Emergency Preparedness Procedures

► Objectives1. Discuss the critical elements of an emergency plan for response to a natural

disaster or other emergency.

2. Identify emergency preparedness plans in your community.

3. Discuss potential roles of the medical assistant in emergency preparedness.

Emergency PreparednessThe term emergency preparedness is defined as preparing for potential disasters, including infectious, occupational, environmental, or terrorist threats. Emergency preparedness may also be referred to as disaster preparedness, emergency management or disaster management. The types of emergencies that affect specific groups—individuals, businesses, or communities—will vary according to different variables. Location can be a big variable whether or not a group is more prone to a specific type of emergency. For example, communities near oceans are more prone to hurricanes, while communities near fault lines are prone to earthquakes.

Disasters can occur at the local, state, national or global levels. The following general description for national emergency preparedness is from the Centers for Disease Control and Prevention (CDC) website:

National emergency preparedness requires a coordinated effort involving every level of government as well as the private sector, non-governmental organizations, and individual citizens. CDC’s work in preparedness supports the Department of Homeland Security, which has overall authority for emergency response activities as laid out in the National Response Framework Document.1

According to the CDC, there are two types of preparedness, public health preparedness and medical preparedness:

“Public preparedness is the ability of the public health system, community, and individuals to prevent, protect against, quickly respond to, and recover from health emergencies, particularly those in which scale, timing, or unpredictability threatens to overwhelm routine capabilities.

1 The National Response Framework Document is available on FEMA’s NRF Resource Center, www.fema.gov/emergency/nrf

Medical preparedness is the ability of the health care system to prevent, protect against, quickly respond to, and recover from health emergencies, particularly those whose scale, timing, or unpredictability threatens to overwhelm routine capabilities.” (www.bt.cdc.gov/cdc)

Medical assistants are able to participate in both types of preparedness because of their dual roles as individuals in the community and as practitioners in the health care setting.

Emergency Preparedness PlanThere are three parts to an emergency preparedness program—planning, responding, and reporting. Each business should have an Emergency Director or Safety Director who will oversee and direct an emergency preparedness team. In large businesses with multiple departments, each department will need an emergency coordinator who will help develop specific plans for particular department and implement the plan during an emergency. Emergency preparedness committees may include two teams, an emergency response team and an emergency recovery team:

Members of the emergency response team should be formally trained in disaster response, be able to assist with evacuation procedures and have formal training in CPR and First Aid Procedures.

Members of the emergency recovery team should be formally trained in disaster search and rescue efforts. These team members will provide assistance both during and following a disaster until formal help arrives.

In smaller health care centers, personnel may be responsible for both response and recovery efforts. An emergency hotline should be implemented which can give recorded messages to staff members during an emergency. This line should be publicized to promote access to all staff members.

Before Designing an Emergency Preparedness PlanEmergency preparedness members should create and maintain a list of community resources and phone numbers for emergency preparedness, including:

Police department

Local Emergency Management and Homeland Security office

Red Cross

Hospitals in the area

Electric company

Gas company

There should also be a master contact list of personnel to contact in the event of an emergency. An example is shown in Figure 1.

MAPLE GROVE FAMILY PRACTICEEMERGENCY KEY PERSONNEL CONTACT LIST

Operator or supervisor should contact the following personnel members in the event of a disaster:

Personnel Cell Phone/ Pager Number

1. Emergency Director: ( ) -

2. Emergency Coordinator: ( ) -

3. ERT Member: ( ) -

4. ERT Member: ( ) -

5. ERC Member: ( ) -

6. ERC Member: ( ) -

7. Head Physician: ( ) -

8. Medical Director: ( ) -

9. Clinical Supervisor: ( ) -

10. IT Director: ( ) -

11. Plant Director: ( ) - Legend:ERT Member—Emergency Response Team MemberERC Member—Emergency Recovery Team Member

Figure 1: Example of an Emergency Key Personnel Contact List

Prior to designing an emergency preparedness plan, members of the emergency preparedness team should contact the local office of the Federal Emergency Management Agency (FEMA) to obtain materials that will assist in the plan’s creation. Helpful questions to ask the local FEMA office include:

What types of disasters should we prepare for?

How will be warned in the event of an emergency?

What are the evacuation routes out of the city?

What is our responsibility in assisting elderly or disabled persons during an emergency?

Where can we obtain an Emergency Preparedness Plan Template?

How can we obtain disaster training for our employees?

How can we assist your office in the event of a community disaster?

Many of these questions can be answered on the website of your local Emergency Management and Homeland Security office. Anything that cannot be answered through the website should be directed to a FEMA representative. Committee members should also check with the employer regarding specific emergencies that apply directly to the workplace.

Next, the team will need to identify specific personnel that will take on the function of the emergency director, emergency coordinators (If applicable) and those employees who will be on the emergency response and emergency recovery team.

Performing a Risk AnalysisEmergency preparedness personnel should conduct a risk analysis after gathering information from local authorities and business leaders within the organization. The form in Figure 2 is an example of a risk analysis form that can be used to identify and address risks common to a specific organization.

DISASTER RISK ANALYSIS FORMPotential Risk Associated with Each Category

HAZARD Low Moderate High

Natural Disasters

Fire

Tornado

Earthquake

Flooding

Blizzard

Outbreak/Epidemic

Industrial Accidents

Chemical

Hazmat

Utility/Resource Disaster

Loss of Power/Electrical/Generator

Communication/Telephone Failure

IT Failure

Mass Casualty Accidents

Gunman/Hostage Situation

Terrorist

Weapons of Mass Destruction

Chemical Weapons

Biological Weapons

Explosives/Bomb Threat

Figure 2: Example of a Disaster Risk Analysis Form

Evacuation Management PlanBecause many disasters require some form of evacuation, a plan should be in place that describes when evacuation is necessary and the process for evacuating in different types of emergencies. Each employee should know his or her specific role during evacuation procedures. Most employees will simply evacuate the building by following an emergency egress plan; however, some employees will have additional responsibilities, such as assisting patients or disabled workers with evacuation. The plan should also identify individuals that will need special assistance during evacuation procedures due to disability.

Emergency Egress PlansEmergency egress plans are maps or drawings that illustrate exit routes that should be taken during an emergency. These should be posted throughout the building. Employees should be properly trained in how to evacuate a building and should receive additional training when the plan changes. Each business should identify an Emergency Assembly Area (EAA)—an area that employees should report to once safely out of the building.

Exit Routes An exit route, as defined by the Occupational Safety and Health Administration (OSHA), is a continuous and unobstructed path of exit travel from any point within a workplace to a place of safety. An exit route consists of three parts:

1. Exit access: portion of an exit route that leads to an exit.

2. Exit: portion of an exit route that is generally separated from other areas to provide a protected way of travel to the exit discharge.

3. Exit discharge: part of the exit route that leads directly outside or to a street, walkway, refuge area, public way, or open space with access to the outside.

Exit routes must be entirely open and free of obstruction. These routes should not lead to high hazard areas unless there are suitable partitions or other physical barriers to shield individuals from danger. Exit signs must be well-lit and properly working at all times.

Persons with DisabilityIndividuals who may have problems escaping during an emergency should have a Personal Emergency Evacuation Plan (PEEP). These individuals include those who are temporarily disabled (pregnant or injured) and those who are permanently disabled. Permanently disabled individuals may include any of the following:

Sight impaired

Hearing impaired

Physically impaired (ambulatory problems)

Individuals with cognitive problems

Plans should also include how to handle patients or other visitors that are in the building during an emergency.

Evacuating the Building The following are guidelines for safely evacuating a building:

Stop what you are doing, avoid panicking, and remain calm.

If it is safe to do so, gather your personal belongings (purse, prescription medications, etc.)

Gather employee rosters and appointment lists that can identify individuals in the building at the time the emergency occurred.

If it is safe to do so, close your office door and window, but do not lock them.

If you are responsible for assisting patients or disabled workers with evacuation, and it is safe to do so, proceed with those responsibilities.

Advance to the nearest exit on the emergency egress map in your area; do not use the elevator.

Proceed to the designated Emergency Assembly Area (EAA) and report to the person responsible for taking roll.

Wait for any instructions from emergency responders.

Do not re-enter the building or work area until you have been instructed to do so by the emergency responders.

Shelter-In-PlaceShelter-in-place is the process of moving vertically or horizontally to the safest area in the building, based on the type of emergency encountered. Types of emergencies which may require shelter-in-place include chemical spills or adverse weather conditions such as tornados. Sometimes shelter-in-place is also necessary during hostage situations or other violent emergencies.

Shelter-In-Place Supplies and EquipmentAll departments should have shelter-in-place supplies and equipment in the event individuals must stay in the building over a prolonged period of time. At the minimum, each departmental kit should contain the following:

First aid kit

Laboratory spill kits

Flashlights/batteries and approved power strips and cords

Potable water (bottled water)

Portable AM/FM radio with batteries

Packaged emergency rations of nonperishable food (enough for everyone in the department for three days) and a non-electric can opener

Blankets or sleeping bags

Whistle

Moist towelettes

Filter masks (enough for everyone in the department)

Trash bags and extra ties

Rolls of plastic and duct tape

Two-way radios

List of emergency numbers

Employee rosters

Individual employees should have their own shelter-in-place kits in the event they are unable to leave their immediate surroundings or must provide personal items that are unavailable in departmental kits. Personal kits should include as many of the items listed above as well as other personal items such as a spare toothbrush and toothpaste, prescription medicine, extra pair of glasses, change of clothes and shoes and personal emergency contact information.

Each individual should also keep a shelter-in-place kit at home as well. It should contain all applicable items above as well as an extra set of car keys, cash, and important documents such as insurance policies, deeds to the house, etc.

CBRNE Shelter-In-PlaceIt is common to associate acts of terrorism with some type of explosive, but acts of terrorism can be in other forms as well. CBRNE is an acronym that refers to an event that involves chemicals, biologicals, radiologicals, nuclear devices, or explosives. These substances may be released intentionally as in acts of terrorism or accidentally. When an event does occur, you should know how to react. The Department of Homeland Security recommends following the guidelines below an event occurs.

CRBNE event at home:

Close and lock all windows and exterior doors.

If you are told there is danger of explosion, close the window shades, blinds, or curtains.

Turn off all fans, heating and air conditioning systems.

Close the fireplace damper.

Get your family disaster supplies kit, and make sure the radio is working.

Go to an interior room without windows that’s above ground level. In the case of a chemical threat, an above-ground location is preferable because some chemicals are heavier than air, and may seep into basements even if the windows are closed.

Bring your pets with you, and be sure to bring additional food and water supplies for them.

It is ideal to have a hard-wired telephone in the room you select. Call your emergency contact and have the phone available if you need to report a life-threatening condition. Cellular telephone equipment may be overwhelmed or damaged during an emergency.

Use duct tape and plastic sheeting (heavier than food wrap) to seal all cracks around the door and any vents into the room.

Keep listening to your radio or television until you are told all is safe or you are told to evacuate. Local officials may call for evacuation in specific areas at greatest risk in your community.

CRBNE event in the workplace:

Close the business.

Bring everyone into the room(s). Shut and lock the door(s).

If there are customers, clients, or visitors in the building, provide for their safety by asking them to stay – not leave. When authorities provide directions to shelter-in-place, they want everyone to take those steps now, where they are, and not drive or walk outdoors.

Unless there is an imminent threat, ask employees, customers, clients, and visitors to call their emergency contact to let them know where they are and that they are safe.

Turn on call-forwarding or alternative telephone answering systems or services. If the business has voice mail or an automated attendant, change the recording to indicate that the business is closed, and that staff and visitors are remaining in the building until authorities advise it is safe to leave.

Close and lock all windows, exterior doors, and any other openings to the outside.

If you are told there is danger of explosion, close the window shades, blinds, or curtains.

Have employees familiar with your building’s mechanical systems turn off all fans, heating and air conditioning systems. Some systems automatically provide for exchange of inside air with outside air – these systems, in particular, need to be turned off, sealed, or disabled.

Gather essential disaster supplies, such as nonperishable food, bottled water, battery-powered radios, first aid supplies, flashlights, batteries, duct tape, plastic sheeting, and plastic garbage bags.

Select interior room(s) above the ground floor, with the fewest windows or vents. The room(s) should have adequate space for everyone to be able to sit in. Avoid overcrowding by selecting several rooms if necessary. Large storage closets, utility rooms, pantries, copy and conference rooms without exterior windows will work well. Avoid selecting a room with mechanical equipment like ventilation blowers or pipes, because this equipment may not be able to be sealed from the outdoors.

It is ideal to have a hard-wired telephone in the room(s) you select. Call emergency contacts and have the phone available if you need to report a life-threatening condition. Cellular telephone equipment may be overwhelmed or damaged during an emergency.

Use duct tape and plastic sheeting (heavier than food wrap) to seal all cracks around the door(s) and any vents into the room.

Write down the names of everyone in the room, and call your business’ designated emergency contact to report who is in the room with you, and their affiliation with your business (employee, visitor, client, customer.)

Keep listening to the radio or television until you are told all is safe or you are told to evacuate. Local officials may call for evacuation in specific areas at greatest risk in your community.

Types of Action PlansEach business should have an action plan for potential disasters in the workplace. The following plans are examples of generic action plans that can be used in specific types of emergencies.

Action Plan for FireIn the event an employee spots a fire, the following procedures should be performed (the “RACE” mnemonic).

R Rescue Remove all patients and visitors that are in immediate danger.

A Alarm Activate the nearest fire alarm pull box. (This may be done simultaneously while removing patients and visitors. This will also automatically notify the fire department.)

Notify all personnel in the area of the fire.

C Contain Isolate the fire

Close all doors and windows starting with those closest to the fire. Note: Never open a door or window in the fire area once it has been closed.

E Extinguish/ Evacuate

Only extinguish the fire if it is contained and manageable.

Use the PASS mnemonic when operating a fire extinguisher:

o Pull the pin (with the nozzle pointing away from you)

o Aim low (at the base of the fire)

o Squeeze the trigger with a slow, even motion

o Sweep the nozzle side to side across the area

Never turn your back on the fire. If fire becomes unmanageable, back out of the area and exit the building immediately.

When fire personnel arrive, allow them to take over.

Evacuation and Reporting for all Remaining Personnel: When employees hear the alarm, immediately exit the building following the emergency egress map, unless assisting with evacuation efforts. If it is safe to do so, employees should close windows and doors and shut off gas jets while proceeding to the designated evacuation area. Front office personnel should take a paper appointment schedule with them as they exit the building. All employees should assist with the evacuation of patients and handicapped workers on their way out of the building. Staff members should report to their supervisor once safely out of the building. Department supervisors should notify the firefighters of any unaccounted employees or patients. All employees should remain outside until the emergency director states that it is safe to return to the building.

Action Plan for EarthquakesIf an earthquake occurs, and you are inside a building:

Duck, cover and hold; remain calm

Move to cover, get underneath a study surface such as a desk. If you are in a hallway, kneel down and back up against the wall.

Cover your head with something sturdy, like a book, or tuck your head between your knees. Remain in that position until the earthquake subsides.

If in an elevator, exit as soon as possible and follow the instructions above. If elevator doors will not open, press the emergency button and wait for assistance.

It is important to stay calm! Panicking will only make matters worse.

When rumbling stops:

When you feel rumbling from the initial quake has subsided, be cautious in your movements; there may be a series of aftershocks. Stay put until it appears that you are out of immediate danger.

Stay away from windows or objects that are likely to fall.

Do not exit the building unless the building is in danger of immediate collapse.

Report Report any injuries, casualties or structural damage to supervisor or safety personnel as soon as possible.

Assist Assist injured/disabled workers, being careful to preserve your safety.

Evacuate Follow instructions from safety/emergency personnel when evacuating the building.

If an earthquake occurs, and you are outside:

Move away Move away from power lines, buildings or any other structures or objects that may collapse; stay away from any fires and smoke.

Go to EAA Go the designated emergency assembly area or alternative and report to supervisor or monitor to let them know you are safe.

Don’t head home

Do not proceed home until your supervisor releases you and you have verified that it is safe to travel to your neighborhood.

Action Plan for a Tornado

If a tornado occurs, and you are inside a building:

Grab Grab a shelter-in-place Kit if time permits.

Assist and move

Assist in the relocation of patients and handicapped workers to the nearest designated shelter area. (This is usually a basement; if basement in not available, move to an interior hallway on the lowest floor possible.)

Move to the shelter area. If at any time your safety becomes a factor, move immediately to shelter area.

Avoid using elevators.

Stay Away Stay away from windows, doors and outside walls.

Go to the center of the room; stay away from corners as debris usually flies toward the corners of the room.

If a tornado occurs, and you are outside:

Shelter If shelter is available: Calmly move toward the shelter location.

No Shelter If shelter is not available: Lay in a ditch or other low lying area.

Avoid bridges and overpasses, as these may collapse.

After the danger has passed:Move Carefully move toward designated assembly area or makeshift

assembly area.

Report Report structural damage, injuries and casualties to supervisor or person in charge.

Assist Assist injured and handicapped workers.

Stay Stay at the scene until formally released by your supervisor or person in charge.

Action Plan for Weapons of Mass DestructionWhen The Emergency Director confirms the threat with federal or state authorities, the Emergency Plan for Weapons of Mass Destruction will be initiated. In the event of a nuclear, chemical or biological threat to the community, employees will take the following actions:

Announce An announcement should be made to all departments; larger facilities may announce over the PA system using a particular code, such as “code brown.”

Report to posts Emergency/Safety personnel will report to their posts.

Emergency/Safety personnel will secure all access points within and outside of the building; no one will be permitted to enter or leave the building except emergency personnel.

All HVAC units should be closed down.

Grab Grab CBRNE supplies, any supplies necessary to seal off doors and windows (such as plastic and duct tape, wash rags, and bottled water), and shelter-in-place kits.

Direct Emergency/Safety personnel will direct patients and non-emergency staff members to shelter-in-place rooms. (Rooms will be determined by the Emergency/Safety director.)

Staff members should help assist patients and handicapped individuals to the shelter-in-place room.

Take a roll call in each shelter-in-place room.

Seal doors and windows

Emergency/Safety personnel will seal doors and windows in the room with plastic wrap and duct tape and place a wet cloth over window sill and door threshold.

Once door and windows are sealed, no one may leave the room.

Instruct Instruct patients and employees to place a wet cloth or clothing over the nose and mouth.

Remove Once given the all clear, Emergency/Safety personnel should remove plastic and tape from windows and doors

Personnel should set up decontamination showers and triage areas.

Assist Staff members should assist ill patients and employees to

decontamination tents/rooms and triage areas for final assessment.

Decontamination/Triage

All trained staff members will assist with decontamination and triage procedures following the event.

Leaving the Premises

No one will leave the premises until they have been cleared by the Emergency/Safety director or other supervising personnel.

Action Plan for Gunfire

If you are inside a building:

Hit the deck If you hear something sounding like an explosion or gunshots, immediately drop to the floor and lay flat; it is best if you can hide behind something like a desk or under a table.

If the gunshots sound far away, lock the doors in the room you are in and turn off the lights before proceeding to a hiding place. Stay away from windows and doors.

If you have a cell phone, call 911 and talk very low, to alert authorities of the problem.

When you have patients you are caring for, give them precise instructions on what to do. Help any disabled patients or employees to a hiding spot if it is safe to do so.

Stay put Do not get up from your hiding place, or open door or windows until instructed by a supervisor or police officer.

Assist Once given clearance to come out from hiding, assist in caring for the injured until emergency personnel arrive.

If you are outside:

Run Run as far away from the gunshots as possible, preferably into a building where you can lock the doors and windows. Alert the police as soon as possible regarding what you heard.

If you are in view of the gunman, run as fast as you can in a zigzag pattern, screaming as loud as you can. Once out of view of gunman, find a hiding place and call 911 as soon as possible.

Action Plan for Communicable DiseasesPolicy in place Have a sign that states that all patients with a rash, respiratory

symptoms, or fever should wear a mask, and perform hand hygiene and alert the receptionist so that they can be taken to a separate area.

Masks, waterless hand cleanser, and tissue should be in the entrance area for patients needing them.

Recognize If patients do not approach you, but you recognize signs or symptoms of a possible respiratory infection or rash, send the patient back to screening area.

Screen Screen patients according to facility guidelines for possible respiratory illness or rash.

Separate If patient does appear to have an infectious disease, follow office protocol regarding the separation of the patient from other patients.

The Medical Assistant’s Role in Emergency Preparedness and Community AwarenessThe role of the medical assistant in emergency preparedness will vary according to location and type of establishment of the workplace. Responsibilities may include any of the following:

Gathering materials to assist in developing an emergency preparedness plan.

Assisting supervisors to develop the emergency preparedness plan.

Assembling shelter-in-place kits for the facility.

Participating in emergency preparedness training and mock drills.

Delivering instruction in emergency preparedness training.

Contacting members listed on the emergency key personnel form during a crisis.

Assisting with evacuation of patients and disabled workers in a crisis situation.

Assisting with shelter-in-place activities.

Providing first aid and CPR to individuals following a disastrous event.

Health care professionals should also review the web site of the local Emergency Management and Homeland Security office. The web site will provide information on how to assist the community during times of disaster, as well as:

Handouts detailing what to do in particular disasters;

Evacuation routes out of the city;

Training information for those wanting to assist with community disasters;

Volunteer information;

Press releases;

Meeting opportunities;

Volunteering your services not only helps the community but also helps to lift the visibility and importance of the medical assisting profession.

Handling the Psychological Affects of a DisasterThe psychological effects of a disaster can be quite devastating. Individuals appearing very strong and confident under normal conditions may break down during or following a traumatic event. Emergency preparedness training can help to prevent feelings of anxiousness when the event occurs; however, even with training, some people just do not do well in crisis situations. It is important to remain positive during these types of events and to have patience with individuals who express fear and negativity. You can help others by performing your duties with confidence and remaining hopeful. Following a disaster, experienced counselors should be available to assist individuals affected by the event.

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