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Evacuation Issues: Institutional Planning

OSHA Training Institute – Region IXUniversity of California, San Diego (UCSD) - Extension

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Purpose

To describe the critical issues that need to be addressed in the pre-planning and active stages of healthcare facility evacuation.

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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

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Phases of a DisasterPictorial from disasterhelp.gov

Planning (Preparedness)

Response Recovery Mitigation

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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

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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

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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

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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

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Response Phase: Evacuation Hazards Falling objects Dark hallways, debris Aftershocks Fires Explosion from flammable

gases Water, risk of electrocution

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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 protectionNo loose articles

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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?

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Response Phase: Situation Assessment Location of Incident Areas of the facility

affected Potential areas to

become involved Define an evacuation

zone-away from threats

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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

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Response Phase: Activation of Evacuation Conditions that require immediate

evacuation Area in need of controlled evacuation Special needs employees or patient

groups Weather conditions

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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

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Response Phase: Staff Communication

Regularly scheduled briefings Handheld radios, phones, etc Computer disaster dashboards

Plan for the relocation of patients back into your facility

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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

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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)

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Response Phase: Physical Movement Develop movement control procedures Continual assessment of evacuation “Safe

Areas” Manpower pool (Augustine 2005)

Reserve of staff membersAwait assignments in safe area of siteSocial & pastoral support for staff & patients

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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

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Response Phase: Destination of EvacueesIf nowhere to transport

patients, consider: Field hospitals Alternative care sites

Now required by The Joint Commission for disaster plan

Clinics, nursing homes Schools Churches

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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”

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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

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Response Phase : Transportation of Evacuees

Immediate vs Delayed EvacuationFire or other imminent danger, power

outages, flooding ImmediateStructural but stable damage Delayed

Immediate requires use of anything availableBuses, hospital vans, personal cars,

tramsAmbulances will likely be tied up in a

multi-site incident

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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

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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

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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”

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Summary PLAN to be PREPARED

Emergency Action PlanTrainingPhysical Plant Preparation

RESPOND SAFELY RECOVER

Once the facility if evacuated, move off-site MITIGATE

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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.

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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.

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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.

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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

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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