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==STAGE 1 GOALS==
==STAGE 1 (INITIATE) GOALS==


◦ Needs Assessment
=== Needs Assessment ===
◦ estimated time-line
◦ injury types
◦ incoming # patients
◦ Incident situation
◦ ED/OR/Hosp capacity assessment
◦ Staff - communicate
◦ Stuff - secure
◦ Space - assign


◦ Activate Response (local)
* Estimated time-line
◦ (understand base concepts of code yellow ED vs. code yellow Hospital)
:Now/10min/60min/hours
◦ Declare code yellow ED
:Walk-in/Ground Ambulance/Air Transport
◦ Activate local incident command (administration)
◦ Notify clinical departments: ED, trauma for Peds & Adults, radiology & shift coordinators
◦ Partial mobilization of staff: ED trauma nurses, radiology, public affairs, EVS, security, public affairs
◦ Activate local reverse triage


◦ Decide/Assess:  
* Injury types (COBRA/CBRNE)
◦ Define staff, space, stuff needs
:Trauma/Burn/Chemical/Radiation/Infectious
◦ Acquire/Prepare additional supplies
◦ [partial] mobilization of hospital incident command
◦ Activate concepts of Triage


==STAGE 2 GOALS==
* Incoming patients
:Children/Adults/Numbers


1. Needs Assessment
=== Incident situation ===
⁃ situation/incoming patients needs assessment/estimated ongoing time-line
ED/OR/Hosp capacity assessment
⁃ Hospital capacity needs assessment


2. Activate Hospital Response
* Census, Open Beds, Expandable Space
⁃ (understand base concepts of code yellow ED vs. code yellow Hospital)
⁃ Declare code yellow HOSPITAL
⁃ Activate Hospital incident command (HICS)
⁃ Notify clinical departments: wards, trauma for Peds & Adults, radiology & shift coordinators
⁃ Stop elective operations (ORs/Clinics)
⁃ Mobilization of staff: Hospital nursing, blood bank, EVS, radiology, public affairs, security, public affairs, facilities
⁃ Call in additional staff
⁃ Activate hospital-wide reverse triage


3. Decide/Assess:
Asset Assignment
⁃ [partial] mobilization of hospital incident command
{| class="wikitable"
⁃ Define staff, space, stuff needs
|+
⁃ Acquire/Prepare additional supplies
!Location
⁃ Establish contact with other hospitals
!Phone
⁃ Go on ED diversion
!
⁃ Contact materials management for more supplies (eg, PPE)
!Location
!Phone
|-
|<small>Hospital Incident Command</small>
|<small>5-3333</small>
|
|<small>ACCM Incident Command</small>
|
|-
|
|
|
|<small>Peds Shift Coordinator</small>
|
|-
|<small>ZBOR4 Anes Commander</small>
|<small>7-2777</small>
|
|<small>Adult Anes Commander</small>
|
|-
|<small>ZBOR4 Surg Commander</small>
|
|
|ZBOR Lead Anesthesia Tech
|667-208-3336
|-
|<small>ZBOR4 Nursing Commander</small>
|
|
|
|
|-
|<small>ZBOR4 Pre-Op</small>
|<small>2-5890</small>
|
|<small>Radiology</small>
|
|-
|<small>ZBOR OR Desk</small>
|<small>5-6520</small>
|
|<small>Blood Bank</small>
|
|-
|<small>ZBOR4 PACU</small>
|<small>5-5722</small>
|
|<small>Security</small>
|
|-
|<small>ZBOR4 PICU</small>
|<small>5-5260</small>
|
|<small>EVS</small>
|
|-
|<small>Adult Emergency Department
|<small>5-2280</small>
|
|<small>Facilities</small>
|
|-
|<small>Peds Emergency Department</small>
|<small>5-5681</small>
|
|
|
|}


4. Activate concepts of Re-Triage
==== Staff - communicate/assign ====
:Pre-OP - Triage Staging/OR Holding
:OR - Immediate Surgical/Damage Control
:Post-OP - PACU/Minor Procedure/PICU Annex
:Consider call-in tree activation
::Keep in
::Call in
::Standby
::Reserve staff (12 hour hold)


==STAGE 3 GOALS==
==== Space - assign/secure ====
:Consider double stretcher in rooms
:PrepPACU/OR Corridor: stretchers/beds/equipment


1. Triage + Treat Patients
==== Stuff - secure/prepare/deliver ====
2. Move Patients Around
:Stretchers/Monitors
3. Expand available space to accommodate more patients
:Fluids/Blankets/Triage Intervention
4. Secure perimeter/crowd control
:Personal Protective Equipement
5. Attempt to Resupply


==STAGE 4 GOALS==
=== Activate Preparation Response (local) ===
<i>(understand basic concepts of Patient Influx Protocols)</i>
:[https://hpo-docs.jh.edu/I8EMHRyj EP318 Patient Influx: Mass Casualty - ED]
:[https://hpo-docs.jh.edu/KxeyOf0y EP317 Patient Influx: Mass Casualty Physician Teams]
:[https://hpo-docs.jh.edu/ZuKVoCVH EP322 Patient Influx: Mass Casualty Bio]
:[https://hpo-docs.jh.edu/1O8qyPQX EP323 Patient Influx: Mass Casualty Chemical]
:[https://hpo-docs.jh.edu/4uVAB1aA EP324 Patient Influx: Mass Casualty Radiation]
:[https://hpo-docs.jh.edu/WlMMKGUN EP333 Patient Influx: Epidemic/Pandemic Respiratory Illness (EPRI) Response Plan]


1. maintain contact with other hospitals
'''Declare/verify''' appropriate Patient Influx Plan (ED/Hospital)
2. needs assessment: open ICU/OR beds check
3. borrow supplies
4. re-supply
5. media/crowd management
6. Triage


==STAGE 5 GOALS==
'''Activate''' local incident command (administration)


1. Staff management – getting more fatigue mitigation; food
'''Notify''' clinical departments: ED, trauma for Peds & Adults, radiology & shift coordinators
2. Family management
3. Advanced triage
4. Definitive Treatment - ICU, OR, Home, Psych Liaison, Morgue
5. Ongoing security


==STAGE 6 GOALS==
'''Mobilization''' [partial] of staff: ED trauma nurses, radiology, public affairs, EVS, security


1. Send excess staff home
Activate local '''reverse triage'''
2. Begin elective procedures again  
 
3. Bring in new staff
'''Decide/Assess:'''
4. De-escalate security
:Define staff, space, stuff needs
5. Restock supplies
:Acquire/Prepare additional supplies
6. Laundry/Room Flips
:[partial] mobilization of hospital incident command
 
==STAGE 2 (RAMP UP) GOALS==
 
=== Needs Assessment ===
:Situation
::Changing time-line
::Incoming patients (numbers, types of injuries)
::Changing needs assessment
::Revised estimated ongoing time-line
:Hospital/Local capacity needs assessment
 
=== Activate Hospital Response ===
:(understand base concepts of code yellow ED vs. code yellow Hospital)
:⁃Declare code yellow HOSPITAL
:⁃Activate Hospital incident command (HICS)
:⁃Notify clinical departments: wards, trauma for Peds & Adults, radiology & shift coordinators
:⁃Stop elective operations (ORs/Clinics)
:⁃Mobilization of staff: Hospital nursing, blood bank, EVS, radiology, public affairs, security, public affairs, facilities
::⁃Call in additional staff
::-Activate hospital-wide reverse triage
 
=== Decide/Assess: ===
:⁃[partial] mobilization of hospital incident command
:⁃Define staff, space, stuff needs
:⁃Acquire/Prepare additional supplies
:⁃Establish contact with other hospitals
:⁃Go on ED diversion
:⁃Contact materials management for more supplies (eg, PPE)
 
=== Activate concepts of Re-Triage ===
 
==STAGE 3 (ACTIVE) GOALS==
 
=== Triage + Treat Patients ===
:Immediate interventions
::Airway (Oxygen)
::Bleeding (Tourniquet)
::Thorax (Chest tube)
::Poisoning  (Antidote)
 
=== Move Patients Around ===
:- match resources to needs
 
=== Expand available space to accommodate more patients ===
:- repurpose space as necessary
 
=== Secure perimeter/crowd control ===
:-“Protect the House”
 
=== Attempt to Resupply ===
:- Anticipate ongoing needs
:- Consider time-limited resources
 
==STAGE 4 (CONSOLIDATION) GOALS==
 
=== Recursive needs assessment: open ICU/OR beds ===
 
=== Maintain contact with other hospitals ===
:-borrow supplies
:-re-supply
 
=== Media/crowd management ===
 
=== Re-Triage ===
 
==STAGE 5 (ON-GOING MANAGEMENT) GOALS==
 
=== Staff management ===
 
* fatigue mitigation
* food
* sleeping quarters
 
=== Family management ===
 
=== Advanced triage ===
 
=== Definitive Treatment ===
 
** ICU, OR, Home, Psych Liaison, Morgue
 
=== Ongoing security ===
 
==STAGE 6 (RESOLUTION) GOALS==
 
=== Release excess staff home ===
 
=== Resume elective procedures again ===
 
=== Refresh new staff ===
 
=== De-escalate security ===
 
=== Restock supplies ===
 
=== Laundry/Room Flips ===

Latest revision as of 12:15, 30 September 2026

STAGE 1 (INITIATE) GOALS

Needs Assessment

  • Estimated time-line
Now/10min/60min/hours
Walk-in/Ground Ambulance/Air Transport
  • Injury types (COBRA/CBRNE)
Trauma/Burn/Chemical/Radiation/Infectious
  • Incoming patients
Children/Adults/Numbers

Incident situation

ED/OR/Hosp capacity assessment

  • Census, Open Beds, Expandable Space

Asset Assignment

Location Phone Location Phone
Hospital Incident Command 5-3333 ACCM Incident Command
Peds Shift Coordinator
ZBOR4 Anes Commander 7-2777 Adult Anes Commander
ZBOR4 Surg Commander ZBOR Lead Anesthesia Tech 667-208-3336
ZBOR4 Nursing Commander
ZBOR4 Pre-Op 2-5890 Radiology
ZBOR OR Desk 5-6520 Blood Bank
ZBOR4 PACU 5-5722 Security
ZBOR4 PICU 5-5260 EVS
Adult Emergency Department 5-2280 Facilities
Peds Emergency Department 5-5681

Staff - communicate/assign

Pre-OP - Triage Staging/OR Holding
OR - Immediate Surgical/Damage Control
Post-OP - PACU/Minor Procedure/PICU Annex
Consider call-in tree activation
Keep in
Call in
Standby
Reserve staff (12 hour hold)

Space - assign/secure

Consider double stretcher in rooms
PrepPACU/OR Corridor: stretchers/beds/equipment

Stuff - secure/prepare/deliver

Stretchers/Monitors
Fluids/Blankets/Triage Intervention
Personal Protective Equipement

Activate Preparation Response (local)

(understand basic concepts of Patient Influx Protocols)

EP318 Patient Influx: Mass Casualty - ED
EP317 Patient Influx: Mass Casualty Physician Teams
EP322 Patient Influx: Mass Casualty Bio
EP323 Patient Influx: Mass Casualty Chemical
EP324 Patient Influx: Mass Casualty Radiation
EP333 Patient Influx: Epidemic/Pandemic Respiratory Illness (EPRI) Response Plan

Declare/verify appropriate Patient Influx Plan (ED/Hospital)

Activate local incident command (administration)

Notify clinical departments: ED, trauma for Peds & Adults, radiology & shift coordinators

Mobilization [partial] of staff: ED trauma nurses, radiology, public affairs, EVS, security

Activate local reverse triage

Decide/Assess:

Define staff, space, stuff needs
Acquire/Prepare additional supplies
[partial] mobilization of hospital incident command

STAGE 2 (RAMP UP) GOALS

Needs Assessment

Situation
Changing time-line
Incoming patients (numbers, types of injuries)
Changing needs assessment
Revised estimated ongoing time-line
Hospital/Local capacity needs assessment

Activate Hospital Response

(understand base concepts of code yellow ED vs. code yellow Hospital)
⁃Declare code yellow HOSPITAL
⁃Activate Hospital incident command (HICS)
⁃Notify clinical departments: wards, trauma for Peds & Adults, radiology & shift coordinators
⁃Stop elective operations (ORs/Clinics)
⁃Mobilization of staff: Hospital nursing, blood bank, EVS, radiology, public affairs, security, public affairs, facilities
⁃Call in additional staff
-Activate hospital-wide reverse triage

Decide/Assess:

⁃[partial] mobilization of hospital incident command
⁃Define staff, space, stuff needs
⁃Acquire/Prepare additional supplies
⁃Establish contact with other hospitals
⁃Go on ED diversion
⁃Contact materials management for more supplies (eg, PPE)

Activate concepts of Re-Triage

STAGE 3 (ACTIVE) GOALS

Triage + Treat Patients

Immediate interventions
Airway (Oxygen)
Bleeding (Tourniquet)
Thorax (Chest tube)
Poisoning (Antidote)

Move Patients Around

- match resources to needs

Expand available space to accommodate more patients

- repurpose space as necessary

Secure perimeter/crowd control

-“Protect the House”

Attempt to Resupply

- Anticipate ongoing needs
- Consider time-limited resources

STAGE 4 (CONSOLIDATION) GOALS

Recursive needs assessment: open ICU/OR beds

Maintain contact with other hospitals

-borrow supplies
-re-supply

Media/crowd management

Re-Triage

STAGE 5 (ON-GOING MANAGEMENT) GOALS

Staff management

  • fatigue mitigation
  • food
  • sleeping quarters

Family management

Advanced triage

Definitive Treatment

    • ICU, OR, Home, Psych Liaison, Morgue

Ongoing security

STAGE 6 (RESOLUTION) GOALS

Release excess staff home

Resume elective procedures again

Refresh new staff

De-escalate security

Restock supplies

Laundry/Room Flips

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