Emergency Preparedness Procedures

► Objectives

  1. Discuss the critical elements of an emergency plan for response to a natural disaster or other emergency.
  2. Identify emergency preparedness plans in your community.
  3. Discuss potential roles of the medical assistant in emergency preparedness.

Emergency Preparedness

The term emergency preparedness is defined as preparing for potential disasters, including infectious, occupational, environmental, or terrorist threats. Emergency preparedness may also be referred to as disaster preparedness, emergency management or disaster management. The types of emergencies that affect specific groups—individuals, businesses, or communities—will vary according to different variables. Location can be a big variable whether or not a group is more prone to a specific type of emergency. For example, communitiesnear oceans are more prone to hurricanes, while communities near fault lines are prone to earthquakes.

Disasters can occur at the local, state, national or global levels. The following general description for national emergency preparedness is from the Centers for Disease Control and Prevention (CDC) website:

National emergency preparedness requires a coordinated effort involving every level of government as well as the private sector, non-governmental organizations, and individual citizens. CDC’s work in preparedness supports the Department of Homeland Security, which has overall authority for emergency response activities as laid out in the National Response Framework Document.[1]

According to the CDC, there are two types of preparedness, public health preparedness and medical preparedness:

  • “Public preparedness is the ability of the public health system, community, and individuals to prevent, protect against, quickly respond to, and recover from health emergencies, particularly those in which scale, timing, or unpredictability threatens to overwhelm routine capabilities.
  • Medical preparedness is the ability of the health care system to prevent, protect against, quickly respond to, and recover from health emergencies, particularly those whose scale, timing, or unpredictability threatens to overwhelm routine capabilities.” (

Medical assistants are able to participate in both types of preparedness because of their dual roles as individuals in the community and as practitioners in the healthcare setting.

Emergency Preparedness Plan

There are three parts to an emergency preparedness program—planning, responding, and reporting. Each business should have an Emergency Director or Safety Directorwho will oversee and direct an emergency preparedness team. In large businesses with multiple departments, each department will need an emergency coordinator who will help develop specific plans for particular department and implement the plan during an emergency. Emergency preparedness committees may include two teams, an emergency response team and an emergency recovery team:

  • Members of the emergency response team should be formally trained in disaster response, be able to assist with evacuation procedures and have formal training in CPR and First Aid Procedures.
  • Members of the emergency recovery team should be formally trained in disaster search and rescue efforts. These team members will provide assistance both during and following a disaster until formal help arrives.

In smaller healthcare centers, personnel may be responsible for both response and recovery efforts. An emergency hotline should be implemented which can give recorded messages to staff members during an emergency. This line should be publicized to promote access to all staff members.

Before Designing an Emergency Preparedness Plan

Emergency preparedness members should create and maintain a list of community resources and phone numbers for emergency preparedness, including:

  • Police department
  • Local Emergency Management and Homeland Security office
  • Red Cross
  • Hospitals in the area
  • Electric company
  • Gas company

There should also be a master contact list of personnel to contact in the event of an emergency. An example is shown in Figure 1.

MAPLE GROVE FAMILY PRACTICE
EMERGENCY KEY PERSONNEL CONTACT LIST
Operator or supervisor should contact the following personnel members in the event of a disaster:
Personnel / Cell Phone/Pager Number
1. Emergency Director: / ( ) -
2. Emergency Coordinator: / ( ) -
3. ERT Member: / ( ) -
4. ERT Member: / ( ) -
5. ERC Member: / ( ) -
6. ERC Member: / ( ) -
7. Head Physician: / ( ) -
8. Medical Director: / ( ) -
9. Clinical Supervisor: / ( ) -
10. IT Director: / ( ) -
11. Plant Director: / ( ) -

Legend:

ERT Member—Emergency Response Team Member

ERC Member—Emergency Recovery Team Member

Figure 1: Example of an Emergency Key Personnel Contact List

Prior to designing an emergency preparedness plan, members of the emergency preparedness team should contact the local office of the Federal Emergency Management Agency (FEMA) to obtain materials that will assist in the plan’s creation. Helpful questions to ask the local FEMA office include:

  • What types of disasters should we prepare for?
  • How will be warned in the event of an emergency?
  • What are the evacuation routes out of the city?
  • What is our responsibility in assisting elderly or disabled persons during an emergency?
  • Where can we obtain an Emergency Preparedness Plan Template?
  • How can we obtain disaster training for our employees?
  • How can we assist your office in the event of a community disaster?

Many of these questions can be answered on the website of your local Emergency Management and Homeland Security office. Anything that cannot be answered through the website should be directed to a FEMA representative. Committee members should also check with the employer regarding specific emergencies that apply directly to the workplace.

Next, the team will need to identify specific personnel that will take on the function of the emergency director, emergency coordinators (If applicable) and those employees who will be on the emergency response and emergency recovery team.

Performing a Risk Analysis

Emergency preparedness personnel should conduct a risk analysis after gathering information from local authorities and business leaders within the organization. The form in Figure 2 is an example of a risk analysis form that can be used to identify and address risks common to a specific organization.

Disaster Risk Analysis Form

Potential Risk Associated with Each Category

HAZARD / Low / Moderate / High
Natural Disasters
Fire
Tornado
Earthquake
Flooding
Blizzard
Outbreak/Epidemic
Industrial Accidents
Chemical
Hazmat
Utility/Resource Disaster
Loss of Power/Electrical/Generator
Communication/Telephone Failure
IT Failure
Mass Casualty Accidents
Gunman/Hostage Situation
Terrorist
Weapons of Mass Destruction
Chemical Weapons
Biological Weapons
Explosives/Bomb Threat

Figure 2: Example of a Disaster Risk Analysis Form

Evacuation Management Plan

Because many disasters require some form of evacuation, a plan should be in place that describes when evacuation is necessary and the process for evacuating in different types of emergencies. Each employee should know his or her specific role during evacuation procedures. Most employees will simply evacuate the building by following an emergency egress plan; however, some employees will have additional responsibilities, such as assisting patients or disabled workers with evacuation. The plan should also identify individuals that will need special assistance during evacuation procedures due to disability.

Emergency Egress Plans

Emergency egress plans are maps or drawings that illustrate exit routes that should be taken during an emergency. These should be posted throughout the building. Employees should be properly trained in how to evacuate a building and should receive additional training when the plan changes. Each business should identify an Emergency Assembly Area (EAA)—an area that employees should report to once safely out of the building.

Exit Routes

An exit route, as defined by the Occupational Safety and Health Administration (OSHA), is a continuous and unobstructed path of exit travel from any point within a workplace to a place of safety. An exit route consists of three parts:

  1. Exit access: portion of an exit route that leads to an exit.
  2. Exit: portion of an exit route that is generally separated from other areas to provide a protected way of travel to the exit discharge.
  3. Exit discharge: part of the exit route that leads directly outside or to a street, walkway, refuge area, public way, or open space with access to the outside.

Exit routes must be entirely open and free of obstruction. These routes should not lead to high hazard areas unless there are suitable partitions or other physical barriers to shield individuals from danger. Exit signs must be well-lit and properly working at all times.

Persons with Disability

Individuals who may have problems escaping during an emergency should have a Personal Emergency Evacuation Plan (PEEP). These individuals include those who are temporarily disabled (pregnant or injured) and those who are permanently disabled. Permanently disabled individuals may include any of the following:

  • Sight impaired
  • Hearing impaired
  • Physically impaired (ambulatory problems)
  • Individuals with cognitive problems

Plans should also include how to handle patients or other visitors that are in the building during an emergency.

Evacuating the Building

The following are guidelines for safely evacuating a building:

  • Stop what you are doing, avoid panicking, and remain calm.
  • If it is safe to do so, gather your personal belongings (purse, prescription medications, etc.)
  • Gather employee rosters and appointment lists that can identify individuals in the building at the time the emergency occurred.
  • If it is safe to do so, close your office door and window, but do not lock them.
  • If you are responsible for assisting patients or disabled workers with evacuation, and it is safe to do so, proceed with those responsibilities.
  • Advance to the nearest exit on the emergency egress map in your area; do not use the elevator.
  • Proceed to the designated Emergency Assembly Area (EAA) and report to the person responsible for taking roll.
  • Wait for any instructions from emergency responders.
  • Do not re-enter the building or work area until you have been instructed to do so by the emergency responders.

Shelter-In-Place

Shelter-in-place is the process of moving vertically or horizontally to the safest area in the building, based on the type of emergency encountered. Types of emergencies which may require shelter-in-place include chemical spills or adverse weather conditions such as tornados. Sometimes shelter-in-place is also necessary during hostage situations or other violent emergencies.

Shelter-In-Place Supplies and Equipment

All departments should have shelter-in-place supplies and equipment in the event individuals must stay in the building over a prolonged period of time. At the minimum, each departmental kit should contain the following:

  • First aid kit
  • Laboratory spill kits
  • Flashlights/batteries and approved power strips and cords
  • Potable water (bottled water)
  • Portable AM/FM radio with batteries
  • Packaged emergency rations of nonperishable food (enough for everyone in the department for three days) and a non-electric can opener
  • Blankets or sleeping bags
  • Whistle
  • Moist towelettes
  • Filter masks (enough for everyone in the department)
  • Trash bags and extra ties
  • Rolls of plastic and duct tape
  • Two-way radios
  • List of emergency numbers
  • Employee rosters

Individual employees should have their own shelter-in-place kits in the event they are unable to leave their immediate surroundings or must provide personal items that are unavailable in departmental kits. Personal kits should include as many of the items listed above as well as other personal items such as a spare toothbrush and toothpaste, prescription medicine, extra pair of glasses, change of clothes and shoes and personal emergency contact information.

Each individual should also keep a shelter-in-place kit at home as well. It should contain all applicable items above as well as an extra set of car keys, cash, and important documents such as insurance policies, deeds to the house, etc.

CBRNE Shelter-In-Place

It is common to associate acts of terrorism with some type of explosive, but acts of terrorism can be in other forms as well. CBRNE is an acronym that refers to an event that involves chemicals, biologicals, radiologicals,nuclear devices, or explosives. These substances may be released intentionally as in acts of terrorism or accidentally. When an event does occur, you should know how to react. The Department of Homeland Security recommends following the guidelines below an event occurs.

CRBNE event at home:

  • Close and lock all windows and exterior doors.
  • If you are told there is danger of explosion, close the window shades, blinds, or curtains.
  • Turn off all fans, heating and air conditioning systems.
  • Close the fireplace damper.
  • Get your family disaster supplies kit, and make sure the radio is working.
  • Go to an interior room without windows that’s above ground level. In the case of a chemical threat, an above-ground location is preferable because some chemicals are heavier than air, and may seep into basements even if the windows are closed.
  • Bring your pets with you, and be sure to bring additional food and water supplies for them.
  • It is ideal to have a hard-wired telephone in the room you select. Call your emergency contact and have the phone available if you need to report a life-threatening condition. Cellular telephone equipment may be overwhelmed or damaged during an emergency.
  • Use duct tape and plastic sheeting (heavier than food wrap) to seal all cracks around the door and any vents into the room.
  • Keep listening to your radio or television until you are told all is safe or you are told to evacuate. Local officials may call for evacuation in specific areas at greatest risk in your community.

CRBNE event in the workplace:

  • Close the business.
  • Bring everyone into the room(s). Shut and lock the door(s).
  • If there are customers, clients, or visitors in the building, provide for their safety by asking them to stay – not leave. When authorities provide directions to shelter-in-place, they want everyone to take those steps now, where they are, and not drive or walk outdoors.
  • Unless there is an imminent threat, ask employees, customers, clients, and visitors to call their emergency contact to let them know where they are and that they are safe.
  • Turn on call-forwarding or alternative telephone answering systems or services. If the business has voice mail or an automated attendant, change the recording to indicate that the business is closed, and that staff and visitors are remaining in the building until authorities advise it is safe to leave.
  • Close and lock all windows, exterior doors, and any other openings to the outside.
  • If you are told there is danger of explosion, close the window shades, blinds, or curtains.
  • Have employees familiar with your building’s mechanical systems turn off all fans, heating and air conditioning systems. Some systems automatically provide for exchange of inside air with outside air – these systems, in particular, need to be turned off, sealed, or disabled.
  • Gather essential disaster supplies, such as nonperishable food, bottled water, battery-powered radios, first aid supplies, flashlights, batteries, duct tape, plastic sheeting, and plastic garbage bags.
  • Select interior room(s) above the ground floor, with the fewest windows or vents. The room(s) should have adequate space for everyone to be able to sit in. Avoid overcrowding by selecting several rooms if necessary. Large storage closets, utility rooms, pantries, copy and conference rooms without exterior windows will work well. Avoid selecting a room with mechanical equipment like ventilation blowers or pipes, because this equipment may not be able to be sealed from the outdoors.
  • It is ideal to have a hard-wired telephone in the room(s) you select. Call emergency contacts and have the phone available if you need to report a life-threatening condition. Cellular telephone equipment may be overwhelmed or damaged during an emergency.
  • Use duct tape and plastic sheeting (heavier than food wrap) to seal all cracks around the door(s) and any vents into the room.
  • Write down the names of everyone in the room, and call your business’ designated emergency contact to report who is in the room with you, and their affiliation with your business (employee, visitor, client, customer.)
  • Keep listening to the radio or television until you are told all is safe or you are told to evacuate. Local officials may call for evacuation in specific areas at greatest risk in your community.

Types of Action Plans

Each business should have an action plan for potential disasters in the workplace. The following plans are examples of generic action plans that can be used in specific types of emergencies.

Action Plan for Fire

In the event an employee spots a fire, the following procedures should be performed (the “RACE” mnemonic).

R / Rescue /
  • Remove all patients and visitors that are in immediate danger.

A / Alarm /
  • Activate the nearest fire alarm pull box. (This may be done simultaneously while removing patients and visitors. This will also automatically notify the fire department.)
  • Notify all personnel in the area of the fire.

C / Contain /
  • Isolate the fire
  • Close all doors and windows starting with those closest to the fire.Note: Never open a door or window in the fire area once it has been closed.

E / Extinguish/Evacuate /
  • Only extinguish the fire if it is contained and manageable.
  • Use the PASS mnemonic when operating a fire extinguisher:
  • Pull the pin (with the nozzle pointing away from you)
  • Aim low (at the base of the fire)
  • Squeeze the trigger with a slow, even motion
  • Sweep the nozzle side to side across the area
  • Never turn your back on the fire. If fire becomes unmanageable, back out of the area and exit the building immediately.
  • When fire personnel arrive, allow them to take over.

Evacuation and Reporting for all Remaining Personnel: When employees hear the alarm, immediately exit the building following the emergency egress map, unless assisting with evacuation efforts. If it is safe to do so, employees should close windows and doors and shut off gas jets while proceeding to the designated evacuation area.Front office personnel should take a paper appointment schedule with them as they exit the building. All employees should assist with the evacuation of patients and handicapped workers on their way out of the building. Staff members should report to their supervisor once safely out of the building. Department supervisors should notify the firefighters of any unaccounted employees or patients. All employees should remain outside until the emergency director states that it is safe to return to the building.