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ECRN Packet: Disaster Activity Responsibilities of the ECRN. Condell Medical Center EMS System Prepared by: Sharon Hopkins, RN, BSN, EMT-P EMS Educator Information contribution: Debbie Semenek, RN, RMT-P Region X Multiple Victims & Mass Casualty Plan, July 2006. Objectives.

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ECRN Packet:Disaster Activity Responsibilities of the ECRN

Condell Medical Center EMS System

Prepared by: Sharon Hopkins, RN, BSN, EMT-P

EMS Educator

Information contribution: Debbie Semenek, RN, RMT-P

Region X Multiple Victims & Mass Casualty Plan, July 2006

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Upon successful completion of this module, the ECRN should be able to:

  • Define the differences between the Multiple Victim Policy from the Mass Casualty Plan

  • State the responsibilities of the ECRN based on being an Associate Hospital (LFH) versus Resource Hospital (CMC)

  • Identify resources utilized in-house

  • Successfully complete the quiz with a score of 80% or greater

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Disaster Plans

  • Multiple Victim and Mass Casualty Plan

    • Local plan with local resources used

    • Resource Hospital for the fire department of the disaster site serves as communication link

  • Emergency Medical Disaster Plan

    • State response plan

    • POD hospitals serve as communication link

  • National Disaster Medical Systems (NDMS)

    • Large scale national response utilized

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IDPH Regions

  • State of Illinois divided into 11 Regions

  • Geographically, Lake County is Region 10

  • 4 Resource Hospitals in Region 10

    • Condell Medical Center (CMC)

    • Highland Park Hospital (HPH)

    • St. Francis - Evanston

    • Vista Health East (Victory Memorial)

  • POD Hospital for Region X is Highland Park Hospital (for activation of State Disaster Plan)

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CMC - As A Resource Hospital

  • Affiliated departments

    • Countryside Libertyville

    • Grayslake  Mundelein

    • Knollwood Ambulance  Round Lake

    • Lake Bluff  Wauconda

    • Lake Forest Fire

  • Associate Hospital

    • Lake Forest Hospital

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What Is A Disaster?

  • Difficult to use a “number” for declaring a disaster

    • 15 patients at 2 pm may not be as big a problem as 15 patients at 2 am based on immediate availability of resources

  • A disaster is any incident that overwhelms your available resources at that particular time or for the particular circumstances of the disaster

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Disaster Plans

  • EMS personnel need to declare and activate one of the plans early

  • Without early activation, hospitals have a hard time getting prepared; hospitals feel “behind the eight ball”

  • It is easier to cancel additional help summoned than to try to work short handed

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Multiple Victim Incident

  • Responding EMS personnel can handle the situation with adequate numbers of additional personnel and equipment available within a short period of time. Normal levels of care and transportation can be provided.

  • Attempts are made to evenly distribute patients to receiving hospitals by field personnel

  • Hospitals may need to activate their internal disaster plan

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Multiple Victim Incident

  • Field application

    • triage tags are not required

    • if possible, one patient per ambulance (normal transport conditions)

    • radio report called to the receiving hospital as normal

    • run reports completed by the transporting ambulance personnel

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Multiple Victim Incident

  • Note:

    • The first critically injured victims most likely would be transported to the nearest, most appropriate hospital before or while the first communications are being established with the Resource Hospital

  • Bottom line:

    • When you hear of a disaster in your region, prepare immediately as if you are receiving patients (because you just might be!!!)

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Multiple Victim Incident

  • Radio reports must be given on all transported patients

    • This means every transporting ambulance will be communicating about their individual patient with the receiving hospital and this will take coordination between the field and the ED

  • With coordination from hospitals and field personnel, goal is to avoid overwhelming any one hospital

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Multiple Victim Incident

  • Think of these incidents as “mini-disasters”

    • similar to the busiest day you have had in the ED

    • just more patients with same or similar complaints are showing up within a tight time frame from of each other

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Mass Casualty Plan

  • Number of patients and nature of injuries make normal level of stabilization and care in field unachievable and/or

  • Number of EMS providers and ambulances that can be quickly brought to the scene is not enough

  • All attempts are to be made to evenly distribute the patients to receiving hospitals

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Mass Casualty Plan

  • Practical application for a MCI

    • Triage tags will be used on all patients

    • Ambulances may transport more than one a patient at a time

    • No radio reports to receiving hospitals; care is delivered via SOP’s

    • Run reports are not necessary

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Field Contact With Hospitals

  • Multiple Victim Incident

    • EMS to contact their specific Resource Hospital (CMC) ASAP

  • Mass Casualty Plan

    • EMS to contact their specific Resource Hospital (CMC) ASAP

  • Coordination of patient transportation will be done via the Resource Hospital

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First Communications From Field

  • Radio report may be initially minimal

    • Type/nature of incident (MVC, explosion, building collapse, etc)

    • Incident location

    • Closest hospitals that could receive patients

    • Estimated number of victims & categories (red, yellow, green)

    • Types of injuries/illnesses (blunt, penetrating, burns, etc)

    • Special needs (ie: decontamination)

    • ETA for the 1st victims

    • Call back number & name to contact the scene (VERY IMPORTANT TO GET THIS NUMBER!)

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The “Green” Disaster Victim

  • Important information to obtain from the field regarding the number of “green” patients:

    • what number of green patients can be placed in a wheelchair or otherwise left sitting up

    • what number of green patients will need a cart

      • these patients are categorized green but may need transportation with a cervical collar and/or backboard due to the nature of their injuries

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Activities In The Field

  • Field personnel performing

    • triage first

      • injuries sorted; patient categories assigned (red, yellow, green, black)

    • followed by treatment

      • performed in the field in areas set up to provide treatment based on acuity levels (red is the most critical patient)

    • and finally transportation off the site

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Triaging of Patients

  • Red - victims who are most critically injured; in need of immediate care for life-threatening injuries or illness

  • Yellow - those less critically injured; non-life threatening injuries

  • Green - those with injuries that are not life or limb threatening

  • Black - those who have died or whose injuries do not support survival

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Disaster Tags - General Guidelines

  • Red

    • Treatable life-threatening illness or injures

    • Patient has a altered mental status - unable to follow simple commands

    • Carotid pulse present; radial pulse absent

      • if both carotid & radial pulses are present, categorized considering respiratory rate and mental status

    • Respirations < 10 or > 30

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Disaster Tags - General Guidelines

  • Yellow

    • Serious but not life-threatening illness or injury

    • Delayed care

    • Patient is alert

    • Patient has a radial pulse

    • Respirations less than 30 per minute

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Disaster Tags - General Guidelines

  • Green

    • Minor musculoskeletal injuries, minor soft tissue injuries

    • Patient may or may not be able to walk

    • Patient is alert

    • Patient has a radial pulse

    • Respirations less than 30 per minute

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Disaster Tags - General Guidelines

  • Black

    • Dead or fatally injured patients

    • Resources limited and cannot be devoted to these patients

    • If resources are unlimited, arrested patients may become a Red (in very unique situations would this occur)

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Hospital Use of Disaster Tags

  • Disaster tag should become a permanent part of the patient’s chart

    • EMS and ED staff can use the tags to initiate documentation

    • during Mass Casualty Plan, EMS run reports are not necessary so all the information from the field is most likely on the disaster tags

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Resource Hospital Responsibilities (CMC)

  • Once notified, serves as medical control of the incident

  • Collaborate with field personnel to identify possible receiving hospitals based on:

    • incident location

    • transport routes open

    • volume/acuity of patients

  • ECRN to notify Charge Nurse immediately of the situation

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ECRN at Resource Hospital

  • Begin filling out “Mass Casualty Incident Log”

  • Establish inter-facility communication

    • describe nature & location of incident,

    • approximate number of patients

    • acuity & type of patients

  • Continually monitor receiving hospital capabilities

  • Resource Hospital also is a receiving hospital

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ECRN at Resource Hospital

  • Assess receiving hospitals’ resources

    • ability to receive patients divided into the number of red, yellow, green that can be accepted

    • blood inventory

    • ability to decontaminate patients

    • ability to send medical personnel and supplies

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ED Bed Capacity

All staff need to remember:

  • This is a DISASTER.

  • This is a unique situation

  • It is a short term unusual operation

  • Take your numbers to the max - EMS in the field need all available beds, wheelchairs, hallways in order to transport patients off the scene

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Excessive Casualty Load

  • ECRN must be prepared and anticipate notification of additional receiving hospitals when casualty load exceeds capabilities in closest receiving hospitals

  • May need to obtain status of specialized facilities as needed (ie: burn units, pediatrics, etc) for additional transport of patients with special needs

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Communication With The Scene

  • ECRN at Resource Hospital (CMC) stays in communication with scene contact (usually Transportation; but could be Incident Commander or designee)

    • ECRN relays to the field the receiving hospital’s capabilities

    • Assists with transport management

    • If casualties imply need for transfusions, may need to coordinate with lab to notify LifeSource for blood

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Communication From the Resource Hospital (CMC)

  • Transportation communicates with ECRN at Resource Hospital (CMC)

  • ECRN at Resource Hospital (CMC) communicates with ECRN at Associate hospital (LFH)

  • ECRN at Resource Hospital (CMC) is the one communication link for all hospitals

  • Maintaining consistent ECRN at the radio minimizes lost information

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Communication Pathway

Transportation Officer*

 

Resource Hospital (CMC)

 

Associate Hospital (LFH)

*Communication contact from the scene to the hospital is most often made with Transportation Officer at the site

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Receiving Hospital

  • In Mass Casualty Plan, notification triggered by Resource Hospital (CMC)

  • Report to Resource Hospital (CMC) ability to receive what number of red, yellow, green patients

    • Need to think “big”

    • Doesn’t help a mass casualty situation to say you’ll accept a small number of patients - everyone needs to think big and switch to “disaster mode” of operating/thinking/responding

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Receiving Hospital

  • May need to activate internal plan depending on the situation

  • Maintain communication log with the Resource Hospital (CMC)

  • Report increases or limitations in capabilities to Resource Hospital (CMC) ASAP

  • Be prepared to send pre-assembled medical supply bags to the scene

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Patient Flow

  • Most critical victims from the scene may be transported to closest appropriate hospital before sophisticated communication network established

  • DO NOT attempt to stop patient flow from individual ambulances not associated with the disaster activity

    • These ambulances will carry on normal communication practices

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  • All communication must go through the Resource Hospital (CMC)

    • Associate Hospitals (LFH) are not to contact the scene directly

    • Associate Hospitals (LFH) are not to divert individual ambulances

  • Associate Hospital (LFH) receiving 1st field call from EMS needs to direct EMS to contact the Resource Hospital (CMC)

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Medical Personnel To The Scene

  • May be requested by Incident Command at the site

  • Team assembled based on need at the scene

  • Supplies specific to the incident should be brought with

  • Police escort to be provided

    • coordinated between Resource Hospital & Incident Command (or designee) at the site

  • Team to report to Command Post for assignment

  • Should be uniformed for easy identification

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Dispatch To The Scene

  • Self-dispatching of medical personnel to a disaster site is strictly prohibited

    • Causes additional chaos due to additional undisciplined and unmonitored persons congesting at the scene

    • For safety, need organized method to know who the rescuers are and where they are functioning

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After Action Report

  • All hospitals and fire departments involved in the Region X multiple victim/mass Casualty plan to to complete a written report following any incident or scheduled mass casualty drill

  • Helps during the critique process

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After-Incident ReportThe Critique

  • Form utilized for post-incident critiques by the Region X DMSC committee with intent of continually reviewing and improving the multiple victim/mass casualty plan as well as the education of fire/rescue/hospital and communication personnel

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Internal Hospital Plan

Better to call for additional help and turn them away than not to have them and wish you did!

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Internal Disaster Plan

  • ECRN needs to coordinate with:

    • ED MD

    • Administrator on duty

      • authorizes the activation of the internal disaster plan and authorizes the cancellation of the plan

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Hospital Incident Command

  • Typical lines of authority in-house

    • Administration on-duty; on-call

    • Nursing Supervisor on duty

    • ED MD

  • The identified person of authority makes and implements decisions to handle the situation

  • Often located in a “Command Center” manned by personal with phone access

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Additional Resources

  • You need to know when to get help and where to find the help at your facility

    • Decontamination capabilities

    • Trained staff to man key areas of the ED or alternate treatment areas

      • will serve as a resource for float personnel

      • how will you identify an ED staff member?

        • ie: vests, arm bands

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Additional Resources

  • RN’s - especially experienced or comfortable in the ED

  • MD’s - based on nature of illness or injury

  • Support personnel - clerks/secretaries/registrars

  • Runners/transporters

  • Persons to man phones

  • Security - control flow of traffic

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CMC versus LFH Disaster Plans

  • The following pages are more specific for CMC staff

  • The following information can be applied to most facilities any of us could be working at

  • LFH staff need to determine specific language and locations for their facility based on the information given in the following slides

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Hospital Disaster Plans

  • Many principles and practices are generic across most hospitals

  • Know where your hospital manual resources are kept (usually close to the radio)

    • Where are your manuals and what do they look like?

    • When is the last time you opened & looked at yours?

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CMC Paging of Disaster

  • Code Green External

    • influx of patients from external source

  • Code Green Internal

    • Need to recruit man-power for unusual activity related to unusual working conditions

      • power outage

      • lack of functioning emergency generators

      • evacuation is needed

      • need for all personnel on duty or off duty to be called in

      • damage to patient care areas (ie: flood, fire, contamination)

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Manpower Resource Center

  • Under direction of VP of Human Resources

  • Located in patient Registration waiting area off main lobby

  • Able to deploy staff to areas of need

  • If called from home, hospital personnel respond to this area (unless preassigned to respond elsewhere)

  • ED staff called from home respond to the ED Disaster charge nurse

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Manpower Resource Center and Additional Resources

  • When you need additional help, you inform the charge person for your area

  • Charge person needs to contact Command Center for additional help

  • Additional help to be assigned as needed/requested

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Responding Staff Members

  • If called from home:

    • Respond to area assigned or Manpower Resource Center if none given

    • Wear hospital ID badge

  • If on-duty at time of disaster page

    • Return to your work unit

    • Await reassignment if necessary

    • Do not respond to an area unless assigned there; adds confusion and does not help tracking of resources

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  • To control access points and flow of traffic by foot and vehicle

    • onto the campus

    • into the facility

    • at key points within the building

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Internal Communication

  • Walkie talkies are provided by Security

  • Key persons need to have easy and quick access for communication to each other

  • Communication support (ie: walkie talkies) need to be requested through the Command Center

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ED Charge RN

  • Makes assignment of on-duty and responding staff

  • Coordinates ED activity

  • Communicate need for additional resources to the Command Center

  • Need to continue to take care of non-disaster involved patients that will still be arriving by personal car and ambulance

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ECRN Radio Nurse

  • Preferably have one person assigned to the radio

    • continuity of conversation decreases missed and mixed messages

  • Use runner to get messages to the Charge RN

  • Keep Charge RN apprised of incoming messages

  • Keep Triage RN apprised of incoming type and number of patients

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Treatment Areas


  • At ambulance bay entrance

  • Patients assigned a location based on condition

  • Main ED

    • Red, critically ill/injured patients

  • Lower level dining room

    • Additional treatment area for yellow and green categorized patients

  • Decontamination l.jpg

    • If 10 or less patients (<10) can be provided in the ED decon room

    • If more than 10 patients (>10) to be provided in the locker room at the Centre Club - Libertyville

    • Manpower Resource Center to disseminate supplies as needed

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    Infection Control

    • Remember to consider proper use of PPE’s (personal protective equipment) based on the situation

      • If patients are coughing, think of an airborne problem

      • Provide and help place surgical masks on the patient (surgical mask helps contain spread)

      • The medical personnel should also put on a mask

        • The N95 mask will protect the medical provider from inhaling microscopic matter

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    Clerical Support

    • Assigned to areas of need

      • triage

      • patient registration

      • manning phones

    • Registrars have patient chart packets at main desk that need to be given out at Triage

    • Disaster log maintained

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    • Public Relations personnel to serve as liaison between hospital and media

    • No staff member should provide ANY kind of information to any persons not privileged to have the information

    • Public Relations to coordinate with the Command Center information being provided

    • Goal - keep media as far away as possible from victims & family

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    System Wide Crisis Preparedness

    • A Region X policy to enhance communication between EMS System Resource Hospital, Associate Hospital, EMS providers and community agencies

    • To be used for potential or actual area-wide crisis such as:

      • overcrowding events for patients with same or similar signs and symptoms

      • weather related problems

      • special events

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    System Wide Crisis Preparedness

    • Purpose of activating this plan is to help all agencies involved be prepared for a crisis that may impact any or all parties

      • ie: summer heat wave in Chicago resulting in large number of deaths

    • Any individual involved can identify a potential or actual crisis

    • The agencies’ supervisor is contacted

    • Resource Hospital EMS Coordinator or designee is contacted

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    System Wide Crisis Preparedness

    • The decision is made to activate this policy

      • POD hospital is notified (HPH for this area)

      • POD hospital member will contact IDPH if necessary

    • Communications continued between all applicable parties

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    Surge Capacity

    • Remember to anticipate a larger number of victims than you think you are getting

    • Not all patients come by ambulance where you receive an advanced call

    • Many victims will self-transport (ie: private car)

    • Often, the “worried well” think they have symptoms that they want evaluated

    • How are you going to handle this surge?

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    Example #1

    • Non-CMC sponsored fire department calls with information regarding a disaster in their town (ie: Gurnee, Lake Villa, Highland Park, Lincolnshire)

    • The ECRN should direct the fire department to their Resource Hospital

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    Example #1

    • The respective Resource Hospital (ie: Vista East or Highland Park Hospital) would call potential receiving hospitals (ie: CMC, LFH) to report pertinent information

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    Example #2

    • LFH receives a call from Lake Forest Fire that they are responding to an incident involving 50 plus students from a local school overcome with fumes

    • LFH should direct Lake Forest Fire Department to contact CMC (Resource Hospital) with the information and assistance with patient distribution

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    Example #3

    • Lake Forest Fire calls Lake Forest Hospital with report of 10 persons injured in a 2 vehicle crash.

    • Lake Forest Hospital directs Lake Forest Fire to contact the Resource Hospital (CMC) to assist in patient distribution

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    Example #4

    • Grayslake Fire contacts CMC with information regarding an incident involving 30 persons injured in a bleacher collapse

    • CMC, as the Resource Hospital, will coordinate location of receiving hospitals

    • CMC will also function as a receiving hospital

    • Each hospital decides if they need to activate their own internal disaster plan for resources

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    Example #5

    • A mass casualty incident occurs in the southern end of Lake County

    • Highland Park Hospital (Resource Hospital for that fire department) will be the communication link between incident and receiving hospitals

    • HPH contacts CMC, LFH, and other indicated hospitals to determine patient capabilities

    • HPH does the communication to the incident site & back and forth to hospitals

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    Example #6

    • Libertyville Fire Department responds to an incident on the tollway involving 7 patients

    • Libertyville Fire Department calls CMC

    • CMC can take all 7 victims

    • No additional involvement with other receiving facilities is necessary - CMC can handle all the injuries with minimal use of some additional resources in-house

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    Example #7

    • CMC receives a call from NWCH stating we are going to be receiving patients from an incident in Buffalo Grove

    • What is CMC’s response?

      • CMC is functioning as a receiving hospital

      • Communication will occur through NWCH to the site and NWCH to the receiving hospitals

      • CMC does not function as a Resource Hospital

      • Communication to LFH would be from NWCH, if LFH would be receiving patients

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    Bottom line...

    • Know where your Disaster Manuals are and how to use them

    • Review the disaster manuals often enough to be comfortable to respond without much prompting

    • Be familiar with your own facilities resources, know who functions in the charge role, and know how to get the disaster response activated