Transcript Emergency Operations Plan v7

UNIVERSITY OF VIRGINIA HEALTH SYSTEM
Emergency Management Working Group
12 May 2014
Please remember to silence your cell phone.
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Agenda
1. Bi-monthly Review
2. 2014 EOP Refresh
3. Red Book Mid-Year Update
4. Workplace Violence Campaigns
5. BERT
6. Upcoming Training and Exercises
7. GETS Cards
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Bi-monthly Update
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Gamma Knife Drill
Water Tabletop Exercise
Fox Fields
Scheduled Outages
No Actual Events
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2014 EOP Refresh
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JC Standards – annual review
Last complete update in 08
Pictorial vs Narrative
Developed more detailed Basic Plan
Refreshed look of other components
Restructured/Reorganized
June timeline
What does this mean to you?
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Red Book Update
Emergency Action Plan
 Bomb Threat Sheet
 Fire Sheets
 WPV Sheet
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Bomb Threat Sheet
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Fire Sheets
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WPV Sheet
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Workplace Violence Campaigns
Active Shooter
• May and June Timeline
• Update to the Red Book
• Broad Education
• Active Shooter Exercise on June 27
BERT
• June and July Timeline
• Introduce and educate to the reorganized BERT response
• Expand our educational approach
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Active Shooter
Active shooter events in a healthcare setting
present unique challenges: a potentially large
vulnerable patient population, complex inprogress medical procedures, presence of
visitors, and hazardous materials.
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Active Shooter
Run – is to immediately evacuate the area
Hide – seek a secure place where you can hide and/or
deny the shooter access
Defend – where your life or the lives of others are at
risk, you may make the personal decision to try to
attack and incapacitate the shooter to survive
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Active Shooter
https://www.youtube.com/watch?v=GT
wh60AWhwk
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BERT
Individual Staff Readiness
− Utilizing E Mgt approach with behavioral emergencies
• Preparedness/Prevention
• Response
• Recovery
Response Team Readiness
− Consistent organization with other emergency teams
− Establishing an algorithm for response
− Leadership and delineated roles
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Prevention: Avoiding Behavioral Issues
Many of our patients are impacted by confusion, delirium, substance abuse/withdrawal, sleep
deprivation, mental health exacerbations, or other conditions affecting sensorium.
Situational Awareness
• Clinical considerations—glucose,
oxygenation, or other changes in condition
• Your actions can escalate or de-escalate
behavioral issues
• Abruptly entering the room or patient’s
personal space can illicit a startle response
• Constant interruptions by multiple care
givers contribute to sleep deprivation
• Perception of pain and related frustration
• Family//visitor interactions
• Insensitivity to cultural mores
Techniques
Situational
Awareness
Early
Recognition
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Techniques
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Early Recognition
Verbal
Yelling
Shouting
Profanity
Threats
Non-Verbal
Pacing
Clenched jaw or
fist
Muscle tension
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Entering patient’s room respectfully
Acknowledge patient feelings
Clearly communicate expectations
Minimize sleep disruptions by
coordinating care, visual reminders
patient is sleeping & advocating for
rest
Maximize comfort therapies for
pain & anxiety relief
Increase your own cultural IQ when
& where appropriate
Do not threaten, challenge or argue
Set clear limits on behaviors that
affect the wellbeing of the patient or
others
Listen carefully and repeat what
they say back to assure
understanding
Respond honestly to questions
Involve Chaplaincy & Social Work
early
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Response to Behavioral Issues
Once behavior escalates to levels
that threaten the safety of the
patient, other patients, staff, or
visitors—decisive response is
indicated.
This 1,2, 3 guide walks providers
through steps for activation.
While definitions of unacceptable
behavior and individual tolerance
to acts of violence vary, it is
essential we establish
standardized behavioral “triggers”
to help define a “behavioral
emergency.”
This flyer has been adapted in two
different versions to cover both inpatient and ambulatory settings.
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Recovery: Staff Resilience After the Event
Recovery after Aggressive or Violent Incident
Acts of abuse, intimidation or violence are not part of the job as hospital employees and should not be
tolerated, regardless of origin.
• If injured as result of a violent act,
• Seek appropriate treatment in Employee Health or Emergency Room
• Notify your Manager
• Consider your rights to press legal charges against the attacker
• If this course of action is chosen, call 911 for the University of Virginia Police (UVA PD)
• UVA PD will facilitate the complainant (you) swearing before the local magistrate to see if a
warrant will be sought for the arrest of the attacker
• UVA PD or UVA Medical Center cannot legally perform this function on your behalf
• If physically or emotionally traumatized as result of workplace violence,
• UVA Faculty & Employee Assistance Program (FEAP) is an excellent resource for
employees recovery
• If unsure about legal course of action, UVA FEAP can facilitate a free 30-minute legal
consultation
UVA Faculty & Employee Assistance Program 434.243.2643
http://www.healthsystem.virginia.edu/pub/feap
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“ERT” Comparison
Response Triggers
Number called
Team composition
Paging sequence
Team Leadership
Documentation
Roles
Code 12
MET/PERT
BERT
Objective: Pulseless Patient
or imminent arrest
Objective: Defined
physiologic triggers
Subjective:
“Demonstrates actual or
potential violent,
aggressive and/or
assaultive” behavior
4-2012
4-2012
4-2012
In-house coverage for
specific services (ie. GM2,
Anes, RT Supervisor, etc)
Designated roles
1. In-house coverage when
available (50% of team)
2. Variable primary MD
Set page group
Set page number
1. Set page group
2. Primary MD
• 2nd year Medicine
Resident
• IRPA Available
• MET Nurse
• IRPA Available
EPIC: Code 12 Narrator
EPIC: MET Form
Clearly delineated
Clearly delineated
Primary MD
Or Pyschiatry—”whomever
is first to arrive”
1. Pysch Note in chart
2. BERT form on-line
May vary depending on
team member availability or
response times
Response Boundaries
• Code 12 Team: In-hospital
patients
• MTN: Non-inpatient
• + Redundancy plan
• In-patients
• + Redundancy plan
1. BERT: In-patients
2. Call for Security: nonpatients
Care Guidelines
• Based on AHA
Guidelines
• Concise algorithms
shared by all responders
• Protocol driven
• Direct orders
• No shared model
• Varies from patient to
patient based on history
BERT CALL
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SAFETY FOCUS
MEDICAL FOCUS
Scene Safe?
No
Yes
Violent
ABILITY TO REFUSE CARE (one
or more)
Yes
Risk to self or others?
No
Protect self & others
until help arrives
Are they:
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De-escalation in
<3 minutes
Access
UPD
Altered Mental Status
Suicidal/homicidal
Documented lack of capacity
Grossly unable to care for self
Yes
No
No
Yes
May leave
AMA
Steps for
ECO
Restraints
Medical Evaluation
Don’t forget:
Notification & Escalation
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Vital signs
Glucose (finger stick)
O2 Saturation
CAM
Physical Exam
Legal
Algorithm
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BERT Checklist & Role Delineation
Scene Management
Patient Management Conducted By
1.
Incident Command: Nursing Supervisor,
Nurse Manager, or Shift Manager
1.
Ensure/Maintain Scene Safety
2.
Identify Responders and brief/orient on
arrival (repeat calls to 4-2012 if needed
to assure response)
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2.
3.
Team Huddle: determine
approach/facilitate assigning tasks
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Monitor Patient Management
5.
Contingency Plan via Huddle
6.
Conclude BERT > via 4-2012
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5.
7.
Submit WEB reporting tool (Nurse
Supervisor or Nurse Manager)
Incident Commander
– Ensure Team safety//oversight
– Lead Team Huddles: initial and concluding
– Report incident via QR//web tool
Primary Nurse
– Initiate restraints if needed (policy 0159)
– Brief BERT team on incident
– Pull medication list and provide CAM score
– Medical Management as ordered
Psych Resident
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Determine Mental status/ECO/TDO
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Provide consult to Primary Team
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EPIC BERT note
Primary Team Resident
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History/Capacity/Medications
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Restraint orders as needed
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Consult with Pharmacy & Psychiatry as needed
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Escalate care//notify chain of command
Chaplain
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Support of patient, family or staff
Security
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Secure scene/patient
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Assist with restraints
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Call for additional backup as needed
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Additional Thoughts
Continued Efforts
Education
– Expanded opportunities for demonstrated high risk areas….train the right people
– Expanded course offerings to accommodate varied needs and time availability…train more
people
– BERT Team education…optimize response through education
– CPI training, CIT training, exercises, informal education…ones size does not fit all needs
Operational Monitoring
– Continue data collection
– Expand data surveillance areas
– Review BERT reports
Issues:
1. Pharmacy—Valuable resource; determine best way to integrate into response
2. Nurse Managers—Availability//notification of incidents to assume incident commander role
3. Education—Expanding educational needs versus resources
4. Operational oversight: “Watch Officer” introduced at the operational level to support the tactical
efforts of the incident commander and BERT team
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VHHA/NW Region Collation
Funding
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Replacement Batteries for HT 50 Ventilators =
$6516.00
Replacement for 800 MHz radios that are 11
years old and Motorola will not support =
$17,000.00
Med Sled Evacuation Unit kits: Command,
Stairwell, Unit, Ambulatory Patient =
$33,000.00
Total for FY13-14= $56,516.00
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Training and Exercises
May 16th, TCH, Active Shooter Table Top at TCH
May 29th, UVAHS, Focused Table Top on Interruption of
Ambulatory Care Services
June 24th, UVAHS, Focused Table Top on Interruption of
the Supply Chain
September 5th, UVAHS, Full Scale Exercise on Medical Gas
Failure
October 2nd, UVAHS, Full Scale Exercise on Decon/Hazmat
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GETS Cards
Department of Homeland Security
GETS provides a valuable
capability to help you respond
to national Security/Emergency
Preparedness events when you
are unable to complete
emergency calls through normal
means.
Please check with Marc for
your card or to get one
ordered
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Next Meeting: July 14, 2014