Incident Command Orientation for Nurse Manager & Directors

1. Incident Command Orientation for Nurse Manager & Directors Outpatient Areas & Clinics 2018

2. It can be confusing for new managers during Incident Command Activations. This presentation will help you be familiar with the most critical items. Slide 4 Communications Regulations Policy Patient Care Command Structure Staff Needs Technology Personnel Preparedness

3. Goal: • This brief presentation is designed to help explain action items and overall concepts that should help you lead your department during an incident command activation. • Most incidents are only successfully resolved if they are met with department level actions at the very first sign of trouble.

4. Sample 7 Topics Covered

6. Sample 7

7. Incident Command (ICS) • Every incident begins with the recognition that something may occur (or has occurred) and the impact is likely to disrupt normal operations. • Internal Events: Any event or incident that can interfere with the ability of the department or clinic to maintain a normal work process or safe environment for patient care. Examples: Fire, power outage, loss of water • External events : Typically we receive little or no warning of an incident happening in the surrounding community. These events often result in a large influx of patients that have the ability to overwhelm the resources of any single department.

8. The Origin of the Incident Command System • The system was meant to tackle several different problems that caused slow response and endangered lives. • Too many responders reporting to a single supervisor • Lack of accurate and reliable information on incidents • Different structures for response throughout different organizations • Incompatible communications • Blurred lines of authority • Difficulty coordinating the planning among multiple agencies • Differences in the terminology used in different agencies

9. Incident Command Levels at SUNY Upstate • There are three fundamental levels for an Incident Command response • These levels are utilized in the various plans and annexes, to meet the response needs of a particular incident. • An event does not often stay at one level for the duration of the incident. • Historically, SUNY Upstate activates Level 2 more than any other.

10. When does Incident Command Start? • Incident Command is simply a process in which we respond to large and small critical events that could have the potential to impact our normal operations. • Incident Command starts at the Department level. • It starts the moment someone recognizes the potential impact or event and moves resources in the department to meet that issue.

11. Sample 7

12. SUNY Upstate Ambulatory and Outpatient Clinics has established the following disaster response priorities: • Ensure life safety – protect life and provide care for injured patients, staff, and visitors • Resume or Continue the delivery of patient care • Restore essential services/utilities • Support the overall community response

13. Integration & Activation (see DIS M -81) • In order to coordinate with the Onondaga County Emergency Response system, SUNY Upstate Ambulatory and Outpatient Clinics has adopted the Incident Command Structure at the management structure (see DIS C-01) • Under ICS, the clinic’s overall response is to be managed by each area’s normal chain of command. • Integration with Community-wide Response SUNY Upstate Ambulatory and Outpatient Clinics will coordinate its response to community-wide disasters with the overall medical and health response directed by the SUNY Upstate Incident Commander or SUNY officers as the situation warrants. • Clinic personnel will cooperate fully with Emergency Medical Services, Fire and Law Enforcement personnel. This may include providing information about the location of hazardous materials or following instructions to evacuate and close the clinic.

14. Integration & Activation (see DIS M -81) • SUNY Upstate Ambulatory and Outpatient Clinics Staff Call List • The clinic will compile and maintain an internal contact list that will include the following information for all staff: name, position title, home phone, cell phone, pager numbers, and preferred method of contact. • The Staff Call List will contain sensitive contact information and should be treated confidentially. • Once a critical situation has been identified each department or area supervisor will communicate with their respective Clinic Administrator (or designee) responsible for that area. • If unable to contact any of the personnel in their normal chain of command they will • contact the Hospital Administrative Supervisor. • The Clinic Administrator (or designee) would communicate resource needs as the situation warrants to the Administrator on call (AOC) for the hospital or Administrative Nursing supervisor on duty. • The Administrative Nursing supervisor on duty will communicate to the AOC on call per normal IC activation guidance. (see DIS C-00)

16. Manager/Supervisor Task List • Assess your current operational status. • Check in with everyone. Account for your staff members currently on duty. • Look to make sure your area is operating normally. • Maintain a heightened awareness: • Changes in the environment (heat, cold, smells, smoke, etc.) • Operational problems (computers, lights, etc) • Staffing issues (higher that normal call-in rate, etc) • Reaction of staff, patients, families to increased stress based on the situation. • Report anything to Incident Command that may impact your ability to operate normally.

17. Supervisor/Manager Task List continued • Inform your staff that shifts have been extended until further notice. • NO ONE leaves unless directed by Incident Command • Staff members are an extremely important resource during critical events. Please check with Incident Command if you believe there is a need to send anyone or any group home at the end of their normal shift. • Please track overtime normally if it occurs. • Do not send staff to the Labor Pool or another specific area until directed • Ensure someone in your department is assigned to monitor their e-mails for incident related communications.

18. Supervisor/Manager Task List continued • Contact their individual Ambulatory Director to communicate any resource needs • Follow the specific actions in DIS J-12 • Unitize the Outpatient Unit leader Job Action Sheet (F95174) • If chosen as the designated Building Director you must coordinate information and resource allocation between all the departments locate within your building. Report information and needs to Incident Command as often as possible. • Ensure each department within the building has utilized their “Go-Kits” and each department has a one specific person wearing the reflective vest. • The person wearing the vest must communicate with the Designated Building director If this person has not been designated please assume that role until otherwise directed.

19. What should I have my staff do? • Staff away from their work area should return and report in to their manager/supervisor. • Staff should not leave at the end of their shift unless you have told them to do so. • Continue normal operations unless instructed (or unable) to do otherwise. • Monitor patients and families for signs of stress related to the incident. • Distribute and communicate approved information to impacted patients or families that you may receive from Incident Command.

20. Needs requests/ resources • Communicate all urgent requests to Incident Command via phone, once it is active. • Downtown Phone: 4-4888 Room: 1307D (Hospital Administration) • Community Campus Phone: 492-5338 Room: Library/Computer Training Room

21. Staff recall/Labor Pool • If staff need to be recalled in from home in response to a Disaster they will be told to report directly to the Labor Pool upon arrival to the hospital as designated by Incident Command. (see DIS G-02) • They should not report to their normal department. • All employees will park in their usually assigned parking location unless notified otherwise.

22. Closing a unit or Area. (See HR policy UW U-04) • State offices and facilities may only be closed by order of the Governor. • In the event of extraordinary circumstances when the Governor has not closed State facilities, Campus presidents are authorized to cancel classes for students; cancel appointments for patients • Employees who do not work as scheduled are required to obtain prior supervisory approval to ensure their services are not required and must charge appropriate leave credits/accruals (other than sick leave) in order to remain in a paid status. • If weather conditions are severe enough to disrupt transportation, early departure and/or allowing employees not to report to work may be permitted based on operational needs, with the supervisor's approval. • In these situations, employees will be required to charge their leave credits (other than sick leave) in order to remain in a paid status.

23. “essential Employees” (See HR policy UW U-04) • When the Governor directs that only “essential employees” are expected to work, essential employees are typically defined as below: •  Employees who are involved in the direct care of patients (e.g., RN’s, LPN’s, HCT’s, UST’s, Rad Techs, Physical Therapists, Respiratory Therapists, Phlebotomists, etc.) •  Employees who work in departments that support direct patient care (e.g., Materials Management, Pharmacy, Clinical Data, Dietary, Clinical Pathology, radiological etc.). •  Employees who preserve the public safety or welfare of the Upstate community, (e.g., University Policy Department, Physical Plant, Environmental Services, etc.). • Employees who provide animal care. • Employees with responsibility for laboratory experiments or other time-sensitive activities.

24.  If a determination is made by Administration to close areas to patients or cancel appointments (e.g., ambulatory areas, etc.), or the President/Dean decide to cancel classes for students, employees must still be provided the opportunity to work if they wish to do so, even if it is in another area of Upstate. • If employees do not work in such a situation, they must obtain supervisory approval, and they are required to charge their leave credits/accruals (other than sick leave) in order to remain in a paid status.

25. Upstate reserves the right to consider all employees essential based on the circumstances of a specific event/situation.

26. Documentation • SUNY Upstate Ambulatory and Outpatient Clinics will immediately begin gathering complete documentation including photographs and detailed information. • See Policy I-03, Event/Occurrence Reporting. • Inventory Damage and Loss • Damage and losses of equipment should be tracked and communicated to Incident Command. • After-Action Report • SUNY Upstate Ambulatory and Outpatient Clinics will conduct an after-action evaluation of the adequacy of the clinic’s plans and response efforts. This meeting should be coordinated with the Department of Emergency Management

27. Sample 7

28. How will Incident Command be Announced? • A Groupwise email will often be sent to all SUNY Upstate staff members detailing specific action steps or situational information • An overhead page containing critical information will be announced. Example: such as a missing patient response or code amber. • This would only be heard in the Hospital building itself and may not be heard in other ancillary areas. • VOCERA could also be used to communicate urgent information. • An Everbridge Notification will be sent whenever possible for critical information or alerts.

29. Ipage status report (DIS J-00 appendix E ) • Included on some Incident Command emails there may be a link for each department manager (or designee) to complete a required status report as soon as possible or if their operational status changes. • Simply Click the link attached in the email and answer the questions when directed. • It is imperative that each departments supervisor (or designee) complete this as soon as possible. • This report can be submitted multiple times as situations change • This page IS NOT to be used during an active fire or any incident that requires immediate University Police response.

30. Everbridge is a mass communications system used by SUNY Upstate in order to reach staff members quickly during critical incidents • Once activated a person can get a voice phone call, text or email from incident command • It is imperative that all staff members update their personnel information on self serve • My Information/Employee details/Personal Profile • If staff do not want to receive texts they can opt out by not filling out that section. • Warning: Any staff member who opts out may not receive critical information during weather events or other disasters.

31. Sample 7

32. CODE Names & Important Plan listing Below are a listing of important plans and codes we use. It is beneficial for you to have a level of familiarity with all of these depending on your location

33. Lets review a few of the less common events so that you are better prepared.

34. Evacuations • During an evacuation of patient areas, patients should be prioritized the following way: • Patients and Visitors in Immediate Danger • Ambulatory Patients • Wheelchairs, Isolettes, Cribs • Bed Bound Patients • Flow of evacuation should first be horizontal then vertical as needed. • If in the event of a catastrophic episode and the need arises to completely evacuate an area or department rapidly • All staff will attempt to meet enter common rally point away from building listed in each departmental disaster plan. • A headcount will be completed by the supervisor (or designee) and reported to Incident Commandand other first responders.

35. Evacuation Equipment • A listing of all evacuation equipment is located in the appendix of DIS M-40 the Evacuation Plan. • Training: • It is imperative that all clinical staff members take the Evacuation Chair awareness blackboard class which offers the student a detailed video specifically developed by SUNY Upstate. Titled “Evacuation Equipment” UH4921 • Every clinical staff member should know the location of the closest piece of evacuation equipment. • If your staff requires some “hands on” instruction with the equipment please contact the Dept. of Emergency Management. • Helpful Hint: this could be reviewed on a yearly basis during a staff meeting to increase staff knowledge.

36. Active Shooter • Definition: An Active shooter is an individual actively engaged in killing or attempting to kill people in a confined and populated area. • When an Active Shooter is in your vicinity do one of the following that best suits the environment you are in at the time. • RUN • Have an escape route and plan in mind prior • Leave your belongings • Keep your hand visible to law enforcement • HIDE • Hide in an area out of the shooters view • Block entry to your hiding place and lock the door if able • Silence your cell phone or pager • FIGHT • As a last resort and only when your life is in imminent danger • Attempt to incapacitate the shooter • Act with physical aggression and throw items at the shooter • When law enforcement arrives • Remain calm and follow instructions • Keep your hand visible to Law Enforcement. • Provide any additional information to Law Enforcement if you are able to (number of shooters, type of weapons, locations of victims) • Please see University Police ipage for more information and specific training videos prior to any event. There are many wonderful trainings on the UPD ipage.

37. Sample 7

38. ICS 100/700 • As a manager at SUNY Upstate you are required to complete the two FEMA (Federal Emergency Management Agency) online training classes titled ICS 100 and ICS 700 during your first 6 months here. • You may look on the SUNY Upstate Departmental ipage for more details under the training section and links to the specific trainings. • All Staff> Emergency Management> Training> FEMA Training • Once completed you will get a certificate of completion. • This completion certificate pdf. Must be emailed to Chris Dunham at Dunhamch@upstate.edu • If you have previously completed the training for other employers, simply send the .pdf certificate to Chris Dunham

39. Departmental Disaster Plan • In order to ensure that everyone is trained consistently it is required that each manager (or designee) must use the tracker code below to record every employee in once a review is completed. • All shifts and all employees in your department need to review your department’s specific plan at least once per year. • Typically many managers take a few minutes to go over the plan during a staff meeting where a large number of staff is already gathered while other managers allow each employee to review a printed copy of the plan during each shift and sign off that they reviewed the plan. • A review of this plan would consists of a brief rundown of the important items each department has listed to insure everyone is clear on their expected actions during a critical event, Incident Command Activation or emergency. • This tracker code and review only applies to those departments that have already created a specific disaster plan. Please look at the MCN system to obtain the most current disaster plan prior to review. • Tracker Code:  DISASTERPLANEDU

40. Sample 7

41. Be prepared at Home • Being prepared at home is the best way to ensure that you are able to participate in your department’s response during a critical incident. • We have several checklists and recommendations you can use for your own personal preparedness. • Please see form F82187 Caring is preparing located on the ipage forms section for more information.

42. “GO” Kits for Outpatient Areas • Often during an emergency, electricity, water, HVAC, or telephone/mobile service may not work. The emergency management department has developed Disaster Packs for use during an emergency. • The kit provides basic items to assist with threats outlined in the Hazard Vulnerability Assessment (HVA) DIS M-46 and lessons learned from previous events. • Please make sure your staff members know where the kit is kept as well as check the contents on a periodic basis.

43. Emergency Management Ipage • All projects and training programs can be found on the EM ipage. • Please review this periodically as we are always updating it with new information • New threats or procedures for unique items (Example: Zika) • Links to federal resources like the CDC and the weather service • Links to specific training programs • Weather preparedness tips

44. Thank you. Any questions please email Chris Dunham at DunhamCh@upstate.edu