All-Hazards Emergency Operation Planning for Small Acute Care Hospitals, Outpatient Surgery Clinics, and Long-Term Care Facilities
August 15, 2016
Author: Doug Hall, Checklist Boards Corporation

“Call 911 for more ambulances and take these casualties to the hospital!” 
The local hospital is the first thing on the minds of first responders and victims of a mass-casualty event. There is an expectation of the public that the emergency department can handle any crisis.  
Recent events such as local terrorist attacks and public transportation accidents put a strain on local emergency facilities, but they responded with efficient, quality care.  A larger mass-casualty event will not be self-limiting and last much longer than a few hours.  
Regional medical centers have made all-hazards preparations to respond to mass-casualty events. An important component of these preparations are the dependence on smaller acute care facilities, outpatient surgery clinics and long-term care facilities. These secondary healthcare facilities need their own all-hazards emergency
operations plan 
before a mass-casualty event. 
Small acute care hospitals, outpatient surgery clinics, and long-term care facilities need to adopt large hospital emergency management principles for an effective rapid response to a mass-casualty event. For example, planning for: 
  • Triage 
  • Patient care  
  • Patient isolation, and
  • Patient staging for evacuation  
Difficult triage and patient care decisions are needed. During a mass casualty emergency there will be no time to consult an individual or committee for direction. An all-hazards plan can make decisions more effective during this crucial time. 
As with any emergency some chaos can be expected. This can result in delayed care and injury to staff and patients. An all-hazards emergency operations plan can reduce the potential for delay and injury.  
A mass-casualty event will place extraordinary pressures on hospital personnel. Good plans, good communication and good staff training will instill the discipline needed for the long hours and the extreme conditions of an all-hazards event. 
The goal of the all-hazards plan for secondary medical facilities is to assist the primary medical facility as conditions change. 
All hospitals, outpatient clinics and long-term care facilities need an all-hazards plan.  
The main categories for secondary facilities are: 
  • Command Center –  
Located at the administrator’s conference room. 
The chain-of-command is reviewed 
Prospective chain-of-command replacements are reviewed 
Communication systems are reviewed 
Consultation with command centers of local primary hospitals  
  • Communication - 
Appointment of primary and secondary spokesperson 
Make a policy for status report statements 
Consult with the communications centers at local primary hospitals 
Make policy to inform staff of official information 
  • Security –  
Assign an emergency security team 
Make policy for facility access, food/water, and medication access 
Make security policy for patient surge and evacuation 
Establish an area for contaminated patients and materials 
Consultation with the security centers at local primary hospitals 
Consultation with local law enforcement for additional planning 
  • Triage  
Assign primary and secondary triage officers 
Plan areas for patient arrival and evacuation 
Make policy to inform staff of official information 
Consultation with triage officers at local primary hospitals 
Consultation with security centers at local primary hospitals  
  • Surge –  
Calculate maximal bed/cot capacity 
Estimate additional capacity using other facility space 
Consultation concerning evacuations to hotels and schools 
Designate a temporary morgue  
Consultation with triage officers at local primary hospitals 
  • Staff –  
Plan discussions about the extraordinary roles and responsibilities 
Plan realistic training and exercises  
Consult and train with the local primary hospitals 
Review past events such as the hospital evacuations during Katrina 
Good plans, good communication and good staff training are responsibilities for all primary and secondary medical facilities. 
Hospital all-hazards planning resources: 
Recommended Reading: 
  1. Command and Control 
National Preparedness Operational Plans – Whole Community 
Establishing a mass casualty management system 
California Hospital Incident Command System 
FEMA National Incident Management Regional Contacts 
  1. Communication 
Crisis and Emergency Risk Communications Toolkit 
Emergency Communication Plans – Federal Communications Commission 
Emergency Communications Center – University of Virginia Health System 
Successful Management of a Mass Casualty Incident 
  1. Safety and Security 
Emergency Preparedness Planning – Centers for Medicare and Medicaid 
Emergency Preparedness Templates & Checklists – CMS.gov 
Safety and Security Programs in Healthcare – IAHSS 
Safety and Security Assessment, Planning, and Training – CHA 
  1. Triage 
Triage Model for Multi-hospital Mass Casualty Incident in New York City 
Emergency Department Triage: An Ethical Analysis – BioMed Central 
Mass Casualty Triage – Pandemic Influenza and Critical Care – BioMed 
Triage and Management for Large Scale Events – UTMB Health 
  1. Surge Capacity 
What is Medical Surge? – U.S. Health and Human Services 
Hospital Surge Evaluation Tool – U.S. Health and Human Services 
Surge Planning Checklist – California Hospital Association 
Surge Hospitals – The Joint Commission 
  1. Staff 
Recommended Disaster Core Competencies for Hospital Personnel 
Disaster-Related Competencies for Healthcare Providers – U.S. HHS 
Core Competencies in Disaster Management -  
Healthcare Worker Competencies for Disaster Training – BioMed Central 
Hospital Readiness Resources – American Hospital Association 
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