Emergency Preparedness

Kern Medical Emergency Operations Plan (EOP)

Hospital Emergency Operations Plan 2019

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Kern Medical Emergency Operations Plan (EOP)

Acknowledgements Note: Development and implementation of this plan complies with relevant sections of Joint Commission Emergency Management guidelines for Joint Commission accreditation of Critical Access Hospitals. Refer to Appendix A.2 - TJC Standards- 2019 CSR EM Self-Assessment for CAHs.

Plan Authorization This Kern Medical Emergency Operations Plan (EOP) has been developed for use by the Kern Medical. By affixing the signature indicated below, this EOP is hereby approved for implementation and intended to supersede all previous versions. This EOP was established to promote a system to: save lives; protect the health ensure the safety of the hospital environment; alleviate damage and hardship; and, reduce future vulnerability within the Hospital facilities and patient care areas. Further, this document indicates the commitment to annual planning, training, and exercise activities in order to ensure the level of preparedness necessary to respond to emergencies or incidents within the Hospital.

Chief Executive Officer

Date

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Kern Medical Emergency Operations Plan (EOP)

Plan Maintenance

The EOP will be reviewed annually and updated as needed. The table below lists the dates and reasons for revision and distribution. Record of Review and Distribution Date Revised Revised By Distribution Remarks September 2017 David Kalish September 2017 Reviewed and approved by EMC/EOC January 2018 David Kalish January 2018 Reviewed and Approved BY EMC/EOC January 2019 David Kalish March 2019 Reviewed and Approved by EMC/EOC

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Kern Medical Emergency Operations Plan (EOP)

Table of Contents Contents Acknowledgements ................................................................................................................................2 Plan Authorization ..................................................................................................................................2 Plan Maintenance...................................................................................................................................3 Table of Contents ...................................................................................................................................4 General................................................................................................................................................6 Purpose ...............................................................................................................................................6 Policy...................................................................................................................................................6 Scope...................................................................................................................................................7 Key Terms ............................................................................................................................................8 ALTERNATE SITES/FACILITIES ................................................................................................................8 CONTINUITY OF OPERATIONS (COOP)....................................................................................................8 EMERGENCY OPERATIONS CENTER (EOC) ..............................................................................................8 EMERGENCY PREPAREDNESS COORDINATOR (EPC)................................................................................8 EMERGENCY MANAGEMENT GROUP (EMG) ..........................................................................................8 EMERGENCY SUPPORT FUNCTION 8 COMMITTEE/COORDINATOR (ESF8C) ..............................................8 ESSENTIAL FUNCTIONS (EF)...................................................................................................................8 HAZARD MITIGATION...........................................................................................................................8 HAZARD VULNERABILITY ANALYSIS (HVA) ........................................................................................... 10 HEALTHCARE COORDINATION SYSTEM (HCS)............................................... Error! Bookmark not defined. HOMELAND SECURITY EXERCISE AND EVALUTION PROGRAM (HSEEP)................................................. 10 INCIDENT COMMAND SYSTEM (ICS) .................................................................................................... 10 MULTI-HAZARD APPROACH................................................................................................................ 10 NATIONAL INCIDENT MANAGEMENT SYSTEM (NIMS) .......................................................................... 10 PHASES OF EMERGENCY MANAGEMENT ............................................................................................. 10 STANDARD OPERATING PROCEDURES (SOP)........................................................................................ 10 1 MITIGATION ............................................................................................................................. 11 1.1 Introduction.............................................................................................................................. 11 1.2 Hazard Vulnerability Analysis .................................................................................................... 11 1.2.1 Hazard and Vulnerability Analysis ....................................................................................... 11 1.3 Hazard Mitigation..................................................................................................................... 12 1.4 Risk Assessment........................................................................................................................ 12 1.5 Insurance Coverage................................................................................................................... 13 2 PREPAREDNESS......................................................................................................................... 13 2.1 Introduction.............................................................................................................................. 13 2.2 Emergency Operations Plan....................................................................................................... 14 2.3 National Incident Management System (NIMS) .......................................................................... 15 2.4 Integration with Community-wide Response .............................................................................. 16 2.4.1 Coordination with Government Response Agencies.............................................................. 17 2.4.2 Coordination with Emergency Responders ........................................................................... 17 2.4.3 Mutual Aid ......................................................................................................................... 18 2.4.4 Relationship to Hospital Coordination System...................................................................... 19 2.5 Roles / Responsibilities – Disaster Recall list (HR)........................................................................ 20 F.2 – Emergency Management Organization Chart. ............................................................................. 20 2.6 Initial Communications and Notifications ................................................................................... 22 K.1 – Communications Equipment Inventory for Communication Resource List. .................................... 23 e. Refer to Appendix P.4 – Communications Procedures.................................................................. 23

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2.7 Continuity of Operations ........................................................................................................... 24 L.1 – Health Care Alternate and Referral Facilities. .............................................................................. 24 2.8 Hospital Patient Surge Preparedness.......................................................................................... 26 2.9 Incident Medical Resources ....................................................................................................... 28 2.10 Incident Mental Health............................................................................................................ 29 2.11 Public Information / Risk Communications ............................................................................... 30 2.12 Training, Exercises and Plan Maintenance................................................................................ 30 2.12.4 Plan Development and Maintenance................................................................................... 33 Appendix H.2 – Emergency Codes........................................................................................................ 33 3 RESPONSE................................................................................................................................. 33 3.1 Introduction.............................................................................................................................. 33 3.2 Response Priorities.................................................................................................................... 33 3.3 Alert, Warning and Notification ................................................................................................. 33 3.4 Response Activation and Initial Actions...................................................................................... 34 3.5 Emergency Management Organization ...................................................................................... 35 3.6 Emergency Operations Center (EOC) Operations ......................................................................... 38 3.7 Medical Care............................................................................................................................. 38 Appendix T.1 - Fire Chiefs Triage Tag. ............................................. Error! Bookmark not defined. 3.8 Acquiring Response Resources ................................................................................................... 42 3.9 Communications ....................................................................................................................... 43 J.3 – Incident Contacts. ....................................................................................................................... 43 3.10 Public Information / Crisis Communications.............................................................................. 44 3.11 Security .................................................................................................................................. 51 3.12 Mental Health Response.......................................................................................................... 52 3.13 Volunteer / Donation Management ......................................................................................... 53 3.14 Response to Internal Emergencies............................................................................................ 54 3.15 Response to External Emergencies ........................................................................................... 59 4 RECOVERY ................................................................................................................................ 62 4.1 Introduction.............................................................................................................................. 62 4.2 Documentation ......................................................................................................................... 63 4.3 Inventory Damage and Loss....................................................................................................... 63 4.4 Lost Revenue through Disruption of Services .............................................................................. 63 4.5 Cost / Loss Recovery Sources...................................................................................................... 63 4.6 Psychological Needs of Staff and Patients .................................................................................. 64 4.7 Restoration of Services .............................................................................................................. 64 4.8 After-Action Report................................................................................................................... 64 4.9 Staff Support ............................................................................................................................ 65 List of Appendices................................................................................................................................. 66 Appendix A TJC Standards ................................................................................................................. 66 Appendix F Organizational Tools ....................................................................................................... 66 Appendix J.1Staff Call Back................................................................................................................. 67 Appendix M Mental Health Coordinator Checklist............................................................................... 67 Appendix P.9 After Action Report ................................................................................................. 68 Appendix Q Volunteer and Donations Procedures............................................................................... 68 Appendix Q.1 Volunteer Management Policies and Procedures ...................................................... 68

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Kern Medical Emergency Operations Plan (EOP)

INTRODUCTION General Kern Medical is an acute care Hospital located in Bakersfield, California . As a community-based nonprofit organization, Kern Medical is committed to providing care that enhances the community’s quality of life through professional health care and related services. In order to meet the health care needs of our growing community,

Kern Medical provides the following services: • Inpatient/Outpatient and Ambulatory Care

• General and Orthopedic Surgery and other physician specialties • Physical Rehabilitation Therapy including speech therapies

• Imaging and Radiology • Emergency Department • Laboratory Purpose

The purpose of the Kern Medical Emergency Operations Plan ( EOP ) is to establish a basic emergency program to provide timely, integrated, and coordinated response to the wide range of natural and manmade events that may disrupt normal operations and require pre- planned response to internal and external incidents. The objectives of the emergency management program include: • To provide maximum safety and protection from injury for patients, visitors, and staff • To attend promptly and efficiently to all individuals requiring medical attention in an emergency situation. • To provide a logical and flexible chain of command to enable maximum use of resources to maintain and restore essential services as quickly as possible following an incident • To protect hospital property, facilities, and equipment. • To satisfy all applicable regulatory and accreditation requirements . Policy • Kern Medical will be prepared to respond to a natural or man-made incident, suspected case of bioterrorism or other emergency in a manner that protects the health and safety of its patients, visitors, and staff, and that is coordinated with a community-wide response to a large-scale incident. • All employees will know and be prepared to fulfill their duties and responsibilities as part of a team effort to provide the best possible emergency care in any situation. Each supervisor at each level of the organization will ensure that employees are aware of their responsibilities. • Kern Medical will work in close coordination with the Kern County Health Care Coalition (KCHCC) partners and other local emergency officials, agencies and health care providers to ensure a community-wide coordinated response to incidents.

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Kern Medical Emergency Operations Plan (EOP)

Scope • Within the context of this plan, an incident is any emergency event which overwhelms or threatens to overwhelm the routine capabilities of the hospital. • This all-hazards EOP describes an emergency management program designed to respond to natural and man-made incidents, including technological, hazardous material, and terrorist events. • Kern Medical tests its Emergency Management and Operations Plan twice a year, either in response to an actual emergency or in a planned exercise • At least one exercise a year is escalated to evaluate how effectively Kern Medical performs when it cannot be supported by the local community. • Kern Medical participates in at least one community-wide exercise a year. • This base plan describes the policies and procedures Kern Medical will follow to mitigate, prepare for, respond to, and recover from the effects of emergencies. • The Appendices contain functional resources and procedures that are followed in specific situations based on the incident type and level of response. An Appendix may also contain checklists, assessments, and technical references that may be necessary and will be included when appropriate and referenced in the base plan. • 42 CFR Part 485 Subpart F: Critical Access Hospitals (CAHs) are required to be in compliance with the Federal requirements set forth in the Medicare Conditions of Participation (CoP) in order to receive Medicare/Medicaid payment. This EOP was completed in order to be in compliance with the CoP set forth at 42 CFR Part 485 Subpart F. • Development and implementation of this plan complies with relevant sections of Joint Commission Emergency Management guidelines for Joint Commission accreditation of Critical Access Hospitals. Refer to Appendix A.2 - TJC Standards-2017 CSR EM Self-Assessment for CAHs.

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Kern Medical Emergency Operations Plan (EOP)

Key Terms Refer to Appendix B - Emergency Management Acronyms and Appendix C - Emergency Management Glossary for a list of acronyms and more extensive glossary, respectively. The following terms are used frequently throughout this document. ALTERNATE SITES/FACILITIES Locations other than the primary facility where Kern Medical will continue operations during an emergency. CONTINUITY OF OPERATIONS (COOP) Plans and actions necessary to continue essential business functions and services and ensure continuation of decision making even though primary facilities are unavailable due to emergencies. EMERGENCY OPERATIONS CENTER (EOC) The location at which management can coordinate Kern Medical activities during an emergency. It is managed using the Hospital Incident Command System (HICS) . The EOC may be established in the primary Kern Medical facility or at an alternate site. EMERGENCY PREPAREDNESS COORDINATOR (EPC) The Emergency Preparedness Coordinator guides the development and maintenance of Kern Medical’s emergency management program and development of its emergency operations plan. EMERGENCY MANAGEMENT GROUP (EMG) The Emergency Management Group consists of Kern Medical staff that will fill the core positions of the Emergency Operations Center (EOC) and manage Kern Medical’s emergency response. Kern County Health Care Coalition (KCHCC) This coalition in the National Incident Management System (NIMS) is responsible for all incident medical and health coordination in Kern County. The ESF8C is often stationed in the County EOC and is frequently, but not always, the County Health representative or designee (Deputy IC or Liaison). During the response to incidents, the ESF8C is the ESF8 point-of-contact for requests for medical and health resources including personnel, supplies and equipment, pharmaceuticals, and medical transport. ESSENTIAL FUNCTIONS (EF) Essential functions and services are those that implement Kern Medical’s core mission and goals. The extended loss of these functions, following an emergency, would create a threat to life/safety, or irreversible damage to, its staff or its stakeholders. HAZARD MITIGATION Measures taken by a facility to lessen the severity or impact a potential incident or emergency may have on its operation. Hazard mitigation can be divided into two categories.

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Kern Medical Emergency Operations Plan (EOP)

Structural Mitigation: Reinforcing, bracing, anchoring, bolting, strengthening or replacing any portion of a building that may become damaged and cause injury, including exterior walls, exterior doors, exterior windows, foundation, and roof. Nonstructural Mitigation: Reducing the threat to safety posed by the effects of earthquakes on nonstructural elements. Examples of nonstructural elements include:

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Light fixtures, gas cylinders, HazMat containers, desktop equipment, unsecured bookcases and other furniture. HAZARD VULNERABILITY ANALYSIS (HVA) Hazard vulnerability analysis identifies ways to minimize losses in an incident considering emergencies that may occur within the facility as well as external to the facility in the surrounding community. HOMELAND SECURITY EXERCISE AND EVALUTION PROGRAM (HSEEP) The Homeland Security Exercise and Evaluation Program (HSEEP) is a capabilities and performance-based exercise program. The intent of HSEEP is to provide common exercise policy and program guidance capable of constituting a national standard for all exercises. HSEEP includes consistent terminology that can be used by all exercise planners, regardless of the nature and composition of their sponsoring agency or organization. HOSPITAL INCIDENT COMMAND SYSTEM (HICS) A temporary management system used to manage and coordinate Kern Medical’s activities during an emergency. HICS is designed facilitate decision-making in an emergency environment. MULTI-HAZARD APPROACH A multi-hazard approach to incident planning evaluates all threats including the impacts from all natural and man-made incidents, including technological threats, terrorism, and a state of war. NATIONAL INCIDENT MANAGEMENT SYSTEM (NIMS) NIMS is the mandatory system established by HSPD-8 for managing the response of government agencies to multi-agency and multi-jurisdiction emergencies in California. NIMS incorporates the use of the Incident Command System (ICS). PHASES OF EMERGENCY MANAGEMENT Mitigation - Pre-event planning and actions which aim to lessen the effects of potential incident. Preparedness – Actions taken in advance of an emergency to prepare the organization for response. Response - Activities to address the immediate and short-term effects of an emergency or incident. Response includes immediate actions to save lives, protect property and meet basic human needs. Recovery - Activities that occur following a response to an incident that are designed to help an organization and community return to a pre-incident level of function. STANDARD OPERATING PROCEDURES (SOP) Pre-established procedures that guide how an organization and its staff perform certain tasks. SOPs are used routinely for day to day operations and response to emergency situations. SOPs are often presented in the form of checklists or job action sheets.

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Kern Medical Emergency Operations Plan (EOP)

1 MITIGATION 1.1 Introduction

Kern Medical undertakes risk assessment and hazard mitigation activities to lessen the severity and impact of a potential emergency. Mitigation begins by identifying potential emergencies (hazards) that may affect the organization's operations or the demand for its services. This is followed by development of a strategy to strengthen the perceived areas of vulnerability within the organization. During the mitigation phase, the Kern Medical Emergency Management Committee, leadership, Medical staff, and general staff identifies internal and external hazards and take steps to reduce the level of threat they pose by mitigating those hazards or reducing their potential impact on Kern Medical. The areas of vulnerability that cannot be strengthened sufficiently are addressed in emergency plan appendices. Mitigation activities occur both before and following an incident. 1.2 Hazard Vulnerability Analysis 1.2.1 Hazard and Vulnerability Analysis 1.2.1.1 Kern Medical conducts a hazard vulnerability analysis to

identify hazards and the direct and indirect effect these hazards may have on the healthcare system. This provides information needed by the hospital to minimize losses in an incident. Risks associated with large-scale emergency events are periodically reviewed and analyzed by the Safety Officer in concert with Executive Team and the local agencies (i.e. County of Kern Emergency Medical Services, City of Bakersfield, Disaster Medical Planning Group, etc). When conducting the risk assessment of the hospital the probability of the event happening, as well as the severity of the impact of a potential event was taken into consideration. Included in the probability is a rating from one (being low) to three (of being high) that the likelihood this event will occur. Issues considered were known risk, historical data as well as past statistics. Appendix D.1 –Hazard Vulnerability Analysis (HVA) is a tool for estimating and ranking the probability of occurrence and potential severity of various events. This assessment is performed annually and whenever its needs and vulnerabilities change , relative to its objectives, scope, performance, and effectiveness. This evaluation process is coordinated through the Safety Officer, in conjunction with the Emergency Management Committee, EOC/Safety Committees, and KCHCC as appropriate. Results of this evaluation process will form the basis for future performance improvement standards, strategic goal setting, planning, and verifying the continued applicability of program objectives and HVA elements.

1.2.1.2 Kern Medical’s Role in Emergency Management Program: Kern Medical participates in several

communitywide emergency management programs, such as

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the Kern County Health Care Coalition (KCHCC), which includes all Bakersfield Hospitals, Bakersfield Police Department, Bakersfield Fire Department, Kern County EMS, Kern County School Districts, Kern County Public Health Department, and local clinics. Kern Medical’s role in relation to these entities in the event of an emergency is discussed, planned, and drilled for accordingly. Vulnerabilities: Kern Medical has met with KCHCC and communicated the hospital’s needs and vulnerabilities based on analysis conducted as part of the Kern Medical EOP and established expectations that the hospital will have from local response agencies in an emergency in terms of the local response agencies meeting the needs of the hospital. Each Hospital offers unique services in different locations of the city/county. Through the KCHCC the local hospitals and EMS discuss various scenarios and responsibilities. 1.2.1.4 The Emergency Operations and Plan (EOP ) have been written based upon the analysis of hazards, risks and vulnerabilities to the organization. The emergency policies and procedures are developed through the Safety Officer in concert with the Emergency Management Committee, hospital leadership, and EOC/Safety Committee. The hospital uses its HVA as a basis for defining mitigation activities designed to reduce risk of and potential damage from an emergency. 1.2.1.3 Communicating the Hospital’s needs and

1.2.2 Risk Management –Life Safety Survey, Risk Management Quarterly review. As part of its risk management program, Kern Medical will also conduct a Management of Environment Safety Survey of its facilities at least annually . Appendix D.4 Management of Environment Hazard Surveillance/Risk Assessment Form is a tool for conducting that survey, ranking problems and setting priorities for remediation. This ongoing remediation contributes to reducing the overall vulnerability of the hospital to various hazards. The tool provided in Appendix D.2 is modified, as necessary, to address problems associated with hazards identified through the hazard vulnerability assessment described in Section 1.2.1. 1.3 Hazard Mitigation Kern Medical will undertake hazard mitigation or retrofitting measures to lessen the severity or impact a potential incident may have on its operation. These measures are taken prior to incidents to minimize the damage to the facility. Refer to Appendix D.5 - Structural and Non-Structural Hazard Mitigation Checklists for a checklist of structural and non-structural hazard mitigation recommendations for specific hazards. 1.4 Risk Assessment Kern Medical will assess the risks identified in its Hazard Vulnerability Assessment that could not be eliminated or satisfactorily mitigated through its hazard mitigation program and determine their likelihood of occurrence and the severity of their consequences. This assessment of remaining risks will help to define the emergency response role Kern Medical adopts for itself and the

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Kern Medical Emergency Operations Plan (EOP) preparation required to meet that role. See Section 1.6 below .

1.5 Insurance Coverage The Chief Operations Officer, or designee, of Kern Medical will meet with insurance carriers to review all insurance policies and assess the facility’s coverage for relocation to another site, loss of supplies and equipment, and structural and nonstructural damage to the facility. 1.6 Kern Medical Emergency Response Roles 1.6.1 Kern Medical may play a variety of roles in responding to incidents including providing emergency medical care, providing temporary shelter and expanding primary care services to meet increased community needs created by damage to other health facilities. However, healthcare facilities are not equipped to respond definitively to all incidents. Kern Medical’s roles may be constrained by limited resources and technical capability and by the impact of the incident on the facility. Refer to Appendix E – Healthcare Response Roles and Requirements for a list of potential roles and the planning and preparedness requirements for meeting those roles. 1.6.2 As a part of its mitigation program, Kern Medical will identify the response roles it will prepare to perform following an incident. This decision will involve input from Kern Medical management and staff, the Kern Medical board of governors, and community and government emergency officials. Based on the findings of the risk assessment, Kern Medical will take the following steps to define the incident response roles for which it should prepare: • Assess the pre-incident medical care environment and the role Kern Medical performs in providing health services. • Assess Kern Medical’s resources including availability of staff to respond and ability of Kern Medical to survive intact. • Discuss potential response roles and findings of risk assessment with Emergency Support Function 8 Coordinator or Kern County Emergency Manager. • Obtain community input. • Obtain input from Kern Medical staff, especially medical and nursing directors, safety officer, and chief operating officer. • Present recommendations to its board of directors for consent, review, or ratification. Preparedness activities build organization capacity to manage the effects of emergencies should one occur. During this phase, the Kern Medical Executive Directors, Emergency Management Committee (EMC) and staff will develop plans and operational capabilities to improve the effectiveness of the Kern Medical response to emergencies. Specifically, Kern Medical will: • Develop / update emergency plans and procedures, including the Emergency Operations Plan. • Develop and update agreements with other community health care providers and with civil authorities. • Train emergency response personnel. • Conduct drills and exercises. 2 PREPAREDNESS 2.1 Introduction

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Kern Medical Emergency Operations Plan (EOP)

2.2 Emergency Operations Plan The Kern Medical Emergency Operations Plan is a ―all-hazards‖ plan that will guide Kern Medical response to any type of an incident or emergency. 2.2.1 On an annual basis, the EOP will be evaluated relative to its objectives, scope, performance, and effectiveness. This evaluation process is coordinated through the Safety Officer, in conjunction with the Emergency Management, EOC/Safety Committees, and hospital leadership. Results of this evaluation process will form the basis for future performance improvement standards, strategic goal setting, planning, and verifying the continued applicability of program objectives. The annual evaluation will include: 2.2.1.1 The continued appropriateness and relevance of program Objectives are assessed, as well as whether or not these objectives were met. 2.2.1.2 The Scope is evaluated relative to its continuing to comprise

meaningful aspects, relevant equipment, technology and systems, items that add value and elements conducive to continuous regulatory compliance. 2.2.1.3 The Performance dimensions are reviewed to evaluate expectations of performance attainment, measurement techniques, process stability and improvement efforts and outcomes, secondary to performance monitoring results. Such evaluations include the review of established performance standards and reports, hazard surveillance reports, emergency preparedness drills, process improvement projects, staff educational surveys, and staff participation. 2.2.1.4 The year is reviewed retrospectively to determine the extent to which the program was Effective in meeting the needs of the staff, members, and the organization, within the parameters of the given Scope and Objectives. This analysis includes initiatives, accomplishments, problem solving, examples and other evidence of effectiveness. 2.2.1.5 Kern Medical tests its Emergency Management and Operations Plan twice a year, either in response to an actual emergency or in a planned exercise 2.2.1.6 Kern Medical will conduct at least one exercise a year that includes an influx of actual or simulated patients. 2.2.1.7 At least one exercise a year is escalated to evaluate how effectively Kern Medical performs when it cannot be supported by the local community. 2.2.1.8 Kern Medical participates in at least one community-wide exercise a year.

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Kern Medical Emergency Operations Plan (EOP)

2.2.1.9 Emergency response exercises incorporate likely disaster scenarios that allow Kern Medical to evaluate its handling of communications, resources, and assets, security, staff, utilities, and patients.

2.2.1 The response procedures address the prioritized emergencies and is adapted to other emergencies as well that the hospital may experience. The response procedures include but are not limited to the following: • Determination for maintaining and or expanding services during a disaster. • Conservation of resources. • Curtailment of services.

• Supplementing resources from outside the community. • Suspension of services to new patients during disaster. • Staged evacuation.

2.3 National Incident Management System (NIMS) 2.3.1 Kern Medical has incorporated the principles of NIMS into its Emergency Operations Plan to ensure maximum compatibility with local government response plans and procedures. 2.3.2 According to Homeland Security Presidential Directive- 8, NIMS shall be used by all State Agencies responding to any of the following emergency operations: • Single jurisdictional/agency involvement • Single jurisdictional responsibility with multiple agency involvement • Multiple jurisdictional responsibilities with multiple agency involvement 2.3.3 NIMS incorporates the Incident Command System (ICS) which provides an efficient tool for the management of emergency operations. NIMS/ICS is designed to be adaptable to any emergency or incident. The system expands in a rapid and logical manner from an initial response to a major incident call- out. When organizational needs dictate, the system also contracts just as rapidly. 2.3.4 These components of NIMS / ICS are incorporated or referenced in this EOP.

• Common terminology • Modular organization • Unified Command • Action Planning • Manageable Span-of-Control • Multi-Agency and Inter-Agency Coordination 2.3.5 NIMS operates at the following levels of government:

• State - Statewide resource coordination integrated with federal agencies through the California Division of Emergency Management (DEM) and the California Department of Public Health (CDPH.) • Regional – Management and coordination of information and resources among City/Counties can be accomplished through

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Kern Medical Emergency Operations Plan (EOP) timely monitoring of REDINET systems. • Local/County – Manages and coordinates all local governments within the geographic boundary of a county. • Field - On-scene responders are coordinated through ICS. • Healthcare Coordination System (HCS) • Kern Medical interfaces with agencies as part of the Hospital Coordination System, as outlined in the Kern County Disaster Plan, and the Coordinator and/or Kern County Health Department Liaison.

Kern County Health Department

TIER III

Primary Care & Medical Offices

Emergency Medical Supply Cache

County Healthcare Coordination System (HCS)/ESF8

Medical Reserve Corps

Hospital

Human & Environmental Health

County Emergency Manager/ Operations Center (EOC)

Hospital

Regional Communications Center

Hospital

Hospital Coordination System or Hospital Designee

Regional Liaisons (e.g., MMRS )

Behavioral/Mental Health Agencies

Behavioral Health/Mental Health

State EOC

Emergency Medical Services

EMS Agencies

TIER IV

TIER II

TIER I

Figure 1: The healthcare coordination process for resource allocation and policy guidance. 2.4 Integration with Community-wide Response Kern Medical will notify the ESF8 Coordinator of any emergency impacting healthcare operations and will coordinate its response to community-wide incidents with the overall medical and health response of the County. See Appendix J.4 – Incident Contacts for list of agencies and individuals, including the ESF8 Committee , who should be contacted in emergencies. (Figure 1 above shows the general structure for ESF8 Coordination in Kern County).

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2.4.1 Coordination with Government Response Agencies To the extent possible, Kern Medical will ensure that its response is coordinated with the decisions and actions of the ESF8 Committee and other health care agencies involved in the response. To ensure coordination, Kern Medical staff will: 2.4.1.1 Coordinate with the ESF8 Committee to define Kern Medical’s role in the emergency response system. Determine which response roles are expected by officials and which are beyond the system’s response needs or Kern Medical’s response capabilities. See Appendix E – Healthcare Response Roles and Requirements for a list of potential healthcare roles 2.4.1.2 Participate in planning, training and exercises sponsored by medical and health agencies. 2.4.1.3 Develop reporting and communications procedures to ensure integration with City/County response. 2.4.1.4 Define procedures for requesting and obtaining medical resources and for evacuating / transporting patients. 2.4.1.5 During a response, report the status and resource needs of Kern

Medical and obtain or provide assistance in support of the community-wide response. This is accomplished through the standardized ESF8 reporting process established by the Healthcare Coordination System. See Appendix O.5 – ESF8 report.

2.4.2 Coordination with Emergency Responders

2.4.2.1 Emergency services availability- During an area-wide incident, fire, EMS and law emergency services may not be able to respond to emergencies at Kern Medical. 2.4.2.2 Response authority -Kern Medical personnel will cooperate fully with EMS and law enforcement personnel when they respond to emergencies. This may include providing information about the location of hazardous materials or following instructions to evacuate and close a Kern Medical facility. 2.4.2.3 Command post -Kern Medical has identified a recommended location for an emergency responder command post for coordinating the response to an emergency at the hospital. The location of the primary command post and an alternate are listed in Appendix L.2 – Health Care Alternate and Referral Facility Locations .

2.4.2.4 Establishment of an Alternate Care site

In the unlikely event the facility is deemed unsuitable for continued occupancy or cannot support adequate patient care, establishment of alternate care sites will be coordinated through a collaborative effort between the IC, Operations, Planning, and Logistics sections. The

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Kern Medical Emergency Operations Plan (EOP) management of necessary patient materials, the transfer of medications, medical records, medical equipment, as well as transportation arrangements and tracking patients to and from the alternative care site(s) is also a collaborative effort. Communications to Kern County EMS and other healthcare facilities to find potential adequate outside facilities may be obtained through the Kern County EMS radio system, Reddinet, cell phones, or RACES. The Incident Commander will work with Kern County EMS to determine where patients can be relocated. Determination of the site to be used in any given situation will be made at the time by the incident commanders of the hospital and Kern County EMS. Consideration will be given to clinical services required by the patients along with the nature of the emergency. Every effort will be made to provide the same quality of care at the alternate site chosen. Kern Medical collaborates with the KCHCC in the designation, establishment and support of alternate care sites. Kern Medical recognizes that it may need to rely on other health care facilities, especially those nearby, in responding to an incident to augment its capacity to meet patient care needs. Kern Medical will review existing formal and informal arrangements with health facilities to explore expanding their provisions to cover incident response conditions. The hospital will also seek to establish agreements with relevant facilities where no agreement currently exists. Kern Medical views these agreements as reciprocal and will also explore opportunities to provide support to these facilities if conditions allow. 2.4.3.1 Incident related arrangements with nearby hospitals include: 2.4.3.1.1 Kern County Mass Casualty Plan : Includes referral / diversion of patients to nearby hospitals, especially patients that require a higher level of care than Kern Medical can provide. The plan also references acceptance of diverted patients from hospitals to increase their capacity to care for seriously ill and injured. 2.4.3.1.2 Kern County Mass Fatality Plan : Includes references to

2.4.3 Mutual Aid

assistance rendered by Kern Medical in instances requiring support and staffing of surge facilities such as a temporary morgue, handling of deceased, and coordination with other healthcare facilities in management and transport of deceased.

2.4.3.2 Limitations

During an area-wide incident in which Kern County has opened its EOC , patient transfers and access to ambulances may need to be coordinated through the EOC-ESF8, overriding other agreements. The Mass

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Kern Medical Emergency Operations Plan (EOP) Casualty Plan may be activated in this instance. Developing arrangements for receipt or diversion/referral of incident victims requires careful and detailed planning including: • Alert and notification • Sharing of medical information • Patient tracking • Contingencies that impact ability of either party to meet the terms of the agreement. The Hospital Coordination System and Kern Medical will define their emergency response relationship in accordance with the role established by the Hospital Coordination System (HCS). 2.4.4.1 In the preparedness phase, the HCS includes: • Strengthening the relationship and coordination between the ESF8C and hospitals in the county. • Resource acquisition including grant funding, group • Coordinated planning. • Exercise coordination. 2.4.4.2 In the response and recovery phases, the HCS role includes: • HCS coordinated hospital assistance to hospitals. • Information gathering and dissemination to other hospitals or City/County. • Resource acquisition. • Public information. • Technical assistance 2.4.4.3 In the recovery phase, assisting with obtaining financial recovery assistance. 2.4.4.3 As soon as practicable during an incident, Kern Medical’s Incident Commander, or designee, will report the following to the Hospital Coordination System. See Appendix J.4 – Incident Contacts for call list: • Nature of the emergency. • Impact of the emergency on hospital operations. • Current operational status of the hospital. • When the hospital expects to become fully operational. • Hospital resource needs. 2.4.4.5 Hospital reporting to the Hospital Coordination System (HCS) does not take the place of reporting to the EM , unless the County plans call for hospital – EM coordination to be mediated by the Hospital Coordination System as described in the Kern County ESF8 Operations Plan . 2.4.4.6 Hospital reporting to the Hospital Coordination System (HCS) purchasing and shared equipment. • Training and technical assistance.

2.4.4 Relationship to Hospital Coordination System

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Kern Medical Emergency Operations Plan (EOP) does not necessarily constitute a request for resources or other assistance.

2.4.5 Coordination with Hospital Board of Governor’s (HBG) The Kern Medical Administrator-on-Call will notify the HBG of the hospital in the event of any emergency that requires hospital evacuation, 911 response of emergency medical or law enforcement personnel, or the opening of the hospital EOC . 2.4.6 Acquiring Resources 2.4.6.1 Kern Medical has procedures for augmenting supplies, equipment and personnel from a variety of sources. Assistance may be coordinated through the following channels: • Prior agreements with vendors for emergency re-supply. • EM.01.01.01(8) Assets, stockpiles of medical supplies and pharmaceuticals anticipated to be required in an emergency response (i.e. Strategic National Stockpile, SNS.) All items are inventoried and documented • Emergency Support Function 8 Committee (ESF8C) assistance to hospitals in coordination with the Kern Medical Emergency Medical Supply Cache as outlined in the Kern County Supply Allocation Matrix . See Appendix L.4- Kern County Supply Allocation Matrix . • From other hospitals, hospitals or health care providers. 2.5 Roles / Responsibilities – Disaster Recall list (HR) EM.02.01.01(1)/EM02.01.01(2) 2.5.1 The Kern Medical Chief Executive Officer (CEO) The Hospital CEO is responsible, directly or through delegation, for the development of the EOP and for directing the response to emergencies. Specific responsibilities include: a. Execute (oversee) the development and implementation of the incident plan. b. Appoint an Emergency Preparedness Coordinator (EPC) to coordinate the development and maintenance of Kern Medical’s Emergency Operations Plan; ensure the organizations emergency preparedness program meets all applicable standards or government regulations; and, provide for ongoing training for hospital staff. See Appendix A – TJC and CMS regulations. The EMC will chair a committee that should include the safety manager, facility manager(s) and senior representatives from administration and health care staff. c. Assign staff emergency management duties and responsibilities. Appoint the Emergency Management Committee (EMC). See Appendix F.1 – Day-To-Day Org Chart / EMG Assignment based on Job Action Sheets and AppendixF.2 – Emergency Management Organization Chart.

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Kern Medical Emergency Operations Plan (EOP)

d. Ensure staff is trained to perform emergency roles. See Appendix G - Training And Exercises.

e. Ensure that drills and exercises are conducted semi-annually and records are maintained. See Appendix G - Training and Exercises. f. Evaluate the incident program annually and update as needed including a description of how, when and who will perform the activity. g. Activate the hospital’s emergency response. h. Direct the overall response to the incident/emergency. i. Develop the criteria for and direct the evacuation of staff, patients and visitors when indicated. j. Ensure the hospital takes necessary steps to avoid interruption of essential functions and services or to restore them as rapidly as possible. See Section 2.5. k. Ensure a hazard vulnerability assessment is performed periodically. The Medical Director, directly or through delegation, will: a. Serve as leader, co-leader, or member of the Emergency Management Committee (EMC) . b. Identify alternates and successors if unavailable or if response requires 24 hour operation. c. Contact local health department to determine local system for bioterrorism updates. Monitors Electronic Disease Reporting Systems for updates. Provide hospital with updates from the CDC and Kern County Health Department on standards for the detection, diagnosis, and treatment of chemical and bioterrorism agents. d. Ensure the continuity of care and maintenance of medical management of all patients in the care of the hospital during an incident. e. Assign hospital staff to medical response roles (triage, treatment, decontamination, etc.) f. Determine incident response hospital staffing needs in cooperation with the Nursing Director. The Nursing Director may fill the following roles: a. Serve as a member of the EMC. b. Monitor electronic medical records repositories and Electronic Disease Reporting Systems for bioterrorism updates. c. Provide hospital with updates from the CDC and NHD of standards or the detection, diagnosis, and treatment of chemical and bioterrorism agents. d. Determine the incident response hospital staffing needs in cooperation with the Medical Director. e. Perform other duties delegated by the Kern Medical Medical Director , Chief Executive Officer or Incident Commander consistent with training and scope of practice. The Safety Officer will appoint teams and develop procedures for the following response tasks:

2.5.2 Medical Director

2.5.3 Nursing Director

2.5.4 Safety Officer

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