KaMMCO Emergency/Disaster Preparedness Checklists for the Physician Practice

The purpose of the Emergency/Disaster Preparedness Checklists is to provide guidance for the physician practice during development of policies and procedures in the event of a catastrophic event that disables the medical and business functions of a medical practice. These checklists are designed to provide procedure guidance for operational capability to the greatest extent possible so that the work of a medical practice may continue with as little interruption as possible.

The best time to plan for an emergency or disaster is before it occurs. When preparing the emergency plan, the following questions will help shape policies and procedures.

How would the physician practice respond to a potential disaster? What should the practice consider in planning for a disaster? What steps should the practice take to protect the personnel and property of the practice?

Emergency/Disaster Preparedness

InsuranceInsurance coverage is adequate to resume business operations post event.Insurance coverage provides “replacement value” of lost assets.

If insurance coverage provides “current value” of assets; there is additional coverage to assist in replacement of the lost assets.Additional insurance needs such as flood, earthquake, business income or business interruption have been evaluated.Copies of the insurance policies are stored offsite in a secured location with appropriate access when needed.Copies of important information regarding insurance policies including: Agents name, address, phone number, types of policies, policy numbers, deductibles, policy limits and coverage.

Back-Up SystemsComputer/ EHR back-up is occurring at regular intervals.Alternate use of paper charts, consents, protocols and narrative notes paper are available should the EHR system become unavailable.Back-up system for billing, accounts receivable, accounts payable and payroll.Alternate use of paper – appropriate forms available.Video or written documentation of inventory including medical and office equipment and supplies.

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KaMMCO Emergency/Disaster Preparedness Checklists for the Physician Practice

Important Contact InformationFire Department Local Health DepartmentPolice Department Master Patient ListAmbulance Service Employee ListHospitalInsurance AgentMajor Suppliers/VendorsUtility CompaniesCommunications Companies

Office Disaster SuppliesFlashlight(s)Portable First Aid kitBasic tool kitBattery operated radio and batteriesBattery operated weather radio and batteries

Offsite Storage of InformationCopy of insurance policiesCopy of video/list of inventoryCopy of important contact informationCopy of lease/rental agreementBack-up tapes, discs, thumb drivesCopy of the Emergency/Disaster planMaster patient list with contact information

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KaMMCO Emergency/Disaster Preparedness Checklists for the Physician Practice

The physician practice should consider identifying and implementing the following policies and procedures prior to a potential emergency or disaster occurring.

Document Preservation Evacuation Communication Outage Fire Electrical Power Outage Bomb Threat Public Water Supply Disruption Earthquake Localized Water Disruption (Froze/Burst Pipes) Tornado Flood Work Place Violence – Active Shooter Natural Gas Leak Biohazard/Pandemic Events Hazard Communication Medical Emergencies

After identification of the necessary policies and procedures to be developed and implemented, it will be necessary to ensure all employees are educated and training is performed. Education and training on emergency/disaster policies and procedures ideally occurs at hire, annually, and when the policies and procedures are modified unless otherwise stated by a regulating agency.

Physician practices are encouraged to review this material and adapt it to the unique circumstances of their particular practices. For additional information on preparing a disaster plan including how to respond to particular disasters, the Small Business Administration and the Federal Emergency Management Agency (FEMA) have excellent resources on their websites. Go to www.sba.gov and www.fema.gov.

Emergency/Disaster Preparedness Checklists3

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KaMMCO Emergency/Disaster Preparedness Checklists for the Physician Practice

Document Preservation Yes No Comments1. Electronic information is electronically backed up (patient

health records, patient billing, AP/AR and payroll).2. Paper information/documentation is kept in locked fire proof

cabinets or locked cabinets in a sprinkled room.3. Security policies are in place to protect the information during

an emergency or disaster event.(HIPAA/HITECH)Communication Outage Yes No Comments

1. Telephone and internet provider service numbers are identified and readily available.

2. Policy for personal cellular and/or smart phone use.3. Telephone outage only: alternate notification to patients

regarding contacting the practice (radio, television, cellular phone, text messaging, or announcements through outside vendors).

4. Forms (paper) available for tasks normally transmitted via internet (prescriptions, tele-radiology, Health Information Networks).

Electrical Power Outage Yes No Comments1. Electric company service/emergency telephone number is

identified and readily available.2. Back up electrical supply is available (solar battery, generator).3. Emergency lights are operable.4. Portable flashlights are available and operational.5. Patient fall precaution initiation due to reduced visibility.6. Protocol for documentation outside the computer system (paper

encounter forms, progress notes, order sheets, receipt book, dictation system).

7. Procedure for securing refrigerated medication and/or vaccine to prevent spoilage.

8. Exit plan for mobility impaired patients during elevator inoperability (practices/departments off the ground floor).

9. Protocol for determination of necessary operations/services during electrical power outage.

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KaMMCO Emergency/Disaster Preparedness Checklists for the Physician Practice

Public Water Supply Disruption Yes No Comments1. Water company or city service/emergency telephone number is

identified and readily available.2. Protocol for necessary services/operations involving potable

water.3. Back up supply of potable water (drinking water).4. Back up supply of sanitary water (hand washing and toilets).5. Supply of waterless hand sanitizer is available.

Localized Water Disruption (Frozen/Burst Water Pipes) Yes No Comments1. Building manager and/or plumber emergency telephone number

identified and readily available.2. Policy outlines precautions to be taken to prevent frozen or

burst water pipes.3. Employees know where the water shut off valve is and how to

shut it off.4. Protocol for clearing important equipment, documents and

personnel from the affected area.5. Plan for cleanup of affected area and/or contact information for

service to clean the affected area.6. Protocol for necessary services/operations involving potable

water.7. Back up supply of potable water (drinking water).8. Back up supply of sanitary water (hand washing and toilets).9. Supply of waterless hand sanitizer.

Flood https://www.osha.gov/dts/weather/flood/preparedness.html and http://www2.agilityrecovery.com/assets/SBA/floodprepsba.pdf

Yes No Comments

1. Proximity to flood zone has been identified.2. If in a flood zone – base flood elevation (BFE) has been

identified and the potential impact on the practice.3. Sump pit is installed and operational for floors below BFE.4. Utilities and storage areas are above BFE.

5. Protocol for notification of employees, patients and visitors regarding a flood warning and/or flash flood warning.

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KaMMCO Emergency/Disaster Preparedness Checklists for the Physician Practice

6. Consider implementation of evacuation procedure to ensure patient, employees and visitor safety.

Natural Gas Leak Yes No Comments1. Proper ventilation of flue and chimney is checked and

maintained.2. Air filters are cleaned or replaced regularly.3. Air intake areas near appliances remain clear.4. A qualified contractor inspects the heating and cooling

equipment annually.5. Protocol for action if the smell, even the faint odor of mercaptan

(rotten eggs) or hear a hissing noise.6. Protocol includes implementation of the evacuation plan.7. The notification of others in person to leave the premises. Do

not use the telephone.8. Any open flame is extinguished; no flames are initiated

(matches, lighters or cigarettes).9. Appliances or lights are not to be turned on or off.10. Do not use the telephone. Electrical currents in switches and

telephones may spark an explosion.11. After evacuation of the building, call the local service provider

to report a natural gas leak or call 911.12. Ensure all employees stay away from the building until an

official familiar with the situation tells you it is safe to return.Hazard Communication https://www.osha.gov/dsg/hazcom/MTP101703.html

Yes No Comments

1. Hazard Communication program is in place.2. Hazardous chemicals are identified for each work area.3. Appropriate Personal Protective Equipment (PPE) is available

and used for each chemical.4. Employee Training – per OSHA requirements.5. Material Safety Data Sheets (MSDS) are available to employees

for each chemical they work with.6. Labels are attached to all chemical containers including

secondary containers.6

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KaMMCO Emergency/Disaster Preparedness Checklists for the Physician Practice

7. Hazard Communication program is updated annually and/or as new chemicals are introduced into the practice.

Evacuation http://www.mgma.com/Libraries/Assets/About/About%20MGMA/About%20Center%20for%20Research/MedicalOfficeEmergencyPreparednessPlanChecklist.pdf

Yes No Comments

1. Events requiring evacuation have been identified (fire, gas leak, bomb threat, etc…).

2. Primary evacuation routes are posted and visible for all employees, patients and visitors.

3. Off sight meeting point has been designated and employees are notified.

4. Employees and patient accountability procedure has been established.

5. Roles have been designed to ensure all rooms are evacuated appropriately.

6. Protocol for employees and patients with disabilities or special needs are established.

Fire Yes No Comments1. The building has a sprinkler system and maintenance records

are available to all requesting tenants.2. The building has fire alarms, fully functional and tested

regularly.3. Fire extinguishers are available with certification

documentation.4. Fire prevention plan is in place and reviewed regularly with all

employees.5. There is a no smoking policy for the building.

6. All employees are familiar and drill regularly on Rescue, Alarm, Contain and Extinguish/Evacuate (R.A.C.E.).

7. All employees are trained to use a fire extinguisher using Pull pin, Aim, Squeeze and Sweep (P.A.S.S.).

8. If medical gases are present ensure employees are trained where

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KaMMCO Emergency/Disaster Preparedness Checklists for the Physician Practice

and how to turn them off.9. Additional information:

http://www.minotnd.org/pdf/fire/businesschecklist.pdfBomb Threat Yes No Comments

1. Written bomb threat procedure developed.2. Protocol established when written threat of a specific device is

received.3. Employees will notify the Practice Administrator/Physician

and/or Police.4. Telephone/Cellular phone bomb threat procedure developed.5. Person taking the bomb threat call understands the necessary

documentation. (See attached check list.)6. A search plan has been developed.7. Employees are trained and drill on a regular basis.

Earthquake http://www.ready.gov/earthquakes and http://www2.agilityrecovery.com/assets/SBA/quakeprepsba.pdf

Yes No Comments

1. Identification of potential earthquake activity in practice area.2. Earthquake procedure is developed for staff and patient safety.3. Areas of the building are identified and marked as earthquake

safe areas for protection from falling debris, i.e., under sturdy desks or tables, away from any type of glass.

4. Staff and patients are prepared for aftershock activity.5. Evacuation plan is initiated if necessary.6. Staff is trained to use emergency lights and flashlights for

lighting. Avoid open flame or turning on/off light switches due to potential gas leak.

7. Staff is trained to check for injured or trapped persons and when it is appropriate to move those persons.

Tornado http://www2.agilityrecovery.com/assets/SBA/tornadoprepsba.pdf

Yes No Comments

1. Areas of the building are identified and marked as “Tornado 8

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KaMMCO Emergency/Disaster Preparedness Checklists for the Physician Practice

Safe” areas (basements, small interior rooms without windows, interior hallways).

2. Tornado procedure is developed for staff and patient safety.3. If time allows, desk tops and workstations will be cleared and

computers turned off to preserve documentation and supplies.4. If time allows, blinds and curtains will be closed to add

protection from broken glass and debris.5. No building damage and utilities remain intact – practice returns

to normal business.6. Building damage and/or utility interruption – evacuation is

considered with appropriate precautions in place due to potential debris.

Workplace Violence https://www.osha.gov/Publications/osha3148.pdf

Yes No Comments

1. Demonstration of organizational concern for employee emotional and physical safety and health as well as patients.

2. There is a written workplace violence prevention program.3. Someone is clearly responsible for the program to ensure that

all managers, supervisors and employees understand their obligations.

4. Those responsible have sufficient authority and resources to take all action necessary to ensure worker safety.

5. The program addresses the kinds of violent incidents that are occurring in the practice.

6. The program provides for post-assault medical treatment and psychological counseling for health-care workers who experience or witness assaults or violence incidents.

7. There is a system to notify employees promptly about specific workplace security hazards or threats made.

8. Employees are aware of the above system.

9. There is a system for employees to inform management about workplace security hazards or threats without fear of reprisal.

10. Employees are aware of the above system.

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KaMMCO Emergency/Disaster Preparedness Checklists for the Physician Practice

11. There is a system for employees to promptly report violent incidents, “near misses,” threats and verbal assaults without fear of reprisal.

12. The tracking and reporting captures all types of violence—fatalities, physical assaults, harassment, aggressive behavior, threats, verbal abuse and sexual assaults.

13. High-risk locations or jobs with the greatest risk of violence as well as the processes and procedures that put employees at risk have been identified.

14. A process for reporting violent incidents within the facility to the police or requesting police assistance has been established.

15. Training occurs upon hire and at least annually.Additional Resources: Active ShooterWorkplace Violence: Protecting employees without violating the law: http://www.dinsmore.com/files/Publication/88e2e5de-fb3d-451e-9451-f9941ee6d56d/Presentation/PublicationAttachment/67b5f574-7fe5-412d-aa14-fb79329f81a2/BNA%20-%20Nelson.pdfActive shooter training video: http://www.youtube.com/watch?v=Cp6_fPPtlpEActive shooter training and certification FEMA/Homeland security: http://emilms.fema.gov/IS907/index.htmBiohazard/Pandemic Events: http://www.bt.cdc.gov/bioterrorism/prep.asp

Yes No Comments

1. Specific to pandemic influenza but can be adapted: http://www.aafp.org/dam/AAFP/documents/about_us/disaster/PanFluChecklist.pdf

2. Equipment, supplies and PPE for respiratory and/or contact isolation are available.

3. All staff is up to date on immunizations and seasonal vaccinations.

4. A process is in place to receive alerts from the County Health Department, County Emergency Manager and/or KDHE.

5. A plan is developed and implemented for a bioterrorism or

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KaMMCO Emergency/Disaster Preparedness Checklists for the Physician Practice

pandemic event.6. A plan is developed and implemented to procure and administer

appropriate medications needed in a bioterrorism or pandemic event.

Medical Emergencies Yes No Comments1. Procedures are identified for medical emergencies that may

occur in the practice setting.2. Staff is trained on their role during the medical emergency.3. Staff is trained on necessary equipment required during an

emergency (medication doses, Automated External Defibrillator (AED)).

4. Staff is certified in cardiopulmonary resuscitation (CPR).

BOMB THREAT CHECKLIST Use this checklist to help determine the seriousness of any bomb threat.

Report any threatening phone calls, crimes and suspicious activity to (name) at (phone number or extention).

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KaMMCO Emergency/Disaster Preparedness Checklists for the Physician Practice

Immediate Action: Notify your Practice Administrator and call the (insert) immediately. Bomb threat calls: Write down the caller’s message in its entirety and note your perceptions of the call.

Phone Number the threat was received on: _______________________ Time: ____________Date: / / Remarks:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Bomb Threat Search Techniques

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Threatening Phone Calls:

LISTEN – Do not interrupt except to obtain the following information.

QUESTIONS TO ASK

Verbal Bomb Threats1. When is the bomb going to explode?2. Where is it located?3. What does it look like?4. What is your name?5. Where do you live?

6. Name of the person being threatened?7. When will this happen?8. Why are they being threatened?

Try to obtain the following:Caller’s Voice: ___ Female ___ Male ___ Angry ___ Excited ___Calm ___ Raspy ___ Soft ___ Loud

Background Sounds:___ Street Noises ___ Traffic Noises ___ Office Noises ___ Local or Long Distance ___ Plane, Train ___ TV or Radio

Suspicious Packages:

DO NOT TOUCHLISTEN CAREFULLY FOR TICKING SOUNDS OR CLOCKWORK MECHANISMS

Mail Bomb Recognition1. Restricted markings such as confidential, personal,

etc.2. Excessive postage3. No return address4. Foreign mail5. Handwritten or poorly typed addresses6. Excessive securing material such as masking tape

or string7. Excessive weight or lopsided packages8. Pictures, drawings or visual distractions

KaMMCO Emergency/Disaster Preparedness Checklists for the Physician Practice

Search Technique: An initial search by supervisory personnel can be made to avoid employee/patient suspicion. This search is made to deter the interruption of business operations. Select search teams. Use people who are knowledgeable of certain areas of the building. Use two-person search teams if possible and follow these steps.

Search logical bomb areas first: restrooms, stairwells, office areas, boiler room, etc. Enter the room, close your eyes and listen for any ticking sounds or clockwork mechanisms. Divide the area and select a search height (see picture above). Start from the bottom and work up. Start back-to-back with another search team member and work around the room toward each other. Go around the walls and proceed toward the center of the room. Place a piece of tape across the outside doorjamb or mark with chalk in a conspicuous manner when search is complete. Relay search information by phone to Practice Administrator. It is important to remember that a bomb can be placed anywhere; therefore, a complete search should be made. Depending on

available time, make as complete a search as possible. Report back to the Practice Administrator when entire search is complete or suspicious item is found. IF A BOMB OR SUSPICIOUS DEVICE IS FOUND, IT SHOULD NOT BE TOUCHED. Report the device to your Practice

Administrator.

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