Administrative and Ancillary Services
• Hospital administration
• Ambulance- Critical Care Ambulance (ICU on wheels)
• Medical Record Department
• Human Resource Department
• Hospital Management Information System
The ADMIN team should include the senior administrators responsible for making decisions about when (and if) the hospital should reopen, as well as managers who work in the main administrative offices (e.g., human resources, billing, accounting, purchasing). The ADMIN team will be responsible for coordinating the hospital assessments and assessment teams. After the hospital has been deemed safe for human occupation, the ADMIN team will conduct a preliminary, high-level assessment of the entire hospital (external and internal). Based on the degree of damage observed, the ADMIN team will determine the assessment strategy for the entire hospital: when each team will conduct their assessments and in what order, which assessments can occur simultaneously, and whether assessments are needed for every area of the hospital or not. The ADMIN team will determine who should serve as the leader of each of the other teams and then will let those team leaders build their own specialized teams.
After all of the individual assessments have been completed, the ADMIN team will work with the leaders from each team to make an overall assessment of the level of damage, determine how long it will take to reopen the hospital, and create a full recovery plan.
The ADMIN team will also assess the administrative offices throughout the hospital and will work with the MATERIALS team to inventory administrative supplies and equipment, and with the IT/COMMteam to identify damaged administrative computer systems that require repair. If outside inspections will be needed (e.g., city/county, State, accrediting organizations), this team will determine when the hospital is ready for these inspections and will organize their sequencing.
The FACILITIES team should include engineers and other staff responsible for maintaining the hospital building and systems, such as heating/ventilation/air conditioning and refrigeration (HVAC-R), medical gases, plumbing, and electrical systems. The FACILITIES team will tour the entire hospital (external and internal), paying particular attention to the area (usually the basement) housing the main hospital utilities and environmental control systems. The FACILITIES team will assess any negative and positive pressure rooms, rooms with high efficiency particulate air (HEPA) filters, and internal decontamination units, to assure that all are functioning properly. The FACILITIES team will also assess other specialized ventilation systems throughout the hospital, including those located in laboratories.
Security and Fire Safety (SAFETY)
The SAFETY team should include hospital security and fire safety experts. The SAFETY team will assess the entire hospital (external and internal) to identify potential security and safety issues, and determine how to return to proper security and fire safety standards and monitoring throughout the hospital.
Information Technology and Communications (IT/COMM)
The information technology (IT) experts on this team will be responsible for checking all general hospital computerized systems to identify malfunctions and make needed repairs/replacements. Communications experts will check all internal and external communication systems to identify and make necessary repairs.
Any specialized computerized systems, programs, or equipment that are used by departments throughout the hospital (for example, specialized databases used by fertility clinics and bone marrow registries) that are not part of the main hospital computer system will need to be tested and repaired by the vendors that regularly service these systems. However, the IT/COMM team will work with the vendors and the hospital personnel who use these specialized computer programs to assist with returning these systems to full operations.
Hospital security includes IT security: the carefully controlled and monitored user IDs and passwords that control access to information systems and to secured areas of the hospital (e.g., pharmacy, nuclear medicine). These electronic security systems also require inspection and testing by trained professionals, which may include IT vendors who routinely support and maintain such systems.
Biomedical Engineering (BIOMED)
The BIOMED team will assess all medical equipment in the areas of patient and ancillary care that are supported by biomedical engineering during normal hospital operations. Some patient care areas (e.g., adult respiratory therapy, dialysis) and ancillary service areas (e.g., laboratories, pharmacy, blood bank) may maintain their own equipment separately from biomedical engineering, in which case these areas will be responsible for assessing, repairing or replacing their own equipment with the help of vendors.
The BIOMED team will determine what equipment has been destroyed, what is undamaged, what is damaged but salvageable/repairable, and what needs to be recalibrated by the team or by vendors. The team will determine how long it will take or for damaged equipment to be repaired.
The MEDICAL team should include physicians, nurse managers, and other clinical staff who are intimately familiar with each patient care area of the hospital, inpatient and outpatient. Sub-teams with expertise in the following areas should make up the MEDICAL team:
- Inpatient care (floors/units).
- Emergency department.
- Intensive care units (ICUs, NICU, PICU, etc.).
- Operating rooms and post-operative/post-anesthesia care.
- Radiology/nuclear medicine.
- Respiratory therapy.
- Outpatient care (including specialized clinics such as outpatient surgery, dialysis, chemotherapy, physical therapy, etc.).
The services provided by every hospital are different. If the hospital has other specialty units, such as a burn unit or a transplant unit, sub-teams with expertise in these areas should also conduct assessments and can use this guide to assist with their assessments.
The MEDICAL team should first assess all patient care areas together, looking for common deficiencies and damage, and then personnel from each specialty care area (ED, ICU, etc.) should assess their own specific units in depth. The MEDICAL team will assist the BIOMED team to locate and reconfigure medical equipment that was moved during the event or the evacuation. The MEDICAL team will also assist the MATERIALS team to inventory necessary supplies and equipment (medical and non-medical), and will assist the IT/COMMteam to test any specialized computer systems within each unit.
Ancillary Services (ANCILLARY)
The ANCILLARY team should be made up of staff and technicians from departments that provide ancillary services throughout the hospital. Sub-teams with expertise in the following areas should make up the ANCILLARY team:
- Advanced diagnostic technologies (non-radiation emitting imaging such as ultrasound, MRI).
- Medical records/Medical informatics.
- Blood bank/Tissue bank.
- Clinical laboratories.
- Research laboratories.
The ANCILLARY sub-teams will assess and inventory equipment and supplies in their area, and work with the other teams and vendors to have all equipment and computer systems assessed, repaired, or replaced as needed. BIOMED, IT/COMM, and MATERIALS will assist in these activities whenever possible, but if the equipment/system is not usually supported by these departments (for example, the blood bank may operate its own donor database, or the clinical laboratory may have specialized scanning equipment that is not supported by hospital IT), the ANCILLARY team will need to work directly with vendors.
Materials Management (MATERIALS)
The MATERIALS team should include staff members who regularly order the supplies and equipment for departments throughout the hospital. The MATERIALS team will assess all patient areas, ancillary service areas, and support service areas and work with all of the teams to inventory equipment and supplies and coordinate ordering needed replacements. The MATERIALS team will attempt to locate equipment that was evacuated with patients (e.g. ventilators) and determine whether it is possible and feasible for this equipment to be returned. The team will also determine whether equipment and supplies currently held in storage can be used and what outsourcing might be needed to reopen the hospital. The MATERIALS team will also work with vendors to determine how long it will take for replacement equipment to arrive. (This will be especially important for large equipment and if other hospitals were affected by the disaster and will be ordering similar equipment.)
Building and Grounds Maintenance/ Environmental Services (BUILDING)
The BUILDING team should include managers and staff who provide maintenance services to the hospital buildings and grounds. This team will tour the entire hospital (external and internal) to determine where repairs are needed.
Support Services (SUPPORT)
Managers from each of the main support service areas throughout the hospital (e.g., kitchen/nutritional services, housekeeping/linens, patient transport) will serve on the SUPPORT team and assess the area within their service specialty. The sub-teams will work with vendors as needed to repair/replace equipment and with the MATERIALS team to inventory and reorder needed supplies. These teams will advise the ADMIN team as to whether temporary outsourcing will be required (e.g., laundry service).