Practice Name

Emergency Manager

Person or Designated Position

Single Point of Contact:

Person or Designated Position

BUSINESS CONTINUITY

PLAN

During an Emergency:

Expect normal routine to be disrupted for the duration of the emergency

If at work, stay at work until ALL CLEAR given or otherwise instructed

Restrict telephone use to essential communication only

The most senior staff member present at work shall assume control of the emergency response if the designated person is not available until a more senior staff member formally takes over

Business Continuity and Emergency Plan:

Organisation: Practice Name

Address:

______Telephone & Fax

______

E-mail Address

Date Plan Created:______

Plan Approved by: ______

Plan Review:

Date:______Approved By:______

______

______

______

______

______

We acknowledge the various DHB’s who have assisted in developing this template and to Pete Kara from Nelson Marlborough DHB for the use of the Red E logo.

TABLE OF CONTENTS

INTRODUCTIONp2

Section AREDUCTIONp3

A1Service/business risks

A1.1Environmental risk and hazards (see Appendix 3–Regional risks as identified.

A1.2Facility risks and hazards – example provided

A1.3Business risks and hazards– example provided

A2Service/business continuity

Section BREADINESSp11

B1Service description

B2

B2 Equipment essential to service delivery

B3Clinical supplies essential to service delivery

B4Utilities – information, dependency level and back up or contingency plan

B5External service dependencies

B6Contact lists:

B6.1Staff (includes expected travel time to facility)

B6.2Emergency response support agencies

B6.3Service providers

B6.4Utility providers

B7Staff training, education and exercises

B7.1Staff training template

Section CRESPONSEp17

C1General emergency response checklist
C2Action checklist for person activating the response

C3Guidelines for Staff

C3.1Service manager

C3.2 Information for staff on duty andstaff called back

Section DRECOVERYp23

D1Recovery Action Planning

Section E REFERENCES, RESOURCES & Templatesp24

E1Emergency planning references and resources

Appendix 1Template –Memorandum of Understanding

Appendix 2Template - Influenza Pandemic Plan – available at

Appendix 3Risk Assessment Tool

Appendix 4Template - Action Cards for Staff

Appendix 5 Staff Communication Tree

Appendix 6Staff Scenario Training Record

Introduction

In order to manage an emergency and mitigate its immediate and potential effects, healthcare facilities and services need to have pre-prepared and tested emergency response plans.

There are also a number of legal requirements incumbent on health care services with regard to emergency planning, including (but not limited to) the following:

NZ Public Health and Disability Act 2000,

The Health and Safety in Employment Act 1992, and

The National Civil Defence Emergency Management Act 2002 and Plan Order 2005.

This plan is intended as a guide to the systems and processes Practice NAMEwill use to prepare and respond to an emergency situation. It is intended that this plan be flexible enough to cater for a variety of situations and be based on known hazards and risks and available resources.

This plan needs to be coordinated with other local health services, the emergency services and relevant national plans. To assist with the planning process and exercising of plans, make contact with emergency planning advisors from yourDHB and Civil Defence

Practices should have arrangements in place to manage an increased demand for services i.e. the short term response to a single event affecting several people, or the longer term increase in demand due to an outbreak of infectious diseases.

These arrangements should include the ability to assess and prioritise several acute patients presenting at the same time, provide essential treatment and referral to other providers as needed.

Planning for health emergencies uses an ‘all-hazards’ approach across the four ’Rs’ of emergency management planning:

The Four ‘Rs’ of Emergency Management Planning
Reduction / Recognition of hazards and risks and mitigation to avoid or minimise the impact prior to the event
Readiness / Planning, establishing response systems, training, maintaining readiness to respond
Response / Mobilising and activating the Emergency Plan
Recovery / Actions to recover from the incident, including moving back to business/service as usual and reviewing and updating the emergency plan, based on what has been learnt from the incident

For simplicity we have included Mitigation, Reduction and Response activities in the same section.

A Risk Assessment tool is attached as Appendix 3.

Section AREDUCTION

In the context of emergency management planning, reduction activities are those that will reduce the health impact of emergencies or other events.

A1Service/Business Risks

A1.1Environmental risks and hazards

Low Med High
Hazard/Risk / Likelihood / Consequence/Impact / Mitigation, Reduction & Response Options
Located in flood prone area / May need to evacuate the building
Could be isolated until flooding subsides /
  • MOU with alternative location(see Appendix 1)
  • Local Civil Defence aware of risk and facility plan
  • Staff trained/updated regularly (seeB8)
  • Emergency supplies kept on site and rotated prior to expiry dates

Building structure affected by storm / Total or partial evacuation of building /
  • MOU as above if total evacuation needed
  • Decide if non affected areas of the building will allow business as usual to be conducted
  • Plan for operating with reduced staff numbers

Earthquake
Earthquake continued / Total or partial evacuation of building
Possible Mass Causality Incident
Staff and patients injured by falling furniture and equipment
Loss of access to main server.
Disruption to payroll and provider payments
Staff unable to get to work place
Patients unable to get to surgery. Loss of income
Ability to provide services impacted /
  • Adequate insurance to cover relocation costs and interruption to business.
  • Business Continuity Plan, read and practiced
  • Practice Evacuation Plan consistent with Fire Evacuation Plan
  • Alternative locations predetermined
  • Liaise with DHB & Civil Defence and participate in training exercises
  • Fit seismic restraints to furniture and equipment where required, especially filing cabinets, storage containers, tables, couches, computersand desks
  • Ensure that items are prevented from falling
  • Ensure remote access to server
  • Plan for multi tasking of staff so more than one staff member is familiar with essential processes
  • Ensure adequate back up and retrieval system for data
  • Suspend nonurgent services and devote greater resources to those services still functioning
  • Staff from other practices may be used if they are unable to get to their normal work place
  • Liaise with Civil Defence
  • Become part of assistance programme
  • Investigate possibility of combining with other practices in close proximity

Tsunami / Premises in danger of being flooded
Building isolation
Patients may be isolated
Staff may not be able to get to work
Essential supplies may be affected /
  • Identify whether your practice is within the expected tsunami inundation zone
  • Move quickly either 1km inland or 35 metres above sea level
  • Consider possibility of disruption to staffing levels and services
  • Advise Civil Defence/DHB of patients likely to require assistance
  • Suspendnonessential services
  • Liaise with DHB, PHO, Civil Defence and suppliers

A1.2Facility risks and hazards

Hazard/Risk / Likelihood / Consequence/Impact / Mitigation, Reduction & Response Options
Electricity outage / Impact on hot water, heating, and kitchen facilities
No Eftpos
Loss of PABX telephone system
Loss of fax
Unable to fax scripts.
No computer or
printer access
No Lighting /
  • Pre-identify critical resources that require electricity
  • Agreement with hire company to have preference for generator hire
  • Torches and batteries stored in reception
  • Battery lighting (30mins)
  • Equipment on UPS identified
  • Testing of UPS on regular basis.
  • Ensure supply of manual eftpos forms available and staff trained in their use
  • Ensure hard wired, analogue telephone available and staff trained in their use
  • Print off appointments first thing each morning and afternoon
  • Prepare a pack for each doctor and nurse thatcontains, templates for manual recording of patient information, script pads, ACC and radiology forms, carbon paper and any other forms considered necessary
  • Have a fully backed up laptop available, with software loaded to access/enter patients’details, and spare charged battery
  • Relocate closer to windows where possible
  • Ensure egress, corridors are clear to prevent accidents/injury to patients and staff
  • Utilise alternative light sources. Purchase or hire generator if possible.

Building structure damaged / Total or partial evacuation of building /
  • MOU as above if total evacuation needed
  • Decide if nonaffected areas of the building will allow business as usual to be conducted

Fire / May need to relocate
Equipment destroyed
Building (or part) destroyed
Total or partial evacuation of building /
  • MOU with alternative location
  • Ensure adequate insurance cover to replace building if owned by practice
  • Ensure adequate insurance cover to replace equipment
  • Ensure adequate fire extinguishers available, all staff aware of location and trained in use
  • Adequate insurance to cover relocation costs and interruption to business

Loss of Water Supply / No water for hand washing, toilets, cleaning /
  • Store a supply of water for use in an emergency
  • Activate water conservation measures and display appropriate signage for staff and patients
  • Access bottled water from supermarkets
  • Access hand washing gel

Loss of Sewage Service / Health and safety breaches /
  • Establish length of service interruption
  • Consider relocation if warranted
  • Arrange use of neighbouring toilet facilities
  • Supply on hand of strong plastic bags, ties, bleach and gloves
  • Limit number of operational toilets
  • Position appropriate signage advising situation for patients and staff

1.3Business risks and hazards

Hazard/Risk / Likelihood / Consequence/Impact / Mitigation, Reduction & Response Options
Inability to staff to required levels (eg due to pandemic influenza) / Unable to provide care to required standards or contracted levels /
  • Identify options ahead of time
  • Identify potential volunteers and service groups which might assist
  • Involve PHO in planning

Adverse Media Report / Lack of public confidence, reduced enrolled population, reduced cash flow /
  • Ensure only management release information to media. If necessary contact PHO or DHB for guidance

Unable to handle surge capacity / Staff fatigue resulting in mistakes occurring.
Patients become agitated at delays and lack of treatment /
  • Ensure staff breaks are taken
  • Call back part time staff
  • Advise PHO prior to reaching maximum capacity
  • Extend opening hours if able to staff effectively and stagger staff presence?
  • Communicate situation and solutions

Data Failure / Unable to access data including patient and financial records.
No access to internet /
  • Staff utilise manual documentation
  • Staff ensure backup processes completed and checked on a monthly basis
  • Ensure server is surge protected as a minimum precaution or UPS (uninterrupted power supply) is incorporated
  • Have a laptop available with software and able to run back up medium in case of relocation requirements in addition to server failure
  • Unable to access information for patient, for example:patient history, medication, alerts
  • Unable to invoice

Recommendation:

Contact your contracted IT supplier to find out the following,

  1. How long will it take to replace, enter our back up data, test and fit a new server to our practice? ……………days.
  2. How long will it take to replace the computer hardware (workstations ) in our practice?...... days.

This information is useful as it means that you can calculate the quantity of paper based forms etc you need to be able to function over the period of replacement

Loss of a business partner / Increased workload, especially for a smaller practice
Reduction in revenue but not fixed costs
Stress on remaining staff
Business viability at risk /
  • All partners have adequate insurance cover and a predetermined exit strategy to cover such an eventuality

Unable to obtain Personal Protective Equipment (PPE) / Staff/patients exposed to infection /
  • Always maintain sufficient PPE for staff and patient use for 5-7 days
  • Arrange with suppliers to respond to sudden increase in use to ensure replacement at short notice
  • Arrange with DHB for access to and delivery of supplies in an emergency

Loss of Communications / No:
Internet
Eftpos
Telephone
Fax
Access to web based information /
  • Ensure supply of manual eftpos forms available
  • Ensure analogue style telephone available to allow limited communications

A2Service/Business Continuity

Name will take all possible steps to maintain service delivery or restore essential services as rapidly as possible following an event. This includes arrangements for (as appropriate):

  • moving to temporary facilities
  • includes pre-organised agreements (eg MOU’s – see Appendix 1)
  • acquisition of emergency supplies
  • includes arrangements with usual suppliers
  • protection of clinical records, personal information, data
  • includes offsite backup of critical data at regular intervals
  • continuation of payroll services
  • sprinkler systems, intruderand smoke alarms
  • protection of medical and business equipment
  • includes identifying/using Uninterrupted Power Supply (UPS), surge protectors, etc
  • ensure all serial numbers, dates of purchase, costs and maintenance agreements are listed for insurance purposes

Plus:

  • determining the length of time the service can operate on emergency power; if available
  • ensuring staff are aware of emergency procedures and are regularly updated – see B8.1 – staff training, education and exercises. This may include:
  • emergency management planning as part of new staff orientation/induction;
  • use of PPE (location,when and how to use it, how to test it, etc);
  • emergency management exercises – table top, simulated and actual event;
  • fire drills.
  • maintaining an up-to-date contact list for local emergency services, Civil Defence

officer and other support services available to assist in an emergency – see B7.2;

  • testing systems (eg generator/battery testing, UPS checks, smoke alarms, etc) regularly.


Section BREADINESS

Readiness activities are those taken to ensure a state of readiness for health emergencies.

B1Service Description

Providing General Practitioner services to the community of
Number of staff:
Doctors / Nurses / Admin/management/support staff
Location/building information
Location of Hazard Register
Relocation Site Preferences
Two alternative sites if the service has to relocate; including one location outside your immediate area:
1.
2.
Memorandum of Understanding (MOU) in place for the above two alternative sites? Yes No 
If yes:
(See Appendix 1 – MOU template)
Name of Service: Name, address and key contact details. / MOU covers: Details of services to be provided.

1

B2 Equipment Essential to Service Delivery
Essential Equipment Name / Current Location / Mobile or Fixed?
(include any moving instructions) / Back up equipment available at alternate locations? Where? / Name and contact details of supplier. Include account numbers

1

B3 Clinical Supplies Essential to Service Delivery
Item Name/Description / Amount Required / Name and contact details of supplier. Include account numbers

1

B6CONTACT LISTS

B6.1STAFF

NAME / POSITION / ADDRESS / EXPECTED TRAVEL TIME TO FACILITY
(for emergency call back purposes) / PHONE / MOBILE / RESPONSE
(coming in; unable to come in; not home; message left)

B6.2 EMERGENCY RESPONSE SUPPORT AGENCIES

Support Agency / Name and Address / Phone / Mobile
Ambulance (non emergency)
Civil Defence
DHB
Fire (non-emergency)
Hospital
Police (non-emergency)
Public Health Officer
Red Cross
PHO
Other

B6.3SERVICE PROVIDERS

Service Provider / Details / Phone / Mobile
Computer Maintenance
Network Backup
Fire Equipment maintenance
Insurance company
Internet service provider
Security provider
Clinical Equipment provider
Pharmaceutical provider
Bank & Account Numbers
Cleaner
Elevator Company
Hire Company Portaloos/Generator / Contact Person
Add others where necessary. / The more information entered the greater your capacity for response.

B6.4UTILITY PROVIDERS

Utility / Provider Details / Contact Name / Phone / Mobile
AIR CONDITIONING / REFRIGERATION
DISTRICT / CITY COUNCIL
ELECTRICITY SUPPLIER / Main switchboard located:
ELECTRICAL COMPANY
TELEPHONES
WATER / Turncock situated:
PLUMBER
GAS
Add others where necessary. / The more information entered the greater your capacity for response.

B7STAFF TRAINING, EDUCATION AND EXERCISES

This section should:

  • Outline how staff are orientated to emergency management procedures at the start of employment;
  • Outline the programme for regular (annual) updates and refreshers
  • Identify the programme for exercising all, or aspects of, the plan on an annual basis;
  • Identify any other relevant emergency management planning activities, eg DHB emergency planning workshops.

B7.1STAFF TRAINING TEMPLATE

Training / Activity / When / Provider / Invites
Staff induction /
  • Orientation / educate staffin emergency preparedness, procedures and plan
  • Orientate / educate staff to Personal Protective Equipment (PPE) and the resources held on site.
  • Orientate staff to the location of water and gas mains, fuse boxes, etc
/ On commencing employment / Facility Manager / All staff
Staff training /
  • First aid
  • Identification of hazards
  • Evacuation exercise
  • Natural hazards
  • Regular refresher training/updates
  • Attend workshops on emergency planning

Staff participation in emergency exercises (table top; simulated; actual) /
  • Example of emergency exercise undertaken
  • Document outcomes and improvements required and plan to achieve these
  • Review of lessons learned and any procedural changes advised to staff
  • Update staff training records.

Review / update the Service’s emergency management plan /
  • Review Date:
  • Person responsible:

Other relevant emergency planning activities undertaken /
  • Attendance at Civil Defence/DHB emergency planning workshops

Other training: /
  • Attendance at stakeholder meeting

1

Section CRESPONSE

C1GENERAL EMERGENCY RESPONSE CHECKLIST

Take all necessary action to maintain safety and protect patients, staff and visitors

DATE:

TIME:

DETAILS OF PERSON ACTIVATING THE RESPONSE:

Call 111 if life/safety may be compromised

Assess situation and decide course of action. Use action checklist for person activating the response (C2 -next page).

If required:

Activate the emergency plan;

Evacuate the facility using the site/service evacuation plan;

Assess the availability of staff and determine if you can continue to provide a service. Activate service/business continuity plan; this may include relocating services off-site.

In a community emergency, provide support to a community response as able.

Following the immediate response:

 If necessary conduct a damage assessment of the building, including supplies and utilities. Note that a Building Inspector has to give permission to re-enter a damaged/affected building after an incident.