All items with an asterisk (*) are required for submission.
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Other facility, if not listed above:
RESOURCES REQUIRED
The workload will require adequate staffing and backup personnel for the initial response, and mechanisms for notification and activation, credentialing volunteers, and for ensuring the safety and welfare of responders.
Which of the above resources, if any, necessitated additional expenditures over those currently planned for your department?
Based on your experience implementing the template, what resources should be added to the "Required Resources" section?
Which of the above resources, if any, caused you the biggest concerns or problems? (Please explain.)
What were the most significant barriers you encountered related to the "Required Resources"?
ACTION STEPS 1. Make all physical beds available for care, including those in storage and those that can be rented on short notice. Place cots in rooms or hallways.
* Indicate your current progress in implementing this action step
Please provide any additional comments or explanation that will help to explain your progress.
* How long did it take to implement this step? (If you have not completed this step, estimate how long it will take you to complete implementation.)
Please provide an estimate of the effort — # of people and # of actual person hours — required to complete this action step
Please provide an estimate of the cost of implementing this action step.
What types of additional resources were required to complete this action step?
What would you change about this action step?
What were the most significant barriers you encountered in implementing this action step?
2. Develop criteria and policy to discharge patients who can go home or be quickly transferred to long-term care.
* Indicate your current progress in implementing this action step
Please provide any additional comments or explanation that will help to explain your progress.
* How long did it take to implement this step? (If you have not completed this step, estimate how long it will take you to complete implementation.)
Please provide an estimate of the effort — # of people and # of actual person hours — required to complete this action step
Please provide an estimate of the cost of implementing this action step.
What types of additional resources were required to complete this action step?
What would you change about this action step?
What were the most significant barriers you encountered in implementing this action step?
3. Make sure each department has a procedure for mass casualty care. These procedures need to be reviewed and be accessible to the command center.
* Indicate your current progress in implementing this action step
Please provide any additional comments or explanation that will help to explain your progress.
* How long did it take to implement this step? (If you have not completed this step, estimate how long it will take you to complete implementation.)
Please provide an estimate of the effort — # of people and # of actual person hours — required to complete this action step
Please provide an estimate of the cost of implementing this action step.
What types of additional resources were required to complete this action step?
What would you change about this action step?
What were the most significant barriers you encountered in implementing this action step?
4. Departments need to determine procedures for what will be done immediately (0–120 minutes), intermediately (2–4 hours) and long term (4–24 hours).
* Indicate your current progress in implementing this action step
Please provide any additional comments or explanation that will help to explain your progress.
* How long did it take to implement this step? (If you have not completed this step, estimate how long it will take you to complete implementation.)
Please provide an estimate of the effort — # of people and # of actual person hours — required to complete this action step
Please provide an estimate of the cost of implementing this action step.
What types of additional resources were required to complete this action step?
What would you change about this action step?
What were the most significant barriers you encountered in implementing this action step?
5. Request that policies be approved by a centralized committee that oversees the emergency operations and plan. .
* Indicate your current progress in implementing this action step
Please provide any additional comments or explanation that will help to explain your progress.
* How long did it take to implement this step? (If you have not completed this step, estimate how long it will take you to complete implementation.)
Please provide an estimate of the effort — # of people and # of actual person hours — required to complete this action step
Please provide an estimate of the cost of implementing this action step.
What types of additional resources were required to complete this action step?
What would you change about this action step?
What were the most significant barriers you encountered in implementing this action step?
6. Update call lists. Every department should have a current list that identifies staff by their proximity to the hospital.
* Indicate your current progress in implementing this action step
Please provide any additional comments or explanation that will help to explain your progress.
* How long did it take to implement this step? (If you have not completed this step, estimate how long it will take you to complete implementation.)
Please provide an estimate of the effort — # of people and # of actual person hours — required to complete this action step
Please provide an estimate of the cost of implementing this action step.
What types of additional resources were required to complete this action step?
What would you change about this action step?
What were the most significant barriers you encountered in implementing this action step?
7. Make staff aware of where to park, where to report, how to respond, etc. during a disaster or emergency.
* Indicate your current progress in implementing this action step
Please provide any additional comments or explanation that will help to explain your progress.
* How long did it take to implement this step? (If you have not completed this step, estimate how long it will take you to complete implementation.)
Please provide an estimate of the effort — # of people and # of actual person hours — required to complete this action step
Please provide an estimate of the cost of implementing this action step.
What types of additional resources were required to complete this action step?
What would you change about this action step?
What were the most significant barriers you encountered in implementing this action step?
8. Maintain a centralized data base with staff competency skills like ACLS (Advanced Cardiac Life Support®), TNCC (Trauma Nurse Core Course), ENPC (Emergency Nurse Pediatric Course), and PALS (Pediatric Advanced Life Support). Identify who is competent to care for critically ill patients.
* Indicate your current progress in implementing this action step
Please provide any additional comments or explanation that will help to explain your progress.
* How long did it take to implement this step? (If you have not completed this step, estimate how long it will take you to complete implementation.)
Please provide an estimate of the effort — # of people and # of actual person hours — required to complete this action step
Please provide an estimate of the cost of implementing this action step.
What types of additional resources were required to complete this action step?
What would you change about this action step?
What were the most significant barriers you encountered in implementing this action step?
9. Add on-call staff to the disaster call list.
* Indicate your current progress in implementing this action step
Please provide any additional comments or explanation that will help to explain your progress.
* How long did it take to implement this step? (If you have not completed this step, estimate how long it will take you to complete implementation.)
Please provide an estimate of the effort — # of people and # of actual person hours — required to complete this action step
Please provide an estimate of the cost of implementing this action step.
What types of additional resources were required to complete this action step?
What would you change about this action step?
What were the most significant barriers you encountered in implementing this action step?
10. Maintain names of retired or unemployed staff in a hospital or health system database.
* Indicate your current progress in implementing this action step
Please provide any additional comments or explanation that will help to explain your progress.
* How long did it take to implement this step? (If you have not completed this step, estimate how long it will take you to complete implementation.)
Please provide an estimate of the effort — # of people and # of actual person hours — required to complete this action step
Please provide an estimate of the cost of implementing this action step.
What types of additional resources were required to complete this action step?
What would you change about this action step?
What were the most significant barriers you encountered in implementing this action step?
11. Include Medical Reserve Corp information/lists in the emergency response plan.
* Indicate your current progress in implementing this action step
Please provide any additional comments or explanation that will help to explain your progress.
* How long did it take to implement this step? (If you have not completed this step, estimate how long it will take you to complete implementation.)
Please provide an estimate of the effort — # of people and # of actual person hours — required to complete this action step
Please provide an estimate of the cost of implementing this action step.
What types of additional resources were required to complete this action step?
What would you change about this action step?
What were the most significant barriers you encountered in implementing this action step?
12. Prepare badges in advance for credentialed professional staff.
* Indicate your current progress in implementing this action step
Please provide any additional comments or explanation that will help to explain your progress.
* How long did it take to implement this step? (If you have not completed this step, estimate how long it will take you to complete implementation.)
Please provide an estimate of the effort — # of people and # of actual person hours — required to complete this action step
Please provide an estimate of the cost of implementing this action step.
What types of additional resources were required to complete this action step?
What would you change about this action step?
What were the most significant barriers you encountered in implementing this action step?
13. Credential volunteers in advance. Community agencies typically manage volunteers.
* Indicate your current progress in implementing this action step
Please provide any additional comments or explanation that will help to explain your progress.
* How long did it take to implement this step? (If you have not completed this step, estimate how long it will take you to complete implementation.)
Please provide an estimate of the effort — # of people and # of actual person hours — required to complete this action step
Please provide an estimate of the cost of implementing this action step.
What types of additional resources were required to complete this action step?
What would you change about this action step?
What were the most significant barriers you encountered in implementing this action step?
14. Set up a system so that the hospital can verify credentials (i.e., State ESAR–VHP).
* Indicate your current progress in implementing this action step
Please provide any additional comments or explanation that will help to explain your progress.
* How long did it take to implement this step? (If you have not completed this step, estimate how long it will take you to complete implementation.)
Please provide an estimate of the effort — # of people and # of actual person hours — required to complete this action step
Please provide an estimate of the cost of implementing this action step.
What types of additional resources were required to complete this action step?
What would you change about this action step?
What were the most significant barriers you encountered in implementing this action step?
14. Ensure that staff is assigned to tasks with which they are most familiar and perform daily; do not change routine procedures.
* Indicate your current progress in implementing this action step
Please provide any additional comments or explanation that will help to explain your progress.
* How long did it take to implement this step? (If you have not completed this step, estimate how long it will take you to complete implementation.)
Please provide an estimate of the effort — # of people and # of actual person hours — required to complete this action step
Please provide an estimate of the cost of implementing this action step.
What types of additional resources were required to complete this action step?
What would you change about this action step?
What were the most significant barriers you encountered in implementing this action step?
