This plan is designed for health care facilities in normally resource-sufficient regions. It may need to be adapted for facilities in resource-poor areas.
“Triggers” indicate the situations that should initiate the “Actions” and associated “Treatment Priorities.”
The Triggers change with each “Level.” Within each Level, all Actions or Treatment Priorities are in addition to or modify those listed for the preceding Levels.
In resource-poor institutions:
“ICU” beds and treatment mean any beds and treatment used for the sickest patients
“ED beds” are beds in the facility’s intake or reception area
“ED physician or equivalent” is the clinician with the most experience in quickly evaluating patients to make difficult triage decisions
The institutional disaster plan should be used when the facility does not use the “Hospital Incident Command System”
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|Level 0 |
|Triggers ||“Normal” demand-to-available-resource ratio. |
|Actions ||Normal activity. |
|Treatment Priority || |
Five-level nurse-run triage in emergency department (ED).
Immediately lifesaving surgeries before urgent surgeries before elective surgeries.
ICU bed allocation based on greatest need. Patients’ attending physicians and intensivist make decisions.
|Level 1 |
|Triggers || |
50% of ED (A&Ea) beds are filled with admitted patients.b
- or -
Staffed inpatient beds are 98% filled.b
- or -
External incident(s) is likely to generate or has already generated a combination of critical and/or noncritical patients exceeding 30% of normal ED or reception-area bed capacity in a short period of time.
- or -
Only 75% of any critical resourcec will be available for a significant period during the next 24 hours.
|Actions || |
Notify the Hospital Incident Command System (HICS) leadership.d
Stop all elective admissions and do not begin any elective surgeries.e
Refuse to accept transfers from other facilities if patients can be treated elsewhere.e
Whenever possible, transfer admitted patients who are not yet inpatients to other institutions.f
Immediately discharge all patients from the hospital (a) whose discharge is planned to occur within 12 hours and (b) who can be safely managed at home or in another available facility. The vacated bed must be available for new patients within 2 hours of discharge papers being signed.e
Fill all physical beds, use all levels of nursing personnel (expand their scope of practice to the extent that safety and the law permit), and, if necessary, decrease nurse-to-patient ratios.g
Discharge all ambulatory patients. Send them to other appropriate facilities, if available.e
If the situation is caused by an infectious agent or other contaminant, institute protective measures, including isolation and quarantine.
Activate “over-capacity” plan(s), including opening pre-identified locations to accommodate “surge capacity.” h
Consider implementing disaster plan.i
Consider using a trained risk-communicator to inform the public about the situation.i, j
|Treatment Priority |
The most experienced ED physician or the equivalent triages incoming patients.
Do not start any elective surgeries.
Physician Crisis ...