In an emergency, could you evacuate everyone? Learn from 3 ASCs that did
Bomb threat, vapors in the AC system, and fire alarm meant clear out now
By Joy Daughtery Dickinson, Executive Editor
On the surface, evacuating a facility might seem like a simple and straightforward process, but have you ever thought through exactly how you would evacuate patients, some of whom might be in surgery, as well as staff and families? Although such a scenario might seem far-fetched, consider these three recent examples:
- A disgruntled relative of a former patient called in a bomb threat to an ambulatory surgery center (ASC) in Eureka, CA, at 8 a.m. Aug. 8, 2011, and said a bomb would detonate at 11 a.m. Fifteen people had to be evacuated, including one from an operation in progress.
- On Sept 7, 2011, a roofing contractor was working with a cleaning solvent at an outpatient surgery facility in Stockton, CA, and vapors entered the building. A few dozen patients and staff members were evacuated, and one person with respiratory problems was taken to a hospital.
- At a surgery center in Jackson, MI, a fire alarm went off at 1:13 p.m. Nov. 8, 2011. About 20 people, including three patients, were evacuated from the building.
Learn from their experiences:
When an anonymous man called in two threats that bombs would explode in about three hours at St. Joseph Hospital's Surgery Center in Eureka, CA, one surgery was in progress, according to the hospital.1
"We informed the surgeons and staff on the case of the bomb threat," says Sherie Henderson-Bialous, regional director of facilities-safety/security officer for St. Joseph Hospital, Eureka, and Redwood Memorial Hospital, Fortuna, CA. "They were willing to stay until the patient's case was complete. The patient was then transported via ambulance to St. Joseph Hospital for recovery." Two other patients scheduled to have surgery later were told to go to the hospital for their surgery.
Waiting patients were told to leave due to a security issue. A building maintenance supervisor informed police when he found a suspicious package outside the building, near some bushes. Traffic was closed for two hours.
The bomb squad examined the box and searched the building. The box was X-rayed and found empty. To be certain, the bomb squad used a robot to inspect the box and confirmed it was empty. The building was cleared for re-entry after about two and one-half hours. Because of the threat, the surgery center and hospital heightened their security procedures and didn't allow visitors to enter either facility with personal items on that day.
One lesson learned: Have a designated person you can radio or call to take down timelines, Henderson-Bialous says. "This was crucial due to the fact that this is a reportable event to the California Department of Public Health," she says.
Another lesson was that it would be helpful to have cameras aimed at the building's exterior, Henderson-Bialous says. "This would allow you to see if a suspicious package outside was left by a staff member or someone else," she says.
Also, be aware that if you have a bomb threat, your staff probably will be asked to search the building. "As pointed out by the bomb squad, they would know what was supposed to be in the facility or not," Henderson-Bialous says. "Make sure when you hold a bomb threat drill to include this detail in the scenario."
Vapors came in, staff & patients cleared out
In another 2011 evacuation, vapors from a cleaning solvent named Sarnasolv, used to remove glue, entered the central air system at the outpatient surgery facility of the Stockton (CA) Medical Offices of the Kaiser Permanente Central Valley Area.2 A published report said roofing crews had been instructed not to use that solvent during the facility's business hours.2
"We had a roofing contractor doing maintenance work on our roof that day, and vapors entered the system after one of the roofing contractor's employees made an inadvertent error," says Melanie Hatchel, public affairs director at Kaiser Permanente Central Valley Area. "As soon as we learned of the problem, we took immediate action to prevent additional vapors from entering the ventilation system, stopped procedures in the surgery center, evacuated the building, and thoroughly cleared the air inside. We also contacted the Stockton Fire Department."
All Kaiser Permanente facilities have evacuation maps and procedures, Hatchel says. "We perform evacuation drills frequently to reinforce the practice, and this event demonstrated that the procedure worked quickly and smoothly," she says.
Persons who were evacuated waited in a lobby. One employee who complained of respiratory symptoms was treated and released, Hatchel says. By late morning, the fire department had cleared the facility, and scheduled surgeries were resumed, she says.
"We conducted a thorough review of the incident and used the information to strengthen our processes in place to identify and respond to any conditions that may be unique to a particular project, and to reinforce contractors' training of their employees," Hatchel says. She declined to provide more details. (For information on an evacuation in response to a fire alarm, see story, below. For information on hostage drills and others that included evacuations, see story, below.)
References
- Greenson T. Bomb threat leads to evacuation of surgery center; hoax under investigation, FBI involved. The Times-Standard, Aug. 9, 2011. Accessed at http://bit.ly/LbjVEu.
- Daly T. Stockton Kaiser facility exposed to solvent spill. News10/KXTV, Sept. 7, 2011. Accessed at http://on.news10.net/nUjrje.
Resource
To view an audiotape with photos demonstrating how an evacuation plan was tested at OA Centers for Orthopaedics in Portland, ME, go to http://bit.ly/A5bdMF.
|
Fire alarm led to center evacuation A fire alarm went off at Allegiance Health Surgery Center in Jackson, MI, in November 2011 that caused the evacuation of about 20 people, including three patients, from the building.1 However, a fire wasn't to blame. A faulty sensor on a fire detector in the decontamination room caused the excitement. The building was cleared for staff and patients to return within 15 minutes. When the alarm went off, two patients were in recovery, and one had just been taken back to the OR but still was awake, according to Kay Morgan, RN, nurse manager at Allegiance Surgery Center. "When the alarm went off, we didn't know if it was a fire or not," Morgan said. The center's policy is to evacuate when the alarm goes off, regardless of whether a fire is seen or smelled. The center performs quarterly fire drills, so staff members knew just what to do. The center has an agreement with a doctor's office across the street to use their facility and grounds in the event of an evacuation. Two patients who were in phase 2 postop were sitting in recliners with wheels, so nurses rolled them across the street. "We made sure they were covered so their privacy was protected," Morgan says. The patient who was on a surgery cart was wheeled into the doctor's office. Staff then ensured everyone was out of the surgery center. Once that building was cleared by the fire department, staff had to tear down the OR setup and start again, since they didn't know if anyone had been in the room during the evacuation. The process went smoothly, because when the center holds quarterly fire drills, they don't merely talk through the exercise, but they actually walk through the drill. "Everyone did exactly what they were supposed to do," Morgan says. "It couldn't have gone smoother." Afterward, Morgan sent flowers to the patients because they had been inconvenienced, and she wanted to know they were appreciated. "They all called back and said that wasn't necessary, and they mentioned how safe they felt," she says. To have the most effective evacuation: • Keep a list at the front desk of everyone in the facility. This list should include staff, physicians, sales representatives, patients, and visitors, says Mark Mayo, executive director, ASC Association of Illinois, and director of ambulatory services, Ambulatory Surgical Care Facility, Aurora, IL. This list will allow you to conduct a head count when you reach the relocation site, Mayo says. "Otherwise fire officials may have to risk firefighters' lives to conduct a search for missing persons," he says. • Designate one person to lead the evacuation. One person should be designated to lead everyone to the relocation site, Mayo says. "Family may not know where to go to get safely out of the building," he points out. Once everyone is safe, one person needs to conduct a sweep of the building to see that each area is evacuated, he says. Reference
|
|
Drills with 'gunmen' prepare ASC staff To say members of the staff at this surgery center were busy on Feb. 18 of this year is a vast understatement. In one day, they confronted a gunman taking hostages, another who came in to steal drugs, and also a disgruntled employee with a weapon. Luckily for them, these situations were simply drills to test their disaster response capabilities. The drills were held at the McAlester Ambulatory Surgery Center (MASC) of the McAlester (OK) Regional Health Center. Staff worked with the local police department and fire department, and each group selected one scenario to drill, says John Johnson, RN, director of the ASC. The ASC was only the fourth medical facility in the state to perform that type of drill involving multiple scenarios with the police and fire department, Johnson says. Each code situation — bomb threat, fire, earthquake, etc. — has its own special requirements, says Mark Mayo, executive director, ASC Association of Illinois, and director of ambulatory services, Ambulatory Surgical Care Facility, Aurora, IL. "That is why it is important to vary the drill scenario to make sure that potential situations are practiced, etc.," Mayo says. In the scenario selected by the MASC, a man entered the facility with a plastic gun, pretended to shoot people as he went from room to room, and then held "hostages" inside a barricaded OR. Firecrackers added to the realism of the drill. Police brought in members of the SWAT team, who negotiated release of the hostages. The staff learned to evacuate as quickly as possible, Johnson says. "In unaffected areas, you have to get everyone out of the building," he says. Another lesson was that if someone is hurt, you don't run in to save that person, because you might become a casualty, Johnson says. "We're inclined to want to help people and not think about ourselves," he says. In another drill, a person tried to rob the center of narcotics, used a plastic gun to "shoot" people, and took "hostages." As in all the scenarios, the fire department responded to triage those who were hurt. ASC staff assisted with the triage. "Those are good skills to do every few years," Johnson said. In this scenario, members of the SWAT team negotiated the release of the hostages, then "shot" the armed robber after he released the hostages and began "shooting" at the SWAT team. The lesson in this drill was that if someone is trying to steal drugs, give them to the person, Johnson says. "Don't keep anything," he says. "Follow all their commands." Otherwise the situation can become more violent, Johnson says. What do you do with a violent employee? In the final scenario, a disgruntled employee came in the back door, starting "killing" people, and took "hostages." Staff learned they needed to barricade themselves by locking doors and ducking behind large, heavy items, such as operating beds. They learned to not open a door, even if someone identified himself as a police officer, without confirming who was there, says Lee Rogers, charge nurse of the postoperative care unit and education/event coordinator at the MASC. Staff members would crack open the door only far enough to see the person before they let him in, Rogers says. For those who could get away, employees learned to quickly create distance between themselves and the person shooting, Johnson says. "Take visitors and everyone else with you," he says. One important lesson learned in the drill was that the electrical wiring in the ceiling interfered with communication among members of the SWAT team, who used headsets. Eventually the team turned to other channels and communication methods. One of the biggest lessons? Be alert to what can happen, particularly if you work in a geographic area where there is substantial drug abuse, Rogers says. "The biggest thing we learned is that you have to protect the patient, but you also have to protect yourself." Such events aren't an everyday occurrence for ASC staff, Johnson says, "but every day you hear about someone shooting somebody." |
On the surface, evacuating a facility might seem like a simple and straightforward process, but have you ever thought through exactly how you would evacuate patients, some of whom might be in surgery, as well as staff and families? Although such a scenario might seem far-fetched, consider these three recent examples:
Subscribe Now for Access
You have reached your article limit for the month. We hope you found our articles both enjoyable and insightful. For information on new subscriptions, product trials, alternative billing arrangements or group and site discounts please call 800-688-2421. We look forward to having you as a long-term member of the Relias Media community.