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DISASTER RESPONSE PLAN

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I.PURPOSE
This plan is a guide for the actions of the hospital in the event of an internal/external disaster. Supplemental plans are provided for contingencies that might arise. Each department also has detailed plans of action, specific to the department.   

II. POLICY
This plan has been developed to take effect when the safety and welfare of guests (patients) and team members is threatened as a result of fire, explosion, or any other incident that renders all or a portion of the hospital incapable of functioning. It references supplemental plans and outside resources, which may be utilized depending on the nature of the emergency. 

This plan has been devised to provide a concise yet thorough presentation of information required to assure the fulfilling of Dupont Hospital’s role in conjunction with the Allen County Emergency Preparedness Director in any reasonable, conceivable, potential or actual disaster situation that precipitates problems resulting from sharp departure from the normal routine. 


Definition of Disaster:

A disaster is defined as any situation(s), usually catastrophic in nature, where a number of persons are plunged into helplessness and suffering; and, as a result, are in need of food, clothing, shelter, medical/nursing/hospital care and other basic necessities. 

Dupont Hospital is part of the community-wide disaster plan and can expect to receive approximately fifty victims based on available beds and guest acuity. 

III. AUTHORITY AND RESPONSIBILITY
The administration of Dupont Hospital maintains ultimate responsibility for the oversight and effectiveness of the internal/external disaster response and strives to assure a safe environment for guests (of all ages), visitors, team members, volunteers, and medical staff. The administration provides whatever administrative assistance is reasonably necessary to support and facilitate the implementation of ongoing operations of this effort, assigns available team members to coincide with current staffing patterns, and undertakes the management of space, supplies, and security. 

IV. PROCEDURE
In response to a disaster, Dupont Hospital will implement the Hospital Incident Command System (HICS) as the method by which the hospital will operate when a disaster is declared.

Dupont Hospital participates in the statewide Indiana Hospital Mutual Aid Memorandum of Understanding (MOU), which is a voluntary agreement addressing the loan of medical personnel, pharmaceuticals, supplies and equipment, or assistance with emergency hospital evacuation, including accepting/transferring guests.

Disaster information to be provided:

1.Name and telephone number of the person making the telephone call
2.Type of disaster
3.Disaster location
4.Approximate number of victims
5.Estimated time of arrival.

After receiving the above information, the Emergency Department (ED) Charge Nurse will immediately notify the Administer on Call or House Specialist Coordinator (Nursing Supervisor).  This individual will become the Incident Commander.

When the “Incident Commander” has decided to implement the plan, Security will be notified and make the announcement, repeating three times:  “Attention Please—Code D1”.      

Upon hearing the Code D1 announced, all team members would implement their call tree and activate their Job Action Sheets.  At this time, all departments will make sure their handheld radios are on and accessible. 

Channel 1----Security
Channel 2----Incident Command
Channel 3----House wide Department Radios
Channel 4----Emergency Department

When the arrival of victims is imminent, the ED Charge Nurse will notify the Incident Commander.  

The Incident Commander will instruct Security to make the following announcement, repeating three times:  “Attention Please—Code D2”.

At this time, each department will, again, activate their Job Action Sheets. 

The following areas will be activated:

Incident Command Center - 416-5870
Security - 416-3266
Labor Pool—Clinical - 416-2392
Labor Pool—Non-Clinical - 416-2391
Family Center - 416-3009
Discharge Area  (Lobby) - 416-3152
Satellite Phone in Command Ctr - 254-201-2307
HCC fax line - 416-5879

All available clinical team members will report to 2100 and sign in.  All available non-clinical team members will report to 2300 and sign in.

Team members reporting for duty must have their hospital ID and must badge-in at the team member entrance.

EMERGENCY DEPARTMENT

Casualty Flow Plan
Continuous flow of casualties from one treatment area to another will expedite the orderly treatment of mass casualties. The stages of casualty flow are: 

1.Triage (receiving and sorting) 
2.Assignment to an initial treatment area
3.Initial treatment of first aid and release
4.Transfer to inpatient facilities for further definitive treatment, convalescence, and release. 

Triage Area (Receiving and Sorting) 

Location
The area inside the entrance of the Emergency Department (waiting area) will be used as the primary triage area for all categorizing of guests in either an internal or external disaster, unless otherwise designated. The Emergency Department physician and/or the Incident Commander will determine how and when expansion will take place as the situation changes and the numbers of casualties increase on arrival. 

Priorities
Priority I - Emergency Department, Red (Immediate): Seriously or critically injured and/or sick requiring medical treatment to save life or limb. 

Priority II – PACU/Recovery Unit, Yellow (Delayed): Seriously injured or sick requiring medical attention but not of an immediate nature. These guests require continuous monitoring. 

Priority III – Pre-operative Area, Green (Minor): Injured or sick (including hysterical guests) requiring only first aid or minor treatment and may then be released. 

Priority IV - Rehabilitation Services, Black (Dead On Arrival):  In the event of a disaster where guests are transported to the facility by EMS, the guests will arrive with a “Smart Tag”. 

NOTE: Expectant and/or dead-on-arrival guests are BOTH color-coded black.  Color code will be changed immediately upon arrival following determination of status. 

Levels of Emergencies
Level I - Five to ten guests. Existing treatment room plan in effect with additional team members assigned as needed. 

Level II - Eleven to twenty casualties. Utilization of pre-operative area and adjacent areas as needed. 

Level III - Twenty-one plus casualties. Implementation of all or part of the disaster plan as deemed necessary by the Chief Executive Officer/designee.

Staffing of Triage

The triage area will be staffed by: 

1.Triage RN 
2.Emergency Department registrars 
3.Transporters as needed 
4.One security officer.

Procedure
The following steps will be taken in receiving and sorting casualties:

1.All disaster victims will be brought directly to this area by the ambulance or other conveyances. They will be separated into immediate, surgery delayed, minor and DOA categories. 

2.The triage nurse assigned to this area will be responsible only for examining these guests to determine a tentative diagnosis and to which area they are to be routed. 

3.The registrars are responsible for seeing that each casualty is tagged with a pre-numbered disaster tag. All that is absolutely necessary to put on the tag is the diagnosis and destination (color coded). If time allows, the last name, address, and next of kin may be written on the tag. 

4.The transporters will transfer guests to a hospital stretcher or wheelchair with the assistance or by the direction of the nurse. Ambulatory guests may be walked to the Green (Pre-Operative) Area. Guests will need to be evacuated to the designated area as rapidly as possible to prevent congestion in the triage area and to get them to an area where their treatment can be started. 

5.DOA’s will be taken directly to the temporary body holding area and/or rehabilitation services on the ambulance stretchers and transferred into the cooler and/or to the rehabilitation floor.

6. Hysterical guests without serious injuries are to be sent to the Green (Pre-Operative) Area.

7.The triage nurse is responsible for the following: 

a.Filling out the tracking log 

b.Checking to see that each guest has a tag on with a tentative diagnosis and destination written on it.

8.   The security officer is responsible for the following: 

a.Supervising and maintaining order in the triage area 

b.Assisting in directing all visitors and/or family to the Birthplace entrance 

c.Having each ambulance move from the entrance as soon as possible. 

Immediate Casualty Area (Priority I Red) 

Location: The Emergency Department treatment room. 

Staffing: The immediate casualty area will be staffed by: 

1.Emergency Department physicians 
2.Treatment Area Supervisor 
3.Respiratory Therapists 
4.Unit Secretary/Tech
5.Transporters.
 
Procedure
1.The guests routed to this area will be those who need immediate emergency treatment. They may be medical, surgical, or obstetrical. 

2.An emergency department chart will be initiated on each guest. The unit secretary will see that one made available for each guest and that his/her name/tag number is put on the chart. 

3.Each guest will be given the emergency treatment that is required in the emergency area. As soon as it is feasible, the guest will be evaluated and admitted to the appropriate unit. Details for actual room assignment will be made through direct contact with the Operations Chief. 
The transfer will be made as soon as possible to allow for new guests that will be brought in from the triage area. 

4.Surgical guests will first be given needed emergency treatment. The guest’s personal belongings will be removed and placed in a bag with the guest’s name and tag number on it. Prep will be done upon arrival in the operating room. Surgery team members will arrange for the guest’s room assignment by calling the Operations Chief for bed assignment. The guest will be routed to the appropriate area. 

5.Obstetrical guests will be given only the required emergency treatment necessary. If delivery is eminent, the guest will be taken to the Birthplace for care. Should the guest deliver in the ED or Recovery, the guest and baby will be stabilized and transferred to the Birthplace. 

Supplies (located in the Emergency Department)

1.Disaster kits 
2.Disaster logs with clipboards
3.Emergency Department is responsible for other supplies. 

Delayed Casualty Area (Priority II Yellow)

Location: All delayed casualties will be transported to the PACU or designated area.

Staffing: The PACU will be staffed by: 

1.Physician, if available 
2.RNs 
3.Respiratory therapist 

Procedure
1.The guests routed to this area will be those who need surgery but the surgery is not an emergency, or those needing continuous observation. These guests will be held here until the operating room is available, or admission is arranged. 

2.The Emergency Department chart will be updated. 

3.It will be the responsibility of the nurses, under the supervision of the physician, to administer emergency and maintenance treatment and prepare each guest for surgery. 

4.In some cases, it may be deemed advisable to admit these guests to a room if their surgery is to be delayed for several hours.

Supplies

1.Guests will be transferred with a paper ED chart
2.PACU department supplies will be used
3.Runners will be used for supplies not available (retrieve from ED or surgery).
 
Minor Casualty Area - (Priority III Green)

Location:  Pre-Op will be used for minor casualty area or area as designated by Incident Command. 

Staffing
1.One physician, if available 
2.RNs 
3.Unit Secretary. 

Procedure
1.All guests routed here have a type of injury that can be treated and then released. 

2.The physician will instruct the nurses as to the treatment necessary for each guest. 

3.All treatments, medication, and supplies used on each guest will be recorded on the Emergency Department paper chart. 

4.Hysterical medically clear guests will be sent to this area and the nurse in charge of this area will notify St Joe Behavioral Health Assessment Team. Physician will order the type of treatment to be used. If hysterical guests remain in an uncontrollable state, they will be transferred to the St Joe Behavioral Health Program. 

5.When necessary treatment and records are complete, a transporter will escort the guest to inpatient registration. Keep chart and disaster tag together.

6.When registration is complete, the guest will be taken to the café where a team member will see that he/she is reunited with family, if they are present, or escorted out of building. 
                                                    
Supplies

1.ED paper chart will be with guest
2.Department supplies will be used
3.Runner will be used for supplies needed from ED or Surgery.

Dead On Arrival (Priority IV Black)

Location: Rehabilitation services will be utilized as a temporary morgue/body holding area. 

Staffing: RN and team member.
 
Procedure
1.All DOA and those who expire after being brought to Dupont Hospital will be taken to the body holding area. There will be two attendants in this area at all times. 

2.The forms (death packet) and shroud kits will be sent to the body holding area by the triage nurse. 

3.The Coroner/designee must be notified of all deaths. 

4.As soon as possible, the identified bodies will be evacuated at the direction of the Coroner. 

5.Accurate records will be kept as to the bodies received, the name of the family member notified, and the disposition of the body. The usual hospital forms for release of body will be used. 

6.All personal belongings will be placed in a separate paper bag with the guest’s name and tag number on it. These will be sent with the body. 

7.Bodies with no identification will be kept in one area.  Family members will not be brought to the body holding area to identify a body except by police or Coroner. 

8.Security will fill out appropriate paperwork prior to release of the body.  Bodies will be escorted/transported by Security.

9.For multiple fatalities, requiring temporary body holding area, refer to Fatality Management Plan.  

MEDICAL STAFF
1.In times of major influx of disaster victims/casualties into the hospital, the Medical Staff President must delegate extraordinary authority to specific physicians. 

2.In the absence of the Medical Staff President, this responsibility is assigned to the following members of the medical staff in the order listed: 

a.Medical Staff Vice-President

b.Medical Staff Secretary/Treasurer  

b.Chairman, Department of Surgery. 

DEPARTMENT RESPONSIBILITIES 
1.Emergencies involving fire traditionally require a general in-house alarm notification of all inhabitants. Other emergency situations will generally require more direct and precise notification. Use of the telephone or a runner with written messages and return acknowledgment is more appropriate. The Chief Executive Officer/designee will initiate the implementation of the internal/external disaster response. 

2.Necessity for general recall of team members is more likely under external disaster situations. Each Team Leader or person designated “in charge” will be responsible for contacting his or her off-duty team members as needed. 

a.The responsibility for implementing this call list rests with the department head/designee.

3.At the announcement, all departments with hand held radios stationed on their unit, must assure radios are turned on and set to “Channel 3”.

4.Disaster report forms must be filled out and faxed to Incident Command.  The form is located in the Red Emergency Binder under D1D2.  Fax number is 416-5879.

5.If incoming team members require, administration will provide adequately for the needs of immediate family 
members to include: 

a.Sleep Area 

b.Nourishment 

c.Child Care. 

INCIDENT COMMAND CENTER
The Hospital has implemented the Hospital Incident Command Structure (HICS) and is consistent with the National Incident Management System (NIMS).  The Incident Command Center is located in Conference Room 1011, next to Administration. The following is a list of Incident Command Center team members and their duties. (See organizational chart – Emergency Incident Command System and Job Descriptions).  

Incident Command Team
1.Incident Commander

a.The CEO, COO, CNO, CFO, CMO/CQO, all Team Leaders and House Specialists can fill this roll. 

b.Organizes and directs the Hospital Command Center.  Gives overall strategic direction for hospital incident management and support activities including emergency response and recovery. 

c.Authorizes total facility evacuation if necessary.

2.PIO

a.Community Relations fills this position.

b.All press releases are the responsibility of this position.

3.Liaison Officer

a.Those with skills in communication fill this position.

b.Functions as the incident contact person in the command center for representation from other agencies.  Monitors radio communication.

4.Safety Officer

a.Position filled by facility Safety Officer or Support Services Team Leader.

b.Responsibility for advising Incident Commander in regard to the safety of facility and team.

5.Operations Section Chief

a.Position filled by clinical Team Leader or appropriate leader appointed by Incident Commander.

b.Responsibilities are conducting the tactical operations to carry out the plan using defined objectives and directing all needed resources.

6.Planning Section Chief

a.Position filled by CMO/CQO, VP Human Resource, or Team Leader/Specialist in Quality Specialist. or Regulatory Compliance.

b.Responsibilities are collecting and evaluating information for decision support, maintaining resources status information, preparing documents, and maintaining documentation for incident reports.  Position is also responsible for preparing status reports, displaying various types of information, and developing the Incident Action Plan (IAP).

c.The effectiveness of the Planning Section has a direct impact on the availability of information needed for the critical, strategic decision-making done by the Incident Commander and other general staff.

7.Logistics Section Chief

a.A Team Leader/Specialist with knowledge of the building structure, utilities, material resources, etc. would be appropriate for this role.

b.This section provides support, resources and other essential services to meet the operational objectives set by the Incident Commander.

8.Financial Section Chief

a.It is recommended that the position be filled by the CFO, Controller or another individual experienced in fiscal operation.

b.This section monitors costs related to the incident while providing accounting, procurement, time recording, and cost analysis.

9.Medical/Technical Specialist

a.This position is filled with those Specialists in the field of the current disaster.

10.  All other roles and responsibilities are filled as needed.

V. NOTIFICATION SYSTEM 
If telephone communications are inoperative, team members will report to Dupont Hospital upon receipt of information that a disaster has occurred. 

If telephone communications are operative, the following system will be employed. There will be three types of voice communications used when notifying team members. 

1.   Code “D” Telephone Check:  “I repeat this is a telephone check only. Do not report.” 

2.   Code “D” Drill:  “I repeat this is a drill. Do NOT report to the hospital. If needed, what would  be your estimated time of arrival?”  Obtain and document availability status.

3.   Code “D”:  “This is a Code “D”. This is NOT a drill. What is your estimated time of arrival?” 

Upon receiving notification of a D1, the Team Leader/Charge person will proceed with the departmental recall, using the same voice communication. Once contacted, persons will not place calls to the hospital. 

VI. SPECIFIC DUTIES OF DEPARTMENTS/TEAM MEMBERS

INCIDENT COMMANDER (CEO, COO, CNO, CFO, CMO/CQO, House Coordinator Specialist)

The Incident Commander will:

1.Upon receiving word of a possible or imminent disaster, be responsible for the overall coordination and implementation of the Emergency Operation Plan.  The Conference Room will serve as Command Post (Extension 5870).

2.Consult with the Emergency Department Physician to determine that the number of guests and/or the severity of injuries constitute a disaster and that the Hospital Emergency Operations Plan should be implemented.

3.Maintain contact with

a.President of the Medical Staff or designee

b.Emergency Department Medical Director, who will call in additional physicians as need

c.Hospitalist

d.Appropriate Team Leaders and Team Specialists

e.Other members of the Executive Staff/Administration.

4.The Command Center will receive information from the ED Charge Nurse, listing casualties and their status. 

5.If deemed necessary, the Incident Commander will authorize:

a.The hospital Community Relations Department to contact local media to broadcast the disaster alert and ask all off-duty team members to report to the hospital.

b.The Support Services Team Leader/designee to request assistance from the Police Department for external traffic control.

c.The discharge of ambulatory inpatients will be done in cooperation with and on the advice of the Medical Staff President or the Hospitalist, if the Medical Staff President is not available.

d.The PIO from Community Relations to release information to the media in accordance with the circumstances prevailing at the time.

e.The Registration team to cancel routine and elective admissions.

f.The preparation of food service for appropriate people.

g.The acquisition of additional hospital supplies.

h.Pastoral Care and Case Management to notify families of victims as to their presence in the hospital and their condition. A list of families that have been notified to be provided to Community Relations/PIO.  

COMMUNITY RELATIONS/PIO (435-7119) 
Upon declaration of a D1, the Community Relations team member on-call will be contacted, according to the on-call schedule implemented through Security/Switchboard.  The on-call team member is responsible for contacting all other Community Relations team members so they may report to their assigned network facilities. In the event that the on-call team member is not immediately available, the Media Coordinator, Director of Community Relations, or Senior VP Strategic Development may be contacted to ensure proper department representation at the hospital when the disaster is declared.

See the Dupont Hospital HICS organizational chart and Job Action Sheet(s) for this area. The Job Action
Sheet is a position job description, which has a prioritized list of emergency response tasks, serves as a
reminder of the lines of reporting, and promotes documentation of the event.

1.The hospital representative from Community Relations/designee will be based in the command center common area of Building 2510 and will be directed by the Incident Commander.

2.Only information, approved by the PIO (Public Information Officer) from Community Relations/designee, will be released to the news media.

3.The Family Center will be located in the Resource Center.  A representative from Pastoral Care will release information obtained from the PIO to families of casualties.

4.Telephone inquiries regarding casualties will be directed to the Community Relations Department at 435-7119. Community Relations team members will operate the phone lines. All inquiries from the media will be directed to 435-7119. Information on the names of victims will be released to family with instructions to report to the Family Center in the Resource Center.

EMERGENCY DEPARTMENT
The Emergency Department Specialist (ext. 3143)/ED Charge Nurse (ext. 3002) will assume the role of Treatment Area Supervisor. If neither person is available the Incident Commander will designate a person to fill the role.

See the Dupont Hospital HICS organizational chart and Job Action Sheet(s) for this area. The Job Action
Sheet is a position job description, which has a prioritized list of emergency response tasks, serves as a
reminder of the lines of reporting, and promotes documentation of the event.

1.In the event of a community disaster, the City Dispatcher will notify the Emergency Department.

2.The ED person taking the call obtains:

a.Name of person calling – status
b.Type of disaster
c.Disaster location
d.Approximate number of victims
e.Estimated time of arrival.

3.ED charge person will then notify the AOC or House Coordinator Specialist.

4.In the community of Fort Wayne the Control Center is the Allen County Community Relations Department, phone number 911. The Emergency Department team will maintain contact with the Control Center. Contact with local, county, governmental and other disaster affiliated agencies, concerned with disaster relief, will originate from the Allen County Community Relations Department. All information from the disaster scene will be relayed via telephone (or Ihern radio in the event of telephone system failure) to the hospital Emergency Department.

AFTER D1 HAS BEEN ANNOUNCED, EMERGENCY DEPARTMENT IS RESPONSIBLE FOR:

1.Dismissing non-emergent guests already in the department.

2.Requesting family members of remaining guests to wait in the main lobby.

3.Initiating Emergency Department “Call Tree”.

4.Turning all radios on to “Channel 4.  Channel 4 is the ER channel.  Channel 2 is Incident Command and the Chiefs.  

a.The Treatment Area Supervisor will turn their radio to “Channel 2” to talk with Incident Command and Operation Section Chief.  

b.Preparing for arrival of disaster victims

a.Obtain extra carts from Med/Surg and Radiology

b.Notify Materials Management of need for extra supplies, dressings, etc.

c.Ensure rooms stocked.

5.Establishing the triage area.  

PREPARE FOR ARRIVAL OF DISASTER VICTIMS:
1.ED nurse will call Incident Commander to inform of estimated time of arrival (ETA).

2.ED nurse will call Administration and/or House Coordinator Specialist in the Command Center to announce D2 when arrival of victims is imminent.

3.In the ED, the triage nurse and Treatment Area Supervisor/Charge Nurse will be given handheld radios to communicate to each other.  If decontamination is necessary, the nurse at the shower will also be assigned a radio.  All will use “Channel 4”.

4.ED physician will assign other MDs to treatment areas.

5.Victims are sorted according to ED triage: 

a.Additional manpower can be obtained via notification of Operation Section Chief.

b.Separation of victims will provide optimal care.

UPON ARRIVAL OF DISASTER VICTIMS:
All victims will be seen in the triage area. 
1.Registration personnel will tag all victims with a Disaster Tag. The Disaster Tag is designed to identify victims, allow the physician to order appropriate tests, provide ancillary departments with written orders, and provide information regarding disposition of the victim. 
2.A guest log will be initiated at triage to track guest movement.  Depending on the number of victims, the log may be faxed to the Command Center to facilitate knowledge as to where guests are in the process of their care.

If victims are transferred to secondary stations prior to having a hospital chart, the Disaster Tag stays with the victim, securely attached, until an admitting chart can be obtained.  
TRANSFERRING VICTIMS TO SECONDARY STATION:

1.Stabilization of critically injured victims will include: brief exam, IV access established, airway management, and chest tube placement, control of hemorrhage, lab draws, and x-rays. Some medication may be given.

2.Surgical candidates will be sent to Pre/Post/PACU only when physicians are present in those areas to assume care of those victims.

3.Burn victims, only if there are no other injuries, will be stabilized and transferred to Med/Surg or ICU.  

4.OB victims will be transferred to the Birthplace after stabilization.  

5.DOA (dead on arrival) victims will go directly to the body holding area after being tagged.

COMPLETION OF THE DISASTER:

1)As the Emergency Department begins to diminish in guest load, the Treatment Area Supervisor/   Charge Nurse is responsible for:

a.Notifying the Operations Section Chief

b.Dismissing ancillary team members to home units

c.Restocking unit

d.Reviewing charts:

1)Keeping disaster tags with charts
2)Transferring orders from tags to charts
3)Obtaining physician signatures on records.

e.Post-conference with all departments will be held within one week of the event. 

f.Allow staff to vent feelings both (+) and (-) and allow for team input for improvement.

FOODS AND NUTRITION DEPARTMENT
The Nutritional Services Specialist (ext. 3261)/ Nutritional Lead will assume the role of Unit Leader. If neither person is available the Logistics Chief will designate a person to fill the role.

See the Dupont Hospital HICS organizational chart and Job Action Sheet(s) for this area. The Job Action
Sheet is a position job description, which has a prioritized list of emergency response tasks, serves as a
reminder of the lines of reporting, and promotes documentation of the event.
 
1.The Nutritional team will interrupt all meetings in progress and inform members of the disaster.

2.The Nutritional team who are away from the department will quickly complete their jobs and return to the kitchen.

3.Upon notification and authorization by the Logistics Section Chief, the Nutritional team, under the direction of the Nutritional Services Specialist/designee, will begin the preparation of simple meals for casualties, inpatients, team members, volunteers, families, and physicians.

4.The Nutritional Services Specialist/designee will notify the Logistics Section Chief when food items are anticipated to be in short supply and it becomes necessary to contact outside sources for additional food supplies/needs.

5.The Nutritional Services Specialist/designee will assess staffing needs and, if necessary, call in additional team members.

6.In the event that a disaster occurs outside of normal working hours, the Nutritional Services Specialist and the department managers will be contacted as part of the call process to develop the non-nursing personnel pool. 

7.At the announcement of D1, the Nutritional Services Specialist/designee will assure the department’s handheld two-way radio is turned on and monitor “Channel 3”.

FACILITIES/SUPPORT SERVICES
The Support Services Team Leader (ext. 3216, cell 452-6908)/Maintenance Lead will assume the role of Unit Leader. If neither person is available the Logistics Section Chief will designate a person to fill the role.  Security/Switchboard will notify Support Services Team Leader upon announcement of D1.

See the Dupont Hospital HICS organizational chart and Job Action Sheet(s) for this area. The Job Action
Sheet is a position job description, which has a prioritized list of emergency response tasks, serves as a
reminder of the lines of reporting, and promotes documentation of the event.
The Support Services Team Leader/designee will:

1.Coordinate all facilities and maintenance operations through the Logistics Section Chief unless otherwise directed.

2.All Maintenance team members in the hospital will remain in the hospital throughout the disaster alert and alternate duty assignments as necessary.

3.Assign Biomedical Engineers to Emergency Department and OR to assist with equipment difficulties in disaster treatment areas. 

4.The Maintenance Department will be responsible for locating and transporting any necessary equipment and making the hospital vehicles available for emergency transportation.

5.The Support Services Team Leader/designee will receive any specific emergency assignments from the Logistics Section Chief or the Safety Officer.

6.The Support Services Team Leader /designee will arrange through the Logistics Section Chief or Safety Officer for the assignment of additional plumbers, electricians, telephone technicians, elevator maintenance personnel, etc. as needed.

7.The Support Services Team Leader /designee will arrange to call in additional team members as necessary.

8.The Support Services Team Leader/designee will continually monitor the hospital’s energy, communication, and facility needs. In the event the engineering capabilities of the hospital are involved in the disaster, the Support Services Team Leader/designee, upon authorization by the Administrator on Call, will coordinate the implementation of alternative sources of power, water, communication and sewage and trash disposal with the Logistics Section Chief/Safety Officer.

9.In the event that a disaster occurs outside of normal working hours, the Support Services Team Leader and Maintenance on Call will be contacted by Security/Switchboard.  

10.Facilities will use “Channel 3” to communicate with Logistics and “Channel 1” to communicate with Security.

ENVIRONMENTAL DEPARTMENT
The Environmental Services Specialist (ext. 3215)/ES Lead will assume the role of Unit Leader. If neither person is available the Logistics Section Chief will designate a person to fill the role.

See the Dupont Hospital HICS organizational chart and Job Action Sheet(s) for this area. The Job Action
Sheet is a position job description, which has a prioritized list of emergency response tasks, serves as a
reminder of the lines of reporting, and promotes documentation of the event.

1.When a Code D2 is announced the Environmental Services Specialist/designee will assign team members to the non-clinical labor pool in Room 2300.

2.All Environmental Service team members who are assigned to guest areas will keep beds made and the areas tidy during the disaster alert. The Environmental Services team member in the ED will rearrange the furniture in the ED Lobby and triage area to make space for the walking wounded.

3.The Environmental Services Specialist/designee will coordinate the activities related to the physical preparation of disaster care areas (when possible) and perform other assignments as required by the Logistics Section Chief.

4.The Environmental Services team will expedite the preparation of vacated beds for incoming casualties and upon notification from the Logistics Section Chief, will direct the preparation of additional areas.

5.The Environmental Services Specialist/designee will assess staffing needs and, if deemed necessary, call in additional team members.  If the Specialist is not in the hospital, the department lead will notify at the announcement of D1.

6.Upon the announcement of D1, the department lead will access the handheld radio assigned to the department and monitor “Channel 3” for instructions.

HUMAN RESOURCES
The Human Resources (HR) Vice-President (ext. 3018)/designee will assume the role of Unit Leader. If neither person is available the Incident Commander will designate a person to fill the role.

See the Dupont Hospital HICS organizational chart and Job Action Sheet(s) for this area. The Job Action
Sheet is a position job description, which has a prioritized list of emergency response tasks, serves as a
reminder of the lines of reporting, and promotes documentation of the event.

1.Upon the D1 announcement, the HR Vice President must be notified.  If this person is not present in house, Administer on Call will notify/call in.  Upon arrival to the hospital, the HR Vice President /designee will report to Incident Command for assignment.  HR will use department radio and monitor on “Channel 3”.

2.The HR Vice President /designee will be in charge of the clinical and non-clinical labor pool area in 2100 and 2300.  

3.All team members reporting to the labor pool areas will be registered, screened by position, and assigned to work areas as appropriate.

a.Human Resource team member will generate a telephone list of all hospital team members. 

b.Human Resource team member will notify Chaplain of the event.

DISASTER PRIVILEGES FOR LICENSED INDEPENDENT PRACTITIONERS
1.Volunteer practitioners will be required to sign-in at Incident Command and the following will take place: 

a.When the Emergency Operations Plan has been implemented and the immediate needs of guests cannot be met, Dupont Hospital may implement a modified process for determining qualifications and competence of volunteer practitioners. The volunteers addressed here include only those practitioners that are required by law and regulation to have a license, certification, or registration to practice their profession. The usual process to determine the qualifications and competence of these practitioners would not allow a volunteer practitioner to provide immediate care, treatment, and services in the event of a disaster due to the length of time it would take to complete the process. Even in a disaster the integrity of two parts of the usual credentialing and privileging process must be maintained: 

1)Verification of licensure, certification, or registration required to practice a profession.

2)Oversight of the care, treatment, and services provided. 

b.     The option to grant disaster privileges to volunteer practitioners will be made on a case-by-case basis in accordance with the needs of the facility and its guests, and on the qualifications of its volunteer practitioners. 

c. Disaster Responsibilities: 
1)Disaster responsibilities will be assigned only when the following two conditions are  present: 

a)The volunteer practitioner must present at a minimum, a valid government issued photo identification issued by a state or federal agency such as a driver’s license or passport and at least one of the following: 

(1)A current hospital picture identification card that clearly identifies professional designation.

(2)A current license, certification, or registration. 

(3)Primary source verification of licensure, certification, or registration. 

(4)Identification indication that the individual is a member of a Disaster Medical Assistance Team (DMAT), Medical Reserve Corp (MRC), or ESAR-VHP(Indiana Center for all Licensed health care workers) or other recognized state or federal organization or group. 

(5)Identification indication that the individual has been granted authority to render guest care, treatment, and services in disaster circumstances such as authority having been granted by a federal, state, or municipal entity. 

(6)Identification by current organization member(s) who possesses personal knowledge regarding the volunteer practitioner’s qualifications. 

b.Primary source verification of licensure, certification, or registration will begin as soon as the immediate situation is under control, and must be completed within 72 hours from the time the volunteer practitioner presents to Dupont Hospital. 

c.Person(s) responsible for setting-up the labor pool, while assigning disaster responsibilities, will have the volunteer practitioners discuss their credentials and competencies with a qualified staff member of Dupont Hospital. 

d.Each volunteer practitioner will be required to complete an application for Disaster Privileges for Non-Licensed Independent Practitioners located in the Disaster Drill Folder. Once the decision has been made and the volunteer practitioner is assigned disaster responsibilities, the volunteer practitioner’s professional performance will be overseen by a mentor at all times, demonstrating ability to provide adequate care, treatment, and services and providing opportunity for documentation of same. 

LABORATORY
The Laboratory Services Specialist (ext. 3130)/Department Charge will assume the role of Unit Leader. If neither person is available the Operations Chief or Ancillary Services Team Leader will designate a person to fill the role. 

See the Dupont Hospital HICS organizational chart and Job Action Sheet(s) for this area. The Job Action Sheet is a position job description, which has a prioritized list of emergency response tasks, serves as a reminder of the lines of reporting, and promotes documentation of the event.

1.Upon announcement of Code D1:

a.The Laboratory Services Specialist/Department Lead will notify the Pathologist “on call.”

b.The Laboratory Services Specialist/Department Lead will assess the laboratory situation and, if necessary, arrange to call in additional personnel.

c.An immediate assessment of blood and component needs will be made. The Laboratory Blood Bank will contact and make arrangements with the local supplier as appropriate.

d.Upon announcement of D1, the Specialist/Lead will assure the department’s handheld two-way radio is turned on and monitor “Channel 3”.

a.Upon announcement of Code D2 all Laboratory personnel will return to the Laboratory and function as indicated below:

1)All lab work related to disaster casualties and inpatient emergencies will receive top priority.

2)Laboratory test orders will be indicated on the guest’s “Disaster Tag”. 

3)Immediate dispersal of test results will be made.

2.The pathologist will be in charge of both the body holding area and the temporary body holding area (Rehab room on Med/Surg East). 

MATERIALS MANAGEMENT/LINEN SERVICES
The Hospitality Team Leader (ext. 3215 or 3031)/designee will assume the role of Unit Leader. If neither person is available the Logistics Section Chief will designate a person to fill the role. 

See the Dupont Hospital HICS organizational chart and Job Action Sheet(s) for this area. The Job Action Sheet is a position job description, which has a prioritized list of emergency response tasks, serves as a reminder of the lines of reporting, and promotes documentation of the event.

1.The Hospitality Team Leader/designee will be responsible for monitoring and meeting all supply needs of the hospital and arranging for additional sources of supplies as deemed necessary with the authority of the Logistics Section Chief.

2.In the event that a disaster occurs outside of normal working hours, the Hospitality Team Leader/designee will be contacted as part of their call process.  

3.Upon notification of D1, the Hospitality Team Leader/designee will turn on the department handheld radio and monitor “Channel 3” for further direction.

4.The Materials Management team, if on duty, will take linen carts to the Emergency Department and Pre/Post/PACU.

MEDICAL STAFF
The Medical Staff Office (MSO) Coordinator (ext. 3219)/designee will assume the role of Unit Leader. If neither person is available the Incident Commander will designate a person to fill the role.   

See the Dupont Hospital HICS organizational chart and Job Action Sheet(s) for this area. The Job Action
Sheet is a position job description, which has a prioritized list of emergency response tasks, serves as a
reminder of the lines of reporting, and promotes documentation of the event.

The MSO Coordinator/designee will notify the Medical Staff President of the disaster alert and report to the non-clinical labor pool for further assignment.

The Medical Staff President/designee will:

1.Assist with treatment of disaster victims until enough help arrives.

2.Cooperate with Administration in the discharge of ambulatory guests.

3.Direct any evacuation and/or transfer of inpatients.

4.Assist in making inpatient and disaster victim assignments to members of the Medical Staff.

5.Will work with HR in providing privileges for volunteer medical staff according to the Emergency Privileging Policy.  

HEALTH INFORMATION SERVICES (MEDICAL RECORDS) 
The HIS Specialist (ext. 3279)/designee will assign a team member to Incident Command. The rest of the team will report to the non-clinical labor pool.  

NURSING ADMINISTRATION
The CNO/House Specialist Coordinator(ext. 3023 or 3198) will assume the role of Unit Leader. If neither person is available the Operations Section Chief will designate a person to fill the role. 

See the Dupont Hospital HICS organizational chart and Job Action Sheet(s) for this area. The Job Action
Sheet is a position job description, which has a prioritized list of emergency response tasks, serves as a
reminder of the lines of reporting, and promotes documentation of the event.

1.The CNO/House Specialist Coordinator is responsible for the overall direction of nursing personnel during the disaster. The nature of the disaster, number of victims, and types of casualties are the determining factors that are taken into consideration for the action that occurs.

2.The CNO/House Specialist Coordinator will report to the Incident Command Center.

3.Upon the notification of “CODE D1” each nursing Specialist/Charge Nurse/designee, using the Departmental Report for Disasters, will assess:

a.Number of staff on duty

b.Number of staff available to report to Labor Pool in Room 2100

c.Number of empty beds

d.Number of guests to be dismissed or transferred

e.Number of possible Administrative dismissals or transfers

f.Number of available carts and wheelchairs.

4.The completed Department Report for Disasters will then be faxed to the Command Center at 416-5879.  In the event of power failure, use the form in the Emergency Manual and take form to Command Center.

5.The Command Center will print a census summary.

6.The Operations Section Chief will be notified when resources are needed. As necessary, each unit’s call tree will be initiated.

NOTE: When a Code D1 is announced, all nursing departments will notify their Team Leader/Specialist(s).  Each department will assure that their handheld two-way radio is turned on  and monitor “Channel 3” for further direction.

PASTORAL CARE
The Chaplain (ext.3068)/On-Call Chaplain will assume the role of Unit Leader. If neither person is available the Operations Section Chief will designate a person to fill the role. 

See the HICS organizational chart and Job Action Sheet(s) for this area. The Chaplain/On-Call Chaplain will be notified of the disaster by Human Resources.   

1.The Chaplain/On-Call Chaplain will report to the Command Center and will lead/coordinate the pastoral care needs of the facility.    

2.The Chaplain will determine if additional pastoral care staff needs to be called in.

a.The Chaplain may contact area clergy to assist with family support.

3.A Chaplain will be assigned to the Family Center, located in the Resource Center, as needed.   

4.Other Chaplains will be assigned as needed.

5.The Chaplain will assure the department’s handheld two-way radio is turned on and monitor “Channel 3”.

PATIENT ACCESS
The Patient Access Specialist (ext. 3050)/Lead Registrar assume the role of Unit Leader. If neither person is available the Planning Chief will designate a person to fill the role.

See the Dupont Hospital HICS organizational chart and Job Action Sheet(s) for this area. The Job Action
Sheet is a position job description, which has a prioritized list of emergency response tasks, serves as a
reminder of the lines of reporting, and promotes documentation of the event.

1.The Patient Access Specialist/Lead Registrar will:

a.Assign adequate people to the triage area.

b.Assign the following personnel directly to the triage area for tagging casualties and obtaining information when feasible:

1)Two registrars to tag victims in the triage area.

2)One registrar to coordinate bed assignments.

2.In the event a disaster occurs outside of normal business hours, the Emergency Department registrar will implement the Patient Access call list. As registrars arrive they will assume responsibilities as described.  The registrars will register victims into the STAR computer system. If victims’ names are not available the registrars will enter the Emergency Predetermined Numbers. 

3.The Emergency Department registrar will assemble a master list of victim’s names from list used at triage and fax to Hospital Command Post. (416-5879)

4.All disaster casualties will be tagged in the triage area. An emergency record will be issued to all casualties.  Victims will be given predetermined numbers for identification until the registration process can occur.  The ED triage team will use a log to assign victims numbers and location as a tracking mechanism.  This log will periodically be faxed to the Command Center.

5.The Emergency Department record will accompany the victims to all areas of treatment.

6.The Emergency Department’s telephone number will serve as the hospital’s number for the victims until the Patient Access team assigns a bed and encounter number.

7.Patient Access team will work with the Planning Section Chief to determine the number of empty beds and their locations. They will keep the Planning Section Chief apprised of bed availability.

8.If necessary, the Patient Access team will cancel all routine and elective admissions.

9.Upon notification of D1, the Patient Access Lead will assure the department’s handheld two-way radio is turned on and monitor “Channel 3”.

PHARMACY
The Pharmacy Services Specialist (ext. 3139)/designee will assume the role of Unit Leader. If neither person is available the Operations Section Chief will designate a person to fill the role. 

See the Dupont Hospital HICS organizational chart and Job Action Sheet(s) for this area. The Job Action
Sheet is a position job description, which has a prioritized list of emergency response tasks, serves as a
reminder of the lines of reporting, and promotes documentation of the event.

1.The Pharmacy Specialist/on duty Pharmacist, upon notification of a disaster, will determine if additional personnel will be needed. In the event that a disaster occurs outside of normal working hours, the on duty Pharmacist will notify the Pharmacy Specialist.  Upon notification of D1, the on duty Pharmacist will assure the department’s handheld two-way radio is turned on and monitor “Channel 3”.

2.Upon notification of a disaster alert, an immediate survey of reserve stocks will be made.

3.All outstanding drug orders for inpatients will be filled as quickly as possible. All medication orders for disaster victims will receive top priority.

4.Pharmacy personnel (pharmacists and/or technicians) will circulate between Emergency Department, Pre/Post/PACU to deliver medication and to assist in determining the need for additional medications.  As clinical team members are floated through out the hospital, pharmacy will assist in Acudose concerns.

5.The Pharmacy team will dispense medication and supplies upon demand to disaster treatment areas. Pharmacy orders will be by CPOE.  Paper orders will be faxed to pharmacy.

6.At the end of the disaster alert, all unused drugs will be returned to the Pharmacy along with a list of all drugs used. The Pharmacy Specialist/on duty Pharmacist will determine the amount of drugs used by each area. 

7.All medications dispensed to disaster treatment areas require a physician’s signature on the Emergency Department record.

8.The pharmacist, on the order of the ED physician, will access the ChemPack from Lutheran when all mini Chem Packs and in house supplies are exhausted.  The pharmacist will notify Lutheran Hospital pharmacist with the number of patients to be treated.  Lutheran Hospital will arrange transportation of the medication to Dupont and the pharmacist will sign the chain of custody.  The pharmacist will dispense the medication to the ED.

RADIOLOGY/SPECIAL PROCEDURES
The Radiology Specialist (ext. 3075)/Special Procedures Specialist (ext. 3392) will assume the role of Unit Leader. If neither person is available the Operations Section Chief or Ancillary Services Team Leader will designate a person to fill the role. 

The nurses from Radiology and Specials will report to the Clinical Labor Pool.

See the Dupont Hospital HICS organizational chart and Job Action Sheet(s) for this area. The Job Action
Sheet is a position job description, which has a prioritized list of emergency response tasks, serves as a
reminder of the lines of reporting, and promotes documentation of the event.

1.In the event that a disaster occurs outside of normal working hours, the Radiology team member in charge will notify the Radiology Specialist and the Special Procedures Specialist.  If the situation warrants, additional personnel will be called in.  The Lead Diagnostic Tech at the time of D1 will assure the department’s handheld two-way radio is turned on and monitor “Channel 3”.

2.All team members and students present in the Radiology Department will be maintained on a standby basis.

3.All hospital inpatients will be returned to their rooms as soon as possible when a Code D1 is announced.

4.All portable x-ray equipment will be made readily available for use.

5.The number on the guest’s medical record (disaster tag) will be placed on the film at the time of exposure. All other paperwork will be completed after the alert.

6.One Radiology Tech will be assigned to report to the Pre/Post/PACU area along with a portable x-ray machine. A second Radiology Tech will be assigned to the critical area in the Emergency Department.

CARDIOPULMONARY SERVICES
The Cardiopulmonary Lead (ext. 3185) will assume the role of Unit Leader.  In the event that the Lead is not available the Operations Chief or Medical Services Team Leader will designate a person to fill the role. 
See the Dupont Hospital HICS organizational chart and Job Action Sheet(s) for this area. The Job Action
Sheet is a position job description, which has a prioritized list of emergency response tasks, serves as a
reminder of the lines of reporting, and promotes documentation of the event.

1.When Code D1 is called the in house therapist will notify their Specialist.   The in-house therapist will assure the department’s handheld two-way radio is turned on and monitor “Channel 3”.

a.The Lead Therapist will contact the Operations Section Chief for all available information on the disaster.

2.When Code D2 is called:

a.One Cardiopulmonary team member will report to the ED triage area with necessary equipment.

b.One Cardiopulmonary team member will report to the Pre/Post/PACU area.

c.One therapist will be assigned to the Birthplace as needed.

SECURITY
If the Switchboard receives notification of the disaster, Security will immediately transfer the call to the Emergency Department.  All Security Officers will monitor “Channel 1” for further directions.

1.One Security Officer will maintain the switchboard until relieved by trained personnel.

a.When requested by the Incident Commander, Security will initiate the page and announce: “ATTENTION PLEASE:  CODE D1” (or D2 if applicable). This announcement is repeated three times.

2.One Security Officer will report to the Emergency Department.  

3.Team members will use only the team member door with card access.

4.Security will call all persons included in the Master Call List (See below).

5.All routine calls and all guest calls will be suspended. 

a.All calls not related to the disaster will not be transferred by Security. 

b.If phone lines are jammed, runners will be obtained from the non-clinical labor pool to provide information to necessary departments.

c.Security will transfer all calls from official agencies (media) to Community Relations.

6.When the Code D1/D2  is over, the Incident Commander in the Emergency Command Center will notify the Switchboard Operator who will then announce:  “ATTENTION PLEASE:  CODE D CLEAR”.  This announcement is repeated three times.

MASTER CALL LIST
In all disaster situations, the switchboard operator is to call the following:  

1.  Administrator on Call

a.    The Administrator on Call will contact the CEO, COO, CMO/CQO, CNO, CFO, and the VP of Human Resources.

2.  Community Relations team member on call

3.  Maintenance on call

4.  Support Services Team Leader

5.  Any others as directed by the Incident Commander. 

CASE MANAGEMENT
The Case Management Specialist (ext. 3061/designee will assume the role of Unit Leader. If neither person is available the Operations Section Chief will designate a person to fill the role. 

See the Dupont Hospital HICS organizational chart and Job Action Sheet(s) for this area. The Job Action
Sheet is a position job description, which has a prioritized list of emergency response tasks, serves as a
reminder of the lines of reporting, and promotes documentation of the event.

1.Upon being notified of the D1, the Case Management Specialist/designee will initiate the call list for Case Management.

2.One Case Manager will go to the Discharge Area (Lobby) to aid in guest discharge

3.One Case Manager will go to the Family Center, located in the Resource Center, to work with families of disaster victims.

4.One Case Manager will report to the Operations Section Chief to assist in contacting the families of victims.

SURGERY/PRE/POST/PACU
The Surgical Services Team Leader (ext. 3229)/Specialist will assume the role of Unit Leader. If neither person is available the Operations Section Chief will designate a person to fill the role. 

See the Dupont Hospital HICS organizational chart and Job Action Sheet(s) for this area. The Job Action
Sheet is a position job description, which has a prioritized list of emergency response tasks, serves as a
reminder of the lines of reporting, and promotes documentation of the event.

1.Incident Command will direct surgery in continuing elective surgeries.  Disaster victims needing surgery will become a priority;

2.PACU will prepare to receive “just completed” surgeries from OR. The Pre/Post Holding area, as well as PACU, will prepare to give care to those guests sent from ED.

3.Casualties will be brought directly to surgery from Pre-Op according to the priority established.

4.Casualties will be taken to general units, intensive care, or recovery areas from surgery as ordered by the surgeon, completing the procedure(s).

5.Environmental Services team members in the Perioperative Department will make sure all carts are clean and ready for disaster victims.  

6.The Specialist will assure the department’s handheld two-way radio is turned on and monitor “Channel 3”.
           
AMBULATORY SURGERY/PRE/POST/PACU:  
The Ambulatory Surgery Department is located in the 2510 Building and is open weekdays from 8:00am to 5:00pm.
 
Surgical Services Specialist (ext. 3383)/designated Charge Nurse report to Surgical Services Team Leader for direction of the Ambulatory Department.

Notify each suite of Code D1 

1.Hold operating room cases not already in progress 

2.Initiate disaster call list as necessary 

3.Assess conditions and fax to Incident Command the department’s report on bed and staff availability. 

4.The Specialist will assure the department’s handheld two-way radio is turned on and monitor “Channel 3”.
 
Surgical Services Specialist/designee will implement communication line with house surgery designee: 

1.   Obtain and provide to house surgery extra supplies or equipment as necessary. 

2.   Assign operating nurses to house surgery rooms as necessary. 

3.   Cancel elective surgery cases if directed by the Incident Commander, and notify physicians. 

4.Prepare for area to be used as surge bed for guests. 

5.Maintain up-to-date call list for Ambulatory Surgical Services Department. 

6.Unassigned team members will report to the clinical labor pool in Room 2100 of the hospital. 

SLEEP CENTER
The Sleep Center Specialist (ext. 5820) will assume the role of Unit Leader. In the event that this person is not available, the Operations Section Chief will designate a person to fill the role.

The Sleep Center is located in Medical Office Building 2514.  The Center will be alerted of a D1/D2 by the Ancillary Services Team Leader/designee. 

1.If the department has guests, the technicians will remain with their guests.  If there are no guests or the guests can be dismissed, the technicians will report to the non-clinical labor pool (Room 2300).
2.The Specialist will assure the department’s handheld two-way radio is turned on and monitor “Channel 3”.

PREADMISSION TESTING/CENTRAL SCHEDULING
1.During normal business hours, all team members will report to the clinical labor pool and sign in.  All team members will be assigned duties from this area.

2.During after hours or weekends, team members will be contacted as need arises.

PERFORMANCE IMPROVEMENT TEAM
1.During normal business hours, all team members will report to the clinical labor pool and sign in.  All team members will be assigned duties from this area.

2.During after-hours or weekends, team members will be contacted as need arises.

NURSING INFORMATICS
1.During normal business hours, all team members will report to the clinical labor pool and sign in.  All team members will be assigned duties from this area.

2.During after hours or weekends, team members will be contacted as need arises.

INFECTION CONTROL
1.During normal business hours, all team members will report to the clinical labor pool and sign in.  All team members will be assigned duties from this area.

2.During after-hours or weekends, team members will be contacted as need arises.

HEALTH SERVICES
1.During normal business hours, all team members will report to the clinical labor pool and sign in.  All team members will be assigned duties from this area.

2.During after-hours or weekends, team members will be contacted as need arises.

NURSING EDUCATION
1.During normal business hours, all team members will report to the clinical labor pool and sign in.  All team members will be assigned duties from this area.

2.During after-hours or weekends, team members will be contacted as need arises.