Operative Theater Management Plan - PDF by xrt38752


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									                                                         Goals of Exercise
                                             • 1) Demonstrate various methods of patient
                                               movement in a horizontal fashion in an acute care
                                             • 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
• Complex Floor Plans

                                                       Multiple Causes for
 Hospitals are High Risk Areas
• 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
                                                                                                                                                                                                                   • 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
• 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

                                                                                            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
                         Section Chief
                                                                              Section Chief
                                                                                                                             Section Chief
                                                                                                                                                                                         Section Chief
                                                                                                                                                                                                                   • Provides Accountability of Limited
                                                        Personnel Staging Team

  Hospital Operations
                                         Staging        Vehicle Staging Team
                                                        Equipment /Supply
                                         Manager            Staging Team                    Resources        Personnel Tracking            Service                Communicat ions Unit
                                                                                                                                                                  IT/ IS Unit
                                                        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
                                                     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 &
                                                                                                                                                                                                                     – 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
      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
• 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
• 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
                                            – 2 individuals at head, each with knot to
                                              hold…providing counter-traction down

       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
• Exacerbation of chronic conditions
  without their medications
• Oxygen needs




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