Emergency Management Working Group 12 May 2014

1. Emergency Management Working Group12 May 2014 Please remember to silence your cell phone.

2. Agenda • Bi-monthly Review • 2014 EOP Refresh • Red Book Mid-Year Update • Workplace Violence Campaigns • BERT • Upcoming Training and Exercises • GETS Cards

3. Bi-monthly Update • Gamma Knife Drill • Water Tabletop Exercise • Fox Fields • Scheduled Outages • No Actual Events

4. 2014 EOP Refresh • JC Standards – annual review • Last complete update in 08 • Pictorial vs Narrative • Developed more detailed Basic Plan • Refreshed look of other components • Restructured/Reorganized • June timeline • What does this mean to you?

5. Red Book Update • Emergency Action Plan • Bomb Threat Sheet • Fire Sheets • WPVSheet

6. Bomb Threat Sheet

7. Fire Sheets

8. WPV Sheet

9. Workplace Violence Campaigns • Active Shooter • May and June Timeline • Update to the Red Book • Broad Education • Active Shooter Exercise on June 27 • BERT • June and July Timeline • Introduce and educate to the reorganized BERT response • Expand our educational approach

10. Active Shooter • Active shooter events in a healthcare setting • present unique challenges: a potentially large • vulnerable patient population, complex in- • progress medical procedures, presence of • visitors, and hazardous materials.

11. Active Shooter • Run– is to immediately evacuate the area • Hide – seek a secure place where you can hide and/or deny the shooter access • Defend – where your life or the lives of others are at risk, you may make the personal decision to try to attack and incapacitate the shooter to survive

12. Active Shooter https://www.youtube.com/watch?v=GTwh60AWhwk

13. BERT • Individual Staff Readiness • Utilizing E Mgt approach with behavioral emergencies • Preparedness/Prevention • Response • Recovery • Response Team Readiness • Consistent organization with other emergency teams • Establishing an algorithm for response • Leadership and delineated roles

14. Prevention: Avoiding Behavioral Issues Many of our patients are impacted by confusion, delirium, substance abuse/withdrawal, sleep deprivation, mental health exacerbations, or other conditions affecting sensorium. • Situational Awareness • Clinical considerations—glucose, oxygenation, or other changes in condition • Your actions can escalate or de-escalate behavioral issues • Abruptly entering the room or patient’s personal space can illicit a startle response • Constant interruptions by multiple care givers contribute to sleep deprivation • Perception of pain and related frustration • Family//visitor interactions • Insensitivity to cultural mores • Techniques • Entering patient’s room respectfully • Acknowledge patient feelings • Clearly communicate expectations • Minimize sleep disruptions by coordinating care, visual reminders patient is sleeping & advocating for rest • Maximize comfort therapies for pain & anxiety relief • Increase your own cultural IQ when & where appropriate • Do not threaten, challenge or argue • Set clear limits on behaviors that affect the wellbeing of the patient or others • Listen carefully and repeat what they say back to assure understanding • Respond honestly to questions • Involve Chaplaincy & Social Work early Early Recognition Verbal Yelling Shouting Profanity Threats Non-Verbal Pacing Clenched jaw or fist Muscle tension

15. Response to Behavioral Issues Once behavior escalates to levels that threaten the safety of the patient, other patients, staff, or visitors—decisive response is indicated. This 1,2, 3 guide walks providers through steps for activation. While definitions of unacceptable behavior and individual tolerance to acts of violence vary, it is essential we establish standardized behavioral “triggers” to help define a “behavioral emergency.” This flyer has been adapted in two different versions to cover both in-patient and ambulatory settings.

16. Recovery: Staff Resilience After the Event • Recovery after Aggressive or Violent Incident • Acts of abuse, intimidation or violence are not part of the job as hospital employees and should not be tolerated, regardless of origin. • If injured as result of a violent act, • Seek appropriate treatment in Employee Health or Emergency Room • Notify your Manager • Consider your rights to press legal charges against the attacker • If this course of action is chosen, call 911 for the University of Virginia Police (UVA PD) • UVA PD will facilitate the complainant (you) swearing before the local magistrate to see if a warrant will be sought for the arrest of the attacker • UVA PD or UVA Medical Center cannot legally perform this function on your behalf • If physically or emotionally traumatized as result of workplace violence, • UVA Faculty & Employee Assistance Program (FEAP) is an excellent resource for employees recovery • If unsure about legal course of action, UVA FEAP can facilitate a free 30-minute legal consultation • UVA Faculty & Employee Assistance Program 434.243.2643 http://www.healthsystem.virginia.edu/pub/feap

17. “ERT” Comparison

18. BERT CALL SAFETY FOCUS Scene Safe? MEDICAL FOCUS No Yes Violent • ABILITY TO REFUSE CARE (one or more) • Are they: • Altered Mental Status • Suicidal/homicidal • Documented lack of capacity • Grossly unable to care for self Yes Risk to self or others? No Protect self & others until help arrives De-escalation in <3 minutes Access UPD Yes No No May leave AMA Steps for ECO Legal Algorithm Yes Restraints Medical Evaluation • Vital signs • Glucose (finger stick) • O2 Saturation • CAM • Physical Exam Don’t forget: Notification & Escalation

19. BERT Checklist & Role Delineation Patient Management Conducted By • Incident Commander • Ensure Team safety//oversight • Lead Team Huddles: initial and concluding • Report incident via QR//web tool • Primary Nurse • Initiate restraints if needed (policy 0159) • Brief BERT team on incident • Pull medication list and provide CAM score • Medical Management as ordered • Psych Resident • Determine Mental status/ECO/TDO • Provide consult to Primary Team • EPIC BERT note • Primary Team Resident • History/Capacity/Medications • Restraint orders as needed • Consult with Pharmacy & Psychiatry as needed • Escalate care//notify chain of command 4. Chaplain • Support of patient, family or staff 5. Security • Secure scene/patient • Assist with restraints • Call for additional backup as needed Scene Management Incident Command: Nursing Supervisor, Nurse Manager, or Shift Manager • Ensure/Maintain Scene Safety • Identify Responders and brief/orient on arrival (repeat calls to 4-2012 if needed to assure response) • Team Huddle: determine approach/facilitate assigning tasks • Monitor Patient Management • Contingency Plan via Huddle • Conclude BERT > via 4-2012 • Submit WEB reporting tool (Nurse Supervisor or Nurse Manager)

20. Additional Thoughts Continued Efforts Education • Expanded opportunities for demonstrated high risk areas….train the right people • Expanded course offerings to accommodate varied needs and time availability…train more people • BERT Team education…optimize response through education • CPI training, CIT training, exercises, informal education…ones size does not fit all needs Operational Monitoring • Continue data collection • Expand data surveillance areas • Review BERT reports Issues: • Pharmacy—Valuable resource; determine best way to integrate into response • Nurse Managers—Availability//notification of incidents to assume incident commander role • Education—Expanding educational needs versus resources • Operational oversight: “Watch Officer” introduced at the operational level to support the tactical efforts of the incident commander and BERT team

21. VHHA/NW Region Collation Funding • Replacement Batteries for HT 50 Ventilators = $6516.00 • Replacement for 800 MHz radios that are 11 years old and Motorola will not support = $17,000.00 • Med Sled Evacuation Unit kits: Command, Stairwell, Unit, Ambulatory Patient = $33,000.00 • Total for FY13-14= $56,516.00

22. Training and Exercises • May 16th, TCH, Active Shooter Table Top at TCH • May 29th, UVAHS, Focused Table Top on Interruption of Ambulatory Care Services • June 24th, UVAHS, Focused Table Top on Interruption of the Supply Chain • September 5th, UVAHS, Full Scale Exercise on Medical Gas Failure • October 2nd, UVAHS, Full Scale Exercise on Decon/Hazmat

23. GETS Cards • Department of Homeland Security • GETS provides a valuable • capability to help you respond • to national Security/Emergency • Preparedness events when you • are unable to complete • emergency calls through normal • means. • Please check with Marc for your card or to get one ordered

24. Next Meeting: July 14, 2014