Evacuation Issues: Institutional Planning

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

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

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

4. Phases of a DisasterPictorial from disasterhelp.gov OSHA Training Institute Planning (Preparedness) Response Recovery Mitigation

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

28. OSHA Training Institute

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

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

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

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

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

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