Goals of Exercise • 1) Demonstrate various methods of patient movement in a horizontal fashion in an acute care setting • 2) Demonstrate how to set up a vertical evacuation system utilizing available mattresses in the stairwell Hospital Evacuation • 3) Utilizing co-workers as patients, demonstrate how to package and ready a patient for vertical Sue Philpott, RN evacuation down the stairs. • 4) Demonstrate how to slide a packaged patient Training Officer down the mattresses for vertical evacuation utilizing safety measures and correct positional AZ-1 DMAT ergonomics • 5) Demonstrate how to modify the packaging and vertical evacuation practices for an ICU patient that may be intubated and/or have various instrumentation attached to them. Hospitals are High Risk Areas Hospitals are High Risk Areas • Medical Frail Individuals • Low lighting at night with confused and • Many Hazardous Materials contained or medicated patients within hospitals (biological/infectious • Poor Mobility or Non-Mobile Issues agents, chemical (both cleaning / • Occupied 24 hours/day, 7 days/week disinfecting agents as well as drugs such as chemotherapy as an example) • Patient on Life Support and Complex & radiological agents from nuclear med Machinery • Complex Floor Plans Multiple Causes for Hospitals are High Risk Areas Evacuation • Desirable drugs may be sought after • Fires (23%) and stolen if normal security breaks • Internal HazMat events (18%) down • Hurricanes (14%) • Hospitals are often sites for helicopter • Human Threat (Bomb & other) 13% operations • Earthquake (9%) • External Fire (6%) • Flood (6%) • Utility Failure (5%) Evacuation Consideration Evacuation Considerations • Loss of Utilities • Are NOT everyday events – Back-up Power Generators • Are extremely complex to do • Will they work? • How much fuel? • Provision of Patient Care Must • May be working without electricity to anything Continue • How Well Practiced is the Staff • Tracking of Patients, Visitors & Staff is essential • What else is going on? • Transportation of Patients & Staff • All Hospitals Affected or is Event Isolated? Is Community Involved in • Management of Medical Records Event? Command and Control in HICS Evacuations • Hospitals use Hospital Incident Incident Commander • Often working in Unified Command Command Structure Structure with other Agencies Public Information Safety Officer Officer Biological / Infectious Disease Chemical Radiological (HICS) Liaison Medical/Technical Clinic Administrat ion Hospit al Administ rat ion Officer Specialist Legal Aff airs Ris k Management Medical St af f Pediat ric Care Medical Et hicist • ICS Tailored to fit Operations Section Chief Planning Section Chief Logistics Section Chief Finance/ Administration Section Chief • Provides Accountability of Limited Resources Personnel Staging Team Hospital Operations Staging Vehicle Staging Team Equipment /Supply Manager Staging Team Resources Personnel Tracking Service Communicat ions Unit IT/ IS Unit Time Medicat ion St aging Team Unit Leader Mat eriel Tracking Branch Director Staf f Food & Water Unit Unit Leader Employee Healt h & I npatient Unit W ell- Being Unit Out pat ient Unit Family Care Unit • Tactical Operations Medical Care Situation Support Procurement • Narrows down the Span of Control to Casualt y Care Unit Pat ient Tracking Supply Unit Branch Director Mental Health Unit Clinical Support Services Unit Unit Leader Bed Tracking Branch Director Facilit ies Unit Transportation Unit Unit Leader Patient Registrat ion Unit Labor Pool & Credentialing Unit Power / Light ing Unit W at er/ Sewer Unit relate to Patient HVAC Unit Compensation/ Infrastructure Building /Grounds Documentation Damage Unit Claims Branch Director Medic al Gases Unit Unit Leader more Manageable Numbers Medic al Devic es Unit Unit Leader Environmental Services Unit Food Servic es Unit Care Activities Det ect ion and Monitoring Unit Spill Response Unit HazMat Victim Decont aminat ion Unit Demobilization Cost Branch Director Facility /Equipment Decont aminat ion Unit Unit Leader Unit Leader • Personal Safety is of Primary Access Control Unit – Clinical Care Security Crowd Cont rol Unit Traf fic Cont rol Unit Branch Director Search Unit Law Enforcement Int erface Unit – Ancillary Services Importance Business I nf ormat ion Technology Unit Service Continuit y Unit Continuity Records Preservation Unit Business Function Relocation Unit Branch Director – Patient Tracking Evacuation Plans Evacuation Considerations • Best Practice provides for Hospital • Having a Plan is Essential Patient Care Staff to accompany and • Practicing the Plan and Staff Members care for patients at the Receiving Aware of the Plan on all Shifts Facility – When to Evacuate – Horizontally & Vertically – Evacuation Staging Areas – Equipment – HICS Roles Evacuation Response Evacuation Response • Safety • Transport of evacuees off site • Situation Assessment – What method? • Activation of Evacuation – What goes with patients? • Medical Records? • Security • Medications? • Communications • Destination of evacuees • Physical Movement – Tracking? – Staging – Staff with patients? – Accountability for all patients – Transfer of Responsibility? – Medical Records Evacuation Safety Evacuation Safety • Before you move…. • Lifting Injuries – Evaluate Potential Threats Immediately • Trip Injuries Around You • BioHazards – Know Your Evacuation Routes and Alternatives • Helicopter Safety – Assist Other Staff and Patients with Safe • Know Role in Evacuation Plan Egress • Practice – Practice - Practice – Assess Potential Threats Outside Prior to Leaving Building Response Phase - Security Evacuations Challenges • Establish Exterior Security Perimeters • Very ill patients who have several – Prevent entry of personnel into facility simultaneous life threatening medical – Control the area for entrance of issues transporting vehicles • Some patients have medical equipment that can’t be removed or taken off • Establish Interior Security Perimeters • Bariatric Patients – Provide security for patients, Sensitive Patient Information and Staff • Confused Patients • Coordination and Patient Tracking Evacuation Challenges Mitigation/Preparation • Limited Ambulation Patients • Use Command Structure to Manage the • Often on-going Emergency Event in the Situation Midst of Hospital Evacuation • Practice Your Plan • Bad Things Happen! Events Usually • Safety of Staff, Patient’s & Visitors Don’t Happen in Your Favor! Just • Coordination and Tracking are Keeps Getting Worse. Required….Community Involvement Response Phase Movement of Patients • Physical Movement of Patients • Horizontal Evacuation: – Staff Safety First in Movement of Patients – Immediate Response from Area of Danger – Safe methods of lifting and moving to Area where is safe from Hazards patients – In the Staging Area Can take Time (in most – Individual Worker Safety Precautions instances) to evaluate patients and start • Universal Precautions triaging who may move first. • Back and other Injuries – Usually behind Fire Walls and Doors • Environmental Hazards – Most Horizontal Evacuations can wait for Incident Command to make decision for Vertical Evacuation. Horizontal Evacuation Horizontal Evacuation • Move Patients from Immediate Danger • Pull bottom sheet loose from mattress First • Move Them To A Staging Area – Will Need Staff in Area to Monitor Patients • Then Move Patients in Surrounding Rooms Next. Move Mattress to 90 degree End of Mattress on floor Angle to bed frame Pull Patient off Mattress Using Pull Patient to Safety In The the Bottom Sheet Staging Area. Horizontal Movement Staging Area • In less emergent conditions can use: • Once Patients are in Staging Area, – Wheelchairs if available Head Count must be done to make sure – Stretchers all patients, visitors and staff are • If patient’s are ambulatory, can walk present. down to staging area Staging Areas Command to Evacuate • Fire Doors and Walls are Rated for 1.5 • Comes from Decision made by Incident hrs minimum (can be up to 4 hrs) Commander unless immediate area is • Can Set Up Treatment Areas in Dangerous Environment. • Can Take Time to Prepare Patients for • One Floor or Department or Entire Vertical Evacuation Hospital • Vertical Evacuation Is Best If Can Use • Set Up Secondary Receiving/Staging Elevator System, But This May Not Be Area on First Floor Available….Need Secondary Plan Vertical Evacuation Vertical Evacuation • Elevators have to be cleared to be • If unable to use elevators need used. alternative plan to get patients down stairs. • Ambulatory Patients • Chair Carry – Can go down stairs in a group using human chain. • Fireman’s Carry – Staff member in front and staff member • Commercial Devices last in line • **Disclaimer: Not advocating any – Take head count when get to staging area. products shown or demonstrated Vertical Evacuation Vertical Evacuation • Use of devices requires training and • Mattress Slide: practice. • Will have mattresses available in rooms • Devices may have weight limitations • Manual carries still may be required. Vertical Evacuation Vertical Evacuation • Pull 7 mattresses to stairwell • Pull patient to hallway near stairs • Place end to end • Place patient on two flat sheets Vertical Evacuation • Tie square knots in top and bottom of • Using slide board pull patient up onto sheets mattresses in stairwell • 3 individuals will be needed – 1 person guides feet…keeping in center of mattresses – 2 individuals at head, each with knot to hold…providing counter-traction down stairs Vertical Evacuation Vertical Evacuation Vertical Evacuation Vertical Evacuation • At bottom of stairs, slide patient over to another crew to begin same process down the rest of the flight of stairs. Vertical Evacuation Chair Evacuation • Stair Chair • Chair Carry • EZ-Glide Chair • All require practice Difficult Evacuation Accountability & Movement • Sensory Impaired Individuals • Need to maintain accountability for patients and for staff • Any family members with patient during crisis • Patients in the operative Theater • Priority for relocation will depend on stability of patient and resources available in the community Special Considerations Additional Items • Fresh post-op patients • Headlamps/flashlights in case • Patients who are in the OR electrical power is out • Chemotherapy needs • Always use proper lifting • Psychiatric patients techniques • Exacerbation of chronic conditions without their medications • Oxygen needs Questions? •LET’S PRACTICE!
Pages to are hidden for
"Operative Theater Management Plan - PDF"Please download to view full document