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EXTERNAL DISASTER PLAN 

The following is a list of the fundamental procedures to be followed in the event of an internal disaster.  For specific duties and assignment, each employee should refer to their departments specific procedures.

1. The person receiving notice of disaster should attempt to get as much information as possible.  The location and extent of disaster, anticipated number and type of casualties and estimated time of arrival of first casualties should be ascertained.

2. Initial report of an external disaster will be received by the ED through radio communications from the local ambulance or by the switchboard operator.

3. The Executive Director or Senior Administrator in charge are immediately notified by the switchboard operator or Nursing Administrator.

a. Exception:  In the event an outside emergency agent is needed, such as Police or Fire Department, contact them first (Police 9-9-1-1 or Fire 9-9-1-1). 

4. Level of disaster declared as determined by the Senior Administrator is announced by the switchboard or nurse in charge.  Level _____ disaster plan now in effect twice.

5. After assessment, the Disaster Chief or his designee shall contact the necessary departments.  (Call-ins as required)

a. The Disaster Chief shall be the Senior Administrator or their designee who will report to the ED to assist in disaster plan coordination.  
b. The Disaster Chief will assign an individual to manage the personnel pool.
c. Departments contacted should be informed of the level of the disaster.

6. All employees report to their respective departments for assignment by their Department Director per that departments specific disaster plan.

a. Unassigned personnel should report to the dining room to await further instruction to assist the Disaster Chief as necessary.
          In the event the dining room is unavailable, report to the multi-purpose room.

DISASTER LEVEL DEFINITIONS

LEVEL I
On duty staff - all directed to assigned areas.  NO call-ins, remainder of hospital activity postponed as required.

LEVEL II
On duty staff plus call-in of extra personnel as needed.

LEVEL III
On duty staff initially, then all off duty staff personnel called in, maximum effort.

NOTES
Phone treed are not maintained in this Disaster Plan.  It is the responsibility of each department to maintain its own phone tree.  

DUTIES AND RESPONSIBILITES OF HOSPTIAL PERSONNEL

ANESTHESIA
In the event of a medical disaster, it is the policy of the Department of Anesthesia to coordinate its effort with the Operating Room to provide surgical services, if required, or to provide additional manpower to assist other departments with the implementation of the hospitals Disaster Plan.

Director:

In the event of an External Disaster, the Administrative Director shall be responsible for the following: 

1. Reporting to designated area to help implement the hospital Disaster Plan.
2. Coordinating surgical services, if required, with the Operating Room.
3. Contacting off-duty personnel, if required.
4. Assisting in surgical triage, if required.

Staff Anesthetist:

In the event of an External Disaster, the Staff Anesthetist shall be responsible for the following:

1. Helping establish surgical services, if required.
2. Reporting to another department under the direction of the Administrative Director or the Disaster Chief to help implement the hospital Disaster Plan.
3. Assist in surgical triage, if required. 

CARDIOPULMONARY

1. Technician receiving notice of emergency shall notify department director and if unable to reach director, call other technicians, if necessary.
2. Director or technician in charge (technician notified of emergency is in charge until director arrives) will provide assignments to staff according to need of disaster.
3. All technicians without assignments will stay in the department and await call for additional help.  

DIETARY

Purpose

1. To supply nourishment to personnel, volunteers, casualty victims, relatives, visitors, and news media relative to the emergency.
2. To meet in-house patients needs with as close adherence to the dietary prescription as possible.

Functions

1. The Food Service Director will alert on-duty employees.  If the disaster occurs at night, the Food Service Director will initiate phone tree from home phone.
2. The Food Service Director shall be advised of the need for increased dietary needs as soon as possible from the Disaster Chief.
3. Liquids and meals will be served in the cafeteria, if possible.  Refreshments will be sent to the Information Center as needed.
4. In the event the disaster affects the normal operation of the Food Service Department, the Food Service Director will be responsible for any changes in food service and will notify the nursing floor.
5. The Food Service Director will organize the kitchen for mass feedings.
6. Additional needed supplies (paper goods, groceries, frozen foods) may be obtained from Hannaford (723-8047, Pangburn Family IGA (723-5077), or Maine Sysco (#41).
7. Volunteers may be utilized for vegetable prep, making sandwiches, pouring juices, washing dishes, and for general clean up.

LABORATORY

When notified of a disaster plan in effect, all persons shall report to their assigned areas.

All non-emergency, non disaster work will be suspended.

The Laboratory Director will report to the triage area (or other designated location) for information / instructions from the Disaster Chief.  In the Directors absence, the person in charge, using lab organizational seniority, will report to the Disaster Chief.  The on-duty person, if working alone will report.

Organize the Laboratory for all emergency procedures needed to give adequate medical care.

Call in additional personnel, if necessary, using the Laboratory telephone tree.

In any on-duty lab staff can be spared from performing emergency procedures, release them to the personnel pool.

If additional units of blood are necessary to deal with the disaster, other than those in-house, contact the Red Cross - Bangor.  Inform them of the disaster, and ask units to be released to us from their emergency inventory in Bangor.

NURSING SERVICES

Notification

Upon receiving notification from either the ED staff or appropriate EMS official, the Nursing Supervisor in-house / on-call will execute the following:

1. The in-house supervisor will notify the Director of Nurses or his / her designee that an external disaster situation exists.  The in-house supervisor, based on information at hand, will, as soon as is possible, decide the level of the disaster response and proceed accordingly.

The designation of a Level I, II, or III plan differs only in the amount of personnel needed or could possibly be needed.

Level I - On duty staff - all directed to assigned areas.  No call-in remainder of MRH activity postponed.

Level II - On duty staff plus call in of extra nurses and physicians as deemed necessary.

Level III - On duty staff plus all off duty personnel called in - maximum effort.

Once this has been determined, in house supervisor will notify the appropriate personnel to have the following announcement to be made on the PA system:  Level _____ Disaster Plan is now in effect.  Repeat once.

1. The Nursing Supervisor will begin the process of assisting the ED nurse in the appropriate triage procedures.  These include:
a. Preparing the ED bays for the receipt of multiple casualties
b. Initiation of emergency discharge of patients from critical care area in order to make room for the injured
c. Notification of all nursing areas to prepare for multiple casualties
d. Preparation of the Minor OR / Endoscopy suite for the use as an added OR, if necessary

Responsibilities by Department

THE EMERGENCY ROOM
Upon notification of the existence of a multi-casualty situation by either ambulance personnel or appropriate EMS official, the ED nurse will initiate the following steps:

1. The nurse will assess and determine the extent to which he / she feels the Disaster Plan must be utilized and delegate the initiation of the ED and / or Disaster Call List to the appropriate personnel.  He / she will, at this time, advise the Nursing Supervisor of this decision.

2. Perform the role of triage nurse unless it is felt that this role can be more effectively performed by another nurse.  Triage will begin at the ED entrance.  The triage team will consist of:

a. Physician Assistant
b. The ED nurse or his / her designee (and one other nurse)
c. Stretchers and wheelchairs
d. A supply of bandaging material
e. Other equipment as needs identify

Triage Proceedure
1. Tag all patients - aides or record clerk
2. Triage PA will complete tag with provisional diagnosis, destination, suggested treatment and / or drugs administered.
3. Triage PA will contact physicians on call for medicine, surgery, pediatrics, radiology, orthopedics.
4. Nurses will begin treatment and control stretchers and wheelchair traffic in area.  Nurses will communicate patient condition and treatment begun in the triage area to the receiving area.

THE SPECIAL CARE UNIT 
Upon receiving word from the Nursing Supervisor that a disaster situation exist, the charge nurse in the Special Care Unit will execute the following plan:

1. Begin arranging for transfer of all patients whose condition is stable enough to a less critical area, private residence or appropriate holding area.
2. Prepare unit bays for the reception of multi-trauma patients and assign appropriate personnel to each bay area as they arrive.
3. Begin or delegate the transfer of patients from the step-down unit beds to less critical areas, or for immediate discharge, if possible.

THE MEDICAL SURGICAL FLOOR 
Upon receiving word from the Nursing Supervisor that a disaster situation exists, the RNs of Med Surg will execute the following functions:

1. Initiate the discharge of patients who can be released from the hospital, if required.  Arrange for their safe transfer to either home or to a safe holding area.
2. Make preparation to receive patients from ICU and the step-down unit, as well as direct admissions from the triage area.
3. Designate appropriate personnel to keep a log of discharges, transfers, and admissions for traffic control.
4. Problem solving on a case-by-case basis.

THE OPERATING ROOM
1. Upon arrival the OR staff will assess its case load capability and adjust its schedule accordingly.
2. The staff will, in cooperation with Central Sterile Supply, maintain the necessary supplies to continue case load until finished.
3. The OR Nurse Manger will assign additional staff members to assist as he / she feels is necessary and warranted.

NURSING ADMINISTRATION 
Upon notification from the hospital that a disaster situation exists, the members of Nursing Administration will proceed directly to the hospital and present themselves to the nurse who is currently directing the situation.  From then they will ascertain the best course of action for the situation.  Specific roles are as follows:

1. CNO:  Will avail her / himself to the Executive Director to assist in the coordination of resource with the outside.
2. Shift Coordinators:  Will report to assigned areas to coordinate efforts, maintain supplies and assist as needed.
3. Inpatient / Outpatient Managers:  Will report to their areas of responsibility, report to CNO, or person in charge what their needs are, coordinate materials and personnel.

ALL STAFF MEMBERS:  NURSING
Upon receiving notification from the hospital that a disaster situation exists, the staff person will either report directly to the station requested or to the dining room to await further assignment.

PHARMACY / MATERIALS MANAGEMENT
The Pharmacy and Materials Management Departments shall, in the event of a disaster, be available to provide assistance and materials as required.

1. Pharmacist and / or technician (s) to remain the Pharmacy and IV room to answer phone and provide drugs, IV solutions, etc. to requesting departments.  In the event Pharmacy personnel require additional courier (delivery personnel), they shall call the Dining Room (203) or the multi-purpose room (267) and request volunteers.

2. Materials Management Manager / clerk (s) are to remain in the Materials Management Department to answer the phone.  As soon as possible, they are to call either the Dining Room (203) or multi-purpose room (267) and request two people to deliver items to requesting departments.

PHYSICAL THERAPY
1. When notified of a Disaster Plan in effect, all Physical Therapy staff will report to the PT Department for instructions.  The PT Department staff member who receives initial notification of a Disaster Plan in effect, will immediately contact the Department Director or designee.  If the Director or designee is absent and unreachable by phone, the PT Department organizational chart will be utilized to determine the designee.  The person receiving first notification will be in charge until the Director or designee is located.
2. The Department Director or designee will gather information from the triage area and / or Disaster Chief regarding the potential need for Physical Therapy staff and Physical Therapy physical plant.  The Physical Therapy Department may be utilized for extra bed space if needed.
3. With consideration to the disaster details and with consideration of the potential for admitting and other departments to be impacted by the disaster, the Department Director  or designee may coordinate the suspension of all non-emergency, no disaster work in the Physical Therapy Department.
4. The Department Director or designee may call in extra personnel utilizing the PT department phone tree and Occupational Health Department phone tree, as necessary. 
5. Call in staff will report to the Physical Therapy Department for further instruction unless directed by the Department Director designee.

PLANT OPERATIONS DEPARTMENT

MAINTENANCE
1. One man to Spruce Street, one man to Brownville Road Entrance I, emergency vehicles only.
2. One man to secure and lock all doors except ED and Main Entrance.  After all doors are locked, report to Main Entrance for pedestrian traffic control.
3. Assist in setting up beds, moving supplies or any other actions as required by the Disaster Chief.
4. Secure personnel to carry Maintenance Department hand radios.
  
HOUSEKEEPING  
1. Report to your department after alerting all other department members of disaster.
2. Assist with the movement of supplies, beds, etc.
3. Report to personnel pool.

LAUNDRY  
1. Insure treatment areas have adequate linen supplies.
2. Stay in Laundry Department to receive calls for more linens at treatment area.

RADIOLOGY
1. Alert on duty personnel.
2. If needed, initiate phone tree.
3. Set up portable machine.

NUCLEAR MEDICINE / ULTRASOUND
1. Report to Dining Room for assignment.

SOCIAL SERVICES
1. Report to ED to act as patient liaison.
2. Instruct Business Office personnel as to patient availability for information exchange between clerks and patients.

DISASTER PLAN MAINTENANCE
1. This plan shall be reviewed and updated as required, or every two years by the Safety Committee.
2. Upon any significant revision to the plan, all distributed plans shall be recalled and the new revised plan will be issued.
3. Plan distribution:

Administration
Accounting
Ambulatory Clinic
Business Office
Cardiopulmonary
Case Management
Diagnostic Imaging
Dietary
East Millinocket Police Dept.  
East Millinocket Fire Dept.
Emergency 
Health Information
Human Resources
Katahdin Paper  
Laboratory
Millinocket Fire Dept.
Millinocket Police Dept.
Nuclear Medicine
Nursing Services
Operating Room
Pharmacy
Physical Therapy
Plant Operations
Purchasing
Regional Hazardous Substance Coordinator

EMERGENCY PHONE NUMBERS:

American Red Cross Pine Tree Chapter - 941-2903
Aqua Maine - 1-800-287-1643
Bangor & Aroostook Railroad - 848-4254
Bangor Generator - 947-2440
Bangor Hydro Electric Co. - 1-800-499-6600
National Guard - 626-4519
Police or Fire Emergency - 911
WSYY - 723-9657

SENIOR HOSPITAL ADMINISTRATION:

Marie Vienneau - 746-0052
Christine McLaughlin - 746-9534
Sherry Campbell - 723-5261
Shelly Drew - 365-4010
Missy Marter - 723-6520
Lisa Arsenault - 723-9586