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Name: EvacuationPurpose: To provide guidelines for partial and/or full evacuation from the Ambulatory Surgery Center (ASC).Policy: The evacuation policy is not intended to stand-alone and should be initiated as a response to an emergency situation. Authorized personnel should consider partial or complete evacuation based on the current situation. The incident threat could be internal, such as a bomb threat, fire, gas leak, loss of essential utilities, flooding, hazardous materials release, and explosion; or external, such as tornado, fire, or act of terrorism. All could potentially warrant a planned, controlled, or emergency evacuation of the ASC or a decision to shelter-in-place. This policy is created in conjunction with the Emergency Operations Plan with the intent to maintain safety of patients, staff, and visitors and to maintain life-support functions while conducting safe and rapid evacuation procedures. Coordination in the planning process for evacuation procedures is essential and has involved collaboration with Fire, Law Enforcement, Emergency Management Agency, Health Department, Local Government, surrounding Hospitals, and other emergency response agencies. The orderly evacuation of the ASC involves special considerations. Some patients may be medically compromised depending on the type of procedure being performed and support equipment necessary. A complete evacuation is to be ordered by authorized personnel as a last resort, and must progress in a planned and orderly manner.Procedure:All types of evacuations require activation of the Emergency Operations Plan and establishment of the Incident Commander.All staff are authorized to take immediate patient relocation or sheltering actions in response to a life threatening emergency.All non-emergent patient movement or evacuation decisions should be made by the Incident Commander after initial situation assessment. (See attached Command Decision Tree, Advanced Warning Event Evacuation Decisions, and No Advanced Warning Event Evacuation Decisions.)If evacuation is suggested or ordered by local authorities, ASC will collaborate with local officials and assist in the coordination of the ASC evacuation to the degree safely possible – though this may not necessarily involve a complete evacuation depending on the timeframe and risk of the threat compared to the risk to the patients.In the event of an evacuation, it is extremely important for the person in charge of each area to prepare patients, visitors, staff, and equipment for evacuation. The following includes a list of preparations required for a possible evacuation if time allows.Prepare a list of all patients and their status in each area. This list should further be enhanced to indicate which patients are ambulatory or require wheelchair or cart transportation.All patient paper charts should be gathered into one central location to be transported along with the patient should evacuation occur.Visitors should be evacuated with ambulatory patients. Do not allow visitors to wander around the unit and cause confusion.Staff and visitors with limited mobility will be evacuated using whatever physical means necessary, e.g., carry, place on carts, etc. (See Attached Carry Techniques Explanations.)All available staff will be utilized to safely move patients to another area.Anyone moving down a hallway needs to keep to the right if possible.Visitors and others (volunteers, contractors, etc.) may be asked to leave the building.The person in charge of the unit should inventory all wheelchairs, carts, IV poles, portable oxygen tanks, ambu bags, blood pressure cuff and stethoscope, monitors, crash cart, thermometer, blankets, medications and make sure essential equipment is moved with the patient. If time and staffing allow, extra linen should be transported with patients.Medical gases and oxygen will be shut off as a unit is being evacuated. Never evacuate your unit unless you have explicit direction from the Incident Commander and/or the fire department/law enforcement except in life threatening situations.Managers must identify which patients and staff that may have difficulty during an evacuation and pre-plan the best way to aid their movement to a safe location.Ambulatory – limited mobilityEnsure that individuals with disabilities are accounted for. Many individuals with limited mobility do not need assistance on a daily basis and the fact they may require it in an emergency can be overlooked.Allow people to evacuate with other individuals as possible. Alternatively, if they need to evacuate after others, establish a process that is comfortable with the effected individual during drills and exercises.Appoint staff to assist as needed.Non-ambulatory – (lift and assist methods should be determined prior to evacuation – for example, individuals in wheelchairs requiring vertical evacuation)If the situation allows for it, use the Shelter-in-place strategy. Ensure non-ambulatory individuals have moved to a safe location and await further instruction.If elevators are unavailable, assist individuals down the stairs in their wheelchairs or in an assistive device or manual carry technique. If they must be carried, ask what lift will be most comfortable for them and be sure another person brings their wheelchair down as soon as possible (carrying battery-operated wheelchairs may not be possible). A non-ambulatory person feels secure, and is most independent, in their own wheelchair.Hearing Impaired Ensure the hearing impaired individual understands exactly what is happening. If alarms have been triggered it is important they know the reason. An alarm’s strobe light will only signal there is an incident.Provide clear, concise instructions. Speak slowly or communicate in writing if possible.If the individual will assist others in an evacuation, have them work in tandem with another so they can receive situation updates and direction.Accommodate non-English speaking individuals as much as possible during an evacuation. The use of hand signals may be the primary means to provide direction to those individuals.Visually ImpairedEnsure visually impaired individuals are able to navigate to the emergency exits, as the area may change during an evacuation, leading to confusion.Provide assistance as hallways and staging areas can quickly become crowded with people, beds, supplies, and/or debris.Cognitively ImpairedIf a staff member, prior to an incident, provide repetitive training on evacuation from their work area.Assign someone to escort these individuals to safety, if necessary and to provide information in easily understandable format.Service AnimalsEnsure that the service animals of individuals with disabilities are accounted for and needs planned for during exercises and drills.Supplies to have on hand for evacuation process may include, but is not limited to, flashlights/headlamps, blankets/carrying canvas, footies, “room clear” tape or signs, permanent markers, large envelopes for records, tracking forms. Patient assistive devices (hearing aids, glasses, dentures, prostheses, etc.) and belongings will be transferred with the patient, if time permits.If possible, horizontal evacuation should be done first. This is moving through smoke barrier doors or fire doors into next zone following designated evacuation maps located throughout the facility. Move the patients, visitors, staff closest to the danger first. If in a multi-level facility and horizontal evacuation is not sufficient, evacuate vertically to other floors above or below the compromised area. If elevator is not accessible for non-ambulatory patients/staff/visitors, they will be evacuated with assistance using med sled, describe other means you have available. (Attach and reference location of these devices and how to use.) For a full evacuation, initially individuals will be moved to a staging area (identify location internally and location externally). The staging area is used to “hold” patients and those present at the facility until transportation arrives to move individuals to alternate facility. If this primary location is compromised, the incident commander will designate an alternate safe location.The department leader, or designee, will clear the area, making sure all rooms (including non-patient care areas) are checked and mark with an “X” outside the doorway of each room to indicate it has been evacuated and checked.Individuals in an active operating suite will be informed of the nature of the event and the plan for evacuation of that area. The physician in charge will determine if it is safe to finish the surgery/procedure, or if the surgery/procedure should be stopped and the patient and medical team evacuated.All individuals will remain at the pre-determined staging area until final disposition transportation is available, or the proper authorities have cleared the building for re-entry. Staff, patients, and as able, visitors will be accounted for in the staging area. If re-entry is not a consideration the staff will remain with the patients until appropriate transfers are taken. Any patient that can be safely discharged to home, this method of disposition is preferred.Any patient requiring continued monitoring/intervention will be transferred to an acute care hospital following the ASC transfer agreement process. Insert name of hospital(s) you have transfer agreements with.) (See appendix 7 for Transfer Agreement(s).) Consideration will be given by leadership (IC) of the needs for patients to be evacuated and accompanied by staff who could provide care and treatment enroute to the designated relocation site, in the event trained medical professionals are unavailable by the transportation services. Staff and Patient tracking will be initiated and maintained throughout the process. (See Emergency Tracking System Policy.)Information regarding staff and patients will be shared with appropriate individuals/authorities according to the Federal, State, and local laws. (See Communication Plan)ORDER OF PATIENT EVACUATION*Ambulatory PatientsJoin hands with a nurse to lead themWheelchair PatientsMove patients to safe areaBed Bound PatientsRemove by using various carriersTriage LevelEvacuation to Staging AreaGreen – GO (Ambulatory, Minor)These patients require minimal assistance and can be moved FIRST from the unit. Patients are ambulatory and 1 staff member can safely lead several patients who fall into this category to the staging area.Yellow – Caution (Urgent/Delayed)These patients require some assistance and should be moved SECOND in priority from the ASC. Patients may require wheelchairs or stretchers and 1-2 staff members to transport.Red – Stop (Non-ambulatory/Critical)These patients require maximum assistance to move. In an immediate evacuation, these patients move LAST from the inpatient unit. These patients may require 2-4 staff members to transport.*Prioritization of patients for evacuation may change based on the situation and instructions from Incident Command and/or outside authorities with safety being of utmost importance.Transportation: If a full evacuation is necessary, patients would be prioritized for transfer based on a number of factors, including but not limited to the following.Patient condition and complexity of careAmbulatory status (ambulatory with minimal or more assistance, or non-ambulatory)Transfer locationMethod of transfer availableTransportation will be provided by a variety of means to include, but not limited to, Emergency Medical Services (EMS), private ambulances (list any ambulance you may have a contract with for transport), public transportation, privately owned vehicles (POV), and/or taxies. Means of transportation may depend on expediency of need, availability of vehicles, and needs of patients being transported. Incident Commander (or Logistics Officer) will work in concert with transportation agencies directly (including EMS dispatch) and the Emergency Management Agency to assist in procuring necessary available transportation.Additional vehicles may be needed to transport medical equipment (not previously accompanying patients), critical records, critical supplies (medical and non-medical) to alternate care site(s) and/or other hospitals accepting patients. Communication:As with all emergency procedures, communication is key in a successful process. The ASC’s communication plan details primary and alternate means of communication with external sources of assistance. (See Communication Plan.)Evacuation Carry TechniquesIf someone needs assistance to evacuate, various ways of carrying the victim either by yourself or with the help of another can be employed. Your safety is the first priority and these techniques should not be employed if you have not had the proper training.Manual carries are tiring for the rescuer and involve the risk of increasing the severity of the casualty's injury. Choose the evacuation techniques that will be least harmful, both to rescuer and the victim. Causalities carried carefully and correctly handled, otherwise their injuries may become more serious or possibly fatal. Situation permitting, evacuation of a casualty should be organized and un-hurried. Each movement should be performed as deliberately and gently as possible. Cradle DropUse this method to extricate a heavy victim from a room if a blanket is handy. Fold the blanket in half and lay it on the floor. Gently position the victim on the blanket and pull them headfirst from the room. This method works best on non-carpeted floors.Fireman's CarryRaise one arm of the victim while she is in a standing position. If she is unconscious, you will have to support her weight. Stoop down and pull the patient's arm over and down your shoulder. This brings the patient's body across both your shoulders. Bring your other arm between the victim's legs and grab her arm by the wrist. Raise up and carry the victim out, having your other hand free to open doors or move objects.Saddleback CarryUse this carry, often called a piggyback carry, only on a conscious victim. Have the victim stand behind you and place his arms over your shoulders. Reach back and grab under his legs and lift him up on your back. Have him lean over your shoulders so more weight is put there instead of your arms and lower back.Pack-Strap CarryUse this carry for medium distances. Pull the victim behind you and lift her arms from behind over your shoulders. Lean forward and carry her on your back with her legs dangling behind. To prevent injury, make sure you hold her arms with the palms down.Arms CarryPick the victim up in front of you with one hand under her legs and the other behind her back. Picture the groom carrying the bride after getting married as an example. Hold her high to lesson fatigue. Only use this carry if traveling for a short distance.Swing CarryTwo people work together on this carry. Stand on either side of the victim, who is sitting up on the edge of a bed or chair. Each of you places one hand behind the victim's back and clasp shoulders. Place your other hands under the patient's knees and clasp wrists. Lift up the victim and carry out, making yourselves a human chair.Extremity CarryUse this carry if you have another helper. Place the victim in a sitting position. Have one of you from behind reach under the victim's armpits and clasp hands in front of his chest. The other stands between the victims knees and faces away him. Lift the victim up with arms around the legs and carry him out feet first.Blanket DragThis is the preferred method for dragging a victim from confined area.Place the victim on a blanket by using a logroll or a three-person lift. Place the victims head approximately 2 feet from one corner of the blanket and wrap the blanket corners around the victim. Keep your back as straight as possible and use your legs, not your back, to pull the victim (head first) in as straight a line as possible. ................
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