Strategies for Maintaining Clinical Support

The hospital manages patient scheduling, triage, assessment, treatment, admission, transfer and discharge.

The hospital manages the activities required as part of patient scheduling, triage, assessment, treatment, admission, transfer, discharge:

Upon activation of the EOP, normal admission requirements will be discontinued. Initially, admissions to the hospital will be limited to those whose survival depends upon services obtainable only through hospital treatment / bed care. Outpatient care will be restricted to those whose lives may ultimately depend upon the present expenditure of medical supplies and healthcare worker time.

All elective admissions and procedures will be canceled, including elective surgery, non-emergency outpatient procedures and transferring patients who are stable to be discharged.

Patients may be transferred to other facilities so those emergency victims may be accommodated.

Individuals may be redirected or relocated for a Medical Screening Exam in the event that the hospital's EOP is activated. (Section 1135(b) of the Social Security Act §489.24(a)(2).

In the event that the hospital's EOP is activated, persons may be transferred prior to being stabilized if, based upon the circumstances of the emergency the hospital is unable to provide proper care, treatment or services. (Section 1135(b) of the Social Security Act §489.24(a)(2).

How the hospital will evacuate (from on section to another within the building, or completely outside the building) when the environment cannot support care, treatment, and services:

St. Mary Medical Center has established a Shelter in Place and Evacuation Plan (a)ppendixes D and F) for evacuation of the hospital or unit within the hospital.  In the event the hospital or a unit is deemed unsuitable for continued occupancy or cannot support adequate patient care, the Evacuation Plan will be initiated. HCWs are educated on evacuating both horizontally and vertically. HCWs are also trained to request assistance in evacuating non-ambulatory patients and may also use the evacuation chairs in the high-rise buildings, if necessary.

The Fire Response Plan dictates that, in the event of a fire emergency, the initial preferred evacuation method will be horizontal evacuation to an area of safe refuge / an adjoining smoke compartment. If evacuation from the facility becomes necessary due to a disaster situation where defending in place is not feasible and when the facility cannot continue to support care, treatment and services, the Incident Commander and the Long Beach Fire Department may initiate and authorize a vertical evacuation of the facility. If vertical evacuation becomes necessary, the following protocol will be followed:

Vertical Evacuations

  1. If a vertical evacuation is required, the patients should be moved vertically down and horizontally away from the affected area(s).
  2. Once evacuation priorities have been established, the safest route to vertically evacuate patients should be chosen and communicated by the HCC. It may be necessary to move patients vertically up and horizontally across then vertically down depending on the location of the affected areas.
  3. Holding areas for the patients shall be identified by the HCC.These areas should be chosen to keep all the patients from a specific unit together. Units can be mixed but units should not be split between areas if at all possible.
  4. HCWs from evacuated units should stay with the patients from their respective floor/unit.Once all patients have been evacuated to the holding area, HCWs shall complete a patient count and check armbands against the census for their unit to account for all patients who have been evacuated.

Facility Evacuation

Once the notification to the Office of Emergency Management (OEM) or Los Angeles County EMS Agency is made, the HCC shall begin planning for complete facility evacuation. Evacuation of the facility shall be addressed in four parts:

  1. Visitors - Because the facility does not have a way to track visitors coming and going from the facility there is not a mechanism in place to account for all visitors. The Operator should announce for all visitors to leave the facility immediately. If a destination for the patients has been identified, the location may also be paged overhead or otherwise communicated to the visitors.
  2. Ambulatory Patients - Ambulatory patients and their medication, equipment, and pertinent information, including essential clinical and medication-related information shall be moved as directed above to staging area as coordinated by the HCC.
  3. Admitting staff shall track each patient as they leave the facility based on the current computer census.  Patient disposition shall be determined based on the destination.
  4. The Patient Evacuation Tracking Form shall be utilized for patient tracking.  When more than two patients are being evacuated, the Master Patient Evacuation Tracking Form shall be completed to gain a master copy of all patients that were evacuated.

Non-Ambulatory Patients

Non-ambulatory patients and their medication, equipment, and pertinent information, including essential clinical and medication-related information shall be transported by ambulance or other vehicle designed for patient transport as coordinated by the HCC.

Healthcare Workers (HCWs)

HCWs may be needed to staff an alternate care site or to assist with the transfer of patients from St. Mary Medical Center to another facility. HCWs shall be tracked through the Planning and the Personnel Tracking Manager using  emergency lists and other resources available through Human Resources. 

4. How the hospital will manage a potential increase in demand for clinical services for vulnerable patient populations served by the hospital, such as patients who are pediatric, geriatric, disabled, or have serious chronic conditions or addictions:

Clinical activities for vulnerable patient populations including pediatric, geriatric, disabled, or have serious chronic conditions (example: dialysis patients, respiratory patients, transplant unit patient, etc.) and psychiatric and addiction patients will be provided in the customary way but additional emphasis will be placed on security, safety, mobility in terms of evacuation should it become necessary during an emergency.

5. The hospital manages personal hygiene and sanitary needs of its patients:

Personal hygiene and sanitary needs of patients during emergencies will be provided. Availability of water supply used for personal hygiene and sanitary water pumps / lift stations at the hospital are connected to emergency power sources. In addition, when water intended for hand washing is not available, the hospital utilizes waterless alcohol based hand rub, which is maintained in ample supply at the hospital.

The alternative means to personal hygiene can be baby wipes, personal wipes, or alcohol-based rubs. Family can also be used to clean the patient during emergencies. The alternative means to sanitation, if toilets are inoperable, is kitty litter, red bags in toilets, or bucket brigade.  Limit changes of bed linen to those patients who have gross soiling from draining wounds, catheters, etc. Environmental Services use of water will be curtailed to the extent of one change of water per day for mopping except in surgery, delivery rooms, and isolation areas.

6. How the hospital will manage its patients' mental health service needs during the emergency:

During an emergency, the organization will provide mental health services to patients. HCWs may use patient registration and triage information, and medical records to determine this population and the appropriate services required.

Chaplains and Social Workers should be made available to attend to the emotional needs of patients. If necessary, psychiatric consultation should occur, and – if necessary – patients should be transferred to a behavioral health setting. If transfer of patients is not possible, then HCWs should be assigned to monitor patients accordingly.

7. The hospital manages mortuary services during emergencies:

The mortality rate during emergency conditions may increase due to casualties brought into the hospital. The hospital is only equipped for handling a minimal number of mortality casualties due limited morgue refrigeration units. The hospital has a supply of body bags to temporarily store casualties. The morgue in the basement has a morgue storage rack and the Disaster Resource Center cache includes adult and pediatric body bags. The hospital will communicate with the county morgue and provide information relative to number of casualties that the county morgues will pickup from the hospital.

In the event of emergency involving deceased patients, the organization will contact the local medical examiner for the appropriate clearance and procedures. If necessary, a refrigerated trailer should be requested for securing bodies not able to be contained in facility's existing morgue. Refer to St. Mary Medical Center Mass Fatality Plan (a)ppendix E)

8. The hospital plans for documenting and tracking patients’ clinical information:

The hospital is equipped with back up data systems designed to be retrieved during emergencies and be utilized for documenting and tracking patients' clinical information. In addition, during emergency conditions, paper forms are available to document and track patient clinical information.

Departments receiving disaster patients such as the Emergency Department and patient care units, patient trackers/transporters will be assigned to track the patients entering and leaving the areas. Patient location information will be given to the Patient Tracking Manager responsible for tracking patients within the facility during disaster.