Welcome to Athens-Limestone Hospital

Response Activities

A. Initiate the Response
1. The Incident Commander is responsible for initiating this plan. Circumstances permitting, he will discuss the situation with the Chief Executive Officer, Chief Nursing Officer and/or Director of Emergency Services before implementing the plan.
2. The Support Branch Director and staff members assigned to a position of “chief” or higher in ALH's Emergency Incident Command System will report to the incident command center for a situation briefing. The hospital staff will be notified following this briefing.
3. This plan will be initiated based on a large, unanticipated influx of patients into the emergency room; upon notification from EMS, EMA, LCHD, ADPH or other agencies of an imminent influx of patients; or when a natural or terrorist incident or a utility system failure impede ALH's ability to provide services.
4. Incident Command Center will open in Classroom 2 when this plan is initiated. All members of the incident command staff to the activity chief level will immediately report to the command center.
5. Labor Pool: will open in the Education conference room.
6. Media Briefing Room: will open in the Wellness Center classroom.

B. Notifying Staff
1. Initial Notification
a. The Incident Commander will tell the telephone operator to announce, “Incident Command Staff report to the Incident Command Center”. The telephone operator will make this announcement three times.
b. The Incident Commander will tell the telephone operator to announce Code 10 over the public address system. The operator will announce Code 10 three times. Runners will be sent throughout the hospital if the overhead paging system is not functioning.
c. After hours the telephone operator will contact the CEO, Assistant Administrator, Chief Nursing Officer, Chief Emergency Services, and Emergency Preparedness Coordinator.
d.During normal working hours, Administration will call physicians' offices and ALH satellite facilities and notify them that Code 10 has been initiated.

2. Secondary Notification
a. The Incident Commander will determine when additional staff is needed. The command center staff will initiate staff call back.
b. The command center staff will contact physician answering services as necessary.
c. The ALH Public Information Officer will ask radio and television stations to make announcements as necessary.

3. All staff members will report to the Labor Pool located in the Education Department conference room and sign in with the Labor Pool Unit leader as soon as they are notified.

C. Notifying External Authorities: The ALH incident command staff will notify the appropriate authorities. SEE Appendix A.

D.Identifying and Assigning Staff to Cover All Essential Staff Functions Under Emergency Conditions
1. Section V of this plan assigns responsibilities.
2. The ALH Emergency Incident Command organization chart and associated job action sheets address alternate roles and responsibilities during an emergency and establishes the ALH incident command structure.
3. When necessary, ALH will seek additional staff members through the EMA, ADPH, Health Group Alabama partner hospitals, HVA and other sources. The Support Branch Director will screen these individuals using criteria in references B, C, and D.
4. The ALH incident command staff will assign staff and volunteers to essential positions as dictated by the situation. The Support Branch Director and Labor Pool Leader direct these activities.

E.Managing Activities Related to Care, Treatment and Support
1. DISASTER CASUALTY PROCESSING PROCEDURES – SEE APPENDIX B
2. The CEO in coordination with the ALH Incident Commander, the Chief Nursing Officer and other key staff members determines when and which services will be modified or suspended. Every effort will be made to continue all services: However, those daily functions which do not contribute directly to the emergency operation may be suspended for the duration of the emergency.
3. The Planning Section Chief will control patient information during an emergency. She will coordinate the transfer of medical records if an evacuation is required.
4. The Staging Manager will coordinate patient transportation requirements with the Emergency Management Agency and other ambulance services.
5. Patient family members will be sent to the cafeteria. The Public Information Officer and the Liaison Officer will coordinate briefings for family members.
6. Death notifications will be made by qualified clergy, physicians or coroner personnel.

F. Managing Staff Support Activities
1. The Employee Health & Well Being Unit Leader is responsible for managing support activities
2. Temporary staff housing may be established in local churches, the Wellness Center and other non-patient care facilities. Staff support requirements will be coordinated with the Emergency Management Agency.
3. Staff transportation is coordinated with the Emergency Management Agency, Athens Police Department, Limestone County Sheriff's Office and other available resources.
4. The Finance/Administration Section Chief will establish procedures for cashing employee pay checks if local financial institutions are disrupted.
5. Psychological support will be coordinated through Behavioral Health Systems and other agencies.

G.Managing Staff Family Support Activities
1.ALH has a very limited capability for assisting in staff-family support.
2.The Family Care Unit Leader is responsible for coordinating staff-family support and serving as liaison with staff families.
3.ALH will rely heavily upon the American Red Cross and the EMA for family support.

H.Logistics
1. The Incident Command Center staff will coordinate all supplies, equipment, pharmaceuticals, food, linen and water requirements.
2. ALH will, to the extent storage space and finances permit, keep a 96-hour response inventory of these materials on hand. The directors of Purchasing, Pharmacy, Food Service and Environmental Services are responsible for managing these as part of their operational stocks.
3. Purchasing will keep disaster supply carts stocked for immediate movement to designated positions when this plan is activated.

I.Security
1. HOSPITAL LOCK-DOWN – under most circumstances, the hospital will be locked down when Code 10 is announced. The ALH Incident Commander will make this determination. The Security Branch Director will assign members of the labor pool to augment security and post an individual at each locked door to direct everyone (except staff members) requesting access to the Emergency Room entrance.
2. Emergency Room Entrance – all individuals requesting access to ALH will be screened before they are admitted.
a. Only those individuals seeking emergency care or with pre-scheduled appointments will be admitted. If a decision has been made to curtail non-emergency services, individuals with appointments will be screened before they are allowed to enter.
b. Chemical, radiological or biological contamination – access to ALH will be granted only after screening. Policy EC-406, Decontamination.
3. STAFF MEMBERS SEEKING ACCESS DURING A LOCK-DOWN – should enter through the loading dock door. The security officer posted at this door will check staff members' ALH issued identification badges before allowing them to enter the building. The security officer will radio the command center for instructions when an employee does not have a badge.
4. The Security Branch Director will immediately request additional support from the Athens Police Department.
5. The Security Branch Director will immediately contact the security contractor and request additional guards.
6. The Security Branch Director will coordinate other security needs with the EMA through ALH's Liaison Officer.
7. ALH will continue to provide unobstructed access to the Emergency Room ambulance entrance, the helipad and fire lanes. See Policy EC-204.

J.Identifying Staff, Patients and Others
1. Current staff members will wear their ALH identification badges.
2. The Credentialing Unit Leader will issue Disaster Volunteer identification badges based on criteria found in references B, C, and D.
3. Incident command center staff will wear identifying vests.
4. Security, registration personnel and other designated staff will wear identifying vests.
5. Patients will be identified with disaster tags and given ID bracelets as soon as the situation permits.

K.Building Evacuation - see policy EC-407.

L. Alternate Care Sites
1. The hospital will be evacuated and patients transferred to alternate care sites when the environment cannot support adequate care, treatment or services.
2. There are currently no facilities in the City of Athens that meet patient care needs as an alternate care site.
3. Alternate care sites are available through ALH's affiliations with Huntsville Hospital, Health Group Alabama (HGA) and VHA Southeast.
4. The Incident Commander will work with ADPH to identify available beds if the Huntsville Hospital and the HGA and VHA affiliates cannot accept all ALH patients.
5. See Appendix C for detailed information about transferring patients to alternate care sites.

G.Decontamination
1. The Athens-Limestone Emergency Management Agency Emergency Operations Plan does not assign ALH a specific role during chemical or radiological incidents (the plan assigns first responders at the site of the incident and Athens Fire & Rescue this responsibility): However, ALH must be prepared to participate in these emergencies. The management of situations involving nuclear, biological or chemical contamination is a joint effort among national, state, and local officials and the health care community. ALH is prepared to manage a very limited number of contaminated individuals and to meet the care needs of casualties who have been decontaminated by other agencies.
2. Patients arriving at ALH requiring chemical, biological or radiological decontamination will be processed following Policy EC-406 before they enter the hospital.
3. The Incident Commander will coordinate requirements for additional decontamination support with the Athens Fire & Rescue and the EMA.

H.Alternate Locations in ALH Facilities Used to Implement This Plan
1. Incident Command Center - Class Room 2 or the Ambulance Building
2. Triage Area (receiving, triage) - Emergency Department, Ambulance Parking Area
3. Treatment Areas Priority I (Resuscitation - Immediate), II (Emergent - Rapid), III
(Urgent - Serious), IV (Less Urgent - Delayed), V (Non-urgent – delayed)
a. priorities I, II and III – Emergency Room
b. priorities II and III– Prime Care clinic
c. priorities III, IV, V and minor treatment – One Day Admissions
4. Morgue: regular holding room on first floor. This facility has a very limited holding capacity. The Limestone County Health Department is assigned the primary responsibility for Mortuary Services under ESF 8.
5.  Hospitalization - patient room number assignments will be made at the Triage area. Infectious patients will be cohorted on 2-South to the greatest extent circumstances permit.
6.  Discharged and Released Patients: the Sanders Street lobby will be used for victims      treated but not hospitalized. These victims will remain here until release. All discharged      and released patients will exit through the Sanders Street lobby.
7. Media Pool/Briefing Room: Wellness Center classroom.
8. Patient Family Members: Cafeteria.
9. Staff Housing: Wellness Center or other locations as determined by the Employee Health & Well Being Unit Leader.

I. Media Activities and the Public Information System
1. The ALH Public Information Officer is responsible for coordinating all interaction with the media.
2. When required by the situation and in coordination with the Limestone EMA's EOC and the Joint Information Center (JIC) (when established) a media briefing room will be established in the Wellness Center classroom.
3. A staff member must escort all media members entering the hospital – the media will never be permitted unescorted access.
4. The public information system protocol creates “one message” that is sent to the public. All media releases made by ALH will be coordinated with the EOC and JIC prior to release.
5.ALH's Public Information Officer is responsible for:
a. media and public inquiries;
b. emergency public information and warnings;
c. rumor monitoring and response;
d. media monitoring; and
e. other functions required for coordinating, clearing with appropriate authorities, and disseminating accurate and timely information related to the incident.

J.Communications
1. SEE appendix D, Communication Plan.
2. ALH will use standard and consistent language that conforms to the Limestone EMA. “Plain Language” will be used at all times unless instructed by the EMA. “Code 10” will still be used to notify the ALH staff when the all-hazards response plan is activated. This term will not be used when communicating with the EMA and other external agencies.

US Patent Numbers 7,720,998 B2, 7,836,207