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Operative Theater Management Plan document sample
Document Sample
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!
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