Checklist for Initiating Disaster Planning for Mobilization, Evacuation and Recovery

Service: Risk Management
Type: Risk Notes

In the realm of emergency preparedness, organizations employ a wide range of processes and policies to respond to crisis situations necessitating mobilization, evacuation, and repopulation of facilities (Richmond et al., 2021). While nuances may exist across different entities based on geographical differences, resource constraints, and logistical requirements, the fundamental principles behind developing a coherent plan remain largely consistent (Sahebi, A. et al., 2021). Literature emphasizes the necessity for robust pre-event planning and communication strategies to foster resilience and to adequately support facility evacuation, response, and repopulation strategies (Melnychuk et al., 2021).

This resource was co-designed with HIROC Subscribers and external partners in the field of emergency preparedness. Please note that this checklist does not provide a comprehensive guide for all organizations, regions, or sectors, and it is not intended to replace your organization’s evacuation processes and protocols. The purpose of this checklist is to complement your organization’s existing surge protocol, or other tools related to capacity constraints. Before making any changes to your current procedures, please engage internal and external subject matter experts. Command, control, and communication is critical for saving lives during emergencies. Focusing on people, places, resources, and systems enhances emergency preparedness and response, and recovery.

Planning

  • Ensure your organization has a documented plan
  • Organizations should establish a regular schedule and process for reviewing/updating all evacuation processes, and procedures such as:
    • Review and update of emergency management, evacuation plans and kits
      • Review may consider:
        • Activation (who has authority to activate the plan), trigger points for when to initiate plan
        • Notification - contacts and process
        • Designation of an incident leader
        • Roles and responsibilities of staff
        • Availability of evacuation devices if applicable
        • Records management and patient/client tracking
        • Transportation processes/agreements
        • Family/patient communications
        • Contents of tool kit (Patient tracker, personal belongings list, etc.)
    • Planning includes an assessment of how long it may take to access transportation and evacuate a site
    • Considerations and planning for potential staffing issues if community evacuation occurs simultaneously
    • Discussion and early planning with your community, including equity deserving communities and key system partners

External Resources and Relocation

  • Develop processes for the safe deployment of staff to alternative facilities (where required)
  • Evaluate organization-wide level of care needs, mobility, acuity, and census (acute, long-term care, rehabilitation, etc.) for all clients
  • Identify triage processes for clients who may be:
    • Required to transfer to an alternative facility
    • Transferred to community services
    • Safely discharged
  • Process and policy for record keeping of transferred patients. Ensure privacy of Personal Health Information is maintained
  • Develop policies and procedures required for unexpected/unanticipated downtime for clinical notes and records in event of power loss or medical record not accessible
  • Client tracking system for inpatient, long-term care residents and homecare clients
  • Inform and educate locum healthcare workers and specialists who may not work consistently in the organization on response plans and procedures
  • Prepare evacuation tags and checklists:
    • To ensure that all identified evacuated areas are marked secured and empty
    • To identify clients based on acuity, mobility and transfer needs
    • Triage and identify movement and transfer of necessary equipment, personnel, and resources
  • Identify essential services that may be required throughout the evacuation procedure
  • Consider pre-identified alternate (receiving) facilities in collaboration with your community, regional/federal authorities and equity deserving communities
    • Consider notification of HIROC regarding any formal agreements
    • Legal review of contracts should be considered prior to signing where appropriate
    • Confirm the commitment of alternative facilities utilizing prior written agreements, memorandums of understanding, mutual aid agreements, etc.
    • Optimize transfer site choice based on compatibility with client acuity and healthcare needs and process, for example:
      • Dialysis services
      • Transferring active chemotherapy services
      • Clients requiring urgent medical follow up
      • Managing children in care if part of health services
  • Devise procedure for the management of contract agencies supporting services provisions

Preparedness

  • Establish system partners and agreements
  • Tabletop exercises, training exercises (seminar, table top and/or functional)
    • Provide training in person, virtually and/or self-directed online
  • Provide/facilitate training on use of evacuation devices if used
  • Reinforce the plan on a regular basis
  • Review recent incidents and after-action reports from within the organization, discussion with internal and external subject matter experts (e.g., Emergency Medical Services, fire, police, unions, equity deserving communities, other key community partners, etc.)
  • Conduct regular training and drills to familiarize understanding and role clarity
  • Review assignment/task delegation lists for ease of documentation/tracking decisions
  • Communication devices - radios/walkie talkies/satellite radios are in working order, in place
    • Ensure policy, procedures and documentation processes are in place to manage maintenance and the use of communication devices
  • Test generator back up power supply on a regular basis
    • Ensure policies and procedures associated have a detailed preventative maintenance plan, service checks and documentation process
  • Establish assigned roles and responsibilities to staff members, including assignment of an incident commander and key evacuation-specific roles, evacuation coordinators, frontline team leaders, assembly area supervisors and after-hours essential response team
    • Develop role specific worksheets with tasks required to be completed
    • Worksheets to be available in print and electronic formats
  • Policies, procedures, and documentation processes to keep organization’s vehicle(s) in good repair, ensure gas tank full in anticipation of evacuation, communicate to fleet users
  • Policy and procedure for use of fleet vehicles, plan for use of during evacuation, notify other government levels if this resource can be shared
  • Process to organize and receive assistance for evacuation from other entities such as Emergency Medical Services (EMS), stretcher services, buses, personal vehicles, plane, boat, air ambulance, neonatal transport
  • Rapid electronic medical record client discharge procedure
  • Policy for re-population following evacuation
  • Ensure Employee and Family Assistance Programs are in place

Response - Activating Evacuation

  • Consider the activation of an Incident Management/Command System to aid in coordinating an effective response that would include predefined roles and processes to coordinate and communicate the points identified below
  • Assess need to evacuate versus sheltering in place, if appropriate to the incident based on predetermined trigger points
  • If evacuation is required, decision by Leadership (or delegate) to activate the Evacuation Plan:
    • Activate hospital/health centre/facility/community command centre
    • Establish and communicate a clear chain of command and designate individuals responsible for decision-making during an evacuation
  • Establish regular communication link with equity deserving communities, appropriate external partners, community, government entities
  • Access preestablished or develop messaging for media/organizations web page
    • Develop a pre-built site ready for activation when needed
    • Consider local languages and develop translated versions of messaging
  • If evacuation pre-emptive, determine what level of service may remain (e.g. EMS only, Urgent Care Services, etc.)
  • Communicate service level to community, equity deserving communities, and key system partners
  • Establish regular lines of communication with staff during and following the evacuation
  • Identify designated personnel by job title, authorized to activate the disaster preparedness and evacuation plan
  • Plan, anticipate and communicate foundational tasks that will need to continue during displacement ensuring staff are aware of their role in that and are equipped for remote work (e.g., cell phones, computers, accessibility, etc.)
  • Develop procedures, plans, frameworks for various types/levels of evacuation (e.g., internal, partial, full, entire building(s), regional, etc.)

Communications

Internal Communications:

  • Appoint a Lead to be accountable for coordinating communication within the organization
  • Implement a communication plan to alert organization of the evacuation status
  • Communication plan:
    • Notification of Senior Management and Executive Leadership of evacuation status
    • Establish a communication channel or command center for real-time updates and coordination among different departments
    • Ensure frontline staff have access to information and are updated on regular intervals
      • Inform the hospital’s security (protective services) team to manage any potential crowd control or safety issues
      • Contact the ancillary departments (Laboratory, Radiology, Pharmacy, etc.) to notify them of the evacuation activation
      • Engage Human Resources to support the need for additional staff/staff call in/agency support
      • Notify the client units and request their collaboration in managing Emergency Department (ED) admissions and transfers
    • Establish a feedback loop to gather input and suggestions from staff and stakeholders to improve the response and address any concerns
    • Consider triggers to reach out to the hospital’s supply chain department to ensure an adequate supply of essential items such as medications, personal protective equipment (PPE), and medical equipment
    • Summarize surge situation for future reference and debriefing

External Communications:

  • Engage equity deserving communities within your community
  • Consider local languages and develop translated versions of messaging
  • Plan for crowd control, security and facility access
  • Ensure communication with local authorities regarding evacuation orders, and transmit these directly to command centre
  • Ensure Internal Communication Lead is informed and aware of status updates
  • Communication plan should consider external media, community partners, Emergency Services, Family Reunification Centres, and local authorities
  • Coordinate with local facilities for necessary transfers and resources
  • Designate safe passage routes, exits and collection points for evacuation, update as relevant
  • Evacuation plan for home care clients

Facility Services

  • Facility services has updated blueprints informing outlets on generator back up in event of power loss
  • Ensure that designated outlets (e.g., red outlets in some organizations) are functioning and used to indicate emergency backup power
    • Develop policy and procedure and ensure documentation of testing dates and results
  • Consider what services will be on generator back up in the event of power loss
  • Ensure a procedure to identify the designated order for preparing to shut down a facility, including oxygen plants and Heating, Ventilation and Air Conditioning (HVAC) systems
  • Consider the covering of facility signage in community and on highways (“H” sign) if facility is closed/evacuated
  • Consider planning for shutting down large laboratories/transferring services as required

Evacuation Preparation Kits

  • Site evacuation kits should be developed and maintained on regular basis, each site/unit kit should align with local facility evacuation requirements and may include:
    • Evacuation checklists
    • Procedures and relevant policies
    • On demand evacuation training (live or recorded)
    • Site command area/decision maker/colour coded vests for incident command leader(s)
    • Assignment/task delegation lists for ease of documentation/tracking decisions
    • Command staff, transportation leader, public information officer, client and family assistance branch director, family reunification unit leaders
    • Current list for contacting staff and staff head counts
    • Client preparation, transfer assistance, runners, transport, essential supplies
    • Paper documentation forms, clipboards, pens, prescription pads
  • Evacuation checklists for tracking and identifying patients – name, date of birth, anticipated destination and method of transport if known, contact information and notification to next of kin, personal belongings, cultural or spiritual needs, equipment/resources with patient
  • Current list of staff/resources/agencies/emergency contacts
  • Communication devices – phones, radios/walkie talkies/satellite radios
  • Flashlights/replacement batteries
  • Additional client identification arm bands (color-coded or evacuation tag)

Evacuation in Progress

  • Activate evacuation plan and use toolkit resources to prepare/stage and evacuate patients
  • Implement communication plan for situational updates and regular communication cycle
  • Implement communication strategy to employees on shift/off shift and for patients, families and media
    • Assess staffing availability
  • Implement plan for the transportation of records and supplies to the receiving facility (i.e., electronic versus paper client medical records, medication administration records, controlled substances, specialized treatment supplies, etc.)
  • Consider closure of clinics, non-essential services
  • Assess need for additional assistance (e.g., provincial, territorial, federal resources)

Assessment of Current Patient/Resident/Homecare Client Status

  • Client needs
    • Level of care dialysis, behaviour challenges, scheduled medications/treatments, critical care (vent, inotropes, post op), obstetrics, neonates, oncology
    • Consider mobility needs, assistance needed, bariatric or dependent clients
    • Consider unique dietary needs
    • Consider cultural needs
    • Assign location and transport method
    • Condition exacerbated by smoke in environment
    • Equipment needs; resources that accompanied client (Oxygen tanks, pumps, oxygen concentrator, wheelchair, medical supplies required by patient, etc.)
    • Care plans, medical records, one page transfer information sheet stays with patient
    • Kits for each client need to be created/put together and include blister packed medications, medical supplies, clothes, charts, etc. that the client will require for their care during transport and once settled before scripts are written in the new location
    • Consider management of patient valuables

Post Evacuation Facility Preparation

  • Following facility abandonment but prior to closing building,
  • Established/Designated team to complete developed checklist for walk through entire facility to ensure:
    • All rooms checked and vacant. (Client rooms, medication rooms (secured), dining area, kitchen, recreation area, tub rooms, supply rooms, bathrooms, staff rooms, mechanical rooms, storage spaces, offices, basements)
    • Shutdown of high risk systems (gases/heating ventilation air conditioning (HVAC) systems)
    • Safely secure all pharmaceuticals, removal/transfer of refrigerated pharmaceuticals and medical equipment, maintain temperature control
      • Controlled substances in secure locked storage with assigned staff member at all times
    • Information technology system security and backup, including off site servers and data storage
    • Final sweep then secure building(s)
    • Rooms identified and marked as checked & vacant
    • Signage on facility doors
    • Communication to equity deserving communities, emergency services, community partners
    • Provide a primary contact and phone number for the evacuated facility
  • Track and reconcile patients sent to receiving facilities
  • Ensure physical and psychological supports for any staff, physicians, learners, and volunteers who remain engaged on site (e.g., Employee Assistance Programs (EAP), temporary lodging)
  • Tracking of staff, volunteers, etc. to ensure all are accounted for

Re-Population Post Evacuation

  • Determine process for client population return
  • Determine sequence of service resumption
  • Communication to staff, patients and media
  • Obtain regulatory/government clearance
  • Re-population of staff including supports - clinics, EMS, pharmacies, community and homecare
  • Develop site re-entry assessment tool/checklist for building re-entry preparation for all areas and rooms
    • Infection control protocols
    • Cleaning of heating, ventilation and air conditioning (HVAC) system, indoor air testing if required
    • Supply restocking
    • Sewage/waste system functioning
    • Biomedical check of medical equipment
    • Confirm water supply safety
    • Cleaning of facility, empty/clean fridges/freezers, discard food if deemed unsafe
  • Food, shelter and supplies for staff/community
  • Repatriation of patients
  • Continued security, crowd control

Recovery - Post Evacuation

  • Staff supports, housing, safety, financial, mental health, child/elder care,
  • Time for staff to get re-settled if impacted by evacuation
  • Equipment/supplies tracking and return
  • Debrief, emotional support staff and patients.
  • Post incident review - Lessons gleaned, update policies, toolkit
  • Staff appreciation/recognition

References

Date last reviewed:
This is a resource for quality assurance and risk management purposes only, and is not intended to provide or replace legal or medical advice or reflect standards of care and/or standards of practice of a regulatory body. The information contained in this resource was deemed accurate at the time of publication, however, practices may change without notice.