A DISASTER ORGANSZATEON PLAN FOR
8?. JOHNS HQSPITAL, ST: PAUL. MENNESOTA

Thesis for Hm Dsqrfia of M. A.
MICHIGAN STATE UNIVERSITY

Virginia Ann Reid
1958

A DISASTER ORGANIZATION PLAN FOR ST. JOHNS HOSPITAL,

ST. PAUL, MINNESOTA

BY

VIRGINIA ANN RElD

A THESIS

Submitted to the College of Business and Public Service
Michigan State University of Agriculture and
Applied Science in partial fulfillment of

the requirement for the degree of
MASTER OF ARTS

School of Hotel, Restaurant, and Institutional Management

1958

ACKNOWLEDGMENT

The writer wishes to express appreciation
to all those who made the completion of this
thesis possible. ESpecially, she wishes to
thank Dr. S. Earl Thompson for his valuable
suggestions and encouraging support.

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TABLE OF CONTENTS

CHAPTER Page
I. INTRODUCTION TO THE PROBLEM. .............................. 1
History of Hospital Disaster Planning ............ . ..... 2
General.............. ....... . ....................... 2
St. Johns HOSpital..................... ......... .... _ 5
Definitions of Terms Used.... .......................... 10
Disaster..................... ..... ‘ ................. . 10
Disaster Plan................ ....... . ........ _ ....... 12
Disaster Situations.... ........ . .................... 12
Statement of the Problem............ ............... .... 13
The Problem ........ .......... ....................... 13
The Purpose............... ...... . .................. 13

The Limitations of the Problem...... ................ 1h '
The Organization of the Study..... ................. . 15
Summary........................... .............. ....... lf
References... ....... .......... ......... . .......... ..... 18

II. FACTORS WHICH MDDIFY.A HOSPITAL'S FUNCTION IN A DISASTER.. 19

Community'pflanning................. .................. .. 19
Medical. Staff Planning.... ................... . ......... 23
Summary... ..... ... .................................. 26
References... ....... .. ..... . ........... ’ ................ 27

III. THE DEVELOPMENT OF THE OVERHALL DISASTER PLAN AND RELATED

POLICIES.................. ........ ..... ..... . .......... 28
General........................... .............. .... 28
Administrative Committee on Disaster Planning ...... .... 29
General P1an..................... ................. .... 31
Organization of the Hospital at the Time of a
Disaster............. ......... .... ...... . ....... . 31
Chief Control Officer. ...... ...... -.. .............. 32
Functions that are.Assigned to Key Personnel. . ...... 35
Disaster'Warning.............. ...................... 38
Phases of the Disaster Plan. ....... ....... .......... 39

Notification.of Personnel at the Time of a Disaster. ho
Plan for Handling Mass Casualties in the Hospital... D3
Assignment of HOSpital Space........................ NS
Personnel.................. ......................... 50
Traffic Control.... ................ ' ................. .52

iii

TABLE OF CONTENTS - Continded

CHAPTER Page
Control of Visitors.......... ...... . ................ Sh
Functions of the Chaplin......... ........... ........ 55

AMSSion 0f htien‘tSOOOOQIOOO00.00.000.000.00.00... 56
Financing the Cost of Hospital Services to Casual~

ties.................... ......... ................ 56
Access to Facilities.............. ........ . ...... ... S7
Supplies and Equipment....... ....................... 57
Termination of Disaster Operations..... ......... .... 61
Evaluation of the Functions of the Hospital after

the Disaster has Occurred............... ......... 62
Training and Rehearsing for Disasters ............... 63

Summary.............. ....... .. ................ . ........ 66
References.. ..... ........ ...... ... ...................... 67

TV. THE ORGANIZATION AND OPERATION OF CLINICAL AND NON-
CLINICAL FACILITIES OF THE HOSPITAL FOR THE USE AT THE

TIME OF.A D[SASTER..... ....... .................. ....... 69
The Receiving, Admitting, and Sorting Area. . . . . . . . ..... 70
General...................... ........ ............... {0
Functions and Procedures..... ...................... 72
Equipment and Supply Requirements ........... . ....... 73
Emergency Medical Records.......... .................... 73
Types of Records that Should be Kept ................ /h
Operation and Policies.................. ..... . ...... 76
Equipnent and Supplies........., ........ ..... ‘78
Specific Procedures.... ................... .......... 78
Communications................... ...................... 81
Public Relations.......... ......................... . 81
Communications............. ...... . .......... . ...... . 83
Telephone................. ....................... 83
Radio....................... ............... ...... 85
Hospital Paging System...... ......... ..... ....... 86
Message Center. . ....................... ..... 86
Suppli.es, Equipment and Utilities Division ..... ..... 87
Housekeeping... ...... ..... ...................... 88
Central Stores............... .......... . ......... 89
Engineering and Maintenance ....... .....,......... 90
General............. .......................... 9O
Elevator Service.... ......... . ........... ..... 90

Traffic Control....... ..... .. ............... .. 9O
Emergency'Utilities... ......... . ...... . ........ 91

Dietary» ...... ............ .......................... 96
Nursing .......... .............. ....... . ..... . ....... 99

iv

TABLE OF CONTENTS - Continued

CHAPTER ' Page
General.............. ..... .. ..... .... .......... _.. 99
Functions.................................. ...... 100

.Amount of Nursing Personnel and.Assignments... 100

Bed Capacity for Casualties........ ...... ..... 100
Procedures.................. .................. 102
Central SuppLy.......... ..... . ................. .. 106
Special Services............ ..................... ... 108
Laboratory............... ..... . ...... . ........... 108
X-Ray Service......................... ......... .. 109
Pharmacy.............. ............ . .............. 110
Emergency Personnel........... ............. . ....... . 111
Summary........... ...... ...... ...... . ............. .. 113
References.......................................... 11h

V. AN OUTLINE OF BASIC STEPS FOR THE PREPARATTON OF A

DISASTER PLAN FOR ST. JOHNS HOSPITAL. 116
HOSpital Disaster Committee.................. .......... 116
Medical Staff Disaster Subcommittee. ................. 117
Assignment of Hospital Space........... ............... 117
Preparation of the Preliminary Master Disaster Plan”... 120
General..................... ............ ... ...... . . 120
Proposed Master P1an................................ 123
Preparation of Detaileerepartmental P1ans....... ...... 132
Review and Lntegration of Detailed Plans ............... 132
Community Coordination................ ....... .......... 132
Four Concurrent'StepSp..................... .......... .. 137
Distribution of the Master P1an............. ....... . 137
Assignment of Personnel to Their Duties............. 137

Orientation and Training of Personnel............... 13’7
Carrying Out of the Lonngerm.Aspects of the Plan... 137

.Periodic Drills and Exercises........ .............. .... 138
Periodic Reviews and Revisions of the P1an............. 138
Summary...................... ....... . .................. 138
References....................... ..... . ....... . ........ 139

VI. THE PREPARAT[ON OF DETAILED DEPARTMENTAL DESASTER PLANS... 1DO

Emergency.Administration.... ....... . ............ ' ....... 1H1
First.Aid Post............ ............................. 1&2
Ambulance Reception. . . . . . . . ......................... . . . 111D
Admission and Sorting..... ............................ . 1h5
Emergency Medical Records....... ....................... lh6
Expansion of Surgery... ...... - .......................... 1h?

 

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TABLE OF CONTENTS — Continued

CHAPTER Page
Expansion of'Ward Sections ............................. 150
Nursing Services.............. ......................... 153
Morgue.......... ......... . ............................. 155
Laboratory... ...... . ............... 7 .................... 155
X-Ray........................... ........... . ......... .. 157
Pharmcyoooooooaooooooo. oooooooo o oooooooooooooooooooooo 158
Central Supply................... ...................... 159
Dietary-....OOCOOIOC.OOO'OO......O OOOOOOOOOOOOOOOOOOOOOO 1w
m-pplyOII......UOCCOOOCQODOCIOOI OOOOOOOOOOOOOOOOOOOOOOO 162
Maintenance and Engineering...... ...................... 16h
Housekeeping and Linen Service.. ..................... .. 166
Emergency Communications..... .......................... 168
Information 0ffice............. ................ . ...... . 169
Policing and Traffic Control.. ......................... 170
Emergency Personnel Office ............................. 172
Evacuation................ .......... . ........... . ...... 173
Medical Staff........ .................................. 173
Summary .............. ...., ..... . ....................... 175
References ........... .. ................................ 176
CONCLUDING STATEMENT ......... .... ....... . .......... . ............. 177
BIBLIOGRAPHY... ................. _ ......... . ....................... 128
APPENDICES:
A. Testing and Rehearsal of HOSpital Disaster Plans ........... 189
B. Federal Civil Defense Emergency Medical Records ............ 195

vi

TABLE

I. St. thns Hospital PerSOnnel as of December 31, 1957 .......

LIST OF TABLES AND FIGURES

FIGURE

1.

11.
12.
13.
1h.
15 .

16.

17.

.A Map of St. Paul, Minnesota Showing the Industrial and

Suburban.Area that St. Johns HOSpital Serves...... ........

Suggested Organization and Composition of a Community

Disaster Service................. .........................
Suggested Disaster Organization of a Hospital ......... ....

Casualty Flow P1an.... ...... ...... ........ .I ..............

Suggested Organization of the Receiving, Admitting, and

Sorting.Area...................... .................. . .....
. Suggested Organization for Emergency Medical Records ......

. Suggested Organization for the Communication Division .....

Suggested Organization for the Supplies, Equipment, and

Utilities Division. .............. .......................
Suggested Organization for the Dietary Division ...........
. Suggested Organization for the Nursing Division.. .........
Suggested Organization for Special Services. ..............
Suggested Organization for the Emergency Personnel ........
First Floor Plan of the Hospital Showing Expansion.Areas...

Ground Floor Plan of the Hospital Showing Expansion Areas..

Plan Snowing Entrances and Driveways Leading to the

HospitaJ-IOOOCO0.0.0.000...0......0...‘ OOOOOOOOOOOOOOOOOOOO
Personnel Identification Card............. ................

Emergency Volunteer.Application.Blank ................. ....

vii

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70
73
81

87
96
99
108
111
121

122

. 127
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INTRODUCTION TO THE PROBLEM

The need for hospital disaster planning is no longer idle talk.
Hospitals, today, are having it brought home to them forcefully that
indecision and the lack of planning for emergency situations can be
disastrous professionally and costly from a public relations stand-
point (1).

A.1oca1 disaster such.as a tornado,flood, or industrial explosion
might occur at any moment, without advanced notice. [n disasters of
any magnitude, people turn to hospitals for help. The task of providing
immediate medical and hospital care for casualties as the result of a
disaster falls directly on the hospitals, the doctors, and the nurses
within the stricken area. The disaster's impact on the medical re-
sources of the community is immediate and demanding, whether or not
these resources are prepared to care for mass numbers of casualties.

Dr. Dean A. Clark, Consultant to the Committee on Disaster Planning
of the American Hospita1.Association, said at the New England Hospital
Assembly in Boston, Massachusetts in March, 1956:

Disaster planning is not the product of the imagination of a

science fiction writer, but rather the basic realization of

a possibility which exists in the country as a whole and in

every city and community. The hospitals, themselves, are

ultimately reaponsible to develop a workable program for the

handling of mass casualties as the result of a community
disaster. (2)

Provisions for adequate hospital care at the time of a disaster in the
community is a reaponsibility that is inherent upon the hospital. The
efforts of a hospital which lacks a definite plan to meet emergency
situations are almost certain to result in confusion and a haphazard
program that will, in effect, endanger the quality of patient care
within the hOSpital. Therefore, there must be adequate and realistic
plans in all hospitals that have been made well in advance to meet
these demands (3).

During the past eight years almost every issue of the journals
dealing with hospital administration such as Hospitals, ModerngHospitals,

Hospital Managgment_and Hospital Tgpics, has contained one or more

 

articles on the various aspects of the functions of heapitals in a
disaster situation. The frequency with which such articles have appeared
in the literature gives some indication of the importance and the need
for the adequate planning of hospital functions and facilities in a

time of disaster.
HISTORY OF HOSPITAL DISASTER PLANNING

General. The first federal movement toward disaster planning
occurred in 1950. At this time, in retrospect of the lessons taught
by'WOrld'War II, it became apparent that the safety of the civilian
population of the United States could no longer be taken for granted
under the brutal concepts and practices of total war. This realization
led to the conclusion that in future wars our country must be prepared

to defend the home front just as effectively as the front lines in the

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combat areas. In keeping with this new concept and upon recommendation
of the National Security Resources Board under the chairmanship of

‘W. S. Symington, the defense of the United Statesi home front was
strengthened by former President Truman and the Congress by the estab-
lishment of the Federal Civil Defense Administration (Public Law 920
approved January 12, 1951). This agency'was given the mission to
prepare comprehensive plans for the protection of the major cities of
this country in the event of an attack by an aggressor. As this work
progressed, the scope of the Federal Civil Defense.Administration was
broadened to also include natural disasters iExecutive Order.No. th2?,
January 16, 1953, Public Law 875) (h).

Surveys were made by the Federal Civil Defense Administration and
its components at the state and local levels. These surveys quickly
revealed that the United States not only lacked the means to cope with
the effects of a major natural or man-made disaster, but that in our
states, counties, and cities there were not plans for meeting the needs .
of such a situation. These studies showed also that our shocking
unpreparedness for disaster extended to the same or even greater extent
among the hospitals and their medical staffs (5).

The disclosures of the Federal Civil Defense Administration were
heeded by the American College of Surgeong, the American Medical Associ-
ation, and the.American Hospital Association. For example, in June of
195h, the American Hospita1.Association*s Board of Trustees created a
Committee on Civil Defense and told it "To explore with the Federal

Civil Defense Administration the role to be played by hospitals in the

 

 

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event of a national emergency." This action by the Association was in
recognition that hospital planning for civil defense should be high on
the order of priority of its activities (6).

One of the tasks undertaken.by this Committee was to investigate
the type of planning hospitals should do to prepare for their role in
nuclear attack. During its investigation the committee came to realize
that civil defense was but one dramatic aSpect of hospital disaster
planning. .As a result of its studies concerning the role of the
hospital in responding to community disasters, the Committee‘s original
frame of reference was broadened and officially recognized in a title
change from the Committee on Civil Defense to the Committee on Disaster
Planning.

This Committee conducted a survey among the 6,970 hospitals regis-
tered with the American Hospital Association in September of 195h. The
Committee asked three questions that involved disaster planning in
these hospitals:

1. Do you have a written plan for the mobilization of the
employees and the medical staff of your hospital?

2. If the answer is "yes" to the above question, does the
community have a master plan for a community disaster
within which the hospital plan is integrated?

3. Is your hospital represented on a disaster planning
committee for your community?

The results of these questions showed that only 32 per cent of all of
the hospitals in the United States had a written disaster plan, and

only 27 per cent of the hOSpitals had integrated the hospital plan with

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the community plan. Forty~two per cent of the nation‘s hOSpitals were
represented on a community committee for disaster planning (7).
Although the officers of the American Medical Association, the
.American College of Surgeons, and the American Hospital Association
'were untiring in their efforts to induce their members to prepare them-
selves to render adequate medical and hospital services in the event
of a catastrophe, the reSponse of the members was very slow. There was
little or no improvement in this situation until the Joint Commission
on the.Accreditation of Hospitals at its meeting on January 28, 1956
decided to put an end to the delays.’ In accordance, and in order to
stimulate the hOSpitals to action, The Joint Commission on the Accredi-
tation of HOSpitals prescribed a new requirement for accreditation.
This standard made it mandatory for every hospital seeking accreditation
by this Commission to develop an adequate disaster plan, to implement
the planning by providing the necessary equipment and supplies, and to
assure the efficiency of the plan in the event of a disaster by means
of a continuous training program for hospital personnel in their

respective duties in such an emergency (8).

Background of disaster planning at St. Johns Hospital, St. Paul
Minnesota. St. Johns Hospital is a 250 bed community hospital. It is
located one—half mile from the center of downtown St. Paul, Minnesota,
on a bluff overlooking the lowlands of the Mississippi River and the
main railroad yards of the Upper Midwest. Although this hospital is

one of three hospitals located on the east side of St. Paul, it is the

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only general hospital in this area that is equipped to handle a general
emergency situation. The two other hospitals are specialty hospitals-
one for the treatment of crippled children and one for the treatment of
mental patients. The area that St. Johns Hospital serves includes a
large industrial section (Minnesota, Mining and Manufacturing Company,
Hamms Brewrey, Whirlpool-Seeger, 00., etc.) and a large suburban area
(Figure I).

St. Johns Hospital emplqys 213 nurses and other professional people
as well as 361 non-professional people (Table I). The Medical Staff
includes 56 doctors of which the majority are general practitioners.
This hospital does not have an intern or student nurse training program.

Because of its location, the area it serves, and pressure from
various medical associations, the Board of Directors of the hOSpital
had become increasingly aware of the necessity for disaster preparedness.
Therefore, a Hospital Disaster Planning Committee was established during
the winter of 1956 to coordinate the development of a disaster plan for
the hospital. There were twelve members appointed to this committee
representing most of the key positions in the hospital‘s administrative
organization. At the same time a Medical Staff Disaster Committee,
composed of eight doctors, was established to assign physicians to
disaster positions within the hospital in cooperation with the Ramsey
County Medical Society and to establish standard medical care pro—
cedures to be used in times of emergency situations.

Basically, these committeess did not function well because of

inadequate preparation for the job and because there was no clear

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FIGURE 1

A MAP OF ST. PAUL, MINNESOTA SHOWING THE INDUSTRIAL AND SUBURBAN AREA
THAT ST. J DIETS HOSPITAL SERVES

TABLE I

ST. JOHNS HOSPITAL PERSONNEL AS or DECEMBER 31, 1957

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Department Professional or

 

 

Personnel Heads Supervisory Non-professional

Nursing .

Reg. Nurses h 159

L. P. N. 25

Aides 108

ward Secretaries ll

ward Clerks 6

Orderlies 15
Surgery and Anes. l 2
Dietary 1 6 6h
Laboratory 1 12 2
X-ray 1 8 2
X-ray Students 6
Physical Medicine 2 6 6
Pharmacy ' l 2 2
Housekeeping and Linen 1 1 52
Plant Operation.and

Maintenance 1 17
Business Office 1 l 15
Admitting 1 8
PBX and Receptionist l 13
Purchasing and Stores 1 2
Medical Records 1 f5

Total 16 197 361

 

 

 

definition as to what the scope of the problem was to be. The Committee
became bogged down on questions such as:

1. How many battery operated lights should there be on hand in the
hospital in case of a power failure?

2. What should be done about stockpiling narcotics for use in an
emergency situation?_

Eventually, questions such as these must be answered, but the prime
objective, the development of a hospital disaster plan, was never
achieved. The committees, also, did not consider the inclusion of
community agencies such as Civil Defense and the Red Cross in their
planning. Representatives of agencies such as these could and should
have offered valuable help and assistance in the development of such
plans.
Even though the committees did not develop an over-all plan, some
things were accomplished:
1. On review of the facilities of the hospital, it was felt that
the hospital could handle effectively 100-200 disaster victims.
~2. A survey was made to determineé
a. The number of beds that could be put into emergeney
use.
b. The amount of surplus linen and bedding on hand.
c. The amount of certain other supplies such as bed pans,
thermometers, etc. generally kept on hand.
As a result of this survey 50 army-type cots were purchased,
’ 50 linen packs (sheet, blanket, pillow) were made up, and an

emergency drug box was stocked. These items were-stored in a

 

 

 

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central location within the hospital that was easily access-
ible and provision was made for routine periodic checks of
these supplies.

3. A complete roster of employees and medical personnel and their
telephone numbers was made up and given to the switchboard
operator for posting.

h. The medical staff was given assignments as to their responsi-
bilities in case of an emergency situation.

5. A list of the names and telephone numbers of the various
suppliers of hospital items was developed.

As can be noted from this discussion, no complete plan was

developed and, at this time, St. Johns Hospital still lacks an adequate,
over-all hospital disaster plan. It is felt that the Committees? work

should be re-evaluated and a new approach to the problem be taken.
DEFINITIONS OF TERMS USED

Disaster. For purposes of this study, a disaster is a massive
accident which throws upon the medical system of a community a sudden
excess of patients in urgent need of emergency treatment and at a rate
greater than the medical and administrative system is normally adjusted
to absorb (9). Examples of such types of accidents might be floods,
tornadoes, fires or explosions. Specifically, a disaster can be defined
as any situation in which the victims of said situation reach a hospital
in.such numbers, or so concentrated in a period of time, or with such

severity of injury or disturbance that their prompt, adequate hospital

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care creates demands upon the hOSpital which cannot be met by the

hospital's routine treatment or admission procedures (10).

Because the disaster planning that is discussed in.this paper

involves St. Johns Hospital in St. Paul, Minnesota, the types of

potential disasters in this area (11) are:

1.

Floods. Because the Mississippi River flows through the heart
of the St. Paul area, this is the most likely type of disaster
and the most devastating.

Tornadoes. The tornado is the most destructive of natural-
caused disasters in this area. The extent of damage or possible
area involved is completely unpredictable.

Fires. Fires of disaster proportions are always a potential
danger in a crowded municipality. The slum areas contain the
greatest likelihood or potential widespread destruction where
many frame structures containing great numbers of people are
crowded into small areas.

Explosions. ,As evidenced by a recent Minnesota Mining and
Manufacturing Company explosion, great damage may result from
chemical or heating plant explosions in areas of concentrated
population,.Apartments, hotels, industrial plants, and office

buildings are likely spots for.such incidents.

S. wrecks--bus, train, airplane, etc. St. Paul is a substantial

transportation center for the above types of travel which cause
a continuing possibility to exist for accidents in such travel

resulting in damage to persons and property.

 

 

12

6. Epidemics. 'The St. Paul Health Department gives careful atten-
tion to water supplies, milk distribution, and_the handling of
food, but typhoid epidemics have occurred in connection with
the floods. Also, epidemics, such as the Asian Flu during the
'winter of 1957, cause great strains to be placed on the medical
facilities of the community.

Qisaster_?lan. A disaster plan is a well-organized, flexible plan

 

of action to be used by a hOSpital at the time of an emergency result-
ing from a natural disaster. This plan of action is worked out in
advance of the disaster situation to cover all phases of the management
of mass casualties within the hospital. The expected disaster never
happens, so no disaster plan can meet all the situations in every detail.

Qigaster Situations (l2):' In general the disaster plans of a

hospital should provide for two major types of action at the time of
an emergency.

1. Evacuation. This term refers to the movement of patients and
personnel from the hospital to another place for various pur—
poses and in varying degrees in as rapid and safe a manner as
possible under the existing disaster situation. This includes
the procedure of discharging certain types of patients from the
hospital either for their own safety or to free additional beds

' for casualties being admitted to the hospital.

2. Expansion. This term refers to the emergency procedures of

increasing the capacity of the hospital's facilities and

services for rendering casualty care.

 

 

 

 

 

 

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In any type of disaster, regardless of cause, the hospitalis response
would usually involve either one or both of these actions in varying
degrees. Outlined.below are basic disaster situations that may be

faced by a hospital and the hospital‘s response to the situation:

 

Disaster Situations Hospital Response
1. Minor disasters, external. Expgpsion of the hospital treatment
area

Community disasters involving 3 0 care for the casualties.
relatively small numbers of -

casualties as a result of

storm, fire, flood, etc.

2. Major disasters, external. Expgpsion of reception and treat-
Community disasters involving . ment areas to care for the casual—
large numbers of casualties as ties.

a result of storms, fire, Evacuation of some in-patients to
floods, etc. free beds for incoming casualties.
3. Disaster Threats--disaster Precautionary expapsion or

threatening the community such evacuation, either partial or total.

as impending storms, tornadoes, “Alert" notification to the staff

floods etc. and outside cooperating agencies.
Preparation of reserve equipment
and supplies .

STATEMENT OF THE PROBLEM

The Problgm. The problem to be dealt with in this paper is the
development of a guide to be used in the preparation of a disaster plan
for St. Johns Hospital, St. Paul, Minnesota.

The Purppse. The purpose of this guide is to help the adminis-
trative staff of St. Johns Hospital to prepare a disaster plan that
will promote sound, orderly mobilization of the hospital to an emergency
status as the result of a. natural disaster. This plan.should be:

1. Flexible to the extent that it can be quickly adapted to meet

emergency situations resulting from natural disasters.

 

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2. Provide for the rapid admission of a large number of casualties
to the hospital.

3. Provide for the initial.and.continued.medical care of the
casualties and the critically ill non-casualty patients.

h. Provide for the protection of patients already in the hospital
and their evacuation if necesSary from the hOSpital.

5. Provide for the continuation of hOSpital services under adverse
conditions such as the disruption of water, power, electricity,
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the problem to a comprehensive review of the special problems and needs
which a disaster situation imposes on a hospital. Experience, as eviv
danced by reports of many disaster situations, indicates that the
essential provisions of a hospital disaster plan should include
policies, facilities, equipment and supplies, and special methods and
procedures.

There will be no attempt made to develop a "master" plan that could
be used for all hospitals. There has been much demand on the part of
hospital administrators, as can be noted by the literature, for a so-
called "master" plan on the disaster functions of a hospital. As
desirable as such a plan might be, it has been found neither advisable
or feasible. It has been and will continue to be impossible to develop

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15

of individual communities and hospitals. This presentation will be
limited to a suggested plan for one institution—~St. Johns HOSpital
Iocated.in St. Paul, Minnesota. .

'While it will be briefly recognized as a definite need in planning
for emergency situations, community disaster planning will not be dis-
cussed in great detail. The discussion that will be presented on
community planning for disasters will be limited to the need for com-
munity planning and the present status of community planning in the
St. Paul area.

_.Another part of planning for emergency situations in a hospital
that is extremely important but which will not be covered in detail is
the responsibilities of the medical staff in disaster planning. This
type of planning must go on jointly with over-all hospital planning,
but it is not within the knowledge of the author to adequately cover
the subjects of disaster assignments of physicians and the treatment
of disaster victims.

Finally, the disaster planning that is discussed in this paper
will be limited to planning for disasters that occur outside of the
hospital. Internal disasters such as fires or explosions within the
hospital do occur, but because this type of planning calls for a dif-
ferent approach and because St. Johns Hospital has a plan covering this

type of disaster it will not be covered.within the scope of this

problem.

Orgppization of the Study. The material that will be covered in

the preparation of the proposed guide will be a discussion of the three

 

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16

essential provisions of disaster plans:

1. Policies

2. Facilities, equipment, and supplies

3. Special methods and procedures.

This material will be based on the findings of other hospitals that
have been reported in the current literature, a review of actual dis-
aster plans that have been developed by specific hospitals throughout
the country, and the needs of the particular institution under
consideration.

Finally a proposed.disaster plan will be developed using the
suggestions presented above and those proposed by the American Hospital
llssociation in a phamplet, Pgippiples_pf_Disaster_PlanningLfor_Hpspitals,
‘published in 1956 (13). The purpose of this handbook is to "provide
Inospitals with an outline of the general principles of hOSpital disaster
pflxxnning'which‘will serve as a guide and a checklist to be used in
dkaveloping their specific plans." .Actually, this is the only official
basis that has been developed that a hOSpital has for help in planning
.fcxr emergencies. However, it is too general and must be adapted to a
erecific situation. The principles outlined in this phamplet are:

l..Appoint a hospital disaster committee.

2. Appoint a medical staff disaster committee.

3. Prepare a preliminary, general disaster plan..

h. Prepare detailed departmental disaster plans.

5. Prepare standard emergency medical care procedures.

6. Review and integrate the detailed.departmental plans and

requirements into an over—all master plan.

7. Coordinate the hospital‘s disaster plan with the community

disaster plan.

8. Distribute copies of the master plan to all employees, the

medical-staff, the board of directors, and to community

officials, other hospitals and community disaster agencies
such as Civil Defense and.Red Cross.

17

9. Give employees and the staff their disaster assignments and
instruct and train them in their disaster responsibilities.

10. Develop procedures to orient and train new employees and
staff members in their diSaster reSponsibilities.

ll. Begin to carry out other aSpects of the disaster plan that
require a longer period of time to accomplish.

12. Conduct frequent and periodic drills and exercises under
various simulated.disaster situations to practice the
disaster plan, to test its effectiveness, and to maintain
constant readiness.

13. Carry out periodic review and revisions of the hospital's
disaster plan to make improvements and changes as needed or
as indicated.

These principles will be employed in the development of the suggested
disaster plan for St. Johns Hbspital with particular emphasis on

Principles one, two, three, four, six, and twelve.
SUMMARY

During the past eight years it has become more and more evident
'that hospitals must be prepared.to care for casualties that result from
£1 disaster in the community such as flood, tornado, transportation.wreck,
ikire, epidemic, or explosion. The purpose of this paper is to develop
a. guide that can.be used by the administrative staff of St. Johns
HOSpital in planning to meet disaster situations. This guide will con-
tain basically four main topics:

1. Policies

2. Facilities, equipment, and supplies

3. Special methods and procedures

h..A suggested disaster plan for St. Johns Hespital.

1.

1J..

12?.

13 .

18

REFERENCES

William Slabodnick, "Duties of the Purchasing Agent in Planning
for Disasters," Hospitals, 32:62-oh, January 16, 1958.

. "Disaster Planning," New England Journal of Medicipg, 2943819,

April 26, 1956.

Donald R. Newkirk, "147 Casualties Treated in 32 Minutes,"
Modern Hospital, 88:62-68, February, 1957.

Curtis H. Lohr, The Planning of Hospital Functions in a Disaster,
(Kansas City, Missouri: Mid West Hospital Association, 1957), p. 1.

W. P. Chesbro, "Organized Medicine and Civil Defense," Journal of
the American Medical Association, 162 :985-988, November 3, 19%.

Principles of Disaster Planning for Hospitals, (Chicago: American
Hospital Association, 19351: p. v.

"Annual Statistics," Hospitals, Part 2, 29:92, August 29, 1955.

"Standards for Hospital Accreditation," Bulletin of the Joint
Commission on Accreditation of Hospitals, No. 11, March, 1956.

Slabodnick, loc. cit.

"Two Disasters Taught the Same Lessons," Hospitals, 31:h2—hh,
June 16, 1957.

American Red. Cross, "Disaster Plan," (St. Paul Che oter, American
Red Cross: Subcommittee on Survey, January, 1956). aiMiJneographed.)

Principles of Disaster Planning for Hospitals, pp. 231., pp. 5-6.

Ibid., pp. 1-3.

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CHAPTER TI

FACTORS WHICH MODIFY A HOSPITAL‘S
FUNCTION IN A DISASTER
When plaIming the emergency operations of a hospital during a
disaster situation there are two modifying functions that rust be

considered in order to develop a well-coordinated plan of action:

1. Community planning,
2 . Medical staff planning-

COMMUNITY PLANNING

The disaster plans which have been developed recently in compliance
With the action of the Joint Commission on Accreditation of Hospitals
Show that most of these plans cover only the second phase of casualty
management-“the care of the seriously sick and wounded in hospitals (1) .
While it is understandable that hospital officials should be primarily
concerned with the internal functions of their institutions in a major
emergency, some of these officials have given little or no thought to
the fact that the efficiency of their hospitals' services in a disaster
is conditioned indirectly at such times by the services of other agencies
1‘? or which they are not responsible. Community disaster planning is an
essential part of a successful reSponse to major disastersa A hospital,
cEmmet do its best job of saving lives unless the community has estab-

lished a practical disaster plan for other agencies such as police,

Given Defense, Red Cross, fire department, public health, etc.

 

 

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Two lessons with respect to community planning have been learned

from past disasters (2):

1.

.All disaster efforts must be centrally directed and coordinated
to insure the full and equitable use of all the community‘s
hOSpitals and health resources. The first phase of casualty
care includes the search for the sick and injured in the dis-
aster area, the administration.of first aid, the assignment

of casualties to Specified hospitals, and the tranSportation
of the casualties to the designated hospital. Too often one

or two hospitals have carried.the full brunt of the disaster
impact when others nearby available to assist have not been
utilized. .The centralized coordination of this work is vital
because promptness determines to a large extent the final fate
of the casualties.

Other community resources must be drawn into disasters in a
planned.manner to provide assistance and.support to hospital
efforts. Community agencies such as police, fire department,
public health departments, Civil Defense forces, Red Cross,
fraternal organizations and others, should have supporting roles
outlined.in.advance. The scope of these supporting roles
should be clearly defined.by mutual agreement among all agencies
involved. If this is not done and these agencies fail to per—
form their reSpective duties in the disaster area promptly and
efficiently, their deficiencies will slow up the first phase
of-casualty care and this in turn will affect the work of the

hOSpital unfavorably.

 

 

 

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In Spite of the fact that the fulfillment of the above listed
vital functions in disaster management is not the direct responsibility
of the individual hospital and is in effect beyond their control,
hospital officials must realize that they cannot develop effective
hospital disaster plans unless they know how those who are responsible
for these functions propose to implement them. If hospitals are ex-
pected.to accomplish their mission and objectives, they must have the
support and help of many other agencies and individuals in the community.
EXperience has shown that the various agencies and individuals who are
needed, in addition to hospitals, to cope with the destruction caused
'by a disaster, cannot function effectively if they work independently
of each other. It is also recognized, that in order to get the best
jpossible results, the work of these agencies and of the hospitals must
13s fully coordinated under a single command. These requirements are not
anitomatically met. In order to fulfill these complex and extensive
rheeds there must be an all-inclusive plan which has been accepted.and
Ftill be supported by all concerned.

Some other functions that require community participation include:

~l. Police and traffic control.

2. Supplementary personnel, staff, supplies, and equipment.

3. External communications.

h. Tagging procedures for casualties.

5. Identification cards for authorized personnel.

6. Transportation of casualties and evacuated.patients.

7. Provision of alternate sources of essential utilities. (3)

22

In St. Paul, Minnesota there are four groups that are currently involved
in the medical care of the community: The Red Cross, Civil Defense
Agencies, Governmental Agencies including the Police, Fire, and Public
Health agencies, en the hospitals. At the time of this writing there
has been no coordinated organization for community disaster planning.
The Twin City Regional Hospital Council has requested that all of
the hospitals under its jurisdiction submit their disaster plans. In
a letter received from this organization it was stated that the plans
received from the hospitals of the area are "few and far between" and
”frankly not of much value." Only nine of the 2? hospitals in the
Twin City area that were contacted have a written plan. Six are cur—
rently working on such plans. None of the plans have been rehearsed
under a similated situation nor have they been integrated with any
other organization in the community.
The governmental agencies such as the police, fire, and public
health departments make ambigious statements such as:
The governmental responsibilities in the time of disaster is
in general the same as in normal times--the protection of life,
health, welfare, and property, and the maintenance and repair
of public preperty. Disasters do not change the legal reSponsi-
bilities of government but rather increase the need of meeting
them promptly and adequately. ()4)
There are no plans of action for these agencies in a catastrophic
Situation.
The Civil Defense organization in the St. Paul area, while
responsible for planning for natural disaster as well as nuclear dis-
aster, has concentrated their efforts and training to only the latter

Sitaxation'gS). Actually the only agency within the St. Paul community

23

that is ready to meet a disaster situation within the community is the
St. Paul Chapter of the American Red Cross (6). This Chapter has
functioning units that are well organized and which are continually
meeting many catastrophic situations. Unfortunately while the Red
Cross has the organization, the authority to function in a natural
disaster, and in this comnnmity, is the logical coordinating unit, it
has not been successful in gaining the cooperation of the governmental
agencies, the Civil Defense, and the hospitals.

While it is not within the scope of this paper to develop a com-
munity disaster plan, it is important to re-emphasize that the disaster
plan of St. Johns Hospital to be completely effective must be coordi-
nated with the other commmity health and welfare agencies under a

centralized authority.
MED [CAL STAFF PIANN ING

Dr. William T. Pitts, Jr., As‘Sociate Professor of Surgery at the
University of Pennsylvania, in a talk before the American College of
Surgeons, said, "Less than 10 per cent of the nation‘s hospitals are
Organized to cope efficiently with mass disaster. . . . rIhis lag in
Planning is chiefly the result of apathy on the part of the doctors." ( I)

The medical staff of a hospital has one of the most important
1" Ogles in the planning and the handling of mass casualties resulting
from a disaster situation. . It makes no difference how efficient a
hOSpital is in receiving patients and expanding its facilities if there

is no organized and trained medical staff.

To help overcome this apathy on the part of the doctors, the
American HOSpital.Association Suggests that the medical staff by~laws
of a hOSpital be revised to include a statement about disasters and
disaster planning. For example the following paragraph is suggested
as one which could be included in the rules and regulation section of
these by-laws:

Medical Staff Disaster Assignments. All doctors have been
assigned to various posts in the hospital and.it is their
responsibility to report to their assigned places. No
physician will perform any duties other than those assigned.
The chief of the (disaster emergency) medical and surgical
services in the hospital and.the director of the hospital
will work as a team to coordinate activities and direction.
In.cases of evacuation of patients from one section of the
hospital to another or evacuation from the hospital premises,
the chief of the medical and surgical services during the
disaster will authorize the movement of patients by direction
of the director of the hQSpital and the chief of the medical
and surgical services. All policies concerning patient care
will be a joint reSponsibility of the chief of the medical
and surgical services and the director of the hospital and in
their absence the deputy chief and the alternate in adminis-
tration are next in line of authority reSpectively. (8)

Probably one of the reasons for the apathy of medical staffs is
‘that in.many communities physicians often are members of the staffs of
=twn or more hospitals. This fact poses a major problem with respect
‘to determining on which hOSpitals' disaster staff the physician will
serve. To overcome this problem, the following statement was adopted
EIY the board of Trustees of the.American Hospital Association on
September 19, 1955:

The medical staff should be assigned to a specific hospital in

a community by the local medical society for purposes of treat-
-ing mass casualties in an emergency situation. (9)

25

'When the local medical society has made an assignment of doctors
‘bc> specific hospitals within a community, a professional medical staff
Ctisuaster committee should be established within the hospital to plan
'tkue physicians? responsibilities for disaster situations. This committee
sfl10uld.include key members of the medical staff such as the Chief of
fitnaff, the Chiefs of Clinical Services, Heads of Diagnostic and Thera~
Frantic Departments as well as other members of the medical staff (10).

The functions of this professional (medical staff) disaster
committee should include (11):

1. Planning for the professional handling and care of mass

casualties by:

a. Assigning physicians to disaster positions within the
hOSpital.

b. Conducting training and educational programs for
physicians on the management of mass casualties.

c. Supervising programs for the training of nurses, nurse
aides, technicians and other personnel within the
hospital in the medical aSpects of handling mass
caSualties.

d. Establishing standard emergency medical care procedures
for the hospital.

2. Briefing of the hospital medical staff to insure complete
familiarity on the part of all concerned with the total hOSpital

and medical plans.

26

3. Coordinating the actiVities of this committee with the over~all
hospital disaster committee to insure availability of facilities
and supplies to meet the requirements of the professional
activities.

The successful development of the total hOSpital disaster plan

tnill.depend, to a large extent, on the degree of support and promotion

the concept of disaster preparation receives from the medical staff (12) .

SUMMARY

Any hospital—~no matter what size or what location-~should be
prepared and organized to meet a large influx of patients from a
(zinrilian.disaster. The hospital as a vital community health center
cualxnot afford to neglect this reaponsibility if it is to discharge its
(:cunplete obligation. There is only one way to accomplish this goal and
this is planning in advance. Planning in advance involves close team-
work between many groups within the hOSpital and the community. Within
the hoSpital there nnlst be close liason between the administrative
fitziff and the medical staff. Outside the hospital, a hospital disaster
Iiléun will not be complete until such groups as the local Civil Defense,
the Red Cross and. the governmental agencies have been consulted and

the utilization of their services provided for in one central authority.

1..

2?

REFERENCES

Curtis H. Lohr, M. D., The Planning_of HospitalgPunctions in.a
Disaster (Kansas City,—Mlssouri: Midwest Hospital Association,
l9§7$, p. h.

_Principles of Disaster Planninggfor Hospitals, (Chicago: .American
Hospita1,Association, 19355, p. 21.

[bid.

Orville Freeman, Governor of the State of Minnesota, from a letter
concerning a "Statement of Understanding between Minnesota Civil
Defense.Agency and the American National Red Cross," (St. Paul,
Minnesota: State of Minnesota Executive Office, February 3, 1958).

"Annex G. municipal Survival Plan--Hea1th, Medical, and
Special Weapons Service-~Operations Order," (St. Paul: MinneSOta
Civil Defense.Authority, April 1, 1958).

"When Disaster Strikes. General Information and Instructions to
Chairman," (St. Paul: American Red Cross Committee Reports,
January, 1957).

"Hospitals Unprepared for Handling Mass Casualties American College
of Surgeons Told," Modern Hospital, 86:190, March, 1956.

guinciples of DisastergPlanninggfor Hospitals, (Chicago: American
HospitalfiAssociatiofi, 19577, p. 22.

Ibid.
Ibid., p. 1.
Ibid., p. 2.

'W} D. Piercy, M. D., G. E. Fryer, M. D., "Hospital Preparedness,"
Canadian,ngg;ca1;A§§pciation.Journal, 76:361-36h, March 1, 1957.

CHAPTER III

THE DEVELOPMENT OF THE OVER-ALL DTSASTER PLAN
AND RELATED POLICIES
An over-all disaster operating plan must be developed by the
hospital as one of the first steps in planning for an emergency. An
ver-all plan should:

1. Show the relationship between the departments of the hospital
at the time of a disaster,

2. Show the general assignment of hospital space for the disaster
functions,

3. Specify the procedures and policies that should be followed by
all employees and workers in the hospital at the time of an
emergency, and I

)4. Help to coordinate all of the disaster planning activities of

the hospital .
GENERAL

Before a hospital can formulate a concrete disaster plan, the
board of directors of the hospital must be interested in and must
s"‘lpport this activity. One of the primary duties of the governing
board of a hospital is "to determine the policies of the institution
with relation to the community needs." (1) Disaster planning is

rec3<>gnized generally by governing boards as a vital function of their

mstitutions .

29

When disaster planning has been approved by the Board of Directors,
the reSponsibility for the actual planning is delegated to the Hospital
Administrator. Because this planningcovers every facet of the hospital,
it is obvious that the Administrator cannot do all of the planning by
himself. More important, though, as many persons as possible should
be brought into the planning functions. It is by this method that
interest in disaster planning is fostered and developed in all of the
hOSpital's employees. Therefore it is suggested that disaster planning
begin by the appointment by the Administrator of two advisory commit-
tees (2) within the hospital:

1. The Medical Staff Committee on Disaster Planning.

2. The Administrative Committee on Disaster Flaming.

As has been already stated, it is not within the scope of this
paper to discuss the details of the medical staff planning for emergen~
Cies. .However, the activities of this committee must be properly co-
Ordinated with the AdministratiVe Committee on Disaster Flaming by the

hOSpital administrator.
AMHVISTRATIVE COMTTEE ON DISASTER PLANNING

The composition of this committee should include:

a. The Administrator, Chairman

b. The Director of Nilrses

c. Radiologist

d. Pathologist

e. Dietitian

f. Pharmacist

g. Hospital Auxillary Representative
h. Other Department Heads

1. Member of the Medical Staff

j. Member of the Governing Board (3)

30

The functions of this committee (h) should be to:
1. Coordinate the development of the hospital‘s disaster plan.
it should be pointed out that the disaster committee is en-
visioned not only as a coordinating group but also as a policy
making group. The detail of the actual planning is delegated
to others who submit the results of their efforts to the
committee for approval. The coordination of the plan is obtained
by the Disaster Committee by:
a. Supervising the plan.preparation,
b. Assigning the planning and emergency operational
responsibilities to key people in the hospital,
0. Implementing the planning provisions.

2. Coordinate the hospital's disaster plan with the over-all

community disaster plan.

3. Supervise the conduct of frequent drills to practice and test

the plan under various simulated disaster situations.

h. Review and revise the hospital's disaster plan at regular

intervals.

5. Be responsible for the heapital's continued preparedness for

disaster.

Before the disaster committee can expect to delegate detail plan-
ning responsibilities to key personnel, they must develop a general
dis-Aster plan as a guide to be used by these people. The objective of
this general plan is to establish policies and procedures to be followed

by the entire hospital staff at the time of an emergency (5).

31

Full authority for establishing disaster policy must be delegated to
the disaster planning committee by the hospital's governing board and
administrator to insure a flexible and. well-operating plan at the time
of g a disaster.

Any disaster plan is worthless unleSs it is clearly understood by
all concerned that the established policies will be followed at the
'biJne of a disaster. However, the policies established by the planning
cecnnmittee should.be flexible. If a policy modification is dictated.and
justified by the disaster requirements, the Chief Control Officer at
the time of an emergency should have the authority to make the needed
Change.

The disaster committee has the responsibility of informing and
training all hospital personnel in the operation of the general disaster
Plan. Not only do the hospital employees need to be given copies of
the plan and to be informed about the plan, but copies of the plan must
I>ee distributed and thoroughly discussed with the medical staff, the
Governing Board, comrrnlnity officials, other hospitals, and community

dSLSaster agencies such as Civil, Defense and the Red Cross.
THE GENERAL PLAN

It is believed that the general plan must be simple and easily
understood. The following areas that are discussed form the basis for
Such a plan. ,

organization of the hpspital at the time of a disaster. The follow-

511g tw0 charts outline a suggested functional organization showing:

32

1. What the relationship of the hospital should be to the over-

all community plan, (Figure 2) and

2. What the relationships of the disaster functions of a hospital

are to the Chief Control Officer in a hospital, (Figure 3).

Chief'gpntrol Officer. The following persons, in the order listed,
(cxr any other combination desired) should be placed in charge of the
activation of. the disaster plan and the over-all coordination of the
activities of the various disasterfxmctions with the medical staff:

1. The Administrator

2. The Director of Nursing Service

3. The Comptroller

h. Other designated.Administrative Assistants.

Whoever is the acting supervisor at the time of the disaster noti-
ikixzation should be in authority and should keep that authority until
Efibrneone higher in the chain of command.arrives on the scene (7).

Full authority must be vested in the Chief Control Officer or his
ailiaernate to direct all operations pertaining to the conversion of the
11<>sspital to a disaster status and.the effective care-of casualty and none
ci-Lsualty patients during a disaster (8).

The functions of the Chief Control Officer should be to (9):

1. Determine the magnitude and type of disaster from official

sources.

2. Activate the various stages of the disaster plan as needed.

3. Act as the central authority for all situation and policy

changes in the disaster plan.

W)MMUNITY-AT--LARGE

 

 

 

 

LCONMJ'NITY DISASTER COMNI‘I'TF. I J

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

l WELFARE SERVICE IL J memmggcgENDSERva
EHEALTH SERVICE ‘ FIRE CONTROL SERVICE J
EWNSPORTAT ION SERVICE POL ICE SERVICE J
EOMU'N’ICATTON SERVICE J ‘ UTILITIES SERVICE J
[TIEDICAL AND HOSPITAL J

I SERVICE

 

 

 

HOSPITALS J

 

FIGURE 2

SUGGESTED ORGANIZATION AND COMPOSITION OF A COMMUNITY DISASTER SERVICE

314

 

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LOCAL DISASTER ORGANIZATION
(Medical and Surgical Division)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

[CHIEF CONTROL OFFICER] - - -|DISASTER COIDIITTPEJ
‘ J ,
‘ MEDICAL AND SURGICAL
I , DIRECTOR
J1NURSING 1— L
PECIAL l CLINICAL
SERVICES SERVICES
EMER. MEDICAL'
_.RAY JRECEIVJNC AND ,
J IEIEEI em I SORTI‘NG
[DIETARY -{—a
W Mom-roar lam Am
JQOI'H'IUNICATICNF MORGUE [EDICINE , }
NURSING HARDS J
- - r ILHAMEY j-d .LSURCERY J4
m ‘BURNS JD
_ SUPPLY, EQUIPMENT *
ELAINE: ”mm-3
. L TRAUMA H
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TRAFFIC CONTRofl

 

 

 

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FIGURE 3

SUGGESTED DISASTER ORGANUATION OF A HOSPITAL

35

h. Direct and coordinate the operation of the disaster plan.

5. Direct the expansion of the hoSpital facilities.

6. Authorize procurement of needed supplies, equipment and

personnel not anticipated in the pre-disaster planning.

it is obvious that the Chief Control Officer can not, at the time
of a disaster, assume all of the reSponsibility for all of the functions
of a hospital. Therefore, in the pre-disaster stage, pre-planning and
responsibility for the various functions of the hospital during an
emergency must be delegated to key personnel by the disaster committee.
‘When these assignments are made, provision Should be made for a
"succession of command" for every key disaster position for use in the
event that the regularily assigned person is unable to get to the
hospital or cannot serve for any other reason.

The Chief of the Medical Staff or his alternate is delegated the
reSponsibility for the professional work and general supervision of the
members of the medical staff.

The functions that must be assigned to key personnel for pre-

planning and emergency operational responsibility are {10):

Function ' Purpose
1. First Aid Post . To provide emergency medical

care for ambulatory casualties.

2..Ambulance Reception 1. To provide for the reception and
' unloading of ambulances and other
vehicles bearing casualties.
2. To separate ambulatory casualties
from those who are seriously
injured.

3. Receiving and Sorting 1. To receive all caSualties who
enter the hospital.

Function

h. Emergency Medical Records

5. Surgical Section
6.'Ward.Sections:
Shock Fractures
Trauma Obstetrics and
Medical Gynecology
Surgical

Nursing Service

Evacuation of pre-disaster
patients.

9 . Morgue

10. Laboratory

11 o X-Rfly

12. Pharmacy

36

Purpose

2'

3.

To determine the extent of the
injuries. ,

To determine the priority for
treatment.

To provide simplified but adequate
emergency admission and medical
treatment records.

. To perform essential emergency

operations.
To perform less urgent surgery
when condition and time permit.

. To provide initial and.continuous

"medical care for casualties.

To provide medical care for non-
casualty patients.

. To provide adequate nursing serv-

ice to all emergency areas on the
basis of planned casualty accom-
modation.

. To direct the activities of volun-

teers assigned to patient care.
To staff emergency ward areas.

To make room for a larger number
of casualties.

To receive bodies of those who
expired in the hospital and those
who died on admission.

To provide means for implementing
the identification of bodies.

To match blood.in preparation for
transfusions.

‘To perform other eSsential labora-

tory functions when time permits.

To provide x-ray information
essential to life-saving.

To supply all treatment areas and
emergency patient care areas with
essential drugs.

To Supply other areas as needed.

Function

13 . C antral Supply

1h. Dietary

15. Supply

16. Maintenance and Engineering

17. Traffic Control

18. Housekeeping

19 . Linen Service.

20. Emergency Communications.

21. Public Information Center.

37

Purpgse

NH

To supply the operating rooms,
admission areas, treatment areas
with essential sterile goods.

To provide prompt emergency food
service to a large number of
casualties,,hospita1 personnel,
and'volunteers.

To provide initial supplies for
the first aid.post, admission
areas, and other emergency patient
care areas.

. To procure authorized supplies

and equipment needed.

To maintain essential utilities
in time of emergency.

To exclude unauthorized persons
from the hOSpital.

To keep hospital approaches open
for the use of ambulances or
other emergency vehicles.

To maintain an orderly flow of
traffic within the hospital.

To set up all disaster areas.
To maintain such housekeeping
functions as are necessary and
possible under the conditions.

To provide essential laundry
service for surgery and patient
care areas.

To give fast notification to off-
duty personnel of the disaster.

. To alert personnel on duty.

To establish a message center.

To furnish information concerning
casualties to relatives and the
press as soon as the information
is secured.

Function Purpose
22. Volunteer Personnel Office 1. To provide a central place where

unassigned hospital personnel
may report for duty.

2. To provide for the screening of
volunteers.

3. To facilitate an orderly assign—
ment of personnel and volunteers
to areas of greatest need.

Standard operating procedures must be developed for each of these
key functions by the persons who have been delegated these responsi-
bilities. These standard.operating procedures must be approved by the
Disaster Committee before they are incorporated.into the over—all
emergency plan.

It is felt that by carefu1 planning and good understanding most
of the situations that will occur at the time of a disaster will be
answered. However, not all of these situations can be anticipated.

Any major change of procedure within any of the disaster functions should
be cleared with the Chief Control Officer or the Chief of the Medical

Services.

Disaster‘warning, The hospital generally learns that a disaster

 

has occurred in the community from a source outside of the hospital.
This outside source usually lacks the full knowledge of the situation.
Therefore, no matter how or by whom the first notification of disaster
is received, this information must be directly communicated to the
Chief Control Officer {11). Unless the notice to the hospital that a
disaster has occurred in the community is received from an official
source or an unquestionably reliable private source, the Chief Control

Officer should delay activation of the disaster plan until he has

 

39

verified.the correctness of the report. A semi-alert should be estab—
lished by this officer until accurate details are obtained. The semi-
alert should.inform key personnel that a disaster situation may exist
and.that they should be prepared to activate the disaster plan. The
authentication of the claim that a disaster has occurred can be obtained
in a few minutes from an official source and this delay will have no
appreciable effect on subsequent preparations of the hospital for
service if there has been a disaster.

in areas where there has been community disaster planning, official
warning and notification procedures have been developed for hospitals.
In communities where there is no coordinated planning for disaster, the
police department is a reliable primary source of information that may
be counted on 2h hours per day.

Phases of the Disaster Plan. There should be developed a plan of
action that is simple, flexible, and.sufficiently extensive to cover
the most destructive of disasters. The requirements of lesser disasters
can be provided by dividing the plan into different phases on the basis
of casualty load. Each phase or stage that is discussed below should
be covered by appropriate standard operating procedures for each
function of the hospital during disaster.

The following is taken from the "Disaster Plan" of Harper HOspital
in Detroit, Michigan (12).

Plant “A"eAlert. This phaSe of the disaster is initiated.at the
order of the Chief Control Officer in those instances when disaster is
imminent and the hospital has had.advanced.warning and when waiting for

vertification of a disaster warning. This is a stand-by phase.

to

Plan "B" refers to the disaster plan which will be put into effect
on the Order of the Chief Control Officer.‘ Plan."b" may or may not be
preceded by Plan “A," depending upon whether or not the hospital has
had advance warning of the disaster and could effect an alert. Plan "B"
Should be carried out in stages as Set forth here. Eacn stage should
be put into effect at the specific order of the Chief Control Officer.
These stages are:

Stage 1: ‘When more than 10 but less than 25 casualties have

been received or their arrival is anticipated.

Stage 2: ‘When more than 25 but leSs than 50 casualties have

been received or their arrival is anticipated.

Stage 3: 'When more than 50 but less than 75 casualties have

been received or their arrival is anticipated.

Stage h: ‘When more than 75 casualties have been received or

their arrival is anticipated.

Notification of Personnel at the Time of a Disaster. When the
disaster situation has been verified through official Sources, the Chief
Control Officer should give instructions to the person or persons
reaponsible for alerting on~duty perSonnel and calling in off-duty
personnel and members ofthe Medical Staff.

To facilitate the notification of personnel an up—to-date list of
key personnel, in order of priority to be notified, should be developed
and kept at the hospital switchboard. This list should contain both
the business and home telephone numbers of the key personnel. The
priority call list might be arranged.by departments something like the

following:

bl

Priority Call List (13)
Day g7z30 am to 5:00 pm)

1. Notification should be given in this order:

Nursing Department Pharmacy
HOusekeeping Department Central Supply
Storeroom Medical Records
Operating Room Business Office
.Anesthetists Nursing Floors
X-Ray Department Engineering
Laboratory Dietary -
Chaplin

2. Notify the priority list of physicians who have disaster
assignments within the hospital or call the Physician’s
Exchange. '

Night (5:00 pm to 7:30 am)
1. Immediately notify all departments with staff on duty.

2. Notify the Medical Staff
3. Notify the following key personnel off—duty:

Administration Anesthetist
Nursing Director Pharmacist
Housekeeper - Stores Clerk
Laboratory Hear Engineer
X-Ray Head Chaplin

Operating Room Supervisor

Generally there are three methods by which on-duty personnel in

the hospital can be notified (1h):-

1. The Paying System. This system may be used to advise all
personnel that a disaster has occurred and that the hospital
must be prepared to receive casualties. Each time a new phase
of the disaster plan has been declared by the Chief Control
Officer, the hospital is advised by the same system. In order
to avoid alarming patients already in the hospital, a paying
code should be developed that is familiar to all hospital

employees. For example, the Telepage operator should page in

a calm voice as follows: "Plan.’A‘ Stat, Plan.‘A‘ Stat, Plan
iA‘ Stat." This page should be repeated three times at approxi—
mately one minute intervals. When a new disaster stage has
been declared by the Chief Control Officer, the Telepage opera-
tor should substitute the appropriate stage number in her page--
"Stage 2 Plan VB? Stat, Stage 2 Plan 3E” Stat, Stage 2 Plan 'B'
Stat," repeating the page three times at approximately one minute
intervals.

2. The Telephone System. Telephone contact should be used as an
alternative method or in those areas of the hospital which do
not hear the paging system. In using the telephone contact
system, the priority notification list should be used.

3. Messengers. 1n the event that the paging and telephone systems
are out of order, the Chief Control Officer should delegate to
messengers the responsibility of alerting key personnel.

Alerting personnel off duty and away from the hospital. There are

three methods by which this may be accomplished:

1. By Telephone. If possible, key personnel and others who are
vitally concerned with the disaster program Should be contacted
by telephone. This can be accomplished by the use of the
priority list of notification. .At the time of a disaster it is
not feasible for the telephone operators to notify all of the
hospitalls personnel by telephone. If the situation warrants
the recall of more employees, it is recommended that this be

done by the key personnel needing help by using the "triad chain

h3

call" system K15)- Under this arrangement and with a roster of
personnel at hand, the key person calls three employees who are
off duty. Each of these call three other designated employees.
in turn each of them calls three more specified members of the
department. These chain calls continue until all off duty
personnel have been reached. Although it is obvious that some
of these employees may not be at home when called, their call
assignments can be easily transferred to other employees.

To augment the notification of the medical staff arrange-
ments can be made with a Physicians' Exchange in the community
to call the doctors assigned to the hospital‘s disaster services.

2. By Radio Announcement. .Arrangements can be made with the local
broadcasting stations to interrupt their programs and announce

. that " ''''' Hospital's employees are to report for duty im—
mediately%" It is obvious that the request for this type of
action on the part of the broadcasting stations must originate
with the Chief Control Officer of the hospital.

3. By Messenger. It may not be possible to use either the tele—
phone or the radio systems at the time of a disaster. Ln this
case, it might be feasible to use messengers to contact the key
personnel of the hospital. Because the area of the city may be
wide and the number of personnel large, this system has definite
limitations and it cannot be used to contact the entire hOSpital
staff.

Plan as Handling Mass Casualties in the Hospital. Casualty flow

in the hospital at the time of a disaSter is very important. Experience

in diasters has shown that a continuous flow of Casualties from one
casualty treatment area to another expedites the treatment and care of

mass casualties.

 

__ :_—‘ -..-

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Casualty Flow Functions
Disaster Emergency,
Scene Life Saving,
First Aid
1 l l--l. --l--lllnlll_~_nll_l,- l__
‘. Temporary , Receiving Initial
Mor e and Sorting at the
J ' Sorting Hospital J
4 Medical, Surgical, Shock, ’ Initial
Burns, Fractures and Definitive
4 Obstetrics-Gynecolo Treatment
‘—_l _ it- __.__,-I_.,,.,.._., . l-._.i_-._ -l, l ....-. . _ r-
J X-Ray, Laboratory and ‘ Diagnostic
other Diagnostic Proce- ' Procedures
_dures {as required) Prior to
Hospitalization
_= —~——.. - ... - .4 '1"°’”""‘"""""“
_Surgery, Plaster Casts,‘ Further
Delivery, and others Definitive
as required _ Treatment
. « Prior to
a ----..I----HF’SPlta-J-izili°¥ -
Continued Diagnostic, *
Procedures and Definitive Hospitalization
Treatment. Convelescencen .
f-—~s- ,” .J_ _ _- l ,
Release
ix; #- ..l.........n...--. _. _ ,_ .. J
FIGURE h

CASUALTY FLOW PLAN (16)

1:5

Assignment of Hospital Space A17)- To expedite the flow of casual-
ties at the time of an emergency, the disaster committee must plan for
the expansion of the hospital wOrk "areas. This expansion will involve
rearrangement or reassignment of present patient areas and the conversion
of hospital work space not normally used for patient care to emergency
use. This planning must be done in advance so that needed equipment-
and supplies can be procured. It is desirable that floor sketches of
the hospital showing the assignment of space for emergency use be in-
cluded in the planning material {18) .

1. Ambulance Reception Area. In a situation of severe disaster it
can be anticipated that many ambulances and other vehicles bearing
casualties will arive at the hospital within a short period of time.

An area of sufficient size to permit the reception and unloading of
several of these vehicles simultaneously is needed. This area should

be located adjacent to the admission area. This post should be activated
at Stage 1 of the disaster._ .

2. Receiving and Sorting Area. If possible this area should be
spacious and located near the plan-assigned ambulance unloading points.
I u should be a large single area through which all incoming casualties
must pass. No workup, treatment, or identification of casualties should
Occur at this point. This area should serve as a sorting station where
patients are examined, sorted and transferred to Specific treatment
a-1"eas. This station should be activated at Stage 1 of the disaster.

3. Initial treatment areas. Separate areas properly equipped must

be planned for:

’46

a. First Aid. This area should be established to provide
emergency care for patients with injuries of a relatively
minor nature. In consideration of the need to minimize
congestion in the corridors and admission area, it is
desirable that this station be located in a place where
its activities will not interfere with the handling and
and admission of seriously;wounded casualties. This area
should be large enough to accommodate at least 50.
casualties at one time. This post should be activated
at Stage 2.

b. Other initial treatment areas. Space should be provided
for shock, surgical, medical, burn, fracture, obstetric
and gynecology wards. These areas should be readily
accessible from the receiving and sorting area. They
should also be accessible to the operating rooms,
laboratory, x—ray and other service areas. These wards
should be established.at Stage 2 of the disaster.

h. Other Definitive Treatment Areas.

a. Surgery. Operating facilities should be expanded for

the accommodation of as many surgical teams as Space

«and equipment permits. If possible expansion of this
area should occur in proximity to the present facilities.
Use of additional tables in all operating rooms should
be considered. The following types of operating rooms

should be provided:

’47

1. General (all cases except orthopedic and
gynecology).

2. Orthopedic (fractures, dislocations, etc.).

3. Gynecology (spontaneous abortions, etc.).

In most disasters the general Surgery rooms will receive
the majority of Surgical cases (19). However, because
othhe special equipment requirements, the other surgical
areas should be provided if possible. The expansion of
Surgery Should be activated at Stage 2 of the disaster.

. Patient Facilities. Expansion of patient facilities

to accommodate casualties should be accomplished in
stages, each activated in Succession as required by the
size of the casualty load. The following are some
examples of Stages that might be used (20):

l. Restrict nonycasualty admission to critically
ill patients, full term pregnancies, and Other
non-casualty patients of an emergency nature.

2. Discharge all patients awaiting discharge.

3. Set up cots, foldsanay beds, stored hospital
beds, etc. in suitable, non-bed areas such as
sun porches, patient day rooms, lobby Spaces.

h. Further evacuation of non~disaSter patients
that have been.approved for transfer by a member

of the medical staff.

’48

S. Reassignment, within the hospital, of non—
disaster patients So as to concentrate them in
one or more areas.

6. When further expansion within the hospital is
impossible transfer movable non-disaster patients
to improvised patient facilities in nearby
hospital buildings. This evacuation area should
be chosen.with consideration for traffic problems
and suitability for ambulance approach and load-
ing.

0. Morgue. The possibility that the present morgue area
will not be adequate must be considered. .An area
should be assigned for auxilliary facilities which
is well removed from the main areas of activity.

The location should.be near an entrance so that the
public can enter to identify the bodies and so that
bodies may be removed with a minimum of exposure.
This station Should be activated at Stage 2 of the
disaster.

5. Non—clinical Facilities and Departments.

a. Central Control Station. This area should be assigned
to a spot that is located away from the main flow of
traffic. The area should be large enough to provide
space to hold briefing Sessions with key employees

and to allow for the control of the operating

h9

procedures of the disaster program. The area should
be easily accessable to all personnel concerned. The

area should be activated at the notice of an.Alert.

. Communications Center. Anticipated, unprecidented

demand for communications requires planning for co—
ordination and augmentation of both external and
internal communications. This center should.be
established considering the main telephone facilities
and providing room for the accommodation of messengers.
Consideration should also be given to space required
for the installation of a two-way radio System. This
area should be activated.at Stage 2 of the disaster.
Public Information Center. A place should be provided
where relatives, the Press, and the public can come
for information concerning casualties. Individuals
seeking information should not be permitted to enter
the main treating areas of the hospital. ‘ This area
Should be located well away from the planned admis—
sion areas and the main flow of casualties. This

Station Should be activated at Stage 1 of the disaster.

. PerSOnnel Offices. .An area Should be established

where unassigned.hospital employees and volunteers
report for work. More effective use and distribution
of help can.be made if these people can be first

assembled as a controlled group for screening and

So

assignment. .A place is required where these people
can be pooled for aSSignment to the area of need.

The place Should be large and chosen with regard for
traffic problems. This area should be activated at
Stage 1. ;

Personnel. ‘Specific disaster assignments should.be made when
planning for an emergency. The disaster assignments should be made in
depth, listing a number of alternates for each position. Generally, it
is a good idea for the key perSonnel responsible for the pre-planning
of the hospital's functions to make the individual job assignments.

All disaster assignments should be by job title instead of using
individual names (21). This method is deemed necessary in view of the
fact that, when a disaster strikes, the named individual may be on
vacation or may no longer be employed at the hospital. If names are
used confusion is obviously inevitable.

in a major disaster the hours of work of the personnel will have
to be increased. It must be remembered that if the work hours are in,
creased too much, a lag in the work output will result. No matter how
pressing the situation may be, perSonnel must have some rest.

In so far as possible, arrangements should be made to keep the
personnel on the premises of the hospital, at least for the first 2h~h8
hours of the disaster situation or until the situation becomes stabil-
ized. Cots should be made available for rest and sleep.

The disaster plan should Specify that the assignment of employees

to other than their normal duties may be necessary in a disaster.

51

For example clerical employees might be reassigned to duty in the
Patient Information Center or assigned to help with identification and
registration of casualties.

'While it is believed that most hospital employees will donate
their services at the times of a disaster, the p1an.must consider that
the perSonnel may have to be paid for overtime if they demand such
extra compensation (22).

Two types of identification for employees should be considered for.
use at the time of an emergency Situation:

1. Identification cards (23). In order to assure that the hospital
employees will not be stopped and delayed on their way to the hospital,
all employees, including members of the medical staff, of the institution
should be issued an identification card showing that they are an employee
of the hospital.

2. Identifying arm bands. Consideration should also be given to
the use of identifying arm bands for all regular personnel and others
working in the institution. This procedure should help to reduce
confusion within the hospital and Should help to reduce the number of
unauthorized personnel within the building.

'When hospital employees have received notice of a disaster, they
should report immediately to the hospital and to their pre-assigned
disaster stations. Any employee who is not on duty and who has a
Specific disaster assignment Should report to his department head on
arriving at the hOSpital and from there report to his disaster assign-

ment.

52

.All personnel who do not have specif disaster positions should
report directly, upon notice of the emergency situation, to the
Emergency Personnel Station for assignment.

All key personnel on duty when an alert or a disaster is declared
should report to the Control Center for a briefing period. Key perSon-
nel not on duty when the alert or disaster is declared Should also report
to the Control Office for briefing on arrival at the hospital.

Any volunteer who reports to the hoSpital should be directed to
the Emergency Personnel Office for screening and assignment to a dis-
aster position. These volunteers should also report to this office
before leaving the hospital when their work has been completed.

The members of the medical Staff, upon arrival at the hospital,
should Sign into the hOSpital in their usual manner. On signing in,
they should report directly to their disaster station. 'When their
primary assignments are completed, the doctors should report to the
Chiefs of their services for poSSible reassignment.

Traffic Control. To avoid confusion and to minimize the amount of
cross traffic, plans should be established for the control of both
internal and external traffic. Traffic flow charts (2h) should be
established to Show:

1. External traffic flow, indicating entrances to be used for

various purposes .
2. Casualty flow through the hospital.

3. Flow of supplies and other services to treatment areas.

53

The plans for the control of external traffic Should consider the

following:

1. Road blocks to keep unauthorized people away from the hospital.

2. Posting guards to direct ambulances and other vehicles arriving
with casualties, equipment and supplies.

3. Strict control of vehicular traffic in the casualty receiving
area to maintain constant accessability.

h. Direction and control of pedestrians and non—emergency vehicular
traffic on all roads leading to the hospital.

5. Screening of perSons seeking admission to the hOSpital area and
directing authorized personnel and.visitors to the proper
entrances.

Internal traffic control plans should consider the following:

1. Employees should be stationed at critical points within the
hOSpital for control and direction of traffic.

2. Personnel should be instructed touse stairways to free elevators
-for transportation of casualties. All automatic elevators
Should be run and controlled by an operator at the time of a
disaster.

3. Cross traffic should be restricted as much as possible.

he Closing of all entrances to the hospital except those that are
to be used for a specific purpose.

5. Unessential entrances that cannot be locked should be guarded
to prevent the entrance of unauthorized personnel and to direct

visitors, Supplies, volunteers, etc. to the proper entrances.

_m _, , __.l.__ -aw

5h

Official law enforcement agencies are essential for both internal
and external traffic control. Such arrangements as necessary with these
agencies should be done in advance through individual contact or through
the community disaster planning committee.'

Consideration Should be given to the preparation and storage of
directional signs to be posted in the event of a disaster. These signs
should be an invaluable aid in the conServation of manpower (25).

Control of Visitors.. Every hospital that has had disaster experi-
ence reports that one of the biggest problems they encountered was the
hundreds of visitors who rushed in.through all doors, swamped the wards
and interferred with the care of patients to a paralyzing extent. The
lesson to be learned from these reports is that it is of the utmost
importance to prescribe and enforce the various measures which are
necessary to effect adequate control over visitors to the hOSpital in
a disaster situation.

An.examp1e of the measures to follow taken from the disaster puma
of the St. Louis County Hospital, St. Louis, MisSouri is as follows.(26):

1. Restrict visiting to the immediate next of kin of patients who

are classed as serious or critical. Admit only one visitor per
patient at a time.

2. Stop visitors from entering the hospital grounds by establishing

police posts at the entrance to the grounds and at strategic
points along the perimeter of the premises. Instruct visitors

to park along the streets outside of the grounds.

3.

6.

55

Connect the police post at the entrance to the grounds with
the Patient Information Center by installing a two-way radio
at that point. This will make it possible to learn quickly
the condition status of any patient. If he is not critical or
serious inform the visitor that the patientis condition is

satisfactory and that visitors are not allowed for this group.

. If the patient's condition is serious or critical, permit the

visitor to enter the grounds on foot; give him a pass which has
been provided for this purpose, and direct him to present it to
the police officer at the entrance to the Patient Information
Center.

Upon presentation of the pass, which will be taken up, the
visitor will be admitted to the Information Center. The clerk
on duty will ascertain from a roster at hand to which division
or ward the patient has been assigned. ;

A guide will group the visitors who are going to the same area,
will take them to the patients Concerned and.after five minutes
will return them to the Information Center where they will be

requested to leave.

Functions of the Chaplin (27). The services of a chaplin will be

of the utmost importance for the morale of the patients and the person—

nel. The Chaplin should be summoned.at once when it becomes known that

a disaster has occurred. In order to assure that all persons who need

and desire Spiritual consolation will receive it promptly, the chaplin

Should be authorized to request other clergymen to serve at the hospital.

56

.Admissiongpf_Patients. .A Specific policy should be established
regarding the admission of all casualties to the hospital so that there
will be no question about determining the casualties? ability and will~
ingness to pay for the cost of their care. At this point no consider-
ation should be given to cost and ability to pay. The main consideration
should be the adequate care and treatment of the casualties.

It would be impossible and impractical for one hospital to have to
assume the entire casualty load in an extensive disaster. For this
reason arrangements should be made through the Community Disaster
Committee for coordination with other health care facilities to assure
equalization of hospital casualty loads. The Chief Control Officer
should have some central community control point where he can receive
information and also where he can report the situation in his hOSpital.
.dy having the hospital work through a central control point in the
(sommunity, equalization of casualty loads can be accomplished. If
there is no community organization the best contact would be the local
police agencies.

Financinguthe Costfigf’Hospita1_§ervices to Casualties. HOSpitals
generally do not ask for payment for care given in cases that are a
result of a disaster. This also holds true in the case of the doctors
(28). However, this problem should be solved long before a disaster
occurs. This problem requires a thorough study at the community level
with the participation of the administrators of all of the hOSpitals,
their boards, the Hospital Council, Blue Cross officials, insurance
companies, the legislative body of the community, the American Red

Cross, and appropriate Federal and State agencies.

 

 

57

If it is possible to agree on the question of how hospitals will
be reimbursed for their services in.a disaster, the method agreed upon
should.be covered in the policies of the hespital disaster plan.

One of the biggest prdblems.in.the financing of casualty care is
the determination of the point at which "free care" ends and payment
of treatment by the patient begins. It is wise to try to determine this
point before the disaster situation occurs. Some thinking along this
line indicates that this point can.be determined when it has been con—
firmed.by the doctor that the casualty victim must be retained or
hospitalized for further diagnostic procedures, definitive treatment,
and convalescence. This point must become a policy and must be under-
stood by all concerned (29). I

Access to Facilities. The Sudden need to have access to store—
rooms and other facilities which a disaster creates makes it imperative
to provide some type of key management System. One method (30) by
which this can be accomplished is to place a set of keys to all essential
Sections of the hospital that are not open.2h hours a day in a central
location. Generally, this central key depository can be placed.under
the control of the Nursing Department. Since this department is staffed
at all times the keys would be available for use when official notifi-
cation of a disaster is received-

gupplies‘and_§quipment, LiStS of all necessary supplies and equip-
ment should be prepared in advance for each disaster function. These
lists should be approved.by the disaster committee and subject to the

approval of the governing board.

58

1. General. Almost all hospitals carry enough medical and surgical
supplies to carry them through a few hours of a critical Situation.
However, in planning for disasters, it is essential that the professional
groups within the hospital anticipate their needs (31). The best pro-
cedure in estimating needs is for theSe groups to agree on standardized
procedures and treatment of certain types of casualties. From the
standardized procedures that have been developed, medical supply and
equipment lists can be drawn up and there is no reason why at least a
representative quantity of each item cannot be kept on hand for when
it is needed.

The feasibility of stockpiling medical and surgical Supplies in
hOSpitals as part of the disaster plan is open to debate (32). In some
disaster programs, a great deal of emphasis is placed on filling chests,
boxes and cartons with supplies of every description and placing these
disaster boxes in stategic positions throughout the hospital to be used
only in case of an emergency Situation. Usually these disaster boxes
have been clearly labeled with a complete listing of all of the contents.
While personnel are oriented in the use of the disaster boxes at the
time that they are made up, with the passage of time and the turnover
of personnel, the subject becomes forgotten. Occasionally, because there
is no control placed on the boxes, items are borrowed and not replaced
leaving the packs of little value. .AlsO, hundreds of dollars worth of
supplies are in these boxes and they may become obsolete or may
deteriorate.

If disaster boxes are made up, they should be (33):

 

...-I'll. IlllHtllh.)

59

a. Properly stored in a central location clearly marked. for
disaster and known to all key perSonnel.

b. Checked periodically to see that the supplies are properly
rotated and replaced with fresh stock. This system also
insures that usuable Supplies are on hand at all times.
Freshness is important with antibiotics and certain pre-
packaged sterile supplies.

0. Checked at least annually with the professional staffs to
determine which supplies, if any, should be deleted or
added to the pack. I

Although the hospital carries enough medical and surgical supplies
and- equipment to carry them through a few critical hours, the source of
supply should be known for every item on the disaster supply lists.
Alec it is important to know how long it will take to get a rush Ship-
ment at the least convenient tine. An accurate, up—to-date listing of
sources for essential items should be posted in the storeroom. This
list Should include:

a. Names of at least 3 perSonS connected with each source,
with the addresses and telephone numbers for contacting
them both day and night. These perons should have access
to warehouses where supplies are kept. This list might
include, hospital. Supply houses, warehouses, wholesale
drug companies, key salesmen and drug stores.

b. HOSpitals in neighboring comrmmities. However, it should

be kept in mind that other hOSpitals in the community will

probably be facing emergencies of their own and will not
be able to lend much assistance.

0. Names and telephone numbers of such agencies as the Red
Cross and the Civil Defense. '

2. Food. In reference to fresh meat, vegetables, fruit, etc. it
must be remembered that the average hospital rarely carries more than
a one or two days supply which will be used up quickly by the increased
case load and personnel. A disruption of gas and electrical eqlipment
would aggrevate the problem even more. For these reaSOns the hospital
should carry on hand at least a three day supply of canned food items.
Meals can be prepared rapidly from such items with little effort and
with the minimum of use of utilities.

3 - Beds, cots, bedding, etc. The expansion of the hOSpitalVS bed
cVh'il-IJEi-City is a common requirement of most disaster Situations. With
this in mind and to keep the cost of disaster preparation from being
excessive, the feasibility of procuring and centrally storing several
hundred folding cots must be kept in mind. Stored with the cots should
be linen packs that contain one blanket, one Sheet, towel, face cloth,
and other items considered essential. The actual number of these items
can be determined by arriving at an estimate of the maximum number of
Patients that the hospital can effectively care for in an emergency and
then Surveying the supplies that are on hand.

A. General considerations. Arrangements should be made for the
delivery of supplies to all disaster sections immediately upon notifi-

cation that the disaster plan has been activated.

61

If additional inventory supplies and equipment are needed, the
person in charge of the division needing the supplies should request
them by requisition in the usual manner.

Supplies and equipnent in addition to the hospital inventory should
not be requested unless these items are cleared by the Chief Control
Officer. Only this officer should have the authority to authorize any
expenditure for equipment and supplies that are found necessary.

In the event that supplies are needed and authorized from sources
outside the hospital, all deliveries should be made to the Central
3 boreroom. These supplies should be carefully recorded as to material
received, name of sender, amount and date before being dispensed to the
requesting unit.

Termination of Disaster gigging. Because the Chief Control
Officer has the full authority at the time of a disaster, he is the
only one that should be allowed to give notice to the various hOSpital
units that the emergency has ceased.

The end of the disaster status of a hospital can be determined by
this officer when:

1. Patients ceaSe coming into the hospital.

2. Notification is received from an official community source that

all casualties have been transferred from the disaSter site.
The emergency status of the hospital cannot be stopped immediately when
GasHalties cease being admitted to the hospital, but gradually the
Special functions that had been activated at the beginning of the dis-

aster situation can be stopped. The key person responsible for the

62

function Should determine this point when he has been notified that no
more ca5ualties will be received and their work is completed.

Evaluatioi of the mngtiqhs pffthejosfital after a Disaster has

Occurred. As soon as possible after the emergency has ended and all of
the casualties have been properly cared for, the Disaster Committee and
all key personnel reaponsible for the operation of all functions during
the emergency should be called together for an evaluation of the
hospital's experience during the disaSter period. At this time arrange-
ments must be made for (3)4):

1. Records. Permanent records should be established for all
casualties treated as rapidly as possible. The patient records
should be permanently filed as out-patients or as in-patients.

2. Statistics. Some type of statistics should be prepared to show
the number of casualties treated, the types of casualties
treated, the supplies that were uSed, etc.

3. Borrowed supplies. Any supplies that were borrowed must be
returned or the agencies from whom they were borrowed must be
reimbursed.

)4. Finance. Application should be made for reimbursement from
any agency who participated in the medical care of the casual-
ties. Settlement should also be made for any emergency supplies
that were procured during the disaster period.

The points listed above are important and essential, but more

jmPortant is an evaluation of the total hospital action during the

disaster. It is at this time that the failures of the plan and

 

63

perSonnel can be noted.and improvements and changes needed can be
implemented. A written report should be required from all key person-
nel. This report should.briefly cover all of the activities of the
function, shortcomings of the function, equipment and personnel that

tvere used.but had not been anticipated in the pre-planning stages, and

slny'recommended changes.
Training:and_Rehearsingfifor Disasters, A disaster plan that exists
<3h.paper and that is not familiar to all profeSSional and non-professional

enmplqyees of a hOSpital is worthless. The most valuable asset that a

knospital possesses is its personnel. Therefore, staff education is as
Inecessary as a clear-cut disaster plan. .All employees must learn and
urnderstand how to carry out their assignments in changed routines in
uxlfamiliar conditions (35). -

Training must be planned for the following groups of personnel:

1. The Medical stair. '

2. The Nursing Staff--regular and part-time

3. All levels of Administration.

h. Non-professional personnel-regular and voluntary.

The purpose of training personnel for disaster is threefold:

1. To review the role of the hospital in a disaster situation.

2. To familiarize staff members with their role in the emergency

hospital plan.
3. To afford opportunity for developing group skills necessary

to carry out assigned tasks.

6h

The responsibility for arranging for these training programs lies with
the Hospital Disaster Committee. Training programs should be planned

so that they are held periodically and not just once (36).

If the hospital has an Orientation Program for all new employees,

:it should consider the possibility of introducing the subject of dis-
alster at this time. The new employees can be given their identification
czards, their disaster assignments, and they also can.be given Some type
:3f'a phamplet that briefly describes the total hospital disaSter program.
{This method should be an effective'way to begin the training of employees.
Nflxre specific training can follow later by the use of Specified,
scheduled training programs.

The training activity for the hospital should take several forms--

each form very important in its own right:

1. Review of emergency house orders by department heads and subse-
quently by them with their staffs.

2. Review of emergency operating orders by professional groups at
staff meetings. This would include a periodic revision of the
plans to make improvements and changes as needed or indicated
by drills or actual experiences.

3. Orientation and training of volunteers such as the‘WomanVS
Auxillary or Nurses? Alumni Associations in Specific duties
and first aid.

h. Meck exercises using portions of the emergency plan. An
unannounced test stimulates interest and enthusiasm both before

and after the trial. Reluctance on the part of the Medical

65

Staff and the department heads .to Spend time in planning can be
largely dispelled with the knowledge that the hospital is going
to test the disaster plan.

Post disaster critiques of hospital operation in disaster situations
have repeatedly disclosed weaknesses in segments of the hOSpital dis-
aster plan. Drills that have taken place in some hOSpitals which have
attempted testing have invariably led to practical changes in the hos—
pital disaster planning. As a practical measure, it seems that the
disaster plan of every hospital Should be subjected to rehearsal or
drill which will test its workability and the extent to which its pro-
visions are understood by hoSpital personnel. The Detroit Area HOSpital
Council has prepared material for hOSpitals to use to test disaster
plans (37) . This material, "Testing and Rehearsal of Hospital Disaster
P313113," covers three areas (see Appendix A):

1. Standards for hospital testing.

2. Procedures for hospital testing.

3. Complete plantesting.

If trials of the disaster plans reveal any deficiencies in the
departmental, the hospital, and the conmrunity aspects of the disaster
Plan, they must be corrected promptly. It is also obvious that if the
Personnel of the hospital, including the medical staff, is to remain
interested and is to remain proficient in its disaster duties, periodic
Des-t, exercises are an essential requirement.

In preScribing the objectives of the training program, the hOSpital

administration must be realistic. While, theoretically, every employee

66

should be fully informed and interested concerning the provisions of
the disaster plan, the administration must realize that in actual prac-
tice this objective is hard to reach in view of turnover. 'With this in
:mind, the administration must recognize that the success or failure of
'the hoSpital disaster planciepends, primarily, on the proficiency of

1ihe department heads, among which changes are less frequent.
SUMMARY

'When disaster planning has been approved.by the Governing Board of
a. hospital, it has been found that the actual planning can be most ads-
<1laiely'accomplished.by the appointment of a Disaster Committee.

One of the main functions of the Disaster Committee is to antici—
parte the many problems that will have to be met in an extensive emergency.
TC) accomplish this function, this Committee should establish an over-
all, general hospital plan and policies for meeting disasters.

The general plan should cover Such areas as:

Organization
Heeponsibilities of the Chief Control Officer
Disaster'Warning
Phases of the Disaster
Notification of PerSonnel
Casualty Flow Plans
Assignment of Hospital Space
PersOnnel
- . Traffic Control ‘
10. Visitor Control
11. Functions of the Chaplin
2. Admission of Ratients
13. Financing the Cost of Hospital Care
th Access to Facilities
15. Supplies and.Equipment
16. Termination of the Disaster Activities
17. EWaluation of the Hospital's Activities
‘18. Training and Rehearsing for Disasters.

. O

\OOD-NJQVl-P'UJNH

10.

ll.

15.
lb.
17.

18.

67

REFERENCES

Malcolm T. MacEachern, Hos ital Or zation and Management
(Chicago: Physicians? Record Company, l9§75, p. 90.

American Hospital-Association,-Princi les of Disaster Plannin for
Hosgiltals (Chicago: Committee of Disaster Plaxmm: g, l9§55, p. 1.
Ibid., p. 1.

Ibid., p. 1.

Harper Hospital, "Disaster Plan" (Detroit, Michigan. Draft of
March 17, 1958).

Curtis H. Lohr, M. D., The Planniniof Hospital Eunptions in a
Disaster (Kansas City, Missouri: Midwest Hospital Association,
19375, p. 70.

Cooper Hospital, "Civil Defense and Disaster Plan" (Camden, New
Jersey, 1956), p. 2.

. Harper Hospital, loc. cit.

. Minnesota Hospital Association, "Suggested Hospital Disaster Plan"

(Minneapolis: Council on Hospital Planning and Plant Operation,
1957). p- 2.

Michigan Office of Civil Defense, "Michigan Hospital Disaster Plan"
(Detroit: Medical and Public Health Division, 1951;), p. ‘3.

Donald R. Newkirk, "iv Casualties Treated in.32 Nfinutes," Modern
Hospital, 88:62-68, February, 1957.

. Harper Hospital, loc. cit.

Minnesota Hospital Association, pp. 922., p. 1.

Royal Jubilee HOSpital, "Disaster Plan" (Victoria, B. C., Canada,
195(4), p0 halo

Lohr, _p. cit., p. 31;.
American Hospital Association, _p. 913., p. 12.
Michigan Office of Civil Defense, pp. £33., p. 8.

Ibido , p. 654

2h.
25.

26.
27..
28.

29.

3").

33-
3h.
35.

36.
37.

68

American Hospital Association, _p. pit” p. 1b,.
zea- ‘

Lohr, pp. 2312., p. 16.

22.2., p. 66.

J. Dewey Lutes, "Operation: Major Disaster,” Hospitals, 30:36-h0,
March 1, 1956. A

Michigan Office of Civil Defense, pp. 931..., p. 65.

New York State Department of Health, "Outlining a Hospital Disaster
Plan," (New York: Office of Medical Defense, 1955), p. 18.

Lohr, _p. 9313., p. 55.
Lbi‘d.” p. 61;.

J. H. Pace, "Tornado In Texas Showed Need for a Disaster Plan,"
Modern Hospital, 80:82, August, 1953.

Lohr, pp. cit., p. 17.
American Hospital Association, pp. 91.3., p. 20.

William Slabodnick, "Duties of the Purchasing Agent in Planning
for Disaster," Hospitals, 32:62, January 16, 1958.

' Ibid.

Ibid.
Minnesota Hospital Association, _p. cit., p. 12.

Harold G. Leuth, "Meeting Disasters ," American Journal of Nursing,

American Hospital Association, pp. 9313., p. 2.
Michigan Office of Civil Defense, "resting and Rehearsal of Hospital.

Disaster Plans," (Detroit: Medical and Public Health Division of
Civil Defense, 195k).

'CHAPTER TV

THE ORGANIZATION AND OPERATION OF CLINICAL.AND NON-CLINICAL
FACILITIES OF THE HOSPITAL FOR USE AT THE
TEME OF.A DISASTER

Disaster planning not only includes the preparation of an over-all
Hospital Disaster Plan, but detailed plans must be included for the
activity of each clinical and noneclinical facility in the hOSpital.
These plans must be developed to indicate when the specific activities
are to begin after notification that an emergency situation exists.

The plans should set forth:

1. The departmental organization.

2. The location of the area, (See page )5).

3. The activities and procedures to be carried out during an

. emergencyas well as the activities that must be planned for
in advance.

h. The personnel required--their duties, assignments, and

reSponsibilities.

5. The emergency supplies and equipment items needed.

The material that is presented in this chapter will be a discussion
of the organization of various hospital functions and some of the
specific activities, procedures, and problems that must be met. When
a specifip institution applies this material to its organization, plans

then can be made for the actual number of people that will be needed

70

to carry out the functions and for the types and amounts of equipment

and supplies that will be needed.

THE RI'IfEIV ING, ADMITTING, AND SORT LNG AREA

 

CHIEF CONTROL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

OFFICER
MEDICAL SERVICE — - RECEPTION OFFICE}; - - - - NURSING SERVICE
DIREr-TOR OFFICER
STRETCHER CLERICAL
BEARERS PERSONNEL.
FIGURE 5

SUGGESTED ORGANIZATION OF THE RECEIVING,
ADMITTING AND SORTING AREA

The Reception Officer should be reSponsible for coordinating the
activities of the medical, nursing, clerical and other groups that are
participating in the reception and treatment of casualties, and in
general to see that the immediate needs of these groups are met.

Casualty reception is one of the most important functions in the
hospital‘s disaster plan. Every effort has to be made to coordinate
and expedite the activities relating to the reception and subsequent
treatment of the casualties (1)..

'When vehicles bearing casualties are unloaded at the hospital,

any casualty requiring assistance should be helped or carried into the

reception area by the stretcher bearers. In the reception area the

 

 

71

casualties should be received by the nursing personnel and made as
comfortable as possible pending examination by one of the doctors.

To insure that a record is made of all casualties that are admitted,
clerical personnel must be assigned to maintain a running "log" of all
casualtiesand to "tag" these casualties for purposes of identification
and treatment information. If possible, it is suggested that this
operation be completed before the patient is seen by the physician.

,All casualties arriving at the reception area must be seen by the
doctor that is a member of the Receiving and Sorting Team. This exami-
nation is not for treatment but is a procedure by which the sick and
the wounded are classified according to types and urgency of conditions
presented. The major purpose of this procedure is to properly route
the casualties to the apprOpriate treatment areas. The procedure of
sorting is the key to the management of these oasmlties,’ for it is
only by this means that casualties_may be categorized properly and
separated so that there will be a minimum time lag between injury and
treatment (2). Because this is such an.important phase of the casualty
care, the doctors and nurses assigned to this division should be the
best available. This function requires a high degree of professional
skill to make the required clinical judgments (3).

when the doctor has seen the patient, he should see. that the
information required on the emergency disaster tag is completed--
indicating to which treatment area the casualty should be sent and the

urgency of treatment.

 

 

72

l. Casualties requiring immediate medical or surgical attention
should be transferred to the operating rooms or the appropriate
treatment area: burn, trauma, shock, fracture, etc.

2. Casualties requiring only first 'aid should be directed or
assisted to the first aid division.

3. Casualties to be admitted to the hospital, but not in need of
immediate medical or surgical attention should be transferred
to the appropriate ward.

h. Deceased casualties should be classified, tagged, and trans-
ferred to the morgue.

The stretcher bearers and others who are assigned the responsi-
bility for assisting with casualty tranSportation and control of casualty
traffic should concentrate on the importance of carrying out their
duties quickly. Congestion in this area should be avoided.

'Functions and Procedures:

1. Nursing Staffn-see page 99.

2. Clerical Staff--see page 7h.

3. Stretcher Bearers.

a. Upon notification of a disaster the stretcher bearers
should report immediately to the Casualty Reception.Area
for instructions from the Reception Officer.

b. Collect stretchers and wheel chairs that have been assigned
to this service. To implement this function, plans must

be made for where this equipment can be easily located.

73

0. Transfer casualties from the receiving area to the treat-
ment areas as indicated by the nursing personnel. This
requires prompt action. 'Wheelchairs and stretchers should

be returned to the reception area.

d. Assist when neceSSary'with the unloading of the casualties
by providing physical assistance or a stretcher or wheel-
chair.

Equipment and supply requirements. These items should include
cots, linen, medical and surgical supplies, stationary supplies, wheel-
chairs, stretchers, and frame stretchers. Plans should be made for the
specific items that are needed, the quantity needed, where these supplies

are stored, and how the supplies and equipment are going to be obtained.

EMERGENCY MED ICAL RECORDS

 

CHIEF CONTROL OFI'ICFR]

 

 

 

_ EMERGENCY MEDICAL RECORDS
OFFICER

l

‘1
CLERK'S [ MESSENGERS]

 

 

 

 

 

 

 

 

. I T l
RECEIVING IIIARDSI LINFORMAT ION] [DISCHARGE]

 

 

 

FIGURE 6 .

SUGGESTED ORGANIZATION FOR EMERGENCY MEDTCAL RECORDS

7h

Type§_9f Records that Should berKept. There is general agreement
that medical records are essential in the. identification and treatment
of casualties in a disaster situation. It has been recommended by the
American HOSpital Association that the records should be as simple as
possible and that there should be some means of attaching these records
directly to the patient so that they do not become lost (h).

In most cases,.hospitals have adopted the emergency medical record
system recommended by the Federal Civil Defense Administration. This
system involves the use of five basic documents (5) tSee Appendix B):

l. The emergency medical tag. This tag is made out and attached
to the patient either at the disaster site or upon admission
to the hOSpital. It is used for identification purposes, and
it generally shows any initial treatment or medication that
has been given.

2. The index and information card. This card is filled out in
duplicate in the receiving area for use as an information and
patient locator card. These cards are to be sent to the
Patient Information Center where one card is filed as a permanent
hospital record and the other copy used to compile casualty
lists or made available for use by either the Red Cross or Civil
Defense.

3. The emergency hospital clinical record. This is a folding
card type form which is used for noting brief case histories

and records Of treatment.

"/5

h. The records' jacket. This is an open envelope which is attached

to the patient and used to hold the patient‘s records.

5. HOSpital diaposition log. This is a work-sheet type record

which shows where the patient has been Sent or transferred.
In addition, it is recommended that the hospital continue to use any
standard forms it considers practical and desirable under the circum-
stances.

There have been objections to the system suggested above because
it has gone to extremes in limiting the sizes of the records. The tag-
ging system appears objectionable because it does not provide sufficient
Space for bare essentials such as the physical, X—ray and laboratory
reports, diagnosis, treatment, and a few progress notes. Also, because
these are Special records which will be used only in a period of disaster
they must be especially printed.which raises the question of cost.

Because of these objections, some hospitals have rejected the Civil
Defense system as inadequate and propose to use their hOSpital?s regular
forms and to effect the necessary curtailment of the medical records,
not by reducing the size of the forms but by limiting its written
content. '

The Staff of the St. Louis County Hospital in St. Louis, Missouri
has adopted this plan (6). They prOpose to use the regular hOSpital
forms and restrict the records to five sheets and two half-sheets. The
first sheet of the record would be of the usual standard admitting and
identity data and the various permit forms would be included. This

hospital feels that the permit forms are important because even.in a

76

disaster, the legal aspects of anesthesia and surgery should not be
fbrgotten. The second sheet provides two pages for the recording of
findings, procedures and progress notes. The third and fourth sheets
provide the customary forms for the management of valuables and cloth-
ing. These sheets also have their legal aSpeots. The two half-sheets
are carbon copies of the patient identification and condition data
which are designed to be sent to the Patient Information Center.

The St. Louis County HOSpital proposes to use a "shop envelope" to
keep these records together. This "shop envelope" is described as an
envelope with a celluloid front which has a window over the area where
the identification data and the condition of the patient will be re-
corded on the front sheet of the record; the window facilitates the
recording procedure. .At the top of the envelope is a reinforced "eye"
thrOugh.which a.ribbon loop is threaded. By this means, the "shop
envelope"containing the patient's recOrds can be securely attached to
the arm of the patient. '

Either method is acceptable as a medical record, but the second
system described seems to be more practical because it makes use of
records already used by the hospital and that are familiar to all
professional personnel. The only additional expense to the hospital
'would be to purchase a supply Of "shop envelopes" that fit their
standard record sheets.

Operations anquolicies. ‘The paper work during the emergency should
be effected as quickly and as simply as possible, fulfilling only the

most essential purposes of a system of records and documentation.

77

The fbllowing elements should be considered necessary:

l..A record of diagnosis and treatment given and prescribed for
individual patients for effective and continuing medical care.

2. A record of identity, location, and condition of individual
patients for the information of family and friends.

3. The records that have been mentioned to be kept for purposes
of compiling statistics and settling accounts.

.An efficient system of record keeping should not only minimize con-
fusion, error and distress at the time of an emergency, but also should
reduce the confusion that might follow. In an emergency, records should
be maintained to keep track of the patient from his admission to his
discharge. To accomplish this and to reduce the work load of the nursing
staff, record clerks should be located at strategic points throughout
the hospital.

1. Admission clerks should identify, tag and list all incoming

patients.

2. Discharge clerks should collect all disaster tags, medical
records, and list all of the patients as they are discharged.

3. Information clerks should classify and give information to the
public, (see page 81). They should also prepare casualty lists
and compile information for the later use of the hospital.

h. Messengers should be used to carry records and maintain contact.
among the various record Centers.

Limitations of time and persOnnel, as well as unforseen occurrences,

will require a thorough knowledge by every clerk of what is expected of

him; furthermore, a flexibility and resourcefulness in case duplication
prevent his completing his duties as prescribed. Each clerk should
bear in mind the basic purposes for record-keeping in an emergency so
that he can adjust the details of his duties to the particular circum-
stances.

Along'with.keeping the records of each casualty, the reSponsi-
bility of accounting for the patients' valuables and clothing is generally
assigned to these clerks. Procedures should be established for the
collection, custody, and identification of the clothing and valuables
of the casualties. This procedure should include a System for handling
the effects of patients who are deceased. Bags, boxes, sacks or some
other type of container for the valuables and clothing should be provided.

Equipment 52d Supplies. Plans must be made for supplies and equip-
ment, for storage of these items so that they are readily accessable,
and for delivery of these supplies to the records sections when needed.
The Supplies that might be needed include:

Emergency medical tags and jacket Pencils or pens

Clinical records Skin marking pencils

Shopping bags for valuables
The supply list should be prepared as soon as the disaster plan has
been approved and forwarded to the supply Officer to enable him to
procure and store these items.

Specific Procedures.

Reception. As the patient is brought into the hospital, he should
be immediately tagged with the emergency medical tag. .An index and

information card should be filled out in duplicate as completely as

’1

Z9

possible. Also, a record of admission should be made in the log book

by name or tag number. Unidentified, both dead or alive, should be
handled.as the other casualties, but under the identification information,
as much information as possible should be given as to appearance, age,
etc. .As the index and information.cards are filled out, they should be
sent by messenger to the Information Center.

Patient Treatment.Areas. Clerks assigned to these areas should
use the hospital's "Daily Report“ sheet to record the name or tag number
of every patient that is admitted to their assigned unit. By means of
this "Daily Report" sheet the clerks can keep track of the unit's
catacity and can send word by messenger to the Receiving Area when the
capacity of the unit is approached. 'Whoever is aesigned to the Morgue
area should also maintain this "Daily Report" sheet.

'When a patient is admitted to the treatment areas, the clerks
should put together the medical record for the patient~~filling out as
much information as possible. These records should then accompany the
patient at all times while he is in the hOSpital.

valuables and clothing of the patient should be placed in a con—
uainer of some description and.marked with the tag number or name of
the patient. These bags should remain with the patient if possible.

Patients who have been sent directly to the operating rooms from
the reception area should not have their medical records compiled until
they have been transferred to one of the patient areas. At this point
the doctor's recommendations and written reports can be incorporated

into the medical chart.

80

Periodically, duplicates of the "Daily Report" sheets should be
sent to the Information Center. These sheets have, besides admitting
information, up—to-date reports on the condition of the patients. This
must be made available to the Information Center. 'When the information
has been Obtained from these sheets, they should be returned to the
proper treatment area. Movement of patients, discharge of patients,
and deaths of patients'should be sent periodically to the Information
Center. It is suggested that a specific schedule of reporting this
informatiOn be set up.

Discharge of patients. There should be one central point to which
all patients are sent for discharge from the ward and treatment areas.
Generally, this point should be established in the first aid area.

1. First aid patients. The doctor in the first aid unit should
indicate on the patient's disaster tag the diagnosis and
treatment administered. 'When treated the patient should then
be sent to the discharge point where the clerks list him in a
discharge log book and remove the casualty tag. This tag is
retained and filed as a permanent record.

2. Casualty patients. The same procedure should follow for these
patients-~the medical records and disaster tags removed from
the patient, clothing and valuables checked out to the patient,
and the patient listed in the discharge log book.

3. Deceased patients. The removal of a body from the MOrgue should
require the signature of the undertaker or other person removing

the body. Clothing and valuables should also be signed over to

81

this person. The medical records and disaster tag must be
retained permanently and a log book on the disposition of the

body should be maintained.

COMMUNICATIONS

Hal—_..-

CHIEF CONTROL CFFICEfl

l

COMMUNICATION OFFICER

 

 

 

 

 

 

  

     
 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

. .o J o I A I
PUBL IC RELATIONS OFFICER
OFFICER . j
I ‘ , 7
[MESSENGEPS] GUIDES TYPIST [_LERH PAGING AN]: SNITCHBOARD RADIO
' MESSAGE
ENCTLER g
. * T _A I
LCLERKS OPERATORSHI‘ESSENGERS]
FIGURE 7

SUGGESTED ORGANIZATION FOR THE COMMUNICATION DIVISION

Public Relations. Public relations is very important in the area
of visitor and press relations. .A disaster inevitably results in the
serious problem of frantic relatives crowding the hospital seeking
information. ,Also, at the time of disaster, false rumors and misleading
information accompanied by panic and lack of control must be encountered
and overcome. In the hospital,.Administration must have reliable

information and must be able to form a true picture of events.

82

For this reason, the information center is.vital in the disaster
organization of the hospital.

The hospital has the responsibility for providing the community,
relatives and friends with information about the condition and diSposi-
tion.of the casualties. The Information Center in the disaster organi-
zation can.accomplish this goal by providing information to the patient's
relatives, the Radio, the NewSpapers, and the Community agencies.

The control of visitors to the hospital in the time of a disaster
was discussed on page Sh. This is one method that can be adopted by
the hospital.

To be able to release information about the casualties, procedures
must be developed to efficiently handle information that is sent to this
center by the Medical Record Clerks. Files should be set up to handle
the index cards that are sent from the Reception Area and some method
must be established for recording on these index cards the periodic
reports that are received from the treatment areas, the morgue, and
the discharge point. These reports and casualty lists should be
available as soon after the first casualties have begun to enter the
hOSpital and at Specific times thereafter.

.As much as can be done, should be, for establishing good press
relationships. It has been suggested that space and telephone service
be allocated to these people at the Information Center to facilitate
their work. Policies regarding picture~taking and allowing reporters
to interview patients must be seriously considered. In so far as picture-
taking is concerned, this work should be limited, as much as possible,

to pictures of the type that show how the hospital and its personnel

83

are functioning in the disaster situation. Every possible effort must
be made to prevent the release of pictures showing gruesome injuries.
If a request is made to take a picture of an individual patient, this
must only be permitted if the patient has given his consent to be photo-
graphed. If photographers and reporters should desire to visit the
treatment areas, they should.be accompanied by'a guide. The purpose of
this guide should be to aSSure that the reporters will not be refused
admission to any of the areas and that if the reporters have any ques-
tions pertaining to the functions of the hospital and its personnel,
they will be put into contact with the hospital person who is best able
to answer their inquiries

The equipment and supplieS'of thiS'unit will vary with the set-up,
but.;flans should.be made in advance for the items needed and how they
will be procured at the tine of an.emergencyu .A suggested list of

supplies and equipment might include:

Equipment: typewriters Supplies: paper
table and chairs files for Index Cards
Information Office sign pencils and pens
Notice Board' thumbtacks

Communications. Probably one of the most serious problems in the
time of an emergency is the lack of adequate communications. It is,
therefore, imperative that concrete thought be given to several alternate
means for communicating-externally as well as internally.

l. Telephones. many authors feel that the telephone is an out-

moded (7) means of contacting personnel and agencies outside

of the hospital because:

8h

a. People frequently are not at home and time is wasted
trying to contact them.
b. Telephone service is frequently interrupted as a reSult
of the disaster situation.
0. Telephone service, if not diSrupted, becomes tied up
with many unnecessary calls coming into the hospital from
anxious relatives and friends.
Nevertheless, the telephone still is one means of communication,
and if planning is done adequately, it can be used to great ad-
vantage if the service has not been disrupted by the disaster.
As mentioned before, in an emergency, frequently all of
the trunk lines of the hospital can become tied up due to an
excess of incoming calls. As a result, it is impossible to
efficiently use these facilities for emergency External com-
munications. This is a severe handicap. One method that has
been suggested to meet this problem is to install a number of
"9th level" telephone lines which by-pass the hospital switch—
board and which are restricted to only out-going calls (8).
Each major department should be equipped with at least one of
these Special lines. This is espeCially true of the Message
Center and the Patient Information Center.
This type of telephone service should be installed when
conditions are normal. These telephones should be of the plug-
in type, and they should not be used except in a disaster situ-

ation. The improper use of these telephones can be prevented

85

by keeping the instruments with the other disaster supplies to
be issued only upon the activation of the disaster plan. By
following such a procedure, as has been described, the cost of
these important facilities can be reduced to the installation
charge plus a nominal monthly "stand-by" charge.
. Radio. It is felt by many hCSpitals that the telephone system
for external communication must be supplemented with a.short—
wave radio network (9). This would insure that the hospital
would have a link with the community in case of telephone
failure. The Heart of.America Radio Club, an organization of
ham radio operators, has done a great deal of work in establish~ .
ing hospital networks (10). The idea behind this program has
been to place all hospitals in a community in communications
'with each other, to establish a central control point, and to
establish a twentysfour hour monitoring system of police radio
frequencies so that the hospitals will be alerted immediately.

It has been suggested that to establish such a system in
a hospital-~"Three steps must be taken:

1. Obtain the services of a properly licensed amateur

radio operator.
2. Seek the asSistance of the Civil Defense Communication
Chief of the area.

3. Prepare to spend about'3500 for equipment." (11)

Such a system would assure that the hospital would be in con-

stant contact with the community in the time of an emergency.

86

3. Hospital Paging system. If this system is not interrupted due
to a power failure, it is an invaluable system to use in trans-
mitting general information to all divisions of the hospital.
It can be used for alerting personnel and making general announce-
ments. It augments the use of the telephone for internal com-
munications.

h. Message Center. Under normal conditions this type of facility
is not needed in the average hospital. In a disaster, the
situation is different-—much time can be wasted locating people,
messages can become lost, and communications can break down.

To solve these problems, a message center should be estab-
lished to act as a clearing house for all incoming and out~
going messages. By this method, the efficient performance of
telephone operators and the radio operator is assured.

A system of message management provides that when a call
is received, it is transferred to the message center where the
message is recorded and transmitted then to the recipient by a
messenger. The messenger obtains and records the recipient's
answer if there is any. The message is returned to the Message
Center and from here it will be relayed to the original sender
over one of the outgoing telephone lines or by radio. By the

' use of this method, the switchboard and radio operators can be
relieved of a great work load, their efficiency increased, and
long delays caused by tiedeup telephone lines eliminated. If
at all possible, the radio system and the telephone Switchboard

should be located at the message center.

87

SUPPLIES, EQUIPMENT AND UTILITIES DIVISION

 

' '“.“'~"

[CHIEF CONTROL OFFICER

 

 

 

 

 

SUPPLIES, EQUIPMENT AND UTILITIES OFFICER l

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

. E ’ ,
F _ . l A ...... 1

ENGINEERING AND CENTRAL STORES HOUSEKEEPING

MAINTENANCE OFFICER OFFICER F--:

_ OFFICER ___ '-

'—-|‘ TRAFFIC CONTROfI DISASTER ‘ ‘OISASTEREETmp

‘ *“ SUPPLIES AND GENERAL -—
L ' MAINTENANCE

l mTERNALj *-

{ ‘_ -

I EXTERNAL ] BERGENCY .

f RECORDS . [TRASH RWOVAL

HENGINEERING j . INERCENCI .

‘ " ' f DELIVERY [LINEN SERVICE I;
h{OEIIERAL l . * '
-|“EI”EVAIO‘R“]

EMEROFN Y
UTuITIEsl
FIGURE 8

SUGGESTED ORGANIZATION FOR THE SUPPLIES,
EQUIPMENT AND UTILITIES DIVISION

The operation of the functions listed above are essential in a
disaster organization. The responsibility of setting up the disaster
units, of providing the supplies and equipment that are necessary in
the emergency units, of maintaining the utilities of the hospital, and

of controlling traffic requires a great deal of pre-planning.

88

Housekeeping. Of the three major functions of this department, the

 

most important deals with setting up the disaster areas. For the most
part, the disaster areas are planned in divisions of the hospital that
are not normally used for patient care. Plans must be developed for
what is to be done with the equipment that is usually found in these
areas in order to make room for the disaster set-ups. Equipment such
as cots, work tables, lights, linen, etc. must be moved in and placed.
This department must know specifically where all of these items are
stored. It is advisable to pregnre floor plans in advance, with the
cooperation of other. departments concerned. This procedure should help
to quickly set up the disaster units when notice of an emergency is
given.
It should be remembered, that to set up these areas quickly, it
Will take all of the manpower that the housekeeping department can
m'llster at the time. After this essential function is over, the majority
of this department's employees can be used for other than housekeeping
pLil-'i‘poses-«as stretCher bearers, guides, traffic control people. etc.
During the disaster period, only a minimum of normal housekeeping
J:‘L‘llcetions should be maintained. This minimum amount of cleaning should
be carefully considered so as not to lose sight of proper sanitation.
A large problem may develop for this department if there is damage to
the hospital's water system. Such damage would curtail or prevent the
“Be of water for cleaning. In this event, the housekeeping department

should be prepared to use substitute materials or methods.

89

Trash removal is, also,- an important area to consider. Undoubtedly,
with an increase of patients and with anyr disruption of major utilities,
problems of paper and sewage disposal must be considered. {See utilities,
page 96) .

Linen service is another necessary function that must be plarmed.
[n a hospital situation where a commercial organization does all of the
hospital's laundry, plans must be made to insure an adequate‘linen
supply in the time of an emergency. Linen supplies routinely stocked
in the hospital should be adequate to service the hOSpital for ’48 hours

at capacity loads {12). Plans should, also, be considered for reducing
the amount of linen that should be used in caring for patients in a
disaster period. Also included in the planning should be methods for
the delivery of clean linen and the collection of soiled linen from the
treatment and patient areas.

Central _ET’OI'EE . Most of the work of this division should be done

throngh the use of advance planning (see page 58). After equipnent and
Supply lists have been prepared for all the disaster functions and
approved by the disaster committee, it should be up to the purchasing
agent to obtain supplies and equipment that are not available in the
hos39:1.tal"s inventory. It would seem wise to set up a disaster stores
area for the storage of all of the requested items. If properly handled

811d controlled by the stores division, disaster boxes can be packed,
labeled, and ready to dispense to each disaster unit in the case of an
emergency.
When a disaster has been declared, assigned personnel should

report immediately to the stores area to dispense and deliver all

9O

pro-planned disaster items. This department should be responsible for

maintaining control of all supplies and equipment with the exception of

maintenance items, drugs, and medications.
When initial disaster supplies have been delivered, this division

should only process requisitions for supplies and equipment from the
disaster units for inventory items. Any other supplies or pieces of

equipment not available in inventory should only be processed if approved

by the Chief Control Officer.
Any equipment or supplies delivered to the hospital during a dis-

aster period should be carefully checked) into the Central Stores area.
Accurate records should be maintained to account for these items to

enable the hospital to properly return or reimburse the sender when the

emergency is over .

Egineering and Maintenance .

General. Under this division, the engineers should follow their

normal pattern of work assignmentsudiscontinuing any work which is not

i3711"!ediately required. Procedures for requesting maintenance service in

the disaster units should follow the'existing hospital. routines. Direct

recl'lilests by telephone should be allowed.

Elevator service. The prOper control of elevators can only be

obteamed by manually operating the elevators. Personnel should be

assigned to this service and plans detailed for the control and. service

of the elevators .

Traffic Control. [t is the responsibility of this division to

implement the general plan for disaster traffic control. Again, to

91

adequately implement these plans, planning should be done in advance
with the cooperation of the comnnmity police and the hospital adminis-
tration, (see page 52).

Ebctemal traffic control: (in cooperation with the Police Depart-

ment or other community agency).

1. Maps should be made of the hospital area showing traffic con-
trol posts, ambulance entrances, and other vehicle and pedestrian
entrances.

2. External traffic control patterns should be established. Traffic
control posts should be designated, instructions written for
each post, and personnel assigned.

Internal traffic control:

1. Sketches of the hospital floors should be made showing dis-
aster areas, entrances, and traffic flow patterns.

2. Guard posts should be designated, instructions written for each
post, and personnel assigned.

General consideration of traffic control:

1 . Guard and traffic control perSonnel should be identified with
some type of official insignia or armband.

2. Directional signs should be prepared in advance, stored, and
personnel assigned to put these signs up in the event of an
emergency.

Emergency Utilities. If there is any break in the utility service

into the hospital, plans should have’been made in advance to substitute

o“iiher sources controlled by the hospital if such are available.

92

1. Reserve light and power supply. It must be recognized that
even though a hospital is not located within the area of destruction,
its light and power supply may be disrupted by tne effect of the dis-
aster on the electric company's distribution system. Without light and
pawer the functions of the hospital are paralyzed. Without electricity
there can be no refrigeration, no illumination, and perhaps no heat.
The X-ray equipnent is inoperative, telephones are dead, and elevators
are useless.

Some type of stand-by electrical power is necessary to meet all- of
the power needs of the hospital except air conditioning. The extent of
stand—by power provision varies with the frequency and duration of
" outages" on theutility system. Engineering authorities and the

Mexican Hospital Asswiation consider the following needs essential:
surgery and delivery room suites, stair lighting, partial corridor
lighting, exit signs, fire alarm system, boiler plant operation, food
911d blood refrigeration, partial laboratory service, incubators, and
31 e"Vators (13). Sources of stand—by power can take several forms:

a. Engine-driven generator. In this system, an engine powered by
gasoline, diesel fuel, or Other fuel drives a generator which,
in turn, furnishes electric power for the hospital circuits.
The engine-driven generator is normally installed near the
electrical facilities switchboard and must be connected to a
fuel storage tank or other device so that it can Operate.

_ This machine will start independently upon power failure.

The generator costs approximately $100 per kilowatt to install

x

{a

PIli‘ices.
tions .'

93

exclusive of the electric wiring and building to house the
generator.* Generator systems are a service problem because
they must be ready for service without notice and they are
seldom if ever operated between emergency needs to see if they
function properly. They normally consume about .15 gallon of
gasoline per kilowatt per hour (1h).

Turbine-driven generator. The turbine is driven by steam from
the boiler. This type of power source has definite disadvantages:
a. If the hOSpital steam pressure is not high enough for
optimum operation, the turbines are not efficient.

b. In case of a power failure, the steam supply is often
lost. By the time the emergeney turbine generator can
be started, all of the steam is gone; consequently, the
power on the burner fails. The cycle-is such that there
is no steam to operate the turbine which in turn operates
the burners.

The cost per kilowatt of a steam driven turbine generator is
about $200 a kilowatt (15).

Batteries. Normally, battery systems are designed to provide
lighting for about four hours. Because batteries furnish direct
current, they will not operate most alternating current equip-

ment. They have a definite advantage of immediate change-over,

but they are heavy- and require good room ventilation to

quoted are based on the Chicago area and on average installs,

9h

remove the hydrogen gas they produce (16) .

Estimating stand-by power requirements. A good rule of thumb for

estimating the size of a disaster power system needed is to provide

about one kilowatt per hour per bed.

2. Reserve Fuel Supply and Dual Firing System. When the boilers

of a hoSpital are fired with fuel gas obtained through the mains of the
gas company, thereis the possibility that the supply of gas may be dis-
rupted by the prevailing distruction in the disaster area. In as much
as the hospital would be hard pressed to function without steam for
sterilizing or cooking, and would be handicapped by the lack of hot
water, it is essential to prevent such a breakdown by procuring and

maintaining a secondary fuel source and firing system.

Liquified propane gas can be used as a secondary fuel source for

the boilers and as stand-by fuel for the kitchen. Special burners can

be purchased in advance for. the stoves and installed quickly in the

time of emergency (1?).
A second source of fuel supply and firing system for boilers could

be a stand-by stoker or oil burner system. Provisions must be made, in

1“flese cases, for the bulk storage of coal and. oil (18) '

3. Reserve water supply. The possibility that the destructive

efIfi‘ects of a disaster may disrupt the water supply of the hospital must

aCLSo be kept in mind. A hOSpital cannot function without water. In
Order to cope with such a contingency the hospital must provide for a
reserve smpply of water. ._ During an emergency, water can come from a

Well (19), it can be obtained from storage tanks or reservoirs, or it

Can be delivered in tank trucks (20) .

95

Some hOSpitals have entered into agreements with milk companies

or water haulers who, on call, will bring water to the hospital in

large tank trucks. Tank truck delivery is somewhat unsatisfactory in

that the volume per delivery is small, and the water must be pumped
under pressure to a storage tank for holding until time of use. Insti~
“butions which prOpose to use or get water by this method intend to haul
the drinking water from the storage tanks by means of a large number of
five gallon cans which they have on hand (21) .

Storage tanks and reservoirs require maintenance and must be kept
full. Wells, also require constant maintenance and, unless they are
used, frequently have a tendency to fill.to an undesirable level.

DesPite their drawbacks, wells are probably the most satisfactory
of the three water sources. Mr. John A. holbrook, Administrative Engi-
neer of Presbyterian-St. Lukes Hospital, Chicago, suggests:

For economic reasons, a six-inch well is usually the most satis-

factory. Under normal conditions, a six-inch well produces about

100 gallons of water per minute. It costs approximately six

dollars a foot plus the cost of piping to bedrock. For example,

if bedrock is fifty feet below the surface, piping would cost

approximately $200. Drilling and piping for a 275 foot well costs

$1600 and a pump capable of delivering 100 gallons of water a

minute (approximately eight horsepower) would cost another $1200. (22)

He i‘urther suggests that a 250 bed hospital would require 30,000 gal-

10118 of water per day. If only the patients and the dietary departments
are considered, twenty-five per cent of 30,000 gallons of water or 7500
g3-:LILons are considered adequate for disaster conditions.

It is suggested that a water conservation policy be prescribed and

eILforced during an emergency situation.

96

h. Reserve Toilet and Other Waste Disposal Facilities. This is

an embarrassing need that will arise if there is a disruption of the

water supply or if Sewage lines are not usuable. Without sufficient

water, water pressure, or usuable sewage lines, the toilets and other

waste disposal units cannot be used. It has been Suggested that, "this

problem can be solved by the use of bed pans, commodes, and large gal-

vanized cans fitted with tight lids. When these items are in use they

should be lined with several thicknesses of paper. The paper-lined
bed pans and commodes can be emptied into the larger cans which are

deodorized and sanitized by chemical means." (_ 23) Arrangements must be

made in advance for the disposal of the contents of such cans with the

local public health department.
It has been estimated that in addition to sewage, provision must

be made for removing approximately 6%» to 9 pounds of Waste per patient

per day (21;). Much of this waste is combustible, but it is nevertheless

a problem. If due to a breakdown in the gas supply, incinerators cannot

be operated, garbage and rubbish must still be diSposed of in some

ma-1'7I-1’?l.er .

DIETARY

 

| CENTRAL CONTROL OFFICE}?!
I .
[DIETARY oRFICER} - - - 1NURSING SERVICEI

w ‘_ “V” "‘ " "‘ ' I
‘ F01130 AND VOL CASUALTY AND NON-CASUALTYI
$13 SERVICE _I\ FOOD SERVICE __

DIETARY EMPLOYEES I
VOLUNlEals

 

 

 

 

 

 

 

 

FIGURE 9

SUGGESTED ORGANIYATION FOR THE DIETARY DIVISION

9',

To accomplish the purpose of providing prompt, emergency food
service to a large number of casualties, non-casualties, personnel, and
volunteers, planning must be done in.advance. To provide adequate
service at the time of an emergency, the advance planning must include:

a. HOw notification is going to be obtained by the Dietary Depart-

ment of the numbers of casualties that need nourishment.

.b. How and where the caSualties are to be served.

c. What type of food and beverage is going to be served to the

casualties and non-casualties.

d. How the personnel and volunteers are going to be served and

‘where they are going to be served.

It has been suggested that plans should be made to simplify the

variety in the diet nsually served.by planning disaster menus {25).
In doing this, estimates can be made for the quantity of Staple items
that.need to be kept on hand.to last for at least a three day period.
.Ehuzs should be made'with local food suppliers for prompt delivery of
food. if the need arises.

The service of food would be greatly hampered if some of the major
utilities are diarupted. Therefore, it is essential that plans must be
made for:

l. Improvising cooking facilities by the conversion to some other

type of cooking fuel. This problem can be met by procuring
and keeping in readiness a.sufficient number of Colman stoves
of the army type along with a one day supply of liquified pro-

pane gas (26).

98

2. Improvising the storage of perishable items if there is no
refrigeration. Partial refrigeration can be obtained.by the
use of dry ice (2h). If this method is considered, plans should
be made for obtaining dry ice in the case of need.

3. Improvising methods for garbage disposal if there is a lack of
water or power.

ha Improvising the service of food by the use of paper goods--
plates, cups, etc (25). The use of these items should cut down
on manpower needs as well as water needs by partially eliminat-
ing dishwashing. However, trash disposal will remain a problem.

5. Improvising methods of delivering food to the patients if there
is no elevator service.

The tremendous work load which will be imposed on the hospital’s
food service by the increased patient and personnel load makes it
necessary to suSpend the regular meals and the regular hours. In as
Jmufll as the personnel prObably'will not be able to observe regular
Reel. hours, provisions should.be made to serve food continuously during

the‘emergency'period.

99

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FIGURE 10
SUGGESTED ORGANIZATION FOR THE NURSING DIVISION

The Nursing Service Officer, on notification of a disaster, should
supervise the activation of certain Vital nursing functions-patient
treatment areas, central supply, and surgery; In order to effectively
do this, this officer should (29):

1. Determine any additional personnel needs for these areas and

request these personnel needs from the Emergency Personnel
Office.

2. Supervise the setdup of disaster facilities in the patient

treatment and care areas in cooperation with the housekeeping

Service.

100

3. Supervise the requisitioning of any additional equipment and
supplies deemed necessary after the receipt of the disaster
packs from the Central Stores.

h. Determine the census of vacant beds in the hoSpital and super~
vise the assignment of patients to rooms or beds from the
reception or treatment areas.

5. Supervise the nursing care given to casualty patients in the
receiving, treatment, and patient areas as well as non-casualty
areas.

To accomplish these functions at the time of a disaster, advance

planning is necessary in the following areas:

1. Determination of the amount of nursing personnel needed to
staff the various nursing areas. This should include the
assignment of nurses, nurse aides, and orderlies to specific
duties.

2. Determination of the hospital's bed capacity for casualties.
‘When it is said that a hospital has a capacity of 250 beds, it
is a mistake to conclude that in.a disaster the hospital will
be able to admit that many casualties without further prepara-
tion. In as much as the casualty load of a hospital as a
result of'a major catastrophe may'be tremendous, consideration
must be given to the possibility of removing as many as possible
or necessary of the pre-disaster patients by sending them home
temporarily; Surveys have shown that as many as 80 per cent of

I the pre-disaster patients in a hoSpital could be removed without

101

jeopardizing their prognoSis (30). For planning purposes,
however, it is wise to estimate, on an average, that only 60

per cent of the hospital's pre~disaster patients can be evacuated
safely.

When evacuation is necessary, it is essential that the
decision on who is to be sent home must be made by a senior
member of the medical staff whose medical judgment is respected.
This determination is a time-conSuming task, but it could be
expedited by incorporating evacuation information into the
Daily Condition Report of Patients. Aside from facilitating
the work of the physician who has the task of determining which
patients leave, this form will also expedite the actual evacuation
procedure in that it enables the grouping of the evacuees accord-
ing to the general area of their destination. It thus becomes
possible to load each evacuation vehicle with patients who are
being moved to the same area, and as a result, a great deal of
time will be saved.

In planning for the evacuation of patients from the
hospital, consideration.must be given to how these patients will
be physically evacuated. Plans should incorporate the use of
automobiles of volunteers or business firms or buses of the
public transit system.

‘When, in a disaster situation, it becomes necessary to
expand the bed capacity of the hospital, there will be no time

to make "rounds" in order to determine where additional beds

102

can be placed. .1f the expansion.is to be serviceable, it must
not be based on guesswork at the moment of need-~it must be
made according to a pre-determined plan. It has been found
that if existing patient areas are to remain functional, their
bed capacity cannot be increased appreciably (31). As a result,
the expansion must be effected by the use of such areas as
offices, waiting rooms, class rooms, and auditoriums.

Usually these expanded facilities lack many of the essen-
tial nursing care instruments. It is obvious, therefore, that
the expanded areas would be without value unless they can be
equipped with basic items for patient care such as beds, linen,
solution stands, urinals, bed pans, etc.

Determining procedures for the following specific functions with
the Medical Staff. The planning should include standardized
procedures, supplies and equipment.

a..Admission, Receiving and Sorting. The nursing personnel

assigned to this area Should be organized to make the
patients as comfortable as possible and to help the
doctors to inSpect the patients to determine diagnosis
and priority of treatment.

The nurses and other nursing personnel, following
the doctor’s directions, should either complete the
disaSter tags or mark the priority of treatment with a

skin pencil on the patient's forehead or other available

103

conspicuous part of the body. A code (32), such as the
following, could be utilized:

1. Priority of treatment indicated with Roman
Numerals I, II, III, and IV in accordance
'with.urgency of the case.

2. Treatment team to which the casualties are to
be sent indicated with the following capital
letters:

OR - surgical operation
M - minor surgical
S - Shock
‘W'- ward
F - fracture
B - burn
'When the patients have been examined and priority
of treatment has been determined, the nursing personnel
should direct stretcher bearers to remove the patients
from the area immediately.
. Expansion of the operating room facilities. In a dis-
aster, it is doubtful that the hospital's operating
rooms will be Sufficient in number for the operative
case load. In order to solve this problem it will be
necessary to:

1. Convert the Obstetrical delivery rooms into
auxillary operating rooms.

2. Convert the emergency rooms into auxillary

operating rooms for minor surgery.

3 . Provide for additional operating equipnent.

104

In cooperation with the medical staff, plans must be
made for the conversion of these areas and the addi-
tional equipment, supplies, and personnel that will be
needed. Plans should, also, include emergency measures
to insure an adequate supply of sterile equipment.

During the emergenqy period, casualties designated
for surgery should be brought directly to this division.
Insofar as pOSSible, the Supervisor of the division
should try to See that priority of treatment established
in the Receiving.Area will be followed.

‘When casualties are brought into the surgical
areas, the nurse should report to one of the surgeons
the diagnOSis and condition of the patients and request
pre-operative orders. To save time, preparation of the
patient for Surgery_should be done on the operating
table.

The anesthetist or nurse should record on the dis~
aster records of the patients, a brief statement of the
surgical procedure as given by the surgeon. Following
the surgical procedure and when the record has been
filled out, the casualty should be taken to the appro-
priate ward by orderlies under the direction of the
operating room supervisor.

c. ward and treatment areas. Nursing personnel assigned

to these areas must supervise the setdup of the area as

105

pre~planned. They are reSponsible for seeing that the
necessary equipment and supplies for the care of the
caSualties are on hand and that the casualties are made
as comfortable as possible.

The nursing personnel should work only under the
direction of the physicians assigned to those areas.
When the doctor has determined the type of treatment
required, the nurses should carry out and supervise
the treatment procedures that have been ordered. The
personnel in these areas must continue the medical
record of the patient by noting on the record any treat-
ment that has been given. If the patientYS condition
requires that he be transferred to another unit, the
personnel in the area are responsible for effecting
this transfer.

Irregardless of the admission of a large number of
patients to these areas, the highest standard of patient
care possible, within the limitations posed as a result
of the disaster, should be maintained.

Routine procedures which are not of essential
nature such as baths, changing of linen, back rubs, etc.
should be reduced to a minimum. In pre-planning the
operation of these units, "standing orders" should be
conSidered. The use of "standing orders" wherever

possible for the care of similar conditions minimizes

106

nursing care. These must be planned with the medical
staff.

d. First aid area. This area should be well marked and
under the direction of‘a qualified physician. In plan-
ning for this area, it should be remembered that a high
percentage of the patients will be ambulatory and will
require only first aid treatment. A great deal of the
emphasis in planning should be placed on equipment,
supplies, area layout, and standard procedures 50 that
the patients can be processed quickly and efficiently.

The nursing personnel should work under the di-
rection of the physician in charge, but certain pro-
cedures can and should be established to implement the
work of the physician.

All patients should be received only from the
Receiving.Area, but a Discharge Center should be estab-
lished here for checking out all patients that have
been treated.

h. Planning for the Central Supply Function. The Central Supply
Room is of primary importance in the event of a disaster. The
numerous tasks normally assigned to this area would be multi-
plied many times over. Therefore, in.planning the staff, of
necessity, should be considerably reinforced. The main
functions of this department in an emergency should be:

a. The maintenance and supply of special equipment.

107

b. The preparation and sterilization of surgical supplies.

0. The delivery and pickdup of sterilized supplies from
the operating rooms, receiving area, first aid area,
and treatment wards.

To implement these functions:

a. Volunteers should be utilized under the direction of
the regular Central Supply personnel to fold and wrap
goods, to perform housekeeping duties, and.to act as
messengers.

b. Major surgical packs should be reduced in size to
shorten the cycle of sterilization.

c. Substitute procedures and materials should be developed
as a part of pre-planning in anticipation of the in-
creased demand for sterile goods or the possibility
that the present equipment may be completely or partially

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FIGURE 11

SUGGESTED ORGAN 'I 7AT [ON FOR SPEC [AL SERVICES

108

lhe Laboratory, X-ray department, and the Pharmacy should function

under the direction and control of the Director of Medical Services.

Labgratogy.

General.

The pathologist or his alternate should supervise the

operation of this department and should Specify the priority of activi-

ties. Advance provision should be made for the procurement of emergency

blood supplies through the.American Red Cross.

If the hospital has no

provision for drawing blood from donors, these people should be directed

109

to the proper place. Provisions should also be made for the proper
storage of the blood if the refrigeration system does not function.

The most essential functions of this department are the typing and
cross-matching of blood and the administration of blood to casualties
if permitted. This department should, also, perform any other technical
tasks if time permits as directed by the pathologist.

The use of volunteers should be considered for non-technical tasks
such as washing glassware, collecting specimens, etc. This would free
the technologists for more critical work.

.Attendants assigned to the Morgue area should be reSponsible for
all casualties admitted to the division. Their reSponsibilities should
include: I

1. Expansion of the morgue area to accommodate an increased number

of deceased patients.

2. Compiling a permanent record of all deceased admitted to this

area and sending such information periodically to the Infor-
mation Center. I

3. Guiding relatives and friends attempting to identify unnamed

bodies.

h. Following established procedures in the release of a body to a

funeral director or relative, (see page h8).

X-Ray Service. The staffing requirements of this division should
be met through the use of regular employees of the department and the
possible use of volunteers. In planning the functions of the department

during a disaster period the following points should be considered:

110

1. Plans for processing as many casualties as possible in a short
period of time by {33):

a. Setting up portable equipment in the operating rooms.

b. Using amateur photographers to develop films.

0. Developing shortcut, but adequate, methods of wet
reading of films and dictation methods of the film
findings.

?. Use of volunteers for clerical duties and for transporting
patients.

3. A list of suppliers for X-ray equipment and supplies should be
maintained so that they can be contacted easily if additional
supplies are needed.

h. X-ray supplies should be maintained at levels adequate to accom-
modate a capacity operation for a 2h hour period of time.

Pharmacv. The regular personnel in this department should be used

with the addition of volunteers to act as messengers. During a disaster,
all non-urgent dispensing, manufacturing, or recording should be sus-
pended. To insure quick delivery of essential drugs to all essential
areas upon the notification of a disaster, drug lists should have been
prepared in advance for all of these areas. These pro-planned drugs

can then be dispensed by messenger to all of the areas as soon as the
disaster alarm has been given. Plans for handling narcotics should be
made to insure the proper accounting procedures {3b). Arrangements
should be made with local drug supply houses so that if the need arises,

drugs can be procured promptly.

111

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FIGURE 12

SUGGESTED ORGANIZATION FOR EMERGFNCY PERSONNEL

[n a disaster situation, the Emergenqy Personnel functions to pro-
vide an orderly procedure for the screening and assignment of volunteers
and for the placement of hOSpital workers who do not have any specific
assignments.

Unassigned hospital workers should be requested to report to this
office when they are notified by the hospital that an emergency exists.
‘Any disaster unit that finds that it needs help should be able to contact
this department for additional workers. It would help this department
to run more efficiently if the different disaster areas could, in their
pre-planning, estimate the additional help that they might need. This
would facilitate the personnel function, at the time of a disaster, to

make better assignments of the people who report to this office.

112

At the time when the hospital is desperate for additional person-
nel, it is easy to understand that the hOSpital would welcome anyone
who would volunteer for work. Under disaster conditions, volunteers
are a Godsend,‘but unless certain precautions are used, they may be
more of a liability than an asset.

Volunteers fall into three groups.(35):

1. Those who have been trained in normal times by the hospital,

Red Cross, or Civil Defense to do Specific jobs. The hospital
should definitely plan advance recruitment and training through
the Red Cross and Civil Defense. Consideration should also be
given to training the Women‘s Auxiliaries for help at the time
of a disaster. 3

2. Those whose normal employment gives them skills which are use-

ful in a hOSpital-~retired nurses, engineers, etc., and finally

3. Those who have no training and special capabilities.

In reference to the first two groups, there should be no difficulty in
using them to good advantage. .The third group will also be helpful,
but as there is no time to train them, they must be assigned to simple
tasks which after brief instructions, they can perform with little or
no supervision. This group can be used as guides or messengers or they
would be useful for transporting patients.

‘When volunteers arrive at the hospital, they should be directed
by the Traffic Control personnel to the Emergency Personnel Office.

The personnel clerks should obtain their names, addresses and note

briefly any experiences or qualifications that they might have.

113

This procedure will help the Emergency Personnel Officer in making
assignments. ‘When assignments have been made, the volunteers should be
furnished with identification armbands and then taken by a guide to
their assignments. The volunteers should be requested to return to this
office to sign off duty when they are no longer needed.

This division should be assigned the function of providing all
perSonnel with identification cards, (see page 51). These cards can
also be used to note the employee's disaster assignment. Some type of
a system should be developed so that all new employees are assured of
receiving an identification card.

Plans should be made for obtaining identification armbands and
issuing them to all employees working in the hospital during a dis-

aster, {see page 51).
SUMMARY

Much cooperative thinking and planning must go into the develop,
ment of standard operating procedures for all of the individual disaster
functions. The more people who can be incorporated in the planning,
the better. As far as possible, all problems must be thought through
and possible solutions sought out. The plans must be simple and easily
understood by all concerned. Above all, plans must be made, and they

must be flexible%

11h

REFERENCES

l. W. D. Piercey, M. D. and G. E. Fryer, M. D., "Hospital Preparedness,"
Canadian Medical Jour_'nal, 76:361-3614, March 1, 1957.

2. H. Haskell Ziperman, "Sorting-«the Key to Management of Victims of
Disaster," Journal of the.American Medical Association, 162: 1h38,
December 15jfll956.

3- ea.

)4. AmericanHospital Association, Principles _of Disaster Plarming for
Heepitals (Chicago: Council on Disaster Planning, 1956), p. 19.

5. Federal Civil Defense Administration, Urge]; fixation and Ogmtion
of CiyilADej‘ense Casualt Service's-~Part_ [I-- edica epords 93
Easualties t: “53-11-35 Wasnin‘gton, D. C.: —§uperintendent of Docu-
ments, March, 1952), pp. 1-211. .

6. Curtis H. Lohr, M. D. , The Planning of Hospital_PUn._c_t-ions in a

Disaster ( Kansas City, —M1's§5uri: wbud-West Hospital Association,
I937), P- 3?.

7. American Hospital Association, Readings on Disaster Plannin for
Hospitals tChicago: Council on Disaster Flaming, 19565, p. 19.

8. Lohr, _p. oit., p. 26.

9. Ibid., p. 30.

10. W. B. Osgood and Sister Loreto, "When the Tornado Turned Up In
Worcester," Mm Hospital, 81:82, August, 1953.

11. "Plan Outlined for Hospital Radio Network," Hospitals, 31:17,
June 1, 1957.

12. Michigan Office of Civil Defense, "Michigan Hospital Disaster Plan"
(Detroit: Medical and Public Health Division, 19514), p. 60.

13. John A. Holbrook, "Why 'Emergency' Utilities May Rail in a Disaster,"
HosEitals, 32:79, May 1, 1958.

1).: . Ibid .
1.5 . mid .

16. Ibid.

17 .

18.

19.
P0.

26.
2'].
28.
29.

Nutrition, 6://-83, January-February, 1958.

115

Liquified Petroleum Gas Association,‘LP‘g§§ for_Civi1 Defeggg
{Chicago , Illinois, 1957).

 

Charles V. wynne, "Disaster Planning," Hospitals, 30:58, February
16, 1956.

.[bid .

Arnold.A. Rivan, "Hospitals in a Flood Crisis," Hospitals, 29: 72-75,

October, 1955.

Holbrook, 10c. cit.
ais-
Lohr, pp. cit., p. 23.

Holbrook, 10c. cit.

F. B. Bovee, "Emergency Feeding in Disaster,".Am§rigan Journal of

Liquified Petroleum Gas Association, loo. cit.

Rivan, loc. cit.

Ibid .

Minnesota Hospital Association, "Suggested Hospital Disaster Plan"
(Minneapolis: Council on HOSpital Planning and Plant Operation,
1957). p- 2.

. Lohr, Em. cit., p. 37.
[bido’ p- 14.0.

Nflehigan Office of Civil Defense, 22, cit., p. 2b.

Ibid., p. hh-

J. A. Oddis, "Narcotics and Disaster Plans," HosEitals, 32:20,
February 1, 1958.

Lohr, _p. cit., p. 66.

CHAPTER V

AN OUTLINE OF BASIC STEPS FOR THE PREPARATION OF
A DISASTER PLAN (1) FOR ST. JOHNS HOSPITAL

The organization, policies, and procedures that have been discussed
in.Chapters lit and [V provide the general topics to be considered by
St. Johns Hospital in planning for disaster situations. The basic steps
to be taken by the hospital in preparing a disaster relief plan will be
outlined in this chapter.

[. Organize the Hospital Disaster Committee
A. Appointment of the Committee by the hospital administrator.

B. Members of the Committee should include:

1. Administrator, Chairman 7. X-Ray Technician

2. Medical Staff Representative 8. Comptroller

3. Director of nurses 9. Housekeeper

h. Dietitian 10. Engineer

5. Purchasing.Agent 11. Representative of the
6. Medical Technologist Board of Directors

12. Director of Physical Medicine

C. Purpose of the Committee: To determine policy and coordinate
the various aspects of the disaster plan. The detail of the
planning should be delegated to others who will submit the
results of their efforts to the committee for approval and
coordination with the master plan.

D. Duties of the Committee

1. To coordinate the development of the hospital‘s disaster
plan.
a. Supervision of the plan preparation.
b. Assignment of planning and emergency operational
responsibilities to key persons in the hospital.
c. Implementation of the planning provisions.

11/

d. Periodic review of the actual plan to revise or
further implement the plan, to revise the assignment
- of duties and to reassign emergency space.

2. To coordinate the disaster plan with that for the community.
3. To supervise the conduct of frequent drills to practice

and test the plan.under simulated disaster situations.
A. To be responsible for the hospital's continued prepared-

ness for disaster. '

II. Organize a Medical Staff Disaster Subcommittee of the HOSpital
Disaster Committee.

A..Appointment of the Committee by the Chief of the Medical Staff.
B. Members of the Committee should include:

1. Chief of the Medical Staff, Chairman

2. Chief of Medicine, of Obstetrics, and of Surgery

3. Heads of the Departments of Radiology and Pathology
A. Other members of the Medical Staff at large.

B. Duties or Functions of the Committee.-

1. Planning for the professional handling and care of mass
casualties by:

'a..Assigning physicians to disaster positions in co-
operation with the RamSey County Medical Society.

b. Conducting training and educational programs for
physicians on the medical management of mass casual-
ties.

c. Supervising programs for the training of hOSpital
personnel in the medical aspects of handling of mass
casualties. ‘

d. Establishing standard emergency medical care pro-
cedures for the hospital and the assigned physicians.

2. Briefing the hospital Medical Staff to insure complete
familiarity on the part of all concerned with the plan.

3. Coordinating this committee's plan with the general plan
for the hospital to insure availability of facilities to
meet the requirements of the professional activities.

IIT..Assignment, by the Hospital DisaSter Committee, of Space to meet
emergency situations.

A. Purpose: Expansion of the hospital‘s work areas, which involves
reassignment of present patient areas and the con-
version of hospital space not normally used for
patient care to emergency areas.

118

B. Proposed.Assignment of hospital area (see Figures 13 and 1h).

1. First.Aid Station.

a. Function:

b. Location:

To provide emergency care for patients who
are ambulatory and whose wounds are of a
relatively minor nature.

The area assigned must not interfere with
the handling and admission of seriously

"wounded casualties. The area should be

0. Facilities

adequate to handle at least 50—75 persons.

The heapital auditorium and adjoining
Nursing Arts laboratories are recommended
for this use.
available in this area:
Emergency storage cabinet
washroom facilities
Kitchenette
Outside telephone lines.

cilities for setting up space for record
keeping and the discharge of patients.

2. Ambulance Reception.Area.

a. Function:

b. Location:

c. Facilities

3. Admission Area.
a. Function:

b. Location:

c. Facilities

To handle many ambulances and other
vehicles arriving at the hospital within
a short period of time and to be used as
an ambulance unloading area.

Main entrance to the hospital (1st floor
level).

available: It is near the proposed ad-
mission area. it has a covered entrance,
and it has large double doors to permit
stretchers to be easily brought into the
hospital.

To provide an area for the reception of
all the casualties who enter the hOSpital.
Main lobby of the hospital and adjacent
Gift shop and.business offices.

available: This area is large enough to
admit approximately 25-30 patients at one

‘ time and is easily accessible to the

h. Surgery.
a. Function:

emergency stockpile of equipment. It is
near the proposed ambulance entrance and
it is acceSsible to the other disaster
areas of the hospital.

To provide Space and facilities for the
maximum number of surgical teams.

b. Location:

0. Facilities

5. Evacuation Area.
-a. Function:

b. Location:
o . Facilities

6.mngm.
a. Function:

b. Location:

c. Facilities:

119

General sur e --main operating rooms, the
eystoscopic room, and the Recovery room.
Fractures-~Emergency Room on the ground

level of the hoSpital.

available: These areas are adequate to

accommodate seven to eight operating teams.
The hallways adjoining can be used for the
preliminary preparation of surgical patients.

To provide an area in which the orderly
procedure of dismissing patients can be
aCcomplished.

The NursesI home-lounges and nurses? rooms.
available: This area can accommodate at
least 20 patients and it contains all of
the essential equipment to provide for the
comfort of the evacuated patients.

To provide Space for the reception of the
bodies of those who expired in the hOSpital
and those dead on admission.
Present area and the ambulance entrance
storage area and dock.

This area is near a major hospital en-
trance so that the public has access to
the area to identify bodies and so that
the bodies can be removed with a minimum
of expoSure to the public view.

7. Communication and Control.

a. Function:

b. Location:

0. Facilities:

To provide for an increased demand for
communications, to augment both external
and internal comMunications, to provide
a control area, to establish a central
station for diapatching foot messengers,
and to provide room for auxillary radio
communications.

Main Switchboard and the administrative
suites.

The main switchboard is located in a bad
area (main reception area), but with the
use of additional space these functions
can be adequately accommodated. The ad-
ministratiVe suites are located in a
strategic place, they are easily access-
ible to the other areas of the hospital,
and there is room to accommodate messengers
and additional communication equipment.

120

8. Public information Center.

a. Function: To provide a place where relatives, the
press, and the general public can come for
information concerning the conditions of
the patients.

b. Location: Occupational therapy office and laboratory.

c. Facilities: This area is near an entrance that is
away from the main admitting area, that is
.out of the main traffic flow area, and
that is near the refreshment area.

9. Personnel Office for Volunteer workers.

a. Function: To make effective use and distribution of

volunteers-«a place to pool volunteers for
. assignment to the areas of need.

b. Location: Physical Therapy office and laboratory.

c. Facilities: This area is near an entrance that is
away from the main admitting area, that is
out of the main traffic flow area, and that
is near the refreshment area.

10. Supply Reception and Diapensing Area.

a. Function: To receive, dispense, and deliver all need-
ed emergency supplies.

b. Location: Main receiving dock and central storeroom.

0. Facilities: This area is adequate to carry out the
functions. There might be Some congestion
in the driveways approaching the receiving
areas.

IV. Preparation of the Preliminary Master Disaster Plan.

A. General: The best disaster plan will not take all the variable
circumstances into consideration. The plan must be
simple and flexible enough to be quickly adapted to
meet any situation.

B. Some.Assumptions to consider.

1. That mass casualties may occur with little or no prior
warning and at times when the hOSpital might be staffed at
a minimum.

2. That mass hysteria may occur among people near the hospital
necessitating augmented and rigid internal security pro-
cedures in the hOSpital area, based on prior guard-post
assignments, instructions, and training.

3. That augmented internal traffic control will be needed to
guide ambulatory casualties to proper treatment areas.

 

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—

h. That present key officials may be immediate casualties,
or unable to reach the hospital, thus necessitating prior
instructions for prompt assumption of key roles by other
members of the hospital staff.

C. Proposed Master Plan.

'PROPOSED MASTER PLAN FOR ST. JOHNS HOSPITAL
NATURAL DISASTER

Intrggugtion. [t is the purpose of this plan to endeavor to meet
the requirements for emergency medical care in the event of a disaster,
regardless of its magnitude, to the extent of the capacity of the
hospital assignments.

It is essential that every person having an.assignment in this
disaster manual do three things:

l..Acquire a general understanding of the entire plans

2. Develop a thorough working knowledge of the detailed operation

of the section to which he is assigned.

3. become completely familiar with his assignment.

To accomplish these three things, every person must acquaint him-
self with the "Guide to the Total Plan,” which follows immediately,
and the section covering his own assignment. In addition, work in Some
sections is so closely tied to the operation of one or two other sec-

tions, it is necessary that persons assigned to these sections which
require such close coordination, or which overlap to some extent, read

all.of the sections which pertain to them.

12h

Guide to the Total Plan
OBJECTIVE: The objective of this section of the disaster plan is
to familiarize all perSons with the overhall procedure to be
followed. Particular assignments and responsibilities are detailed
in subsequent sections. In this section are discussed the relationp
ships between departments, the approach to the problem of supplies,
over-all traffic patterns, and the general assignments of groups
of personnel.
DIRECTOR: The.Administrator or his alternate has the responsi-
bility to coordinate the activities of all departments with the
medical staff: In the absence of the Administrator, his alternate
may be the Assistant Director inrcharge-of--Nursing Service. Full
authority is vested in this person to direct all operations
pertaining to conversion.of the hOSpital to disaster status, and
the effective care of casualty and non-casualty patients during
a disaster.

The Chief of Staff or his alternate will have responsibility
for the professional work and general supervision of the members
of the medical staff.

Plan “A" refers to.ALERT. It will be initiated at the order

of the.Administrator or his alternate in those instances when

disaster is imminent and the hospital has had advance warning.

Plan "B" refers to the disaster plan which will be put into

effect on the order of the Administrator or his alternate.

125

Plan "B" may or may not be preceded by Plan "A," depending
upon whether or not the hospital has had advance warning of

the disaster and could effect an alert.

Plan "B" will be carried out in stages as set forth in this
plan. EaCh stage will be put into effect at the specific
order of the Administrator or his alternate. These stages are:

Stage 1: ‘When more than 10 but less than 25 casualties have
been received or their arrival is anticipated.

Stage 2: 'When more than 25 but less than 50 casualties have
been received or their arrival is anticipated.

Stage 3: 'When more than 50 casualties have been received or
their arrival is anticipated.

Non-casualty refers to any person who was hOSpitalized as a
patient in this hospital at the time Plan "B" was instituted.
It will be used to distinguish these patients from disaster
casualties. Casualty refers to any person who is admitted to

the hospital for treatment as a result of a disaster.

PREPARATION 0F.ALL LOCATTONS

All areas of the hospital and emergency units which are being
utilized for other than their normal functionS'will be cleared and set
up for their disaster purposes under the direction of the Housekeeping
Department, with the assistance of the Maintenance Department, in
accordance with each of these department's plans.

If a disaSter strikes the community without a prior alert having

been declared, then the procedures which would have been carried out

126

during the alert phase will be followed during Stage 1 and Stage 2 of

Plan "B," insofar as necessary and practicable.

TRAFFIC airways

External Traffic.
.Ambulances and.vehicles bearing casualties will enter the
hospital grounds via the main hospital drive and discharge
their patients at the main entrance of the hospital (see

Figure 15).

Physicians may drive their cars to the small parking lot near
the main entrance. Should this lot become crowded, the doctors
may proceed to the parking lot on the right of the main en-

trance to the hOSpital.

Emplqyees are urged to approach the hospital via 6th Street
and park on the city streets to avoid congestion in the im-
mediate vicinity of the hoSpital. In entering the hospital

the employees must use the entrance to the Physical Medicine
Department.

Traffic control in the streets around the hospital will be

provided by the St. Paul Police Department.

[nternal Traffic.
Norml internal traffic will be maintained, except for
elevator service, unless‘congestion oceurs. In the event

that traffic control must be instituted, unassigned personnel

 

 

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FIGURE 15

PLAN SHOWING ENTRANCES AND DRIVEWAYS LEADING TO THE HOSPITAL

128

or volunteers will be stationed in.critical areas to direct

the flow of casualties and personnel.

.All personnel will use stairways instead of elevators to free
elevators for transportation of casualties or evacuation of
patients. Personnel from the Maintenance Department will be

assigned to operate the automatic elevators.

Personnel Entrances to Hospital.
Location: Outside door leading to the Physical Medicine
Department and the X-Ray Department. Doctors will use this
entrance also.
Person in charge: Police officer and volunteers to assure
that unauthorized persons do not enter the building. Employees
and doctors will be required to show identification cards on

entering the hospital.

alerts HELENE
Evacuation Procedure: Depending on the availability of beds, dis-
charge of non-casualty patients will be carried out in the same
manner as patients are routinely discharged. ‘When the need for
additional beds becames critical, the patients (maximum of 20)
located in the Minimal Care Division will be evacuated to the

Student Nurses*s Hbme.

Admission, Reception and Sorting: Casualties will be received

from emergency vehicles at.the main entrance for the hospital

129

where teams of physicians and nurses will sort them to determine
which casualties go where and the priority of treatment. No treat—-

ment will take place at this. point.

The Emergency Medical. Record will be started in the Admission and
Sorting area for all casualties. When it is determined to which

area of the hospital the casualties will be sent, the destination
with the priority of treatment will be marked on the patientg s

EmergenCy Medical Record and attached to the patient.

sites
A list of disaster supplies for each disaster unit should be
formulated by the persons responsible for the organization and
operation of these units. These disaster supply lists should be

filed in the Central Stores area for processing.

Supplies that will be needed immediately for each disaster section
including sterile, non-sterile, and pharmaceutical supplies, will
be delivered by messenger to all disaster sections immediately

after notification that the disaster plan has been instituted.

Emergency supplies will be delivered immediately, without a re-
quest, only to those sections which are functioning in areas which
ordinarily are not used primarily for the care of patients . The
person in charge of each of the regular nursing units should check
their supplies as soon as possible after she is notified that an
alert or disaster has been declared. Additional supplies will

be requested by requisition in the usual manner.

130

PERSONMEE
If a disaster strikes which affects this hOSpital, all physicians,
hospital personnel, and regular Volunteers who are notified by the

hospital will report to the hoSpital as soon as possible.

All department heads on duty when an alert or disaster is declared
‘will report immediately to the Control Center for briefing.

Department heads not on duty when an alert or disaster is declared
‘will also report to the Control Center for briefing on.arrival at

the hospital.

.All other employees on duty who have specific disaster assignments
will go directly to their disaster stations. Employees who are

not on duty and who have Specific disaster assignments will report
to their departmental office on arriving at the hospital, and from
there will report to their disaster stations. Unassigned personnel

‘will report to the Volunteer Personnel Office.

Attending physicians will sign in and out of the hospital in the
usual manner. On signing in, they will report directly to their
disaster stations. 'When their primary assignments are completed,
physicians should report to the chiefs of their services for

possible reassignment.'

SEWQEEIGATflhfii
'When an alert is declared, the.Administrator or his alternate will

request the Switchboard to contact all key personnel and request that

131

they come to the hoSpital ”immediately. A list of key personnel to be
contacted should be at the Switchboard. All key personnel will in
turn be reaponsible to contact those persons under their supervision
who may be needed.

When an alert is declared, all personnel will prepare for the
reception of casualties as outlined in the detailed planning sections.
Nursing supervisors and police will be resPonsible for the direction of
all visitors then in the hospital. All patient areas», lobbies, and
other piblic areas will be cleared of visitors as quickly as possible,
and will be kept cleared. If there will be any danger from the impend-
ing disaster to- the visitors if they leave the hospital, the visitors
will be directed to the hospital's dining room area.

When an alert is declared, all. other personnel will continue to
perform their regilar duties while awaiting activation of Plan "B" or
notice of the "All Clear" signal, to be given on order of the Adminis-
trator.

When the Administrator or his alternate officially notifies the
Commmications Office that an alert status has been declared, the
Telepage Operator will page in a calm voice as follows: ”Plan 'A' Stat."
This page will be repeated three times at approximately one minute
intervals.

When the Director or his alternate officially notifies the Com-
mtmications Office that a disaster has occurred, and a disaster status
has been declared, the Telepage operator will page in a calm voice as

follows: "Stage 1 Plan 'B' Stat." This page will be repeated three

132

times at apprcximately one minute intervals. ‘When a new stage has been
declared by the.Administrator, the Telepage operator will substitute
the appropriate stage number in her page. I

Internal and external telephone calls will be held to an absolute
minimum in order that all telephones will be available for emergency
meSsages. If the telepage unit is effected and does not operate, all

departments will be notified by foot messenger (2).

V. Preparation of detailed departmental plans as assigned by the

Disaster Committee, (Chapter VI).

VI. Review and integrate the detailed departmental plans and require-
ments into the over-all-master plan (by the hospital disaster
committee).

VII. Coordinate the hospital's master plan.with the community disaster
plan- '

A._Cgmmunity Planning. Community planning is an essential part of
successful response to a.major disaster. The hoSpital or
hospitals cannot do their best Job of saving lives unless the
community has established or coordinated practical disaster
plans with other agencies such as the police, Civil Defense,
Red Cross, fire department, etc.

Two lessons with respect to community planning have been
learned frcm past disasters:
1. All disaster efforts must'be centrally directed and
. coordinated to insure the full use of all the commun-

ity‘s hQSpitals and health resources. Too often one

133

or two hospitals have carried the full brunt of the dis-
aster impact when others nearby have been.relatively'un-
used. I i

2. Other community resources must be drawn into disaster
relief in a planned manner to provide assistance and sup-
port to the hOSpitals' efforts. Community agencies such
as the Police, Fire Department, Civil Defense, Red Cross,
industry, and others should have supporting roles outlined
in advance. The scope should be clearly defined by mutual
agreement among all agencies involved.

St. Johns HOSpital's disaster plan will not be complete until
it has been integrated with an over-all community disaster phan.
In the past and up to the present the community agencies and the
hOSpitals in.St. Paul, Minnesota have been developing disaster
plans on individual bases without any attempt to coordinate the
separate plans. .

B. Steps to be Taken for Community Coordination of Disaster Pl§§§_

1. Through the St. Paul HOSpital Council (a council that

represents all hospitals in.St. Paul) develop a committee
to:
a. Coordinate the nine separate hospital disaster plans.
b. Develop a master hospital disaster plan.
2. The St. Paul Hospital Council should take the initiative
in organizing a cityiwide disaster planning committee to
coordinate the hospital plans with the separate plans of

the community agencies.

13h

a. This committee should be composed of the following

representatives:

1.

2

Hospitals

. St. Paul Chapter of the American Red Cross
. St. Paul Office of the Civil Defense

. City Governmental.Agencies, such as police, fire,

and water departments.

. Industry, such as Northern States Power Company,

Nfinnesota Mining and Manufacturing Company,
‘Whirlpool-Seeger Company, etc.

b. The following are Some of the aspects of hoSpital

planning for disaster that require community partici-

pation to be effectively carried out:

1.

8.

Centralized coordination and direction of all
community'efforts.

. Centralized evaluation of the total disaster

problem.

. Police services and traffic control.

. Supplementary personnel, staff, supplies and
-equipment.

. External communications.

. TranSportaticn of casualties and evacuated

patients.

. Provision.of alternate sources of essential

utilities.

Disaster‘warning.

C..Agencies Particularhy Concerned in the Coordination Plans.
It is particularly important that the hOSpitals' disaster plans

be coordinated with the St. Paul Chapter of the American Red

135

Cross and with certain.gcvernmental agencies because of the
inherent responsibilities and the many facilities of these
agencies.

1. Governmental agencies. The governmental reSponSibility
(in this case the city government) in the time of disaster
is in.general the protection of life, health, welfare and
property. Disasters do not change the legal reSponsibili-
ties of the government, but rather, increase the need of
meeting them properly and adequatel . This can not be
done unless all agencies concerned plan.together. The
following is a list of some of the government‘s responsi-
bilitiesl(3):

a. Protection of persons and prOperty
. warning of impending danger
. Enforced evacuation
. Rescue
. Maintenance of law and order
. Public health and sanitation
a.‘Water supply
b. Control of communicable disease
6. Care of the dead
7. Traffic control
b. Provision of usual services
lt‘Welfare and health
2. Transportation
3. Communicatidns
h. Removal of debris
5. Salvage
c. Restoration of public property
1. Sewage systems
2.‘Water systems, etc.

‘mp'w N H

2. The Red Cross (h). The Red Cross, in accordance with the
Congressional Charter under which they operate, is

responsible for formulating and putting into operation

136

disaster preparedness plans. .Aid is to be given in what-
ever form or forms that will contribute most effeCtively
and Speedily to rehabilitation. This assistance may in-
clude warning, rescue, evacuation, medical and nursing
aid, food, clothing and shelter in the emergency period
as well as the provision of emergency services as trans-
portation of diSaster victims, transportation of supplies
and equipment, and communication facilities. In St. Paul
the Red Cross has taken the lead in disaster preparedness
and it has a very well-organized and functioning unit that
should be coordinated with the health facilities of St.

Paul.

. Civil Defense. In the time of a natural disaster the

Red Cross operates as a non-governmental agency reSponsible
for disaster relief and those non-governmental phases of
responsibility for natural disaster are discharged by the
'Red Cross. By agreement, the facilities of the Civil
Defense authority are committed to the Red Cross and the
planning and control of this agency comes under the di-
rection of the local Red Cross Director in the time of
natural disaster.

. Industry. Also of importance is the inclusion of the
local industry in the community planning. Industry can
assist in a disaster Situation by providing tranSportation
to move victims and supplies, electric generators, water

from their plants, communications, technical manpower, etc.

137

IX..As soon as the hospital's plan has been coordinated with other

hospitals and the various community agencies, four concurrent steps

should be taken by the Disaster Committee of St. Johns HOSpital.

A.

B.

C.

D.

Distribution of the master plan to all key personnel within the
hospital, the medical staff, the Board of Directors, the Com-
munity Disaster Planning Committee, and other hOSpitals.
.Assignment of the personnel in the hospital to their duties and
the instruction and training of them in their duties and re-
sponsibilities.
1. When will the personnel be trained~-on or off duty?
2.‘Wno will be responsible for this training?
Development of procedures to orient and train new personnel in
their disaster reaponsibilities. This should be a part of the
hospital orientation program.
Begin to carry out aSpects of the plan which require a long
period of time to accomplish. Such as:
1. Procurement and storage of emergency supplies.
2. Setting up of disaster supply boxes.
3. Provision of alternate emergency sources of water, power,
light, heat, and steam.
h. Establishment of external sources for emergency supply and
equipment items that are not available in the hospital.
5. DevelOpment of alternate internal and external communi-
cation facilities such as a telephone trunk at the
proposed information and coordinating center which is

separate from the switchboard.

138

6. Preparation of floor plans and directional signs for the
hospital.

X. Conduct frequent and periodic drills and exercises under Simulated
disaster situations to practice the disaster plan, to test its
effectiveness, and to maintain constant readiness. These drills
should be conducted by the Disaster Committee.

IX. Carry out periodic reviews and revisions of the plan to make im-
provements and changes as needed or as indicated by the drills or

actual experience.'
SUMMARY

The eleven steps to be taken in.the preparation of a disaster plan
that have been discussed in this chapter should lead: to a well-
organized and functioning plan of action. The steps, outlined, in-
corporate planning and cooperation.by the administration, medical
staff and personnel of the hospital as well as cooperation and planning

by the heapital with the community.

139

REFERENCES
1.,American Hospital Association, Principles of Disaster Planninglfor
Hespitals (Chicago: Committee on Disaster Planning, 1956), pp. 1-3.
2. Harper Hospital, "Disaster Plan” (Detroit, Michigan, March 17, 1958).

3.,American Red Cross, St. Paul Chapter, "Policy" (St. Paul: Disaster
Preparedness and Relief Committee, January, 1957).

h. Ibid.

CHAPTER VI

THE PREPARATION OF DETAILED DEPARTMENTAL DISASTER PLKNS

The material in this section is presented as an outline and guide

to be used in planning the important aspects of the various depart-

mental activities in the time of a disaster. To effectively use the

material, the following things must be done for each detailed depart-

mental disaster plan:

1. In planning for personnel, allowance should be made for "depth"

in case assigned personnel are not available and for continued

operation of specific areas over a long period of time.

2. In planning for the activation of

the departmental plans, all

of the plans must be made for the various stages of the dis-

aster situation which are:
Plan “A" -.Alert

Plan "B" - Stage 1
Stage 2
Stage 3
Stage h ‘

The detailed plans that are included in this section are for the

following activities.

1. Emergency Administration 13.
2. First Aid Post 1h.
3.,Ambulance Reception 15.
ht Admission and Sorting 16.
5. Emergency Medical Records 17.
6. ExpansiOn of Surgical.Area 18.
7. Expansion of ward Sections 19.
8. Nursing Service 20.
9. Mergue 21.
10. Laboratory 22.
11 . X-Ray 23.

12. Pharmacy

Central Supply

Dietary

Stores and Supply
Maintenance and Engineering
Housekeeping and Linen Supply
Emergency Communications
Information Office

Policing and Traffic Control
Emergency Personnel Office
Evacuation

Medical Staff

 

l . EMERGENCY ADM IN ISTRA'I‘JION

A. Planning reSponsibility of (title)

B. Location

 

C. Personnel:

1.

Hospital.Administrator or alternate (provide 2h hr. coverage)

Name PHONE NUMBER

 

D. Function:

1.

2.
3.
h.

Develop lines of authority for delegation of responsi-
bility.‘

Inform hospital personnel of the disaster plan.

Activate the disaster plan.

Survey the hospital operation to see that the following
activities are proceeding satisfactorily and with ade-
quate supervision.
a. Admission area preparation
b. Litter bearers present to unload ambulances
c. Guards for entrances and driveways
d. Ambulatory Station
e. Emergency ward preparation
f. Surgery preparation
g. Initial delivery of supplies and equipment'
h. Preparation for the reception of volunteers
1. Preparation of the Communication and Control Center
Direct essential activities during the period of emergency.
Determine conditions for:
Communication Supply
Blood Personnel

. Maintain contact with Red Cross, Utility Companies, Police

and Civil Defense for:
Transportation
Police protection.and traffic control personnel
Delivery of casualties ‘
Procurement and delivery of supplies
External.communications
Volunteer personnel
Blood, etc.

1&2

E. Questions to be answered

1. Has someone been designated as a liason officer with the
local Red Cross, Civil Defense, etc? 'th? gggfi

 

_—

2..Are specific emergency responsibilities of key personnel
outlined.in the standing orders?

3. Are hospital personnel oriented to the hospital emergency
plan?

h. Are hospital emergency plans and assignments of personnel
reviewed with the staff periodically?

2. FIRST AID POST
A. Planning responsibility of

B. LocatiOn

‘— _
fi—v—v_v — ‘—

C. Purpose: To provide emergency medical care for ambulatory
casualties.

D. Personnel

1. The amount of personnel needed to staff an aid station
will depend upon the circumstances. If the disaster occurs
near the location of the hospital, the demand for treatment
of ambulatory injured will be heavy; if the disaster is
located farther away, this area may be used lightly if at
all.

2. A suggested team for the initial staffing of this area,
(based on 50 ambulatory casualties), is as follows:
1 Physician
1 Nurse
3 Skilled Aides or Attendants
1 Clerk

3. Personnel Organization of this area

Titlg_ Number Address

 

 

 

 

 

11‘: _

 

 

 

 

 

1&3

3. Function

1.

2.

3.

Treat minor lacerations, minor fractures, first and
second.degree burns, hysteria, sprains, and contusions
of a relatively minor nature.

Initiate and complete medical records.

Discharge patients at the conclusion of treatment.

F. Questions to be answered and implemented

1.

2.

\s)

Are signs or identification for this station available?

If the station is established at a main entrance, will
other entrances be locked or guarded so patients cannot
just wander in? . -

. If answer to No. 2 is "yes," will signs and directional

signals be posted at the closed entrances directing the
ambulatory injured to the aid station?

What type of supplies and equipment will be needed? Use
the following lists as a guide in planning.

 

 

ITEE—‘m; E E UNIT AMT. SOURCE
Merthiolate solution» —'Btl.
Needle, Hypo. 20 and 25 guage Bx.
Needle, suture, skin Pkg.
Pencils ea.
Penicillin ~

Pentobarbita, sodium

Pitcher, metal ea.
Pins, safety, large cards
Plaster, adhesive, spool ea.
Razor, safety ea.
Scissors, bandage, lister ea.
Scissors, dissecting, curved ea.
Scissors, dissecting, straight ea.
Soap, cake ea.
Sponge, surgical hxh 200's ea.
Suture, clip, Michel ea.
Suture, dermal, nylon ea.
Syringe, Luer, 10 cc. ea.
Towels, paper Pkg.
'washbasins, enamel .ea.
Other

 

 

 

 

 

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1M:

5. Where and how will supplies for this station be obtained?
6. Where will the emergency medical records be obtained?
3.,AMBULANCE RECEPTION
.A. Planning responsibility of

B. Location

~_ —
fl v—‘_'v——_ _————v _— _ _—

C. Purpose: 1. To provide for the reception and unloading of
ambulances and other vehicles bringing casualties.

2. To separate ambulatory casualties from those who
are seriously wounded.

D. Personnel:

1. A suggested personnel organization is as follows:
1 Physician
Litterbearers
The number of litterbearers needed may be calculated in
the ratio of four to each of the ambulances for which
Space permits simultaneous accommodation.
No. of ambulances No. of litterbearers needed

2. Personnel organization for this area

AND I

 

E. Function:
1. Supervise the unloading of ambulances.

_2. Make cursory examinations of the patients to screen out
casualties with minor injuries.

3. Direct ambulatory casualty patients to the First Aid Post.

h. Transport seriously wounded casualties into the Admission
Area. .

5. Unload ambulances quickly. It is imperative that litter-
bearers be present when the first ambulance arrives.

F.

le

Questions to be answered and implemented.

1. Is there some means of controlling and directing traffic
in this area?

2. Is there a parking area for unloaded vehicles?

3. What type of equipment or supplies will be needed in this
area?

A. Where are these supplies located and who will deliver them
to the area? '

h..ADMISS[ON AND SORTING' (l..Admission signifies the entrance into the

A.

B.

C.

D.

3.

hospital of seriously wounded perSons as
bed patients for initial and continued
definitive treatment.

2. Sorting refers to the process of screen—
ing, and the classification of the injured.)

Planning responsibility of

Patient capacity of the admission area

 

Location

Purpose: 1. To receive all nonsambulatory casualties who enter
the hospital.
2. To determine the extent of the injury.
3. To determine the priority of treatment.

Personnel: (It is recommended that the sorting officers be
skilled surgeons and nurses.)

c
Nurses
Aides

Clerks

Litterbearers.

 

1146

F. Function:

1. Remove casualties from the.Ambulance Reception Area into
the area designated for sorting.

2. Inspect casualties to determine the diagnosis.

3. Mark casualties for priority of treatment with Roman
numerals (I, II, III, IV) in accordance with the urgency
of the case. Indications of to what treatment team or
area the casualties are to be sent should be noted.
Indicate this by means of capital letters:

OR--surgical operation. _ We-ward
M—-minor surgery E--evacuation
N-~shock

h- Mark priority for treatment with skin pencils on the
patients' foreheads or other available conSpicuous parts
of the body.

5. Lnitiate the medical record and the handling of valuables
and clothes.

6. Refer slightly wounded ambulatory casualties immediately
to the First Aid Post.

G. Questions to be answered and implemented:

1. Where will the Emergency medical record forms and tags be
obtained and how?

2. How are the patients valuables and clothes going to be
handled?

3. What type of supplies will be needed in this area? How
will they be obtained?

5. misnomer MEDICAL means

.A. Planning responsibil' ty of_

 

B. Location of storage of the various forms

C. Purpose: To provide simplified, but still adequate, emergency
admission and medical treatment records. To identify
disaster victims in a concise and accurate manner.
To serve as a medium of recording treatments, drug
administration, and emergency orders. To serve as a
means for routing caSualties to the various treatment
areas. Carbon copies of the emergency medical tag
will serve as a means for preparing casualty rosters
in the information center.

11:?

D. Personnel (Personnel muSt be assigned for the following areas:)

First Post

‘Wards~-Shock

Burn
Trauma
Sur
Fracture
Evacuation

Mor e

 

E. FUnction:

1. Be familiar with the various emergency record forms that
will be used (See page.7h.and.Appendix B).

2. Make out and keep all of the emergency records in all of
the disaster areas.

F. Questions to be answered.and.implemented:

1. Are the above mentioned records available within the
hospital?

2. Where are they stored?

3. Who is responsible for the distribution of these records
at the time of a disaster?

6. EXPANSION CF SURGERY

—— ————( www—

A. Planning responsibility of _v

B. Number of operating tables under expanded conditions__

_r

1‘48

C. Location of additional surgical areas.

 

D. Purpose: 1. To perform essential emergency operations.

2. To perform the less essential surgery when condi~
tions and time permit.

E. Personnel: 1. Organization of the surgical staff is based on
the planned number of operating tables.

2. Surgeons are assigned by the Chief of Staff.

3. A suggested major surgical team is:
2 surgeons
1 anesthetist
l scrub nurse
1 circulating nurse
1 medical aide

h. Estimated operating room personnel needs under
severe emergency conditions. The completion.of
the table below will give the operating room
personnel for a 2h hour period.

0. :0-

for 7 or ' ’to be set u ipersonnel personnel
1e tables e required required
room room 0 OR for 12 hrs for

 

1. Figures in column 1 indicate the number of each category of personnel
suggested for 1 operating table for operating room.

2. Figures in.column 2 indicate the number of each category of personnel
suggested for 2 operating tables for operating room.

3. To complete the table, insert the number of operating tables that
will be set up in case of emergency in column 3.

119

h. To find column h, multiply the number in column 3 by the appropriate
number in column 1 or 2, adding the totals for single and double

rooms .

5._Eg£ggolumn;§, multdrly'the;figg£g;in.column h by 2.

F. Functions:

1. Assign casualties to rooms of special function as described

2.

by the type of casualty.

Treat major injuries in order of emergency. Note: If the
casualties are large in number, treatment may be limited.
The circulating nurse will report to the surgeon the
diagnosis and the patient's condition and request pre-
operative orders. Preparation of the surgical site will
be done on the operating room table.

Record a brief statement of the surgical procedure as
given by the operating surgeon.

. Transfer casualties to the recovery rooms or the general

wards following the surgical procedures;

G. Questions to be answered and implemented:

1. What is the present number of operating rooms?

2. Allowing approximately two hours per operation, or 12

3.

h.

operations per operating table, how many major operations
can be carried on.in 2h hours in the expanded conditions?

Has provision.been.made for controlling surgical lag--
that is, bringing to surgery as fast as possible all cases
requiring major surgery by:

a. Improvising an extra operating table in each
operating room?

b. Improvising additional operating rooms?

0. If the answer to either "a" or "b" is yes, how
many operating rooms with one operating table will
be set up? HoW'many'with two? .

Has provision.been made for improvising additional
operating equipment if needed?

5. What emergency measures have to be taken to insure an

adequate supply of sterile goods? Can present facilities
be operated to meet a demand for operating room supplies
8-10 times greater than normal?

150

6. What kinds of additional supplies and equipment may be
needed by the operating rooms? List. Where are they
located? .
7. EXPANSION OF WARD SECTIONS
A. Planning responsibility of
B. Location: Shock
Trauma
Burn__
ObestEtrics

C. Purpose: 1. To provide initial and continuous care for
casualties.

2. To provide medical care for nonecasualties patients.
D. Planning recommendations:
1. Estimate the nursing service personnel.

2. Evaluate the available equipment to furnish the emergency
ward areas.

3. Formulate lists of essential ward supplies and pharmaceuti-
cals.

E. Types of wards:
l. Shock'Ward
a. Personnel
1. There may be a need for an initial concentration
of physicians and nurses in this area. Suggest
1 physician and l nurse for each 25 patients.
2. Volunteer litterbearers.

3. Aides and Orderlies

(Specific personnel provisions are detailed in
the planning division)

b. Function

1. Receive shock casualties from admission area.

2. Determine the types of treatment required.

 

151

3. Carry out and supervise the ordered treatment
procedures. .

h..Assist in treatment, keep necessary records,
and assist in transportation of casualties.

5. Request additional.workers through the volunteer
personnel office.

6. Secure blood, blood substitutes and other supe
plies from the appropriate sources.

7. Reclassify shock wards for other ward uses as
soon as the emergency phase of the disaster
passes. .
c. Equipment and supplies:
1. List equipment and supplies that might be needed.

2. Where will these supplies be stored and how will
they be procured at the time of a disaster?

2. Trauma wards:

a. Personnel: .A suggested organization might be the
following:

For each 50 beds-- 1 nurse

h nurse aides

h litterbearers
A physician should be assigned when there
are more than 50 patients.

(Specific personnel provisions are detailed in the
pbmnning divisions)

b. Function:

1. Receive casualties from sorting, shock, or
surgery areas.

2. Be responsible for the continued medical treat-
ment of the casualties.

3. Carry out the treatment as ordered by the
physician.

0. Equipment and supplies:

152

1. Formulate lists of essential supplies.

2. Where will these supplies be located and how
‘will they be procured at the time of a disaster?

3. Burn and Obstetric'Wards:

Plan for these wards on the same basis as has been
suggested for the shock and trauma wards.

F. Staffing Patterns for Ward Nursing Services (1).

 

The figures provided for use in the above table are based on the

following assumptions:

1. Minimum hours of nursing care per patient per treatment area per
2h hours are:

Shock - h hrs. Trauma — h hrs. Obstetrics ~ 2 hrs.
Burn -'3 hrs. Medical- 2 hrs. Non-casualties- 2 hrs.

2. The patient unit is taken to be the maximum number of patients
in a particular treatment category that can be supervised.by
one professional nurse on a.12 hr. shift.

3. The number of professional nurses required per treatment area
is determined by multiplying by 2 the number of patient units
in the particular treatment areas.

A. The number of non~professiona1 workers required per patient
unit is determined by calculating the total number of nursing
hours required per patient. From the total thus obtained sub-
tract the number of hours to be provided by professional nurses.
The remainder is then divided by 12 to determine the number of
non-professional workers are required.

G. Evaluation of Equipment and supplies:

Note here: 1. The location of unused or surplus equipment as
cots, blankets, mattresses.

2. Any type of'auxillary equipment that might be
needed as bedpans, urinals, etc.

3. Where the equipment and supplies are located

)4. Who is responsible for procuring and delivering
these items?

 

153

 

——

‘ “‘m“ “1m" @‘f‘ “Lg-CLEO N" ‘F "PPECU' R‘fim’“ P'Ro' 'C'EmP' '."E ""

 

 

 

 

 

stetric sizetc .

   

 

 

 

 

 

 

 

8. NURSING SERVICE
A. Plarming reSponsibility of ___w
B. Purpose:

1. To provide adequate nursing service to all emergency areas
on the basis of the planned casualty accommodation.

2. To direct the activaties of volunteers assigned to patient-
areas.

3. To staff emergency ward areas.
C. Personnel:

‘ In the table below surmnarize the nursing personnel needs for
the entire disaster operation. Check other planning areas.

1574

 

D. Functions:

1.

Make the initial assignment of nurses, aides and orderlies
from the personnel on duty. .As far as possible, these
assignments should be made in advance.
a..As far as possible, the admission area, ambulatory
casualty post, shock ward and operating rooms should
be fully staffed.
b. Personnel will be assigned to help convert these
areas to emergency use.

Perform procedures that are ordinarily the responsibility
of the physician, such as giving of infusions, transfusions,
minor suturing, exercising judgment in the administration
of narcotics, sedatives, etc.

Reduce routine and Special nursing procedures such as
morning and evening care, baths, routine TPR's, etc.

Supervise the setaup of the disaster facilities in
accordance with plans.

Supervise the requisitioning of necessary equipment and
supplies. .

Determine the census of vacant beds in the hOSpital.
Determine which patients can be transferred or discharged

and secure permission for discharge if evacuation of non-
casualties becomes necessary.

155

 

 

 

 

 

 

 

 

 

 

9. MORGU'E
A. Planning responsibility of W_ _w m __ ___w
B. Location and expanded area . __ __ _ __ _A
C. Purpose
1. To receive the bodies of those patients who expired in the
hospital and those casualties who were dead on arrival.
2. To provide a viewing area for relatives and friends to
claim and identify bodies.
D. Personnel: The morgue should be attended by a minimum of two
attendants.
we: ; A A“ : f; I TESL mm .. 'N'EJL ER“ "" ‘ “AD__'D RESS' "" i
T . ::l.l_iL:_ _n. _, _.l
2-~* _.- ’7 l _: 'fi‘l T‘: _
WW
E. chtion:
1. Ebcpand the area to allow for identification and extra
storage of bodies.
2. Follow customary identification procedures as far as
possible.
3. Make a record of all the deceased.
F. Special. problems and implementation:

1. How are identification procecmres going to be carried out?

2. Who'will release bodies to relatives, ftmeral directors,
etc.?

3. Are there any special supplies that will be needed?

10 . LABORATORY

A.

Planning Responsibility of

B . Location

156

C. Personnel:

Pathologist or his alternate.

l.
2. Technologists regularly assigned to the laboratory.
3. Volunteers. Number that could be used
D. Purpose:
1. To be prepared for typing and crossmatching of blood in
preparation for blood transfusions.
2. To perform other essential laboratory functions when time
permits. .
3. To procure needed blood supplies.
E. Functions:
1. Supervise laboratory operations and specify priority of
activities.
2. Cross match blood samples and perform other technical tasks
as directed by the pathologist.
3. Utilize volunteers for nonetechnical tasks~~wash glassware,
perform housekeeping duties, collect specimens.
h. Provide whole blood for transfusion.‘ This is primarily

a function of the St. Paul Chapter of the American Red
Cross.
Telephone Numberwwngg

“_..—...

F. Special problems and.ways to implement:

. How to store blood, etc. if there is a large quantity?

How long can the whole blood be stored if there is no
refrigeration?

'What additional supplies will be needed? 'Where and how
'will they be procured.

‘What emergency equipment might be needed? ‘Are they avail-
able in the hospital? If not, where can it be obtained?

157

ll. X-RAY
A. Planning responsibility of fi~;fl:_
B. Location
C . Purpose:
1. To provide x-ray information essential to life saving.

2. To prepare to handle mass casualties for x-ray examination
particularly in fracture cases.

D. Personnel:
1. RadiolOgist
2. Regular employees and technicians assigned to department.
3. Volunteers - Number that can be used
E. Function: I
l. Supervise the operation of this department.

2. Follow shortcut, but adequate, methods involving wet read-
ing of films and dictation of findings.

3. Maintain x-ray supplies for 2h hours maximum output.

h. Use volunteer photographers, who are not X-ray technicians,
to develop film.

5. Use volunteers, Obtained through the personnel office,
for clinical and housekeeping duties and for trans-
portation.

F. Special problems and way to implement:

1. ‘What provisi.ons will be made to use X- -ray equipment in
case of a power failure?

2. Where can additional x-ray supplies be obtained rapidly?

 

158

3. List volunteer photographers (outside of hospital employ-
ment) who can be contacted if necessary.

12. PHARMACY
A. Planning responsibility of_fiw_*_

B. Location

‘_ W—v—v _.. w—fi—v

C. Purpose: To provide, as quickly as possible, drugs.and
pharmaceuticals to the emergency areas as needed
or as predetermined.

D. Personnel

1. Regular personnel of the pharmacy

2. Volunteers to act as messengers -- No. needed

 

E. Function:

1. Maintain lists of drugs to stock expanded emergency patient
areas, the ambulatory care post, surgery, etc.

2. Make up packs of essential drugs at the time of activation
of the emergency pLans.

3. Make deliveries of the essential drugs to all disaster
areas. This can be done by messenger with exception of
the delivery of narcotics.

.b. Procure any additional drugs from local supply areas as
needed.

5. Prepare a list of local suppliers and the person to con-
tact if an emergency need arises-~include phone number.

F . Special Problems:
1. How will narcotics be dispensed and accounted for?
2. What type of essential drugs will be needed for surgery,
first aid post, emergency wards, etc.? Prepare lists of

the essential items and the amount to have available.
(See example)

159

Example of a drug list:

 

13. CENTRAL SUPPLY
A. Planning responsibility of
B. Location
C. Purpose:

1. To supply the Operating rooms, emergency admission area,
emergency wards, ambulatory post with essential supplies,
particularly sterile supplies.

2. To requisition additional supplies from the storeroom as
needs can be anticipated.

D. Personnel:
1. Nurse in charge or her alternate.

2. Personnel regularly employed in this area.

3. Volunteers. How many can be used?

 

E. Function:
1. Supervise the CSR.function as usual.

2. Utilize volunteers under the direction of the regular
central supply personnel. For example, they may be
used for folding and wrapping, for performing house-
keeping duties, and to act as messengers.

 

‘w—U—

*There should be at least two times the present personnel to permit
two 12 hour shifts during the emergency.

160

3. Reduce major surgical packs in size to shorten the
sterilization cycle.

h. Develop substitute procedures and materials in anticipation
of an increased demand for sterile goods and in.anticipation
that the sterilizing equipment may not function properly.

F. Special problems to be considered:
1. Can presented facilities be operated

a. to meet a demand for the operating room supplies
8-10 times greater than.normal?

b. to meet the sterile supply requirements of the other
treatment areas?

2. What emergenqy changes can be made in the method of
making up the surgical packs to allow for a reduction in
sterilizing time?

3. would there be any advantages in stock piling certain
disposable items such as needles? If so, prepare a list.

D POSABLE ITEM SIZE

 

h.'What provisions should be made for sterilization, if it
is impossible to use the autoclaves?

1h . DIETARY
A. Planning reSponsibility of

B. Location

_‘ L__ .A.
w WW——

0- Purpose: To provide prompt emergency food service to a large
number of casualties, hOSpital personnel, volunteers,
and regular patients.

D. Personnel:

1. Dietitian and assistant.
2. Food Supervisors.
3. Those persons regularly employed in the food service.

h. Volunteers -— Number needed__ .

 

161

E .. Functions:

1.

Determine the number of meals and refreshments that need
to be prepared for the casualties.

. Provide refreshments for .the volunteers and the staff

involved in the emergency work.

Modify certain regular flmctions:
a. The variety in the regular diet.
b. The delivery of meals and refreshments to the casualty
and non-casualty wards.
c. The cafeteria service.
d. The meal hours.

. Plan, in advance, the type of meals and refreshments that

will be served in an emergency.

. List the sources of supplies that can be obtained in a

short period of time.

F. Special Problems and ways to implement:

l.

2.

Can food be provided on a round-the-clock basis?

Food supplies (staple) should be adequate for at least a
2).; hour period. Check storage adequacy and the amounts
to be kept on hand.

. If there is a power failure, how will. delivery of food to

other areas of the hospital be done?

If the supply of cooking fuel is disrupted, what is the
plan for possible improvision?

If the water supply is contaminated or disrupted, where
will water be obtained?

If there is a power failure, how will perishable foods
that need refrigeration be protected?

7. What provisions may be made for the disposal. of garbage

if there 'is a power failure and normal service is not
operating? .

. Have simple meals been planned for feeding patients and

personnel? If so, what are they?

9.

10.

15. SUPPLY

A. Planning responsibility offi _

162

Is there an adequate paper supply to use for feeding at
the time of emergency? This should include paper plates,

paper cups, etc.

Is the amount of canned and bottled beverage on hand
adequate to take care of a- large number of people for
21; hours?

B . Location

M _‘+ A —

v—————

C. Purpose: To provide supplies for all departments as needed.

D . Personnel:

1.
2.

3.

Purchasing Agent.
Those regularly assigned to this department.
Volunteers -‘ Amount needed: .

 

E . Functions:

1.

Maintain lists of essential supplies for the ambulatory
post, admission area, emergency wards, etc. in the store
room.

Send boxes containing the initial supplies for the emer-
gency areas to the proper locations immediately when
notified of a disaster.

Make additional deliveries of supplies to the emergency
areas. This can be done by volunteers.

Procure additional supplies from outside sources as needs
can be anticipated.

Maintain, routinely, a supply of essential items that
would support 60 days of normal operation (2) . It is
estimated that Supplies in this quantity would be re-
quired to permit a hospital to be self-sufficient for
2 days following a disaster.

Develop an emergency system of receiving and recording
incoming supplies. Develop a system for emergency requisi-
tioning and recording supplies sent to the various emer-
gency units. '

163

F. Special Problems and Questions to be answered:

1.

2.

HOW'will supplies be delivered if elevators cannot be used?

Is it practical to develop and maintain disaster'bdxes
containing essential disaster items for the various
emergency items?

Use the following lists as a basis for determining
supplies that will be needed for the emergency areas.

 

GENERA. SUPPLIES EQUIPMENT
Soap Urinals
Paper cups Bed pans
Drinking straws washbasins
.Applicators ‘ Pitchers
Tongue depressors HOt water bags
Eye droppers Forceps
Newspapers SciSSOrs
, Safety pins , Tourniquets
Liquid soap Syringes and needles
Adhesive Thermometers
Bandages Medicine cups (paper)
Tubing Bed blocks
Gauze IV standards
Dressings Side rails
Pencils Restraints
Note paper Beakers (graduated)
Emesis basins
FABRICS Catheters
Sheets
Gowns
Towels
Pillows
Blankets

wash cloths

Have forms and procedures been developed to facilitate
receiving and dispensing supplies?

‘What is the feasibility of stockpiling for disaster sup-
plies? If the decision is to stockpile, should these
supplies be located in a specific spot? How should these
supplies be maintained? Should they be rotated?

16h

6. Is there a list of the source of supplies? Such a list
should include the names of at least three persons cons
nected with each source, along with addresses and
telephone numbers for contacting them'both day and night.
This list may include hOSpital supply houses, wholesale

. houses, key salesmen, etc.
16. MAINTENANCE AND ENGINEERING
A. Planning responsibility of
B. Purpose:

1. To maintain essential'utilities.

2. To assist with the expansion of emergency facilities.

3. To operate and install emergency utilities.

C. Personnel:

1. Chief Engineer or alternate.

2. Those normally assigned to this area.

3. Volunteers.

D. Function:

1. Assist Heusekeeping Department in setting up of the emer-
gency areas. Neve heavy equipment where necessary.

2. Post directional signs for controlling internal and external
traffic.

3. Effect, as necessary, measures of conservation for water,
heat, and electricity.

h. Put into use the alternative or emergency sources for
water, power, and electricity if these utilities are
disrupted by the disaster.

E. Questions to be Answered and Implemented:
l. Elevators
a. Can the elevators be operated as express elevators?

b. Have schedules for the use of elevators during an
emergency been developed: If so, what are they?

165

c. Have plans been made to assign operators to the
automatic elevators?

d. Are auxillary generators available to furnish stand-
by power for the elevators in.caSe normal power is
cut off? If so, what is involved in changing over
to the emergency power?

2. General:

a. If utilities are disrupted or cut off:
1. Have provisions been made for using another type
of fuel?
2. Is there an.adequate alternative source of
electrical power? If so, what is it?
3. Can the switch to the alternate source of
electric power be made without delay?
b. In the event that there is no alternate source or all
power lines are out of commission, is there stand—by
electric generating equipment to operate essential

services?
Steam plant Lighting requirements
Elevators Refrigerators, etc.
‘Water pump X-ray equipment

1. What is the primary voltage now being received
by the hospital?
2. What is the phase of power now being received?
3. What is the secondary voltage?.
c. What is the minimum power requirement for operation
of the following:

Steam plant Lighting equipment
Elevators Refrigerators, etc.
‘Water pump X-ray equipment

d. Is there a source for emergency generator equipment?
If so, list the sources.

e. In case emergency generating equipment can or has to
be borrowed, can it be obtained quickly and can it
be connected without delay?

3.'Water:

a. Have plans been developed for distributing available
water to the key areas if this utility is cut off?
If so, what are the plans?

b. Can the steam plant be operated to meet the require-
ments of sterilization equipment by using water
pumped from auxillary'water tanks?

1. 'What is the approximate water requirement per
2).; hours for this purpose? gal.

2. ‘What pressure will have to be overcome to
deliver water U0 the steam plant?

166

3. Can necessary connections be made without delay?
c. Has a survey been made to determine auxillary sources
of emergency water supply? What are these sources?
How can it be obtained at the time of an emergency?
d. What is the approximate amount of minimum water
requirements for the hospital for a 211 hour period?
Can this qantity be obtained from a secondary
Source? Gal. . .
h. Sewage and Waste Disposal:
a. Have plans been made to insure adequate diaposal of
garbage and other wastes under emergency Conditions?
If So, what are they?

 

17 . HOUSEKEEPmG AND LINEN SUPPLY
A. Planning responsibility of
B. Housekeeping.

1. Purpose: To maintain such housekeeping functions as
possible under the circumstances.

To set up the. emergency areas when notified of
a disaster situation.

2 . Personnel:

a. Housekeeper and her assistant.

b. Those regularly employed by the department.
c. Volunteers - Amount needed

3 . Functions:

a. Aid in the expansion of hospital by setting up emer-
. gency areas.

b. Assist in clean-up of treatment areas as needed.

0. Assist with moving patients and equipment.

d. Distribute supplies as needed in various areas.

9. Dispense clean linens and collect soiled linens

f. Aid in guarding entrances and directing traffic with-
in the hospital.

h. Special problems and questions to be implemented:

a. Has a survey been made of furniture and other equip-
ment which will- have to be moved from certain areas
at the time of a disaster? Where will this furniture
be stored when these areas are set up as emergency
wards? What is the location of these storage areas?

167

b. Has provision been made for rediStribution of essen-
tial equipment which will be needed in patient areas?

c. Where is the storage location of extra beds, cots,
linen, etc.? Is there a secondary source for these
items such as the Red Cross, Civil Defense?

d. Are furnishings (tables, lights, stands, etc.) avail-
able for enlarged or additional operating rooms?

If so, where are these furnishings located?

e. HOw many blankets and other types of linen are avail-

able?

How much of these supplies will be needed?

What is the anticipated deficit of these supplies?
Is there a secondary source for these items?

f. What is the minimum amount of cleaning that is re-
quired in patient areas to meet basic sanitary needs?
Remember emphasis is on conservation of manpower and
supplies.

g. What plans have been considered to carry out house-
keeping functions without the use of water?

h. What plans have been made to expand the treatment
areas. It is important that the emergency areas be
set up as quickly as possible. Because of this,
additional hoSpital personnel will have to be temp-
orarily assigned to housekeeping service to assist
in the preparation of these areas. Such personnel
will be used for this purpose for a limited time only
and then can be returned to their original duties.

i. maintenance of the expanded treatment areas will re-
quire a minimum housekeeping staff.

1. How many personnel will be required temporarily
for the preparation of the expanded treatment
areas?

2. Should temporary personnel be obtained from
existing hospital personnel?

3. How many perSonnel will be required for main-
taining minimum housekeeping services?

b. How many male personnel of housekeeping can be
assigned for guard duty, litterbearers, etc.?

C. Linen Service:

1. PurpoSe: to maintain essential linen service for surgery
and the emergency patient areas.

2. Personnel:

a. Those regularly employed in linen service.
b. Volunteers - .Amt. neededfi_

168

3. Function:

a. Stock laundry supplies that will be sufficient for
h8 hours of capacity production. '
b. Deliver needed‘linen to emergency areas.
c. Collect soiled linen from emergency areas.
d. List stock items to be maintained and stored for
emergency use for:
First Aid Post
Emergency“Wards
Surgery, etc.

b. Special problems and questions to be answered:

a. Has provision been made for a reduction of the use
of linen in the time of an emergency.

b. Has provision been made to notify the commercial
laundry who does the hOSpital laundry of the emer-
gency situation, 'What type of c00peration can'be
expected of them?

18. EMERGENCY COMMUNICATION
A. Planning responsibility °£_,'
B. Location _E_

C . Purpose:

1. To give fast notification to off-duty personnel of the
disaster situation.

2. To alert all personnel on duty.
3. To establish a message center.
a. To control meSSage Sending on the basis of relative
importance.
b. To provide an.alternate means of communications in

the event of damage to normal facilities.
c. To provide messenger service within the hospital.

D. Personnel:
1. Communication Control Officer.
2. Regular switchboard personnel.

3. Volunteer messengers-~Number needed
Volunteer Ham Radio operators.

169

E..Function:

1. Notify the key personnel in each department in the event
of a disaster. If possible this should be done by tele-
phone following the instructions that should be posted in
the telephone office.

2. Obtain a list of key people to notify in the case of an
emergency from each planning division.

3. Make arrangements with the local radio and TV stations for .
the recall of off-duty hospital employees in the time of
disaster.

h. Initiate the'internal hospital alert (see page 12h,
Chapter V) at the direction of the Chief Control Officer.

5. Establish contact, if possible, with the disaster site
through the proper agency.

6. Restrict the use of the hospital's telephones to adminis-
trative use. Determine who will be allowed to make outside
telephone calls.

7. Use messengers wherever possible to-relieve the burden on
the internal telephone communication system.

8. Use radio communications if the telephone system fails.
The following regulations should prevail:
a. Only written messages will be sent.
b. All messages that are sent er received will be
recorded in a log book.
0. Establish a priority system for the sending of
messages.

F. Special problems and planning:

1. What instructions should be prepared for the telephone
operators as well as the radio operators?

2. Has a shortwave radio system been procured? 'What pro-
visions have been made to monitor this system?

19. EMERGENCY ENFORMATION OFFICE
A. Planning reSponsibility of;_(_'

B. Location

170

C. Purpose: To furnish information concerning the casualties to
relatives and to the newspapers as soon as possible.

D. Personnel:
l..A member of administration.
2. Persons regularly assigned to this job.
3. Volunteers--Amount needed
E. Function:
1. Form.an information file using the "Index and Information"
cards-that have been delivered to this area from the

Admission.Area.

2. Provide accurate information for the use of the Red Cross
and the Civil Defense Agency.

3. Compile, as soon as possible, a roster of casualties.
This roster must be kept up—to-date and as accurate as
possible.»

h. Release information to the press only if it has been
approved by one of the administrative officers.

20. POLICING-AND TRAFFIC CONTROL
A. Planning responsibility of
B. Purpose:
1. To exclude unauthorized persons from the hospital area.

2. To keep hospital approaches open for the use of ambulances
and other essential vehicles.

3. To maintain an orderly flow of traffic within the hospital.
C. Personnel:
1. Assigned hospital personnel. Number

2. Regular or auxillary police furnished by St. Paul Police
Department. '

3. Volunteers. Number

171

D. Planning recommendations:

1. External traffic control.

a. Maps of the hOSpital area showing traffic control
posts and ambulance and other vehicle entrances.
These should be prepared with the cooperation of the
Police Department.

b. External traffic control patterns should be estab-
lished. Traffic control posts should be designated
and instructions for each pest written. This should
be done with the Police Department.

c. Regular or auxillary police should be furnished by the
Police or Civil Defense agencies.

2. Internal traffic control.

Sketches of the hospital layout should be made showing
entrances and traffic patterns. Guard posts should be
designated and instructions written for each post.

3 . Directional Signs .

These should be made up and conveniently stored so they
can be posted both outside and inside the hospital.

E. Functions:

1. External traffic control.
a. Issue hospital area maps and traffic control
patterns to each person assigned to this duty.
b. Direct traffic in.accordance with pre-established
patterns and instructions.

2. Internal Traffic control.

a. Assign hospital personnel (volunteers) to guard
entrances to exclude unauthorized persons from the
hospital.

b. Direct corridor and stairway traffic as deemed

necessary..
F . Special problems:

1. What types of directional signs (external and internal)
are needed?
Where will they'be stored?
'Who is reSponsible for posting these signs?

2. Internal traffic control.

172

a. Floor sketches showing guard posts and internal
traffic patterns.

b. Compile a list and a set of directions for each
entrance for which guards are needed.

3. External traffic control.
a. Include hOSpital area maps and traffic control
instructions.
b. Who is to be notified at the Police Department that
help is needed to control traffic?
21. EMERGENCY PERSONNEL OFFICE
A. Planning reSponsibility of
B. Location __

C . Purpose:

1. To facilitate the orderly aseignment of all hospital
personnel who do not have a pre-designated assignment.

2. To provide for the reception and screening of any
volunteers. '

3. To provide all hosPital personnel with identification
cards. '

D. Personnel:

1. A member of administration.

2. Volunteers. Number needed. .
E. Function:

1. Supervise the reception.and screening of volunteers and
unassigned hospital employees.

2. Plan.advance recruitment of volunteers through agencies
such as the Red Cross and Civil Defense.

3. Make immediate-plans for issuing identification cards
to all hospital staff and employees.

h. Provide identification arm bands to all people working
in the hospital in the time of an emergency.

173

5. Obtain the names and addresses of all volunteers who re-
port to this office at the time of a disaster. Note
briefly their qualifications and experience. Give this
information to the perSon in.Charge who will use it for
assignment purposes. '

F. Planning:

1. Personnel Identification Cards (see Figure 16).

a. These cards should identify the personnel crucial
in the disaster plan so that they may be admitted
'without question to the hospital in the time of an
emergency .

b. This card should be given to each employee of the
hospital. Some system should be developed by which
all new employees are isSued a card and given an
assignment.

2. Volunteer Identification.Arm Bands-These are available
through the Americaanospital.Association.

3. Emergency Volunteer application blank (see Figure 17)

a. This should.be made out in duplicate.

b. This should.be used for making assignments. One
copy should be sent with the volunteer to be
turned into the person in charge of the area to
which the volunteer has been assigned. The second
copy Should be filed in the Volunteer Personnel
Office for future reference.

h. Summary of the personnel needs for all areas. This should
be worked out in advance with the cooperation of all key
personnel so that the assignment of volunteers at the time
of an emergency can be handled more Smoothly.

22 . EVACUATION ms'x‘
23 . MEDICAL STAFF‘X‘

‘_4
v—Ff

'*Plans for these areas are beyond the scope of this paper.

 

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FIGURE 17

EMERGENCY VOLUNTEER APPLICATION BLANK

17S

SUMMARY

The suggested detailed plans should provide the basis for the
development of procedures, estimated personnel requirements and assignr
ants, and estimated requirements for supplies and equipment for the
emergency operation of every essential hOSpital function. This detailed
planning is delegated by the Disaster Committee to key people within
the hospital organization. 'Upon the completion.of these plans by the
key people, the plans are reviewed.by the Disaster Committee, adopted,

and, finally, integrated into the total HosPital Disaster Plan.

176

REFERENCES

1. New York State Department of Healthy-Office of Medical Defense,

Outlining.A.Hbspital Disaster Plan (New York State: New York State
Civil Defense Commission;fil9§§).

2. Ibid.

177
CONCUUDING STATEMENT

This discussion and guide to the preparation of a disaster plan
has been formulated as an aid to the Disaster Committee of St. Johns
hospital in St. Paul, Minnesota. If the material is to be properly used
the hospital's employees must participate in its implementation to the
end that they are fully oriented and motivated to work effectively in
an emergency.

There has been no attempt to provide detailed solutions to all of
the problems that may be met in planning for a disaster. The objective
has been to provide a basic organization, policies, and procedures, so
that the Disaster Committee of the hOSpital will be better able to
handle more effectively the assignment of "Developing a Disaster Relief
Plan for St. Johns Hospital."

The discussion has been limited to the administrative aspects of
luandling an emergency situation. In the future, it will be necessary
to develop detailed plans for:

l. The total evacuation of the hoSpital if necessary.

2. The functions of the Medical Staff at the time of an emergency.

3. The coordination of the disaster plan with the community effort.

[U is hoped that a plan of action will evolve that will be elastic
emaough to permit changes and effectively cope with the many problems
‘hhai.wdll.arise due to an emergency. The more thorough and complete
true planning and the more realistic the training for disaster-—the more
effective the help which this or any other hospital. will be prepared to

give in a time of disaster.

BIBLIOGRAPHY

178

BIBLIOGRAPHY

A. BOOKS
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Physiciansi Record Company, 19 7.
B. PUBLICATIONS or THE GOVERNMENT AND OTHER ORGANIYAT IONS

,American.National Red Cross. DiSaSter Manual fpr Chapters. No. 209.
washington, D. C., January, l9§§.

American National Red Cross. ngpisast r A_Friepd. No. 1576.
‘Washington, D. C., January, I956.

 

,American National Red Cross. Your Town Could Have_a¥Disaster. No. 1570.
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limerican Hospital Association. Principle§_of Disaster Planning_fg£
Hospitals. Chicago: Committee on Disaster Planning, I936T~

.American hospital Association. 'Readings in Disaster Plannin for
Hospitals. Chicago: Committee on Disaster Planning, 1 36

Federal Civil Defense.Administration. Emergencngedipal Treatment.
(TM;ll-8). “washington, D. C.: Superintendent of Documents,
April, 1953 -

 

Federal Civil Defense Administration. Emergengy Welfare Services,
(AG-12~l). 'Washington, D. C.: Superintendent of_Documents,
July, 1952.

Federal Civil Defense Administration. The Nurse in Civil Defense.
(TM-lle). washington, D. C.: Superintendent of Documents,
June, 1955.

 

federal Civil Defense Administration. Organizationpand Operation of
Cixil Defense Casualty Servipes--Part I--ThefFirst Aid’System.
TTM-ll-l). ‘Washington, D. C.: Superintendent of Documents,
January, 1953.

Federal Civil Defense Administration. Organization and Operation of
Civil Defense Casualt Services-~Part [[Tl-MEdical Records for
Casualties. {TMAll-3 . ‘WaShington, D. C.: Superintendent of
Documents, March, 1952.

 
 

1(9

Liquified Petroleum Gas Association. LP Gas fp£_Civil Defepsg.
Chicago, Illinois, 195?.

Lohr, M. D., Curtis H. The Plapning Of Hospipal Functions In a Disastep.
Kansas City Missouri: _MidWest Hospital Association, 1957.

 

New York State Civil Defense Commission. Manual of Hospital Organi-
zation for Ciyil Defense. (111-A-1) New York State: Emergency
Medical Services, 1952:—

c.’ PERIODICALS
Akeroyd, J. H. and W. H. Crosby. "A Plan to Make Available More Blood

in the Case of Disaster," Journal of the American Mgdical Assopiy
ation, 159:h2h-6, October I: 1955}

 

Allen, G. F. "Five Hours to 7ero," Nprsing_0utlook, 5zle-l9, July,
1957- —"'

Berkow, S. G. "An.Outline For the Emergency Treatment of Catastrophic
Burns, " Journal of the International Coll_ge of Surgeons, 2b: 355- 8,
Part I, Septwfber, l95§'- —' —_—

I
Berry, F. B. "Problems of Disaster Planning," Annals of Surgepy, 1&3:

Birdzell, S. H. "How the Heusekeeper Fits Into the Disaster Plan,"
Heapitals, 32:72, February 16, 1958.

Bovee, D. L. "Emergency Feeding in Disaster,".American Journal of
Clinical Nutrition, 6: {I 83, January-February, l958[—"

 

Brantley, B. N. "After Hurricane.Audrey3 Mobile Feeding," qurnal of
ppe DietitippAssppiation, 3h: , January, 1958.

 

Burns, B. I. "Disaster Planning," Hospitals, 32:hl-h, April 16, 1958.

Campbell, Paul E. and Robert M. Jones. "Experiences in Handling of a
Disaster in a Small Hospital, " Hpspital Management 83: 52- -5,
June, 195/

Carlisle, Benny. "Would Your Hospital Be Prepared?" Hoppital Manage-
ment, 80:39, September, 1955. —" _..

Carr, F. H._ "Medicolegal Aspects of Worcester Tornado," New England
Journal of Medicine, 250: 330- 2, February 25, 195h.

 

Cnesbro,‘W. P. "Organized Medicine and Civil Defense," Journal_ of the
,American Medical. Association, 162: 985-8, November 3jfil956.

180
"Civil Disasters and Civil Defense," Journal of the4American Medical
Association, IN]: 1283- h, November 2h, 1951.

Coveny, E. L. "Psychologic Reactions in Mass Casualties," Journal_g£
the.American Medical Association, 159:h27, October 1, 19

Curry, G. J. "The Flint Tornado,".American Journal of Surgery, 87:
[189-'91, March, 19SLL .

 

"Dealing With Disaster," Lancet, 2:23:1117, December 6, 1952.

"Disaster Medication List," Hospitals, 31: su, May 1, 1951.

. "Disaster Plaanorks At B1ackwe11,"_Modern Hospital, 85:87, July, 1955.

"Disaster Planning‘Statistics," Hospitals, 29:92, August, 1955.

"Disaster Planning Statistics," Hospitals, 30:25, May 1, 1956.

Dobkin, A. 5., G. M. Wyant, and Kilduff, c. J. "The Anesthetist in the
Management of Disaster," Canadianéflggical4Asspplgtion Journal, 76:
763-70, May 1, 1957.

Dolloff, Albert. "Connecticut Hospitals Review Flood Lessons,"
Hospitals, 30:h6—8, September 16, 1956.

Douglas, M. G. "Action in a CatastrOphe," Canadian Nurse, h8:80h-6,
Detober, 1952.

Dunlop, G. R. "The Worcester Tornado," American Journal p§.Surgery,
87:h8Y-8, March, 195M.

 

Dunstan, E. M. "Preposal to Create a Deputy Director of Hospital Civil
Defense for All Community Hospitals," Hospital. _Management 83: 56,
Tune, 1957.

ELleman, V. B. "Disaster NUrsir.g,".AmeIican Journal of Nursing,
%3 1356—/, November, 1953. “F—

Federal Civil Defense.Administration. "Disaster Strikes Twice,"
Eechnipal_flepo£;, September, 1957.

Colin, M. "Saga of the Disaster Doctors. How They Helped Battle a
Paper Enemy that Became Real," Journal of the American Medical
.Association, 16h:1679-83, August 10, 1957.

 

Grant, M. D., and N. w. David. "How Red Cross Can.Assist HOSpitals in
Natural Disasters," Hospitals, 30:h8~50, May 1, 1956.

'Griffiths, Thomas D. "How Do You Know Your Disaster Plan Works?"
Modern Hggpital, 88:85-89, June, 1957.

181

Hart, F. L. "Preparation for Disaster," ipternational Record q:
Medicing:and General Practice_§linics, 169:1524h, March, T956.

 

Hatfield, John N. "Disaster Planning," HosEitals, 31:90, April 16, 1957.

Henrietta, Sister. "Nurses Star in Disaster Test," Nursing Outlook,
S=hlh-7, JUly, 1957.

 

Hess, E. "Medical Disaster Preparedness-qA Team Problem," Hospitals,
30:38, April 16, 1956.

Hight, D., J. T. Blcdgett, E. J. Croce, E. O. Horne, J. W. McKoan, Jr.,
A and C. S. Whelan. "Medical Aspects of the Worcester Tornado

Disaster,” New England Journal of Medicine, 25h:267-Yl, February,

1956. '5 75*

 

Hinsely, J. w. "Hurricane Proyes value of Mobile Hospital,“ Modern
Hospital, 89:68-70, August, 1957.

Hiss, J. G. ”The Doctor in Civil Defense; When the Physician Leads,"
New_Xorkg§tate Journalgof Medicine, 57:2h8h-6, August 1, 1957.

Holbrook, John A. "Why Emergency Utilities may Fail [n.A Disaster,"
HosEitals, 32:79-82, may 1, 1958.

 

"Hospitals Hard Hit By Floods," Modern Hospital, 85:h9-5h, October,
1955- . ‘ ‘

"How Blackwell‘s Disaster Plan Provided Relief to Victims," HosEital
Management, 80:h6—h9, September, 1955.

Howell, L. N. ”A Statewide Disaster Training Program," Nursing Outlook,
S:]—L‘J4~6, hrCh’ 19S".

 

Hunt, M. M. "Tornado Teaches Value of Preparedness," Modern Hospital,
85:86, July, 1955.

 

Irwin, James H. "Role of the Medical Staff in Emergency Service and
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Jawcrski, H. L. "The'waco Tornado," émerigan:gggrnal of Surgery,

 

Jenkins, Susan. "Hospital Plan Works‘Well—-But Integration Fails in
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Kendrick, D. B. "Planning for Multiple Casualties,“ Sur e ,
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.Leuth, Harold G. "Meeting Disaster," Agpgjcan Journal of Nursingb
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182

 

Lopez, E. "They Took the "Twister" in Their Stride," Mpgern Hogpitgl,
78:80-82, May, 1952. . —*

Lowden, T. G. "The Casualty Department-~Llf," Lancet, 270:6931, June,-
1956.

Lutes, J; Dewey. "Operation: -Major Disaster," Hospitals, 30:36~L0,
March 1, 1956. .

Magnussen, A. K. and M. K. Schafer. "Nursing in Disaster-~Red Cross
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56. 1290~ 2, October, 1956.

Maher, T. F. "A lTritical Analysis of the Medical Problems of Three
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Martin, G. H. "The Vicksburg Tornado Disaster," Journal of the Amepican
‘Medipa1.Association, 155:861-3, June 26, 1955} "

 

 

 

Mary Sylvestre, Sister. "Railroad Wreck Proves That the Disaster Plan
‘Works,"pM3gern Hospital, 80:8h, June, 1953.

McGrath, Robert. "Hospital Goes To Town With Disaster Plans," Modern
Hospital, 8]: i1, September, 1956.

McLachlin, A. D. "Treatment of Fractures in Mass Casualties,"
Qapadian Nursg, h9:695-7, September, 1953.

Moore, "Some Emotional Concomitants of Disaster," Mental Hygiene, h2:
January, 1958.

Newkirk, Donald R. "hi Casualties Treated in 32 Minutes," Modern
Hospital, 88. 62-68, February, 1957.

Oddis, J. A. "Narcotics and Disaster Plans," Hospitals, 32:20,
February 1, 1958.

"0peration--Major Disaster," Hospitals, 30:h1-3, March 1, 1956.

03good, W. B. and Sister Loreto. "When the Tornado Turned Up In
“Worcester," Modepn Hospital, 81:82, August, 1953.

Pace, J. H. "Tornado In Texas Showed Need for a Disaster Plan,"
Modern Hospiggi, 80:82, June, 1953.

Perkins, Robert T. ' "A Dry Run for Disaster," Southern Hospitals,
2h:20, August, 1956.

 

183

"PerthHAmboy's Disaster Plan Goes Into Action," Modern Hpspital,
76: 85-7, March, 1951.

 

Piercey,'W'. D. and G. E. P'ryer. "Hospital Preparedness," Canadian
Meiipalessoc iation Journal, 76:361-36h, March 1,1957.

"Plan Outlined for Hospital Radio Network," Hospitals,31:17, June 1,
1957-

Pond, M..A. "Federal Aspects of Health Emergency Plans," American
Journal of Public Health, h2:1194122, February, 1952.

 

"Reality of Disaster Comes to Maryland, " Hospitals 30:h1-h3, March 1,
1956. A

Rivan, Arnold A. "HOSpitals in the Flood Crises," Hospitals, 29:72—75,
September, 1955 -

Ross, J. P. "Building a Hospital Disaster P1an,".American Journal of
Nursing, 57:1h61, 1957.

Scheidt, Albert. "Dalla.s Tornado Caught Them Fully Prepared, "
Modern Hospital, 88: 62, May, 1957.

Seifert, V. D. and w. Gerber. "in This Disaster Plan Student Nurses
.Are the Link Between the Patient and the Treatment Team,"
_Mpdern Hospital, 88:6h-7, February, 1957.

Sibley, H. "Disaster Planning Committee, " Hospim s, 32:20,
February 1,1958.

Sister Gertrudis. "Our Disaster Drill Had Unforseen Benefits,"
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Sister Helen, D. C. "Dress Rehearsal for Disaster," H03pitals, 32:39,
May 16, 1958.

Sister St. Elizabeth, "Sarnia Experiences [ts First Tornado,"
CanadianNurse, h9:5h, October, 1953.

Slabodnick, William. "Duties of the Purchasing.Agent in Planning for
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"Standards for Hospital Accreditation," Bulletin of the Joint
Commission on.Accreditation of Hosp1ta1s, No. 11, March, 1956.

 

 

"Status of National Civil Defense Legislation," Jburnal of the American
Medical Assopiation, 166: February 8,1958.

Stout, George N. "Here‘s a Well Organized Frequently Renearsed Plan,"
Hospital Managemept, 80:hh, September, 1955.

18h

Todd, F. A. and Hardenbergh, J. G. "The Veternarians' Place in Disaster
and Civil Defense, " Journal of the American Veternary Medicine
Association, 130: h33-37, May 1%, i957.

Towle, H. J. and J. V. Niiranen. "Dentistry-~An Aid in Disaster,"
Jgurnal of the.American_Dgntal.Association, 55:22-32, July, 1957.

"Two Disasters Taught the Same Lessons," HOSpitals, 31:u2—DL, June 16,
1957-

Twoney, C. F. and Killoran. "Medical Aspects of Swampscott Train Wreck
Disaster," New England Journal of Medicine, 25?:h08-lo, August,
1957.

‘wallace, R. E. "Don‘t Overlook Mental Hospitals in Disaster Planning,"
Hospital Management, BSth, January, 1958.

'Weatherhead, P. "When Disaster Struck, " American Journal of Nursing.
53:1h9l, December, 1953.

'Williamson, J. A. "The Other Side of Disaster Planning," Hospdtals,
31:h9, Part I, August 1, 1957.

Witkow,A . "And the waters Prevailed, " New England Journal_ of Medicine,
25h: 8h3- 6, May 3, 1956-

‘Witkow, A., and J. F. Smith. "Public Health Aspect of'Worcester Tornado,"
.American Journal of Public Health, h3: 15/2, December, 1953.

‘Witt, B. E. "When Rivers Rose in.Kentucky," Nursing‘Outlook, S:h20,
July, 1957.

‘Wynne, Charles V. "Disaster Planning," Hospitals, 30:58, February 16,
1956.

‘wynne, Charles V., Sister Mary Coronatus, G. R. Dunlop, and A. Murphy.
"Planning for Community Disaster,"lH05pital_ Topics, May 1956.
Reprinted.

law, R. ”In Planning for Disaster," Hospitals, 30:38, December, 1956.

Ziperman, H. Haskell. "Sortingb-the Key to Management of Victims of
Disaster," Journal of the American _Medical.Association, 162: lh38,
December 15,1 l9§6 ‘*i —*

185

D. UNPUBLISHED MATERIALS

"Check List for Written Disaster Plans," Baltimore, Maryland: The
Hbspital Council, Inc., July, 1957. (Mimeographed.)

Children's Hospital. "Procedures for Tornados," St. Paul, Minnesota.
(Mimeographed.)

Cooper HOSpital. "Civil Defense and Disaster Plan." Camden, New Jersey.
(Mimeographed.)

Fairvisw Hospital. "Disaster Plan Manual." Minneapolis, Minnesota.
August 29, 1957. (Mimeographed.)

Gillette state HOSpital for CrippledVChildren. "Disaster and Fire
Plan." St. Paul, MHnneSota. (Mimeographed.)

Harper HOSpital. "Disaster Plan." Detroit, Michigan. Draft of March
17, 1958. (Mimeographed.)

LeMoon, Lt. Col. Ralph G. "Disaster Planning for Hospitals." Fort Sam
Houston, Texas: .Army Medical Service School-~Brooke Army Medical
Center, September, 1957. tMimeographed.)

Luthern Deaconess Home and Hospital. "Emergency Plan for Disasters."
Minneapolis, Minnesota. September, 1957. (Mimeographed.)

Maryland General Hospital. "Disaster Plan." 'Baltimore, Maryland.
(Mimeographed.)

Memorial HOSpital. "The Disaster Plan." Sheboygan, Wisconsin. .April,
1958.

Memorial Hospital. "Disaster Manual." ‘Wilmington, Delaware.
(Mimeographed.) .

Minneapolis General Hospital. "Disaster Plan." Minneapolis, Minnesota.
May, 1958. (Mimeognaphed.)

Minnesota.Civil Defense Authority. "Annex G. Municipal
Survival Plane-Health, Medical and Special Weapons Service--
Operations Order." St. Paul, Minnesota. .April 1, 1958. (Ditto.)

Minnesota Civil Defense Authority. "Annex G. Minnesota Operational
Survival Plan-~Health, Medical, and Special'Weapons Defense Service."
St. Paul, Minnesota. March 10, 1958. QDitto.)

Minnesota Hospital Association, Inc. "Outline of Discussions Regarding
Individual Hospital DiSaster Plans." Minneapolis, Minnesota.
(Mimeographed.) ~

186

Minnesota Hospital Association, Inc. "Suggested Hospital Disaster
Plan." Minneapolis, Minnesota: Council on Hospital Planning and
Plant Operation. June 2M, 1957. (Mimeographed.)

Michigan Office of Civil Defense. "Advanced Casualty--Training Course-—
First Term." Detroit: Medical and Public Health Division of Civil
Defense, September 2M, 1956. (Mimeographed.)

Michigan Office of Civil Defense. "Advanced Casualty Care--Training
Course~-Second Term." Detroit: Mbdical and Public Health Division
of Civil Defense, January 22, 1957. (Mimeographed.)

Hfiohigan Office of Civil Defense. "Basic Casualty Care-~Training Course."
Detrout: Medical and Public Health Division of Civil Defense,
January 31,1956. (Mimeographed.)

Michigan Office of Civil Defense. "Michigan Emergency Medical Plan."
Detroit: Medical and Public Health Division of Civil Defense,
(Mimeographed.)

Michigan Office of Civil Defense. "Michigan HOSpital Disaster Plan."
Detroit: Medical and Public Health Division of Civil Defense,
February 2h, 195h.. gMimeographed.)

Michigan Office of Civil Defense. "Testing and Rehearsal of Hospital
Disaster Plans." Detroit: Medical and Public Health Division of
Civil Defense, February 23, 1958. (Mimeographed.)

Mt. Carmel Hospital. "Disaster Plan." Columbus, Ohio. .April, 1957.

New fork State Department of Healthr-Office of Medical Defense.
"Outlining a HOSpital Disaster Plan." New York State: New York
State Civil Defense Commission, March, 1958. (Mimeographed.)

Northwestern Hospital. "Alert Orders." Minneapolis, Minnesota:
Northwestern Hospital Civil Defense Committee (Printed.)

Perth Amboy General Hospital. "Disaster Procedure." Perth Amboy,
New Jersey. May, 1956. (Mimeographed.)

Providence Hospital. "Disaster Plan." Oakland, California. October
13, 195k. (Mimeographed.)

Roanoke Memorial Hospital. "Disaster Plan." Roanoke, Virginia.
(Mimeographed.)

Royal Jubilee Hospital. "Disaster ELan." Victoria, british Columbia,
Canada, May, 1957. gMimeographed.)

187

St. Joseph Hospital. "Disaster Plan." St. Paul, Minnesota. October,
1957. (Mimeographed.)

St. Luke's Hospital. "Disaster Plan." St. Paul, Minnesota.
(Mimeographed.)

St. Mary's Hospital. "Disaster Plan." Minneapolis, Minnesota.
{Mimeographed.)

San Joaquin General HOSpital. "Disaster Plan." French Camp,
California. September, 1956. (Mimeographed.)

Sinai Hospital. "Disaster Plan." Baltimore, Maryland. March, 1958.
(Mimeographed.)

The Johns Hopkins Hospital. "Disaster Plan." Baltimore, Maryland,
March, 1957. (Mimeographed.)

Veterans' Hospital. "Disaster, Emergency Relief, and Civil Defense
Organization and Plans." Minneapolis, Minnesota, October 30, 1952.
(Mimeographed.)

E. COMMITTEE REPORTS AND SPECIAL LETTERS
Freeman, Orville L., Governor of the State of Minnesota. From a letter
concerning a "Statement of Understanding between Minnesota Civil
DefenseTAgency and the American National Red Cross." St. Paul,
Minnesota: State of Minnesota Executive Office, February 3, 1958.

Sohuyzer, M. D., Hanns C., Medical Director of St. Paul Civil Defense.
Letter to the Superintendents of SD. Paul Hospitals, Ju1y 9, 1956.

St. Paul Chapter of the American Red Cross. Committee Reports.
(Mimeographed.)

1. "Disaster Plan." Subcommittee on Communications. January, 1957.

2. "Red Cross Guide for Local Organizations and Use of Nurses in
Disaster."

3. "When Disaster Strikes--General Information and Instructions
to SubCommittee Chairmen." January, 1957.

h. "Disaster Plan." Subcommittee on warning, Rescue and Evacua—
tion. January, 1956.

5. "Disaster Plan." Subcommittee on Public Information.
February, 1957'.

10.

ll.

12.

13.
1h.

"Disaster Plan." Subcommittee

"Disaster Plano" Subcommittee
Relief. January, 1957.

. "Disaster Plan." Subcommittee

1997—58 -

. "Disaster Plan." Subcommittee

"Disaster Plan." Subcommittee

"Disaster Plan." Subcommittee
January, 1957.

"Disaster Plan." Subcommittee
January, 1957.

on

on

on

on

on

on

on

188

Transportation. January, 1957.

Disaster Preparedness and
Medical and Nursing Aid.

Clothing. January, 195?.
Food, January, 1956.

Central Purchasing and Supply."

Information and Registration.

"Disaster Plan." Subcommittee on Survey. January, 1956.

"Hospital Responsibility for American Red Cross Assignment to

Casualty Stations." 1958.

APPENDICES

189

APPENDIX A

TESTING AND REHEARSAL
OF -
HOSPITAL DISASTER PLANS“

STANDARDS Egg; HOSPI‘TAiiTESTINg

l. The following major elements of the written hospital disaster phmn
should be subject to tests or rehearsals of sufficient magnitude to
permit a valid appraisal of their usefulness and to provide experi-
ence for hospital personnel:

Ambulatory Casualty Post (First Aid)
Reception of Ambulance

.Admission and Triage (Receiving and Sorting)
Medical Records .

Emergency Communications

2. It is desirable, though not essential, that the following elements
of the disaster plan also be tested:
X—ray Department
Supply
Public Information
Volunteer Personnel Office
Traffic Control

3. Remaining hOSpitals function of ancilliary character need not be
rehearsed or tested.

h. An.administrative test involving only department heads and other
key personnel is acceptable.

5. Most Segments of the disaster plan can be rehearsed or tested
separately.

6. Segments of the disaster plan.which have inter-locking relationships
should be tested together. A test of emergency admissions, for
example, should also involve a test of emergency medical records.

7. Testing should not involve any movement or other inconvenience to
patients in the hospital.

 

%Michigan Office of Civil Defense, "Testing and Rehearsal of Hospital
Disaster Plans," {Detroit: Medical and Public Health Division of
Civil Defense, February 2h, l95h).

190

8. Employees should not be pulled away from their jobs for the purpose
of testing if this will in any way be detrimental to provision of
care of patients.

9. The employment of an element of surprise in testing is recommended
but remains a matter of choice for the hospital administrators.

10. Outside help provided by the American Red Cross and the Civil
Defense is available to assist hospitals wishing;to test their
disaster plans.

PROCEDURES 1:93 ggSfllAt TESTING

wivw—vr—

Administrative Test. An.administrative rehearsal or test should involve
oily the admifiistration and department heads. .An administrative test
would be largely a paper test where the administrator outlines and in»
forms department heads of a problem and then obtains the solution of

the problem from each department. This test could be staged with
department heads given time to think over their answer which they could
submit orally or in writing as the administrator prefers, or the test
could be conducted with an element of surprise wherein the information
on the problem could be handed to the department heads without warning .
and an immediate answer requested. Some administrators might prefer to
conduct a staged rehearsal first and then follow it with a surprise
administrative test. '

Example: Hospital X, a ZOO-bed institution, estimates in its disaster
planning that its optimum admission (good and prompt medical
care) of casualties is 30. If circumstances required, it
could, with maximum expansion, accept up to 300 casualties.
Since its normal ambulance entrance is cramped, the plan
calls for establishing an emergency ambulance area in.the
main lobby, which in turn involves relocating the information
desk. The administrator wishes to run an administrative test
rehearsal of the plan to determine the extent to which the
department heads are aware of their role and that of their
departments in a disaster operation. The administrator,
therefore, supplies the department heads with the following
information and problems: .At 7:30 P.M. the hospital is
notified that a disaster of unknown proportions has occurred,
and the hospital-will receive approximately 10 to 20 casual-
ties. The administrator order the disaster plan into effect.
.At 7:50 P.M. the first casualties arrive. Eight casualties
are brought in.by private automobile. Casualties seem to be
suffering mostly from mechanical injuries; only two of the
eight casualties could be termed serious. At 8:10 P.M. 1h
more casualties likewise suffering from mechanical injuries
were brought again by private vehicle. All casualties were

191

covered with dirt and in many cases were dazed, some were in
shock. By 8:20 it became apparent that the estimate in the
original warning was far off base. Either there were far

more casualties than originally estimated, or the police had
not succeeded in isolating the disaster area or properly dis-
patching vehicles carrying casualties. Hospital X was receiv-
ing more than its share. By 8:35 P.M. the Office of Civil
Defense informed the hOSpital that it would be receiving 50
casualties in tetal. By 9:00 the hOSpital had already re-
ceived casualties in excess of 100, most brought in by private
ambulance.‘ However, many of these casualties were merely
shaken up and were otherwise not injured or they had injuries
of a relatively minor nature. In the meantime, the hOSpital
was flooded with calls from off-duty personnel, the general
public, outside agencies, and newspapers. The radio had, of
course, broadcast news of the disaSter and as a result many
well-meaning individuals had come to the hospital to offer
their services.

‘With this problem, the administrator could then check with depart-
ment heads the action taken and their estimate of the situation at
various times as the disaster operations progressed.

 

Ambulatory Casualty4Post (first aid)

The operation of the ambulatory casualty post can be tested
separately. This test, however, should.involve simulated casualties
in sufficient numbers to provide valid conclusions This can.be a
Staged rehearsal or a Surprise test, as the administrator prefers.
The test of the ambulatory casualty post should provide valuable
experience in:

l. Staffing--both adequacy and timing.

2. Clearing the area of routing business for reception of

casualties.

3. Speed of record making.

h..Adequacy of supplies on hand and Speed of delivery of supplies

from the storeroom.

5. Maximum patient flow.

Reception of.Ambulances. A test of the ambulance reception area would
necessarily'involve vehicles. The object of this rehearsal would be to
gain experience or to train personnel in adequately staffing the
ambulance entrance at a moment‘s notice, where, of course, adequate
coverage by male personnel to unload litter casualties is an absolute
essential. The ability of personnel to keep the ambulance area clear
of parked.vehicles would be strengthened in this rehearsal. Simulated
casualties would not necessarily be involved.

192

Admission and Triage. (Reception and Sorting.) .An admission and
triage—refieareal necessarily involves simulated casualties in sufficient
numbers to~provide a valid result. To be checked in a test of the
admission area are:

1. Staffing.

2. Adequacy of area.

3. Adequacy of wheel carts and litters.

h. Adequacy of medical supplies.

~5. Practicality of medical record system.

b. Adherance to triage (sorting) principles.-

Since a test of the admission area should involve mock casualties
and possibly other items that must be obtained outside the hOSpital,
it is suggested that the Office of Civil Defense and the American Red
Cross be called in for prior planning. .At the time of the exercise
relay notice to the department heads, action should be automatic in
accordance with the provisions of the disaster plans.

Medical Records. In almost all stories of disaster, medical records
havepbeen inadequate. The key to the medical record system appears to
be Speed. The medical record System usually breaks down right in the
emergency admission area where it is found that making admission records
takes too much time. As a result, it occurs in disaster that some
patients receive treatment and are discharged without a hospital record
being made. A rehearsal of records could be accomplished in one of

two ways and probably should be done both ways:

1. Familiarization program wherein the personnel assigned to emer—
gency medical records merely makes out a series of records on
hypothetical casualties. A part of this,.of course, should be
a Speed test.

2. A test of record taking ability as a part of the test of the
admission area.

X~Ray. It may be desirable to include the X-ray department in a dis-
aster plan rehearsal. Such rehearSal might involve rehearsal of wet
reading of film and dictation of findings. Dictated information and
film should be keyed to the casualty tag number for easy identification.
If the plan calls for the use of volunteers for clerical duties, in

the X-ray department, these could be involved in the rehearsal.

Supply. One reSponsibility of the supply department is that of rapid

de ivery of essential supplies to emergency areas which are not normally
used for patient care and thus are not medically equipped. The speed
and adequacy of this delivery system may easily be tested.

.— A—‘ _‘

*The uSe of volunteers in the rehearsal will reveal the degree of
effectiveness of volunteer help.

193

Emergengy Communications. Communications is an important segment of
every sas er p . It involves two main areas:

1. Rehearsal of a personnel alert procedure involves getting a
message to all of the essential personnel and receiving back a
report that they received the message and would have acted upon
it if it had been necessary. Test of the alert procedure is
eSpecially desirable since in most institutions a chain calling
system is used. It should involve the medical staff. Unless
this procedure is tested regularly it almost inevitably breaks
down.when it is needed.

2. Mest institutions have made provisions to protect some of their
telephones, that these instruments will always be available
regardless of the pressure from calls coming in from the general
public. This part of the communications procedure can be tested
'with the cooperation of volunteers outside of the hospital.

The Office of Civil Defense can assist the hospital in running
this rehearsal. '

Public Information. Meet hOSpital disaster plans have made provisions
for handling an increased load of information requests from friends
and relatives of disaster casualties. It may be desirable to test the
procedure for doing this. For rehearsal, this will involve forwarding
of admission cards to the information desk, the filing-Of such infor-
mation, and the answering of questions on hypothetical casualties.

A teat Of the public information service could well be worked in with
a test of medical record procedure. The Object of this rehearsal would
be to gain experience in the flow and use of records and the shifting
of the information office if this is called for in the plan. If adminis-
tration wishes to involve outside calls in testing this segment of the
disaster plan, the Office of Civil Defense will assist.

Vplunteer Personnel Office. In hospital disaster Operation volunteer
hslp‘will be on hanHthether or not the hospital wishes it. One of the
problems is, therefore, the reception and control of volunteer help.'
Most disaster_plans make provision for reception and screening of
volunteers. It.nay be desirable to test this procedure. This, however,
involves the utilization Of volunteers. The Office of Civil Defense
'will assist in this if the adminiStration wishes.

TgafjiggC0ntgpl. Traffic control refers to internal traffic control
since it is a_pOlice function to direct traffic beyond the hospital
grounds. The main problem in.internal traffic control is the sealing
of entrances to prevent the entrance of unauthorized personnel except
at designated places. This procedure can be rehearsed in conjunction
with a general test. ‘By itself it scarcely poses a problem. However,
combined in a.test with the other segments it may be significant since
the personnel assigned to traffic control will most likely have another,
and possibly conflicting assignment.

19b

Other_Functions. There are other segments of hospital disaster plans
which need not be tested or which it is not practicable to teSt. These
functions may be listed as follows:
1. Evacuation of Patients.
. Laboratory.
. Mergue.
. Pharmacy.
. Central Supplies
. Diet.
Maintenance.
Housekeeping.

Laundry .

\O (JD-x} O\\J'14:"\AJ N

(‘0ng PLAN TESTING

All, or almost all Of the above Segments Of the disaster plans
can be tested Separately. waever, a combined rehearsal of the complete
disaster plan.is both feasible and desirable. If a hospital wishes to
undertake a complete test, the Office of Civil Defense and the.American
Red.Cross will assist in every possible way and will provide all of the
. things which must be obtained.outside the hospital, such as casualties,
ambulances, volunteers, and.additional supplies. The Civil Defense and
the.American Red Cross will also provide advice and assistance in
setting up any rehearsal or test or any part or all of the disaster plan
as desired by the hospital administrator or the hospital disaster com-
mittee.

It should be pointed out that all of the foregone applies to local
or community disaster. However, all planning and testing is applicable
to large Scale disaster as envisioned in Civil Defense. In either
instance it provides an Opportunity for all persons involved to gain
experience in the familiarity with disaster planning and potential
operation.

APPENDIX B

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