Community Health Center
Emergency
Management Plan
2007 EDITION
Contents
Acknowledgements... ................................................................................................... ..i
Introduction... ............................................................................................................ .. ii
1. General Information............................................................................................... 1
1.1. Policy and Primary Objectives .....................................................................1
1.2. Purpose and Scope......................................................................................2
1.3. Activation of Emergency Management Plan................................................5
1.4. General Hazard Vulnerability Analysis ........................................................ 6
1.5. Key Personnel.............................................................................................. 7
1.6. Definitions ............................................................................................... 8
2. Notification... ........................................................................................................12
2.1. Telephone List - Duties External Disaster... ..............................................12
2.2. Key Personnel - Phone/Pager Notification... .............................................13
2.3. Staff Notification List... ............................................................................14
2.4. Medical Spokesperson...............................................................................15
2.5. Facility Checklist... ..................................................................................16
2.6. Employee Demographic Sheet..................................................................17
2.7. Classification Assignment List... ................................................................18
2.8. Disaster Recall List Survey... .....................................................................19
3. Continuity of Operations... ...................................................................................... 20
3.1. Goals & Planning Elements... ....................................................................20
3.2. Emergency Generator... ............................................................................22
4. Staff... ........................................................................................................................... 23
4.1. Volunteer Staff........................................................................................23
4.2. Volunteer Staff Registration/Credentialing Form... ...................................25
5. Incident Command System... ................................................................................. 26
5.1. Activation Of Incident Command System... ..............................................26
COMMUNITY HEALTH CENTER EMERGENCY MANAGEMENT PLAN
5.2. EOC Activation Criteria And Setup............................................................28
5.3. EOC Habitability Considerations ...............................................................29
6. Hazard Vulnerability Analysis (HVA)... ................................................................... 31
6.1. HVA - General... .....................................................................................31
6.2. Determination Of Potential Risk... .............................................................34
6.3. Mitigation, Preparedness, Response & Recovery... .................................35
7. Incident Action Plan... ..........................................................................................37
7.1. Action Plan Development... ........................................................................37
7.2. Forms... ..................................................................................................39
7.3. Job Description Forms... ............................................................................41
7.4. Evacuation: General, Earthquake, Flood... ...............................................46
7.5. Telephone Disaster Procedure..................................................................51
7.6. Surge, Hospital... ........................................................................................53
7.7. Snow/Ice Emergency... ..............................................................................58
7.8. Internal Disaster Plan: Fire.........................................................................59
7.9. Weapons Of Mass Destruction..................................................................61
7.10. Resource Accounting Form... ....................................................................62
7.11. Urban Search & Rescue Task Forces Resource... ...................................63
7.12. Procurement Summary Report Form... .....................................................64
7.13. Radiation Disaster... ..................................................................................65
7.14. Radiation Accident Plan... .........................................................................74
7.15. Communicable Disease.............................................................................78
8. Patient Tracking... ................................................................................................... 89
8.1. Patient Tracking, General... ....................................................................89
8.2. Status Report... .......................................................................................91
8.3. Incident Completion Report... ....................................................................92
9. Decontamination/Personal Protective Equipment... ............................................. 93
9.1. Decontamination Procedure... ...................................................................93
9.2. Decontamination Tent Setup... ............................................................ ...101
9.3. PPE Inventory Tool... ......................................................................... ..103
COMMUNITY HEALTH CENTER EMERGENCY MANAGEMENT PLAN
10. Communications/IT.............................................................................................. 104
10.1. General Communications/IT Capacity... .................................................104
10.2. Risk Communication... .............................................................................105
10.3. EOC Message Form... ..........................................................................106
10.4. Portable Radio Usage... ..........................................................................107
10.5. Redundancy Of Communication Systems... ...........................................108
11. Mental Health... .................................................................................................... 109
11.1. Mental Health Team Activation... ............................................................109
11.2. Call In Center Activation...........................................................................110
11.3. Public Information Officer... ......................................................................111
12. Job Action Sheets ................................................................................................ 112
12.1. List Of Positions ....................................................................................112
12.2. Emergency Job Action Position Assignments .........................................113
12.3. Chief Executive Officer.............................................................................114
12.4. Emergency Incident Commander ............................................................115
12.5. Public Information Officer .........................................................................117
13. Facility Checklist ...............................................................................................156
13.1. General Facilities Checklist ......................................................................156
13.2. Management Of Environment ... .............................................................157
13.3. Facility’s Operational Status.....................................................................162
14. Drills/Exercises .........................................................................................................165
14.1. General Drills & Exercises .......................................................................165
14.2. Critique Of Drills & Exercises ..................................................................166
COMMUNITY HEALTH CENTER EMERGENCY MANAGEMENT PLAN
Acknowledgments
Portions of this emergency management plan have been adapted from excellent emergency
management materials by the following organizations:
CHCANYS Community Health Center Emergency Management Plan
Emergency Preparedness Project, California Primary Care Association
This project was made possible by the generous support of the Wisconsin Primary Health Care
Association and HRSA National Bioterrorism Hospital Preparedness Program-Wisconsin Hospital
Emergency Preparedness Program
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COMMUNITY HEALTH CENTER EMERGENCY MANAGEMENT PLAN
Introduction
The Community Health Center Emergency Management Plan: A template developed to assist Wisconsin’s
community health centers with emergency preparedness and planning.
The purpose of this manual template is to aid Community Health Centers (CHCs) in developing and
maintaining an emergency management plan that guides their response to all hazards. Included are
policies, procedures, and forms needed to create a comprehensive plan. These templates may be used to
both initiate and maintain emergency management programs.
The information, tools, and templates in this plan should be adapted for the individual needs of each CHC.
When planning and preparing, the CHC must consider:
• The hazards the CHC faces.
• The CHCs emergency management system.
• The CHCs own resources as well as the resources in the community.
The plan stresses the importance of collaboration with external agencies. CHCs will need to coordinate their
emergency preparedness, response, and recovery activities with local organizations. Forming these linkage
relationships prior to an emergency situation is key to preparing to activate them during an actual incident.
How to Begin
All-hazards planning is difficult. The Wisconsin Primary Health Care Association is committed to assisting
your health center in the step-wise approach that is needed to developing your center’s plan.
A first step that centers can take even before tackling this manual is to perform Awareness Training at your
center. Awareness Training can be something as simple as watching a webcast on “Emergency
Preparedness 101” or reaching out to WPHCA and asking for a tabletop exercise for your center staff.
These types of trainings serve to expose your staff to the concept of being prepared, why it is important, and
what it means for them as individuals and as part of a health center.
The next step would be to organize an Emergency Preparedness Team for your center. The mission of this
team would be to coordinate and formalize the center’s Emergency Management Plan. The number of staff
and the variety of job titles that form this team may vary depending on staff availability and familiarity with
developing policies and procedures. From that point forward, your team would want to follow this manual
template, adjusting it for your center as necessary, and asking WPHCA for further guidance and support
whenever needed.
WPHCA is indebted to the entire emergency preparedness planning community for much of the material in
this guide, and would like to thank in particular:
Community Health Care Association of New York State
California Primary Care Association
Frank Riedijk, Facilities Director, Sixteenth Street Community Health Center, Milwaukee, Wisconsin
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