydton, Chatham and Martinsville

In case of a Fire go to the nearest Alarm Panel and press the “Fire” button

If there is a Medical Emergency announce “Code Blue” with the location of the
emergency by using the “All Page” button on any phone in the office.

If there is an Abduction of an infant, child or adult, announce “Code Amber” with the
description of the person abducted by using the “All Page” button on any phone in the
office.

In case of Severe Weather, announce “Code Gray” with the description of what type of
weather emergency by using the “All Page” button on any phone in the office.

If there is a Mass Casualty, announce “Code White” with the location of the event by
using the “All Page” button on any phone in the office
.
If there is an unruly patient or other type of incident dealing with Security, announce
“Code Silver” plus the description and location of the security alert by using the “All
Page” button on any phone in the office.


If it is necessary to Evacuate for any reason, announce “Code Green” by using the “All
Page” button on any phone in the office.

In case of a Bomb Threat announce “Code Black” along with as much information as
possible without causing panic by using the “All Page” button on any phone in the office.
Danville

In case of a Fire, go to the nearest “Alarm Panel” and press the “Fire” button

If there is a Medical Emergency, announce “Code Blue” with the location of the
emergency by dialing “7” with the handset down and then “8”.
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
If there is an Abduction of an infant, child or adult, announce “Code Amber” with the
description of the person abducted by dialing “7” with the handset down and then “8”.

In case of Severe Weather, announce “Code Gray” with the description of what type of
weather emergency by dialing “7” with the handset down and then “8”.

If there is a Mass Casualty, announce “Code White” with the location of the event by
dialing “7” with the handset down and then “8”.

If there is an unruly patient or other type of incident dealing with Security announce
“Code Silver” plus the description and location of the security alert by dialing “7” with the
handset down and then “8”.

In case of an Evacuation for any reason, announce “Code Green” by dialing “7” with the
handset down and then “8”.

In case of a Bomb Threat announce “Code Black” along with as much information as
possible without causing panic by dialing “7” with the handset down and then “8”.
Use common sense in all cases and give as much information, including descriptions, as
possible for any emergency without causing panic. If you feel that you cannot make the call
please have a co-worker make the call for you.
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