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Lander Regional Hospital Alternate Care Site Plan
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In the event of a mass casualty disaster or evacuation, this plan outlines processes for the admission through discharge of patients directed to Ambulatory Surgical Center which will be the designated alternate care site.  

An Alternate Care Site (ACS) is defined as a location that would be used when a disaster has overwhelmed the community and/or the hospital or an evacuation has occurred.  In terms of using the Ambulatory Surgical Center as an alternate care site, the volume of patients is overwhelming the hospital and an additional location is needed or an evacuation as been ordered. The types of patients that would be seen in the ACS would be ambulatory acute injured, worried well and/or those with minor first aid needs from the disaster site or the evacuated patients that would need care to sustain.  The site(s) have been careful selected due to the assessment performed (EP-EM.02.01.01EP7 b Attachment I-Alternate Care Site Selection & Assessment) and an agreement has been signed by all parties as in using the site for care (EP-EM.02.01.01EP7 a Policy on Alternate Care Site Agreements).  Additional assessments have been performed to on the site capabilities and utilities (EP-EM.02.01.01EP7 c Attachment II- Alternate Care Site Assessment Tool 1 and EP-EM.02.01.01EP7 d Attachment III- Alternate Care Site Assessment Tool 2).

An Alternate Care Site will not be established until the Incident Commander has determined by the scenario and patient population/injuries that one is needed or once it has been determined that an area will be evacuated.  Once that determination has been made, the Alternate Care Leader will be notified to establish the site.  In turn, the Alternate Care Leader will contact the predetermined leaders and individuals needed to set up.  Depending on the time and day of week, this notification may be an overhead page. 

The Hospital Command Center (HCC) will maintain communications with the ACS.  Once the ACS has been established, the site will initiate contact with the HCC and establish an Alternate Care Command Center (ACCC) at the location of the ACS to ensure that continuous communication, leadership and documentation will occur. 

The Lander Regional Hospital does not have their own means of transporting patients via ambulance or bus.  The city of Lander will need to be notified through the proper channels once the need has been identified by the Incident Commander that patients/victims will need to be transferred or evacuated to the ACS.  Once transportation has been established, the patient/victims will be transported with the medical equipment needed for sustainability, medications, patient chart or information documentation, and staff. 

The Alternate Care Leader will be the point of contact for establishing, organizing and directing the operations at the ACS.  This leader will relay pertinent information and updates to the Command Center and/or Incident Commander.

The staff working in the ACS will be identified by their Lander Regional Hospital badge and their additional role on a laminated card indicating their position during the disaster.  

The Human Resources department and the Alternate Care Leader will respond to aid in the establishment and staffing of the ACS.  The following is a list of the minimum of staff to establish a site in the IC center: 

1.The patient(s) will be directed into the Surgical Center for treatment and logged into the ACS.

2.The patient will be treated and documentation will be on the ACS forms obtained from the Alternate Care Leader upon setup.  That documentation will be sent to Medical Records after the patient has been discharged. 

3.If the patient begins to deteriorate and/or have conditions that are beyond the means of the ACS, the patient will be transported or evacuated out of the area to a facility such as a hospital.  

The following is a list of the minimum resources needed to establish an alternate care site in the ASC:  

1.Patients will be directed and/or transported to the Front entrance of ASC as a primary route and the Stair well exit by ICU into the Hospital as a secondary route. 

2.The Intake Tracker will enter the patients, as they arrive, on the HICS Disaster Victim Tracking Log. 

3.The patient(s) will be directed into the Preop area for treatment.

4.When the patient is called into the treatment area, the tracker for that area will use the HICS Disaster Victim Tracking Log to document the patient's arrival into the treatment area. 

1.Individuals designated as Trackers will document and maintain patient location information on the HICS Disaster Victim Tracking Log in their assigned areas.

2.The Intake Tracker and Discharge Tracker will update the list at thirty-minute intervals via Floor Runners to the Alternate Care Command Center (ACCC).

3.The ACCC will be located in the Lobby of the ASC and will:

Track building occupancy
Maintain a patient listing
Communicate with the Hospital Command Center

4.The updated list in the ACCC will be sent to the Hospital Command Center at thirty- minute intervals via fax or runners. 

5.The master Disaster Tracking Log for the alternate care site will be maintained in the Alternate Care Command Center. 

1.When the patient is discharged, the discharge tracker will update the HICS Disaster Victim Tracking Log. 

2.The discharge trackers in the treatment area will update the list at thirty-minute intervals via Floor Runners to the ACCC.

3.The patients will be discharged through the exit door of the treatment area and then transported/escorted out the exit.

1.Security will provide 1 to be positioned in the ACS. These individuals may or may not be from the Security department.  They may be serving in the capacity of an additional role under the Emergency Operations Plan. 

2.The security individual/s will ensure that the patients are not roaming the building or entering other areas of the ACS.