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EMERGENCY PREPAREDNESS PLANPolicy #: 02-04-014

Reviewed/Updated: 09/01/2014, 10/14//2015

Table of Contents

Page #3 I. Introduction3 A. Purpose3 B. Policy3 C. Scope4 D. Key Terms

5 II. Phases of Emergency Management5 A. Mitigation6 1. Hazard Vulnerability Analysis6 2. Hazard Mitigation6 3. Risk Assessment6 4. Insurance Coverage7 5. Emergency Response Roles7 B. Preparedness7 1. Emergency Operations Plan8 2. Standardized Emergency Management System8 3. Integration with Community Response8 4. Coordination w/ Government Response Agencies9 5. Coordination w/ Emergency Responders10 6. Limitations10 7. Acquiring Resources10 8. Roles/Responsibilities13 9. Initial Communications and Notifications14 10. Continuity of Operations16 11. Clinic Patient Surge Preparedness19 12. Disaster Medical Resources20 13. Mental Health Disaster22 14. Public Info/Risk Communications23 15. Training, Exercises and Plan Maintenance26 16. Plan Development and Maintenance26 C. Response26 1. Response Priorities27 2. Alert, Warning & Notification27 3. Response Activation and Initial Actions27 4. Emergency Management Organization29 5. Emergency Operations Center (EOC) Operations30 6. Medical Care33 7. Acquiring Response Resources34 8. Communications34 9. Public Information/Crisis Communications36 10. Security36 11. Mental Health Response38 12. Volunteer/Donation Management39 13. Response to Internal Emergencies45 14. Response to External Emergencies50 D. Recovery50 1. Introduction51 2. Documentation51 3. Inventory Damage and Loss

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51 4. Lost Revenue through Disruption of Services51 5. Cost/Loss Recovery Sources52 6. Psychological Needs of Staff and Patients52 7. Restoration of Services52 8. After-Action Report52 9. Staff Support

54 Appendix A: Emergency Management Acronyms

56 Appendix B: Emergency Management Glossary

64 Appendix C: Mitigation Tool – Clinic Hazard and Vulnerability Analysis

70 Appendix D: Management of Environment/Hazard Surveillance & Risk Assessment Report Form

73 Appendix E: Structural and Nonstructural Hazard Mitigation Checklist

75 Appendix F: Response Roles & Requirements

78 Appendix G: Emergency Response Team – PATHS Day-to-Day Organizational Chart

79 Appendix H: Emergency Response Team – Position Assignments

80 Appendix I: Emergency Response Team Organization Chart

81 Appendix J: Training & Exercises

91 Appendix K: Disaster Contact List

92 Appendix L: Health Care Alternate and Referral Facility Locations

Appendix M: Emergency Procedures93 a. Fire Related Emergency95 b. Medical Related Emergencies96 c. Bomb Threat99 d. Suspect Package100 e. Power Outages101 f. Gas Leak or Chemical Spill102 g. Environmental Emergencies103 h. Personal Threat105 i. Natural Disasters

Appendix N: Emergency Floor Plans106 a. Danville – Ground Floor/Basement107 b. Danville – First Floor108 c. Danville – Second Floor109 d. Martinsville110 e. Chatham Facility Floor Plan111 f. Boydton – Ground Floor/Basement112 g. Boydton – First Floor

113 Appendix O: Job Action Sheets114 a. Incident Manager (IM)115 b. Public Information Officer (PIO)116 c. Operations Section Chief117 d. Division/Group Supervisor118 e. Planning Section Chief119 f. Logistics Section Chief120 g. Finance/Administration Section Chief

121 Appendix P: Home Emergency Preparedness Guide

127 Appendix Q: Damage Check List

131 Appendix R: Emergency Codes

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I. INTRODUCTION

A. Purpose: The purpose of the PATHS’ Emergency Preparedness Plan (EPP) is to establish a basic emergency program to provide timely, integrated, and coordinated response to the wide range of natural and manmade events that may disrupt normal operations and require preplanned response to internal and external disasters.

The objectives of the emergency management program include:

1. To provide maximum safety and protection from injury for patients, visitors, and staff.

2. To attend promptly and efficiently to all individuals requiring medical attention in an emergency situation.

3. To provide a logical and flexible chain of command to ensure maximum use of resources.

4. To maintain and restore essential services as quickly as possible following an emergency incident or disaster.

5. To protect clinic property, facilities, and equipment.

6. To satisfy all applicable regulatory and accreditation requirements.

B. Policy: PATHS will be prepared to respond to a natural or man-made disaster, suspected case of bioterrorism or other emergency in a manner that protects the health and safety of its patients, visitors, and staff, and that is coordinated with a community-wide response to a large-scale disaster.

All employees will know and be prepared to fulfill their duties and responsibilities as part of a team effort to provide the best possible emergency care in any situation. Each supervisor at each level of the organization will ensure that employees are aware of their responsibilities.

PATHS will work in close coordination with the State Medical Health Operational Area Coordinator (MHOAC) and other local emergency officials, agencies and health care providers to ensure a community-wide coordinated response to disasters.

C. Scope: Within the context of this plan, a disaster is any emergency event which overwhelms or threatens to overwhelm the routine capabilities of any facility.

This all-hazards EOP describes an emergency management program designed to respond to natural and man-made disasters, including technological, hazardous material, and terrorist events.

This plan describes the policies and procedures PATHS will follow to mitigate,

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prepare for, respond to, and recover from the effects of emergencies.

D. Key Terms: Refer to “Appendix A - Emergency Management Acronyms” and “Appendix B - Emergency Management Glossary” for a list of acronyms and more extensive glossary, respectively. The following terms are used frequently throughout this document.

1. ALTERNATE SITES/FACILITIES: Locations other than the primary facility where operations will continue during an emergency.

2. CONTINUITY OF OPERATIONS (COOP): Plans and actions necessary to continue essential business functions and services and ensure continuation of decision making even though primary facilities are unavailable due to emergencies.

3. EMERGENCY OPERATIONS CENTER (EOC): The location at which management can coordinate clinic activities during an emergency. It is managed using the Incident Command System (ICS). The EOC may be established in the primary facility or at an alternate site.

4. EMERGENCY PREPAREDNESS COMMITTEE (EPC): The Emergency Preparedness Committee guides the development and maintenance of the organization’s emergency management program and development of its emergency operations plan.

5. EMERGENCY RESPONSE TEAM (ERT): The Emergency Response Team (ERT) consists of the clinic staff who will fill the core positions of the Emergency Operations Center (EOC) and manage the clinic’s emergency response.

6. ESSENTIAL FUNCTIONS (EF): Essential functions and services are those that implement the clinic’s core mission and goals. The extended loss of these functions, following an emergency, would create a threat to life/safety, or irreversible damage to the facility, its staff or its stakeholders.

7. HAZARD MITIGATION: Measures taken by a facility to lessen the severity or impact a potential disaster or emergency may have on its operation. Hazard mitigation can be divided into two categories.

a) Structural Mitigation. Reinforcing, bracing, anchoring, bolting, strengthening or replacing any portion of a building that may become damaged and cause injury, including exterior walls, exterior doors, exterior windows, foundation, and roof.

b) Nonstructural Mitigation: Reducing the threat to safety posed by the effects of earthquakes on nonstructural elements. Examples of nonstructural elements include: light fixtures, gas cylinders, hazmat containers, desktop equipment, unsecured bookcases and

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other furniture.

8. HAZARD VULNERABILITY ANALYSIS: Hazard vulnerability analysis identifies ways to minimize losses in a disaster, considering internal and external emergencies to the facility and the surrounding community.

9. INCIDENT COMMAND SYSTEM (ICS): A temporary management system used to manage and coordinate clinic activities during an emergency. ICS is designed to facilitate decision-making in an emergency environment.

10. MEDICAL HEALTH OPERATIONAL AREA COORDINATOR (MHOAC): The position in the Standardized Emergency Operations System (SEMS) responsible for all disaster medical and health operations in an operational area. The MHOAC is stationed in the County EOC and is frequently, but not always, the County Health Officer or designee. During the response to disasters, the MHOAC is the Operational Area contact point for requests for medical and health resources including personnel, supplies and equipment, pharmaceuticals, and medical transport.

11. MULTI-HAZARD APPROACH: A multi-hazard approach to disaster planning evaluates all threats including the impacts from all natural and man-made disasters, including technological threats, terrorism, and a state of war.

12. OPERATIONAL AREA (OA): An intermediate level of a state emergency organization, consisting of a county and all political subdivisions within the county area. Clinics and other health facilities will coordinate their disaster response with the State Medical Health Operational Area Coordinator (MHOAC).

II. PHASES OF EMERGENCY MANAGEMENT: Emergency management involves work to be completed under four separate, yet integrated processes: Mitigation (Pre-event planning and actions which aim to lessen the effects of potential disaster), Preparedness (Actions taken in advance of an emergency to prepare the organization for response.), and Response (Activities to address the immediate and short-term effects of an emergency or disaster. Response includes immediate actions to save lives, protect property and meet basic human needs), and Recovery (Activities that occur following a response to a disaster that are designed to help an organization and community return to a pre-disaster level of function).

A. Mitigation: PATHS will undertake risk assessment and hazard mitigation activities to lessen the severity and impact of a potential emergency. Mitigation begins by identifying potential emergencies (hazards) that may affect the organization's operations or the demand for its services. This will be followed by development of a strategy to strengthen the perceived areas of vulnerability within the organization.

During the mitigation phase, PATHS’ Safety Officer and staff will identify internal and external hazards and take steps to reduce the level of threat they pose by

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mitigating those hazards or reducing their potential impact on the clinic. The areas of vulnerability that cannot be strengthened sufficiently are then addressed in emergency plans.

Mitigation activities may occur both before and following a disaster.

1. Hazard Vulnerability Analysis: PATHS will conduct a hazard vulnerability analysis to identify hazards and the direct and indirect effect these hazards may have on the organization. This will provide information needed by the organization to minimize losses in a disaster.

“Appendix C - Clinic Hazard and Vulnerability Analysis” provides a tool for estimating and ranking the probability of occurrence and potential severity of various events. This assessment should be performed every three to five years.

As part of its risk management program, PATHS Safety Officer will also conduct a Management of Environment safety survey of its facilities at least quarterly. “Appendix D: Hazard Surveillance / Assessment Form - Hazard Vulnerability Assessment Tool” provides a tool for conducting that survey, ranking problems and setting priorities for remediation. This ongoing remediation contributes to reducing the overall vulnerability of the clinic to various hazards. The tool provided in Appendix D.2 should be modified, if necessary, to address problems associated with hazards identified through the hazard vulnerability assessment.

2. Hazard Mitigation: PATHS will undertake hazard mitigation or retrofitting measures to lessen the severity or impact a potential disaster may have on its operation. These measures are taken prior to disasters to minimize the damage to the facility.

Refer to “Appendix E - Structural and Non-Structural Hazard Mitigation Checklists”, for a checklist of structural and non-structural hazard mitigation recommendations for specific hazards.

3. Risk Assessment: PATHS will assess the risks identified in its Hazard Vulnerability Assessment that could not be eliminated or satisfactorily mitigated through its hazard mitigation program and determine their likelihood of occurrence and the severity of their consequences. This assessment of remaining risks will help to define the emergency response role the clinic adopts for itself and the preparation required to meet that role.

4. Insurance Coverage: PATHS’ Director of Human Resources will meet with insurance carriers to review all insurance policies and assess the facility’s coverage for relocation to another site, loss of supplies and equipment, and structural and nonstructural damage to the facility.

The Director of Human Resources will assess facility coverage for floods or earthquakes. If coverage is absent or inadequate, the organization will

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evaluate if it is financially sound to acquire it. Facilities located in special flood hazard areas must have flood insurance to be eligible for disaster assistance.

5. Emergency Response Roles: PATHS may play a variety of roles in responding to disasters including providing emergency medical care, providing temporary shelter and expanding primary care services to meet increased community needs created by damage to other health facilities. PATHS may also provide mental health services to disaster victims and serve as a conduit for information dissemination to affected communities. However, facilities are not equipped to respond definitively to all disasters. Clinic roles may be constrained by limited resources and technical capability and by the impact of the disaster on the clinic facility. Refer to “Appendix F – Response Roles and Requirements” for a list of potential roles and the planning and preparedness requirements for meeting those roles.

As a part of its mitigation program, PATHS will identify the response roles it will perform following a disaster. This decision will involve input from clinic management and staff, the Board of Directors, the community and government emergency officials. Based on the findings of the risk assessment, PATHS will take the following steps to define the disaster response roles for which it should prepare:

a) Assess the pre-disaster medical care environment and the role the organization performs in providing health services.

b) Assess clinic resources including availability of staff to respond and ability of the clinic to survive intact.

c) Discuss potential response roles and findings of risk assessment with Medical Health Operational Area Coordinator or Office of Emergency Services.

d) Obtain community input.

e) Obtain input from staff, especially the Medical Staff, Site Managers, Safety Officer, and Chief Operating Officer.

f) Present recommendations to the Board of Directors for ratification.

B. Preparedness: Preparedness activities build organization capacity to manage the effects of emergencies should one occur. During this phase, PATHS’ Safety Officer, Chief Executive Officer, Emergency Preparedness Committee (EPC) and staff will develop plans and operational capabilities to improve the effectiveness of the clinic’s response to emergencies. Specifically, the clinic will: Develop / update emergency plans and procedures, including the Emergency Operations Plan; Develop and update agreements with other community health care providers and with civil authorities; Train emergency response personnel; and Conduct drills and exercises.

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1. Emergency Operations Plan: PATHS’ Emergency Operations Plan is an “all-hazards” plan that will guide PATHS response to any type of a disaster or emergency.

2. Standardized Emergency Management System (SEMS): PATHS has incorporated the principles of SEMS into its Emergency Operations Plan to ensure maximum compatibility with local government response plans and procedures.

SEMS incorporates the Incident Command System (ICS) which provides an efficient tool for the management of emergency operations. SEMS/ICS is designed to be adaptable to any emergency or incident. The system expands in a rapid and logical manner from an initial response to a major incident call-out. When organizational needs dictate, the system also contracts just as rapidly.

These components of SEMS / ICS are incorporated or referenced in this EPP: Common terminology; Modular organization; Unified Command; Action Planning; Manageable Span-of-Control; and Multi-Agency and Inter-Agency Coordination.

PATHS interfaces with SEMS through the Medical Health Operational Area Coordinator (MHOAC), who is usually the county health officer.

SEMS operates at the following levels of government:

a) State - Statewide resource coordination integrated with federal agencies.

b) Regional - Manages and coordinates information and resources amongst operational areas.

c) Operational Area – Manages and coordinates all local governments within the geographic boundary of a county.

d) Local - County, city or special district.

e) Field - On-scene responders.

3. Integration with Community-wide Response: PATHS will notify the local MHOAC of any emergency impacting clinic operations and will coordinate its response to community-wide disasters with the overall medical and health response of the Operational Area. See “Appendix K - Disaster Contact List” for list of agencies and individuals, including the MHOAC, who should be contacted in emergencies.

4. Coordination with Government Response Agencies: To the extent possible, PATHS will ensure that its response is coordinated with the decisions and actions of the MHOAC and other health care agencies

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involved in the response. To ensure coordination, clinic staff will:

a) In coordination with the organization’s Consortium, meet with the MHOAC to define the organization’s role in the emergency response system. Determine which response roles are expected by officials and which are beyond the system’s response needs or the clinic’s response capabilities. See “Appendix F - Response Roles and Requirements” for a list of potential clinic roles.

b) Participate in planning, training and exercises sponsored by medical and health agencies.

c) Develop reporting and communications procedures to ensure integration with Operational Area response.

d) Define procedures for requesting and obtaining medical resources and for evacuating / transporting patients.

e) During a response, report the status and resource needs of the clinic and obtain or provide assistance in support of the community-wide response.

5. Coordination with Emergency Responders:

a) Emergency services availability: During an area-wide disaster, fire, EMS and law emergency services may not be able to respond to emergencies at the clinic.

b) Response authority: PATHS’ staff will cooperate fully with EMS and law enforcement personnel when they respond to emergencies at any facility. This may include providing information about the location of hazardous materials or following instructions to evacuate and close the facility.

c) Command post: PATHS has identified a recommended location for an emergency responder command post for coordinating the response to an emergency at each facility. The location of the primary command post and an alternate are listed in “Appendix L – Health Care Alternate and Referral Facility Locations”.

d) Coordination with other Medical Facilities: PATHS recognizes that it may need to rely on other health care facilities, especially those nearby, in responding to a disaster to augment its capacity to meet patient care needs. PATHS will review existing formal and informal arrangements with health facilities to explore expanding their provisions to cover disaster response conditions. The organization will also seek to establish agreements with relevant facilities where no agreement currently exists. PATHS views these agreements as reciprocal and will also explore opportunities to provide support to these facilities if conditions allow.

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Examples of potential disaster related arrangements with nearby hospitals include:

(1) Referral / diversion of patients to nearby hospitals, especially patients that require a higher level of care than PATHS can provide.

(2) Acceptance of diverted patients from hospitals to increase their capacity to care for seriously ill and injured.

6. Limitations: During an area-wide disaster in which the Operational Area has opened its EOC, patient transfers and access to ambulances may need to be coordinated through the MHOAC, overriding other agreements. Developing arrangements for receipt or diversion/referral of disaster victims requires careful and detailed planning including:

a) Alert and notification;

b) Sharing of medical information;

c) Patient tracking; and

d) Contingencies that impact ability of either party to meet the terms of the agreement.

7. Acquiring Resources: PATHS will develop procedures for augmenting supplies, equipment and personnel from a variety of sources. Assistance may be coordinated through the following channels:

a) Prior agreements with vendors for emergency re-supply;

b) Stockpiles of medical supplies and pharmaceuticals that may be required to be required in an emergency response;

c) Medical Health Operational Area Coordinator (MHOAC) assistance to clinics.

d) From other clinics, hospitals or health care providers.

8. Roles / Responsibilities:

a) PATHS’ Chief Executive Officer, or designee, is responsible for the development of the EPP and for directing the response to emergencies. Specific responsibilities include:

(1) Execute (oversee) the development and implementation of the disaster plan;

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(2) Appoint an Emergency Preparedness Committee (EPC) to coordinate the development and maintenance of PATHS’ Emergency Operations Plan and provide for ongoing training for all staff.

The EPC should include the Chief Operations Officer, Information Technology Director, Safety Officer, Facility Maintenance Engineer, and the Director of Administrative Operations. The EPC role may be assigned to an existing committee of the clinic, such as the Continuous Quality Improvement (CQI) Committee.

(3) Assign staff emergency management duties and responsibilities. Appoint the Emergency Response Team (ERT). See “Appendix G – PATHS Day-To-Day Org Chart”, “Appendix H – Emergency Response Team Position Assignments” and “Appendix I - Emergency Response Team Organization Chart”.

(4) Ensure staff is trained to perform emergency roles. See “Appendix J - Training And Exercises”.

(5) Ensure that drills and exercises are conducted semi-annually and records are maintained. See “Appendix J - Training and Exercises”.

(6) Evaluate the disaster program annually and update as needed including a description of how, when and who will perform the activity.

(7) Activate the clinic’s emergency response.

(8) Direct the overall response to the disaster/emergency.

(9) Develop the criteria for and direct the evacuation of staff, patients and visitors when indicated.

(10) Ensure the organization takes necessary steps to avoid interruption of essential functions and services or to restore them as rapidly as possible.

(11) Ensure a hazard vulnerability assessment is performed periodically.

b) Chief Operations Officer, or designee will:

(1) Serve as leader, co-leader, or member of the emergency response team (ERT).

(2) Identify alternates and successors if unavailable or if

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response requires 24 hour operation.

(3) Contact local health department to determine local system for bioterrorism updates and monitors for updates.

c) Medical Director, or designee will:

(1) Provide clinicians with updates from the CDC and local Health Department on standards for the detection, diagnosis, and treatment of chemical and bioterrorism agents.

(2) Ensure the continuity of care and maintenance of medical management of all patients in the care of the organization during a disaster.

(3) Assign clinical staff to medical response roles (triage, treatment, decontamination, etc.)

(4) Determine disaster response clinical staffing needs in cooperation with the Director of Administrative Operations.

d) Director of Administrative Operations will:

(1) Serve as a member of the ERT.

(2) Monitor CDC for bioterrorism updates.

(3) Provide clinicians with updates from the CDC and NHD of standards or the detection, diagnosis, and treatment of chemical and bioterrorism agents.

(4) Determine the disaster response clinical staffing needs in cooperation with the Medical Director.

(5) Perform other duties delegated by the PATHS’ Chief Executive Officer, Chief Operations Officer or Safety Officer consistent with training and scope of practice.

e) The Safety Officer will: Appoint teams and develop procedures for the following response tasks:

(1) Light search and rescue: Appoint and train a light search and rescue team to ensure all rooms are empty and all staff, patients, and visitors leave the premises when the facility is evacuated. If required and safe, this team will perform additional search and rescue tasks that do not entail using equipment or disturbing collapsed structures.

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(2) Damage Assessment: Appoint and train a damage assessment team on each shift to evaluate items on the “Damage Assessment Checklist” (see Appendix Q). Supply the teams with hard hats, work gloves, flashlights, clipboards, tape, cameras, film and videotape, if possible.

f) All PATHS’ Staff:

(1) All PATHS’ staff members have emergency and disaster response responsibilities. The job descriptions of all staff positions will include the following language: “Participates in all safety programs which may include assignment to an emergency response team.”

(2) Additional specific response duties may also be included for staff with appropriate skills and responsibilities.

(3) In addition, all staff are required to:

(a) Familiarize themselves with evacuation procedures and routes for their areas. See “Appendix M - Emergency Procedures” and “Appendix N – Facility Floor Plans”.

(b) Become familiar with basic emergency response procedures for fire, HAZMAT and other emergencies.

(c) Understand their roles and responsibilities in PATHS’ plans for response to and recovery from disasters. See “Appendix O – Job Action Sheets”.

(d) Participate in training and exercises. These exercises are intended to practice emergency response activities and improve readiness. See “Appendix J - Training And Exercises”.

(4) All staff will also be encouraged to:

(a) Make suggestions to their supervisor or the Emergency Preparedness Committee on how to improve organizational preparedness.

(b) Prepare family and home for consequences of disasters. See “Appendix P – Home Emergency Preparedness Guide” for guidelines.

9. Initial Communications and Notifications:

a) PATHS Staff Call List: PATHS’ Safety Officer will compile and

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maintain an internal contact list that will include the following information for all staff: name, position title, home phone, cell phone, and preferred method of contact during off hours. The Staff Call List contains sensitive contact information and will be treated confidentially. The list of staff phone numbers will be kept offsite as well as onsite by key employees and at key locations. The phone list will be provided to the organization’s contracted answering service.

PATHS’ Director of Information Technology will develop an email group to facilitate rapid staff contact.

b) External Notification: The Safety Officer will compile and maintain an external contact list of phone numbers of emergency response agencies, key vendors, stakeholders, and resources.

c) Primary Communications Methods: The primary means of emergency communication is the local telephone system. If telephones fail, staff will notify the telephone provider by any means available including: telephones in another area of the facility, cell phones, or e-mail.

(1) PATHS has installed standard telephone jacks that bypass the electronic phone system. These jacks are used for fax machines and for telephones that do not require electricity to operate.

(2) Other alternate communications tools include:

(a) FAX, Cell Phones, Internet/Email, and Voice Messaging.

(b) If telephone and radio communications are unavailable, runners will be assigned to take messages to and from the facility and appropriate agencies rendering assistance.

(3) The clinic EOC will monitor television and radio broadcasts to remain up-to-date on official government announcements and other information during a disaster.

10. Continuity of Operations: It is PATHS’ policy to maintain service delivery or restore services as rapidly as possible following an emergency that disrupts those services. As soon as the safety of patients, visitors, and staff has been assured, the organization will give priority to providing or ensuring patient access to health care.

a) Continuity of Operations Goals and Planning Elements: The organization will take the following actions to increase its ability to

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maintain or rapidly restore essential services following a disaster to ensure:

(1) Patient, visitor and personnel safety: Develop, train on and practice a plan for responding to internal emergencies and evacuating clinic staff, patients and visitors when the facility is threatened. See “Appendix M – Emergency Procedures” and “Appendix N – Emergency Floor Plans”.

(2) Continuous performance or rapid restoration of the organization’s essential services during an emergency

(3) Develop plans to obtain needed medical supplies, equipment and personnel. See “Appendix K – Disaster Contact List”. Identify a backup site or make provisions to transfer services to a nearby provider. See “Appendix L.1 – Health Care Alternate and Referral Facilities”.

b) Protection of medical records: To the extent possible, protect medical records from fire, damage, theft and public exposure. If a facility is evacuated, provide security to ensure privacy and safety of medical records.

c) Protection of vital records, data and sensitive information:

(1) Ensure offsite back-up of financial and other data.

(2) Store copies of critical legal and financial documents in an offsite location.

(3) Protect financial records, passwords, credit cards, provider numbers and other sensitive financial information.

(4) Update plans for addressing interruption of computer processing capability.

(5) Maintain a contact list of vendors who can supply replacement equipment.

(6) Protect information technology assets from theft, virus attacks and unauthorized intrusion.

d) Protect medical and business equipment:

(1) Compile a complete list of equipment serial numbers, dates of purchase and costs. Provide list to the Director of Finance and store a copy offsite.

(2) Protect computer equipment against theft through use of

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security devices.

(3) Use surge protectors to protect equipment against electrical spikes.

(4) Secure equipment to floors and walls to prevent movement during earthquakes.

(5) Place fire extinguishers near critical equipment, train staff in their use, and inspect according to manufacturer’s recommendations.

e) Relocation of services: PATHS will take the following steps, as feasible and appropriate, to prepare for an event that makes the primary clinic facility unusable. PATHS will:

(1) Identify a back-up facility for continuation of clinic health services, if possible. See “Appendix L – Health Care Alternate and Referral Facility Locations” for location of back-up facility.

(2) Establish agreements with nearby health facilities to accept referrals of clinic patients.

(3) Establish agreements with nearby health facilities to allow clinic staff to see clinic patients at these alternate facilities.

(4) Identify a back-up site for continuation of clinic business functions and emergency management activities. See “Appendix L – Health Care Alternate and Referral Facility Locations” for location.

f) Restoration of utilities: PATHS will:

(1) Maintain a contact list of utility emergency numbers.

(2) Ensure availability of phones and phone lines that do not rely on functioning electrical service.

(3) Request priority status for maintenance and restoration of telephone service from local telephone service provider.

(4) PATHS will strive to obtain emergency generators at each facility to ensure its ability to continue operations in the event of an emergency that creates power outages.

(5) PATHS will obtain assistance from local utilities or vendors. Specific steps include:

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(a) Inventory essential equipment and systems that will need continuous power.

(b) Determine the maximum length of time the clinic will operate on emergency power (i.e., is emergency power primarily for short term outages or for extended operations)

(c) Determine power output needs.

(d) Determine location of nearest supplies of selected fuels that can be accessed in an emergency.

(e) Perform recommended periodic maintenance.

(f) Run monthly generator start-up tests.

11. Clinic Patient Surge Preparedness: Surge capacity encompasses PATHS’ resources required to deliver health care under situations which exceed normal capacity including potential available space in which patients may be triaged, managed, vaccinated, decontaminated, or simply located; available personnel of all types; necessary medications, supplies and equipment; and even the legal capacity to exceed authorized care capacity.

a) Normal clinic capacity could be exceeded during any type of emergency for reasons that include the following:

(1) Random spikes in numbers of presenting patients.

(2) Seasonal or other cyclical spikes (e.g., school required immunizations, flu epidemics, etc.).

(3) Convergence of ill or injured resulting from disasters.

(4) Psychogenic convergence that results from emergencies.

(5) A combination of any of the above.

b) Events that create patient surge may also reduce clinic resources through exhaustion of supplies and pharmaceuticals and reduced staff availability. Staff may be directly impacted by the emergency, unable to reach the clinic or required to meet commitments at other health facilities.

c) PATHS’ Medical Director and Director of Administrative Operations, and other staff with responsibility for emergency preparedness will review provisions of Operational Area emergency plans that describe:

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(1) How the surge capacity of the health system will be increased.

(2) Patient transportation policies and procedures for bioterrorism and other major disasters.

(3) Procedures for augmenting medical care resources at sites of medical care including Operational Area plans for accessing and distributing the contents of the National Pharmaceutical Stockpile.

d) The Medical Director and Director of Administrative Operations will develop a surveillance process to provide early indications of potential for patient surge that may result from an infectious disease outbreak, bioterrorist attack, or release of a hazardous material. Staff will monitor:

(1) Appointment patterns.

(2) Walk-in utilization patterns.

(3) News reports about flu and other pandemics.

(4) Signs of bioterrorism attacks.

(5) Past utilization experience to identify cyclical variations in utilization.

e) Patient flow and site planning: PATHS’ Medical Director and Director of Administrative Operations will:

(1) Periodically review patient flow and identify areas on facility grounds that can be converted to triage sites and patient isolation areas.

(2) Evaluate the appropriateness of the use of break rooms and other spaces for patient holding, decontamination or treatment areas.

(3) Designate sites available for isolating victims of a chemical or bioterrorist attack. Sites should be selected in coordination with the site managers based on patterns of airflow and ventilation, availability of adequate plumbing and waste disposal, and patient holding capacity.

(4) Ensure triage and isolation areas are accessible to emergency vehicles and to patients.

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(5) Triage, decontamination and isolation sites should have controlled access.

f) PATHS will also take the following actions to increase surge capacity:

(1) Store blankets and other items required for holding and sheltering patients while they await transfer.

(2) Establish reciprocal referral agreements with nearby clinics and hospitals.

(3) Survey staff to develop estimates of the likely number of clinical and non-clinical staff able to respond during operating hours and off hours for each day of the week. The estimates will take into account distance, potential barriers and competing responsibilities (hospital practice, other clinics, etc.).

g) PATHS may be also be able to refer/divert patients to other nearby sites if a site is damaged or overwhelmed, or could obtain space and support from other health care providers nearby.

12. Disaster Medical Resources

a) Personnel: PATHS will rely primarily on its existing staff for response to emergencies and will, therefore, take the following measures to estimate staff availability for emergency response:

(1) Identify clinical staff with conflicting practice commitments.

(2) Identify staff with distance and other barriers that limit their ability to report to the site.

(3) Identify staff who are likely to be able to respond rapidly to the site.

(4) Develop a roster of bi-lingual staff by language.

(5) Promote staff home emergency preparedness and to encourage staff to identify childcare resources that are likely to remain open following a disaster. See “Appendix P – Home Emergency Preparedness Guide”.

b) Pharmaceuticals / Medical Supplies / Medical Equipment:

(1) PATHS will determine the amount of medical supplies and pharmaceuticals that is prudent and possible to stockpile. Given limited resources, the organization will stockpile only

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those items it is highly likely to need immediately in a response or in its day-to-day operations. All stored items will be rotated to the extent possible.

(2) PATHS will identify primary and secondary sources of essential medical supplies and pharmaceuticals and develop estimates of the expected time required for resupply in a disaster environment.

c) National Pharmaceutical Stockpile: In a bioterrorist event, if mass quantities of pharmaceuticals are needed then the county will request mobilization and delivery of the National Pharmaceutical Stockpile through the State of Virginia. The CDC has established the National Pharmaceutical Stockpile (NPS) program as a repository of antibiotics, chemical antidotes, life support medications, IV administration sets, airway maintenance supplies including ventilators, and other medical/surgical supplies. The Virginia Department of Health and the Governor's Office of Emergency Services are the lead state agencies for obtaining access to the NPS. The NPS is designed to supplement and re-supply state and local public health and medical response teams in the event of a biological and/or chemical terrorism incident anywhere in the U.S.

It is not anticipated that healthcare facilities will be directly involved with the distribution of NPS assets. However, organizational leadership should be informed of local level plans and what role, if any, they might be expected to play in the distribution of assets to the community.

d) Personal Protective Equipment (PPE):

(1) PATHS will take measures to protect its staff from exposure to infectious agents and hazardous materials. Health care workers will have access to and be trained on the use of personal protective equipment. PATHS will obtain and maintain an adequate supply of complete sets of PPE at each site.

(2) All clinical support staff members receive training on the proper use of PPE during new employee orientation, and whenever there are changes made to PPE design. Training Records will reflect the nature of training each employee receives in the proper use of PPE.

(3) The Medical Director and Director of Administrative Operations will designate clinical staff members who are to receive PPE when a patient with a suspected infectious agent is present. Licensed medical personnel and support personnel assigned to respond to care for victims of

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weapons of mass destruction will be assigned PPE.

(4) Protective equipment is located in nursing storage at each site, and will be accessed by the individual site manager or designee when a patient with a suspected infectious disease presents.

13. Mental Health Disaster:

a) Following a bioterrorism event, or other major disaster, anxiety and alarm can be expected from infected patients, their families, healthcare workers, and the worried well. Psychological responses may include anger, fear, panic, unrealistic concerns about infection, fear of contagion, paranoia, and social isolation. When available, mental health workers (psychiatrists, psychologists, social workers, and clergy) can be deployed to help manage the mental health needs of patients and families.

b) PATHS’ Chief Operations Officer will establish a mental health disaster program and appoint a clinic Disaster Mental Health Coordinator who will be the Director of Behavioral Health, or other licensed mental health professional. (If the clinic has no behavioral health professionals available, the Medical Director may choose a staff person to identify and coordinate with external mental health resources.)

c) The scope of mental health services PATHS can perform depends in large part on the availability of licensed mental health providers at the clinic during the response to disasters.

d) Mental Health Preparedness: The Behavioral Health Director, Medical Director, and Director of Administrative Operations (and Disaster Mental Health Coordinator, if applicable), in coordination with Emergency Preparedness Committee, will develop and exercise plans and procedures for implementing the disaster mental health program during an emergency. Specific preparedness tasks for the Mental Health Coordinator or designee may include:

(1) Develop an internal clinic mental health disaster response plan.

(2) Serve as a member of the Emergency Preparedness Committee and the Emergency Response Team.

(3) Promote mental health preparedness through clinician and staff training and exercises to test mental health response. Promote training of clinicians in the basics of disaster mental health intervention, especially if there is a site that does not employ a licensed mental health professional.

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(4) Establish a mental health response team. Develop mental health team member callback lists and alert and notification procedures for off-hour activation.

(5) Coordinate with local jurisdiction and Operational Area (county) to identify community resources and define procedures for accessing those resources in an emergency.

(6) Develop and maintain a resource list of community mental health resources (County Mental Health Agency, American Red Cross, clergy, community mental health providers, etc.) that could augment the response of the clinic’s mental team. Establish MOUs when possible.

(7) Identify mental health disaster communications needs.

(8) Work with the clinic PIO to develop information (brochures, PSAs, etc.) that could be used in a response.

(9) Acquire and maintain the following resources that will be stored with other disaster supplies in a container labeled “Mental Health Supplies”

(10) Contact information for clinic disaster mental health team and other mental health resources updated annually.

(11) A master copy of one or more brochures providing information about typical survivor responses to a disaster or critical incident with clinic or mental health agency contact phone numbers.

(12) A supply of brochure copies available for immediate use.

(13) Culturally appropriate brochures in the languages of the organization’s target populations.

(14) A basic office supply "go-box" with pens, paper clips, tape, note pads, etc. available to go with staff to work sites.

(15) Paper, crayons and other items for children.

(16) Cell phone or calling cards available for staff to use.

(17) Disaster forms to document contacts.

(18) Copies of a local resource directory and an agency directory to facilitate referrals.

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14. Public Information / Risk Communications:

a) The Chief Executive Officer, or designee, will appoint a Public Information Officer (PIO) to coordinate the release of information internally and externally to media and community. The PIO will develop a Disaster Public Information Plan to guide clinic information dissemination and response to media and community inquiries following the disaster. This plan will include:

(1) Provisions for coordination with the Operational Area Public Information Officer during an emergency to ensure availability of up-to-date information and consistency of released information. It will address the information needs of the organization’s various “publics” that need to be considered when providing information. These stakeholders include community, patients, staff, volunteers and other interested parties.

(2) Explanation of how the following information is gathered, verified, coordinated with the PIO, and communicated to communities served by the clinic and other stakeholders:

(a) The nature and status of the emergency.

(b) Appropriate actions for protection, seeking health care services, and obtaining needed information.

(c) The status of the organization’s facilities and its ability to deliver services.

(3) Provisions for employee meetings, internal informational publications, press releases and other programs intended to disseminate accurate information regarding the event and its impact as well as deal with misinformation.

b) PATHS will incorporate disaster preparedness information into its normal communications and education programs for staff and patients including:

(1) Home and family preparedness. See “Appendix P – Home Emergency Preparedness Guide” for guidelines.

(2) Information on facility emergency preparedness activities.

(3) Information dissemination channels for these activities include newsletters, pamphlets, health education and in-service education classes, and internet postings.

15. Training, Exercises and Plan Maintenance

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a) Training (See “Appendix J - Training and Exercises” for general guidelines.)

(1) Employee Orientation: All employees will learn the following information from their new employee orientation or subsequent safety training. This checklist will also be used to design facility-wide drills to test clinic emergency response capabilities. All employees must attend annual training and updates on emergency preparedness, including elements of this plan. Employee essential knowledge and skills include:

(a) The location and operation of fire extinguishers.

(b) The location of fire alarm stations and how to shut off fire alarms.

(c) How to page a fire.

(d) How to dial 911 in the event of a fire.

(e) How to assist patients and staff in the evacuation of the premises.

(f) Location and use of oxygen (licensed staff).

(g) Location and use of medical emergency equipment (medical staff and staff trained on AED).

(h) Actions to be taken during fire and other emergency drills.

(2) Clinician Bioterrorism Training:

(a) All medical and clinical support staff will receive documented training on procedures to treat and respond to patients infected with a bioterrorism agent. Training will include:

(i) Recognition of potential epidemic or bioterrorism events.

(ii) Information about most likely agents, including possible behavioral responses of patients.

(iii) Infection control practices.

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(iv) Use of Personal Protective Equipment.

(v) Reporting requirements.

(vi) Patient management.

(vii) Behavioral responses of patients to biological and chemical agents.

(b) General staff training will include:

(i) Roles and responsibilities in a bioterrorism event.

(ii) Information and skills required to perform their assigned duties during the event.

(iii) Awareness of the backup communications systems used in a bioterrorism event.

(iv) The location of and how to obtain supplies, including Personal Protective Equipment (PPE) during a bioterrorism event.

(c) Clinicians and other staff will receive periodic updates as new information becomes available.

(3) Mental Health Team Training: PATHS’ Mental health team members will receive training that promotes understanding of the normal human response to disasters. The training for the Mental Health Coordinator and other mental health professional team members will include delineating the difference between traditional mental health therapy and crisis counseling. Training will also address cultural considerations of the service population and how they are affected by disasters.

b) Drills and Exercises:

(1) PATHS will rehearse this disaster plan at least annually. All drills shall include an after-action debriefing and report evaluating the drill or exercise. See “Appendix J - Training and Exercises” for further guidance.

(2) Exercises should include one or more of the following response issues in their scenarios:

(a) Clinic evacuation

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(b) Bioterrorism

(c) Mental Health response

(d) Coordination with government emergency responders

(e) Continuity of operations

(f) Expanding clinic surge capacity

(3) See “Appendix J - Training and Exercises” for a variety of scenarios to test internal and external disasters and disasters that require extensive community cooperation.

(4) PATHS will participate in community drills that assess communication, coordination, and the effectiveness of the organization’s and the community's command structures.

c) Evaluation:

(1) The effectiveness of the administration of this plan will be evaluated following plan activation during actual emergencies or exercises. Staff knowledge and responsibilities will be critiqued by the Emergency Preparedness Committee (EPC) and reported to the Chief Executive Officer.

(2) Based on the after-action evaluation, the Emergency Preparedness Committee will develop a Corrective Action Plan that includes recommendations for:

(a) Additional training and exercises.

(b) Changes in disaster policies and procedures.

(c) Plan updates and revisions.

(d) Acquisition of additional resources.

(e) Enhanced coordination with response agencies.

16. Plan Development and Maintenance:

a) The Emergency Preparedness Committee (EPC) is responsible for coordinating the development and implementation of a comprehensive emergency preparedness program and this plan. The EPC will review and update this plan at least annually. The plan will also be reviewed following its activation in response to

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any emergency, following exercises and other tests, as new threats arise, or as changes in clinic and government policies and procedures require.

b) PATHS environment undergoes constant change including remodeling, construction, installation of new equipment, and changes in key personnel. When these events occur, the Emergency Preparedness Committee will review and update the PATHS’ EOP to ensure:

(1) Evacuation routes are reviewed and updated. See “Appendix M – Emergency Procedures”.

(2) Emergency response duties are assigned to new personnel, if needed.

(3) The locations of key supplies, hazardous materials, etc. are updated.

(4) Vendors, repair services and other key information for newly installed equipment are incorporated into the plan.

C. Response: During this phase, PATHS will mobilize the resources and take actions required to manage its response to disasters.

1. Response Priorities: PATHS has established the following disaster response priorities:

a) Ensure life safety – protect life and provide care for injured patients, staff, and visitors.

b) Contain hazards to facilitate the protection of life.

c) Protect critical infrastructure, facilities, vital records and other data.

d) Resume the delivery of patient care.

e) Support the overall community response.

f) Restore essential services/utilities.

g) Provide crisis information to the public.

2. Alert, Warning and Notification: Upon receipt of an alert from the MHOAC or other credible sources the Chief Executive Officer will notify key managers, order the updating of phone lists, and the inspection of protective equipment and supply, and pharmaceutical caches.

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3. Response Activation and Initial Actions: This plan may be activated in response to events occurring within a facility or external to it. Any employee or staff member who observes an incident or condition which could result in a emergency condition should report it immediately to the Safety Officer or his/her supervisor. Fires, serious injuries, threats of violence and other serious emergencies should be reported to fire or police by calling 9-1-1. All staff should initiate emergency response actions consistent with the emergency response procedures outlined in “Appendix M – Emergency Procedures”. If the emergency significantly impacts clinic patient care capacity or the community served by the clinic, the CEO will notify the MHOAC. This plan may also be activated by the CEO, or designee, at the request of the MHOAC.

4. Emergency Management Organization :

a) PATHS will organize its emergency response structure to clearly define roles and responsibilities and quickly mobilize response resources. PATHS will use the Incident Command System (ICS) to manage its response to disasters. ICS is a standardized management system used by government agencies and hospitals in emergencies. Under ICS, the clinic’s overall response is directed by an Incident Manager. The CEO may serve in that role or may appoint someone else to the position. See “Appendix I – Emergency Response Team Organization Chart” for an expanded organization chart and example of staff assignment to Emergency Response Team positions.

b) The Incident Manager overseas the command/management function (command at the field level and management at all other levels) is the function that provides overall emergency response policy direction, oversight of emergency response planning and operations, and coordination of responding staff and organizational units.

c) The management staff supporting the Incident Manager consists of a public information officer, safety officer and security officer. Liaison officers, who are responsible for coordination with other agencies, and legal counsel may also be added to the management staff. (Management staff is sometimes referred to as the Management or Command Section).

d) ICS employs four functional sections (operations, planning, logistics, and finance) in its organizational structure. A detailed description of staff roles and functions is included in “Appendix 0 – Job Action Sheets”.

(1) Operations Section — Coordinates all operations in support of the emergency response and implements the incident action plan for a defined operational period. Medical care and mental health services are managed

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through the Operations Section.

(2) Planning and Intelligence Section — Collects, evaluates and disseminates information, including damage assessments; develops the incident action plan in coordination with other functions; performs advanced planning; and, documents the status of the clinic and its response to the disaster.

(3) Logistics Section — Provides facilities, services, personnel, equipment and materials to support response operations. The Logistics Section also manages volunteers and the receipt of donations.

(4) Finance and Administration Section — Tracks personnel and other resource costs associated with response and recovery, and provides administrative support to response operations.

e) The Incident Command System has the following additional characteristics:

(1) Organization Flexibility - Modular Organization: The specific functions that are activated and their relationship to one another will depend upon the size and nature of the incident. Only those functional elements that are required to meet current objectives will be activated. A single individual may perform multiple functional elements, e.g., safety and security or finance and logistics.

(2) Management of Personnel - Hierarchy of Command and Span-of-Control: Each activated function will have a person in charge of it, but a supervisor may be in charge of more than one functional element. Every individual will have a supervisor, except the Incident Manager.

(3) EOC Action Plans: Action Plans provide EOC and other response personnel with knowledge of the objectives to be achieved and the steps required for their achievement. They also provide a basis for measuring achievement of objectives and overall response performance. The action planning process should involve the EOC Incident Manager, management staff and other EOC sections.

Action plans are developed for a specified operational period which may range from a few hours to 24 hours. The operational period is determined by first establishing a set of priority actions that need to be performed. A reasonable time frame is then established for accomplishing those actions. The action plans need not be complex, but should

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be sufficiently detailed to guide EOC elements in implementing the priority actions.

f) EOC Staff Assignments: See “Appendix O - Job Action Sheets” for position duties and responsibilities during an emergency. Positions will be filled only as needed to meet the needs of the response. Some overlap will occur to account for limited personnel resources during an emergency, however all significant decisions within the five primary functions of the Incident Command System (ICS) will be made or delegated by the Incident Manager.

g) ICS positions should be assigned to the most qualified available and trained staff. Under emergency conditions, however, it may not always be possible to appoint the most appropriate staff. In that case the Incident Manager will be required to use best judgment in making position appointments and specifying the range of duties and authority those positions can exercise.

h) Following are examples of potential position assignments of clinic staff to ICS position. See “Appendix I - Emergency Response Team Organization Chart” for example of how assignments can be made.

(1) Incident Manager – CEO, Chief Operating Officer (COO), Medical Director

(2) Operations Section Chief – Chief Operating Officer, Medical Director, Administrative Operations Director

(3) Planning / Intelligence Section Chief – COO

(4) Logistics Section Chief – Administrative Services Director, Human Resources Director

(5) Finance / Administration Section Chief – Chief Financial Officer (CFO), Chief Operating Officer (COO) or Finance Director

5. Emergency Operations Center (EOC) Operations:

a) The Emergency Operations Center will be located at the PATHS’ Danville location.

b) In the event this site is obstructed or inoperable, a new location will be chosen by the Incident Manager and ERT based on environmental conditions.

c) The EOC will be activated by the CEO, COO, Medical Director, or other designated staff under the following circumstances:

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(1) One of PATHS’ facilities will be inoperable for more than 24 hours during its normal work week.

(2) Coordination is required with the MHOAC or local medical responders over an extended period of time.

(3) PATHS requires augmentations of medical supplies, pharmaceuticals or personnel.

(4) PATHS needs to coordinate movement of patients to other facilities through the Operational Area EOC.

(5) Damage to the clinic or clinic operations is sufficient to require management to set priorities for restoring clinic services and manage the full restoration of clinic services over an extended period of time.

(6) Potential evacuation of a site.

(7) Locally declared disaster with potential for illness or injury in clinic service area.

d) Required supplies include copies of this disaster plan, forms for recording and managing information, frequently used telephone numbers, marking pens, floor plans, and alternative communications equipment. See “Appendix O - Job Action Sheets”.

e) The EOC will be deactivated by the Incident Manager when the threat subsides, the response phase ends and recovery activities can be performed at normal work stations.

6. Medical Care: It is PATHS’ policy that:

a) The confidentiality of patient information remains important even during emergency conditions. Staff will take feasible and appropriate steps to ensure confidential information is protected.

b) Due to legal liabilities, staff will never transport patients in private vehicles under any circumstance. In a widespread emergency, the Operational Area will determine how and where to transport victims through already established channels selected by the county.

c) Patients will be permitted to leave with family or friends ONLY after they have signed a release form with the Medical Director or designated clinic staff.

d) Children will be allowed to leave only with parents, family members or other adults who accompanied them to the site and

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who provide confirming identification (e.g., driver’s license or other government identification). If no appropriate adult is available, staff will:

(1) Provide a safe supervised site for children away from adults.

(2) Attempt to contact each child’s family.

(3) If contact is not possible, contact Child Protective Services to provide temporary custodial supervision until a parent or family member is located.

e) Medical Management: To the extent possible, patients injured during an internal disaster will be given first aid by clinical staff. If the circumstances do not permit treating patients at the site, they will be referred to the nearest local emergency room unless their injuries require immediate attention. “Appendix L – Health Care Alternate and Referral Facility Locations” lists the alternate clinic site and hospital and clinic referral facilities.

If immediate medical attention is required and it is not safe or appropriate to refer the patient to the emergency room, 911 will be called and the patient will be sent by ambulance to the nearest emergency room. If 911 services are not available, a request for medical transport will be conveyed to Medical Health Operational Area Coordinator (MHOAC).

Visitors or volunteers who require medical evaluation or minor treatment will be treated and referred to their physician or sent to the hospital. Employees who need medical evaluation or minor treatment will be treated and referred to their physician or sent to the hospital.

As directed by the Medical Director or designee, clinical staff will take the following actions:

(1) Triage/First Aid: The clinic Medical Director or Site Manager will establish a site for triage and first aid under the direction of a physician. Triage decisions will be based on the patient condition, clinic status, availability of staff and supplies and the availability of community resources. The most likely location may be either the patient or the staff parking lot. A nurse or physician will be assigned to triage.

(2) Assessing and administering medical attention: A physician or nurse will assess victims for the need for medical treatment. The medical care team will provide medical services within the clinic’s capabilities and

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resources.

f) Increase Surge Capacity: The CEO, Medical Director, or COO will activate the clinic’s procedures for increasing surge capacity when (1) civil authorities declare a bioterrorist emergency or other disaster that affects the community or (2) clinic utilization or anticipated utilization substantially exceeds clinic day-to-day capacity with or without the occurrence of a disaster. PATHS will take the following actions to increase clinic surge capacity:

(1) Establish a communication link with MHOAC at the County EOC

(2) Periodically report clinic status, numbers of ill/injured, types of presenting conditions and resource needs and other information requested by the (MHOAC) in a format defined by the Operational Area (OA).

(3) Reduce patient demand by postponing / rescheduling non-essential visits. Cancel and reschedule non-essential appointments.

(4) Report status to facilities with which site has patient referral reciprocity or to which patients may be referred. Inform them of types of conditions that presenting patients have. See “Appendix K – Disaster Contact List” for contact information.

(5) Refer patients to alternative facilities. Patients with symptoms that indicate exposure to infectious, nerve, or other toxic agents will be referred to the nearest hospital.

g) Triage procedures: PATHS will establish a triage in an area that is clearly delineated, secured and with controlled access and exit.

(1) If bioterrorism is suspected, all staff in the triage area will wear Personal Protective Equipment (PPE).

(2) All patients entering the triage area will be tagged and registered.

(3) Triage converging patients to immediate and delayed treatment categories.

(4) In response to suspected or verified bioterrorist attack, isolate infected patients from other patients, especially if suspected agent is human-to-human contagious or is unknown. Use standard infection control standards at a minimum.

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(5) Implement decontamination procedures as appropriate.

(6) Arrange for transport of patients requiring higher levels of care as rapidly as possible through 9-1-1 or MHOAC.

(7) Direct uninjured yet anxious patients to the area designated for counseling and information. Recognize that some chemical and biological agents create symptoms that manifest themselves behaviorally.

(8) Provide written instructions for non-contagious patients seen and discharged.

7. Acquiring Response Resources: The Logistics Section should carefully monitor medical supplies and pharmaceuticals and request augmentation of resources from MHOAC at the earliest sign that stocks may become depleted. The clinic will maximize use of available hospitals, other clinics and other external resource suppliers as is feasible. EOC Request Process:

a) In the response to a disaster, staff may require additional personnel, supplies, or equipment or an executive decision concerning the acquisition or disposition of a resource, or the expenditure of funds. Requests for assistance will be transmitted from the various areas of the clinic via existing lines of communications to the EOC. The EOC will acknowledge the receipt of the request and, immediately address the need from current resources or incorporate the request into planning and priority setting processes.

b) The Logistics Section staff in the EOC may turn to external vendors for the resources or the MHOAC.

c) The MHOAC will seek resources to fill the request from within the OA. If resources cannot be found and the request is high priority, it will be submitted to Regional, State, and Federal response levels until the requested resource can be obtained.

d) Vendors: As information develops about current and future resource needs, PATHS will consider contacting vendors of critical supplies and equipment to alert them of pending needs and to ascertain vendor capacity to meet those needs. PATHS recognizes that in a major disaster, medical supply vendors may face competing demands that exceed their capacity. In that case, request for assistance will be submitted to the MHOAC, who will set resource allocation priorities.

e) Other Sites: PATHS will notify other sites with which it has mutual assistance arrangements.

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8. Communications

a) The Incident Manager will appoint a Communications Officer, who may be the Communications Coordinator, who will work under the Logistics Section and will use the clinic’s communications resources to communicate with:

(1) The Medical Health Operational Area Coordinator (MHOAC).

(2) Emergency response agencies.

(3) Outside relief agencies.

(4) Other healthcare facilities.

b) Contact Lists:

(1) Telephone service providers and maintenance for the organization’s internal telephone system, along with utilities.

(2) Staff contact telephone numbers.

(3) Disaster response agency contact telephone numbers are listed in “Appendix K – Disaster Contact List”.

c) Communication Procedures:

(1) All external communications will be authorized by the Incident Manager or designee unless emergency conditions require immediate communications.

(2) All outgoing and incoming messages will be recorded on message forms or in notebooks.

(3) All incoming messages will be shared with the EOC Planning Section.

9. Public Information/Crisis Communications

a) During a disaster response, all public information activities must be coordinated with the Operational Area PIO.

b) PATHS may perform the following public information / crisis communications tasks coordinated by the clinic’s Public Information Officer (PIO). See “Appendix O - Job Action Sheets”:

(1) Conducting interviews with print and broadcast news

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media.

(2) Coordinating the dissemination of information to clinic staff, community members, patients and other stakeholders.

(3) Managing visits by VIPs.

c) Media Relations: In an emergency, the Public Information Officer is designated as the media contact and will receive approval from the Incident Manager or CEO prior to any interviews or media releases.

Most media inquiries regarding a disaster will be managed by the City or County. Media requests and responses regarding a disaster should be coordinated through the Operational Area Public Information Officer in the County EOC. It is critical that information disseminated by the clinic be consistent with information disseminated through the Operational Area PIO.

If PATHS receives a media inquiry, it will be handled by the headquarters PIO.

d) Community Relations:

(1) The PIO will coordinate clinic release of information to the community on the status of staff, family and friends. Briefings will be held at a safe location away from the designated assembly area to prevent further interruptions with evacuation and treatment efforts.

(2) The PIO will participate in media interviews and develop communications strategies to keep patients and community members informed of the situation at the clinic, its operating status, and alternatives for receiving services.

(3) The PIO should establish relationships with community media, especially outlets that are preferred by communities served by the clinic including non-English language broadcast media, where appropriate.

(4) In coordination with the Operational Area, the PIO can provide information to the community that includes recommended actions, protective measures, and locations of various services and resources. Under some circumstances, the PIO can request broadcast media to broadcast a message specifically for the staff of the clinic to inform them of clinic operational status and expected actions. Information should be disseminated in the languages spoken in the communities served by the clinic.

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e) Communication with Staff: The PIO will coordinate the delivery of information to staff through flyers, meetings, and conference calls. Information provided can include clinic status, impact of the disaster on the community, status of the overall response, and clinic management decisions. The PIO will also be alert for the spread of rumors among staff and will apply rumor control procedures to curtail the spread of false information.

f) The PIO will ensure that all public releases of information protect patient confidentiality.

10. Security: The purpose of security will be to ensure unimpeded patient care, staff safety, and continued operations. The Incident Manager will appoint a Security Officer (see “Appendix O - Job Action Sheets”) who will be responsible for ensuring the following security measures are implemented:

a) Security will be provided initially by existing security services or by personnel under the direction of the Security Officer. Existing security may be augmented by contract security personnel, law enforcement, clinic staff or, if necessary, by volunteers.

b) Checkpoints at building and parking lot entrances will be established as needed to control traffic flow and ensure unimpeded patient care, staff safety, and continued operations.

c) Supervisors will ensure that all staff wears their ID badges at all times. Security will issue temporary badges if needed.

d) Security staff will use yellow tape to assist in crowd control, if needed.

e) The Security Officer will ensure that the facility is and remains secured following an evacuation.

11. Mental Health Response:

a) The Mental Health Coordinator will report to the Medical Director position in the Operations Section of the clinic’s emergency organization. When directed by the Incident Manager to activate the clinic mental health response, the Mental Health Coordinator will:

(1) Assess the immediate and potential mental health needs of clinic patients and staff, considering:

(a) The presence of casualties.

(b) Magnitude and type of disaster.

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(c) Use or threat of weapons of mass destruction.

(d) Level of uncertainty and rumors.

(e) Employee anxiety levels.

(f) Level of effectiveness of EOC operations.

(g) Convergence of community members.

(h) Patient levels of stress and anxiety.

(i) Presence of children.

(j) Cultural manifestations.

(2) Request the EOC to notify the Operational Area of the mental health response.

(3) Communicate community mental health assessments to Operational Area (county) and local jurisdiction contacts.

(4) Determine need to: recall mental health staff to the clinic, request the response of contract mental health clinicians, or request mental health assistance from the MHOAC or other sites. Establish communications and alert contract and other mental health providers who may need to support clinic’s mental health response. Coordinate with other mental health service responders.

(5) Establish site for mental health team operations.

(6) Conduct ongoing monitoring of the mental health status of employees and patients.

(7) Establish procedures to refer employees or patients to required mental health services beyond the scope that can be delivered by the mental health team.

(8) Document all mental health encounters with staff and patients. Include information required for follow-up on referrals. Maintain records of events, personnel time and resource expenditures.

(9) Coordinate any issuance of mental health information with the Incident Manager or PIO.

(10) Provide reports on the mental health status of clinic employees and patients. Report mental health team

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actions and resource needs to the clinic EOC.

(11) Activate procedures to receive and integrate incoming mental health assistance.

(12) Initiate recovery activities.

b) Response to psychological aspects of emergencies including bioterrorism events: The following are some steps that can be taken by clinicians and licensed mental health personnel to mitigate and respond to the psychological impact of the disaster:

(1) Communicate clear, concise information about the infection, how it is transmitted, what treatment and preventive options are currently available, when prophylactic antibiotics, antitoxin serum or vaccines will be available, and how prophylaxis or vaccination will be distributed.

(2) Provide counseling to the worried well and victims' family members.

(3) Give important tips to parents and caregivers such as:

(a) It is normal to experience anxiety and fear during a disaster.

(b) Take care of yourself first. A parent who is calm in an emergency will be able to take better care of a child.

(c) Watch for unusual behavior that may suggest your child is having difficulty dealing with disturbing events.

(d) Limit television viewing of terrorist events or other disasters and dispel any misconceptions or misinformation.

(e) Talk about the event with your child.

12. Volunteer / Donation Management: In a widespread emergency, physicians and nurses may seek to volunteer at the clinic. The Logistics Section will establish a Volunteer and Donations Reception Center. The center’s location will be set-up in a safe location based on existing disaster conditions away from the clinic treatment center.

All volunteers who arrive at the clinic will be sent to the Center for verification of identity and credentials and to complete volunteer registration forms. This center will provide for organization of the intake

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process.

The Center will also coordinate the receipt of donations. The Logistics Section Chief will delegate the appropriate staff on site to handle this task:

a) All donations will be documented and accounted for by the CFO or delegated staff.

b) The Medical Director and Director of Administrative Operations will supervise distribution and disposal of donated medical supplies, equipment and pharmaceuticals.

c) All donations will be documented and acknowledged by the CFO or designated staff prior to being handed over to the Medical Director for disbursement.

13. Response to Internal Emergencies: An Internal Emergency is an event that causes or threatens to cause physical damage and injury to the clinic, personnel or patients. Examples are fire, explosion, hazardous materials releases, violence or bomb threat. External events may also create internal disasters. See “Appendix M – Emergency Procedures”. The following procedures provide guidance for initial actions for internal emergencies:

a) If the event is a fire within the clinic, institute RACE:

R = Remove patients and others from fire or smoke areas.

A = Announce CODE RED (3 times) and Call 9-1-1

C = Contain the smoke/fire by closing all doors to rooms and corridors.

E = Extinguish the fire if it is safe to do so. Evacuate the facility if the fire cannot be extinguished.

b) If the internal emergency is other than a fire, the person in charge will determine if assistance from outside agencies is necessary. Such notification will be done by calling 911.

c) Notification of on-duty employees of an emergency event will be made by calling the appropriate code, (shown in “Appendix R” Appendix R), telling them of the situation or calling for help, as appropriate. During the early stages of an emergency, information about the event may be limited. If the emergency is internal to the clinic, it is important to communicate with staff as soon as possible.

d) If the event requires outside assistance and the telephones are

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not working, a person may be sent to the nearest working telephone, fire station or police department for assistance.

e) PATHS will conduct an assessment of damage caused by the disaster to determine if an area, room, or building can continue to be used safely or is safe to re-enter following an evacuation. Systematic damage assessments are indicated following an earthquake, flood, explosion, hazardous material spill, fire or utility failure. The facility may require three levels of evaluation: Level 1 (a rapid evaluation to determine if the building is safe to occupy), Level 2 (a detailed evaluation that will address structural damage and utilities), or Level 3 (a structural/geological assessment).

Depending on the event and the level of damage, fire or law services may conduct a Level 1 or 2 assessment. If damage is major, a consulting engineering evaluation, assessment by a county engineer, and/or an inspection by the licensing agency may be required before the facility can reopen for operations.

Following each level of evaluation, inspectors will classify and post each building as: 1) Apparently OK for Occupancy; 2) Questionable: Limited Entry; 3) Unsafe for any Occupancy. In some cases, immediate repairs or interim measures may be implemented to upgrade the level of safety and allow occupancy.

f) PATHS will maintain a list of all hazardous materials and their MSDSs, locations, and procedures for safe handling, containing and neutralizing them. Each facility should keep this list in a central location. A master copy will be kept by PATHS’ Safety Officer.

All materials will have their contents clearly marked on the outside of their containers. The location of the storage areas will be indicated on the facility floor plan.

In the event of a hazardous material release inside the clinic, clinic staff should:

(1) Avoid attempting to handle spills or leaks themselves unless they have been trained, have appropriate personal protective equipment (PPE) and can safely and completely respond. NOTE: Level C protection, or below, is not acceptable for chemical emergency response.

(2) Immediately report all spills or leaks to the Safety Officer or designee.

(3) Isolate area of spill and deny entry to building or area. Initiate fire or hazmat cleanup notifications, as appropriate.

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(4) Obtain further instructions from the CEO, COO or Safety Officer, or refer to management guidance maintained at the site.

g) Evacuation:

(1) A facility may be evacuated due to a fire or other occurrence, threat, or order of the CEO, or designee. Refer to PATHS’ Facility Evacuation Plan for complete information. See “Appendix N – Emergency Floor Plans”. The following instructions are communicated to staff:

(a) All available staff members and other able bodied persons should do everything possible to assist personnel at the location of the fire or emergency in the removal of patients.

(b) Close all doors and windows.

(c) Turn off all unnecessary electrical equipment, but leave the lights on.

(d) Evacuate the area/building and congregate at the predetermined site. Evacuation routes are posted throughout the clinic.

(e) Patients, staff, and visitors should not be readmitted to the clinic until cleared to do so by fire, police, other emergency responders, or upon permission of the Incident Manager.

(f) Procedures for evacuation of patients.

(2) Patients will be evacuated according to the following priority order:

(a) Persons in imminent danger.

(b) Wheelchair patients.

(c) Walking patients.

(3) Staff should escort ambulatory patients to the nearest exit and direct them to the congregation point. Wheelchairs will be utilized to relocate wheelchair bound patients to a safe place.

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(4) During an evacuation, a responsible person will be placed with evacuees for reassurance and to prevent patients from re-entering the dangerous area.

(5) If safety permits, all rooms will be thoroughly searched by the Search and Rescue Team upon completion of evacuation to ensure that all patients, visitors, and employees have been evacuated.

(6) When patients are removed from the facility, staff will remain with them until they are able to safely leave or have been transported to appropriate facility for their continued care and safety. If patients evacuated from the facility are unable to return home without assistance, the relatives of patients evacuated from the facility will be notified of the patient’s location and general condition by the staff as soon as possible.

(7) In case a partial or full facility evacuation is required, see “Appendix M – Emergency Procedures” for general clinic evacuation procedures. The following information should be used to facilitate the evacuation:

(a) Floor plan and map of exits with the building, location of emergency equipment including fire extinguishers, phones, fire route out of the building, and first aid supplies. See “Appendix N – Emergency Floor Plans”.

(b) Know where and how to shut-off the utilities, including emergency equipment, gas, electrical timers, water, computers, heating, AC, compressor, and telephones.

(8) Following the occurrence of an internal or external disaster or the receipt of a credible warning the CEO will decide the operating status for that location. The decision will be based on the results of the damage assessment, the nature and severity of the disaster and other information supplied by staff, emergency responders or inspectors. The decision to evacuate, return to the facility and/or re-open the facility for partial or full operation depends on an assessment of the following:

(a) Extent of facility damage / operational status.

(b) Status of utilities (e.g. water, sewer lines, gas and electricity).

(c) Presence and status of hazardous materials.

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(d) Condition of equipment and other resources.

(e) Environmental hazards near the facility.

(9) Extended site closure: If PATHS experiences major damage, loss of staffing, a dangerous response environment or other problems that severely limit its ability to meet patient needs, the CEO may suspend facility operations until conditions change. If that decision is made, staff will:

(a) If possible, ensure the site is secure.

(b) Notify other staff of site status and require that they remain available for return to work unless permission is provided.

(c) Notify the Medical Health Operational Area Coordinator (MHOAC) of its change in status. Request location of nearest source of medical services.

(d) Notify the Virginia Department of Health Services, local field office or other appropriate licensing.

(e) Notify the nearest hospital(s) and clinic(s) of the change in operating status and intent to refer patients to alternate sources of care.

(f) Notify PATHS’ federal project officer at HRSA.

(g) Place a sign on the facility that explains the circumstances, indicates when the site intends to reopen (if known), and location of nearest source of medical services. See “Appendix L – Health Care Alternate and Referral Facility Locations”.

(h) If the environment is safe, staff will be stationed at the site clinic entrance to answer patient questions and make referrals.

(i) Implement business recovery operations.

h) PATHS’ Response to Disaster Alert, Warning or Notification:

(1) Disasters can occur both with and without warning. Upon receipt of an alert from the MHOAC or other credible sources the CEO, or designee, will notify key managers, order the updating of phone lists, and the inspection of protective equipment and supply and pharmaceutical

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caches.

(2) Depending upon the nature of the warning and the potential impact of the emergency on the PATHS’ location, the CEO, COO and Medical Director may decide to evacuate the facility; suspend or curtail clinical operations; take actions to protect equipment, supplies and records; move equipment and supplies to secondary sites; backup and secure computer files; or other measures he/she may find appropriate to reduce clinic, staff and patient risk.

(3) The CEO, or designee, will consider the following options, depending on the nature, severity and immediacy of the expected emergency:

(a) Close and secure the facility until after the disaster has occurred. Ensure patients and visitors can return home safely.

(b) Review plans and procedures. Update contact information.

(c) Check inventory of supplies and pharmaceuticals. Augment as needed.

(d) Ensure essential equipment is secured, computer files backed-up and essential records stored offsite.

(e) Notify the Operational Area, community members and staff. Cancel scheduled appointments.

(f) If time permits, encourage staff to return to their homes.

(g) If staff remains in the facility, take shelter as appropriate for the expected disaster.

(h) Ensure staff is informed of call-back procedures and actions they should take if communications are not available.

(i) Take protective action appropriate for the emergency.

(j) Communicate status to the MHOAC.

i) Determining PATHS’ Response Role: If PATHS remains fully or partially operational following a disaster, the CEO, COO, Medical Director, and other members of the ERT will define the response role the clinic will play. The appropriate response role for PATHS

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will depend on the following factors:

(1) The impact of the disaster on the PATHS’ location.

(2) The level of personnel and other resources available for response.

(3) The pre-event medical care and other service capacity of PATHS.

(4) The medical care environment of the community both before and after a disaster occurs as assessed by the MHOAC (e.g., medical care demands may be reduced if the 9-1-1 system and nearby hospitals are operational and not overwhelmed).

(5) The needs and response actions of residents of the community served by PATHS (e.g., convergence to the facility following disasters).

(6) The priorities established by the PATHS’ CEO and Board of Directors (e.g., to remain open if at all possible following a disaster).

(7) The degree of planning and preparedness of PATHS and its staff.

14. Response to External Emergencies: An External Disaster is an event that occurs in the community. Examples include earthquakes, floods, fires, hazardous materials releases or terrorist events. An external disaster may directly impact a facility and its ability to operate.

a) Local vs. Widespread Emergencies:

(1) Local emergencies are disasters with effects limited to a relatively small area. In local emergencies, other health facilities and resources will be relatively unaffected and remain viable options for sending assistance or receiving patients from the disaster area.

(2) In widespread emergencies, nearby medical resources are likely to be impacted and therefore less likely to be able to offer assistance to the facility. Hospitals may also have a higher response priority than clinics for resupply and other response assistance.

b) Weapons of Mass Destruction (WMD):

(1) Preparations for an event involving weapons of mass destruction - chemical, biological, nuclear, radiological, or

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explosives (CBRNE) - should be based on existing programs for handling hazardous materials. If staff suspects an event involving CBRNE weapons has occurred, they should:

(a) Remain calm and isolate the victims to prevent further contamination within the facility.

(b) Contact the Medical Director, Site Manager, or other appropriate clinician.

(c) Secure personal protective equipment and wait for instructions.

(d) Comfort the victims.

(e) Contact appropriate Operational Area authorities. See “Appendix K – Disaster Contact List”.

(2) Shelter-In-Place: Terrorist use of Weapons of Mass Destruction may result in the release of radiation, hazardous materials and biological agents in proximity to the clinic. Shelter-In-Place may be the best strategy to minimize risk of exposure to these agents.

c) Bioterrorism Response

(1) PATHS’ Medical Director should immediately report to the local health department those diseases that pose a significant public health threat, such as agents of biological terrorism.

(2) PATHS will report diseases resulting from bioterrorist agents, like other communicable and infectious diseases, to the Health Department Epidemiologist at (804) 864-8141.

(3) PATHS’ response to a bioterrorism incident may be initiated by the CEO or Medical Director due to:

(a) The request of local civil authorities.

(b) Government official notification of an outbreak within or near the facility’s community.

(c) Presentation of a patient with a suspected exposure to a bioterrorist agent. In case of presentation by a patient with suspected exposure to a bioterrorist agent, PATHS will follow current CDC response guidelines. Potential indicators of a

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bioterrorism attack are:

(i) Groups of people becoming ill around the same time.

(ii) Sudden increase of illness in previously healthy individuals.

(iii) Sudden increase in the following non-specific illnesses:

(a) Pneumonia, flu-like illness, or fever with atypical features.

(b) Bleeding disorders.

(c) Unexplained rashes, and mucosal or skin irritation, particularly in adults.

(d) Neuromuscular illness, like muscle weakness and paralysis.

(e) Diarrhea.

(iv) Simultaneous disease outbreaks in human and animal or bird populations.

(v) Unusual temporal or geographic clustering of illness (for example, patients who attended the same public event, live in the same part of town, etc.).

(4) Infection Control Practices for Patient Management:

(a) PATHS will use Standard Precautions to manage all patients, including symptomatic patients with suspected or confirmed bioterrorism related illnesses.

(b) For certain diseases or syndromes (e.g., smallpox and pneumonic plague), additional precautions may be needed to reduce the likelihood for transmission.

(c) In general, the transport and movement of patients with bioterrorism related infections, as with patients with any epidemiologically important infections (e.g., pulmonary tuberculosis, chickenpox, measles), should be limited to movement that is

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essential to provide patient care, thus reducing the opportunities for transmission of microorganisms within healthcare facilities.

(d) PATHS has in place adequate procedures for the routine care, cleaning, and disinfection of environmental surfaces, and other frequently touched surfaces and equipment, and ensures that these procedures are being followed.

(i) Facility approved germicidal cleaning agents are available in patient care areas to use for cleaning spills of contaminated material and disinfecting noncritical equipment.

(ii) Used patient care equipment soiled or potentially contaminated with blood, body fluids, secretions, or excretions is handled in a manner that prevents exposures to skin and mucous membranes, avoids contamination of clothing, and minimizes the likelihood of transfer of microbes to other patients and environments.

(iii) PATHS has policies in place to ensure that reusable equipment is not used for the care of another patient until it has been appropriately cleaned and reprocessed, and to ensure that single use patient items are appropriately discarded.

(iv) Sterilization is required for all instruments or equipment that enter normally sterile tissues or through which blood flows.

(v) Contaminated waste is sorted and discarded in accordance with federal, state and local regulations.

(vi) Policies for the prevention of occupational injury and exposure to blood borne pathogens in accordance with Standard Precautions and Universal Precautions are in place.

(e) If exposed skin comes in contact with an unknown substance/powder, recommend washing with soap and water only. If contamination is beyond the sites capability, call 911. Local government, fire

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departments and hospitals normally conduct decontamination of patients and facilities exposed to chemical agents.

(5) Patient placement: In small-scale events, routine patient placement and infection control practices should be followed. However, when the number of patients presenting to a healthcare facility is too large to allow routine triage and isolation strategies (if required), it will be necessary to apply practical alternatives. These may include cohorting patients who present with similar syndromes, i.e., grouping affected patients into a designated section of a clinic or emergency department, or a designated ward or floor of a facility, or even setting up a response center at a separate building.

(6) Evidence collection:

(a) PATHS will establish procedures for collecting and preserving evidence in any suspected terrorist attack. In the event of a suspected or actual terrorist attack involving weapons of mass destruction, a variety of responders, ranging from health care providers to law enforcement and federal authorities, will play a role in the coordinated response. The identification of victims as well as the collection of evidence will be a critical step in these efforts.

(b) The health care provider's first duty is to the patient; however interoperability with other response agencies is strongly encouraged.

(c) The performance of evidence collection while providing required patient decontamination, triage and treatment should be reasonable for the situation.

(d) Information gathered from the victims and first responders may aid in the epidemiological investigation and ongoing surveillance.

(e) It is imperative that individual healthcare providers work with the local law enforcement agencies and prosecutors in the development and customization of these policies.

(f) Evidence to be collected could include clothing, suspicious packages, or other items that could contain evidence of contamination. At a minimum:

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(i) PATHS has a supply of plastic bags, marking pens, and ties to secure the bags.

(ii) Each individual evidence bag will be labeled with the patient's name, date of birth, medical record number, date of collection and site of collection.

(iii) An inventory of valuables and articles will be created that lists each item that is collected. The list will be kept by the clinic and a copy given to the patient.

(iv) The person responsible for the valuables and articles will be identified and documented. If possessions are to be transported to the FBI or local law enforcement agency, the facility will document who received them, where they were taken, and how they will be returned to the owner.

(7) Mass prophylaxis: PATHS encourages its clinicians to participate in a mass prophylaxis program, if the disruption to clinic operations would not negatively affect the health of the community the organization serves.

Health care providers from other organizations throughout the county could be called to volunteer to distribute medication or provide vaccines in response to a large-scale attack. Under this scenario, the County or City would establish mass prophylaxis sites throughout their jurisdiction. These sites would be large facilities such as school gymnasiums or warehouses that can accommodate large groups of people. These sites would require a large number of healthcare providers to administer medications. Since the county does not employ enough practitioners to staff the sites, they will look to the private sector, including PATHS, to adequately staff mass prophylaxis sites.

D. Recovery:

1. Introduction: Recovery actions begin almost concurrently with response activities and are directed at restoring essential services and resuming normal operations. Depending on the emergency's impact on the organization, this phase may require a large amount of resources and time to complete. This phase includes activities taken to assess, manage and coordinate the recovery from an event as the situation returns to normal. These activities include:

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a) Deactivation of emergency response: the Chief Executive Officer or designee will call for deactivation of the emergency when the clinic can return to normal or near normal services, procedures, and staffing. Post-event assessment of the emergency response will be conducted to determine the need for improvements.

b) Establishment of an employee support system. Human resources will coordinate referrals to employee assistance programs as needed.

c) Accounting for disaster-related expenses. The Finance Section Chief will account for disaster related expenses. Documentation will include: direct operating cost; costs from increased use; all damage or destroyed equipment; replacement of capital equipment; and construction related expenses.

d) Return to normal operations as rapidly as possible.

2. Documentation: To continue providing the same efficient service as was provided prior to the incident, PATHS will immediately begin gathering complete documentation including photographs. Depending on the event, it may be necessary to expedite resumption of health care services to address unmet community medical needs.

3. Inventory Damage and Loss: PATHS will document damage and losses of equipment using a current and complete list of equipment serial numbers, costs, and dates of inventory. One copy will be filed with the Director of Finance and another copy in a secure offsite location.

4. Lost Revenue through Disruption of Services: The Director of Finance will work with the Finance Section to document all expenses incurred from the disaster. An audit trail will be developed to assist with qualifying for any Federal reimbursement or assistance available for costs and losses incurred by the site as a result of the disaster.

5. Cost / Loss Recovery Sources: Depending on the conditions and the scale of the incident, PATHS will seek financial recovery resources in accordance with the following:

a) The eligibility of organization for federal reimbursement for response costs and losses remains ambiguous. It may be possible to gain reimbursement through county channels under certain (largely untested) circumstances.

b) Public Assistance (FEMA/OES) - After a disaster occurs and the President has issued a Federal Disaster Declaration, assistance is available to applicants through FEMA and the OES. The Small Business Administration (SBA) provides physical disaster loans to businesses for repairing or replacing disaster damages to property owned by the business. Businesses and Non-profit organizations

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of any size are eligible.

c) Federal Grant - Following a presidential disaster declaration, the Hazard Mitigation Grant Program (HMGP) is activated.

d) A private, non-profit facility is eligible for emergency protective measures (i.e., emergency access such as provision of shelters or emergency care or provision of food, water, medicine, and other essential needs), and may be eligible for permanent repair work (i.e., repair or replacement of damaged elements restoring the damaged facility):

(1) pre-disaster design;

(2) pre-disaster function; and/or

(3) pre-disaster capacity.

e) Insurance Carriers – PATHS will file claims with its insurance companies for damage to a facility. The facility will not receive federal reimbursement for costs or losses that are reimbursed by the insurance carrier. Eligible costs not covered by the insurance carrier such as the insurance deductible may be reimbursable.

6. Psychological Needs of Staff and Patients: Mental health needs of patients and staff are likely to continue during the recovery phase. The Mental Health Coordinator will continue to monitor for and respond to the mental health needs of clinic staff and patients.

7. Restoration of Services: PATHS will take the following steps to restore services as rapidly as possible:

a) If necessary, repair the facility or relocate services to a new or temporary facility.

b) Replace or repair damaged medical equipment.

c) Expedite structural and licensing inspections required to re-open.

d) Facilitate the return of medical care and other site staff to work.

e) Replenish expended supplies and pharmaceuticals.

f) Decontaminate equipment and facilities.

g) Attend to the psychological needs of staff and community.

h) Follow-up on rescheduled appointments.

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8. After-Action Report: PATHS will conduct after-action debriefings with staff and participate in Operational Area after-action debriefings. The organization will also produce an after-action report describing its activities and corrective action plans including recommendations for modifying the surge capacity expansion procedures, additional training and improved coordination.

9. Staff Support: The organization recognizes that staff and their families are impacted by community-wide disasters. PATHS will assist staff in their recovery efforts to the extent possible.

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Appendix A: Emergency Management Acronyms

AAR After Action ReportARC American Red Cross

BT Bioterrorism

CFR Code of Federal RegulationsCOG Continuity of GovernmentCOOP Continuity of OperationsCPR Cardiopulmonary Resuscitation

DFO Disaster Field Office

EAS Emergency Alert SystemEOC Emergency Operations CenterEPC Emergency Preparedness CommitteeEPP Emergency Preparedness PlanERT Emergency Response TeamESA Emergency Services Act

FBI Federal Bureau of InvestigationFEMA Federal Emergency Management Agency

GIS Geographic Information System

ICS Incident Command System

JIC Joint Information Center

MACS Multi-Agency Coordination SystemMCS Mass Care and ShelterMMAA Master Mutual Aid AgreementMOU Memorandum of Understanding

NDAA National Disaster Assistance Act

OA Operational AreaOES Office of Emergency ServicesORP Operational Recovery Plan

PDA Preliminary Damage AssessmentsPPE Personal Protective EquipmentPIO Public Information Officer

REOC Regional Emergency Operations CenterRIMS Response Information Management System

SEMS Standardized Emergency Management SystemsSEP State Emergency Plan

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SITREP Situation Status ReportSOC State Operations CenterSOP Standard Operating ProceduresSSCOT State Strategic Committee on Terrorism

TSA The Salvation Army

WMD Weapons of Mass Destruction

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Appendix B: Emergency Management Glossary

A

Action Plan - Documented outline of specific projected activities to be accomplished within a specified period of time to meet a defined need, goal or objective.

After-Action Report (AAR) - A narrative report that presents issues found during an incident and recommendations on how those issues can be resolved.

Alternate Database/Records Access - The safekeeping of vital resources, facilities, and records, and the ability to access such resources in the event that the emergency plan is put into effect.

Alternate Facilities - An alternate work site that provides the capability to perform minimum functions until normal operations can be resumed.

Advanced Life Support (ALS) - Procedures and techniques utilized by EMT-P, EMT-II, nursing and physician personnel to stabilize critically sick and injured patients which exceed Basic Life Support procedures

B

Basic Life Support (BLS) - Initial procedures in the care of a patient in cardiac and/or respiratory arrest which may include the assessment of ABCs, opening the airway, artificial respiration and CPR (cardio-pulmonary resuscitation) as needed to maintain life. Basic non-invasive first-aid procedures and techniques utilized by most all trained medical personnel, including First Responder, to stabilize critically sick and injured people

BLS Responder - Certified EMT-I or First Responder

Bioterrorism - The planned, unlawful use or threat of use, of biological weapons made from living organisms with the intent of causing death or disease in humans, animals, or plants. The goal of bio-terrorism is usually to create fear and/or intimidate governments or societies for gaining political, religious, or ideological goals

C

Chemical Attack - The deliberate release of a toxic gas, liquid or solid that can poison people and the environment

Command Post - Location where the administrative staff coordinates the other overall operations. The Incident Commander remains here; other area chiefs assemble here regularly for debriefings

Crisis - exists when physical infrastructure is destroyed, political and social systems are ruptured, and economic activity is seriously disrupted; population displacement grows quickly and suffering increases, particularly among the aged, disabled, children and women. Such a situation is often described as a "complex emergency".

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Crisis Relocation Plan (CRP) - The contingency planning designed to move populations from high hazard areas to those of lower risk and to provide for their well being (i.e., congregate care housing, feeding, fallout protection, etc.). Also frequently referred to as evacuation planning

D

Deceased - Fourth (last) priority in patient treatment according to the S.T.A.R.T. and other triage systems.

Delayed Treatment - Second priority in patient treatment according to the S.T.A.R.T. and other triage systems. These people require aid, but injuries are less severe. A hospitalized patient may be categorized from "guarded" to "serious"; a patient requiring at least minimal hospital services.

Delegation of Authority - A statement provided to the Incident Manager by the Chief Executive Officer delegating authority and assigning responsibility. The Delegation of Authority can include objectives, priorities, expectations, constraints and other considerations or guidelines as needed.

Disaster - A sudden calamitous emergency event bringing great damage loss or destruction.

E

Emergency - A condition of disaster or of extreme peril to the safety of persons and property caused by such conditions as air pollution, fire, flood, hazardous material incident, storm, epidemic, riot, drought, sudden and severe energy shortage, plant or animal infestations or disease, the Governor’s warning of an earthquake or volcanic prediction, or an earthquake or other conditions, other than conditions resulting from a labor controversy.

Emergency Medical Services Authority (EMSA) – Virginia’s agency responsible for coordinating the State's medical response to a disaster.

Emergency Medical Services Agency, Local (LEMSA) - Local EMS agency responsible for coordinating the local response of emergency medical resources.

Emergency Operations Center (EOC) - A location from which centralized emergency management can be performed. The EOC is established by the clinic to coordinate the overall organizational response and support to an emergency.

Emergency Operations Plan (EOP) - The plan that each organization has and maintains for responding to hazards.

Emergency Response Team (ERT) - Staff and volunteers responsible for the operational functions; such as medical, evacuation, communications, supply procurement, shelter, building assessment and mental health services. Assignments are made by determining the needs and skills of those reporting.

Exercise - Maneuver or simulated emergency condition involving planning, preparation, and execution; carried out for the purpose of testing, evaluating, planning, developing, training,

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and/or demonstrating emergency management systems and individual components and capabilities, to identify areas of strength and weakness for improvement of an emergency operations plan.

F

Finance Section - One of the four primary functions found in all ICS organizations which is responsible for all costs and financial considerations. The Section can include the Time Unit, Claims Unit and Cost Unit.

First Responder - Personnel who have responsibility to initially respond to emergencies such as fire fighter, police officers, Virginia State Police Officers, lifeguards, forestry personnel, ambulance attendants, and other public service personnel. Virginia law requires such persons to have completed a first-aid course and to be trained in cardiopulmonary resuscitation.

Flip Chart – A chart with several sheets hinged at the top; sheets can be flipped over to present information sequentially.

H

Hazard Mitigation - A cost effective measure that will reduce the potential for damage to a facility from a disaster event.

Hazard Mitigation Plan - The plan resulting from a systematic evaluation of the nature and extent of vulnerability to the effects of natural hazards present in society that includes the actions needed to minimize future vulnerability to hazards.

Hospital Emergency Incident Command System (HEICS) - A management program for hospitals modeled after the Fire Service Plan; comprised of an organization chart with a clearly delineated chain of command and a preordered job action sheet which assists the individual in focusing upon his/her assigned position function.

I

Immediate Treatment - First level of patient priority according to the S.T.A.R.T. and other triage systems. A patient who requires rapid assessment and medical intervention in order to increase chances of survival. A hospitalized patient who may be classified from "serious" to "critical" condition; requiring constant nursing care.

Incident Command System (ICS) - A flexible organizational structure which provides a basic expandable system developed by the Fire Services to mitigate any size emergency situation. An organization structure designed to improve emergency response operations; it originated with fire service and is now adapted to many different types of agencies, including hospitals.

Incident Manager/Commander (IM/IC) - The individual who holds overall responsibility for incident response and management.

Information Officer - A member of the Management Staff responsible for interfacing with the

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public and media or with other agencies requiring information directly from the incident. There is only one Information Officer per incident. This position is also referred to as Public Affairs or Public Information Officer in some disciplines. The individual at EOC level that has been delegated the authority to prepare public information releases and to interact with the media.

In-Place Protection Plan (Formerly Community Shelter Plan) - A planning document which includes a published map and emergency public information materials that enable a local government to give people the answers to questions, "Where do I go for shelter?' and "What do I do?" when the warning sounds. The IPP designates specific shelters to be used by people working or living in specific areas of the community, thus allocating the people to the best available fallout protection

L

Level 1 Disaster - A moderate to severe incident where local resources are adequate and available, either on duty or by call-back.

Level 2 Disaster - A moderate to severe emergency where local resources are not adequate and mutual aid may be required.

Level 3 Disaster - A major disaster where resources in or near the impacted areas are overwhelmed and extensive mutual aid is required. A State of Emergency will be proclaimed and a Presidential Declaration of an Emergency or a Major Disaster will be requested.

Liaison Officer - A member of the Management Staff responsible for coordinating with representatives from cooperating and assisting agencies. The function may be done by a Coordinator and/or within a Section reporting directly to the EOC Incident Manager.

Logistics - A working group responsible for coordinating the resources and activities associated with relocation planning and deployment of operations and positions during an event. Person responsible for the organization and direction of those operations associated with maintenance of the physical environment, including adequate levels of food, shelter and supplies to support the overall objectives.

Logistics Section - One of the five primary functions found at all SEMS levels. The Section responsible for providing facilities, services and materials for the incident or at the EOC.

M

Management Staff - The Management Staff at the SEMS EOC level consists of the Information Officer, Safety Officer, and Liaison Officer. They report directly to the EOC Incident Manager.

Medical Health Operational Area Coordinator (MHOAC) - The Medical Health Operational Area Coordinator is responsible for coordinating all medical and health operations of the Operational Area, including mutual aid, and is located in the County EOC.

Memorandum of Understanding - Agreement between or among government agencies, community organizations, and other entities that define respective roles and responsibilities in preparing for and responding to emergencies.

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Minor Treatment - Third priority of patient in the S.T.A.R.T. and other triage systems. A patient requiring only simple, rudimentary first-aid. These patients are considered ambulatory. A hospitalized patient may be considered minor if they are in "stable" condition and capable of being treated and discharged.

Mitigation - Pre-event planning and actions which aim to lessen the effects of potential disaster.

O

Office of Emergency Services (OES) - Agency responsible for the overall coordination of resources. OES can be a city, county, regional, or state level agency

Operations - Function in ICS organization responsible for coordination of medical personnel, treatment and triage areas, social services and evacuation of patients.

Operational Period - The period of time scheduled for execution of a given set of operation actions as specified in the EOC Action Plan. Operational Periods can be of various lengths, although usually not over 24 hours.

Operations Section - One of the five primary functions found in all organizations managed by the Incident Command System. The Section responsible for all tactical operations at the incident, or for the coordination of operational activities at the EOC.

P

Packet Radio - A system of digital transmission of information via radio; information is typed into a computer, transmitted via air waves in short bursts ("packets") and retrieved at the receiving end as a typed document.

Personal Protective Equipment - The equipment and clothing required to mitigate the risk of injury from or exposure to hazardous conditions encountered during the performance of duty. PPE includes, but is not limited to: fire resistant clothing, hard hat, flight helmets, shroud, goggles, gloves, respirators, hearing protection, and shelter.

Planning Section (Also referred to as Planning/Intelligence) - One of the four primary functions found in all ICS organizations. Responsible for the collection, evaluation, and dissemination of information related to the incident or an emergency, and for the preparation and documentation of EOC Action Plans. The section also maintains information on the current and forecast situation, and on the status of resources assigned to the incident. The Section typically includes Situation, Resource, Documentation, Message, and Action Plan Units.

Plan Maintenance - Steps taken to ensure the plan is reviewed annually and updated whenever major changes occur.

Preparedness - The preparedness phase involves activities taken in advance of an emergency to ensure an effective response to the emergency, if it should occur.

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Primary Facility - The site of normal, day-to-day operations; the location where the employee usually goes to work.

Public Information Officer - An official responsible for releasing information to the public and other stakeholders, usually through the news media. (Also see Information Officer).

R

RACES/Radio Amateur Civil Emergency Service - One of several groups of amateur radio operators commonly referred to as "HAM Radio Operators". RACES is designated by the FCC to provide amateur communications assistance to federal, state and local government agencies in a disaster.

Radiation Threat - The use of common explosives to spread radioactive materials over a targeted area. Also known as a "dirty bomb," a radiation threat is not a nuclear blast, but rather an explosion with localized radioactive contamination.

Recovery - Activities that occur following a response to a disaster that are designed to help an organization and community return to a pre-disaster level of function. These activities usually begin within days after the event and continue after the response activities cease. Recovery includes government individual and public assistance programs which provide temporary housing assistance, grants and loans to eligible individuals, businesses and government entities to recover from the effects of a disaster.

Relocation Site - The site where all or designated employees will report for work if required to move from the primary facility.

Response - Activities to address the immediate and short-term effects of an emergency or disaster. Response includes immediate actions to save lives, protect property and meet basic human needs.

Risk Communications - Communication of risks resulting from site operations and the implications for the surrounding community. Organization risk communications include effective processes for risk assessment & management, emergency preparedness, and community dialogue.

S

Safety Officer - A member of the Management Staff within the EOC responsible for monitoring and assessing safety hazards or unsafe situations, and for developing measures for ensuring personnel safety.

Search and Rescue, Heavy - Rescue techniques for victims entombed by the partial or total collapse of a structure, done by specially trained teams with mechanical or hydraulic equipment.

Search and Rescue, Light - Rescue techniques for victims trapped by non-structural contents, even if structural damage has occurred, done by trained or non-trained teams (depending on accompanying structural damage) using hand-held tools.

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Section - That organization level with responsibility for a major functional area at the EOC, e.g., Operations, Planning, Logistics, Finance.

"Shelter-in-Place" - The process of staying where you are and taking shelter, rather than trying to evacuate.

Situation Report (SITREP) - A written, formatted report that provides a picture of the response activities during a designated reporting period.

START - Acronym for Simple Triage and Rapid Treatment. Field triage system used that allows field care personnel to triage patients into one of four categories within 60 seconds.

Staff Protection - Personal Protective Equipment – (See Personal Protective Equipment).

Staff Protection - Decontamination - Decontamination is the physical removal of harmful substances from victims, equipment, and supplies of a HAZMAT or NBC attack. It should be performed whenever there is a risk of secondary exposure from a hazardous substance. Failure to adequately "decon" NBC victims could not only increase the number and severity of casualties, but could also cripple medical response to a terrorist event. Various methods for performing decontamination are available (such as mechanical removal, absorption, degradation, and dilution), with dilution being the most applicable to the medical environment.

Standard Operating Procedures (SOPs) - A set of instructions having the force of a directive, covering those features of operations which lend themselves to a definite or standardized procedure. Standard operating procedures support an emergency plan by describing in detail how a particular task will be carried out.

Standardized Emergency Management System (SEMS) - SEMS consists of five organizational levels which are activated as necessary: Field Response, Local Government, Operational Area, Region, and State.

Surge Capacity - In times of disaster so called excess capacity contributes to surge capacity which provides the ability to care for large numbers of casualties. Surge capacity encompasses potential available space in which patients may be triaged, managed, vaccinated, decontaminated, or simply located; available personnel of all types; necessary medications, supplies and equipment; and even the legal capacity to deliver health care under situations which exceed authorized capacity.

T

Technological Hazard - Includes a range of hazards emanating from the manufacture, transportation, and use of such substances as radioactive materials, chemicals, explosives, flammables, agricultural pesticides, herbicides and disease agents; oil spills on land, coastal waters or inland water systems; and debris from space.

Training and Exercise - These activities include: 1) efforts to educate/advise designated staff on responsibilities, and on the existing plans; and 2), tests to demonstrate the viability and interoperability of all plans

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Trauma Center Criteria – A method for deciding which patients need a trauma center, based on the patient’s injuries, vital signs, mechanism of injury and the paramedic’s judgment.

Triage - It literally means "to sort"; commonly means prioritizing patients into categories according to the severity of their condition. Patients requiring life-saving care are treated before those requiring only first aid. The process of screening and classification of sick, wounded, or injured persons to determine priority needs in order to ensure the efficient use of medical manpower, equipment and facilities.

Triage, Expectant Category - A patient who requires more extensive resuscitation than available resources will allow, but is still alive at that time; this category is used only in catastrophic disasters where personnel and/or medical supplies are too limited to use standard resuscitation guidelines.

Triage Personnel - Trained individuals responsible for triaging patients and assigning them to appropriate transportation or treatment areas.

Triage Tag - A tag used by triage personnel to identify and document the classification, or level, of a patient's medical condition.

V

Vital Records & Systems - Records necessary to maintain operations during an emergency, to recover full operations following an emergency, and to protect the legal rights and interests of citizens and the Government. The two basic categories of vital records are emergency operating records and rights and interests records.

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Appendix C: (Mitigation Tools) Clinic Hazard and Vulnerability Analysis

Instructions: Evaluate potential for event and response among the following categories using the hazard specific scale. Assume each event incident occurs at the worst possible time (e.g. during peak patient loads). Complete all worksheets, including Natural, Technological, Human and Hazmat.

Issues to consider for probability include, but are not limited to:o Known risko Historical datao Manufacturer/vendor statistics

Issues to consider for response include, but are not limited to:o Time to marshal an on-scene responseo Scope of response capabilityo Historical evaluation of response success

Issues to consider for human impact include, but are not limited to:o Potential for staff death or injuryo Potential for patient death or injury

Issues to consider for property impact include, but are not limited to:o Cost to replaceo Cost to set up temporary replacemento Cost to repairo Time to recover

Issues to consider for business impact include, but are not limited to:o Business interruptiono Employees unable to report to worko Customers unable to reach facilityo Company in violation of contractual agreementso Imposition of fines and penalties or legal costso Interruption of critical supplieso Interruption of product distributiono Reputation and public imageo Financial impact/burden

Issues to consider for preparedness include, but are not limited to:o Frequency of drillso Training statuso Insuranceo Availability of alternate sources for critical supplies/services

Issues to consider for internal resources include, but are not limited to:o Types of supplies on hand/will they meet need?o Volume of supplies on hand/will they meet need?o Staff availability

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o Coordination with MOB’so Availability of back-up systemso Internal resources’ ability to withstand disaster/survivability

Issues to consider for external resources include, but are not limited to:o Types of agreements with local and state agencieso Types of agreements with community agencies/drillso Coordination with local and state agencieso Coordination with proximal health care facilitieso Coordination with treatment specific facilitieso Community resources

Keeping this in mind, complete the assessment beginning on the next page.

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Facility Location: _________________________________ Completed by: ___________________________ Date: __ / __ / ____

Hazard and Vulnerability Assessment Tool Worksheet: NATURAL OCCURING EVENTSA B C D E F G H I

Event

Probability(Likelihood this

will occur)

Human Impact(Possibility of

Death or injury)

Property Impact

(Possibility of physical losses and damages)

Business Impact

(Possibility of Interruption in

Services)

Preparedness(Amount of

Preplanning)

Internal Response

(Likelihood of immediate

availability of resources)

External Response

(Likelihood of access to quick

community/ mutual aid staff and supplies)

Total Risk(Add columns

B – H)0 = N/A1 = Low

2 = Moderate3 = High

0 = N/A1 = Low


0 = N/A1 = Low


0 = N/A1 = Low


0 = N/A1 = Low


0 = N/A1 = Low


0 = N/A1 = Low


Hurricane

TornadoSevere

ThunderstormSnow Fall

Blizzard

Ice Storm

EarthquakeTemperature

ExtremesDroughtFlood,

ExternalWild Fire

LandslideDam

InundationVolcano

Epidemic


Hazard and Vulnerability Assessment Tool Worksheet: TECHNOLOGIC EVENTSA B C D E F G H I

Event


will occur)

Human Impact(Possibility of

Death or injury)

Property Impact


Business Impact


Services)


Preplanning)

Internal Response



External Response

(Likelihood of access to quick

community/ mutual aid staff and supplies)


B – H)0 = N/A1 = Low


0 = N/A1 = Low


0 = N/A1 = Low


0 = N/A1 = Low


0 = N/A1 = Low


0 = N/A1 = Low


0 = N/A1 = Low


Electrical Failure

Generator Failure

Fuel Shortage

Natural Gas Failure

Water Failure

Sewer Failure

Fire Alarm Failure

Communications Failure

HVAC Failure

IT Systems Failure

Fire, Internal

Flood, Internal

Hazmat Exposure

Supply Shortage

Structural Damage


Hazard and Vulnerability Assessment Tool Worksheet: HUMAN RELATED EVENTSA B C D E F G H I

Event


will occur)

Human Impact

(Possibility of Death or

injury)

Property Impact


Business Impact


Services)


Preplanning)

Internal Response



External Response

(Likelihood of access to

quick community/ mutual aid staff and supplies)


B – H)

0 = N/A1 = Low


0 = N/A1 = Low


0 = N/A1 = Low


0 = N/A1 = Low


0 = N/A1 = Low


0 = N/A1 = Low


0 = N/A1 = Low


Mass Casualty (Trauma)

Mass Casualty (Medical/Infectious)

Terrorism, Biological

VIP Situation

Infant Abduction

Hostage Situation

Civil Disturbance

Labor Action

Forensic Admission

Bomb Threat


Hazard and Vulnerability Assessment Tool Worksheet: EVENTS INVOLVING HAZARDOUS MATERIALSA B C D E F G H I

Event


will occur)

Human Impact

(Possibility of Death or

injury)

Property Impact


Business Impact


Services)


Preplanning)

Internal Response



External Response

(Likelihood of access to

quick community/ mutual aid staff and supplies)


B – H)

0 = N/A1 = Low


0 = N/A1 = Low


0 = N/A1 = Low


0 = N/A1 = Low


0 = N/A1 = Low


0 = N/A1 = Low


0 = N/A1 = Low


Mass Casualty (Hazmat, >=5

victims)Mass Casualty (Hazmat, < 5

victims)Chemical

Exposure, ExternalSmall-Medium

Sized Internal Spill

Large Internal Spill

Terrorism, Chemical

Radiologic Exposure, Internal

Radiologic Exposure, External

Terrorism, Radiologic

Appendix D: Management of Environment/Hazard Surveillance & Risk Assessment Report Form

Facility Location: _____________________________________________________________

Completed by: _________________________________ Date: __ / __ / ____

Program Hazard Surveillance/Risk Assessment ItemScore (1 – 5)

(1 = Outstanding, 5 = Needs

Improvement)

Comments

Safety

1. Are grounds clean and free of hazards?

2. Are floors clean, dry, in good repair and free of obstruction?3. Are mechanisms for access (i.e., ramps, handrails, door opening mechanisms, etc.) operational?4. Is the parking area free of potholes or other hazards?

Program Total:

Security Management

1. Are doors functioning and locked as appropriate?2. Are alarms functioning, tested, and maintained in accordance with manufacturer’s specifications?3. Are systems/mechanisms in place to quickly notify officials or other staff quickly in the event of a security related problem?

Program Total:

Hazardous Materials &

Waste Management

1. Are OSHA Hazard Communication and Exposure Control Documents available?2. Have all biohazard and toxic substances present been identified?3. Are MSDS sheets quickly available for all identified toxic substances?4. Are all waste contaminated with blood/body fluid considered and handled as infectious?5. Are sharps containers puncture resistant and in accordance with required safety standards?6. Are sharps and disposable syringes placed in approved sharps containers?7. Are all engineering, personal protective equipment, and workplace controls in effect?

Program Total:

Emergency Preparedness Management

1. Is there an updated disaster plan in the facility?2. Has a non-fire related emergency drill been performed in the past six months?3. Is staff aware of at least three different types of potential non-fire emergencies and their role in eliminating or reducing the risk of patients, staff and property?4. Is staff aware of the primary and secondary exits from the facility?

Program Total:

Life Safety Management

1. Is the evacuation plan posted and can staff demonstrate knowledge of the plan?2. Are fire extinguishers located in accordance with NFPA standards?3. Are fire extinguishers inspected monthly and documented on/near the extinguisher?4. Are smoke/fire alarm systems functioning, tested and maintained in accordance with manufacturer’s specifications?5. Are exit hallways well lit and obstacle free?

6. Is emergency exit lighting operational and tested in accordance with NFPA standards?7. Are fire/smoke doors operating effectively?

8. No smoking policies are in effect and signs are posted appropriately?

Program Total:

Medical Equipment

Management

1. Is there a unique inventory of all medical equipment in the facility?2. Has all equipment been tested/maintained according to manufacturer’s specifications?3. Are maintenance records complete, are they capable of tracking the maintenance history of a particular piece of equipment, and do they record the results of both electrical safety as well as calibration, as appropriate?4. Are systems/mechanisms in place to respond appropriately to a medical equipment failure?

Program Total:

Utility Management

1. Are the lights, emergency lights, and power plugs operational and in working order?2. Does the water/sewage system appear to be working properly and has the water quality been tested within the past year?3. Is the telephone system operational?4. Has the HVAC system been inspected in accordance with manufacturer specifications and have the filters been checked quarterly?5. Are fire suppression (sprinkler) systems checked at least once a year, or as appropriate by a qualified individual?6. Are shut-offs for all utility systems clearly marked and accessible for all staff in the event of an emergency?7. Are systems/mechanisms in place to respond in the nature of a failure of any utility system?

Program Total:

Infection Control &

Monitoring Issues

1. Is all staff utilitizing Universal Precautions (i.e., using PPE, hand washing, etc.) in the performance of their job duties?2. Are cleaning solutions secured, mixed and utilized appropriately throughout the facility?3. Are potentially “infectious agents” aggressively identified and processed in a manner which would minimize the risk of infection of staff and other patients?4. Can staff intelligently describe their role in infection control within the organization?

Program Total:Other Key Safety Monitoring Issues

1. Are utility rooms locked, clean and free of debris?2. Are storage rooms secure, clean, and free of flammable objects?3. Are emergency carts present, as appropriate, fully stocked, and checked per schedule?4. Are all medications, including samples, secured and accounted for by lot number?

Program Total:

OVERALL ASSESSMENT TOTAL:

As PATHS’ Safety Officer, I have reviewed the findings of this audit and I am responsible for seeing to it that any deficiencies are corrected as soon as possible, but at least before the next inspection.

Safety Officer: __________________________________________ Date: __ / __ / ____

Appendix E: Structural and Nonstructural Hazard Mitigation Checklist

Facility Location: _____________________________________________________________

Completed by: _________________________________ Date: __ / __ / ____

Structural Mitigation:

Structural Mitigation is reinforcing, bracing, anchoring, bolting, strengthening or replacing any portion of the building that may become damaged and/or cause injury. For example:

Exterior walls (e.g., use a wind resistant design for tornados or windstorms); Exterior doors (e.g., non-combustible materials for wildfires or urban fires); Exterior windows (e.g., use shutters or windows for tornados or windstorms); Foundation (e.g., brace, anchor or bolt the facility for earthquakes) Exterior columns/pilasters/corbels (e.g., steel or concrete columns) Roof (e.g., use non-combustible materials for wildfires or urban fires)

Check to certify that the facility is reasonably expected to withstand the following disasters:

Earthquakes : Anchor/brace (mobile home) or bolt the facility to its foundation and reinforce any portion of the exterior of the facility that may cause injury.

Floods and flashfloods : Elevate and reinforce the facility but ultimately avoid a floodplain location.

Landslide and Mudflow : Build retaining walls on slopes. Build masonry walls to direct the mudflow around the facility. Bolt the foundation and reinforce the walls of the facility.

Wildfire and Urban Fire : Use fire resistant materials (e.g., non-combustible roofing materials

Tornado : Follow local building codes to use a wind resistant design for the facility.

Dam Failure : Reinforce and flood-proof the facility.

Nonstructural Hazard Mitigation:

Nonstructural hazard mitigation reduces the threat to safety posed by the efforts of earthquakes on such nonstructural elements as building contents, internal utility systems, interior glass and decorative architectural walls and ceilings. These actions involve identifying nonstructural fixtures and equipment, which are vulnerable to an earthquake and which are either essential to continued operations or a threat to public safety.

Nonstructural mitigation is: Retrofit: Refers to various methods for securing nonstructural items. Retrofitting

methods are bracing, securing, tying down (tethers or leashes), bolting, anchoring, etc.

Replace: Replacing the item with a new one that is resistant to the hazard. Relocate: Moving items from a hazardous location to a non-hazardous one. Backup Plan: If there is a concern that an essential service will be disrupted, provide for

the backup service.

Nonstructural mitigation includes all contents of the structure that do not contribute to its structural integrity such as:

Systems and elements which are essential to operations; Emergency power generating equipment, plumbing, HVAC; Fire protection systems including sprinklers and distribution lines, emergency water

tanks/reservoirs, etc.; Medical equipment (x-ray equipment, refrigeration units used to store pharmaceuticals,

etc.) Hazardous materials (chemicals restrained on shelves, containers stored on braced

storage rack or tall racks, gas tanks with flexible connections, gas tank legs anchored to a concrete footing or slab).

Non-essential elements whose failure could compromise facility operations, such as:o Suspended lights and ceilings;o Partitions;o Interior doors;o Furniture and contents (bookshelves, file cabinets, etc.);

Check to certify that the facility is reasonably prepared by having addressed the following:

Light fixtures and other items that could fall are braced.

The top and bottom of compressed gas cylinders are secured with a safety chain.

Stored containers of hazardous materials are on braced storage racks, and tall stacks are restrained (metal or wire guardrails, etc.).

All desktop equipment, such as computers, televisions, and printers are secured.

Shatter-resistant protective film or blinds are used on windows to prevent glass from shattering onto people, or safety glass is installed.

All tall, unsecured furniture items are either anchored to the wall or to each other.

Heavy objects are hung away from workstations.

All large equipment (such as copiers or heavy machinery) is secured to the floor, or tethered to the wall.

The main breaker or fuse box, and all utility meters, are elevated above the anticipated flood level of the facility.

Appendix F: Response Roles and Requirements

Emergency Roles Requirements1. Internal Emergencies:

Protect patients, visitors and staff Protect facilities and vital equipment

Generally requires planning, training and exercise. Also requires internal culture where safety and preparedness are given high priorities. Specific requirements include:

Emergency Plans Training/Drills/Exercises Emergency/Evacuation Signage Business Continuity Plans Security Internal Communications Staff notification and recall Emergency procedures distribution

2. Mass Casualty Care: Sufficient staff to manage patient surge Triage capability ALS capability Holding Agreements with receiving hospitals Integration of a site into an operational

area medical response system3. Reception and Triage:During disasters, PATHS’ sites may become points of convergence for injured, infected, worried, or dislocated community members. Depending on the emergency and availability of other medical resources, sites may not be able to handle all of the presenting conditions. Minimum site role will likely be triage, reporting, stabilization, and holding until transport can be arranged.

Response plan Staff recall procedure Procedures to obtain outside additional

assistance (volunteers, assistance from city/county, etc.)

Crowd management Location of shelters Reception area Triage tags Triage training Medical supplies

4. Reception of Hospital Overflow:In disasters, hospitals may be overwhelmed with ill and injured patients requiring high levels of care, while at the same time facing convergence from patients with minor injuries or the worried well. Sites may be requested to handle people with minor injuries to relieve the pressure on the hospital.

Requirements above for mass casualty care, and prior agreement that defines:

Circumstances for implementation Types of patients that will be accepted Resource/staff support provided by the

hospital Patient information/medical records Liability releases

5. Maintaining Ongoing & Routine Patient Care (Normal levels and extended surge): The community’s need for routine medical care may continue following a disaster.

Sites should prepare to maintain their service capacity through protection of equipment, critical supplies, critical medications, and personnel. Requirements include:

Continuity of Operations Plan Procedures to augment resources in

areas subject to frequent power outages, consider adding generators to ensure operational capacity.

6. Mental Health Services:Sites can expect the convergence of the “worried well” following a disaster.

Disaster mental health training for clinicians/licensed mental health staff

Internal or external mental health team External source of trained personnel to

augment response.7. Bioterrorism Agent Initial Identification and Rapid Reporting:Sites may be the “early warning system” for a bioterrorism outbreak. Providers should look for unusual symptoms or other signs of use of BT agents. Rapid reporting is critical. Unusual events may include a single case, or multiple cases with the same symptoms.

Infectious disease monitoring procedures and protocols.

Zebra-Pack: If an infection is suspected, the “Zebra-Pack” provides information on precautions and initial treatment.

Procedures for reporting to county health department.

Evidence kits Training

8. Staff Protection: Provide protection to staff in event or presence of Bioterrorism agent.

Adherence to standard precautions Level C PPE Training Infectious disease procedures Reporting procedures

9. Mass Prophylaxis:Sites may be requested to participate in mass prophylaxis managed by the local health department. Provider participation should include requesting site staff to support mass inoculations at other sites.

Availability of staff who can volunteer Procedures for determining when the

clinic staff can volunteer

10. Hazardous Material Response:Sites near major transportation routes, distant from hospitals, or with emergency medical capabilities, may be called upon to treat injured patients who have been contaminated by a hazardous material. Generally, in urban areas, sites will not be required to be hazardous material responders.

Protective equipment Decontamination

procedures/Capability/Equipment Reporting procedures Waste holding container

11. Risk Communications:Sites are often important conduits of health information for the communities they serve. Patients, staff and community members may look to the site for answers to their questions about a bioterrorist attack or other emergency.

Communications link with Operational Area

Procedures for communication with patients, staff and community (in languages spoken in the community).

12. Provide Volunteer Staff:Sites may be requested to provide staff to deliver medical services at shelters, for mass prophylaxis, or at other response sites.

Back-up staff Policy for receiving requests, polling

staff, and releasing staff for non-clinic duties.

Policy on release of staff for volunteer duty.

13. Receive Volunteer Staff (Providers, teams, etc.):

Reception procedures Credentialing/Background checks Logistic support

14. Community Preparedness: Educational materials Educators/volunteers Ability to organize/sponsor

“Neighborhood Emergency Response Teams”

15. Sheltering: Holding area Protection from the weather Bedding Medical Supplies Pharmaceuticals for common

conditions (insulin, etc.)

2015-2016 Organizational Chart

Appendix G: Emergency Response Team / PATHS Day-To-Day Organizational Chart

The day-to-day organizational chart provides a starting point for selection of staff to fill Emergency Response Team (ERT) positions and to identify potential ERT backups and replacements

Appendix H: Emergency Response Team / Position Assignments

Name Day-to-Day Role ERT Location ERT Role

Appendix I: Emergency Response Team Organization Chart

Incident Manager

Management Staff Operations Section Chief

Planning Section Chief

Safety Officer

PIO

Security Officer

Liaisons

Logistics Section Chief

Finance Section Chief

Medical Care Director

Triage Leader

Treatment Leader

Mental Health Coordinator

Lab/Pharmacy Leader

Dependent Care Leader

Search and Rescue Leader

Situation/Status Leader

Patient Tracking Leader

Facility Leader

Communications Leader

Transportation Leader

Materials Supply Leader

Team Leader

Procurement Leader

Claims-Cost Leader

Appendix J: Training and Exercises

I. Purpose: The purpose of this guide is to define a successful method for PATHS to meet its emergency training needs. There are many reasons PATHS has chosen to provide training for emergency staff. The training provided for members of the ERT has three primary purposes, which are to:

A. Know their role and responsibilities;

B. Possess the skills and knowledge needed to perform respective functional responsibilities; and

C. Understand the disaster management processes to achieve effective coordination and communications.

II. Desired Outcomes: There are three major outcomes PATHS expects from this training. These are to ensure that:

A. The emergency organization performs effectively in protecting health and safety, property, and the environment;

B. PATHS’ staff is prepared to work effectively with other emergency response and recovery organizations, by appropriate and timely use of resources, and by recovery of damages and operating costs, to the extent possible; and

C. The emergency organization members can work in a safe manner to prevent injury to themselves and others.

III. Curriculum Defined:

A. A curriculum defines the approaches to training and delivery methodologies, which may include:

1. Reading assignments,

2. Briefings,

3. Classroom instruction (with or without examinations),

4. Videotape,

5. Online instruction,

6. Demonstration,

7. Drill/Exercise

B. A curriculum also defines the types of training materials that will be used, which may include:

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1. Written materials (e.g., manuals, checklists, guides, graphics)

2. Audio materials (e.g., compact discs)

3. Audio/Visual materials (e.g., slide shows, movies)

C. A curriculum defines content and purpose for each training approach and the materials. The contents are defined with specific:

1. Goals

2. Objectives (including knowledge and skill to be achieved)

3. Materials needed (printed, A/V, testing devices, etc.)

4. Location Requirements

5. Prerequisites for the Participants

6. List of Assigned Positions

7. References (source of the curriculum content)

IV. Legal Requirements

A. Hazardous Materials Training: PATHS must decide what level of training is appropriate for hazardous materials and bioterrorism events, including use of personnel protective equipment. PATHS should identify the types of actions expected of staff at a scene (especially in bio-hazard and chemical treatment situations). Training decisions should be based on whether staff will be in the vicinity of materials that are causing the event. References exist in OSHA 29 CFR 1910.120(q)

B. General Safety Training: All PATHS’ staff members are required to have general safety training and training in appropriate actions to take in an emergency. Safety Team members are required to have additional training in safe work practices, building evacuation, first-aid, fire safety, and CPR. PATHS training personnel should work with the Safety Officer to integrate safety training with disaster response training.

V. Curriculum Development Process

A. Identification of the Organization: PATHS must first identify an Emergency Response Team (ERT) roster. “Appendix G” provides the day-to-day organization chart from which the Chief Executive Officer will identify staff to fill the emergency management positions.

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B. Identification of Skill and Knowledge Needs by Position: The Chief Executive Officer can use tools such as “Appendix H” and “Appendix I” to match the staff to the positions based on their daily assignments, current skills, and knowledge. This will help identify gaps that need to be addressed through training.

C. Identification of Delivery Methodologies:

1. The curriculum delivery methodologies must then be developed to match the skill and knowledge needs that have been identified. The methodologies may include:

a) Reading assignments: Reading assignments are appropriate when the material is general in nature, timely, and requires immediate attention (rather than waiting for the next training cycle). A reading assignment should be accompanied with a “read and sign” sheet to be returned to the Safety Officer. This will be scanned into the employees file. These assignments can include:

(1) Revised sections of the Plan and SOPs that are relevant to the readers

(2) New laws or regulations that can immediately affect emergency performance

(3) Changes in emergency organization structure or components

(4) Changes in the EOC operations

(5) Changes in assignment of key positions

(6) Changes to the annual training assignments

b) Briefings in person in the office or at field locations: Briefings are time intensive. They often involve fewer individuals than would be featured in classroom presentations. Sometimes a briefing is for a specific individual. There must be compelling reasons to hold briefings. These can include:

(1) Changes that require immediate awareness and change of behavior

(2) Warnings regarding impending threats to safety, health, the environment, or property

(3) Updates on current issues that can impact staff morale

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(4) Directives from the Operational Area or Chief Executive Officer that require immediate attention

(5) Updates on information that a member of the emergency organization was not able to acquire because of a missed training opportunity—this fulfills a legal requirement to keep everyone in the organization properly trained in accordance with his/her assigned training curriculum

c) Classroom instruction (with or without examinations): Classroom instruction provides a formal environment for training and learning. Most classroom training should be held at either the primary or alternate EOC, when possible. For larger classes, or when the emergency facilities are not available, the organization should house classroom training. The Safety Officer should present most training.

Some classroom instruction can be provided by specialized training organizations. Some of these organizations can come directly to PATHS’ sites. Other training organizations may require staff to travel to another site. Training can be provided through such diverse organizations as:

(1) Regional Healthcare Association

(2) County / regional EMS Agencies and Offices of Emergency Services

(3) Hospitals

(4) The Federal Emergency Management Agency (FEMA), Emmetsburg, Maryland

(5) The American Red Cross (ARC) (through numerous local chapters)

(6) Colleges and universities specializing in emergency management courses

d) Videos:

(1) Video-based training should include:

(a) Overview of ICS

(b) EOC facility layout and operations

(c) Public Information

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(d) Other specific interests as noted by staff (specific hazards, command and control, field operations, mass care and shelter)

(2) Videos should not be used to replace formal training requirements such as classroom training, drills and exercises.

e) Web-based presentations: PATHS can post emergency management, self-guided training on its website for its own emergency organization. This can include short video presentations and PowerPoint slide shows. Other formal, accredited courses can be taken online through FEMA’s website. This training does not replace the required, formal PATHS classroom, drill, or exercise activities.

f) Demonstrations: Demonstrations develop skills for a limited function. This helps staff perform properly in drills, exercises and actual events. Typical demonstrations for PATHS might include:

(1) Communications use and protocols

(2) Use of computers in the EOC, including e-mail and other software

(3) Use of fax machines and copiers (including electronic faxing and scanning of documents)

(4) Set up of the EOC or set up of a triage or isolation area

(5) Tours of facilities (PATHS and others), hazards sites, and equipment storage sites

g) Drills (unevaluated activities for developing skills):

(1) The response phase of the emergency management plan is tested twice a year, either in response to an actual emergency or in planned drills. Drills are conducted at least four months apart and no more than eight months apart.

(2) Testing includes participation in at least one community-wide practice drill yearly (where applicable) relevant to the priority emergencies identified by the organization's hazard vulnerability analysis, that assesses communication, coordination, and the effectiveness of the organization's and community's command structures.

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(3) PATHS follows FEMA’s definition of “drill” as a drill has the following elements:

(a) Single emergency response function

(b) Single agency involvement

(c) Often a field response component

(d) Field evaluators and messaging is critical

(e) Limit focus to ensure program is thoroughly evaluated and improves

(4) PATHS does not grade for achievement. Drills are low-stress activities for demonstrating skills after formal training and/or demonstrations. Participants usually focus on a single activity of recovery or response to limit the time involved while increasing the value of the activity. PATHS drills might include:

(a) Plan and Procedures

(b) Emergency Call Outs

(c) Evacuation (fire/flood/bomb threat)

(d) Emergency Operations

(e) Emergency Techniques

(f) Communications

(g) Bomb Threat

(h) Use of Forms

(i) EOC Activation

(j) Safety Operations

h) Exercises (evaluated activities for testing skills):

(1) Exercises are evaluated activities that usually require some element of realism and varying levels of stress. The definitions of the types, as defined by FEMA, is:

(a) Orientation Exercise: having the following elements (often called a Walk-Through):

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(i) Informal

(ii) No simulation

(iii) Discussion of roles and responsibilities

(iv) Review past cases and lessons learned

(v) Introduction of policies, procedures, plans and responsibilities

(b) Tabletop Exercises have the following elements:

(i) Information discussion of simulated emergency

(ii) Messages to players, but no time pressures

(iii) Low stress

(iv) Initial evaluation of plans and procedures

(v) Raise questions of coordination and responsibility

(c) Functional Exercises have the following elements:

(i) Emergency simulation, timeline with messages allowing player communications

(ii) Policy and coordination tested...personnel practice emergency response

(iii) Stressful, realistic simulation

(iv) Takes place in real time

(v) Emphasizes emergency functions

(vi) EOC is activated

(d) a Full-Scale Exercise has the following elements:

(i) Takes place in real time

(ii) Employs real people and equipment

(iii) Tests several emergency functions and mixes field elements with response facilities

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(iv) Activate EOC

(v) Produces high stress

(2) Some form of exercise should be held at least every two years, and more often as time and budgets allow. An off-hours exercise should be performed every four years. A weekend exercise should be performed every five years. Some exercises (full-scale) can be very expensive and require substantial staff time and resources for planning and performance. All exercises should be followed by a debriefing, or “hot wash,” with the participants. This should then be followed with a formal report.

2. Combined, these elements can meet the required training needs. In addition, there can be credit for training by performance during the coming training cycle for all who performed in real emergency operations, whether at PATHS or as assigned to other organizations and facilities as a PATHS employee.

3. Exercise Scenarios: The following scenarios may prove useful in developing drills and exercises. These scenarios should be viewed as starting points that can be adapted to reflect local conditions (for realism) as well as local hazards and priorities.

a) Major apartment fire occurs in the neighborhood: Fire trucks arrive just as 200 people flee the apartment. The clinic is the closest provider of health care in the neighborhood. Within 10 minutes 5 people enter the lobby of the clinic complaining of smoke inhalation. They demand care. Within another 5 minutes another 5 people arrive also requesting care. It is clear that calling 911 and requesting EMS support will not be a sufficient response. The Site Manager contacts a site Provider and decides to begin to triage patients. The Site Manager contacts the Lt. in charge of the first response and informs him that the site is beginning triage efforts. What patients can the site provide care for, what stabilization activities will the site begin and who gets transported to the hospitals first?

b) School Bus crash: Right in front of the site a school bus is rear ended. Thirty children are on the bus. EMS arrives, but decides that because of the weather all of the children should be brought into the site. The EMT requests that a Provider evaluate the patients since transport to the hospital will take up to 45 minutes. What patients can the site provide care for, what stabilization activities will the site begin and who gets transported to the hospitals first?

c) Bio-event: Beginning at 8:00 am today the phone is ringing off the hook with worried parents calling because their kids are sick with

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flu-like symptom, 104 degree temperatures and nausea. By 8:30AM, 20 children have been brought to the site with the same symptoms. Mothers are unwilling to leave until their kids are seen. It is clear that over the next several hours the number of patients will continue to grow. How does the site determine which patients are in need of immediate care, what they have been exposed to what, and how does the site reorganize to evaluate this tidal wave?

d) Flood in the city: It has been raining for several days. The river on the other side of town has begun to overflow its banks. A number of elderly who live near the river have begun to come and sit quietly in the site lobby. Right now there are about 30 people in the lobby. All of a sudden one slumps to the floor. Two others begin to scream for help. 911 is called, but because of the community emergency, the 911 operator informs the site that they request the site Providers to handle the emergency.

e) Earthquake: At 10:10AM, a 6.5 earthquake rumbles through the city. Roads are cut and commercial utilities are severed. Within minutes, members of the community begin to arrive at the site with both minor and major injuries. It is clear that the site will become a place of care for the community members near the site.

D. Identification of Curriculum Content: Each of the core curricula (classroom training, drills, exercises) will be consistent in their format for their type. The classroom training materials should include both an instructor and a participant manual for each course. The manuals need not be elaborate, but must be based on a formal one-sheet lesson plan that includes the following contents:

1. Topic

2. Length of class

3. Participant Prerequisites (if any)

4. Emergency Organization Positions Required to Attend

5. Location (if fixed)

6. Instructor(s) name(s)

7. Materials for presentation

8. References

9. Goal of Course

10. Performance Objectives

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E. Assignment of Training Elements for Each Position: The formal training should cover the topics in accordance with PATHS’ Emergency Plan SOPs and ICS. These topics may change as new threats develop, as they did for nuclear power plants, hazardous material spills, and terrorism.

F. Development of a Training Delivery Schedule: PATHS’ Safety Officer will develop a regular training schedule for the emergency management program. With this completed, the organization will now know its needs, how to address them, and how often to provide training to meet the skill and knowledge needs.

G. Cost Analysis (Time and Budget): PATHS’ Director of Finance will develop a formal method of planning for training costs each year. There may be changes in the number of staff, the types of training, and the amounts of training each year. The length of each course may also change as laws, regulations and lessons change. Most classroom subjects can be presented individually in one hour or less, with the exception of specialized training such as ICS, CPR and First Aid. Most drills will last two to three hours. Exercises last from a half-day to a full day, depending on the type of exercise. Remember to consider staff time for preparation and implementation of these activities. Also consider outsourcing costs to outside training organizations and consultants.

H. Evaluation of Training Effectiveness: Formal training requires evaluation. PATHS’ Safety Officer will provide minimum evaluation instruments for each formal classroom experience to ensure the objectives of the course have been achieved. This also helps the instructors to revise course materials or training modalities to ensure the effective use of staff time and costs. The same is true for exercises, which by definition should always have some form of evaluation as a formal record of the activity. Additional measurement devices are used after exercises in the form of critiques, After Action Reports, and Corrective Action Reports. External audits can also be used as a tool to evaluate the total training curriculum effort.

I. Maintaining Training Records: In all cases, a record must be kept of any training methodology that was performed, including who received the information and the results of any evaluation. Records of required training elements must be kept with the individual’s personnel record.

J. Program Maintenance and Schedule: Training programs are part of the 5-year maintenance schedule for this emergency management program. The schedule is as follows:

YEAR1 2 3 4 5

1. Redesign Emergency Plan X X2. Redesign Primary EOC X X X3. Redesign Alternate EOC X X4. Redesign Communications Systems X X X5. Redesign Budget Process X X6. Perform Off-Hours Exercise X7. Perform Weekend Exercise X

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8. Develop New MOUs/Letters of Agreement X X X X X9. Audit Emergency Programs X X X10. Revise 5-year Plan X X11. Revise Annual Plan X X X X X

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Appendix K: Disaster Contact List

Danville/Pittsylvania CountyContact Telephone Email Website

Police: Danville 434-799-6510 (non-emergency)Police: Pittsylvania County 434-432-7800Local Emergency Manager: Danville

Steve Dishman 434-799-6535

Local Emergency Manager: Pittsylvania County

James Davis 434-432-7920

Health Department: Emergency Coordinator

Eric Clark 434-766-9822434-770-9166 (cell)

[email protected]

Health Department: Epidemiologist

434-766-9828

Danville Regional Medical Center

434-799-2100

Martinsville/Henry CountyContact Telephone Email Website

Police 276-638-8751 (non-emergency)Local Emergency Manager: Henry County

Matthew Tatum, Public Safety Dir.

276-634-4663

Health Department: Emergency Coordinator

Christopher Garrett 276-638-2311 x145276-732-1800 (cell)

[email protected]


Sharon Ortiz-Garcia 276-638-2311 x129276-732-8833 (cell)

[email protected]

Memorial Hospital of Martinsville

276-666-7200

Mecklenburg CountyContact Telephone Email Website

Police 704-336-7600 (non-emergency)Health Department: Emergency Coordinator

Dave Martin 434-738-6815 x110


Agathe Hoffer-Schaefer 434-579-1674

Community Memorial Hospital 434-447-3151

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Appendix L: Health Care Alternate and Referral Facility Locations

PATHS Community Medical Center – Boydton380 Washington St., Boydton, VA 27308434-738-6420

PATHS Community Medical Center – Chatham4 South Main Street, Chatham, VA 24531434-432-4443

PATHS Community Medical Center – Danville705 Main Street, Danville, VA 24541434-791-4122

PATHS Community Medical Center – Martinsville287 Commonwealth Blvd, Martinsville, VA 24112276-632-2966

____________________________________________________________________________

DANVILLE/PITTSYLVANIA COUNTY: Danville Regional Medical Center

142 South Main Street, Danville, VA 24541434-799-2100

MARTINSVILLE/HENRY COUNTY: Memorial Hospital of Martinsville

320 Hospital Drive, Martinsville, VA 24112276-666-7200

MECKLENBURG COUNTY: Community Memorial Hospital

125 Buena Vista Circle, South Hill, VA 23970434-447-3151

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Appendix M(a): Emergency Procedures

FIRE RELATED EMERGENCY

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Appendix M(a): Emergency Procedures

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Appendix M(b): Emergency Procedures

MEDICAL RELATED EMERGENCIES

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DANGER: Ensure that the area is safe for you,

others, and the patient.

Check for Response:Ask name; Squeeze Shoulders.

Response “YES”:Make comfortable and monitor response. Response “NO”

SEND FOR HELP:Dial 9-1-1 and state “AMBULANCE”

AIRWAY: Check airway is clear by opening the

mouth; remove any foreign material, place

in recovery position, clean airway with fingers.

CHECK FOR BREATHING:Look, listen, feel

Normal Breathing “YES”:Place in recovery position; Monitor

Breathing

Normal Breathing “NO”:Start CPR

CPR:30 Chest Compressions / 2 Breaths

DEFIBRILLATION:Apply defibrillator if available and follow

voice prompts

Appendix M(c): Emergency Procedures

BOMB THREAT

If you receive a bomb threat, do not use a mobile phone or set off the fire alarm – they may trigger an explosion.

Remain Calm: Treat the call as genuine. Attempt to prolong the conversation and DO NOT hang up. Try to attract the attention of a second person to call 9-1-1.

Be attentive: Note distinguishing background noises, music, traffic, etc. Note voice characteristics. Does caller indicate knowledge of the building?

Record: Enter the details immediately on the “Bomb Threat Checklist” form on the next page.

Notify: Dial 9-1-1 and state “BOMB THREAT” Notify your Site Manager

Prepare: To assist in the search, if requested. To evacuate, if necessary. To follow instructions of security, police and other emergency service personnel.

If Object Found: DO NOT TOUCH IT! Report that you have found it. Open doors and windows where possible and evacuate the area, to reduce the

impact of an explosion.

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BOMB THREAT CHECKLIST

Remember to keep calm and do not hang up from the call.

Exact wording of the threat: _______________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

Questions to ask:

1. When is the bomb going to explode? ___________________________________

2. Where did you put the bomb? ________________________________________

3. When did you put it there? ___________________________________________

4. What kind of bomb is it? _____________________________________________

5. What will make the bomb explode? ____________________________________

6. Why did you place the bomb? ________________________________________

7. What is your name? ________________________________________________

Callers Voice:

1. Accent: Asian American English European Middle Eastern2. Speech: Fast Slow3. Voice: Loud Soft4. Gender: Male Female5. Impediment: Lisp Stutter6. Manner: Calm Emotional7. Diction: Clear Muffled8. Do you recognize the voice? Yes No9. Other: ___________________________________________________________10. Was the caller familiar with the building/area? Yes No

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Threat Language:

11. Well spoken: Yes No

12. Incoherent: Yes No

13. Taped: Yes No

14. Abusive: Yes No

15. Message read by caller: Yes No

16. Other: ___________________________________________________________

Background Noises:

Voices Street Noises Aircraft House Noises Machinery

Music Other: ____________________________________________________

Recipient of Phone Call:

Name:________________________________________________________________

Title: _____________________________ Date: ___ / ___ / ____ Time: __:__ (AM/PM)

Work Phone: (____) ____ - _____ Home Phone (____) ____ - _____

Signature: _____________________________________________________________

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Appendix M(d): Emergency Procedures

If you receive a Suspect Package:

STOP WHAT YOU ARE DOING AND PUT THE ITEM DOWN!

1. Do not smell, touch, taste, shake or empty contents of the item or substance.

2. Turn off any equipment that could disturb air flow (i.e., fans or air conditioning).

3. Where there is a likelihood of contamination, remain in the area, but step away (approximately 2 meters) from the item or substance. Instruct other people in the vicinity to do the same.

4. Dial 9-1-1, and state “SUSPECT PACKAGE”. Provide your name, location and as much detail about the item as you can. DO not use a mobile phone in close proximity.

5. If anyone is exposed to the substance, isolate the person and call for medical assistance.

6. If possible, ask a co-worker who was not in the immediate area to notify the manager or person in charge immediately who will arrange a temporary isolation of the area.

7. Do not allow co-workers into the isolation area.

8. Follow any further instructions from your manager, or other person in charge, until emergency personnel arrive.

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Appendix M(e): Emergency Procedures

POWER OUTTAGES

Remain calm: Provide assistance to others if necessary.

During a power outage:

1. Report the outage to Tara Riddle or Carmen Gee at 434-791-3630. Please note: During a power outage, digital phone systems may not work. Please use a mobile phone instead.

2. If evacuation is necessary, move cautiously. Lighted signs will indicate emergency exits.

3. Remain with any immobile individuals who become stranded as a result of the outage. If emergency assistance is required, dial 9-1-1.

4. Keep all refrigerators and freezers closed during an outage and ensure staff is available to monitor.

5. Outage times are difficult to predict depending on the cause. This may take some time to identify. Await further instructions from PATHS’ Administration.

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Appendix M(f): Emergency Procedures

GAS LEAK OR CHEMICAL SPILL

If it is a gas leak or chemical spill, DO NOT activate building alarms, use mobile phones, hand-held radios, electronic equipment or light flammable material.

If a gas leak or chemical spill is affecting people in your area, immediately:

1. REMOVE anyone in immediate danger only if it is safe to do so. DO NOT allow other people in the area. If anyone is exposed to a substance, set up an isolation area. If available and only if it is safe to do so, put on personal protective equipment (PPE), observe, and support the person until emergency responders arrive. DO NOT put yourself at risk.

2. ISOLATE the hazardous material by clearing the area, close the doors. If safe to do so, turn off isolation switches, ventilation and machinery. DO NOT touch suspect materials.

3. NOTIFY people in the area by shouting a warning. Pass the alarm by word of mouth.

4. CONTAIN: Do not risk contact with material or allow it to spread. Do not smell, touch or taste it. Close doors between you and the hazardous material.

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Appendix M(g): Emergency Procedures

ENVIRONMENTAL EMERGENCIES

An environmental emergency includes any accident, or potential for an incident of uncontrolled discharge of a substance into water, air or land that harms or threatens to

harm the environment.

1. REMAIN CALM. Don’t panic.

2. REPORT: Alert others in the area. Report to your site manager Report to PATHS’ Safety Officer.

3. CONTAIN the emissions if safe and possible to do so (e.g., stopping valves, using temporary bunds or spill kits)

4. EVACUATE: Keep the area clear of people not directly responding to the emergency. Prepare to evacuate, if required.

5. CLEAN UP and rectify any damage when safe to do so. Expert assistance may be required.

6. RECORD the incident on PATHS’ Incident Report Form available at http://splash.pathsinc.org.

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http://splash.pathsinc.org/

Appendix M(h): Emergency Procedures

PERSONAL THREAT

Threats to self or others may include harassment, assault, suicide, robbery or armed hold-ups.

1. REMAIN CALM: Don’t panic or shout, avoid eye contact. Do not make sudden movements

2. DO NOT TAKE RISKS: Hand over whatever is requested. Do not do anything that may antagonize the offender. Alert others around you if safe to do so. Contain yourself in a secure area, by locking your office door, closing blinds and staying out of sight.

3. DO ONLY WHAT YOU ARE TOLD. Do not volunteer any other information.

4. BE OBERSERVANT. Pay attention to the offender’s sex, height, voice, clothing, tattoos, jewelry, items touched, etc. Also note the type of vehicle used for escape, license plate number if possible and last known direction.

5. TELEPHONE: Dial 9-1-1 and state “PERSONAL THREAT” Stay on the line, and keep the line of communication open. Give your name and site address. Most importantly – REMAIN CALM.

6. RECORD: Immediately complete a Personal Threat Report (next page) with the offender’s description, what they may have taken (models and serial numbers), descriptions of any items they may have or any other relevant details.

7. REPORT any aggressive, physical or verbal abuse, armed hold up/robberies and or suspicious activities to your Site Manager immediately.

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PERSONAL THREAT REPORT

To be completed immediately after an incident. Try to be as descriptive as possible. Use a separate form for each offending person’s description.

Threat details: __________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

OFFENDER’S DETAILS/DESCRIPTION

Any names or nicknames used: ____________________________________________

Approximate age: ___________ Male Female

Height: ______________ Weight: __________

Complexion: Fair Pale Ruddy Pimply DarkFresh Normal Suntanned

Hair: Straight Bald Thick Crew cut WavyCurly Long Short

Facial: Moustache Beard

Glasses: Yes No

Build: Thin Stout OverweightMedium Small Obese

Posture: Erect Stooped Slouchy

Walk: Quick Springy Slow Limp Pigeon Toed

Hands: Callused Soft Hairy Nails missingDeformed fingers

Voice: Thick Accent Clear Loud SoftLisp Stutter

Eyes: Squinty Intense Stare

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(Use back of form for other comments.)

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Appendix M(i): Emergency Procedures

NATURAL DISASTERSRemain calm, remove anyone from immediate danger if safe to do so.

1. FLOODING: If the building is in danger of being flooded, evacuate all staff, students, patients and visitors to a safe area unaffected by flooding. Otherwise, do not evacuate unless instructed to do so. Call PATHS’ Safety Officer. Switch off any electrical equipment and gas that could be affected by water, only if safe to do so. Move any chemicals, documents, equipment and valuables to a safe area if time permits.

2. STORMS: Move all people away from windows. Close all curtains, drapes and blinds. Shelter in strongest part of the building (e.g., central corridors). Stay clear of large areas with glass atriums. Stay inside. Report any storm damage to PATHS’ Safety Officer.

3. EARTHQUAKE: If inside:

o Stay inside.o Do not use elevators or stairs.o Take shelter in doorways, under desks, or down beside an internal wall.o Stay clear of large areas with glass atriums.o Keep away from windows or objects that could fall on you.

If outside:o Stay outside.o Take shelter clear of buildings, trees, power lines and other potential hazards.

When the earthquake stops:o Check for signs of fire, hazardous material spill or major structural damage.o Account for all staff, students, patients and visitors. Treat any minor injuries.o Do not evacuate unless area is immediately threatened or instructed to do so.

Appendix N(a): Emergency Floor Plans

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Danville Facility Floor Plan – Ground Floor/Basement

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Appendix N(b): Emergency Floor Plans

Danville Facility Floor Plan – First Floor

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Appendix N(c): Emergency Floor Plans

Danville Facility Floor Plan – Second Floor

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Appendix N(d): Emergency Floor Plans

Martinsville Facility Floor Plan

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Appendix N(e): Emergency Floor Plans

Chatham Facility Floor Plan

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Appendix N(f): Emergency Floor Plans

Boydton Facility Floor Plan – Ground Floor/Basement

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Appendix N(g): Emergency Floor Plans

Boydton Facility Floor Plan – First Floor

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Appendix O: Job Action Sheets

Job Action Sheets are tools for defining and performing specific emergency response functional roles. The Job Action Sheets contained within this appendix are designed to assist PATHS’ staff during all hazards. They can easily be amended to fit the specific requirements of the situation at hand.

The key elements are as follows:

1. Position Title: The name of the Incident Command System (ICS) functional role. Note that this generally is not the same as every day, non-emergency job titles.

2. Supervisor: The official who maintains direct authority over the worker.

3. Mission: The purpose of the role and a brief guiding principle for the responder to keep in mind.

4. Location: The place of operations.

5. Immediate Actions: Tasks that must be completed first upon assuming the role or coming on duty.

6. Intermediate Actions: Tasks to be completed after the immediate tasks are addressed.

7. Extended Actions: Tasks completed later or on an ongoing basis.

The following Job Action Sheets contain recommended actions that are reminders of activities to take into consideration when fulfilling the assigned role.

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Appendix O(a): Job Action Sheets

INCIDENT MANAGER (IM)

Supervisor: Chief Executive Officer (CEO)

Mission: To organize and manage Command and General Staff; Coordinate and report on organizational components; responsible for performing emergency response operations.

Location: PATHS’ Facility

Immediate Actions:

Read this entire Job Action Sheet. Identify all Command Staff and Section Chiefs who are required for this response. Construct an agency Incident Command System (ICS) Organizational Chart. Develop and provide an initial incident briefing to all personnel staffing the ICS. Distribute section packets to each position, which contain: Job Action Sheets and any

other relevant guides, forms, or templates. Refer all assigned personnel to the EON IMS for additional material.

Provide direction in regards to activating the Incident Action Plan (IAP). Notify all relevant internal and external personnel of activation level and reporting requirements.

Confer with Command Staff and Section Chiefs to develop an IAP for a defined period of time, establishing priorities (Section Chiefs will communicate completed plan to responsible emergency personnel).

Consider and assign responsibilities for communicating with agency organization components and external agencies, as appropriate.

Assure that contact has been established and resource information shared with relevant parties.

Intermediate Actions:

Schedule routine briefings with Section Chiefs and update the plan regarding the continuance and/or termination of organizational emergency operations.

Participate in regularly scheduled situation/status briefings and teleconferences. Maintain contact with all relevant agencies.

Extended Actions:

Observe all staff for status and signs of stress and provide regular rest periods. At shift change, provide a briefing on past and ongoing organizational emergency

response activities to incoming staff. Provide additional detailed information to your replacement, as required.

Plan for the possibility of extended operations.

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Appendix O(b): Job Action Sheets

PUBLIC INFORMATION OFFICER (PIO)

Supervisor: Incident Manager (IM)

Mission: To serve as a conduit of information between, and maintain regular communications between all levels of the Emergency Management Team. Provides information on any/all associated activities, concerns, and requests related to incident information.

Location: PATHS’ Facility

Immediate Actions:

Upon notification, report to Emergency Operations Center (EOC). Notify appropriate staff of activation status and close out performance of all day-to-day activities.

Read this entire Job Action Sheet and review the Incident Command System (ICS) organizational chart.

Obtain briefing from the Incident Manager (IM). Report this information to appropriate communications staff.

Assist the Planning Section Chief with formulation of an Incident Action Plan (IAP).

Intermediate Actions:

Report on organizational and field public affairs and communications activities, concerns, and scheduled press conferences.

Evaluation organizational strategy in support of the IAP and overall response efforts. Assist in drafting press reports and media releases. Ensure that the IM and Section

Chiefs, as appropriate, review and approve all public information releases. Assist in developing and posting public and industry messaging and guidance to the

organization’s web site. Participate in regularly scheduled status briefings and teleconferences. Provide spot

reports to appropriate staff as necessary.

Extended Actions:

At shift change, provide a briefing on past and ongoing external affairs activities to incoming staff. Provide additional detailed information to your replacement, as required.


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Appendix O(c): Job Action Sheets

Operations Section Chief


Mission: Coordinate and report on all activities from administration and the field. Establish an organizational wide operating picture.

Location: Emergency Operations Center (EOC)

Immediate Actions:

Upon notification, report to the EOC. Obtain packet containing Operations Section Job Action Sheets.


Obtain briefing from IM. Notify staff of activation, as appropriate. Appoint Division/Group Supervisors and

distribute Job Action Sheets. Assist the Planning Section Chief with the development of an Incident Action Plan (IAP).

Intermediate Actions: Routinely brief the IM and Planning Section Chief on the status of administration’s field

response operations. Participate in regularly scheduled situation/status briefings and teleconferences.

Extended Actions: At shift change, provide a briefing on past and ongoing agency and Operations Section

activities to your replacement, as required. Plan for the possibility of extended operations.

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Appendix O(d): Job Action Sheets

Division/Group Supervisor

Supervisor: Operations Section Chief

Mission: Organize and direct the activities of personnel assigned to a designated division or functional group.

Location: Emergency Operations Center (EOC) or normal work location

Immediate Actions:

Read this entire Job Action Sheet. Review the Incident Action Plan (IAP). Provide information on the incident and

objectives to supporting staff, as appropriate. Establish and maintain communications with other agencies, as appropriate. If operating from your normal work location, provide contact information to the

Operations Section Chief.

Intermediate Actions: Issue mission assignments to, and monitor, the activities of Division/Group staff.

Maintain a log of all objectives and the staff assigned to associated tasks. Ascertain information on resources needed by Division/Group staff and arrange for

appropriate support. Monitor the progress and status of responding Division/Group staff and immediately

report any changes or issues that cannot be resolved to the Operations Section Chief. Participate in regularly scheduled situation/status briefings and teleconferences.

Provide spot reports to Division/Group staff, as necessary.

Extended Actions: At shift change, provide a briefing on past and ongoing agency and Division/Group

activities to your replacement, as required. Plan for the possibility of extended operations.

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Appendix O(e): Job Action Sheets

Planning Section Chief


Mission: Collect, evaluate, and disseminate incident information to EOC and other staff. Coordinate status reporting, monitor and display situational information, and develop and update the Incident Action Plan (IAP).


Immediate Actions:

Upon notification, report to the EOC. Read this entire Job Action Sheet and review the Incident Command System (ICS)

organizational chart. Obtain briefing from IM. Notify supporting Unit staff and necessary technical specialists of activation, as

appropriate. Confer with the IM and Operations Section Chief to develop an IAP.

Intermediate Actions: Issue mission assignments to support staff and technical specialists. Collect, interpret, and analyze information regarding the status of resources and

response activities. Update the IAP to reflect this information and distribute to the IM and other staff, as necessary.

Coordinate regularly scheduled situation/status briefings and teleconferences. Send invitations, agendas, and other meeting materials to the IM and all other staff.

Extended Actions: At shift change, provide a briefing on past and ongoing organizational and Planning

Section activities to your replacement, as required. Plan for the possibility of extended operations.

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Appendix O(f): Job Action Sheets

Logistics Section Chief


Mission: Organize, direct, and coordinate those operations associated with maintenance of physical environment (facilities), security, and staff deployment. Provide for adequate levels of equipment and supplies to support all activities.


Immediate Actions:

Upon notification, report to the EOC. Notify appropriate staff of activation status and close out performance of all day-to-day activities.


Obtain briefing from IM. Notify supporting Unit staff and necessary technical specialists of activation, as

appropriate. Assist the Planning Section Chief with the development of an Incident Action Plan (IAP). Receive direction from the IM regarding current agency logistical services and support

needs.

Intermediate Actions: Monitor deployment of agency resources (staff, equipment, and supplies) in support of

field response operations. Provide facility management and security services support. Coordinate provision of headquarters information technology assistance, as necessary.

Ensure headquarters voice and data communications systems and equipment are functioning properly.

Inventory equipment and supplies and project needs based upon requests from the IM, Operations Section, and/or Planning Section.

Participate in regularly scheduled situation/status briefings and teleconferences, as appropriate. Provide spot reports to appropriate staff, as necessary.

Extended Actions: At shift change, provide a briefing on past and ongoing organizational and Logistics

Section activities to your replacement, as required. Plan for the possibility of extended operations.

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Appendix O(g): Job Action Sheets

Finance/Administration Section Chief


Mission: Serve as a conduit of information between the IM, and other responsible staff, on all financial and human resource related matters. Monitor and report on resource costs, procurement issues, and employee compensation/claims.


Immediate Actions:

Upon notification, report to the EOC. Notify appropriate staff of activation status and close out performance of all day-to-day activities.


Obtain briefing from IM. Report this information to appropriate staff. Assist the Planning Section Chief with the development of an Incident Action Plan (IAP).

Intermediate Actions: Report on the anticipated or requested costs of field activities. Advise the IM of financial systems and human resource-related policies and procedures

as they apply to field response efforts. Assist in accounting, payment processing, financial reporting, travel, employee

relocation, payroll liaison, and financial systems related to the incident. Participate in regularly scheduled situation/status briefings and teleconferences.

Provide spot reports to appropriate staff, as necessary.

Extended Actions: At shift change, provide a briefing on past and ongoing financial/human resource related

activities to incoming staff. Provide additional detailed information to your replacement, as required.


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Appendix P: Home Emergency Preparedness Guide

Even though no one actually knows when the next emergency might occur, it makes sense to be prepared. Begin planning and communicating with family members now. Regardless of the type of event -- ice storm, hurricane, blizzard, hazardous materials emergency, terrorist activity, etc. -- there are things that you can do to minimize the effect on you and your family.

This Home Emergency Preparedness Guide is designed to help you plan for such an emergency. Although it does not cover every conceivable emergency, it does offer information and resources to help you plan for most home emergency situations.____________________________________________________________________________

1. Check on Relatives and Neighbors. During storms and other emergency events, check to see how your relatives and neighbors are coping, especially senior citizens and persons with disabilities. If possible, consider helping them plan or locate resources in which to obtain assistance.

2. Preparing Your Home for an Emergency. Planning for any emergency requires considering all likely scenarios that could result when things that you rely on daily -- like electricity, water, heat, air conditioning, telephone service and transportation -- are disrupted or lost for a considerable amount of time. Consequently, you should plan on having enough food, water and other essentials, to get you through the emergency. Most emergency management planners suggest having enough supplies to last you and your family for at least three to seven days. However, many things may impact your decision, including storage space, special needs, and number of people in the household and available resources.

3. What To Include In Your Home Emergency Preparedness Kit: The six basic items that should be stored in your home are water, food, first aid supplies, clothing and bedding, tools and emergency supplies, and specialty items. Keep the items that you would most likely need at home in one easy-to-carry container, such as a trash can, camping backpack or duffel bag. Store it in a convenient place and put a smaller version in your car. Keep items in airtight plastic bags. Remember to change the stored water and rotate the food supplies every six months (place dates on containers). Check the supplies and re-think your needs every year. Consult your physician or pharmacist about storing prescription medications, and maintain a list of your prescriptions needs.

A. Water: Store water in plastic containers or purchase bottled water, avoiding using containers that will decompose or break, such as milk or glass bottles. Plan for one gallon of water per person per day. Water should be stored in a cool, dark place with the date labeled on the container. This is a good use for two liter soda

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bottles; rinse clean and refill with tap water.

B. Food: Store a supply of three to seven days of nonperishable food per person. Foods should require no refrigeration, preparation or cooking and little or no water. Examples include: ready-to-eat canned meats, fruits and vegetables; canned or boxed juices, milk and soup; condiments such as sugar, salt and pepper; high-energy food like peanut butter, jelly, low-sodium crackers, granola bars and trail mix; vitamins; foods for infants or persons on special diets; cookies, hard candy, instant coffee and sweetened cereals. Bulk food items such as rice, powdered milk, and grains can be stored for long periods of time. Some camping and outdoor suppliers have available MREs (meals ready to eat) that store for long periods and require no cooking. Remember to include utensils to open the containers and eat the foods.

C. First Aid Kit: Assemble a first-aid kit for your home and each vehicle. Items should include: sterile adhesive bandages in assorted sizes, gauze pads, hypoallergenic adhesive tape, triangular bandages, sterile roller bandages, scissors, tweezers, needle, moistened towelettes, antiseptic, thermometer, tongue blades, tube of petroleum jelly or other lubricant, safety pins, cleansing soap (preferably waterless), eyewash, latex gloves, aspirin, anti-diarrheal medication, activated charcoal (for poisoning), laxatives.

D. Tools and Supplies: Keep the following items handy for all-around use: extra batteries of assorted sizes (check shelf life before purchasing), paper cups, plates and plastic utensils, battery operated radio, flashlight, battery powered carbon monoxide and smoke detectors, cash, (include change) and/or traveler's checks, non-electric can opener and utility knife, small ABC fire extinguisher; pliers and other small tools you might need, waterproof matches, plastic storage containers, signal flares, paper and pencil, needles and thread, and medicine dropper. For sanitation, make sure you have a sufficient supply of the following: toilet paper, soap and liquid detergent, feminine supplies, plastic garbage bags with ties, disinfectant and household chlorine beach.

E. Clothing and Bedding: If you have to utilize the emergency shelter, assemble at least one or two complete changes of clothing per person, sturdy shoes or work boots, rain gear, blankets or sleeping bags, sleeping pad, hat and gloves, and thermal underwear (during cold weather)

F. Specialty Items:

1. For babies: formula, diapers, bottles, powdered milk and medication

2. For adults: medications, prescriptions, denture needs, eye glasses and/or contact lenses and related supplies

3. For entertainment: games, books and several quiet toys for children

4. Important Family Documents: wills, insurance policies, contracts, deeds, passports, stocks and bonds, immunization records, important phone numbers, credit card accounts, social security cards and other personal

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family records. All should be stored in a safe and secure place.

4. Public Emergency Shelters: Your home is the safest place to be even during an emergency. However when conditions warrant, your community may establish community-based shelters for local residents. Normally, shelters are setup in public schools, or other appropriate facilities where residents can seek refuge from the event. Shelters to be opened will be designated based on the situation by Emergency Management. Persons in need of shelter are asked to bring food (as outlined previously), a change of clothing, bedding (blankets or sleeping bag and pad, bathing, and sanitary supplies, pre-filled prescription and other medical needs, denture and eye care materials and special dietary supplies or requirements. With the exception of guide dogs, PETS ARE NOT PERMITTED IN THE SHELTERS. ALCOHOLIC BEVERAGES AND SMOKING ARE NOT ALLOWED.

5. What To Do For Pets in Emergencies: Emergency planning should include all members of the family, including pets. If your family must re-locate to a shelter or other site, confine your pet to a specific room in the house and provide plenty of food and water to sustain the animal while you are away. If possible, arrange for someone to board the animal, or locate a relative or friend who can check on its well being on a regular basis. Put together a basic disaster kit for your pets, in case you must leave your residence quickly. Recommended items would include:

A. An extra supply of pet food (for dogs a lower protein dog formula will produce less stool, a benefit when kept indoors).

B. Plenty of clean water.

C. Bowls (disposable containers if you must leave your residence), can opener, kitchen trash bags, bleach, disinfectant, blankets, towels, paper towels, and other waste disposal supplies.

6. What To Do When Electrical Power is Lost: Disruption of electrical service can occur as a result of many things, including lightning, high winds, ice and heavy snow, and equipment failure. For the most part, service is normally restored within a short period. However, major power outages can happen for extended periods from time to time. When power is lost, you should:

A. Check to see if your neighbors have power. It may be only in your home, a blown fuse or a tripped circuit. If your neighbors are also without service, call your local power company (see phone numbers). If you must go outside to assess the situation, take a flashlight and watch for downed power lines that could still be energized. If downed lines are located, don’t go near them or touch anything that they may be in contact with. Report downed power lines immediately.

B. Turn off all major appliances. Leave just a couple of light switches on in the home and the front porch light. When major appliances – refrigerators, electric water heaters, air conditioners and pumps – are left on, they could overload electric lines when power is restored causing a second outage.

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C. Refrigerators and freezers. Food can be kept cold enough for a day or two, if the doors are kept closed. During the winter, you may be able to store some items outside in a proper container. If temperatures are below freezing, it’s possible to freeze water outside in containers and place them inside your refrigerator to help keep food cold. Try to consume perishable foods first. Some partially frozen foods can be refrozen as long as they contain ice crystals or are no warmer than 40 degrees Fahrenheit. Consider purchasing a thermometer for both the refrigerator and freezer. Don’t refreeze meat, seafood, poultry, ice cream, cream sauces or anything susceptible to spoilage. When in doubt… throw it out!

D. Flashlights or Battery-operated Lanterns -- should be used to illuminate the home. Candles and kerosene lanterns are not recommended for lighting because of the inherent fire safety hazards.

E. Portable Emergency Generators – can be used to provide limited electrical power during an outage. But, take care to ensure that they do not pose a threat to you and your family. Never fuel or run a portable generator or store extra fuel in the home or attached garage. Gas-powered generators pose a serious fire and carbon monoxide threat. Never connect the generator directly to the house electrical service, unless approval has been granted by the power company and the generator is equipped with a double-throw transfer switch that protects your equipment and prevents feedback on power lines. Always operate according to the manufacturer’s instructions. For additional information on the proper use of emergency generators, call your power company or the Town’s electrical inspector.

F. Water Systems and Waste Water Systems with Electric Pumps – such as wells or sewer ejector pumps -- will not operate when the power is out. Alternate sources of water and /or waste disposal will have to be used until power is restored. However, home connected to the Town’s Water and Sewer system will usually have service during power outages.

G. Gas Appliances – may not work if the electricity is off because the equipment may require electricity for ignition or valve operation.

H. Water Heaters – that are drained to prevent damage from freezing, must have their power circuit shut off as well. Failure to do so could result in loss of the heating element when power is restored. Never turn on a water heater unless the tank is full.

I. Plumbing – can freeze when power is lost during cold weather periods. Drain supply lines, water heaters, boilers and traps in drains of tubs, sinks, commodes, washing machines and dishwashers. Special environmentally safe anti-freeze is available to winterize drains. To avoid major flooding when temperatures rise, you should also turn off supply lines to outside spigots. Leaving a cold water line running (just slightly) may keep the supply line from freezing during a prolonged period without heat.

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J. Life Support Equipment – required for family members who depend on these devices (respirators, ventilators, oxygen equipment or other life-sustaining devices) should be listed with the power company. If the power outage is not widespread, power companies attempt to restore power to these homes first. Regardless, you should have a contingency plan that always includes an alternate power source for the device and relocating the person.

K. Trees – While power companies have a regularly scheduled program for trimming trees away from power lines, they do not go on private property. Consider this when planting and/or trimming trees on your property, and always seek professional help in trimming limbs or branches that are close to power lines.

L. Keeping Warm- Select a single room in the home in which the entire family can live; ideally a room, which gets sunlight during daylight hours. Use fireplaces and wood-burning stoves with care and always supervise them when in use. Make sure the fireplace is in proper working condition and has been inspected before use. Wear layers of clothing, including sweaters and coats, which entraps warm air and helps to maintain body heat for longer periods. For homes with natural gas heaters, homeowners are reminded to keep meters and vents clear of ice and snow.

M. SAFETY NOTE – Never use gas ovens or stovetops to heat homes; charcoal or propane grills should never be used inside the home. They pose a serious threat of fire and the creation of poisonous carbon monoxide. When removing ashes from the fireplace, make sure that the ashes are cool, and are placed in a metal container outside and away from the home.

7. Keeping Updated on an Emergency: Getting information during an emergency situation is vital, especially at the height of the event, when evacuation may be required. Radio and television stations provide the quickest means to obtain information. If you have electrical power and cable television, turn to the local access channel for frequent updates. Have a battery-operated radio tuned to a local all-news or talk-radio station. In situations requiring immediate action by residents, the Emergency Manager will transmit messages over the cable television system. Have a family contingency communications plan so relatives can contact you.

8. Technology/Computer Contingency Planning: Every home and business should have a Continuity and Contingency Operating Plan, which assumes that there may be computer and embedded chip glitches. These plans provide a road map for ways to get around problems should they occur.

A. Financial and Personal Records: Keep all your financial records in order and up-to-date. Bank statements, credit and debit cards, investment portfolios, medical and prescription, insurance information, taxes and other records show transactions related to your account may be susceptible to technology glitches. Should a problem exist with any of these records because of a computer or software problem, your records may be the sole source for validating the correct information. Keep your documents and records in a safe place and preferably in

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a container. If you leave your home for an extended period you can take the documents with you, if necessary

B. Travel: If you plan to travel, check to see how the community you are planning to visit is prepared to deal with issues. If your plans include transportation by airplane, train or ship, inquire about the carrier’s planning efforts, including contingency plans for alternate travel means should a problem develop. Also, consider taking some extra cash or travelers checks (preferred) in case of problems related to ATM machines and credit card verification systems.

C. Testing Your Personal Computer: Your Personal Computer's (PC) hardware and software may be vulnerable; with some planning and attention to detail, you can protect yourself from technology disruptions.

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Appendix Q: Damage Assessment Checklist

It is essential to perform a damage assessment following an adverse event to help ensure the safety of building occupants as well as prevent additional losses. This checklist has been developed to guide assessments of damage immediately following adverse events like fire, flood, severe weather, acts of violence or any other incident that may have potentially damaged a facility.

The safety of the facility’s employees must be considered first and foremost. This assessment shall not be completed if it is determined that a facility has been “severely damaged” and conducting such an assessment may place the safety of an employee(s) in jeopardy.____________________________________________________________________________

SITE INFORMATION:

Date of Incident: ___ / ___ / _____ Date of Assessment: ___ / ___ / _____

Name/Title of Person Completing Assessment: ______________________________________

Facility Name: ________________________________________________________________

Facility Address: ______________________________________________________________

Phone Number: (____) ____ - ______

General Impression of Damage: None Minor Moderate Severe Total Loss

TYPE OF INCIDENT: Fire Power Failure Vandalism Explosion without Fire Natural Gas Failure Severe Weather Incident of Workplace Violence HVAC Failure Civil Disturbance Internal Flooding Technology Failure Vehicle Striking Building External Flooding Criminal Activity Other Mechanical System Failure: ______________________________________________ Other Striking the Building: ____________________________________________________ Other: ____________________________________________________________________

Describe the incident in detail: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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EXTERIOR PROPERTY ASSESSMENT: Check any that were damaged in the incident. Landscaping Freestanding Signs Parking Lot Outside Water Pipe Rupture Out-Buildings Light Poles Patios Downed Trees/Tree Limbs Broken Glass on Ground Flagpole Driveways Outside Gas Leaks Damage to Entire Area Fences/Gates Vehicles Fire Hydrants Mailboxes Hazardous Materials Damage to Neighboring Buildings Windows Generator Enclosure Doors Roof Structure Partial Structural Collapse Pipes on Building Penthouse Steeple Utility Transformers Balconies Light Fixtures Foundation Railings Exterior Walls Exterior Structural Damage Utility Control Boxes Canopies Soffits Wiring on Building Porches Complete Structural Collapse Blood, Body Fluids or other Biohazards Present

Describe damage to the exterior of the property in detail: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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INTERIOR ASSESSMENT: Check any that apply.

Building Assessment Fire Damage Smoke Damage Interior Contents Damage Interior Structural Damage Water Damage Hazardous Materials Presence of Mold or Mildew Blood, Body Fluids, or other Biohazards Present

Interior Building Elements Ceilings Floor boards Exit Doors Windows Attic Wall Structure Carpeting Interior Doors Window Latches Stairs Wall coverings Floor Tile Screen Doors Window Screens Stairwells Foyer/Entry Way/Vestibule Other Floor Coverings Door Handles Basement Elevator Cars Graffiti Ramps Door Locks Crawlspace Elevator Shafts Electrical Outlets PA System Circuit Breaker Boxes Computers/Servers Railings Fuse Boxes Security System Light Fixtures Open/Exposed Wiring Fire Extinguishers Electrical Switches

Fire Alarm System Components Control Panel Horn/Strobe Devices Annunciator Panels Battery Cabinet Smoke Detectors Pull Stations

Mechanical Equipment Boilers Sump Pumps Elevator Equipment Sewer Pipes Emergency Generator Hot Water Tanks Furnaces Soil Stacks Hot Water Heaters Return Air Units Gas Pipes Condensers Air Conditioning Units Water Pipes Incinerator Pumps Water Meter

Offices, Treatment Rooms, and Other Rooms Desks Fax Machines Office Furniture Paper Shredders Filing Cabinets Computers Shelving Copy Machines Other Office Equipment Toilets Sinks Plumbing Fixtures

Evidence of Theft or Missing Items Evidence of Burglary Evidence of Looting Missing Appliances Missing Supplies Missing Equipment Missing Personal Items Missing Furniture

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Describe damage to the interior of the property in detail: _______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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Appendix R: Emergency Codes

PATHS has adopted 8 standardized codes that will be used for all sites in cases of emergency:1. Fire Code Red2. Medical Emergency Code Blue3. Abduction Code Amber4. Severe Weather Code Gray5. Mass Casualty Code White6. Security Code Silver7. Evacuation Code Green8. Bomb Threat Code Black

Boydton, Chatham and Martinsville

In case of a Fire go to the nearest Alarm Panel and press the “Fire” button

If there is a Medical Emergency announce “Code Blue” with the location of the emergency by using the “All Page” button on any phone in the office.

If there is an Abduction of an infant, child or adult, announce “Code Amber” with the description of the person abducted by using the “All Page” button on any phone in the office.

In case of Severe Weather, announce “Code Gray” with the description of what type of weather emergency by using the “All Page” button on any phone in the office.

If there is a Mass Casualty, announce “Code White” with the location of the event by using the “All Page” button on any phone in the office.

If there is an unruly patient or other type of incident dealing with Security, announce “Code Silver” plus the description and location of the security alert by using the “All Page” button on any phone in the office.

If it is necessary to Evacuate for any reason, announce “Code Green” by using the “All Page” button on any phone in the office.

In case of a Bomb Threat announce “Code Black” along with as much information as possible without causing panic by using the “All Page” button on any phone in the office.

Danville

In case of a Fire, go to the nearest “Alarm Panel” and press the “Fire” button

If there is a Medical Emergency, announce “Code Blue” with the location of the emergency by dialing “7” with the handset down and then “8”.

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If there is an Abduction of an infant, child or adult, announce “Code Amber” with the description of the person abducted by dialing “7” with the handset down and then “8”.

In case of Severe Weather, announce “Code Gray” with the description of what type of weather emergency by dialing “7” with the handset down and then “8”.

If there is a Mass Casualty, announce “Code White” with the location of the event by dialing “7” with the handset down and then “8”.

If there is an unruly patient or other type of incident dealing with Security announce “Code Silver” plus the description and location of the security alert by dialing “7” with the handset down and then “8”.

In case of an Evacuation for any reason, announce “Code Green” by dialing “7” with the handset down and then “8”.

In case of a Bomb Threat announce “Code Black” along with as much information as possible without causing panic by dialing “7” with the handset down and then “8”.

Use common sense in all cases and give as much information, including descriptions, as possible for any emergency without causing panic. If you feel that you cannot make the call please have a co-worker make the call for you.

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