The degree to which we respond is based on the complexity of an incident …

1. How We Respond • The degree to which we respond is based on the complexity of an incident … … small and simple incidents do not require as many resources as large and complex ones • Therefore, our resource commitments (people, equipment, time, money) during a response will grow based on the complexity of an event • Our response levels are graduated to ensure a measured response

2. Agency Executives / Incident Advisory Council Command Staff Incident Commander Administrator on-call Public Information Officer Safety Officer Deputy Incident Commander Liaison Officer Medical/Technical Specialist(s) Clinical Operations Next week’s A-on-call Plans Logistics Finance Family Care Center General Staff Who is In Charge?

4. Coordination and Communications … with external partners … requires two-way comms LOCAL REGIONAL/STATE Financial Services Clinical Care Services EOC NW Region Hospitals Pre-hospital Services Operations VDEM UVA Hospital Command Center VDH Plans City Fire & Police Logistics Virginia National Guard County Fire & Police Facilities Planning & Capitol Dev’t Finance Marketing and Program Development Thomas Jefferson Health District 34th WMD CST Regional NDMS Martha Jefferson Information Services Private companies providing clinical and service support Volunteer Organizations

5. UVa HS leadership will determine sequence of activation High Utilize Operating Rooms (Also consider Regional STIP, State, or Federal assets) Beyond Designated Surge ... (Refurbishment areas, alternate unit care areas, Nursing Homes) Designate Surge//Overflow Areas … (SSU, Endoscopy, CTU, PACU, SAS, KCRC) Capabilities and Resources Designate 3 W // 7 W and MICU // PICU for Flu … • (Implement 13/40 rule … work w/ region hospitals to protect ours) Flu Clinic in 1222 JPA and Call Center in 1224 JPA Situational and Heightened Awareness (WHO Phases 1-2) (Vaccinate, use PPE, Flyers/education, visitation, weekly surveillance, pharm and medsup levels, infection control, increased lab testing) Low Minimal Severe Low Medium High Categories of Escalating Threats Flu Surge Operations A scalable surge plan allows the flexibility to care for an expanded volume of patients while striving to maintain operational capacity.

6. Resuscitation and Medical Emergency Response • Responses are; • Standardized • Consistent • Predictable Resuscitation and Medical Emergency Response Subcommittee Operationally coordinate (not control) and synchronize TCH Medical Transport Network Code 12 MET NERT PERT BERT Ambulatory • Recognizes the unique characteristics of separate teams but joins them by; • Establishing standardized concepts of operation and clinical guidelines • Facilitating the acquisition of common supplies and equipment wherever possible • Establishing recurring meetings to share operational and quality indicators … these indicators would be reported two ways … to the Quality Committee and the Patient Care Committee

7. MC Policy 0187 Emergency Response & Cardiopulmonary Resuscitation (Code 12) • First Response: Team capable of providing BLS while awaiting advanced life support. Once ALS arrives, area staff representatives are expected to participate as needed until the emergency has ended or the patient is moved to another location. • Institutional Req’t: Team capable of providing ALS at the MC complex, contiguous locations, and KCRC 24/7/365 for any medical emergency including cardiac arrest, respiratory arrest, or acute illness or injury requiring medical interventions. MET PERT NERT BERT First Response Code 12 • Adult • Peds • Neo • KCRC • TCH Initial care that occurs in potential life and limb threatening situations; can include not only medical care but also safety, comfort and emotional support until designated response team arrives on the scene and assumes care. Ambulatory Medical Transport Network Institutional Response Internal Response External Response • Level A-BLS Only • Level B-BLS Enhanced • Level C-Advanced • Level D-Specialized

8. Code 12 Dispatchfor Requests w/in University Hospital and Contiguous Areas Call Received by 911 Operator Call Received by Hospital Operator (4-2012) Patient Care or Public Area? Decision Making Patient Care Area Public Area Adult or Peds? Transfer to Medcom Adult Pediatric Team Execution Dispatch to Internal ETT (Pegasus, Medic V, etc) MET Code 12 PERT Code 12 Locations Locations • 2d floor and above • 1st floor procedural areas • Radiology • IR • CT • Endoscopy • MRI • Waiting rooms UH Ambulatory Clinics (incl 2f fl Heart) West Complex PCC Upper and lower links Jordan Hall McKim Hall All entrance portals All elevators Garages Lounges • G-Level • 1st floor • Cafeteria • Main Lobby • Admitting • Public Restrooms • Gift Shop • Chapel All visitors or staff, if known—any location Note: Teams can request dispatch of another team at any time.

9. The Framework Call for Security and Police For Medical Center and Contiguous Areas Life Threatening e.g. Active Shooter Dial 911 UPD Security Incident Mgt Team Evacuate Area or Defend in Place Isolate incident, close doors, clear hallways, turn off lights, eliminate line of sight. Call for BERT Call for Security Bomb Threat Hostage Situation Infant Abduction Actual Physical Event e.g. pinching, pushing, punching Potential Threat e.g. clenched fists/jaw, pacing, restlessness, agitation, shouting Dial 4-2012 Security Behavioral response teams Police, as necessary. De-escalate Situation Isolate incident, close doors, clear hallways Security Assistance Security Information Threat Assessments Dial 4-5048 or PIC 1647 Green Alert Yellow Alert Red Alert

10. The Framework For “Off-site” Locations Dial 911 then PIC 1655 UPD Security Incident Mgt Team (UVa HS) Life Threatening Active shooter Evacuate Area or Defend in Place Isolate area of incident, close doors, clear hallways, turn off lights, eliminate line of sight Law Enforcement Support Bomb Threat Hostage Situation Infant Abduction Actual Physical Event e.g. pinching, pushing, punching Potential Threat e.g. clenched fists/jaw, pacing, restlessness, agitation, shouting Dial 911 and PIC 1655 Police Incident Mgt Team (UVa HS) De-escalate Situation Isolate incident, close doors, clear hallways Security Assistance Security Information Threat Assessments Dial 4-5048 or PIC 1647 Preparedness Response

11. HAZMAT Response Levels 4 3 Normal Opns Altered to Manage Incident Augment ED with Pt Care Capabilities 2 Augment ED with Decon Resources 1 Emergency Department Support 0 Alert IMT and Maintain Awareness

12. Emergency Numbers • 4-2267 • Power failure • Elevator outage • Flooding • Gas leak • Heating, air conditioning, and ventilation • Sewage back up • Water supply or contamination • Tube outage • 4-2012 • Bomb Threat • Fire • Medical emergency • Infant abduction • Medical gas outage • Workplace violence • 2-FIXX • Transportation • Pool equipment • Environmental Services • Tube system (this probably needs to be a 4-2267 call) • Courier/Interfacility services • Linen • Nutrition Services • 4-5334:  Computer system failure • 2-4911:  HAZMAT • 4-8600: Telephone outage

13. “Plans are useless, but planning is indispensable” (D.D. Eisenhower)