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Lander Regional Hospital Emergency Operations Plan
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The hospital shall maintain policies and procedures to guide all staff during occurrences that prevent the normal functioning of the hospital. These policies are maintained in the hospital Emergency Procedure Manual.

The Emergency Preparedness Program provides a guide to all hospital staff when the consequences of an internal or external event disrupt the hospitals ability to provide care and treatment.

Situations included in our emergency preparedness plan are:

Adverse Weather
Bomb Threat
Civil Disturbance
Disaster/Mass Casualty
Epidemic/Pandemic Mass casualties
Hazardous Material Spill
Helicopter Landings
Hospital Evacuation
Hostage Situations
Infant Abduction
Radiation Accident
Telephone Outage
Utility Failure

Specific plans for each are in the Emergency Management manual.

Training of employees will include general house orientation, annual Safety Inservice, and specific department training as necessary. There will be disaster drills. These will be followed by a review to identify problems for correction. All Department Managers will be asked to report on their department and these will be forwarded to the Management of Human Resources and Environment of Care Team. Fire Drills will be held in accordance with JCAHO requirements and NFPA Life Safety Code 101 (2000). Documentation will be maintained in the Maintenance Department and reported to the Management of Human Resources and Safety Committee.

Incident Commander: The Incident Commander will be the administrative person available or on-call or at the Hospital:

1. Chief Executive Officer
2. Chief Nursing Officer
3. Chief Financial Officer
4. Nursing Supervisor

The Incident Commander (IC) is responsible for the changes through transfers of command, this responsibility shifts with the title. The term Command refers jointly to both the person and the function. The IC may use one or more deputies to perform specific tasks, reduce the IC's span of control or work in a relief capacity.

The Emergency Room physician will be in charge of medical activities in the event of mass casualties. The Incident Commander will assist the ED physician, as necessary. (See Section VIII - Assignments, Medical Staff of the Disaster/Mass Casualty Policy).

1.A paging system is established at the hospital to facilitate reaching on call personnel.

2.In the event that the telephone facilities are not usable, due to the emergency, several types of radio and computer communication equipment are available locally.

3.   Runners will be available in case of total outage of communications in the facility. 

a.Radio contact with Fremont County EMS system is available in the ER, ICU and WHU
b.City police - 332-3131 or 911
c.Sheriffs office - 332-5611 or 911
d.EMS Emergency Coordinator - 332-3958 or 856-2374
e.Lander Fire department - 332-2209 or 911
f.National guard - 332-5579
g.Wyoming Highway Patrol - 332-3958 or 1-800-442-9090

Resource and Assets: 
Supplies are not available from Materiel Management, the emergency procurement distribution system shall be implemented.

1.The director of materiel Management will maintain an up to date call list of key personnel and vendors. When the Director is unavailable, the purchasing assistant will respond.   

2.Materiel Management personnel who have been notified of the disaster will report to the materiel Management department. Job assignment will be made by the person in charge

3.The Director of Materiel Management and or personnel will monitor key supply areas for supply usage. Unit supply carts maybe re-assigned to another area at the request of the nursing coordinator. Unit supply carts will be re-supplied as necessity dictates or supplies will be delivered to designated areas on a frequent basis.
4.The director of materiel Management with the coordinator will determine if the inventory of supplies is sufficient to handle the disaster. If necessary additional supplies shall be obtained from:

a.Riverton Memorial Hospital - Riverton, Wyoming - 857-3491 or 856-4161
b.Allegiance - Denver, Colorado - 1-800-964-5227 or 303-799-6868
c.McKesson - Denver, Colorado - 1-800-525-3000 or 415-983-8568 

5.The director of Materiel Management shall determine any alternate supply companies and the quickest method of delivery.

6.Materiel Management personnel or designated hospital personnel may be sent to obtain supplies. Materiel Management personnel will remain on duty until relieved or the disaster has been canceled.

7.Emergency diesel for the emergency generator will be the responsibility of the Director of Plant Operations. The DPO will maintain enough fuel to run the generator for 72 hours on site.

Utility Management: 
1.The hospital heating system is natural gas fired with the gas supplied by Kinder Morgan. In the event of a break in service, the hospital is equipped with an above ground storage with a minimum 1000 gallons of #1 diesel at all times. The fuel is supply for the boilers and the generator. There is a bottle of propane that supplies the pilot of the boilers.

2.In the event of an interrupted water supply the Director of Plant Operations will be notified of the interruption. In the event of absence of the Director the Senior Maintenance Mechanic shall be notified. The City of Lander shall be notified so they can work on problem and get a time line of how long the interruption will be.

3.Potable water will be supplied by Sweetwater Cistern Service 332-3167. Dietary will have bottled water available in the kitchen

4.In the event of extended period of time. Use of water will be minimal and bed side commodes will be used, waste will be double bagged and placed in bio-hazard containers. The use of sterilizers will discontinue and instruments will be transported to Riverton Memorial for sterilization. Surgeries shall halt.

Safety and Security:
1.Upon determination of emergency, all staff shall be called in.

2.Under the direction of the Incident Commander, the Safety Officer will provide crowd control of the outside area, allowing only emergency vehicles and hospital personnel to enter the area.

3.Other Maintenance/Security personnel will be posted at the intersection of Buena Vista Dr and Bishop Randall Dr. Others will be assigned as needed.

4.A locker located in ER will have supplies, i.e. flashlights, vests, yellow tape. Red tape.

5.Law enforcement agencies may be called for assistance.

Staff Responsibilities:   
First Administrator to arrive will assume IC and set up the Hospital Command Center in conference room #3.

1.Admitting department: Report to the Finance/Administration Section Chief in conference room 2. They will be responsible for filling out the outpatient sheets on all patients. Assign one or more employees to assume responsibility for maintaining information regarding the destination of patients.

2.Auxiliary Members: Report to the conference room2.

3.Chaplains: report to the conference room.

4.Chief Executive Officer: report to the Conference room 3, assume duties of  IC as required, and assign duties as needed for the emergency

5.Cardiology: report to the Cardiology Department.

6.Chief Nursing Officer: will assume IC in the absence of CEO, or CFO, or assume duties of the Medical/Technical Specialist, delegate responsibility for employee pool in conference room #1 ext. 6436. Advise person covering Emergency department radio to notify the PBX operator when patients begin arriving in the ER. The CNO will be responsible for assigning the following personnel:

a.One person to cardiology/Cath lab with DOA patients
b.Two people to help transfer patient from triage area
c.Designate one person to be assigned to the ER to act as a runner.
d.Designate one nursing coordinator to remain the in-house supervisor; another to triage the non-disaster patients presenting to the ER.

7.All departments shall contact the IC to give up dates of status.

8.Chief Financial Officer: will assume IC in absents of the CEO or CNO, or assume duties of Finance/Administration Section Chief and report to switchboard to help direct visitor and families to the dining room. He/she will also assign personnel not needed in the business office to the conference room pool.

9.Community Relations: will report to administration to receive, control, and inform the media.

10.Dietary: will maintain a supply of readily prepared foods and canned fruit juices which can be used in the event of water shortage and maintain food service in cafeteria. Offer coffee and beverages to family member in waiting rooms and responding personnel. Simple meals will be served to patients and personnel. Use disposable dishes and utensils will be used where possible. Procure supplies from outside in the event of depletion or contamination of in-house supply

11.Environmental Services: will report to conference room or dining room; assist in obtaining linens, and terminal cleaning of triage area as notified.

12.Human Resources: will report to conference room and help with

13.Laboratory: will assign two technologists to draw blood on Priority #1 and #2 patients. The physicians will be responsible for ordering specific test to be done. The orders are to be written on the back of the disaster tag attached to the patient. Assign two runners to take blood to the lab after drawing.

14.Linen Service: will put additional supplies of linen into circulation upon notification. Disposable linen may be put into place as linen supply decreases.

15.Maintenance Security: will call in additional staff. In the event of disrupted public service utilities, emergency utility services are to be put into operation IMMEDIATELY. Under the direction of the Nursing Coordinator the first maintenance worker will take charge of crowd control in the assigned area inside the building. The second Maintenance Security person to arrive will dispense the security vests, radios, and other equipment from the locker in ER and take charge of crowd control outside the building.

16.Materiel Management: will report to your department and stand by.

17.Off duty nursing personnel: will Report to conference room or to area assigned by the coordinator

18.OR staff: defer scheduled cases, if any, prepare, and stand by for surgical cased from triage.

19.Pharmacy: will report to your department and stand by.

20.Pine Ridge Staff: will report to conference room #1, unit manager will help CNO assign personnel to help with victims' family. Social workers and discharge planners, psychologists may be assigned victims as well as helping family members.

21.Radiology: will report to department

22.Respiratory: therapy will report to your department.

23.Safety Officer: Appointed by the IC, will report to the HCC and maintain a safe environment for the patients, staff, and family.

24.Social Services: will report to dinning room to assist with relatives of patients, assign psychologists to other areas as needed.

25.Sterile processing: will report to your department and stand by.

Patient clinical support activities:
All patients who can be discharged will be expedited to do so or provided with alternate placement. All elective surgery will be cancelled. Pine Ridge patients will be triage discharge or transfer as able.

ICU will be on divert.

If the possibility of an influx of patients, Public Health will be contacted and triage will be manned by Public    Health Nurses at the Community Center. Police will be contacted to provide assistance to prevent people from flooding the ER. 

ER MD will contact PHN to provide guidance of who should be transported to ER.

ER MD/ER Unit Manager will be certified as CERT personnel to have adequate disaster management skills.
Infection Control Nurse will monitor conditions and assess and provide feedback.

Public Health, State Health Department and Infectious Disease MD and staff will be contacted for feedback and recommendations.

Pine Ridge and/or Rehab areas will be utilized for staff members who will need to be housed, if they are needed to stay for an extended period of time.

Areas of the hospital may have air supplies isolated to prevent spread of possible contamination.

Standard Precaution will be maintained along with any additional precautions recommended by Public Health or Infectious Disease physicians.