Appendix 1: Hospital Disaster Plan: Generic All-Hazard Hospital Disaster Resource-Allocation Plan

5-level nurse-run triage in emergency department (ED).

Immediately lifesaving surgeries before urgent surgeries before elective surgeries.

ICU bed allocation based on greatest need. Patients' attending physicians and intensivist make decisions.

50% of ED beds are filled with admitted patients.†

- or -

Staffed inpatient beds are 98% filled.†

- or -

External incident(s) is likely to generate or has already generated a combination of critical and/or noncritical patients exceeding 30% of normal ED bed capacity in a short period of time.

- or -

Only 75% of any critical resource‡ will be available for a significant period during the next 24 hours.

Activate Hospital Incident Command System (HICS).§

Stop all elective admissions and do not begin any elective surgeries.||

Refuse to accept transfers from other facilities if patients can be treated elsewhere.||

Whenever possible, transfer admitted ED patients to other institutions.#

Immediately discharge all patients from the hospital (a) whose discharge is planned to occur within 12 hours and (b) who can be safely managed at home or in another available facility. The vacated bed must be available for new patients within 2 hours of discharge papers being signed.||

Fill all physical beds, use all levels of nursing personnel (expand their scope of practice to the extent that safety and the law permit), and, if necessary, decrease nurse-to-patient ratios.**

Discharge all ambulatory patients. Send them to other appropriate facilities, if available.||

If the situation is caused by an infectious agent or other contaminant, institute protective measures, including isolation and quarantine.

Activate "overcapacity" plan(s), including opening pre-identified locations to accommodate "surge capacity."††

Consider implementing disaster plan.§§

Consider using a trained risk communicator to inform the public about the situation.§§,##

The most experienced ED physician triages incoming patients.

Do not start any elective surgeries.

Physician Crisis Triage Officer (CTO)*** asks individual attending staff to discharge ICU patients who will probably not benefit from ICU care.

75% of ED beds are filled with admitted patients.†

- or -

Staffed adult inpatient beds are >100% filled.†

- or -

External incident is likely to generate patients rapidly or has already generated 6 to 20 critical and/or 31 to 100 noncritical patients.

- or -

Only 50% of any critical resource‡ will be available for a significant period during the next 24 hours.

[Take actions as described for prior Levels, modifying them as described for this Level.]

Refuse to accept transfers ...