Harbor:Disaster plan

Disaster Plan & Equipment

ACTIVATING

Triggers: • 5 ADULT or 3 PED critical (red triage/TTA1) arriving within 30 min period (from single separate incidents!) • 10 or more critical/urgent (red/yellow triage,TTA1/TTA2/ED Trauma) • ED discretion – (potential for extensive decontamination, need to deploy HERT for extended period, leaving ED with decreased staffing, etc) • Hospital administration initiates (EMS notification, active shooter)

ED Command Post - AED Acute Side A Nursing Station. ED Nurse Leader (OCN) - assign roles/responsibilities. Physicians usually treat not lead

Physician-specific roles include: • Immediate Unit Leader – Purple Attending • Delayed Unit Leader – Green Attending • Pediatrics Unit Leader – PED Attending

Physicians may be reorganized to other Units as needed.


FOR PHYSICIANS

• “MCI alert” or “Code Triage” – o Attendings - report to the radio room or AED A-side for briefing o Residents - report to the Trauma Bays to receive patients o Purple Attending –  Go with the AED Charge/ Trauma nurses to clear all possible rooms,  “Post” at the ambulance entrance -triage to either Trauma (“Immediate”) or AED (“Delayed”). • You will need to triage, often together with the Trauma Attending: 1) initial evaluation space (Immediate, Delayed, or Minor), 2) priority for CT scanner, 3) ability to move out of a Trauma Bay to another room after initial evaluation and stabilization, 4) priority to OR /Admission. These triages, and retriages, will need to be performed in an ongoing fashion until the emergency has ended.


DECOMPRESSING THE ED

If the EOP is activated, physicians in the ED and Gold Unit must review their current patients and designate each in the “MD Comments” column of Cerner as: • Chair – patient may be seated in a chair and discharged if bed is required emergently • Admit – patient requires admission and can be moved to an inpatient bed as soon as available • Stay – patient must remain in a monitored bed and is not sufficiently stabilized/evaluated to be admitted

These designations should be adjusted as patient condition/evaluation progresses, at least every 2 to 4 hours until the disaster event is over and normal functions resume.


TRIAGE

• Will occur at the Pedestrian Spine & Ambulance Entrance. • If there is a security threat to the hospital, all patients will be routed to the Ambulance Entrance. • In a “slow going” disaster, START Triage may be used. However, for a limited notice MCI, the Purple Attending (or another senior physician) should stand in the ambulance bay and use clinical judgement and/or START Triage to designate patients as “Immediate”, “Delayed” or “Minor” based on clinical presentation and nature of injuries. • Patients may be labeled with a colored Triage bracelet, and then sent to the appropriate treatment area or waiting area.


DECONTAMINATION

• All ED physicians have been trained in use of Level C PPE (PAPRs) at Harbor-UCLA and may be called upon to perform decontamination. • For events with < 20 patients, decon should be performed in the fixed shower outside the Ambulance bay (access with an NA-7 key). • Refer to the ED EOP binder for additional information.


PATIENT CARE AREAS & ED BED ASSIGNMENTS

• Immediate Unit: Trauma Bays (if no beds available, care can be initiated in Trauma hallway or in an AED room until bed available). Patients MUST be moved out of this area immediately after evaluation. • Delayed Unit: AED Rooms 1 – 23; surge space may be created in Pedestrian Spine (using disaster gurneys) or in Gold Unit • Minor Unit: RME Rooms 1 – 20; surge space in Adult Waiting Room • Pediatric Unit: Pediatric ED Rooms 1-16; Trauma Bays 6 – 7; surge space in AED or Peds Waiting Room (using disaster gurneys) • Expectant Unit: Gold Unit (per nursing)

If necessary, the hospital owns a surge tent that may be used as an alternate care site. Contact Facilities for set-up


PATIENT TRACKING/REGISTRATION/RECORD KEEPING

• In an MCI requiring rapid movement of large numbers of critical patients, the HICS 254 form is the initial method for ED patient tracking. • In a large no-notice MCI, charting will be performed on paper charts with Disaster Packets. • The Trauma Clerk has a number of “HAR-DIS” pre-printed stickers/wrist bands, similar to those used for Trauma patients, that can be used for rapidly arriving MCI patients. • Longer duration and/or slower-influx disaster events (i.e. Hospital Code Triage) may use regular registration and charting processes via Cerner, or some combination of paper and Cerner charting.


ADMITTING PATIENTS TO THE HOSPITAL

During a Hospital “Code Triage” activation

• ED Attendings should request the names of, and Spectra Link numbers assigned to, the Medicine Hospitalist, Pediatric Hospitalist, Trauma Attending and OB/Gyn Attending. • To admit the patient, the ED Physician will enter a “Request for admit” order under the Hospitalist/Attending name, and will contact that Hospitalist/Attending to give report. • The hospitalist will assign patients to admitting teams per his/her discretion.

During a Surge event without hospital “Code Triage” activation

• Patients with traumatic injuries will be admitted under the name of the Trauma Attending on-call and/or present in the ED. • If rapid decompression of patients with medical complaints/conditions is requested, the Green Attending (Delayed Unit Leader) will contact the Inpatient/ED Hospitalist at pager (310) 501-1325 to request “Code Triage admission” procedures, as described above. • If surge patients are primarily pediatric in nature, the Pediatric Hospitalist should be paged to request “Code Triage admission” procedures.


SUPPLIES & STAFFING

• Disaster Key should be retrieved by the OCN from the Pyxis in SE-1J25, listed as “*Keys, ER disaster keys” • Disaster vests, binders, forms and checklists are found in the shelves next to the AED Clerk desk • Disaster medical supplies, including gurneys, wheelchairs, linens, etc, or stored in various areas. An inventory list is in the ED EOP Binder.

For the detailed plan:

File:ED Emerg Operations Plan_rev11_2019 Disaster Plan 1.pdf

Disaster Triage

ADULT AND YOUNG ADULT Triage Category Definitions

  • Minor - Ambulates without assistance OR minor lower extremity injury
  • Expectant - No spontaneous breathing after airway positioned
  • Immediate
    • Apnea responds to positioning
    • RR >30
    • No palpable Radial Pulse/Cap refill > 2sec
    • AMS
  • Delayed - Needs gurney but not immediate

CHILD Triage Category Definitions

  • Minor - Ambulates without assistance OR minor lower extremity injury
  • Expectant - No spontaneous breathing after airway positioned and 5 rescue breaths
  • Immediate
    • Apnea responds to positioning or rescue breaths
    • RR <15 or >45
    • No palpable Radial Pulse/Cap refill > 2sec
    • Posturing or unresponsive
  • Delayed - Needs gurney but not immediate

Supplies

  • Airway Cart –
  • Atropine - use ED supplies first- Mark I antidote stock in basement - requires MAC approval (see Code Triage Manual for Phone number)
  • Cones - Triage Color Coded - Wheelchair Storage Closet
  • Decon Team Supplies (PAPRs, Level C PPE) - Storage Closet under Helipad
  • Decon Trailer - Trailer Lot
  • Disaster Cart - Central Supply and Linen Room SE BF09 - keys on big ring in Command Post (1L1) cupboard
  • Disaster Packets/Clipboards - Shelving unit next to clerk's desk, AED A-side
  • Disaster Tags - (Pedestrian spine storage by Router desk)
  • Dosimeters - Radiation Safety Office Building N32
  • Geiger Counters
    • 3 in ED Charge Nurses Office
    • 6 in Radiation Safety Office Building N32
  • Gurneys, disaster – Trailer #3 - Give keys to housekeeping - they will open trailer and assemble gurneys
  • Keys - AAED Pyxis (SE 1J25)
    • For instructions see disaster manual
  • Privacy Kits for Patients - Decon Trailer
  • Signs - Triage Station - Wheelchair Storage Closet
  • Trailers 1-5 - keys in Pyxis AAED
  • Additional Vests - Wheelchair Storage Closet
  • Wheelchairs - (SE1A04) - NA7 Key

Dir OPS 9/14/16

See Also

References