September 15, 2009

Disaster Preparedness Plan for St. Luke’s Eye Care & Laser Center

1715 N. Weber Street, Suite 360, Colorado Springs, CO 80907

Prepared by Frankie Gales, LPN

I.  Structure for planning and decision making

A.   The Disaster Preparedness Incident Commander is Sandra M. Robben- Weber, Administrator, home phone number ____________, cell phone number __________.

B.   The Disaster Preparedness Liaison is Sandra M. Robben- Weber, Administrator, home phone number ____________, cell phone number ___________.

C.   Members of the Disaster/ Emergency  Preparedness planning committee include the following:

1.  Blake Simmons, Optometrist, home phone number ____________.

2.  Brad Lovelace, Back Office Manager, home phone number ___________.

3.  Gaby Estrada, Front Office Manager, home phone number _____________.

4.  Jennifer Mabee, Satellite Manager, home phone number _______________.

5.  Jamie Sanderson, Surgery Scheduler, home phone number _______________.

D.   A point of contact for questions/consultation on the disaster preparedness plan is Frankie Gales, LPN, home phone number __________________.

II. Development of a written disaster preparedness plan

A.   The Medical Clinic Emergency Operations Template provided by the El Paso County Medical Society (EPCMS) has been used to develop and maintain an emergency management program to guide our response to all emergencies, regardless of cause.

B.   Copies of relevant sections of the Department of Health and Human Services Pandemic Influenza Plan have bee obtained from www.hhs.gov/pandemicflu/plan.  Copies of available state pandemic plans have been obtained.  See enclosed CDPHE Internal Emergency Response Implementation Plan Appendix 1, Pandemic Influenza, Annex U: Disease Outbreak, Attachment 1, Attachment 2, Attachment 5a, Attachment 6b, Attachment 7, and The Colorado Medical Society “Progress Report on Physician Disaster/Pandemic Influenza Preparedness and Response Initiative.”

C.   A written plan has been completed.  The plan describes the organizational structure of St. Luke’s Eye Care and Laser Center that will be used to operationalize the plan.

D.   The plan incorporates and compliments the community response plan.

III. Plan for surveillance and detection of predicted disasters

A.  Responsibility has been assigned to Sandra Robben-Weber to monitor disaster advisories (federal and state) and inform members of the disaster preparedness planning committee and/or the disaster preparedness commander when a disaster is nearing the geographic area (e.g. state and/or city).

B.  The purpose of the St. Luke’s Eye Care and Laser Center Emergency Operations Plan (EOP) is to establish a basic emergency program to provide a timely, integrated, and coordinated response to the wide range of natural and man made events that may disrupt normal operations and require preplanned response to internal and external disasters. The Emergency Operations Plan is an “all-hazards” plan that will guide St. Luke’s Eye Care and Laser Center response to any type of a disaster or emergency.

C.  The objectives of the emergency management program include:

1.     protecting patients, visitors, and staff safety

2.     providing prompt and efficient medical care

3.     establishing a clear chain of command

4.     maintaining and restoring essential services as quickly as possible

5.     protecting clinic property, facilities, and equipment

D.   Local vs. Widespread Emergencies

1.     Local emergencies are disasters with effects limited to a relatively small area. In local emergencies, other health facilities and resources will be relatively unaffected and remain viable options for sending assistance or receiving patients from the disaster area.

2.     An External Disaster is an event that occurs in the community.  Examples include earthquakes, floods, fires, hazardous materials releases or terrorist events.  An external disaster may directly impact the clinic facility and its ability to operate.

3.     In widespread emergencies, nearby medical resources are likely to be impacted and therefore less likely to be able to offer assistance to the clinic.  Hospitals may also have a higher response priority than clinics for re-supply and other response assistance.

IV. Disaster Preparedness Policy

A.  St. Luke’s Eye Care and Laser Center has established an Emergency Preparedness Committee (EPC) with the authority to energize necessary preparedness action and to develop / update emergency plans and procedures.  As a result of the EPC, St. Luke’s Eye Care and Laser Center will be prepared to respond to a natural or man-made emergency in a manner that protects its patients, visitors, and staff, and that is coordinated with a community-wide response to a large-scale disaster.

B.  All employees will know and be prepared to be part of a team to provide the best possible emergency care in any situation.  Each supervisor at each level of the organization will ensure that employees are aware of their responsibilities.  Clinical personnel will cooperate fully with Emergency Medical Services and law enforcement personnel when they respond to emergencies at the clinic.  This may include providing information about the location of hazardous materials or following instructions to evacuate and close the clinic.

C.  The St. Luke’s Eye Care and Laser Center will work in close coordination with the El Paso and Teller counties’ Public Health Emergency Operations Center and other local emergency officials, agencies and health care providers to ensure a community-wide coordinated response to disasters. 

D.  St. Luke’s Eye Care and Laser Center has identified the Office Manager’s office as the Command Post for an emergency responder command and coordinating center.

E.  Insurance Coverage.  St. Luke’s Eye Care and Laser Center will review insurance coverage for relocation, loss of data, supplies and equipment, and structural and nonstructural damage to the facility, as well as coverage for floods or earthquakes.

1.  The following information is kept off site in a fire proof cabinet by Robben- Weber, office manager and Shan Ozbun, Accounts payable.

a. Property insurance

b. Liability insurance

c. Business interruption insurance

d. Life, Disability, and Workers compensation policies.

    2.  The information about St. Luke’s Eye Care and Laser Center includes:

a. Agent’s name, address, phone number, email address

b. Type of insurance

c. Policy number

d. Deductible

e. Policy limits

f. Coverage

  F.  Backup systems 

  1. St. Luke’s Eye Care and Laser Center uses Rain Technologies to manage the computer system.  Everything to include payroll, patient information, medical records, and billing is backed up electronically off site and we are able to access it from anywhere.  Passwords and access information are managed by Sandra Robben- Weber, office manager and Shan Ozbun, Accounts payable.  The network architect is Andrew Jahnke.

a. Business phone number ____________

 b. Mobile Phone number _____________

 c. E-mail address: ___________________

2.   If the building were destroyed and damaged to make it unusable our mail will be sent to ____________________________________________________________.

3.  A list of inventory of equipment and other assets is kept on file in a fire proof cabinet off-site managed by Sandra Robben- Weber, office manager and Shan Ozbun, Accounts payable.

V.  Communication plan

Under the county and city’s Emergency Operations Plan, there will be a Medical and Health Branch Director which will direct the medical response when needed.  The Medical and Health Branch Director will operate Emergency Support Function #8 which includes public health, mental health, and environmental health. Dependent upon the type of emergency or disaster, such as an infectious disease outbreak or an earthquake, this operative section may perform a joint lead or supportive role.

A.  Command Structure

In order to coordinate with the County Emergency Response system, St. Luke’s Eye Care and Laser Center   has adopted the Incident Command Structure (ICS) as the management structure to be used in an emergency.

St. Luke’s Eye Care and Laser Center Incident

B.  The following roles will be filled by the listed persons:

1.  Incident Commander: Sandra Robben-Weber

2.  Incident Commander (backup): Brad Lovelace

3.  Liaison: Sandra Robben-Weber

4.  Liaison (backup): Brad Lovelace

C.  Under ICS, the clinic’s overall response is directed by an Incident Commander.  The Liaison officer is responsible for coordination with other agencies and with County Incident Command.

D.  See Appendix A for EOC Phone numbers for El Paso County.

E.  See Appendix B for Key public health points of contact for pandemic influenza.

F.  Initial Communications and Notifications

1.  Staff Call List.  The clinic has an internal contact list that includes the following information for all staff: name, position title, home phone, cell phone, pager numbers, and preferred method of contact during off hours.  [See Appendix D.]

a. The Staff Call List contains sensitive contact information and should be treated confidentially.)

b. The list of staff phone numbers is kept offsite as well as onsite by Office Manager, Sandra Robben- Weber; Back office manager, Brad Lovelace, Satellite manager, Jennifer Mabee, Front office manager, Gaby Estrada, Optometrist, Blake Simmons, Surgery Scheduler, Jamie Sanderson, and Accounts Payable, Shan Ozbun. 

2.  The clinic has compiled a list of communication equipment available for use in an emergency.  These include: fax, pagers, cell phone, internet/Email, public pay phones, and voice messaging. (See Appendix D).

3.  A working television and battery-operated radio in the waiting area in order to remain up-to-date on official government announcements and other information during a disaster.   County and city law enforcement channels: Radio: _______ and Television: Channel 13.

4.  Internet access:  http://www.cdphe.state.co.us/epr/han.html – CDC’s Health Alert Network through the Colorado Department of Public Health and Environment.

G.  External Notification.   St. Luke’s Eye Care and Laser Center has an external contact list of phone/fax numbers and/or e-contact information of emergency response agencies, key vendors, stakeholders, insurance companies, and resources. This information is kept off site in a fire proof cabinet by Robben- Weber, office manager and Shan Ozbun, Accounts payable. See Appendix A and B.

VI. Education and training plan

Sandra Robben-Weber has been designated to provide and education and training program to ensure that all personnel understand the implications of, and control measures for, pandemic influenza and disaster preparedness.

A.  Record of attendance at education and training programs will be maintained and stored in the OSHA training record book under the heading “Pan Flu” and “Disaster Preparedness.”

B.  Current and potential opportunities for long-distance (e.g., web-based) and local (e.g., health department or hospital sponsored programs offered by professional organizations or federal agencies) education of medical and nursing personnel have been identified. (http://www.cdc.gov/flu/professionals/training/ ).

C.  Language and reading-level appropriate materials on pandemic influenza and disaster preparedness for professional, allied and support personnel have been identified and obtained from the El Paso County Medical Society.  Handouts were created from the Pandemic Flu Preparedness Guide.  (For more information see www.cdc.gov/flu/professionals/patiented.htm ).

D.  Education and training includes information on disaster preparedness and infection control measures to prevent the spread of pandemic influenza.  www.s.gov/pandemicflu/plan/sup4.html

E.  It is mandatory that all employees and new employees attend periodic training and updates on Bloodborne Pathogen Policy, Hazard Communication Policy and OSHA Regulations, general safety, emergency preparedness, emergency action plans, ergonomics, workplace violence, Pandemic Flu Preparedness, Tuberculosis and SARS.

F.   Employee essential knowledge and skills include:

1.     The location and operation of fire extinguishers

2.     The location of fire alarm stations and how to shut off fire alarms

3.     How to notify clinic staff regarding an emergency

4.     How to dial 911(access the Emergency Response System) in the event of any emergency

5.     How to assist patients and staff in the evacuation of the premises

6.     Location and use of oxygen (licensed staff)

7.     Location and use of medical emergency equipment (medical staff and staff

trained on AED)

8.     How emergency codes are called in the clinic and appropriate initial actions 

9.     Actions to be taken during fire and other emergency drills

10.                        Employment expectations regarding attending work during in emergency

G.  Clinician Infectious Disease Emergency Training.  All staff will receive documented training on procedures to treat and respond to patients infected with an infectious disease.  Training should include:

1.     Information about most likely agents

2.     Possible behavioral responses of patients

3.     Infection control practices, including:

a.     Use of and location of Personal Protective Equipment

b.     Reporting requirements

c.      Patient management

d.     Behavioral responses of patients to biological and chemical agents and to medical emergencies

e.      Roles and responsibilities in an infectious disease emergency

H.  Drills and Exercises.  St. Luke’s Eye Care and Laser Center will rehearse this disaster plan periodically.  All drills shall include an after-action debriefing and report evaluating the drill or exercise.  Effective exercises may include one or more of the following response issues in their scenarios:

1.  Clinic evacuation

2.     Infectious disease emergencies

3.     Mental health response

4.     Coordination with government emergency responders

5.     Continuity of operations

6.     Expanding clinic surge capacity

I.  Evaluation.  The effectiveness of the administration of this plan can be evaluated following plan activation during actual emergencies or exercises.  Staff knowledge and responsibilities may be critiqued by the EPC and reported to the Disaster Preparedness Incident Commander, Sandra Robben-Weber.

J.  Based on the after-action evaluation, the clinic Emergency Preparedness Committee could develop recommendations for:

1.  Additional training and exercises

2.  Changes in disaster policies and procedures/Plan updates and revisions

3.  Acquisition of additional resources

4.  Enhanced coordination with response agencies

K.  Mass prophylaxis.  St. Luke’s Eye Care and Laser Center encourages its clinicians to participate in a mass prophylaxis program; if the disruption to clinic operations would not negatively affect the health of the community the clinic serves. 

VII. MITIGATION

The purpose of this section of the St. Luke’s Eye Care and Laser Center plan is to address the perceived areas of vulnerability within the organization, to identify important hazards and take steps to lessen those hazards or reduce their potential impact on the clinic.

Mitigation activities may occur both before and following a disaster.

A.  Hazard Vulnerability Analysis.  As part of its risk management program, St. Luke’s Eye Care and Laser Center will also conduct a Management of Environment safety survey of its facilities at least quarterly and a Hazard Vulnerability Analysis every 1-2 years.  See HAZ Annexes.

B.  Hazard Mitigation.  St. Luke’s Eye Care and Laser Center will undertake mitigation or retrofitting measures before disasters to lessen the severity or impact a potential disaster may have on its operation.

1.  St. Luke’s Eye Care and Laser Center may experience situations that would require an immediate and safe evacuation from this facility.  These potential hazards include but are not limited to:

·        Fire            

·        Bomb Threat       

·        Flood         

·        Gas Leak             

·        Freezing and Bursting of Pipes

·        Medical Emergencies

·        Office Disruption

·        Tornado

·        Blizzard

·        Workplace Violence resulting in bodily harm

2. Everyone in the suite will quickly and safely leave the facility.  Personnel in the business area or optical area will assist their coworkers and anyone in the reception areas.  Those in clinical areas will assist their coworkers, as needed, and patients in the clinical areas.

3.  When an emergency requiring evacuation occurs, the first person to discover the emergency will alert others by quietly and calmly announcing, “We need to leave the facility.”  There is no emergency alarm in the building.

a. If the event is a fire within the clinic, institute RACE:

·        R =    Remove patients and others from fire or smoke areas.

·        A =    Announce <CODE RED (clinic’s fire code)> (3 times) and Call           9-1-1

·        C =    Contain the smoke/fire by closing all doors to rooms and           corridors.

·        E =    Extinguish the fire if it is safe to do so. Evacuate the facility if           the fire cannot be extinguished

4. In addition, the person in charge of phones will call 911 and give the answering party the following information:

(1). the name and address of the facility

(2). the nature of the emergency

5. One person from the business area is responsible to notify the other offices in the building by knocking on the doors of adjoining businesses to advise them to evacuate as well.

6. If a fire is involved, the following person(s) will use the portable fire extinguisher to put out the fire:  Back Office Manager (Brad Lovelace) and Technician (Tom Vallin). 

7. Employees responsible for extinguishing the fire must remove the extinguisher from its brackets, break the seal and remove the safety pin, and then aim the nozzle at the base of the fire.  Begin 8-10 feet away from the fire and approach the fire using a sweeping motion.

8. The fire extinguishers are located in the front office hall, optical office, and back office tech station.

9. All personnel will evacuate.  The portable extinguisher(s) will be used to attempt to extinguish the fire, if the fire is too large to control evacuate immediately and call 911.

10. The smoke detector will sound an alarm.

11. There is no sprinkler system.

12. Everyone will exit through the nearest unobstructed exit, avoiding the area affected by the emergency.

13. Stairwells will be used rather than elevators.

14. Additional assistance will be provided to disabled persons as needed.

15. When going down the stairs ambulatory patients will walk on the left side. Non ambulatory patients will sit and scoot down the stairs on the right side with assistance from able staff members.

16. Everyone will meet at Steele Elementary School play ground, check in with the Safety Coordinator, Sandra Robben-Weber, and remain there until advised otherwise.  The Safety Coordinator will account for all personnel and will inform the emergency responders if anyone is missing.

17. Injured employees or other persons will be offered appropriate first aid and will be transported to the nearest emergency room at Penrose Main Hospital, if needed.  Employers trained in CPR may administer CPR if needed.

18. If the emergency involves a civil defense or terrorism incident, the practice will proceed as directed by civil defense authorities.

19. If the internal emergency is other than a fire, the person in charge will determine if assistance from outside agencies is necessary. Such notification will be done by calling 911.

20. Notify on-duty employees of an emergency event, telling them of the situation or calling for help, as appropriate.  During the early stages of an emergency, information about the event may be limited. 

21. If the emergency is internal to the clinic, it is important to communicate with staff as soon as possible.  The code words “Angel in the break room” or what ever room the emergency is located in will be used.

VIII. Disaster Medical Resources

A.  Personnel.  St. Luke’s Eye Care and Laser Center will rely primarily on its existing staff for response to emergencies and will, therefore, take the following measures to estimate staff availability for emergency response:

1. Identify clinical staff with conflicting practice commitments

2. Identify staff with distance and other barriers that limit their ability to report to the clinic

3. Identify staff that are likely to be able to respond rapidly to the clinic

4. Identifying childcare resources that are likely to remain available following a disaster, including possible on-site child care

B.  Pharmaceuticals / Medical Supplies / Medical Equipment St. Luke’s Eye Care and Laser Center will determine the level of medical supplies and pharmaceuticals it is prudent and possible to stockpile.  Given limited resources, the clinic will stockpile only those items it is highly likely to need immediately in a response or in its day-to-day operations.  All stored items should be rotated to the extent possible.

C. Strategic National Stockpile (SNS).  In an infectious disease emergency event, if mass quantities of pharmaceuticals are needed then the county will request mobilization and delivery of the Strategic National Stockpile (SNS) through the county or city’s Emergency Operations Center and the State of Colorado. The CDC has established the Strategic National Stockpile program as a repository of antibiotics, chemical antidotes, life support medications, IV administration sets, airway maintenance supplies including ventilators, and other medical/surgical supplies. The SNS is designed to supplement and re‑supply state and local public health and medical response teams in the event of a biological and/or chemical terrorism incident anywhere in the U.S. If required and delivered, the city or county’s Emergency Medical Operations Center will administer and distribute the stockpile.

D.  Personal Protective Equipment (PPE).  St. Luke’s Eye Care and Laser Center will take measures to protect its staff from exposure to infectious agents and hazardous materials.  Clinic health care workers will have access to and be trained on the use of personal protective equipment.  St. Luke’s Eye Care and Laser Center will obtain and maintain a minimum of 10 complete sets of PPE. 

1. The recommended PPE for clinic personnel is at a minimum, well-fitted N95 HEPA masks, and covering gowns, gloves and booties. (TYVEK Coverall with hood and booties, with TYVEK booties, face shield, and Nitrile Gloves.)

2. The Emergency Planning Committee will designate clinical staff that is to receive PPE when a patient with a suspected infectious agent is present. 

3. Protective equipment is located in Clean room, and will be accessed by the doctor or technician when a patient with a suspected infectious disease presents.

IX. Clinic Emergency Response Roles

St. Luke’s Eye Care and Laser Center may play a variety of roles in responding to disasters including providing emergency medical care and expanding primary care services to meet increased community needs. St. Luke’s Eye Care and Laser Center may also be asked to distribute important public information. 

Clinic roles may be constrained by limited resources and technical capability and by the impact of the disaster on the clinic facility. 

A.  During an emergency St. Luke’s Eye Care and Laser Center will consider taking the following roles if appropriate:

1.  If possible, St. Luke’s Eye Care and Laser Center will continue to see its regular patients with priority to those impacted by the emergency.

2.  When the number of patients affected by the emergency exceeds the availability of same-day-appointments (refer to the section on surge capacity) St. Luke’s Eye Care and Laser Center will:

1)           Cancel non-emergency appointments

2)           Consider schedule changes to increase hours

3)           Consider increasing the number of staff by the use of qualified volunteers

b.           If the emergency is community-wide St. Luke’s Eye Care and Laser Center will consider becoming a triage center in support of the Memorial and Penrose hospitals and working with the El Paso or Teller county health department and the El Paso or Teller County Office of Emergency Preparedness.

B.  St. Luke’s Eye Care and Laser Center working with the El Paso or Teller county health department will consider the following to determine if its facilities should continue operation or close:

a.          Availability of medications/vaccines locally or through the Strategic National Stockpile (SNS)

b.          Integrity of the facilities

c.           Ability to access facilities

d.          Security

e.           Availability of support staff

f.            Availability of medical staff

g.          The need to consolidate staff at a particular location

h.          Ability to provide uncompromised care under the CDC altered standards of care specifications, if appropriate

i.            Adequate supplies for staff, e.g. water, food

j.            Availability of power and other utilities

k.          Orders from authorities

C.   During an emergency St. Luke’s Eye Care and Laser Center will Triage and manage patients using the following plan:

1.  Optometrist, Blake Simmons, O.D., will ensure all employees are capable of phone (and e-mail, when appropriate) triage of patients to determine who requires a medical evaluation, to limit office visits to those that are medically necessary. Dr. Simmons will update the current Triage algorithm used by St. Luke’s Eye Care and Laser Center.

2.  Plans have been developed to manage patient care at the height of a pandemic or disaster including the following possibilities:

a. Temporarily canceling or rescheduling non-essential medical visits (e.g.,          routine eye exams). 

b. Temporarily canceling or rescheduling a pressure check must be “OK’d” by a technician who will follow a strict triage algorithm prepared by Charles D. McMahon, M.D.

c. Designating separate blocks of time for non-communicable illness and communicable illness related patient care.

                              (1). Non-communicable illness patients will be seen 8:00 a.m. to 3:00 p.m.

                             (2). Communicable illness patients will be seen 3:30 p.m. to 5:00 p.m.

(3). Times will be adjusted by administrator, Sandra M. Robben-Weber, as   needed.

3.  Local plans and criteria for the disposition of patients following a medical evaluation (e.g., hospitalization, home health care services, self-or family-based care at home) have been discussed with local hospital an health care agencies and local health department.  There have not been any predetermined facilities identified as of August 30, 2009.  This information was provided by Brian R. Crawford, M.D., M.P.H., Medical Director, EPCMS.  (Flexibility will be necessary based on hospital bed capacity).

D. Acquiring Resources.   St. Luke’s Eye Care and Laser Center has developed procedures for augmenting supplies, equipment and personnel from a variety of sources.  Assistance has been coordinated through the following channels:

1. Prior agreements with vendors for emergency re-supply

2. Stockpiles of medical supplies and pharmaceuticals anticipated to be required in an emergency response

3. From other clinics, hospitals or health care providers with established Memorandums of Understanding (MOU’s).       

4. Medical and Health Branch Director under the county or city Emergency Operations Center.

E. St. Luke’s Eye Care and Laser Center has established the following disaster response priorities:

1. Ensure life safety – protect life and provide care for injured patients, staff, and visitors

2. Contain hazards to facilitate the protection of life

3. Protect critical infrastructure, facilities, vital records and other data

4. Resume the delivery of patient care

5. Support the overall community response

6. Restore essential services/utilities

7. Provide crisis public information

F.  Medical Care.  It is the policy of St. Luke’s Eye Care and Laser Center that the following will be maintained as far as possible given the nature of the emergency:

1. Confidentiality of patient information

2. Transportation restraints due to legal liabilities

3. Documentation of patient discharges AMA

4. Custody of children

G. Medical Management

1. To the extent possible, patients injured during an internal disaster will be given first aid and treatment by the clinic staff unless their injuries require more acute immediate attention. 

2. Visitors or other non-established patients who require medical evaluation or minor treatment will be treated and referred to their own physician.

3. As directed by the Incident Commander (Person in Charge), clinic staff will take the following actions:

a.       Triage/First Aid: The Incident Commander will establish a site for triage and first aid under the direction of a medical provider. Triage decisions will be based on the patient condition, clinic status, availability of staff and supplies and the availability of community resources. 

b.      Assessing and administering medical attention: A clinician will assess victims for the need for medical treatment. The medical care team will provide medical services within the clinic’s capabilities and resources.

X.  Surge capacity plan 

St. Luke’s Eye Care and Laser Center has implemented the following plan to deal with issues related to surge capacity (i.e., dealing with an influx of patients and staff and supply shortages) during a pandemic or other disaster.

A. The plan for managing a staffing shortage within the organization due to illness in personnel or other family member will require a “Total Team Concept.” 

1.  It has been predicted that during a mild to mod Pandemic or disaster 20-25% employee absenteeism will occur due to sickness, fear or care of others.  These employees are projected to be out of the office for approximately 4 to 5 days per worker.

a.    The administrator, Sandra M. Robben-Weber will instruct the front office manager, Gaby Estrada, to meet with Dr. McMahon and Dr. Simmons and decrease the number of patients on the schedules by 20% for the next 6 – 8 weeks. This will be done to ensure the health and well-being of the working employees can be maintained.

b. Patients will be canceled or rescheduled according to the recommendations made by Dr. McMahon and Dr. Simmons after reviewing patient charts.

c. The individual canceling or rescheduling patients will document any patient concerns in their chart and relay the concerns to Dr. McMahon and Dr Simmons.

2.  It has been predicted that during a severe pandemic or disaster 30-40% employee absenteeism will occur due to sickness, fear or care of others.  These employees are projected to be out of the office for approximately 3 weeks per worker.

a.    The administrator, Sandra M. Robben-Weber will instruct the front office manager, Gaby Estrada, to meet with Dr. McMahon and Dr. Simmons and decrease the number of patients on the schedules by 35% for the next 6 – 8 weeks. This will be done to ensure the health and well-being of the working employees can be maintained.

b. Patients will be canceled or rescheduled according to the recommendations made by Dr. McMahon and Dr. Simmons after reviewing patient charts.

c. The individual canceling or rescheduling patients will document any patient concerns in their chart and relay the concerns to Dr. McMahon and Dr Simmons.

B.  Staff has been encouraged to develop their own family care plans for the care of dependent minors and seniors in the event community containment measures are implemented. (e.g., “snow days,” school closures). (For more information go to www.pandemicflu.gov/planguide/checklist.html or www.pademicflu.gov/planguide/familyhealthinfo.html ).

C.  The minimum number and categories of personnel necessary to keep the office / clinic open on a given day are one doctor, one technician, and one receptionist.

D.  If no doctor is available the office will be closed except for essential personnel who will monitor the phones and assist patients with finding emergency care.

E.  It is anticipated that consumable resources will need to be increased by 15% when there is evidence that pandemic influenza has reached the United States.  St. Luke’s Eye Care and Laser center will stockpile at least a week’s supply of consumable resources, including all necessary medical supplies.  The acquisition of supplies will be through normal channels.  Arrangements will be made prior to return any unused items once the pandemic is over.  The contingency plan will be to use more commercial vendors at a possible higher expense or make local purchases as necessary. The following is a list of consumable supplies needed by St. Luke’s Eye Care and Laser Center.

1.  Hand hygiene supplies (antimicrobial soap and alcohol-based, waterless hand hygiene products).

                    2.  Disposable N95, surgical and procedure masks.

                    3.  Face shields (disposable or reusable)

                    4.  Gowns

                    5.   Gloves

                    6.   Facial tissues

XI. Decision on clinic operational status

A. The decision on the operational status of St. Luke’s Eye Care and Laser Center will be based on the results of the damage assessment, the nature and severity of the disaster and other information supplied by staff, emergency responders or inspectors.  The decision to evacuate the clinic, return to the facility and/or re-open the facility depends on:

1. Extent of facility damage / operational status

2. Status of utilities (e.g. water, sewer lines, gas and electricity)

3. Presence and status of hazardous materials

4. Condition of equipment and other resources

5. Environmental hazards near the clinic

B.  Extended Clinic Closure.  If the St. Luke’s Eye Care and Laser Center experiences major damage, loss of staffing, a dangerous response environment or other problems that severely limit its ability to meet patient needs, clinic operations may be suspended until conditions change.  If that decision is made, the clinic staff will:

1.  If possible, ensure clinic site is secure

2. Notify staff of clinic status and require that they remain available to return to work unless permission is provided

3. Notify the county or city Emergency Operations Center of its change in status

4. Implement business recovery operations

5. Allow clinic to remain fully or partially operational

6. Review plans and procedures 

7. Update contact information

8. Check inventory of supplies and pharmaceuticals, augment as needed

9. Reduce clinic operations to essential services

10. Cancel non-essential appointments

11. Ensure safety of patients and staff

12. Communicate status to county or city Emergency Operations Center as requested

C. Response to External Emergencies

    Weapons of Mass Destruction (WMD)

1. Preparations for an event involving weapons of mass destruction - chemical, biological, nuclear, radiological, or explosives (CBRNE) - should be based on existing programs for handling hazardous materials.  [See Appendix for a matrix of biological weapons agent characteristics.]

2. If staff suspects an event involving CBRNE weapons has occurred, they should:

a. Remain calm and isolate victims to prevent further contamination within the facility

b. Contact appropriate clinician 

c. Secure personal protective equipment and wait for instructions

d. Comfort the victims

e. Contact 911 or appropriate Operational Area authorities [Appendix]

D. If St. Luke’s Eye Care and Laser Center remains fully or partially operational following a disaster, the Incident Commander (person in Charge) and other members of the Emergency Response Team will define the response role the clinic will play, depending on:

1. The physical impact of the disaster on St. Luke’s Eye Care and Laser Center 

2. Staff and other resources available for response

E. The clinic may be requested by the county or city Emergency Operations Center to assume specific treatment, triage and transportation roles depending on the nature of the disaster.

F. Extended clinic closure. If the St. Luke’s Eye Care and Laser Center experiences major damage, loss of staffing, a dangerous response environment or other problems that severely limit its ability to meet patient needs clinic operations may be suspended until conditions change.

                G.   Infection Control Practices for Patient Management

1. St. Luke’s Eye Care and Laser Center will use Standard Precautions to manage all patients, including symptomatic patients with suspected or confirmed bioterrorism‑related illnesses or other infectious disease. 

2. In general, the transport and movement of patients with any epidemiologically important infections should be limited to movement that is essential to provide patient care, thus reducing the opportunities for transmission of microorganisms within healthcare facilities.

a.       St. Luke’s Eye Care and Laser Center has in place adequate procedures for the routine care, cleaning, and disinfection of environmental surfaces, and other frequently touched surfaces and equipment, and ensures that these procedures are being followed.

b.      Facility‑approved germicidal cleaning agents are available in patient care areas to use for cleaning spills of contaminated material and disinfecting non‑critical equipment.

c.       Used patient‑care equipment soiled or potentially contaminated with blood, body fluids, secretions, or excretions is handled in a manner that prevents exposures to skin and mucous membranes, avoids contamination of clothing, and minimizes the likelihood of transfer of microbes to other patients and environments.

d.      St. Luke’s Eye Care and Laser Center has policies in place to ensure that reusable equipment is not used for the care of another patient until it has been appropriately cleaned and reprocessed, and to ensure that single‑use patient items are appropriately discarded.

e.       Sterilization is required for all instruments or equipment that enter normally sterile tissues or through which blood flows.

f.       Contaminated waste is sorted and discarded in accordance with federal, state and local regulations.

g.      Policies for the prevention of occupational injury and exposure to blood borne pathogens in accordance with Standard Precautions and Universal Precautions are in place. 

3. If exposed skin comes in contact with an unknown substance/powder, recommend washing with soap and water only. If contamination is beyond the clinic’s capability, call 911. Local government, fire departments and hospitals are able to decontaminate patients and facilities exposed to chemical agents.

XII. Recovery

A. Recovery actions to assess, manage and coordinate the recovery may take place concurrently with response activities and are directed at restoring essential services and resuming normal operations. Post-event assessment of the emergency response should be conducted to determine the need for improvements.  These activities include:

1.  Deactivation of emergency response and return to normal clinic operations 

2.  Establishment of employee support as needed

3. Accounting for disaster-related expenses to include: direct operating cost; costs from increased use; damage or destruction; replacement of capital equipment; and construction related expenses

B. Documentation. St. Luke’s Eye Care and Laser Center will immediately begin gathering complete documentation including photographs and detailed financial information.   Areas for documentation include:

1. Action, decision and receipt of information

2. Patient registration and services performed

3. Expenditures and utilization of equipment

4. Damages and losses incurred. Damage and losses of equipment may be easily tracked using preexisting current and complete list of equipment serial numbers, costs, and dates of inventory

5. Staff costs (overtime)

6. Potential revenue loss

7. Use of petty cash

8. Philanthropy and in-kind gifts

C. Vender and Supplier Invoices

1.  Medical/Non-medical supplies and equipment used during the response phase.

2. Oxygen and fuel deliveries

3. Durable Medical Equipment from vendors

4. Food service

5. Mortuary services

6. Transportation services

7. Waste management services

8. Federal and State Government materials used (including medications and controlled substances).

9. Temporary staffing agencies

D. Insurance Carriers. St. Luke’s Eye Care and Laser Center will file claims with its insurance companies for damage to the clinic.  (The clinic will not receive federal reimbursement for costs or losses reimbursed by the insurance carrier.)  

1. Legal counsel may be needed to assess policies, coverage, and assist with claims.

2. Acts of terror require rigorous documentation and may not be covered.

3. All correspondence via first class mail with return receipt in suggested.

E. Assistance Documentation and Applications (FEMA). Nonprofit institutions providing “essential government type services to the general public” including emergency services are eligible (are eligible for compensation?).   It is essential that the applicant owns or operates a facility providing “government-type services” and that it is open to the general public.  See publication No. 323, Public Assistance Applicant Handbook.

1. Submit a Request for Assistance, FEMA 90-49 (See Appendix) within 30 days of the presidential declaration.

2. FEMA determines eligibility

3. Kickoff” meeting with applicant to discuss damages suffered, repairs needed, and costs incurred.

4. FEMA then determines the eligibility of particular work needed and reasonability of the cost.

  F. Restoration of Services. If necessary, repair, decontaminate or relocate clinic services

1. Replace or repair damaged medical equipment.

2. Facilitate the return of clinic staff to work.

3. Replenish expended supplies and pharmaceuticals.

4. Follow-up on rescheduled appointments.

G. After-Action Report St. Luke’s Eye Care and Laser Center will conduct an after-action evaluation of the adequacy of the clinic’s plans, preparation and mitigation efforts. 

XII. Post Disaster Checklist

St. Luke’s Eye Care and Laser Center will use the following Post Disaster Checklist:

1.  Physicians and/or office manager contact employees regarding the extent of the disaster and what action employees should take in the short-term.

2.  Contact landlord and, if necessary, fire department for a general assessment of the damage.  If the damage is such that the practice may have to relocate for a significant amount of time (weeks or months), or permanently, the steps below should be considered.

3.  Reroute mail and phone calls.  _________________________________________. A recorded message may be made available by the phone service provider until a temporary phone line can be established.

4.  Contact insurance carrier.  When the insurance company is notified, the event that has occurred and initial damage assessment should be relayed.  The company should also be asked how quickly it can have an assessor sent to the location for a full assessment of the damage to the building and facilities.  It is important that such an assessment occur as quickly as possible.  The practice should request that the property damage assessment be videotaped to ensure all damage is recorded.

5.  Keep an accounting of all damaged-related costs.  The practice should track, and encourage all employees to track, all damage-related costs that may be incurred in the event of a disaster.  Such cost might include mileage driven by employees, long-distance phone calls, equipment, mailing, leasing equipment, etc.  Such costs should be reported, with receipts, to the practice’s bookkeeper as they may be reimbursable by the insurance company.

6.  Conduct salvage operations.  Keep damaged goods on site until seen by an insurance adjuster.  Once it is safe to enter the premises, the practice should assign personnel to conduct salvage operations as soon as possible.  Any items or equipment that can be saved should be removed, but damaged goods should be kept on site until seen by an insurance adjuster.  If it is believed damaged property can be used again, it should be protected from further damage while remaining on the premises.

7.  Call a meeting of Key Employees. Once the extent of the damage is known and the insurance company has been notified, the practice will have a meeting with the members of the disaster/ emergency planning committee.  While the following list is not all-inclusive, it is a suggested list of topics that may be discussed at the meeting:

                   a. Damage assessment

                   b. Status of employees

                   c. Medical records access

                   d. Financial resources

                   e. Information processing

                   f. Office space needs – temporary/permanent

                   g. Immediate equipment needs

                   h. Contacting patients and suppliers

8.  Obtain new office space.  The landlord should be contacted regarding whether the office spaces will be able to be occupied in the near future.  If not, a search for new office space should be conducted.

9.  Equipment needs for temporary office space.  Consideration should be given regarding what equipment will be needed, both in short-term and the long-term in the event the office equipment id damaged or destroyed.  The practice should consult the list of equipment and assets kept for insurance purposes to have a good idea of what might be needed.

10.  Contact patients.  Once the extent of the damage and priorities are determined, the practice’s patients should be contacted. Depending on circumstances, patients should be told about the damage and where inquires regarding treatment and records should be made.  This may be done by an ad in the newspaper, on the radio or some sort of mailing to existing patients.  You may also want to consider contacting other medical providers to find suitable alternatives for the care of your patients.