General Policies and Procedures During a Hurricane Emergency

Valley Regional Medical Center HURRICANE PLAN

The National Weather Service (NWS) issues a hurricane watch when hurricanes are possible in our area. Remain alert for approaching storms. This is the time to remind staff where the safest places within the hospital are located, and listen to the radio or television for further developments.

The hospital’s plan for hurricanes is divided into four stages, which generally conform to the hurricane stages identified by the National Weather Service. The action steps indicated in the stages may or may not be taken within the stages listed, depending on the circumstances of the storm and time of day in which the stage occurs.

General Policies and Procedures During a Hurricane Emergency:

This hurricane Preparedness Plan has been developed to provide as comprehensive a guide as possible to employees concerning their actions, and to dependents and visitors, while continuing to provide the essential services needed by the patients in the hospital.

Employees:

Only needed and assigned personnel, as determined by the Department Managers, will be housed in the hospital during a hurricane. The unused portions of the hospital will be utilized for this purpose. Some employees will be needed at the hospital prior to, during, and after the hurricane’s passage. After the hurricane has passed, the employees at the hospital will need to be relieved by the incoming employee. This must be accomplished in a manner to maintain the necessary services of the hospital.

Dependents:

Only the dependents of “on-duty” hospital personnel will be housed in the building during a hurricane. All persons must adhere to the policies of the hospital with respect to the type of items, which may be brought into the hospital at the time of such an emergency. (See Appendix A).

Visitor:

The visitation policy of the hospital during the Stage Three of the Hurricane Plan will be as follows: “No visitors will be allowed in the hospital unless specifically cleared by the Command Center.

Brief Contents of the Plan

The following will serve to indicate the steps that will be taken during the various stages of Hurricane Alerts. Hurricanes may strike the Brownsville area between the months of June through November. Although it is rare for a hurricane to strike the city, Hurricane Alerts may come at any time. This plan mostly includes information relative to Hurricane Alerts, but does not mention what to do when a Tornado Alert is issued. Some areas covered in this manual are:

1 Valley Regional Medical Center

1. Stages of Hurricane Alerts 2. Glossary of Terms 3. Appropriate actions to be followed in the event of a hurricane 4. Personal information concerning hurricanes 5. Steps to be taken when a Hurricane Alert is issued

STAGES OF HURRICANE PREPAREDNESS

Hurricane preparedness means that our plan is reviewed each year and ready for implementation each during if needed during hurricane season. Hurricane Season is June 1 st to November 30th. At the beginning of hurricane season, a letter is distributed to the staff reminding them that the season has begun and to be prepared for a possible storm. Human Resources issues a statement regarding employees and dependents may be required to stay at the facility during the storm and the appropriate items to bring. Directors are reminded to make sure the hurricane supplies are available and disaster call lists are up to date.

Definitions: Hurricane Alerts (VRMC AND NATIONAL WEATHER SERVICE)

Advisory

Once an advisory has been issued that a hurricane or tropical storm has entered the Gulf of Mexico, the CEO, or his/her designee, begins to monitor the progress of the storm. Alerts are distributed to the leadership team that indicates the path of the storm. The team is ready to implement the Hurricane Plan once a “Hurricane Watch” has been issued.

STAGE ONE: HURRICANE WATCH

A hurricane watch is announced by the National Weather Service Hurricane Center in Miami, Florida, when a hurricane has developed and may threaten the Western Gulf of Mexico on the Texas coast within 24-36 hours. At this stage, there is some uncertainty about its future movements. The watch area is specifically defined, and includes the Brownsville area.

STAGE TWO: HURRICANE WARNING

A hurricane warning is issued by the National Weather Service Hurricane Center in Miami, Florida, when the direction of the hurricane indicates that high tides and hurricane force winds will begin to be felt in the Brownsville area within a 12-24 hour period, possibly shorter.

STAGE THREE: ONSET

The hurricane has made landfall and moving inland. The storm may speedup, slow-down, turn, or stall. During this time is when damage and flooding is likely to begin and Emergency Services may shut-down in the area.

STAGE FOUR: IMMEDIATE POST HURRICANE After the hurricane has passed, the hospital will be in an Emergency Operations state and the Disaster Plan will continue in operation as per the Command Center’s instructions.

GLOSSARY OF HURRICANE TERMINOLOGY

1. Advisory: Official information issued by tropical cyclone warning centers describing all tropical cyclone watches and warnings in effect along with details concerning tropical cyclone locations, intensity and movement, and precautions: a) Tropical cyclones prior to issuance of watches and warnings and b) Subtropical cyclones.

2. Best Track: A subjectively-smoothed representation of a tropical cyclone’s location and intensity over its lifetime. The best track contains the cyclone’s latitude, longitude, maximum sustained surface winds, and minimum sea-level pressure at 6 hourly intervals. Best track positions and intensities, which are based on past storm assessment of all available data, may differ from values contained in storm advisories. They also generally will not reflect the erratic motion implied by connecting individual center fix positions.

3. Bulletin: A public release from the National Weather Service Hurricane Warning Office issued at times other than those when advisories are required. A bulletin is similar in form to an advisory, but includes additional general newsworthy information.

4. Cautionary Advisory to Small Craft: When a hurricane is within a few hundred miles of the coastline, small craft operators are warned to take precautions and to avoid entering the open area.

5. Cyclone: An atmospheric closed circulation rotating counter-clockwise in the Northern hemisphere and clockwise in the Southern hemisphere

6. Extreme Hurricane: A tropical cyclone with maximum winds of 126 mph (118knots) or higher and minimum central pressure of 28.00 inches Hg (711.20 Hb 948.19 Mb) or less.

7. Eye: The roughly circular area of comparatively light winds that encompasses the center of a severe tropical cyclone. The eye is either completely or partially surrounded by the eye wall cloud.

8. Gale Warning: A notice added to a small craft advisory when winds of 38-55 mph are expected.

9. Hurricane: A tropical cyclone in which the maximum typhoon sustained surface wind (using the U. S. 1-minute average) is 64 knots (74 mph or 119 km/hr) or more. The term hurricane is used for Northern hemisphere tropical cyclones east of the International Dateline to the Greenwich Meridian. The term typhoon is used for Pacific tropical cyclones North of the equator and West of the International Dateline.

10. Hurricane Categories: The National Weather Service categorized hurricanes by intensity on a scale of 1 to 5. This scale is known as the Saffir-Simpson Hurricane Wind Scale.

11. Hurricane Local Statement: A public release prepared by local National Weather Service offices in or near a threatened area giving specific details for its county/parish warning area on (1) weather conditions, (2) evacuation decisions made by local officials, and (3) other precautions necessary to protect life and property.

11. Hurricane Season: The portion of the year having a relatively high incidence of hurricanes. The hurricane season in the Atlantic, Caribbean, and Gulf of Mexico runs from June 1 to November 30. The hurricane season in the Eastern Pacific basin runs from May 15th to November 30th. The hurricane season in the Central Pacific basin runs from June 1st to November 30th.

12. Hurricane Warning: An announcement that hurricane conditions (sustained winds of 74 mph or higher) are expected somewhere within the specified coastal area. Because hurricane preparedness activities become difficult once winds reach tropical storm force, the hurricane warning is issued 36 hours in advance of the anticipated onset of tropical- storm force winds. Dangerously high water or a combination of dangerously high water and exceptionally high waves may be seen even though winds may be just near hurricane strength.

13. Hurricane Watch: The first alert when a hurricane poses a possible, but yet uncertain, threat to a certain coastal area or when a tropical storm threatens the watch area and has a 50/50 chance of intensifying into a hurricane. Small craft advisories are issued as part of a hurricane watch advisory.

14. Indirect Hit: Generally refers to locations that do not experience a direct hit from a tropical cyclone, but do experience hurricane force winds (either sustained or gusts) or tides of at least 4 feet above normal.

15. Landfall: The intersection of the surface center of a tropical cyclone with a coastline. Because the strongest winds in a tropical cyclone are not located precisely at the center, it is possible for a cyclone’s strongest winds to be experienced over land if landfall does not occur. Similarly, it is possible for a tropical cyclone to make landfall and have its strongest winds remain over the open water Compare direct hit and strike.

16. Land Subsidence: The sinking of land, caused mainly by the withdrawal of underground water from while supplying cities and industries. This phenomenon may cause coastal areas to become more vulnerable to tropical storm flooding.

17. Major Hurricane: A hurricane that his classified as Category 3 or higher.

18. Radius of Maximum Winds: The distance from the center of a tropical cyclone to the location of the cyclone’s maximum winds. In well developed hurricanes, the radius of maximum winds is generally found at the inner edge of the eyewall.

19. Saffir-Simpson Hurricane Wind Scale : The Saffir-Simpson Hurricane Wind Scale is a categorization based on the hurricane’s intensity at an indicated time. The scale provides examples of the type of damage and impacts in the United States associated with winds of the indicated intensity. The following table shows the scale broken down by wind speed.

Category Wind Speed Surge Damage (mph) I 74-95mph 04 -05 Very dangerous winds will produce (64-82kt) ft some damage II 96-110 (83- 09-12 Extremely dangerous winds will cause 95kt) ft extensive damage III 111-130 (96- 09-18 Devastating damage will occur 113kt) ft IV 131-155 09-18 Catastrophic damage will occur (114-135kt) ft V >155 or > > 19 ft Catastrophic damage will occur 135 kt 20. Seiche: A series of fast moving waves that sometimes are superimposed upon the storm surge. This phenomenon may cause total destruction and great loss of life. 21. Storm Surge: An abnormal rise in the level of the sea produced by the hurricane. This inundation is usually responsible for the greatest loss of life and destruction of property. 22. Storm Warning: A notice added to small craft advisories when winds of 56-73 mph are expected. Both gate and storm warnings indicate the coastal area to be affected and the expected intensity of the disturbance. 23. Tornado: A violently rotating column of air, nearly always observable as a funnel cloud. 24. Tornado Forecast Information: An advisory stating that a tornado is in the area 25. Tornado Warning: An advisory stating that a tornado actually has been sighted by the human eye or has been indicated by radar. 26. Tropical Cyclone: A general term for the nearly circular cyclones that originate over tropical oceans. It includes tropical storms, tropical depressions and all types of hurricanes. 27. Tropical Cyclone/Hurricane Advisories: Message issued simultaneously by the Hurricane Warning Offices and the National Hurricane Center in Miami, every six hours, describe the storm, its position, anticipated movement and prospective threat. 28. Tropical Depression: A tropical cyclone with sustained winds of less than 39-mph (34 knots). 29. Tropical Storm: A tropical cyclone with sustained winds of 39-73 mph (34-63 knots).

HURRICANE MAPS AND TRACKING

Official updates will be sent electronically via email from the National Weather Service/NOAA to Department Directors and Clinical Managers from the Command Center. This update will occur every 4 to 6 hours as released by the National Weather Service.

PREPAREDNESS

From December 1 to May 31, normal operating conditions exist. At the May meeting, the Safety Committee should review the Hurricane Plan and suggest changes to the Hurricane Plan, including reminder of hurricane season and generate “A” of SECOND STAGE.

Of particular importance during this period is the practice of a planned drill to promote the emergency preparedness of hospital staff. A simulated disaster exercise and subsequent, written appraisal can greatly facilitate the Safety Committee’s efforts in assuring Disaster Plan effectiveness.

DUTIES TO BE PERFORMED DURING HURRICANE SEASON

Notification of Personnel

Notification in writing by the Safety Committee Chairman is sent to all hospital personnel including the Medical Staff that we are now in Hurricane Season.

Employee Dependent Update Meeting

To ensure the coordination of everyone’s efforts that may be brought to the hospital in the event of a hurricane warning. It is necessary that families of employees be informed of any changes made in the Hurricane Plan. It is also important in order to determine their assignments and to designate dependent activities such as babysitting, helping in nursing care, helping in food service, etc. This allows for a smoother coordination of efforts in the event that personnel are called to the hospital. This memo is to be coordinated through the efforts of the Human Resources Director.

Departmental Call Lists

All departments should provide the Safety Director, Administration, and Human Resources with an updated Call Dependent List. Each department will have their Call List accessible for reference.

DUTIES TO BE PERFORMED DURING HURRICANE PREPAREDNESS/HURRICANE ADVISORY The following key actions may be undertaken during the Hurricane Advisory by the personnel indicated. A. Administration 1. The Administrator, at his/her discretion, will cancel vacations of all key administrative personnel. (See list – Appendix C). 2. The Safety Committee Chairman, or Safety Officer, at his/her discretion, will

convene the Safety Committee and update the Department Directors and personnel as needed. B. Nursing Service 1. (See Appendix D). C. Engineering 1. See Appendix J).

D. All Departments 1. Upon notification by the Administrator, Safety Officer or Safety Committee Chairman, all Department Directors will be required to implement Stage III of their Hurricane Disaster Plan. 2. All Department Directors will be instructed to stay in close contact with the hospital or close to a telephone in the event the Disaster Call-In roster is implemented.

STAGE ONE: HURRICANE WATCH

A. Command Center Staffing Notification of Hurricane Watch comes through the public media, which is normally radio or television. The Administrator or his/her designee during this phase establishes the Command Center in the Administrative Board Room. The Command Center will be staffed by the following: 1. Administrator, C.E.O or designee 2. The Chief Nursing Officer 3. The Facility Manager or designee 4. The Medical Director or designee B. Administration 1. The Administrator or designee requests that all key personnel report to the hospital in person. Key personnel are designated in Appendix C. 2. Satellite phones and other devices are delivered to the Boardroom. 3. Television is turned to local or Weather Station to track the storm. C. All Departments 1. Each Department Director or their designee will implement Stage IV of their Hurricane Preparedness Plan. 2. Each department is responsible for reporting the number of employees and the number of dependants they will be expecting to come to the hospital. The Department Directors will deliver the lists to the Commando Center. 3. Nursing Units will review patient roster to identify all early discharges, patients that may require transfer, equipment needed, type of transfer (air, ground, bus), if nurses will need to accompany the patient(s). Of particular importance, Directors and managers must identify patients who require close monitoring, i.e., suicidal patient, elopement risks, and high fall risk patients. These patients will require monitoring through transfer or evacuation and their sitters will follow through that process until a safe handoff has occurred. 4. Surgery and special procedure schedules (including cardiac catheterization lab) are reviewed for possible cancellation of elective cases. Urgent cases may continue, especially those with minimal recovery time.

D. Director of Human Resources and Utilization Review 1. The Director of Human Resources will take such actions as are necessary to establish a transportation system for employees to go home to secure their personal possessions before returning to the hospital. 2. E. Medical Director 1. The Medical Director will keep the physicians’ call list current and will be responsible for calling any physician who is needed.

STAGE TWO: HURRICANE WARNING

A. Command Center Staffing Notification of Hurricane Watch comes through the public media, which is normally radio or television. The Administrator or his/her designee during this phase establishes the Command Center in the Administrative Board Room. The Command Center will be staffed by the following: 1. Administrator, C.E.O or designee 2. The Chief Nursing Officer 3. The Facility Manager or designee 4. The Medical Director or designee B. Administration 1. The Administrator or designee requests that all key personnel report to the hospital in person. Key personnel are designated in Appendix C. 2. Satellite phones and other devices are delivered to the Boardroom. 3. Television is turned to local or Weather Station to track the storm. 4. Strength of the storm is evaluated and the expected track. Decisions are made for: a. key personnel to be in place and shelter in place b. evacuate (storm is greater than a category 3), inform skeleton crew. i. finalize and submit # and list of patients that require evacuation and equipment/personnel needs, and type of transfer to the State ii. implement transfer log to record patient destination iii. inform Corporate office of plan iv. initiate the securing medical records v. order the movement of portable equipment to 2nd floor in empty patient rooms and storage areas

C. All Departments 1. Each Department Director or their designee will implement Stage IV of their Hurricane Preparedness Plan. 2. Each department is responsible for reporting the number of employees and the number of dependants they will be expecting to come to the hospital. The Department Directors will deliver the lists to the Commando Center. 3. Nursing Directors will ensure that 1:1 sitters or attendants with suicidal patients are moved together. Ancillary personnel or Case Managers may be used to assist in monitoring these patients. Suicidal patients are assigned a LVN, RN Case Manager, Social Worker, or ST/PT/OT, along with the sitter to ensure 2:1 coverage during evacuation. The list of suicidal and 1:1 patients is monitored closely to ensure these

patients are monitored carefully. a. Ensures physicians are notified of the need to appropriately discharge as many patients as possible. b. All elective surgical and procedural cases are cancelled c. Ensures essential staff are aware to report to the hospital along with their dependents and provide that count to the Command Center and Human Resources D. Director of Human Resources and Utilization Review 1. The Director of Human Resources will take such actions as are necessary to establish a transportation system for employees to go home to secure their personal possessions before returning to the hospital. 2. Requests cots and lists of open rooms

E. Medical Staff Coordinator 1. The Medical Director will keep the physicians’ call list current and will be responsible for calling any physician who is needed. 2. Identify any physicians that wish to remain on site at the facility to be available to assist any injured patients that may present post-storm

DUTIES TO BE PERFORMED IMMEDIATELY PRIOR TO THE STORM. A. Command Center 1. The Command Center is staffed by: (See Stage IV list) and is located in the Board Room. 2. Command Center takes complete charge of operations and immediate decisions to be made regarding the discharge of patients, department plans and their appropriate implementation.

C. Human Resources Department Establish “Personnel Pool” to reallocate in-house personnel (to possibly include some of the employees’ family member) at the desecration of the Command Center. D. Marketing Establish temporary headquarters to act as a liaison with the news media and with patients’ families (refer to Appendix F). Public Relations Personnel will maintain this headquarters. E. Transfer If the hospital or any area therein cannot be considered a safe retreat per authorities and/or the safety designee, then the following will occur: 1. Patient remaining in areas considered unsafe will be relocated to safe areas in the hospital. F. Switchboard

1. The Switchboard will be under 24-hour operation until the warning is over.

G. All Departments (Department Directors and Managers) 1. All departments initiate Stage V of Department Plan (See Appendices) unless directed differently by Command Center or by the Hurricane Preparedness Committee. 2. Filling of vessels, bathtubs, hot tub, for non-potable use. a. Nurses will fill vessels with water in each unit for potable and non-potable use. b. Housekeeping is to fill the hot tub in the Hydrotherapy Room. 3. Supplies for hurricanes and other natural disasters should be stored securely and inventoried periodically to make sure that they are adequate and retain their quality. 4. Secure all emergency equipment, extension cords, flashlights, batteries, etc. 5. (See Appendices for more detailed information.) 6. Frequent rounds are expected during the height of the storm to ensure staff, patient, and guest safety by monitoring for new leaks, damage, or the need to internal evacuate from one area to a safer area.

H. Engineering 1. Close hurricane blinds 2. Remove any outside tables, chairs, trash cans, etc. than may become projectile during the storm

STAGE THREE: ONSET

If local radio is available, keep tuned to local radio stations for storm details. The "All Clear" signal is given over FM radio. Try to remain calm at all times

SAFETY RULES DURING HURRICANE

 Move to the designated shelter listed above.

 If an underground shelter is not available, move to a small interior room or hallway on the lowest floor and get under a sturdy piece of furniture. Put as many walls as possible between you and the outside.

 Stay away from windows. Go to the center of the room. Stay away from corners because they attract debris.

 Get out of automobiles immediately and seek shelter in a nearby building. If a building is unavailable or there is no time, get out of the car and lie in a ditch or low-lying area away from the car. In urban or congested areas, never try to outrun a hurricane in a car or truck; instead, leave it immediately for safer shelter. Hurricanes wind strength can change intensity quickly and can lift up a car or truck and toss it in the air.

 If caught outside, lie flat in a nearby ditch or depression and cover your head with your hands. Be aware of potential for flooding.

 Be aware of flying debris. Flying debris from hurricanes causes most fatalities and injuries.

 Avoid places with wide-span roofs such as auditoriums, cafeterias, large hallways, or shopping malls.

 Do not open windows; use time to seek shelter.

 Use arms to protect head and neck.

STAGE FOUR: AFTER THE HURRICANE

A. All Departments 1. Assess damages and submit report to Command Center. 2. Report all problems to Command Center. 3. Rotate employees so that some may return home, but maintain needed staffing levels. B. Engineer 1. Establish those services that are available through the use of emergency power. 2. Contact utilities to provide re-establishment of services as needed. 3. Respond to the needs of the Command Center. 4. Provide for additional electrical service through AGGREKO INC. of Corpus Christi, TX for extended power failure. C. Command Center 1. At the discretion of the Administrator, or designee, implement the External Disaster Plan. 2. Ensure that the Communication networks remain in operation. 3. Respond as needed to internal and external requests for services and supplies. D. Marketing 1. Will call back Social Services and UR personnel as needed. 2. Establish communication by phone with patient families as to the situation at the hospital. 3. Handle all news media requests in conjunction with the Command Center. 4. Determine previously discharged patients’ status. E. Safety/Disaster Committee After the emergency is over, evaluate the disaster plans, in light of what transpired during the actual implementation of the Hurricane Plan (Written appraisal required).

APPENDIX A

PERSONAL INFORMATION FOR EMPLOYEES AND DEPENDANTS

1. The entrance to the hospital will be maintained at the main front lobby.

2. Only “on-duty” physicians will be housed in the facility. Only “needed and assigned” personnel will be housed in the hospital. The immediate family of physicians and other hospital personnel noted above will be allowed to stay.

3. All dependents will be housed in the building. However, they must first report to the Housing Assignments Clerk to assigned by Human Resources in the Lobby, NAME BADGES will be issued, and they are to be worn at all times.

4. It is advised that you stay away from glass windows and keep all blinds closed in the rooms to minimize the danger from flying Shattered glass. It would be best if the interior areas of the hospital were used instead.

5. All dependents will be asked to assist the hospital staff in performing need functions during this alert period. Dependents will be asked to perform those tasks, which an inexperienced person might be able to handle. These may include:

A. Providing childcare for dependents of employees on duty.

B. Helping in the movement of patients as needed.

C. Helping in the serving of food to the patients.

D. Helping housekeeping in some of their many duties.

E. Sitting with certain patients.

6. All dependents and employees should know what they “may” and “may not” bring into the hospital. Below is a list, which may serve as a guide in case there is any confusion:

ITEMS TO BRING:

A. Games and books.

B. Flashlights and batteries.

C. Portable radios and batteries – not plug-in radios.

D. Baby medications, supplies and food.

E. Personal medications (prescriptions) and toiletry items.

F. Provisions for special diets.

G. Money for food.

H. Change of clothing.

I. Sleeping bags.

J. Sheets, blankets and pillows.

K. Large plastic container(s) of drinking water (3 per family).

ITEMS NOT TO BRING:

A. Food.

B. Pets of any kind.

C. Alcoholic beverages.

D. Candles.

E. Fuel lamps.

F. Firearms.

G. Electrical appliances.

7. A nursery will be established in the playroom of the Pediatric Department for small children of hospital employees. The older children and the spouses of hospital employees, as determined by the Human Resources Department/designee will supervise this. This may be moved to the ICU/CCU waiting area if necessary.

8. All persons housed must agree with the above in order to be allowed to remain.

APPENDIX B

TORNADOS

The times of greatest tornado potential for the Brownsville area are the months of February, March, and April, and once again t in the month of November.

A Tornado Watch is issued by the United States Weather Service for a defined area of the greatest potential for the spawning of tornadoes.

A Tornado Warning is issued by the United States Weather Service in a defined area when one is sighted or when it has been confirmed to be in existence by radar.

The best thing to do when a Tornado Warning is issued is to stay away from outside glass opening to a building. Move all patients and yourself to the interior corridors or to the rooms.

When the hospital is included in a tornado warning area, the Nursing Supervisor shall remain in the communication with the Administrator on call and shall implement the Disaster Plan upon direction of the Administrator on call.

APPENDIX C

KEY ADMINISTRATIVE PERSONNEL

1. Administrator

2. Medical Director

3. Chief Nursing Officer

4. Chairman of Safety Committee

5. Marketing Director

6. Engineering/Safety Director

STAGE ONE AND TWO: (See Hospital Wide Plan) STAGE THREE 1. CNO or designee to contact the Command Center. 2. Nurse Management Team will meet to review inpatient census status and staffing requirements. A. DEPARTMENT DIRECTORS: 1. Inform the CNO of personnel needs/deficiencies. 2. Monitor and coordinate flow of information from CNO to staff. 3. Instruct Charge Nurses to maintain and update a log of patients expected to discharge, those who require transfer to another facility (total number), the number of patients that may transfer by bus, the number of patients that must transfer via ambulance (How many require oxygen, IV therapy, etc. ICU NICU will include ventilated patients, those will arterial lines and Intra-aortic balloon pumps, or intra cranial pressure monitoring). ID suicidal and elopement precaution patients. These lists are updated every 4-6 hours (See attached Log Form). 4. Deliver completed log to the Command Center. Report supply needs to Command Center. 5. On notification from the Administrative Team, initiate the Disaster Call List. 6. Review and update as needed shift schedule for emergency implementation. B. ADMINISTRATIVE SUPERVISORS/HN: 1. Determine with medical staff those patients who can be discharged and initiate those orders upon direction by CNO. 2. Communicate the number of the potential discharges to the Department Director. 3. Communicate gross deficiencies in supplies to the Department Director. 4. Upon notification from the Department Director, begin the implementation of the established call system. C. CHARGE NURSES:

1. Instruct Primary Nurses to update potential transfer log that indicates the patients transfer status (E) Emergent – highest priority to move (usually requires air transport) (U) Urgent – Requires transport with equipment, monitoring, pain control, oxygen etc and ambulance services. (B) Bus patient is stable and one nurse can monitor several patients during transfer. Patient may require pain med and intermittent IV antibiotic therapy. (C) Ensure Suicidal and elopement precaution patients have been identified. 2. Inform the Administrative Supervisor/HN of the deficiencies in the supplies quantities. 3. Under the Direction of the Department Director, inform all the patients of the current, existing situation and preparedness. The Nursing Department, under the direction of the CNO, will initiate the Administrative Supervisor'’ patient rounds to assess actual patient census/acuity. A. DEPARTMENT DIRECTORS: 1. Meet with the Administrative Supervisor/HN to evaluate the current census and the status

of discharges. 2. Obtain an up-to-date potential transfer log (tracking log) 3. Intervene with physicians for the discharge and/or the transfers of orders/arrangements. 4. In case that the VRMC is in an evacuation area, transfer will be initiated on all patients. 5. Assess the number of staff available to remain versus the staff required for patient coverage over a 24-hour period.

6. Giving consideration to each of the staff member’s residence location/dependent care needs, designate staff assigned to remain at VRMC, return to their home, or be called in from stand-by at their home. B. ADMINISTRATIVE SUPERVISOR/HN: 1. At the completion of the census estimation, present Department Director the number of patients/staff and estimated number of dependents to be at VRMC within the next 24 hours. 2. Complete and route the bed availability form as per the External Disaster Plan. 3. At the request of the Department Director, call in the staff into VRMC from stand-by. 4. Determine all supply needs. 5. Have a completed list of all patients pending discharge with status of each, and assure that all physicians’ orders are documented. C. CHARGE NURSE: Reassure all patients/SO of conditions and readiness.

A. DEPARTMENT DIRECTORS: 1. Completion/continuation of transfers. 2. Assure continuation of patient/SO reassurance. B. DEPARTMENT DIRECTOR/CLINICAL MANAGER NURSE: 1. Support Staff. 2. Initiate a 12-hour schedule, and review for patient needs. 3. All empty portable water containers to Materials Management. STAGE FOUR All staff assess and report to Administrative Supervisor/HN all: A. Facility problems. B. Changes in staff and staffing needs. C. Changes regarding patient needs. D. Administration Supervisor/HN begin preparation to receive patients from external disaster. E. Begin preparations to receive/retrieve transferred patients. F. Monitor supply and water levels-report needs G. Department director will maintain the availability to staff regular, update the facility staff, and supply all conditions to the CNO. H. Intervene with patients or significant other to support calm return to normal functioning.

APPENDIX E

HURRICANE PREPAREDNESS PLAN FOR MARKETING

The following is the “Hurricane Preparedness” Action Plan for Marketing and Patient Relations.

STAGE ONE AND TWO See hospital-wide plan. Confirm staffing and assigned roles. Have statement prepared for the media as to plan of action anticipated. STAGE THREE 1. Choose Media Center Location and contact reporters as to procedure to follow obtaining information 2. Provide “Visitor Advisory” and begin enforcement of the visitation policy at the information desk. 3. Establish Media Center and be prepared to provide status reports as requested. 4. Establish visitor contact, and inform all families that they must now leave. Promote timely exit and current weather update. 5. Assist where necessary with the transfer of patients, the preparation of the building, and the tasks as assigned by the Command Center. 6. Insure that documentation of hurricane log is maintained. 7. Develop an accurate log of all patients remaining in-house, where located, and family contact. As time allows, call families if not located in-house with status reports.

STAGE FOUR 1. Media Center-Assess status report after “ALL CLEAR”, contact media answer requests. 2. Family Contact-Contact patient’s families by phone with status report.

SUPPLIES

GENERAL

Games/adults and children Extra pillows and blankets Paperbacks and magazines Tape recorders and cassettes Radio and batteries Flashlights and 5 batteries

COMMAND CENTER

Walkie Talkie-means of communication should phones go out: Satellite Phones Radio battery Typewriter (manual) Paper Flashlight and batteries

APPENDIX F

HURRICANE PREPAREDNESS PLAN FOR PHARMACY

STAGE ONE Normal operating conditions. Orientation to External Disaster and Hurricane preparedness Plan. STAGE TWO 1. Notification to department personnel by supervisor that hurricane has begun. 2. Call lists checked and update by department supervisor 3. Hold department meeting at the facility to review key areas. 4. List out duties and responsibilities of employees during disaster. 5. Begin to order supplies that will last 5-7 days. Written inventory is required. 6. The Director of Pharmacy or the Pharmacist-in-Charge must assess par levels. 7. Assigned staff and dependents will report to the hospital. 8. Staff shall begin shift work. 9. Par levels shall remain adequate.

STAGE FOUR 1. The Pharmacist will assess damages and report to the Command Center 2. Pharmacist at the hospital will review staffing requirements to maintain adequate staffing and address any concerns/needs. A. COMMUNICATION 1. The Pharmacist will notify the Command Center of the personnel on duty for the event. B. PERSONNEL DISTRIBUTION 1. A minimum of two Registered Pharmacists will remain in the hospital pharmacy to maintain and dispense and adequate supply of drugs, including narcotics, to the treatment areas and to the patient units. 2. A minimum of one technician will be required to assist the Pharmacist. C. SUPPLIES 1. The pharmacy will obtain any additional pharmaceutical form suppliers if required. 2. A prepared list of necessary pharmaceutical will be available for inventory.

APPENDIX G

HURRICANE PREPAREDNESS PLAN FOR PERSONNEL

Preparedness (JUNE 1 TO NOVEMBER 30) A. The Director of Personnel will send out a notice to all hospital personnel. B. An employee dependent update meeting will be held in the early part of the hurricane season to assign rooms, designate activities, babysitting, etc. This meeting is to be coordinated through the efforts of the Director of Personnel.

STAGE ONE A. Finalized and confirm items under STAGE TWO. Check supplies that are needed. STAGE TWO A. Complete a list of supplies needed for employee nursery and personnel pool. B. Call the City of Brownsville Transportation Department to establish transportation between the hospital and the employees’ homes. C. Report to the Command Center how many dependents expect to house while still in the hospital. STAGE THREE A. Move damageable supplies to a safe area. Establish “personnel pool” to relocate in- house personnel and dependents. B. Assign housing assignments clerk. STAGE FOUR A. Assess departmental damages and report to the Command Center.

APPENDIX H

HURRICANE PREPAREDNESS PLANS FOR:

ACCOUNTING INFECTION CONTROL OFF-SITE CLINICS ADMINISTRATION INFORMATION SYSTEMS PERSONNEL AUXILLIARY MEDICAL RECORDS RISK MANAGEMENT BUSINESS OFFICE NURSING ADMINISTRATION EMPLOYEE HEALTH STAFF DEVELOPMENT

PREPAREDNESS AND STAGE ONE See hospital-wide plan. A. Monitor situation. B. Review Hurricane Preparedness Plan.

STAGE THREE A. Implement item “F” of duties to be performed during the fourth stage of the hurricane. B. Prepare to release employees from work. C. Ask for volunteers to stay during the hurricane. Be prepared to assist in monitoring patients that are suicide, elopement, or fall risk D. Assure adequate supply of disk, tapes, etc. for computer backups. E. Prepare to store all records off floors and away from windows. F. Implement systems back up (computers). G. Raise all records off floor. H. Release nonessential employees at least 8 hours before projected landfall.

STAGE FOUR A. Instruct employees to return to work as soon as roads are passable and systems returned. B. Instruct employees to call in daily if prevented from returning for more than one day.

APPENDIX I

HURRICANE PREPAREDNESS PLAN FOR HOUSEKEEPING/LAUNDRY

Duties to be performed by the Housekeeping Department during the six stages of Hurricane Preparedness

PREPAREDNESS From December 1 to May 31, normal operating conditions exist. A. June 1 to November 30 is hurricane season in the Gulf Coast area. Normal operating conditions exist until notified that possible threat exists in the Gulf Coast. B. Notify any change in the Hurricane Plan to your immediate family. C. Maintain a current call list.

STAGE ONE A. Hurricane advisory is in. B. Review Hurricane Plan with all Housekeeping employees. C. Housekeeping employees should keep “Alert” status. D. Check for emergency supplies such as linens, paper products, and cleaning chemicals. STAGE TWO A. Housekeeping will have extra supplies of paper towels, toilet paper and prepare water in cans for toilets. B. Housekeeping will check inventory on linen for census of 65 and will bring extra housekeepers for post activities to help. C. All dirty linen will be washed and dried before leaving. STAGE THREE A. Linen inventory will be at correct par level for two days due to low census. In case of emergency, Housekeeping may use brand new linen, not currently in circulation. At this time, linen is limited to a few dozen of each item. B. Laundry will be scheduled to assure that all linen available is clean and that a two- day supply is stored at the hospital. C. Water in trashcans will be kept in all units. One trash can per unit will be filled one day before landfall. Two to three extra cans will be kept in the Housekeeping Department. STAGE FOUR A. Post-disaster activities B. Inspect damage to building and maintain integrity. C. Schedule work force as needed.