Strengthening Emergency Response:
Development of Standard Operating Procedures
for Use in Federal Medical Stations
CAPT Holly Ann Williams
Nurse Epidemiologist/Anthropologist, CDC
CDR Robin Bartlett
Pharmacist, Indian Health Service
LT Josef Otto
Occupational Therapist, Department of Defense
2011 U.S. Public Health Service Scientific and Training
Symposium
New Orleans, LA
23 June 2011
Center for Global Health
International Emergency and Refugee Health Branch
Outline

Definition of a Standard Operating Procedure (SOP)
 Purpose
 Description and elements of a SOP
 Template and example of written format

Federal Medical Stations
 Description of services
 Environment during an emergency response and importance of
SOPs during deployments

Development of SOPs by PHS Rapid Deployment Force
(RDF) 3 :
 Types of SOPs
Definition: Standard Operating Procedure (SOP)

Set of written instructions that document a routine or
repetitive activity followed by an organization

Key concepts:






Prescribed procedures
To be followed routinely
Deviations should be noted
Written for specific situations
Should be easily understood by those required to use it
Should be written by persons knowledgeable with the
activity and organizational structure
Purpose of a SOP

Promotes quality:
 Decreases variation and promotes quality through consistent
implementation of activities for a given situation, regardless of
personnel changes



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Provides officers with the information for how to
function in their particular deployment role
Describes how the various sections work together to
complete necessary activities
Illustrates expectations for performance - can be used
in training new officers
Offers the ‘ideal’ framework against which actual
response activities can be compared:
 Can be used to frame “lessons learned”
Description of a SOP

A “living” document:
 Should be reviewed routinely and re-enforced by
command/section/branch leadership

Concise, step-by-step and easy-to-read style:
 Keep it simple and short but have sufficient detail so that someone
with limited experience could successfully understand it and
perform the activity
 Flow charts or diagrams should illustrate processes when
applicable

Tactical in nature:
 How to perform in humanitarian response situations
Elements of a SOP

Numbering system with a unique title:
 Version number with date of approval, date of last revision
 Implementation date

Purpose of the SOP, which should match the title:
 “SOP – Patient Flow”
• Purpose: “The purpose of the SOP is to describe the process in which
patients move through the Federal Medical Station from initial
contact through discharge.”

Scope: identify those individuals that will use the SOP
or be affected by the process:
 “SOP – Patient Flow”
• Scope: “This SOP is applicable to RDF staff, volunteers, patients and
caregivers.”
Elements: II

Responsibilities - who does what by section/branch:
 You may need to add statement that additional staff would be
pulled as necessary during a surge or exacerbated emergency
situation

Procedure – what will be done, described in present
tense

References – other material to support this activity:
 outside sources, other SOPs, checklists

Definitions
SOP Template
Standard Operating Procedure –
1.
Purpose
The purpose of this Standard Operating Procedure (SOP) is to describe
the process in which……
2.
Scope
This SOP is applicable to RDF staff, volunteers, patients, and caregivers.
3.
Responsibilities
Operations Section: Preventative Medicine Branch,
Ancillary Services Branch, Patient Transport/Labor Pool:.
Logistics Section
Procedures:
SOP Template: II
5. References
http://www.apic.org/Content/Navigation
Menu/EmergencyPreparedness/SurgeCapacity/Shelters_Disasters.p
df
6.
Definitions
RDF – Rapid Deployment Force - The RDF consists of five pre-identified
teams, each comprising 105 or more multidisciplinary staff. The teams serve
on a rotating call basis, with the on-call team capable of deploying within 12
hours of notification. RDF teams have a built-in command structure and can
provide mass care at shelters (including FMSs), and staff Points of
Distribution and Casualty Collection Points. The RDF can also conduct
community outreach and assessments, among other functions.
Why are SOPs Necessary in a
Humanitarian Response?
FMS Prior to Patient Arrivals
Credit: Williams, RDF 3, LSU Field House, Hurricane Gustav, 2008
FMS After Patients Arrive!
Credit: Williams, RDF 3, LSU Field House, Hurricane Gustav, 2008
Credit: Williams, RDF 3, LSU Field House, Hurricane Gustav, 2008
Federal Medical Stations

Designed as medical asset to offer scalable surge
capacity for all-hazards casualty care events:
 Provides basic services for displaced populations
 Intended for low-acuity and special needs patients BUT reality
means acuity level often much higher than anticipated

Higher acuity patients create multiple challenges:
 Staffing level often inadequate for number and acuity of patients
 Patients tend to come in surges or waves:
• Need systems for triage , registration and provision of care by acuity
level (red, yellow, green)
 Officers may be in their first deployment situations
 Pace is fast and stressful
 May be co-deployed with a Disaster Medical Assistance Team
(DMAT) and/or local/state partners
Development of SOPs by RDF 3

Standardized, clear and concise guidance for staff was
recognized as need:
 Prompted development of SOPs
 Original SOPs were developed through the Preventive Medicine
Branches of all five RDFs but never approved by OFRD (2006):
• Animal health emergency support, APHT/RDF Collaboration,
community health facility assessment, community outreach,
community water assessment, FMS site selection, infectious diseases
and hand washing, medical waste, solid waste, surveillance in the
community, surveillance in the FMS, vectors, waste water, and water.
 Later, selected SOPs revised again in 2007 and 2009
Development of SOPs by RDF 3: II

Current SOPs that have been sent to OFRD:
 Management of death in a FMS
 Infection control
 Patient flow and patient flow expanded (situation of disease
outbreak)
 Red , yellow/green clinical areas
 Registration
 Triage

Additional SOPs in development with RDF 3:
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Children in the FMS
Patient referral to outside facilities
Rapid needs assessments of existing health care facilities
Special dietary needs
Surge capacity in the FMS
Violence in the FMS
SOP #
Rapid Deployment Force #3
Revision #
0
Implementation Date
TBD
Page #
1 of
Last Reviewed/Update
Date
SOP Owner
Operations Section
Approval
Standard Operating Procedure – Patient Flow
1.
Purpose
The purpose of this Standard Operating Procedure (SOP) is to describe the process in which patients
move through the Federal Medical Station (FMS) from initial contact through discharge.
2.
Scope
This SOP is applicable to RDF staff, volunteers, patients, and caregivers.
3.
Responsibilities
Ancillary Services Branch, Medical Records Group:
•Complete the Patient Admission log on all new arrivals to the FMS.
•Register patients in the Electronic Medical Record (EMR). If EMR system is unavailable, plan a back-up
“paper system” as deemed appropriate.
•Give all patients an armband for identification purposes.
Preventative Medicine Branch:
•Assist with completing Patient Admission log and Surveillance Assessment/Triage Form on all new
arrivals, to identify any potential infectious diseases or conditions requiring isolation.
Medical Services Branch:
•Triage all new patients
•Determine bed availability and assign patients to beds
•Evaluate and treat patients
•Assist with establishing discharge plan in collaboration with staff from the Services Access Team (SAT),
if available.
SOP #
Rapid Deployment Force #3
Revision #
0
Implementation Date
TBD
Page #
1 of
Last Reviewed/Update
Date
SOP Owner
Operations Section
Approval
Standard Operating Procedure – Patient Flow
4.
Procedure
The concept of patient flow will use the RAD model – Registration, Assessment, Discharge. The
flow of patients within the FMS will move from Registration, to Assessment, and finally to
Discharge. Each of the areas will have multiple components and assignments.
Registration -
Enrollment
Enrollment of the patients at the FMS will take place immediately after their arrival and be
located at an identified patient entrance.
RDF staff will complete the Patient Admission Log in written format to ensure accountability of all
patients and provide a backup in the event the EMR is unavailable.
RDF staff will enter all patients in the EMR.
RDF staff will give each patient an armband for identification purposes and direct them to the
Triage area.
Patient
Evaluation
and
Treatment
Discharge
Patient
processed
into FMS
Assessment
Registration
Patient Flow-RAD
Return to
Community
or Transfer
of Medical
Care
Registration
Enrollment
Triage
Patient Flow-RAD
Transport
Assessment
Bed Assignment
Evaluation
Treatment
Discharge
Discharge Plan
Discharge
Reestablish
Thank you to the original five Preventive
Medicine Branches of the RDFs and the
entire RDF 3 staff who have worked on
various versions of the existing SOPs.
For more information please contact Centers for Disease Control and Prevention
1600 Clifton Road NE, Atlanta, GA 30333
Telephone, 1-800-CDC-INFO (232-4636)/TTY: 1-888-232-6348
E-mail: cdcinfo@cdc.gov
Web: www.cdc.gov
The findings and conclusions in this report are those of the authors and do not necessarily represent the official
position of the Centers for Disease Control and Prevention.
Center for Global Health
International Emergency and Refugee Health Branch