Disaster Guidebook With Scenarios

7/23/2019 Disaster Guidebook With Scenarios

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DDIISS A ASSTTEERR EEXXEERRCCIISSEE GGUUIIDDEEBBOOOOKK

Preparing, Conducting and Evaluating an EmergencyPreparedness Exercise

METROPOLITAN CHICAGO HEALTHCARE COUNCIL 2006



DDIISS A ASSTTEERR EEXXEERRCCIISSEE GGUUIIDDEEBBOOOOKK

Preparing, Conducting and Evaluating an Emergency Preparedness Exercise


INTRODUCTION 3

EXERCISE PREPARATIONS 3

SCENARIO 3

LOGISTICS 10

CONDUCTING THE EXERCISE 10

APPENDICES 15

A. VOLUNTEER VICTIM CONSENT FORM 16

B. VOLUNTEER VICTIM BRIEFING SHEET 18C. P ATIENT SCENARIOS 20

D. P ATIENT SCENARIO M ATERIALS 32

E. “ INJECTS” 53

F. DISASTER EXERCISE EVALUATION FORM 56

G. ADDITIONAL EVALUATION M ATERIAL 63

H. LESSONS LEARNED WORKSHEET 69

FORMS 71

HEICS: SECTION PERSONNEL TIME SHEET 72

HEICS: EMERGENCY INCIDENT MESSAGE FORM 73HEICS: ACTIVITY LOG 74

HEICS: PROCUREMENT SUMMARY REPORT 75

HEICS: RESOURCE ACCOUNTING RECORD 76

POST EXERCISE CRITIQUE FORM 77

ABOUT MCHC 78

TABLE OF CONTENTS



INTRODUCTION

The purpose of this guidebook is to assist hospitals in implementing an emergency preparednessexercise involving an outbreak of influenza. It contains suggestions for implementation of the exercisein order to meet accreditation and regulatory requirements.

EXERCISE PREPARATIONS

Announced vs. Unannounced

A decision must be made whether the exercise will be announced or unannounced. There are prosand cons to either approach. An announced exercise will provide the opportunity for staff to reviewand familiarize themselves with the emergency preparedness plan; an unannounced exercise allowsthe organization to test the facility’s strengths and weaknesses in a more realistic manner.

“Real” Patients vs. “Paper” Patients

A determination whether to use “real” or “paper” patients must be made. Using “real” patientsrequires the recruitment and education of volunteers to serve as patients. Consents must also beobtained from the volunteers (Appendix A). If “paper” patients are used, the paper must be treated asthough it is a “real” patient and must be physically moved through the system.

SCENARIO

General Patient Population

The scenario for this exercise is an outbreak of influenza. If “real” patients are used, the volunteersmust be instructed (using the Briefing Sheet {Appendix B} and Patient Scenarios {Appendix C}) onhow they are to act and how they are to answer questions posed to them by hospital staff. Whendistributing Briefing Sheet and Patient Scenarios to volunteers, instruct them as whether material is tobe memorized or referenced. It is also important that the staff talk with the volunteer victims duringthe exercise. Failure to communicate with vict ims regarding histo ry, physical exam, testingand procedures ordered and other relevant information including discharge instruct ions (e.g.,if a prescription is ordered) will limit the information available to direct diagnosis andtreatment. More importantly, it will limit the value of conducting the exercise.

Patient Scenarios are located in Appendix C. Included are scenarios for a sick patient, a “worriedwell” individual and a person that arrives as a “worried well” individual but becomes sick while at thehospital. These scenarios can be duplicated to provide the correct number of individuals the facilityneeds to adequately conduct the exercise. Some volunteer victims should be instructed to complainof severe symptoms (that may necessitate admission) and others should be briefed that they do nothave severe symptoms. For example, the facility may want 35 total patients including 15 sickpatients, 5 of whom are severely ill, 10 “worried well” individuals and 5 people that get sick while atthe hospital.

In order to test the hospital’s response to non-English speaking populations, volunteers that speakforeign languages fluently can be instructed to only speak foreign languages.

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Special Needs Populations

To make the exercise more realistic and to test the hospital’s response to special needs populations,scenarios are available for (Appendix C):

• Adult female person of size• Adult hearing impaired person

• Infant with a tracheostomy

• Infant with a gastrostomy tube

• Infant on home oxygen therapy

If the facility opts to incorporate special needs populations in the exercise, the volunteers acting as“real” patients should be briefed and provided with the appropriate special needs scenario. In order tomake the patients with special needs more realistic, the following “props” can be used:

Adult female person of size

• Inflatable “Sumo” wrestler suit - available at costume shops or on-line

• Housecoat/Mu-mu/duster or a light weight bathrobe to wear over the inflatable suit (it must belightweight and very large so the suit is not compressed)

Infant with a tracheostomy

• Life size baby doll – available at discount stores orresale shops

• Insert an infant-size tracheostomy tube (use either apower drill with the appropriate size bit for a hard-neckdoll, or a seam ripper for soft-neck dolls)

FANFAN

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Infant on home oxygen therapy

• Life size baby doll – available at discount stores or resale shops

• Secure an infant size nasal cannula to the doll with medical tape

• Empty and clean a green two liter soft drink bottle with the cap intact

• Drill a hole in the bottle cap using a drill bit just smaller than the end of the oxygen tubing;insert the end of the tubing into the cap

• Label the soda bottle “OXYGEN”

In order to maximize the impact of the “ props” , it is important to make sure hospital staffknows to take the “ props” seriously.

Patient Scenario Materials

In order to add realism to the patient scenarios, additional materials/props should be provided to thevolunteer victims. This includes a mock nasopharyngeal swab and results, blood test results, andresults of a chest x-ray. The envelopes described below should be attached to the appropriatescenarios (e.g., “worried well” are given only the envelope with “worried well” test results). Volunteervictims should be instructed to give the appropriate envelopes to hospital staff ONLY if theparticular test they have an envelope for is ordered. Appendix D contains printable text for all ofthe patient scenario material. (The text is formatted to print on 2 inch by 4 inch shipping labels.)

Infant with a gastrostomy tube

• Life size baby doll – available at discountstores or resale shops

• Insert an infant size gastrostomy tube (useeither a power driver with the appropriate size

bit for a hard-type doll, razor knife or seamripper for a soft doll)

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Nasopharyngeal Swab For Patients with the Flu (or get sick at the hospital):

1. Print and place a label with the following text on a #10 (9.5 inches x 4 inches) envelope:

2. Place 2 Q-Tips or applicators in the #10 envelope.

3. For Patients with the Flu (or get sick at the hospital), print the following text on labels andplace the labels on 2 index cards (one label only on each card):

4. For “Worried Well” Patients, print the following text on labels and place the labels on 2 indexcards (one label only on each card):

5. Place the index cards in a # 6 ¾ envelope (3.5 inches x 6.5 inches) with a label printed andplaced on the envelope that reads:

6. Place the # 6 ¾ envelope inside of the #10 envelope with the Q-tips or applicators.

Blood Specimens For Patients with the Flu (or get sick at the hospital)


NOTE TO HOSPITAL STAFF: Follow your hospital’s normal procedures forspecimens.

NASOPHARYNGEAL SPECIMEN

NOTE TO PATIENT: Give this to the hospital staff if a swab of your nose is done.

Rapid Antigen Test for Influenza

Positive

NOTE TO HOSPITAL STAFF: Transport the Nasopharyngeal specimen in thisenvelope to the lab.

To be opened by the Lab ONLY.

TEST RESULTS FOR:


NOTE TO LAB STAFF: Report results in usual manner – i.e., once normal testrun time has elapsed.

All Other Tests for Influenza

Positive

NOTE TO HOSPITAL STAFF: You must provide your own appropriate empty BloodSpecimen tube. Follow normal procedures.

BLOOD SPECIMEN

NOTE TO PATIENT: Give this to the hospital staff if they pretend to do Blood Tests.

Rapid Antigen Test for Influenza

Negative

All Other Tests for Influenza

Negative

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2. For not-so-sick patients: Print the following text on labels and place the labels on 2 index

cards (one label only on each card):

3. For “really sick” patients: Print the following text on labels and place the lables on 2 indexcards (one label only on each card):

4. Place the index cards in a # 6 ¾ envelope (3.5 inches x 6.5 inches) with a label printed and

placed on the envelope that reads:

5. Place the # 6 ¾ envelope inside of the #10 envelope.

X-Ray Results For Patients with the Flu (or get sick at the hospital)


2. Print the following text on labels and place the labels on separate index cards (vary the resultsgiven to patients):

3. For “really sick” patients: Print the following text on labels and place the labels on index cards:

CBC

Results: WNL

NOTE TO HOSPITAL STAFF: Transport this envelope to the lab with the mock blood specimen(empty tube). To be opened by lab only!

Blood Test Results

NOTE TO LAB STAFF: Report the results in the usual manner using the appropriate time frame.

Al l Other Tests

Results: WNL

CBC

Results:WBC: 12.2

All else: WNL

Al l Other Tests

Results: WNL

X-RAY

NOTE TO PATIENT: Give this to the hospital staff if they take you to X-Ray.

Chest X-RAY

Results:WNL

Chest X-RAY

Results:Right lower lobe infiltrate

Chest X-RAY

Results:Bilateral Left lower lobe infiltrate

Chest X-RAY

Results:Left lower lobe infiltrate

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4. Place one of the index cards in a # 6 ¾ envelope (3.5 inches x 6.5 inches) (vary the cards)

with a label printed and placed on the envelope that reads:


Pharmaceuticals For Patients Requiring a Prescription


2. Print the following text on a label and place on an index card:

3. Place the index card in the #10 Envelope.

4. Place 10 candies, e.g., M&Ms, Skittles,etc. (all the same color is recommended) in a # 6 ¾envelope (3.5 inches x 6.5 inches) with a label printed and placed on the envelope that reads:


NOTE TO HOSPITAL STAFF: Transport this envelope to X-Ray with the patient.To be opened by X-Ray only.

X-RAY RESULTS

NOTE TO X-RAY DEPT: Report the results in the usual manner using theappropriate time frame.

NOTE TO HOSPITAL STAFF: If a prescription is ordered, the physician should use the enclosed blank“prescription” form.

PRESCRIPTION

(Blank Form)

NOTE TO PATIENT: Give this to the hospital staff if you are told you will be getting a prescription or medication.

PHYSICIAN: Write the prescription here

NOTE TO PATIENT: Transport this envelope to the Pharmacy with the prescription.

PRESCRIPTION

NOTE TO PHARMACIST: Dispense this candy as the prescribed medication”. Follownormal procedures using your true inventory. If you do not have the medication currentlyin your stock, you cannot dispense anything.

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“Injects”

A series of injects has been developed for the exercise in order to more fully challenge the facility andto assure that all areas of the hospital participate in the exercise. The facility can use the provided“injects” or create their own. Hospitals may elect to create their own to test new system or suspected

weaknesses or areas of recent training focus. The “injects” include:

# Situation Departments ThatMay Be Involved:

1 40% of the nursing staff and 30% of the housekeeping staff for the nextshift have called in sick.

• Nursing

• Housekeeping

2 Eight family members have arrived looking for their loved one. They tellthe receptionist that they heard their loved one was not feeling well; theydemand to see their sick family member. Two of the family members arecoughing and sneezing incessantly.

• Social Services

• Pastoral Care

3 President Bush is giving a commencement speech in the area. Thereare massive traffic jams in the area and family members that are comingto pick up patients that have been discharged cannot get to the hospital.The patients awaiting discharge are complaining they are hungry.

• Admitting

• Food Service

4 A city garbage truck has blown a transmission while on a trash runacross from the hospital ED entrance. The truck crew parked the truckand was picked up by another city crew. A large pool of transmissionfluid has formed and is flowing downhill towards the ED doors.

• Security

• Facilities

• Housekeeping

5 The local long term care facility contacts the hospital and indicates theyare unable to accept any transfers of discharged patients.

• Nursing

• Admitting

• Social Services

6A Twenty-five kindergarten children and two teachers from a nearbyelementary school arrive in the ED seeking treatment. They arecomplaining of “not feeling well”. Some of the children have beenvomiting. Many children do not speak English.

• Social Services

• Pastoral Care

6B Twelve of the children from the elementary school require admission dueto dehydration. You are unable to transfer the children to a pediatrictertiary care center due to unavailability of inpatient beds.

• Admitting

• Nursing

7 Staff is refusing to go home at the end of their shift. They are worried

that they might “bring whatever these patients have” home to theirfamilies. Some of them have indicated that they are prepared to stay fora week or longer.

• Housekeeping

•

Facilities

8 After learning that the ED is experiencing a significant number of illpatients, pastoral care reports they have 25 faith leaders in the hospitalthat were at a hospital-sponsored luncheon ready to provide spiritual andpsychosocial support to patients, visitors and staff.

• Pastoral Care

• Social Services

9 A local news station is reporting that the area is in the middle of anoutbreak of pertussis (whooping cough). You have not received any“official” communication from the local public health department.

• Public Affairs

• Infection Control

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In addition, a minimum of five patients should require admission in order to test the facility’s surgecapacity. Injects for this scenario should be: “THIS PATIENT NEEDS TO BE ADMITTED.”

The exercise controller should make the determination which of the messages/events the facilityshould inject. The injects should be printed on cards and handed one at a time to the appropriate

staff member. It would be to the hospital’s advantage to use as many of the injects as possible. See Appendix E for the injects in a printable form.

LOGISTICS

CONTROLLERS

It is recommended that an individual be assigned to act as an exercise controller. This individualshould provide assistance in making the exercise as real as possible. Some of the tasks thecontroller should be responsible for include:

• Creating a roster of volunteers• Distributing briefing sheets, scenarios and props to volunteers

• Instructing volunteers; confirming consent

• Meeting and instructing the volunteers as to where and how they should enter the facility (e.g.,in the E.D., in the lobby)

• Keeping track of the volunteers to make sure no one gets lost

• Expediting the movement of the volunteers

• Assuring that the exercise injects are handled appropriately (e.g., making sure the correctindividual and/or department gets the message)

• Overall coordination of the volunteer victims through the system

EVALUATORS

A Disaster Exercise Evaluation Form (Appendix F) should be completed for the facility to documentperformance during the exercise. A staff member should be assigned the task of completing the formduring the drill. A copy should be kept on file at the hospital and one forwarded to MCHC. In addition,HRSA requires that additional evaluation forms be completed (see Appendix G). These forms shouldalso be returned to MCHC.

HOSPITAL FEEDBACK - POST-EXERCISE DEBRIEFING

A post exercise debriefing should be held shortly after the drill to review the hospital’s response duringthe exercise. Individuals should be encouraged to share positive experiences as well as discussareas where improvements can be made. Open communication and dialogue should be encouragedamongst all areas of the facility.

CONDUCTING THE EXERCISE

H ANDLING ARRIVING P ATIENTS/VOLUNTEERS

To ensure that the victims come into/arrive at the hospital in a realistic manner, the facility should:

• Assign the controller to meet the victims to provide detailed instruction, including how to enter thehospital and via which entrance.

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• Consider sending volunteer victims:• Directly to the emergency department• To the main door/lobby/reception area• From private physician offices as referrals• From the floors, i.e., as a sick visitor

• Provide a card with the controller’s name and information on how to reach that person to each

volunteer victim (in the event a volunteer has a true emergency or complaint/concern following theevent).

• Make the controller available if the volunteer victims have questions or need clarification.

PLEASE MAKE SURE THAT STAFF IS AWARE THAT ABSOLUTELY NO INVASIVEPROCEDURES ARE TO BE PERFORMED ON THE PATIENTS/VOLUNTEERS AND

THAT THEY TAKE THE “ PROPS” SERIOUSLY.

OPERATIONAL POINTS

Due to the nature of the scenario, there will not be an official start time at which the “drill is called.”

Rather, the scenario will evolve. Hospitals will need to take this into account as the exerciseprogresses. For example, the facility may experience an influx of patients with similarsymptomatology. More and more patients may arrive necessitating the hospital to go on “virtual”bypass. When making the determination if bypass would be required, make sure to take into accountreal patients and drill patients/volunteers. At some point, facilities may find it necessary to contact thelocal health authorities, implement their peak census policy, or activate the hospital’s disaster plan. Itis very important that hospitals fo llow their established policies and procedures.

Note! Any communication or reporting to outside agencies, must bepreceded by the statement, “ THIS IS A DRILL, THIS IS A DRILL.” This

must be repeated twice.

In preparing for the exercise, you may wish to review the following:

Hospital Emergency Incident Command System (HEICS)

• Implementation of HEICS

Hospital Bed Capacity

• Surge plan

• Capacity management plan

• Procedures to request ambulance diversion/bypass

• Off-site options/assistance

• Patient discharges & transfers

Isolation Capacity

• Isolation plan

• Negative pressure capability

• Use of appropriate personal protective equipment

• Plan for fit testing of respirators

• Traffic flow

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Healthcare Personnel

• Activation & deployment of Regional Emergency Medical Emergency Response Team(RMERT) members

• Plan for bringing in additional staff

Credentialing

• Plan for granting disaster privileges

• Memorandum of Understanding (MOU) with other facilities

Pharmaceutical Caches

• Timely distribution of prophylaxis to staff/family and others as appropriate

• Procedures to request the Strategic National Stockpile (SNS)

Decontamination

• Plan for decontamination of victims

• Use of appropriate personal protective equipment (PPE)

• Disposal of runoff

Mental Health

• Surge capacity

• Plan for psychosocial interventions

• Mental health services (including family issues for patients and staff)

• Family/visitor centers

•

Spiritual care

Communications and Information Technology

• Redundant communication system

• Access to the appropriate Health Alert Network

Laboratory

• Communication with the laboratory including internal alerts regarding suspected organisms

• Integration of laboratory services in the facility’s disaster plan including rapid & effective labservices

• Capacity to identify threat agents• Protocols for referral of clinical samples to the Laboratory Response Network (LRN) nodes

that have analytical capabilities (the Illinois Department of Public Health Laboratory)

• Process for specimen collection, processing, shipping & handling

Contagious Disease Protocols

• Protocols for patients presenting with febrile rash illness

• Protocols for patients presenting with fever and respiratory illness

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Surveillance

• Process for identification of potential outbreaks

• Laboratory procedures & notification

• Notification of local health authorities

• Reporting

Mortuary

• Storage capacity including surge

• Identification of the deceased

Pediatrics

• Capacity to care for children in the ED & on inpatient units

Special Needs Populations

• Capacity to care for the elderly

• Capacity to care for the disabled

• Translation Services

• Capacity to care for the disabled with service animals

• Persons with other special needs

Finance

• Procedures for documentation of expenses & supply use

Staff Issues

• Immunizations

• Fatigue

• Family responsibilities

• Sheltering in place

• Day care

• Pet care

• Elder care

• Process for communicating situation updates to keep all aware & informed

Other

• Red Cross’ patient locater system

CONTROLLING OVERLY ENTHUSIASTIC VOLUNTEER VICTIM ACTING

In the event that a particular volunteer victim’s acting is jeopardizing the care of actual patients, amechanism should be developed in the facility where the exercise controller uses the command,“ FREEZE” to stop play of the individual volunteer victim. The controller should instruct the staff tocontact them in the event that actual patient care is being compromised. The volunteer victims shouldbe instructed during their briefing to immediately cease play acting when they hear the word“ FREEZE.”

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COMMUNICATION TO ACTUAL P ATIENTS AND VISITORS

In order to alleviate any anxiety experienced by actual patients and/or visitors during the exercise,consider developing signage and/or cards or flyers explaining the hospital is conducting anemergency preparedness exercise.

LOOKING AHEAD: 2006 LESSONS

In order to build upon the experiences gained during this year’s exercise, please complete the“Lessons Learned” (Appendix H) work sheet after the drill and return it to the Metropolitan ChicagoHealthcare Council, 222 S. Riverside Plaza, 19th Floor, Chicago, IL 60606. Our goal to is to compile alist of suggestions that may be helpful for all hospitals going forward. Remember…the drill has notbeen successful if nothing is learned!

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APPENDICES


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APPENDIX A

Volunteer Victim Consent Form


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CONSENT AND RELEASE

1. I, ________________, consent to allow _____________________ to participate in a "mock"Participant or parent/guardian of minor name of participant

disaster drill conducted by ___________________________________.Name of organization sponsoring drill

2. I understand that the "mock" disaster drill is required of hospitals by law as to enable hospitalsand other health care institutions to meet their responsibilities for the care of emergency victimsin the event of any disaster.

2. I understand that as a participant in the "mock" disaster drill, ________________ will havename of participant

make-up applied to so as to look like a "disaster victim"; may have his/her clothing soiled or torn;and will be transported by stretcher, wheelchair or some other method. In addition, it will benecessary for _________________ to travel from the "disaster site" to a hospital by

name of participant whatever method is deemed necessary by the Disaster Committee members or participatinghospitals, including car, ambulance, etc.

3. _________________ does not have any medical condition which would precludename of participant

participation in the "mock" disaster drill.

4. In consideration for being given the opportunity to participate, I voluntarily agree to releaseparticipating hospitals, _____________________________, their officers, agents, employees,

Name of organization sponsoring drill

and all other personnel for myself, my heirs, dependents, and assigns from any and all liability forany participation in and observation of the "mock" disaster drill. I recognize and agree to assumeany and all risks.

6. I further consent to the talking of photographs and videotapes of the disaster drill which mayinclude pictures. I understand that these photographs or videotapes may be retouched and thatno one will be identified by name. I further understand that the photographs and videotapes willonly be used for the purposes of education, knowledge, and research.

__________________________________ ___________________________________

SIGNATURE OF PARTICIPANT SIGNATURE OF PARENT IF A MINOR

__________________________________ ___________________________________

ADDRESS TELEPHONE

__________________________________ ___________________________________

BIRTH DATE OF PARTICIPANT DATE

__________________________________

WITNESS SIGNATURE

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APPENDIX B

Volunteer Victim Briefing Sheet


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VOLUNTEER VICTIM BRIEFING SHEET

PURPOSE:

Thanks for being here today. We are conducting a disaster drill to test the emergency plans at areahospitals. Each of you will be role-playing the part of an ill individual who has gone/been taken to an areahospital in order to be treated for signs and symptoms of an illness.

ITINERARY:

• Receive information, instructions and script handouts

• Participate in group orientation session; ask questions

• Receive scenario materials, props, and envelopes containing test results and lab samples

• Play role of victim

THINGS TO KNOW:

You will be role-playing at real hospitals in real emergency departments and being “cared for” by realhospital personnel. For some organizations, this drill may be a surprise.

• Expect some confusion as personnel may not know you are “acting”, particularly if you are one of

the first to arrive.• If at any point you are asked to stop acting, i.e., the drill is called short due to a real emergency,

please do so.

• If at any point the drill begins to jeopardize “real” patient care, you will be instructed to “FREEZE” . This means you should immediately stop acting to allow staff to appropriately care for “real”patients.

• INVASIVE PROCEDURES ARE STRICTLY PROHIBITED! If at any point, someone tries toperform an invasive procedure (i.e., start an I.V., take x-rays or draw blood) stop them. Make itclear that you are a Volunteer and ask the caregiver to speak to the charge nurse for clarification.The charge nurse is the nursing supervisor.

• If at any point during the drill you need to contact anyone in charge of the exercise, i.e., youbecome ill or seem to have lost your group, ask for the charge nurse or drillcontroller.

• If any aspect of the drill makes you uncomfortable or seems unreasonable, please ask for thecharge nurse.

Regarding role playing:

• Study your script.

• It is critical that you stick to your script as specified. In particular, do not change or embellish anyaspect of your medical condition. Use your script as a cheat sheet even if doing so forces you tobreak out of character. It is more important that you give accurate information than that you are agood actor.

• You can ad lib when asked questions not related to your medical condition or your script, forexample, who is your primary care doctor, do you have an emergency contact, what is the name of

your college, do you have roommates, do you have pets, and do you have allergies. Try to stick tothe truth to make your character more realistic.

• If you are not sure how to respond to a question say, “I’m not certain”.

• Do not offer information unless asked. However, be forthcoming if asked questions related to theinformation you have available.

• Do not share your script with any hospital personnel prior to or dur ing the exercise.

• In some cases, you may be taken to areas of the hospital outside of the E.D. to have testsconducted (i.e., x-ray or lab). This is part of the exercise. However, remember no invasiveprocedures or x-rays should be taken and ask for a charge nurse if anything seems amiss.

• You may receive envelopes with your script that instructs you to give them to the hospital staff ifthey order any tests. The envelopes have instructions on them for you to follow.

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APPENDIX C

Patient Scenarios


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PATIENT SCENARIO:FLU VICTIM

Thank you for participating as a “victim” for our disaster drills. We appreciate your willingness toassist us by playing the part of an ill person presenting to a hospital emergency department for

emergency medical care.

The following information will help you in your role playing. If any portion of these instructions isunclear, please ask for assistance from a hospital staff member prior to the drill. You may keep thisdocument with you to use as a cheat sheet, but under no circumstances give it to the hospitalstaff.

Your Role:

You have the flu – but do not tell the hospital staff you have the flu. They will need to figure it out.Remember the symptoms of the flu (given below) so that you can tell the hospital staff why you havecome to the hospital. You can use your real name and provide other information (such as whether

you have allergies) when you are questioned at the hospital.

You MAY receive envelopes or message cards on the day of the drill with instruction on them. Pleasemake sure to follow the directions.

At the hospital, you will need to complain of flu symptoms. If you are given a card that says you mustbe admitted to the hospital, your symptoms need to be severe.

General Symptoms of Flu: (NOTE: Symptoms come on suddenly and all at once)

• Fever (101 – 104 degrees F)

• Headache in the front, temples, or top of your head

•

Extreme Tiredness (can’t get out of bed, tired after taking a shower, walking to the bathroom,being out of bed for a short period of time, etc.)

• Weakness (like a dishrag, wet spaghetti, legs can’t support you)

• Dry Cough

• Sore Throat

• Runny Or Stuffy Nose

• Muscle/Body Aches (even hair and fingernails hurt)

Stomach symptoms, such as nausea, vomiting, and diarrhea, also can occur but are more common inchildren than adults

Complications of flu can include bacterial pneumonia, dehydration, and worsening of chronic medical

conditions, such as congestive heart failure, asthma, or diabetes. Children may get sinus problemsand ear infections.

Here are some Questions & Answers on the flu:

What is influenza (flu)?Influenza, commonly called "the flu," is caused by the influenza virus, which infects the respiratorytract (nose, throat, lungs). Unlike many other viral respiratory infections, such as the common cold,the flu causes severe illness and life-threatening complications in many people.

What is the difference between a cold and the flu?The flu and the common cold are both respiratory illnesses but they are caused by different viruses.

In general, the flu is worse than the common cold, and symptoms such as fever, body aches, extreme

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tiredness, and dry cough are more common and intense. Colds are usually milder than the flu.People with colds are more likely to have a runny or stuffy nose. Colds generally do not result inserious health problems, such as pneumonia, bacterial infections, or hospitalizations.

How do I find out if I have the flu? Because these two types of illnesses have similar flu-like symptoms, it can be difficult (or even

impossible) to tell the difference between them based on symptoms alone. A test can confirm that anillness is influenza if the patient is tested within the first two to three days after symptoms begin. Inaddition, a doctor's examination may be needed to determine whether a person has another infectionthat is a complication of influenza.

How do Flu viruses spread? Flu viruses spread in respiratory droplets caused by coughing and sneezing. They usually spreadfrom person to person, though sometimes people become infected by touching something with fluviruses on it and then touching their mouth or nose.

For how long is the Flu contagious?Most healthy adults may be able to infect others beginning 1 day before symptoms develop and up to

5 days after becoming sick. Some young children and people with weakened immune systems maybe contagious for longer than a week. That means that you can pass on the flu to someone elsebefore you know you are sick, as well as while you are sick.

How soon will I get sick if I am exposed to the flu? The time from when a person is exposed to flu virus to when symptoms begin is about one to fourdays, with an average of about two days.

How long is someone sick with the flu?Typically the flu resolves after 3--7days, but can persist for more than 2 weeks. Among certainpersons, the flu can make underlying medical conditions worse and can lead to pneumonia.Complications of the flu can include pneumonia as well as other conditions.

How many people get sick or die from the flu every year?Each flu season is unique, but it is estimated that, on average, approximately 5% to 20% of U.S.residents get the flu, and more than 200,000 persons are hospitalized for flu-related complicationseach year. About 36,000 Americans die on average per year from the complications

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PATIENT SCENARIO:“ WORRIED WELL” PERSON WITH FLU ONSET AT HOSPITAL

Thank you for participating as a volunteer for our disaster drills. We appreciate your willingness toassist us by playing the following part: You are quite convinced and worried that you are ill, but you

are not really physically ill at the time you get to a hospital emergency department for help. However,once you get to the hospital, and while you are being examined, you actually do get physically sickand this happens rapidly.

The following information will help you in your role playing. If any portion of these instructions isunclear, please ask for assistance from a hospital staff member prior to the drill. You may keep thisdocument with you to use as a cheat sheet, but under no circumstances give it to the hospitalstaff.

Your Role:

You enter the Emergency Department convinced you are sick, but, at that time, you really are just

worried. Once you begin to be examined, you develop a rapid onset of flu symptoms. Do not tellthe hospital staff that you have the flu.

Follow the Script Below:

1) When you are initially admit ted in the Emergency Department:You are very anxious and worried about getting sick. You should describe ONLY VAGUEsymptoms to the hospital staff – do not mention a specific disease, ONLY the vague,nonspecific symptoms. You can use your real name and provide other information (such aswhether you have allergies) when you are questioned at the hospital.

At the hospital, you will say that you came to the hospital because you are “sick like other people atyour work.” When asked how long you have been sick, answer, “For a little while, maybe a day orso.” You complain of the following symptoms and display the following behaviors:

• SymptomsComplain that you are feeling restless, nervous and very worried about your healthComplain about the following symptoms – but be vague.

Very tiredMuscle tensionTrouble sleepingHeart is racing

The nurse in the emergency room may ask if you have other specific symptoms. If the nurseasks specifically about other symptoms, answer “kind of” or “sort of” - you wil l be very, veryvague in admitting to whatever symptoms the nurse mentions – For example, if asked,“Have you had a fever?” Reply, “I think so.” Do not say that you took your temperature. Ifasked, “Do you have pain anywhere specifically?” Reply, “Kind of everywhere.”

• Behavior Ac t s igni fi can tl y d is tressed but do not in ter fere with regular func tioning of theemergency room staff . Do not be disruptive! When you are being attended to, act veryupset, nervous – crying, trembling, wringing your hands, rocking back and forth. Repeatedlystate such things as “I’m so sick” and “I’m just getting worse here,” or “I really need helpbecause I know I’m really sick.”

2) While you are being evaluated/examined in the Emergency Room:

23



You develop actual flu symptoms. Flu symptoms come on quite rapidly. Do not tell thehospital staff you have the flu. They will need to figure it out. While you are being examined, state,in a frightened voice, “Oh! My head just started to hurt very badly!” Complain of all of a sudden feelingextremely weak (and act extremely weak). Remember any of the othersymptoms of the flu (listed below) so that you can tell the hospital staff.

• Symptoms Fever (101 – 104 degrees F) Headache in the front, temples, or top of your head Extreme Tiredness Weakness (like a dishrag, wet spaghetti, legs can’t support you) Dry cough Sore throat Runny or Stuffy Nose Muscle/Body Aches (even hair and fingernails hurt) Stomach symptoms, such as nausea, vomiting, and diarrhea, also can occur but are more

common in children than adults.

24



PATIENT SCENARIO:“ WORRIED WELL” PERSON

Thank you for participating as a volunteer for our disaster drills. We appreciate your willingness toassist us by playing the part of someone who is quite convinced and worried that he/she is sick (but

he/she is really not phys ically sick) and comes to a hospital emergency department for help.

The following information will help you in your playacting roll. If any portion of these instructions isunclear, please ask for assistance from a hospital staff member prior to the drill. You may keep thisdocument with you to use as a cheat sheet, but under no circumstances give it to the hospitalstaff.

Your Role:You are very anxious and worried about some physical symptoms you are experiencing. Youshould describe ONLY VAGUE symptoms to the hospital staff – do not mention a specificdisease, ONLY the symptoms . You can use your real name and provide other information (such aswhether you have allergies) when you are questioned at the hospital.

At the hospital, you will say that you came to the hospital because you are “sick like other people atyour work.” When asked how long you have been sick, answer, “For a little while, maybe a day ortwo.” You complain of the following symptoms and display the following behaviors:

Symptoms:Complain that you are feeling restless, nervous and very worried about your health.Complain about the following symptoms – but be vague.

Very tiredMuscle tensionTrouble sleepingHeart is racing

The nurse in the emergency room may ask if you have other specific symptoms. If the nurse asksspecifically about other symptoms, answer “kind of” or “sort of” - you will admit to having whateversymptoms the nurse mentions – however, be very, very vague in your response. For example,if asked, “Have you had a fever?” Reply, “I think so.” Do not say that you took your temperature. Ifasked, “Do you have pain anywhere specifically?” Reply, “Kind of everywhere.” Continue to beinexplicit.

Behavior: Ac t s igni fi can tl y d is tressed but do not interfere w ith regular func tion ing o f the emergencyroom staff . When you are being attended to, do not be disrupti ve but act very upset, nervous –crying, trembling, wringing your hands, rocking back and forth. Repeatedly state such things as “I’mso sick” and “I’m just getting worse here,” or “I really need help because I know I’m really sick.”

25



PATIENT SCENARIO: ADULT FEMALE PERSON OF SIZE

Background

You are part of the “special needs population” as a “person of size”, weighing 575 pounds.

Instructions

You will be provided with an inflatable “Sumo” costume and house dress to wear while at the hospital.The suit comes with a fan that is inserted into a pocket on the right hand side at about waist level.Turn the fan on just before you enter the hospital in order to inflate the suit. Make sure the pocketzipper is closed so that the fan doesn’t fall out.

When you are examined by the hospital personnel, tell them that you weigh 575 pounds. Make sureyou act as though you are really large; for example, if the staff asks you to get into a wheelchair,tell them that you wi ll not f it and that you need a larger one.

Ask to use the bathroom. Go to the bath room, and when you come out tel l a staff member thatwhen you sat on the toilet it came off the wall (if it is wall-mounted) or broke (if it is attached tothe floor) and water is going all over the floor. The staff should then call housekeeping andthe engineer.

PLEASE NOTE

Please do not laugh and joke about what you being asked to do; there are people that really arelarge. They require special accommodations at the hospital, and that is what we are testing duringthe drill. While the use of the “Sumo” suit may be amusing, “props” such as this make the drillexperience more realistic for the drill participants.

26



PATIENT SCENARIO: ADULT HEARING IMPAIRED PERSON

Background

You are part of the “special needs population” as a hearing impaired person and are unable to hearanything.

Instructions

When you are examined by the hospital personnel, tell them that you are unable to hear anything. Ifthey write questions on paper for you, you may answer them either verbally or by writing a response.

If the staff provides you with a sign language interpreter, let the interpreter know that you really don’tsign, but that you will pretend to sign. Ask the interpreter to verbalize the words they are signing. Youmay then pretend to sign.

PLEASE NOTE

Please do not laugh and joke about what you being asked to do

27



PATIENT SCENARIO:SPECIAL NEEDS INFANTS: INFANT WITH TRACHEOSTOMY

History

You have a 6 month old infant with a tracheostomy (a surgical opening that creates an airway in theneck in order to bypass the upper airway due to inability to ventilate normally). A tracheostomy tubeis inserted into the stoma (opening) to maintain the airway patency (unblocked airway). Thetracheostomy was performed due to congenital tracheal stenosis, which is a narrowing of the lumen(diameter) of the trachea. Your child is able to breathe on his/her own without a respirator. You

provide the tracheostomy care at home for your child which includes care of the tracheostomy tubeand suctioning as needed to remove accumulated secretions.

Instructions

Please inform the hospital staff that your child needs to be suctioned. Hospital staff should obtainsupplies to perform this (appropriate size suction catheter, normal saline, gloves, suction, bag valvemask with O2). Once the child is suctioned, he/she is fine.

28



PATIENT SCENARIO:SPECIAL NEEDS INFANTS: GASTROSTOMY TUBE (G-TUBE)

Gastrostomy tube (balloon tipped withfeeding por t, medication port andballoon inflation port)

History

You have an 8 month old infant with a gastrostomy tube, which is a feeding catheter that is surgicallyinserted in through the abdomen wall directly into the stomach. Liquid feedings are attached to the G-tube to manage nutritional needs of children that are unable to take food or adequate amounts of foodby mouth for long periods of time. The G-tube was inserted three months ago for failure to thrive, acondition where babies fail to gain weight as expected and is often accompanied by poor heightgrowth. Children with failure to thrive don’t receive or are unable to take in, retain or utilize thecalories needed to gain weight and grow as expected. Failure to thrive is a general diagnosis, withmany possible causes. Most diagnoses of failure to thrive are made in infants and toddlers. Poornutrition during this period can have permanent negative effects on a child’s mental development.Causes can include: parents causing the failure to thrive by restricting the amount of calories theygive their infants, gastrointestinal conditions such as chronic diarrhea and cystic fibrosis (body cannotabsorb and retain food), cleft lip or a milk intolerance. In some cases, doctors are unable to pinpoint aspecific cause. In this case, the doctors are still trying to find the cause.

Instructions

Please inform the emergency department staff that it is time for your baby’s tube feeding and he/sheis hungry. Tell them your doctor said it is very important to give the feedings on time so your babycan gain weight. Tell the staff he /she takes Similac 160 cc every four hours. Hospital staff shouldobtain supplies for the feeding. Once they obtain the supplies, pretend they administer the feedingand your baby is fine.

29



PATIENT SCENARIO:SPECIAL NEEDS INFANTS: HOME OXYGEN THERAPY

History

You have a six month old infant with bronchopulmonary dysplasia (BPD), which is a chronic lungdisease that develops in low birth weight infants. Your child was born with respiratory distresssyndrome (RDS), a lung disease common in premature babies when they do not have enoughlubricant (surfactant) to keep their air sacs (alveoli) open. BPD can result from lung disease,exposure to prolonged high oxygen concentrations and mechanical ventilation after birth. Thecombination of fewer air sacs with a lack of surfactant can result in abnormally stiff lungs. Thisincreases the work of breathing causing fatigue.

BPD causes the most problems during the first year of life. Home management of BPD may includeoxygen therapy and respiratory medications to assist breathing.

30



Instructions

Your child is on continuous oxygen by nasal cannula at 2L/min. Today he/she feels hot and you thinkhe/she has a fever (you have not taken the child’s temperature yet). Your child has also been crankyand a little short of breath so you decided to bring him/her to the Emergency Department to bechecked out. Your child is not on any medications. Please tell the staff your oxygen tank is almost

empty and your child needs to be connected to oxygen.

31



APPENDIX D

Patient Scenario Materials


32



NOTE TO HOSPITAL STAFF: Follow yourhospital’s normal procedures for specimens.

NASOPHARYNGEALSPECIMEN

NOTE TO PATIENT:

Give this to the hospital staffif a swab of your nose is done.



NOTE TO PATIENT:

Give this to the hospital staffif a swab of your nose is done.



NOTE TO PATIENT: Give this to the hospital staffif a swab of your nose is done.






NOTE TO PATIENT: Give this to the hospital staff

if a swab of your nose is done.




if a swab of your nose is done.













33



NOTE TO HOSPITAL STAFF: Transport theNasopharyngeal specimen in this envelope to the lab.To be opened by the Lab ONLY.

TEST RESULTS FOR:


NOTE TO LAB STAFF: Report results in usual manner –i.e., once normal test run time has elapsed.


TEST RESULTS FOR:

NASOPHARYNGEAL SPECIME

NOTE TO LAB STAFF: Report results in usual manner i.e., once normal test run time has elapsed.


TEST RESULTS FOR:




TEST RESULTS FOR:




TEST RESULTS FOR:




TEST RESULTS FOR:




TEST RESULTS FOR:


NOTE TO LAB STAFF: Report results in usual manner –

i.e., once normal test run time has elapsed.


TEST RESULTS FOR:


NOTE TO LAB STAFF: Report results in usual manner

i.e., once normal test run time has elapsed.NOTE TO HOSPITAL STAFF: Transport theNasopharyngeal specimen in this envelope to the lab.To be opened by the Lab ONLY.

TEST RESULTS FOR:




TEST RESULTS FOR:



34



Rapid Antigen Testfor Influenza

Positive


Positive

Rapid Antigen Test

for Influenza

Positive

Rapid Antigen Test

for Influenza

Positive


Positive


Positive


Positive


Positive

35




Negative


Negative

Rapid Antigen Test

for Influenza

Negative

Rapid Antigen Test

for Influenza

Negative


Negative


Negative


Negative


Negative

36



All Other Tests forInfluenza

Negative


Negative

All Other Tests for

Influenza

Negative

All Other Tests for

Influenza

Negative


Negative


Negative


Negative


Negative

37




Positive


Positive

All Other Tests for

Influenza

Positive

All Other Tests for

Influenza

Positive


Positive


Positive


Positive


Positive

38



NOTE TO HOSPITAL STAFF: You must provideyour own appropriate empty Blood Specimen tube.Follow normal procedures.

BLOOD SPECIMEN

NOTE TO PATIENT:

Give this to the hospital staffif they pretend to do Blood Tests.

NOTE TO HOSPITAL STAFF: You must provideyour own appropriate empty Blood Specimen tubeFollow normal procedures.

BLOOD SPECIMEN

NOTE TO PATIENT:



BLOOD SPECIMEN

NOTE TO PATIENT:



BLOOD SPECIMEN

NOTE TO PATIENT:



BLOOD SPECIMEN


if they pretend to do Blood Tests.


BLOOD SPECIMEN


if they pretend to do Blood Tests.


BLOOD SPECIMEN

NOTE TO PATIENT: Give this to the hospital staffif they pretend to do Blood Tests.


BLOOD SPECIMEN



BLOOD SPECIMEN



BLOOD SPECIMEN


39



CBC

Results: WNL

CBC

Results: WNL

CBC

Results: WNL

CBC

Results: WNL

CBC

Results: WNL

CBC

Results: WNL

CBC

Results: WNL

CBC

Results: WNL

40



CBC

Results:

WBC: 12.2

All else: WNL

CBC

Results:

WBC: 12.2

All else: WNL

CBC

Results:

WBC: 12.2

All else: WNL

CBC

Results:

WBC: 12.2

All else: WNL

CBC

Results:

WBC: 12.2

All else: WNL

CBC

Results:

WBC: 12.2

All else: WNL

CBC

Results:

WBC: 12.2

All else: WNL

CBC

Results:

WBC: 12.2

All else: WNL

41



All Other

TestsResults: WNL

All Other

TestsResults: WNL

All Other

Tests

Results: WNL

All Other

Tests

Results: WNL

All Other

Tests

Results: WNL

All Other

Tests

Results: WNL

All Other

Tests

Results: WNL

All Other

Tests

Results: WNL

42



NOTE TO HOSPITAL STAFF: Transport this envelopeto the lab with the mock blood specimen (empty tube).To be opened by lab only!

Blood Test Results

NOTE TO LAB STAFF: Report the results in the usualmanner using the appropriate time frame.


Blood Test Results



Blood Test Results



Blood Test Results



Blood Test Results

NOTE TO LAB STAFF: Report the results in the usual

manner using the appropriate time frame.


Blood Test Results

NOTE TO LAB STAFF: Report the results in the usual



Blood Test Results



Blood Test Results



Blood Test Results



Blood Test Results


43



X-RAY

NOTE TO PATIENT:

Give this to thehospital staff if they take you to X-Ray.

X-RAY

NOTE TO PATIENT:

Give this to thehospital staff if they take you to X-Ray

X-RAYNOTE TO PATIENT: Give this to the

hospital staff if they take you to X-Ray.


hospital staff if they take you to X-Ray


hospital staff if they take you to X-Ray.


hospital staff if they take you to X-Ray

X-RAYNOTE TO PATIENT: Give this to thehospital staff if they take you to X-Ray.

X-RAYNOTE TO PATIENT: Give this to thehospital staff if they take you to X-Ray

X-RAYNOTE TO PATIENT: Give this to thehospital staff if they take you to X-Ray.

X-RAYNOTE TO PATIENT: Give this to thehospital staff if they take you to X-Ray

44



Chest

X-RAY

Results:

WNL

Chest

X-RAY

Results:

WNL

Chest

X-RAY

Results:

WNL

Chest

X-RAY

Results:

WNL

ChestX-RAY

Results:

WNL

ChestX-RAY

Results:

WNL

Chest

X-RAY

Results:

WNL

Chest

X-RAY

Results:

WNL

45



Chest

X-RAY

Results:

Left lower lobe infiltrate

Chest

X-RAY

Results:


Chest

X-RAY

Results:


Chest

X-RAY

Results:


ChestX-RAY

Results:


ChestX-RAY

Results:


Chest

X-RAY

Results:


Chest

X-RAY

Results:


46



ChestX-RAY


ChestX-RAY


Chest

X-RAY


Chest

X-RAY


ChestX-RAY


ChestX-RAY


ChestX-RAY


ChestX-RAY


47



Chest

X-RAY

Results:

Bilateral lower lobe infiltrates

Chest

X-RAY

Results:


Chest

X-RAY

Results:


Chest

X-RAY

Results:


ChestX-RAY

Results:


ChestX-RAY

Results:


Chest

X-RAY

Results:


Chest

X-RAY

Results:


48



NOTE TO HOSPITAL STAFF: Transport this envelopeto X-Ray with the patient. To be opened by X-Ray only.

X-RAY RESULTS

NOTE TO X-RAY DEPT: Report the results in the usualmanner using the appropriate time frame.


X-RAY RESULTS

NOTE TO X-RAY DEPT: Report the results in the usuamanner using the appropriate time frame.


X-RAY RESULTS



X-RAY RESULTS



X-RAY RESULTS

NOTE TO X-RAY DEPT: Report the results in the usual



X-RAY RESULTS

NOTE TO X-RAY DEPT: Report the results in the usua



X-RAY RESULTS



X-RAY RESULTS



X-RAY RESULTS



X-RAY RESULTS


49



NOTE TO HOSPITAL STAFF: If a prescription isordered, the physician should use the enclosed blank“prescription” form.

PRESCRIPTION(Blank Form)

NOTE TO PATIENT: Give this to the hospital staff ifyou are told you will be getting a prescription or medication.

NOTE TO HOSPITAL STAFF: If a prescription isordered, the physician should use the enclosed bla“prescription” form.


NOTE TO PATIENT: Give this to the hospital staff ifyou are told you will be getting a prescription or medica



NOTE TO PATIENT: Give this to the hospital staff if

you are told you will be getting a prescription or medication.



NOTE TO PATIENT: Give this to the hospital staff if

you are told you will be getting a prescription or medica



















50



HYSICIAN: Write the prescription here PHYSICIAN: Write the prescription here



51



NOTE TO PATIENT: Transport this envelope to thePharmacy with the prescription.

PRESCRIPTION

NOTE TO PHARMACIST: Dispense this candy as the

prescribed “medication”. Follow normal procedures usingyour true inventory. If you run out, you cannot dispenseanything.


PRESCRIPTION

NOTE TO PHARMACIST: Dispense this candy as the

prescribed “medication”. Follow normal procedures usinyour true inventory. If you run out, you cannot dispenseanything.


PRESCRIPTION

NOTE TO PHARMACIST: Dispense this candy as theprescribed “medication”. Follow normal procedures using

your true inventory. If you run out, you cannot dispenseanything.


PRESCRIPTION

NOTE TO PHARMACIST: Dispense this candy as theprescribed “medication”. Follow normal procedures usin

your true inventory. If you run out, you cannot dispenseanything.


PRESCRIPTION

NOTE TO PHARMACIST: Dispense this candy as theprescribed “medication”. Follow normal procedures usingyour true inventory. If you run out, you cannot dispense

anything.


PRESCRIPTION

NOTE TO PHARMACIST: Dispense this candy as theprescribed “medication”. Follow normal procedures usinyour true inventory. If you run out, you cannot dispense

anything.


PRESCRIPTION

NOTE TO PHARMACIST: Dispense this candy as theprescribed “medication”. Follow normal procedures usingyour true inventory. If you run out, you cannot dispenseanything.


PRESCRIPTION

NOTE TO PHARMACIST: Dispense this candy as theprescribed “medication”. Follow normal procedures usinyour true inventory. If you run out, you cannot dispenseanything.


PRESCRIPTION

NOTE TO PHARMACIST: Dispense this candy as theprescribed “medication”. Follow normal procedures usingyour true inventory. If you run out, you cannot dispenseanything.


PRESCRIPTION

NOTE TO PHARMACIST: Dispense this candy as theprescribed “medication”. Follow normal procedures usinyour true inventory. If you run out, you cannot dispenseanything.

52



APPENDIX E

“Injects”


53



40% OF THE NURSING STAFF AND30% OF THE HOUSEKEEPING

STAFF FOR THE NEXT SHIFT HASCALLED IN SICK.

ATWENTY-FIVE KINDERGARTEN CHILDREN AND TWO TEACHERS FROM A NEARBY

ELEMENTARY SCHOOL ARRIVE IN THE EDSEEKING TREATMENT. THEY ARE

COMPLAINING OF “NOT FEELING WELL” .SOME OF THE CHILDREN HAVE BEEN

VOMITING. MANY CHILDREN DO NOT SPEAKENGLISH.

EIGHT FAMILY MEMBERS HAVE ARRIVED LOOKINGFOR THEIR LOVED ONE. THEY TELL THE

RECEPTIONIST THAT THEY HEARD THEIR LOVEDONE WAS NOT FEELING WELL; THEY DEMAND TO

SEE THEIR SICK FAMILY MEMBER.

TWO OF THE FAMILY MEMBERS ARE COUGHING AND SNEEZING INCESSANTLY.

BTWELVE OF THE CHILDREN FROM THE

ELEMENTARY SCHOOL REQUIRE ADMISSIODUE TO DEHYDRATION. YOU ARE UNABLE

TO TRANSFER THE CHILDREN TO APEDIATRIC TERTIARY CARE CENTER DUE T

UNAVAILABILITY OF INPATIENT BEDS.

PRESIDENT BUSH IS GIVING A COMMENCEMENTSPEECH IN THE AREA. THERE ARE MASSIVE

TRAFFIC JAMS IN THE AREA AND FAMILYMEMBERS THAT ARE COMING TO PICK UPPATIENTS THAT HAVE BEEN DISCHARGED

CANNOT GET TO THE HOSPITAL. THE PATIENTS AWAITING DISCHARGE ARE COMPLAINING THEY

ARE HUNGRY.

STAFF IS REFUSING TO GO HOME AT THEND OF THEIR SHIFT. THEY ARE

WORRIED THAT THEY MIGHT “BRINGWHATEVER THESE PATIENTS HAVE”HOME TO THEIR FAMILIES. SOME OF

THEM HAVE INDICATED THAT THEY AREPREPARED TO STAY FOR A WEEK OR

LONGER.

A CITY GARBAGE TRUCK HAS A BLOWNTRANSMISSION WHILE ON A TRASH RUN

ACROSS FROM THE HOSPITAL ER ENTRANCE.THE TRUCK CREW PARKED THE TRUCK ANDWAS PICKED UP BY ANOTHER CITY CREW. ALARGE POOL OF TRANSMISSION FLUID HAS

FORMED AND IS FLOWING DOWNHILL TOWARDSTHE ER DOORS.

AFTER LEARNING THAT THE ED ISEXPERIENCING A SIGNIFICANT NUMBER OF IL

PATIENTS, PASTORAL CARE REPORTS THEYHAVE 25 FAITH LEADERS IN THE HOSPITALTHAT WERE AT A HOSPITAL-SPONSORED

LUNCHEON READY TO PROVIDE SPIRITUAL AND PSYCHOSOCIAL SUPPORT TO PATIENTS

VISITORS AND STAFF.

THE LOCAL LONG TERM CAREFACILITY CONTACTS THE HOSPITAL

AND INDICATES THEY ARE UNABLE TO ACCEPT ANY TRANSFERS OF

DISCHARGED PATIENTS.

A LOCAL NEWS STATION IS REPORTINGTHAT THE AREA IS IN THE MIDDLE OF AOUTBREAK OF PERTUSSIS (WHOOPING

COUGH). YOU HAVE NOT RECEIVED AN“ OFFICIAL” COMMUNICATION FROM THLOCAL PUBLIC HEALTH DEPARTMENT

54



THIS PATIENT NEEDS TO BE ADMITTED





55



APPENDIX F

Disaster ExerciseEvaluation Form


56



MCHC 222 South Riverside Plaza

Metropolitan Chicago Chicago, Illinois 60606-60

Healthcare Council Telephone (312)906-600

Facsimile (312)627-900

http://www.mchc.org

DISASTER EXERCISE EVALUATION FORM

For Hospitals Receiving Patients

Observer

(Name & Title)

Hospital Observed Date

1. Explain how the patients began arriving at the facility (e.g., ED, front lobby, from physicianoffices, etc):

2. Time the first patient/victim arrived: a.m. p.m.

3. Did the hospital implement their emergency

management plan?

YES NO

4. Time hospital implemented emergency managementplan:

a.m. p.m.

5. What was the reason stated for implementing the plan?

6. Was the HEOC1 staffed/opened? YES NO

7. If not, provide the reason it was not staffed or opened.

1 Hospital Emergency Operations Center

57



8. Were the following assessed? YES NO N/A

a. Blood availability?

Time s

b. Monitored bed availability?

Time s

c. Total bed availability?

Time s

d. Decontamination availability?

Time s

e. Pediatric beds?

Time s

f. Specialty beds (i.e., burns)?Time(s)

g. Adult ventilators?

Time s

h. Pediatric ventilators?

Time(s)

i. Combination adult/pediatric ventilators?

Time(s)

j. Pharmaceuticals?

9. Were any external agencies/authorities notified? YES NO

10. If yes, what was the response of each of the the agencies notified?

Agency Response

58



11. Were patients placed in isolation? YES NO

12. If yes, what type of isolation was used (check all that apply)?

AirbornePre-existing negative pressure rooms

Temporary negative pressure roomsDroplet

ContactNone

13. Did staff wear (check all that apply):

14. Was there enough personal protective equipmentavailable?

YES NO

15. Was the facility adequately secured? YES NO

16. Indicate how this was accomplished (check all that apply): Access control

Crowd controlTraffic controlOther __________________________________________________________________

_______________________________________________________________________

17. Were alternative care sites within the facilityestablished?

YES NO

18. Indicate how this was accomplished:

19. Were alternative care sites outside the facilityestablished?

YES NO

MaskProcedure/surgical mask

Mask with fluid & eye shieldN-95 respirator

Gloves

Gown

59



20. Indicate how this was accomplished (i.e., through an MOU2, etc ).

21. Indicate how the facility addressed any special needs patients that were received:

22. Was the facility’s family/visitor center activated? YES NO

DEPARTMENT SPECIFIC ISSUES

Laboratory

23. How many specimens were received by each lab area?

ChemistryHematology

HistologyMicrobiology

24. Were the mock specimens transported appropriately tothe lab?

YES NO

25. Were the mock specimens (and envelopes) labeledcorrectly with the patient’s information?

YES NO

26. Were you able to report the results to someonefollowing your normal procedures?

YES NO

Pharmacy

27. Were patient prescriptions brought to the pharmacy? YES NO

28. How many prescriptions were ordered?

29. How many prescriptions were able to be filled basedupon the facility’s true inventory?

2 Memorandum of Understanding

60



Radiology

30. Were the patients brought to x-ray? YES NO

31. Was the transport of the patients appropriate and donewith the appropriate PPE?

YES NO

32. Was the x-ray department notified of any specialneeds of the patients?

YES NO

33. Was the department able to handle any increasedvolume of patients?

YES NO

34. Were the x-ray results communicated appropriatelyand in the proper time frame?

YES NO

35. How many mock x-rays were taken?

36. Total number of drill patients received :

37. Differential diagnosis of patients:

38. Please indicate which departments in the facility and approximately how many staff in eacharea participated in the exercise:

DEPARTMENT NUMBER OF STAFF PARTICIPANTS

Administration

Emergency DepartmentFacilities

FinanceHousekeepingHuman Resources

Infection ControlLaboratory

Materials ManagementMedical StaffNursing

Pastoral CarePharmacy

PsychiatryPublic AffairsRadiology

RespiratorySecurity

Social ServicesOther (specify)Other (specify)

Other (specify)Other (specify)

61



39. Comments on your observations:

Signature:

This report should be completed in duplicate: one copy to be left at the hospital observed,

one copy to be submitted to:

Clinical, Adminis trative, Professional

and Emergency Services

Metropolitan Chicago Healthcare Council

222 South Riverside Plaza, 19th Floor

Chicago, Illinois 60606

FAX: 312/627-9002

5/2006

62



APPENDIX G

Additional EvaluationMaterial

(To Meet HRSA Grant Requirements)


63





Healthcare Council Telephone (312) 906-6000

Facsimile (312) 803-0661

TDD (312) 906-6185

To Whom It May Concern:

MCHC and the council’s HRSA grant partners have developed a means to perform a morequantitative analysis of performance of drill/emergency response activity. The data collected willallow MCHC and the grant partners to provide an enhanced report to the federal government

concerning drill activity and disaster preparedness in the State of Illinois. Your individual facility’sdata will be included anonymously in the overall analysis. The analysis of your facility’s data willbe made available to you for your use in emergency preparedness and compliance with JCAHO.

The first is the Department Evaluation Form which is to be completed by the director or designeeof selected departments at your facility. The second is the Department List which identifies thedepartments selected for the 2006 drill. The third is the Individual Staff Member Questionnairewhich is to be completed by each staff member in the selected departments, whether or not theyparticipated in the recent drill. The Individual Staff Member Questionnaire allows for education ofall staff even if they did not have the opportunity to participate in the drill.

Please return the completed forms to MCHC with 14 days of the disaster exercise.

Thank you for your assistance. Please contact me at 312-906-6062 if you have any questions.

Patrick FinneganDirector, CAPES

64



Selected Departments for May 2006 Drill Analysis

1. Admitting

2. Administrators-on-call/Nursing supervisors

3. Communications/Call Connection Center

4. Emergency Department (physicians, nurses, technicians, secretaries, and othersupport staff)

5. HEICS Administrators

6. Infectious Disease/Infection Control7. Laboratory

8. Media Relations

9. Nursing (Inpatient)10. Pharmacy

11. Radiology

12. Respiratory

13. Safety & Security

14. Transportation15. Trauma

Note on Department Evaluation Form if department report not applicable or if

department did not participate at your facility.

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Page 1 of 2

__________________________________Hospital/Medical CenterDisaster/Emergency Response

Departmental Evaluation

Department: _______________________________________ Date: ______________________

Completed by (Chair/Manager or designate):______________________________________

Total number of Individual Staff Member Questionnaire distributed :

Total number of Individual Staff Member Questionnaire collected :

I. Emergency Response Plan(s) Activated: Time:

II. Time notification received Method of notification

III. Effectiveness of Hospital in Responding to Plan

(Please Grade on A, B, C, D, F traditional scale or indicate NA)

Hospital SupportCriteria

A B C D F N/A

On-Site staff notificationAppropriate PPE available

Procurement and assignment ofstaff

Procurement of supplies

Patient & family communication

Patient information flow

Media interface

Coordination with EMS, fire,police, etc.

Recovery of normal operations

Staff support & debriefing

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Page 2 of 2

IV. Effectiveness of Staff in Responding to Plan

(Please Grade on A, B, C, D, F traditional scale or indicate NA)

V. Analysis

a. Plan changes indicated:

______________________________________________________________________________

b. Communication needs:

______________________________________________________________________________

c. Personnel or Supply needs:

______________________________________________________________________________

d. Staff education needs:

______________________________________________________________________________

f. Helpfulness of drill as training exercise to accomplish objectives:

______________________________________________________________________________g. Other opportunities for improvement:

________________________________________________________________________

Please return forms to Emergency Management Committee Chair.

Staff Knowledge & PerformanceCriteria

A B C D F N/A

Location of plans

Assembly site

Notification of external authorities

Off-site staff notification

Assumption of responsibilities &alternate roles

Appropriate PPE used

Patient management

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__________________________________Hospital/Medical Center

Disaster/Emergency Response

Staff Questionnaire

Name:____________________________________________ Date: ___________________________

Department:_____________________________ Position: __________________________________

1. Estimate the total hours of all Mass Casualty Incident disaster/emergency responsetraining (excluding drills) you have participated in over past three years. Includetrauma, chemical, biological, radiation/nuclear & other events.

NONE 1-5 6-10 11-20 >20

Hours

2. How many disaster drills have you participated in over the past three years?

3. Where would you find the Emergency Response Plans for your department?

4. Where should you go (assembly site) if a Mass Casualty plan is activated?

5. What precautions are required in caring for patients with Influenza A?

□Standard □ Contact □ Droplet □Airborne

6. Is decontamination required for patients with possible Influenza?

□ YES □ NO

7. Is there a medication you can take to help prevent Influenza if you are exposed?

□ YES □ NO

8. What is the best way to prevent the spread of germs and contagious diseases?

9. Did you participate in the Influenza disaster drill at your hospital on 5/13 or 5/20/06? □ YES □ NO

10. If yes, how was the drill in preparing for you an epidemic?

□Very helpful □Helpful □ Slightly helpful □Not helpful □I am more confused

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APPENDIX H

Lessons LearnedWorksheet


69







TDD (312)906-618

2006 DISASTER EXERCISE

“Lessons Learned Worksheet”

Things your hospital did well:

1

2

3

4

Things your hospital could improve upon:

1

2

3

4

Hospital: _____________________________________ Completedby:______________________________

Please forward this form to MCHC - FAX: 312-627-9002.

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FORMS


71



HOSPITAL EMERGENCY INCIDENT COMMAND SYST

SECTION PERSONNEL TIME SHEET

Date: / / Section: ___________

Hours: From: To:______________________

#

( Please Print) Employee/Volunteer Name Title/Job Class Signature

1

2

3

4

5

6

7

8

9

10

11

12

13

Certifying Officer: Date/Time:____________________________

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HOSPITAL EMERGENCY INCIDENT COMMAND SYSTEM

EMERGENCY INCIDENT MESSAGE FORM

_______________________________________________________________________________

FILL IN ALL INFORMATION

TO (Receiver):

____________________________________________________________

FROM (Sender): _____________________________________________________________

DATE & TIME: _____________________________________________________________

PRIORITY

Urgent-Top Non Urgent-Moderate Informational-Low

Message:

Received By: Time Received: Comments:

Forward To:

Received By: Time Received: Comments:

Forward To:

KEEP ALL MESSAGE REQUESTS BRIEF, TO THE POINT AND VERY SPECIFIC.

Original : Receiver Copy #1: Communications Officer Copy #2: Sender

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ACTIVITY LOG

Date: / / Section: _____________________________

Position Title: Individual Name:_______________________

# Time Incident - Problem Situation

1

2

3.

4

5

6

7

8

9

10

11

This form is intended for use by all individuals as an accounting of their personal action or

Original: Immediate Supervisor or Copy: Position/Section Documentatio

Section Chief

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H E I C S

PROCUREMENT SUMMARY REPORT

# P.O. # Date/Time Item/Service Vendor $ Amou

1

2

3

4

5

6

7

8

9

10

11

12

13

Certifying Officer: Date/Time: _____________________

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RESOURCE ACCOUNTING RECORD

Date: / / Section: __________________________________

(Use military time 0000-2359)

Time Item/Product Description ReceivedFrom

Dispensed To Initials

Certifying Officer: Date/Time: ______________________

Original: Section Chief Copy: Finance Chief

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POST-EXERCISE CRITIQUE FORM

PROBLEM/IMPROVEMENT

SOLUTION RESPONSIBLEINDIVIDUAL

MCHC

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TDD (312)906-618

The Metropolitan Chicago Healthcare Council (MCHC) is a membership and service associationcomprising more than 140 hospitals and health care organizations working together, since 1935,to improve the delivery of health care services in the greater metropolitan Chicago area. Moreinformation is available on the MCHC Web site at www.mchc.org.

MCHC’s Clinical, Administrative, Professional and Emergency Services (CAPES) departmentprovides information and support hospitals need to operate effectively and keep up withevolving patient care, administrative and regulatory standards. CAPES assists hospitals in

addressing clinical, emergency preparedness and EMS, patient safety, ethics, environment ofcare, infection control and perioperative issues.

CAPES provides a wide range of consultation, advocacy, education, networking, planning andtechnical assistance services. These include regular electronic communication with participatinghospitals; development of guidance, resource and training documents on emerging topics;regular member surveys and forums to identify important issues and exchange best practices;and educational programs and seminars.

CAPES prepares hospitals for disasters by providing disaster bioterrorism preparedness trainingand resources, and running disaster drills. CAPES supports and coordinates regional hospitalservices should a disaster or terror attack strike. CAPES helps members develop the tools and

skills they need to meet patient care, safety and regulatory challenges – and fulfill theircommunity service mission.

For more information contact Patrick Finnegan, director, CAPES (312) 906-6062,[email protected] or Linnea O’Neill, assistant director, CAPES, (312) 906-6061,[email protected].

Disaster Guidebook With Scenarios

Documents

Transcript of Disaster Guidebook With Scenarios