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Evacuation Plan
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Patient relocation and evacuation is inherently dangerous to patients and staff and is to be undertaken only when conditions of the environment cannot support care, treatment, and/or services.  During emergencies, patients can relocate to adjacent compartments or other areas of safety.  If determined by the Incident Commander, patients evacuated from the building to an adjacent building or moved to an alternate care site(s) (See EOP Appendix I: Alternate Care Site Plan) for patient care and safety.

The Evacuation Plan describes the overall procedures followed by the Lander Regional Hospital staff in response to an emergency requiring the evacuation of patients, staff, and visitors, and their return to the facility after the emergency is resolved.  The evacuation in response to an emergency, from initiation to recovery, utilizes the Lander Regional Hospital Emergency Operations Plan.

B. Types & Levels of Evacuations

Horizontal Evacuation or Relocation
The actions taken to move patients from the immediate area of the emergency to an area of safety or an adjacent smoke compartment may generally on the same floor.  Staff in the area may implement relocation, if conditions are severe enough.

Vertical Evacuation
The actions taken to move patients from one floor of emergency to another floor for safety.  The Incident Commander or designee should only determine this type of relocation. 

Building Evacuation
This involves removal of all persons from a hospital building or large sections of a hospital and requires a plan for its implementation.  Evacuation should only be done by the Incident Commander and/or the Fire Department authority.  This would encompass moving all patients to an alternate care site(s).

Levels of Evacuations

Level 1 - The evacuation of a specific floor or wing to a designated location.  This can include both horizontally or vertically for the preservation of the patients and staff.  Horizontal evacuation will be to the area designated by the Nursing Coordinator.

Level 2 - The evacuation of a building or section of a building to an alternate care site as designated by the Incident Commander.  

Level 3 - The evacuation of the entire Lander Regional Hospital buildings or campus to other alternate care site(s) or locations as designated by the Incident Commander.  

C.  Initiation of Evacuation
The Incident Commander is administratively responsible for the Evacuation Plan, which is an Appendix to the Emergency Operations Plan.  The respective Department Heads will determine the appropriate procedures required to minimize the impact of the evacuation on their department and will communicate this information to the Hospital Command Center (HCC).

To facilitate an orderly initiation of the response to an emergency requiring an evacuation, the following steps are a guide: 

1.Information received by the Lander Regional Hospital concerning an external emergency facing the community, an internal emergency involving the function of the Hospital, or the treatment and care of patients are no longer sustainable by the facility that requires the evacuation of any portion of Lander Regional Hospital.  

2.This designated individual or group will evaluate the information concerning this event and determine if initiation of the Evacuation Plan is applicable.

3.The information evaluated includes issues such as, location of incident (internal or external) requiring an evacuation, the distance from the Lander Regional Hospital if an external event, the scope of the incident (single individual, mass casualty, or malicious attack), and weather conditions (seasonal and current).

4.If deemed necessary, the Incident Commander will initiate the Evacuation Plan, as part of the Emergency Operation Plan along with additional and the appropriate Emergency Response Plans that may apply.

D.  Implementation & Notification
Upon initiation of the Evacuation Plan, in conjunction with the Emergency Operations Plan, the Incident Commander will open the Hospital Command Center (HCC) for directing the evacuation for the Lander Regional Hospital, if not already established. 

1.The Incident Command Center staff report to the HCC, if not already available. 

2.Section Chiefs for Operations, Planning, Finance, and Logistics will report to their designated meeting place to receive further instructions.

3.The Incident Commander, or Liaison Officer, initiates communication with local emergency response groups as needed. 

4. The Director of Security deploys the Security Force to the appropriate location as designated in preparation for securing the facility (lockdown) if necessary.  

5.The Public Information Officer communicates to local Media the needed information concerning the evacuation.

Notification of Staff
During an evacuation, the Incident Commander will notify the Lander Regional Hospital Telecommunications Operator to alert the staff of the emergency involving an evacuation by announcing Code YELLOW, Evacuation is now in effect.

The staff are also notified through alternate announcements including Intranet messages and personal communication devices (pagers, walkie-talkie, or cellular telephones) as well as call lists. 

E.Routes, Exits, and Congregation Areas
The list of evacuation routes and exits are itemized for each building or area on Attachment I: Routes and Exits.  Once outside, there are several Congregation Areas that will be used based on the event requiring the evacuation.


A.Labor Pool Location
1.When a disaster code, Code _____ is announced on the paging system or telephone, appropriate personnel in the departments will report to their respective departments.  

2.If the staff member is not needed in the department, they will wait for direction from the Labor Pool Leader before responding to the Labor Pool. 

3.Once notified in need of labor, each staff member reporting to the Labor Pool will sign in and stand by for further instructions. 

4.The staff member will be assigned to a Department Leader at a designated location.

B.  Media Center Location
1.The Media Center will be located in Conference Room 1.  
2.The Public Information Officer will be responsible for setting up the room and conducting the distribution of information to the media.

C.  Perimeter around Staging Congregation Areas
With cooperative arrangement with the local law enforcement agencies, the Lander Regional Hospital Security Department will establish the perimeters around the Congregation Areas (Attachment II- Staging Areas).


A.Resources and Equipment for Evacuation of Patients
When patients' evacuation is occurring and the normal routes and methods can be used, then generally move patients on the normal equipment used for patient transportation. This would also pertain to usage of elevators, if the situation warrants. The following are some of the resources used in evacuation:

1.Wheelchairs: to move ambulatory patients and some non-ambulatory patients.  These are for normal transportation and staff are trained in their use.

2.Gurneys & Beds: to move non-ambulatory patients.  These are for normal transportation and staff are trained in their use.

3.Special Transportation Equipment: Some specialized transport equipment may be available for specific kinds of patients, and these may be utilized during relocations.  Where necessary, staff is trained about the specific practices needed for their use.  

4.Improvised Equipment: Improvised equipment should only be used when the equipment above has been otherwise depleted and/or situation warrants a quicker response.   In general, beds are not used to move patients, but in special circumstances, such as special care units, it may be less hazardous to the patient to move the entire bed.  In this case, availability of staff used to control the equipment, bed and patient is vital.    Blanket drags, multi-person carries, and baby aprons are not usually used for evacuation but more for relocation to another zone. They might be necessary in special circumstances only. 

B.  Additional Resources for Evacuation (non-patient)
During the evacuation, equipment will be needed to assist in the removal of patients.  This will include flashlight, spotlights and electrical cords, water stations, personnel protective equipment and other non-patient related equipment. (Attachment IV- Additional Non-pt Equipment)

C.  Procedures for using Evacuation Equipment
The staff in each department are trained on the procedures for using the special evacuation equipment that their patient population may utilize during an evacuation.  The procedures will be located in the departmental specific policy for 

D.  Assessment of Evacuation Equipment
The Emergency Management team will review the use of evacuation equipment periodically.  Drills will evaluate the appropriateness of the equipment and address the need for additional or different equipment.

E.  Communication Resources
The communication equipment used while in disaster status will be utilized during an evacuation. The Emergency Operations Plan has the information on the communication equipment systems used during disaster status. 

II.CONTINUITY of Care Resources

A.Medical Equipment for Evacuation of Patients
An assessment of the patient needs for continuity of care during evacuation will be conducted on each patient prior to removal from the floor.  A list of sample equipment for various patient types is in Attachment V. 

B.  Equipment and Procedures for Maintaining Patient Isolation
The Patient Medical Equipment (Attachment V: Patient Medical Equipment) also provides a list of equipment needed for the evacuation of patients under Protective Environment (PE) and Airborne Infectious Isolation (AII) isolation precautions. The procedure for evacuating isolation patients will also be overseen by an Infection Control Professional.

III.Patient Evacuation PROCEDURES

A.  Evacuation Procedures
The Command Staff will contact the local law enforcement, Fire Department, EMS, other emergency agencies, and receiving sites on the status of evacuation.  

1.Move all patients through horizontal exits, if practical (relocation).  Where necessary, move patients in and around stairwells and hold until evacuation can take place.  Never leave a patient unattended.

2.If patients cannot be moved via elevators within adjacent buildings, move them vertically using the secure and safe stairwells.  Patients that cannot walk are transported on special stretchers (Stair Stretchers, etc).  NEVER move patients in a stairwell on regular stretchers or gurneys.  Where no other method is available, use a two-person or three-person carry.

3.Patients should be moved in the same order as for relocation (i.e., ambulatory, non‑ambulatory, then surgical or special patients).

4.Ambulatory patients should be moved to the main lobby for moving them out of the building.  Non-ambulatory patients should be moved to close to the ambulance entrance for transportation via ambulance and van. Surgical or special patients will be moved to ambulance entrance.

5.Move patients with their medical records, medications and necessary medical equipment for sustainability. 

B.  General Priorities for Patient Relocation and Evacuation from the Hospital

A.Ambulatory patients will be moved, one-on-one or in small groups by the staff to the appropriate area.

B.Non-ambulatory patients, without attachments, will be moved next on wheelchairs or gurneys, if practical, and on ordinary chairs or using blanket drags, or multi‑staff lifts if necessary.  They will be moved to the adjacent zones or areas of refuge, and situated in rooms.

C.Critical or Special patients and those with monitoring and/or multiple IVs, active surgical patients, etc, are moved last when the maximum numbers of staff are available.  It will require gurneys, wheelchairs, or similar equipment, if available.  It may be necessary to move them to areas beyond the nearest area of refuge, to ensure they have the appropriate medical services warranted by their condition.

C.  Evacuation of Patient in Departments
Each department has a unit-specific Evacuation Plan.  In most cases, this is a brief listing of the evacuation elements, relocation destinations (primary and backup) and other key data.  Some department plans have more extensive details of how patients will be handled during an emergency, or response to special hazards contained in their areas.  These are found in the individual department manuals along with this Evacuation Plan.

D.  Patient Care Units
The nurse in charge will assume control in an emergency.  This nurse will ensure that all patient rooms are empty, doors are closed, and will check all automatic doors to ensure they have closed fully.  If relocation is occurring, the charge nurse will designate someone to gather the patients' records and medications, if necessary to ensure patient identification and care if patients need to be moved to another area.  Move patient records with the patients, if possible.

If fire or smoke is in a patient's room and is the cause of the evacuation, those patients are to be moved immediately.  The fire is reported as quickly as practical.  After all room doors are closed, patients are to be re-assured, giving special attention to the critically ill and apprehensive patients.  Other patients in immediate danger would be relocated to a safe area in an adjacent zone on the same floor.

Patients on oxygen may require some special attention.  Low flow oxygen patients may be moved without temporary oxygen tanks if necessary.  High flow patients / oxygen-dependent patients must have temporary oxygen portable tanks hooked up by Respiratory Therapy.  Oxygen should not be turned off at oxygen zone valves in an area until Nursing and Respiratory agree all patients are accounted for (not on the piped oxygen).  In addition, the regulator/flow meter/suction regulatory will also be taken with the patient. 


Tracking Patients During & After Evacuation
The procedures located in the Emergency Operations Plan for tracking patients will continue in the same form and method.  A Master Evacuation Tracking Form (HICS 255) will be maintained at all the exit points of the hospital where patients are being transported away from the facility.  Each of the forms will be given to the HCC once they are completed.  The Alternate Care Site Plan would be initiated once the patients are in route to their location.  

VII.  Confirmation of Room Evacuation

A.  Verification of Room Evacuation
Verification of evacuation from every room will be conducted by the charge nurse or lead of the staff in the department.  The rooms, offices and general spaces will verified to be empty of patients, visitors or staff and are identified with a large X on the closed door.

B.  Patient Care Units
The designated person(s) will make a final check of all rooms. Once the patient has been evacuated from the room, the door should be closed and an X should be placed on the door with a marker. This action will reduce property damage. The designated person should notify the Incident Commander in the Command Center when removal of patients, staff and visitors from the danger area has been accomplished. Arrangements will be made for the transfer of patients with means of transport to the designated areas.   

C.  Testing the Verification of Room Evacuation
The room verification plan will be tested during an emergency management exercises and/or fire drill.  The critique of the plan will be included in the drill report form and reviewed for improvements.  The exercise will include a post-it note or sticker for verification of simulated evacuation on the doors rather than placing an X. 

D.  Communication with Local Authorities
Once the command center has been notified that all patients, staff, and visitors have been evacuated from the area, the Incident Commander or designee will notify the local law enforcement or fire department that the areas have been evacuated

E.  Accounting for Staff, Visitors, & Non-employee
The department managers will be responsible for verifying that all their staff, visitors, and non-employees are evacuated from their area.  These individuals will proceed to the designated evacuation route and congregation area.

VIII.  Training Activities

Evacuation Training Activities
The training of staff on the evacuation procedures will be provided during orientation and departmental training sessions as well as during fire and disaster drills.  Once a year an evacuation drill be conducted either separate or in lieu of a disaster drill.  The drill will include the simulation of evacuated patients, tracking, forms, methods of evacuating with use of resources, verification of evacuation, alternate care site establishment and recovery. 
I:   Routes & Exits for Evacuation
II:  Staging Areas
III:  Patient Evacuation Equipment
IV:   Additional Non-Pt Equipment
V:  Patient Medical Equipment