18. Emergency Protective Practices for the Medical Office


Every healthcare facility faces the possibility that a disaster or serious emergency may cause damage and/or threaten its employees, patients, buildings and other assets with harm or inability to provide the usual services. All organizations must plan ahead to minimize the damage from any disaster or serious emergency and to facilitate recovery so that ser­vices can be restored as efficiently as possible.


Hazards are usually categorized as natural or man-made. A natural disaster results from a natural hazard (such as vol­canoes, tornados, earthquakes, fires from lightning strikes, or hurricanes) that causes significant damage to the environ­ment and leads to environmental, financial, and human losses. A man-made disaster refers to serious damage either directly or indirectly caused by intentional or negligent human actions or the failure of a man-made system (such as a fire, structural collapse, or terrorism).

Natural Disasters

Natural disasters may occur with or without warning. Earthquakes usually occur without warning, whereas hur­ricanes develop over a period of days, which allows for some preparation. In addition, the effect of natural disasters often seems random. Many communities must prepare when a hurricane or tornado is in the area because the exact track of the storm is difficult to predict. It is important for all employees of the medical office to be educated about imme­diate response to the types of natural disasters that tend to occur in their geographic area while still realizing that unusual events of great magnitude can also occur. The effect of serious natural disasters is felt far beyond the area that is affected. For example, Hurricane Katrina affected the entire United States, partly because of the shock that a disaster of such scope could even happen, partly because of the exten­sive relocation of people who lost their homes, and partly because of the massive relief effort, which included assis­tance from emergency workers and volunteers.

Man-made Disasters and Emergencies

As with natural events, the amount of threat or damage from man-made hazards can vary considerably; examples include a fire in a wastebasket that is quickly contained, a gunman threatening to injure all the employees of an office, a bomb threat, and a radiation incident that may involve an entire city or area. Man-made hazards include crime, many fires, terrorism, industrial hazards, structural collapse, power outage, radiation hazards, and chemical contamina­tion. Municipal fire departments and police departments provide rapid assistance for fires, injury, and criminal activ­ity, and the National Response Center of the Environmental

Figure 49-1 Teams responding to disasters involving hazardous materials (HAZMAT) must wear protective clothing and initiate decon­tamination of casualties.

Protection Agency responds to the release, or potential release, of oil, radioactive materials, or hazardous chemicals into the air, land, or water (Figure 49-1).


Whenever an event occurs that causes or threatens to cause serious damage or interruption of the normal daily routine, individuals who are affected react positively and negatively to the loss of property or disruption of service. Positive reactions involve the triggering of resources, both internal and external, to meet the challenges. For example, when a serious flood threatens an area, both municipal and state employees and volunteers usually mobilize quickly to fill and place sandbags to minimize the anticipated damage. When physical and emotional resources are depleted, however, individuals react negatively. Disasters that tend to cause the most serious psychological effects include those with the following characteristics:

    Occur without warning

    Pose a serious threat to personal safety or have unknown health effects (such as the tsunami in Japan in 2011 or the damage from Hurricane Katrina)

    Have an uncertain duration (such as serious floods of major rivers)

    Result from malicious intent or human error

    Have symbolic significance (such as the 9/11 attacks)

The Stress Response

Stress is the body’s response to threat or change. Hans Selye, an Austrian doctor who practiced in the middle of the twentieth century, described the body’s reaction to stress as a four-part general adaptation syndrome (GAS), also known as the fight or flight response, which is shown in Figure 49-2. The four stages of the GAS are the alarm reac­tion, the stage of resistance, the recovery phase, and the stage of exhaustion.

Body Reaction When Stress is Removed

Figure 49-2 Hans Selye’s general adaptation syndrome (GAS).

Body Reaction When Stress Persists

Stess remains and body can no longer cope. Increased levels of hor­mones may be unable to sustain life.

Stress remains, but the body adapts. Levels of adrenal hormones return to normal or slightly above normal.

In response to threat, the body produces in­creased amounts of adrenal hormones (fight or flight response).

In the first stage, the alarm reaction, the body senses a stress and begins to react. Epinephrine is released from the adrenal medulla and stimulates the sympathetic nervous system. The pupils dilate, the heart beats faster, respirations become faster and deeper, and the blood pressure rises. The body prepares to fight or run away. The individual’s atten­tion becomes narrowly focused on the perceived threat or significant task. Some people experience the alarm reaction as energizing, whereas others quickly become extremely anxious.

In the second stage, the stage of resistance, the stress remains but the body adapts. This may occur within hours or days, depending on the circumstances. Levels of adrenal hormones may remain slightly high or drop back to normal. More energy is required to maintain the stage of resistance than the normal state.

After the stress has been removed, the body enters the recovery phase, and as the parasympathetic system begins to regain control, the body returns to its normal level of function.

If stress persists or is always present, it causes an increase in blood pressure, elevated glucose (blood sugar) level, increased metabolism, and increased pressure within the eye. This is why constant stress leads to fatigue, hunger, and headaches.

Eventually, in a person subjected to chronic stress, the body is unable to maintain the response, the immune system is compromised, and the person is more prone to a variety of illnesses.

Managing Anxiety

During the alarm reaction, anxiety is a normal part of the “fight or flight response.” Anxiety is defined as a feeling of worry or uneasiness, often triggered by an event with an uncertain outcome. A person who is moderately to severely anxious is not able to notice details and think as clearly as in the normal state. Emergency procedures that have been learned and practiced help individuals to decide what to do without having to think through all possibilities. In addi­tion, they tend to keep the anxiety level from rising because individuals feel more confident when they have a plan to respond to a threat.

Severe anxiety can be medically problematic. In an emer­gency situation it tends to immobilize an individual and stimulate anxiety in others. Symptoms of a full-blown anxiety attack include the following. An overly anxious person hyperventilates, has an extremely rapid heart rate, and becomes unresponsive. When there is an emergency, many people lose control of their emotions and cry or scream. The behavior can be minimized by giving the highly anxious person directions. It may be necessary to touch the person to gain his or her attention, and then directions should be given in short sentences, speaking a little more slowly than usual. Helping the person to breathe deeply will help reduce anxiety, but it is also important to direct the person exactly where to go if a dangerous area must be evacuated or if the person should take cover.

Figure 49-3 shows the various stages of increasing anxiety.

Posttraumatic Stress Disorder

After the initial phase of a disaster or serious emergency, in addition to a possible injury caused by the event, an indi­vidual may be in a state of shock as he or she adjusts to a changed situation. Depending on the individual and the damage to his or her health, property, and personal relationships, it is common to experience irritability, loss of appetite, self-blame, mood swings, physical symptoms such as headaches and stomach pain, nightmares and dif­ficulty sleeping, fatigue, sadness, and depression. It is rec­ommended to return to normal activities as soon as possible. Educational materials and/or grief crisis counseling are helpful as the person gradually adjusts and returns to a more normal state. In some cases, however, weeks or months after the catastrophic event, the individual begins to experi­ence stronger symptoms of stress including flashbacks, memory disturbances, nightmares, severe irritability, severe depression, and impaired functioning. Posttraumatic stress disorder (PTSD) is the name given to the emotional dis­turbance that develops after a traumatic, catastrophic life disturbance when the disturbance lasts for at least a month. Individuals with possible PTSD should be referred for counseling, because this is one of the most effective treat­ments for this disorder.


Fire Hazards in the Workplace

Common fire hazards in the medical office include heating equipment that is poorly maintained or too close to flam­mable materials, overloaded electrical circuits, improper use of stoves or microwave ovens, and improper storage of oxygen, cleaning supplies, and other combustible materials. If the medical office processes its own laundry, poorly main­tained washers and dryers can also cause fires, especially if the dryer is vented improperly or if the lint trap is not kept clean. Shipping boxes and other trash should be removed from the office as soon as possible to prevent the buildup of flammable material.

It is very important to avoid using damaged electrical cords, extension cords, and overloaded plug strips. The cords and plugs for all equipment should be inspected for fraying or cracking and replaced if damaged. Cords should not obstruct walkways, not only because they pose a trip­ping hazard but also because excessive pressure on a cord that is pulled sharply or stepped on may damage the cord and cause a fire. An extension cord may be used with super­vision for a short period of time, but for long-term use a piece of equipment should always be plugged into a grounded outlet.

Fire Protection and Fire Safety Plan

Fire protection for an office building is the responsibility of the landlord or office condominium association (if the units are condominiums), but fire protection for the contents of the office is the responsibility of office staff.

Many states require sprinklers in commercial and office buildings. Some states that require sprinklers for larger office buildings do not require them for smaller offices, such as a physician’s office that has been converted from a house.

In addition to the health hazards smoking presents, there are also potential fire hazards related to smoking. Smoking should not be permitted in a physician’s office, and signs advising patients and visitors that the office is a smoke-free environment should be clearly posted in the waiting area.

Exits should be clearly marked, and an emergency evacu­ation map should be posted near the door to the waiting room. Lighted exit signs should be tested by shutting off the lights in the room; bulbs should be replaced if necessary.

In a large office or freestanding clinic, there may be fire doors at certain points in corridors. These doors are designed to contain any fire on one side of the door from going into another area of the building. Fire doors should never be propped open but should be allowed to shut to their natu­rally closed position. Fire alarm pull stations are frequently located in the building corridors. These alarms alert the entire building and also notify the fire department directly (Figure 49-4).

A fire extinguisher (a portable device that discharges foam or another material to extinguish a fire) should be positioned in each room near the exit, and they may also be located in the corridors of a large building. These fire extinguishers are important both for putting out small fires and for giving a person the ability to clear an exit path from a room that is on fire. There are many types of fire extin­guishers, and many have a numeric rating that indicates how much fire they can handle. For the medical office, the extinguisher should be multipurpose and usually contains a dry chemical. Extinguishers are placed near the door so that the fire does not get between the person and the exit (Figure 49-5). There should always be a fire extinguisher within a 50-foot travel distance of flammable liquids that are stored in containers. Staff should be trained to use the fire extinguishers properly (Procedure 49-1).

Figure 49-4 Fire alarm pull stations are commonly found in the cor­ridors of an office building.

Figure 49-5 Fire extinguishers should be accessible for immediate use.

PROCEDURE 49-1 Demonstrating Proper Use of a Fire Extinguisher

Outcome Demonstrate proper use of a fire extinguisher.


• Portable office-size multipurpose (ABC) fire extinguisher

Procedural Step. Through role-playing (using a dis­charged fire extinguisher) or in an outdoor location using a new fire extinguisher, pull the safety pin from the handle of the fire extinguisher.

Principle. The fire extinguisher is prevented from discharging when the safety pin is in place.

Remove the safety pin.

2. Procedural Step. Aim the nozzle or hose at the base of the fire.

Principle. It is more effective to apply the contents of a fire extinguisher directly to the burning area than to the upper flames.

13. Procedural Step. Stand at the recommended distance printed on the fire extinguisher and squeeze the

moveable top handle against the bottom handle until the extinguisher discharges.

Principle. Different fire extinguishers recommend use at different distances.

Slowly squeeze the movable top handle.

            Procedural Step. Sweep the extinguisher from side to side until the flames are extinguished, gradually moving closer to the flames.

            Procedural Step. Continue to watch the area to be sure that flames do not recur after having been extinguished.

Principle. Material that has been burning can remain hot enough so that flames reignite.


To use a fire extinguisher, the first step is to pull out the pin that keeps the extinguisher from discharging acciden­tally. Then the nozzle of the extinguisher should be aimed at the base of the fire (to prevent the fire from getting fuel). The handles should be squeezed slowly until the foam or other material is released. Finally the nozzle should sweep from side to side to cover all parts of the fire until the fire is out. The person can move toward the fire as it gets smaller. The acronym to remember these steps is PASS: Pull, Aim, Squeeze, Sweep.

Whenever possible, records should be stored in fire- resistant file cabinets. If the office uses a physical system to back up computer files (instead of a network or an Internet system), the backup drives should be stored in a fire-resistant file cabinet or fire-resistant box-type safe. It is always prefer­able to store a backup copy on the Internet or at another location.

Smoke detector laws vary by state, in terms of how many must be in an office and where they must be placed. In many buildings, smoke detectors are wired into the build­ing’s security and safety alarm system and are tied to the sprinkler system. If the office has battery-operated smoke detectors, these should be tested monthly by pressing the test button. Batteries should be changed every 6 months, and the date should be noted on the detector.

Every medical office should have a fire safety plan, provide training to all employees, and perform regular fire drills as often as is required by local and/or state building codes.

What Would You Do?

What Would You Not Do?

Case Study 1

Julie Manning, who is sitting in the waiting room, receives a telephone call, speaks on the telephone for a few minutes, and rushes to the front desk window. She tells Beth Ann that she has to leave immediately because she has just learned that there is a fire at her son’s school. Julie speaks very quickly but her story seems disconnected. It is also clear that she is breathing very rapidly. ■

Emergency Response

The acronym RACE is used to identify the steps in respond­ing to a fire (RACE against fire).

Step 1: Rescue any person who is directly threatened by fire. Patient safety is always a first priority.

Step 2: Activate the emergency response system (or respond to the alarm of a smoke detector). This can be accomplished by using a fire pull alarm or using the telephone to call 911.

Step 3: Confine the fire by closing doors. If you hear a fire alarm, feel doors for heat. Do not open any door if it is warm or if you see smoke leaking out around the door frame. Turn off fans and air conditioners. Step 4: Extinguish the fire or Evacuate the area. If the fire is small, use a fire extinguisher to put the fire out. If the fire cannot be extinguished, evacuate the area, following your fire safety plan to be sure that everyone leaves the area.

Large buildings may be designed so that only the affected areas evacuate during a fire, while employees remain in place in unaffected areas unless told to evacuate by emergency personnel.


Emergency Action Plan

A written emergency action plan is required by the Occu­pational Safety and Health Administration (OSHA) for almost all businesses. It must include several elements:

    A means of reporting fires and other emergencies

    Evacuation procedures and emergency escape routes

    Procedures for employees who remain if there are critical operations to be completed

    A way to account for all employees after evacuation

    Designation of rescue and medical duties

    Who to contact for additional information or clarification

Other elements that are recommended include a descrip­tion of the alarm system to notify employees to evacuate, the site of an alternative communication center (if there is a fire or explosion), and a secure location to store originals or duplicate copies of essential records.

Evacuation Plan

The evacuation plan is an essential part of the emergency action plan in a medical office. It includes preplanned escape routes from the facility with diagrams posted in multiple locations. It identifies the conditions that would require evacuation of the area and the chain of command showing who can authorize an evacuation. Specific evacua­tion routes should be identified and marked on a floor plan, and these plans should be posted throughout the office. The floor plan should designate primary and secondary exits and remind individuals not to use elevators to reach an emer­gency exit (Figure 49-6).

The evacuation plan should also include information about evacuating individuals with disabilities, and the floor plan should indicate wheelchair accessible exits. Certain individuals may be designated to assist individuals who need extra assistance during evacuation. The duties of these individuals should be clearly defined. If necessary, some employees may be designated to stay behind briefly to operate fire extinguishers or shut down electrical equipment or special equipment that could be damaged if left operat­ing. In high-rise buildings, the office evacuation plan should coordinate with the building evacuation plan.

Every plan should identify an assembly site for employees to meet after evacuation and the person designated to take a head count and account for all employees and all patients. There should also be a procedure for further evacuation if needed, such as sending employees home.

Orienting and Training Employees

When they are hired, all employees must be oriented to the emergency action plan and their specific responsibilities, and in most facilities they are required to review their train­ing (especially fire safety training) annually. The training must include the fire hazards of the materials and processes used in the office, such as the use of oxygen. All employees should be trained in the evacuation plan, alarm systems, reporting procedures, types of potential emergencies, and the use of fire extinguishers. Employees who have special responsibility to assist in evacuation of other employees and patients are often called fire wardens, and they should be made aware of their responsibilities.

Fire Drills and Disaster Drills

Fire drills may be required at specific intervals depending on the municipal or state laws for the type of building and insur­ance requirements. Fire drills may be announced or unan­nounced. They remind the employees of a medical facility to review emergency escape routes and procedures to respond to a fire. One individual should coordinate the planning, implementation, and evaluation of the fire drill, including notification of the local fire department. This individual should also be responsible for keeping written records.

Disaster drills are usually more comprehensive than fire drills. Disaster drills often involve several community agen­cies, depending on the severity of the disaster scenario that will be simulated. Disaster drills are time-consuming, but they allow all participants to practice skills that would be needed in the event of a disaster. In addition, they allow organizations and communities to evaluate the effectiveness of their systems and identify potential weaknesses in the ability to respond to an actual disaster. An organization may also have drills to respond to a simulated environmental exposure disaster (Procedure 49-2). This term refers to exposure to pollutants or toxic substances. In a workplace, such exposure can be chronic, because of inadequate shield­ing or work practices. In addition, an acute incident can occur—for example, a gas leak, a radiation incident, or a spill of a hazardous substance.


In case of fire Use stairway for exit Do not use elevator

Primary escape route



Secondary escape route

Figure 49-6 Evacuation floor plans should be posted in the medical office.

PROCEDURE 49-2 Participating in a Mock Environmental Exposure Event

Outcome Participate in a mock environmental exposure event.

Scenario: Role-play a scenario with your classmates. First review the directions, review your building evacuation route map, and make a list of all members of your group (the “employees” and “patients”). Designate a place to meet after evacuating the building.

In this scenario, the office manager of the medical office where your group works has been told to evacuate the office because a natural gas leak is suspected in the building. One member of your group should be chosen to coordi­nate the evacuation. He or she should assign two others to assist patients to leave the building and designate another member to be sure that there is no open flame in the office and be the last to leave the office. Carry out the evacua­tion, meet afterword, and account for everyone in your group. Discuss your process and document the steps in the evacuation.



        Evacuation plan

1. Procedural Step. Prepare for the disaster simulation by obtaining the building evacuation plan and floor map, reading the scenario, making a list of group members, assigning group members to be staff or patients, and designating a meeting place.

Building evacuation route map Pen and paper

Principle. An evaluation plan includes all necessary details so that employees of a specific location know how to leave the location safely, know that they are responsible for patients, and can be accounted for after an evacuation.

PROCEDURE 49-2 Participating in a Mock Environmental Exposure Event—cont’d


            Procedural Step. Choose a coordinator from the “staff members” to manage the evacuation scenario. Principle. A coordinator assigns tasks, works with community services, and generally facilitates any response to an emergency.

            Procedural Step. Begin the simulation, and assume that the office has been notified that the office must be evacuated because a natural gas leak is suspected in the building.

            Procedural Step. The coordinator assigns two staff members to assist patients to leave the building and one staff member to check that there is no open flame and to be the last to leave the office area.

Principle. An open flame can trigger an explosion when natural gas is present. While checking for an open flame in all rooms, the staff member can also make sure that staff and patients have left each room in the office.

            Procedural Step. Leave the building using the primary escape route marked on the building evacuation route map.

Principle. The building evacuation route map identi­fies a primary and secondary escape route. Unless the primary escape route is blocked, it is assumed to be the fastest and most efficient way to evacuate the building.

            Procedural Step. Meet at the designated meeting area. The coordinator checks the list to be sure that every­one is present and that there have been no injuries. Principle. As part of a disaster drill, everyone must be accounted for.

            Procedural Step. Discuss the process of the evacuation.

            Procedural Step. Document the evacuation including your role and effectiveness of the group as a whole in carrying out the evacuation.

Principle. Evaluation of the disaster drill identifies system and individual weaknesses that should be strengthened.

What Would You Do? What Would You Not Do?

Case Study 2

One afternoon, the office manager in the medical practice where Beth Ann works receives a telephone call from the building manager stating that the building must be evacuated because there is a smell of gas in the basement of the building. The office manager instructs Beth Ann to escort all the patients in the waiting room to the designated meeting place outside at the rear of the parking lot. There are three adults and two children in the waiting room, all able to walk. The office is on the fourth floor of an office building. When Beth Ann tells the patients that they will have to leave the building, one woman asks, “Can I just go to the rest room first?” ■

Medical Assistant’s Role

The medical assistant is an important team member in developing and implementing the emergency action plan for a health care setting and can also contribute to emer­gency preparedness in the community. He or she may make recommendations to supplement emergency equipment or facilities in the office, serve on a committee to review or revise the emergency plan, participate actively in all fire drills and disaster drills, and participate in the review of the effectiveness of any drill. In addition, the medical assistant must be prepared to provide emergency first aid or cardio­pulmonary resuscitation (CPR), both in the workplace and in the community (see Lecture 35). In an actual disaster, medical assistants might assist by providing emergency first aid, conducting patient interviews, helping to calm victims, documenting services provided, and performing phlebot­omy or other procedures as directed.


Several very serious natural and man-made disasters have occurred since the 9/11 attack on the World Trade Centers, including Hurricane Katrina, major earthquakes and tsu­namis, and other terrorist attacks and mass shootings. These have increased awareness of the need for all com­munities to increase preparedness and improve communi­cation among different parts of the emergency response system. Community and state emergency preparedness plans involve coordination of all services including the emergency medical services (EMS) system, fire and police departments, the National Guard, the American Red Cross, and hospitals and other health care facilities (Figure 49-7). As the disaster unfolds, communication may be disrupted owing to electrical outages, damage to cell towers and tele­vision towers, and overloading of communication infra­structure. When a serious terror attack or disaster occurs, the governor of the affected state implements the state emergency plan and declares a disaster. If the state’s resources are inadequate, the governor petitions the president to declare a major disaster. Federal assistance and resources then become available.

Figure 49-7 When multiple emergency units respond at a scene, it is important for the actions of police, fire, and emergency medical services (EMS) assets to be coordinated.

What Would You Do? What Would You Not Do?

Case Study 3

After a tornado that caused serious destruction in a neighboring town, Joanne Williams, a 32-year-old mother of two toddlers, asks Beth Ann how to prepare for a tornado. She tells Beth Ann that she lives in a fairly new house that doesn’t have a basement. She says that she can’t stop thinking about the images she saw on the television news, and she expresses fear that she might not be able to protect her children if a tornado were to strike her neighborhood. ■

provide assistance in disaster planning, and volunteers respond to fires and other emergencies. The Red Cross provides individuals and families a place to stay, food, and mental health services to help them meet their basic needs, recover from the disaster, and resume their normal activities.

Beth Ann Wilson: The office where I did my externship was a clinic in a large city hospital. While I was there, I was allowed to attend a hands-on fire training session for hospital employees. We met at a training facility at the fire department where we saw two training films. One of them showed how to test a door for warmth and emphasized that a warm door or a door with smoke leaking around the edge should never be opened. In the film, a fireman did open the door, and we saw how the flames and smoke gushed out when the fire received the new supply of oxygen. Someone asked what you should do if you knew there was a patient in the room behind a warm door. The fireman answered that if possible, you should wait for a firefighter, who would be prepared to handle the flame and smoke. After the films, we were dressed in protective equipment and allowed to discharge fire extinguishers to put out small fires. Even though the fires were small, it was still a scary experience. I hope I never have to deal with a fire, even a small one, but I know that this experience helped to prepare me if it ever happens. ■

Community and National Organizations

The Federal Emergency Management Agency (FEMA), an agency of the Department of Homeland Security (DHS), is tasked with coordinating a response to any disaster that overwhelms the resources of state and local authorities. It also provides publications to assist with emergency pre­paredness planning for businesses and individuals. FEMA maintains 10 regional offices that work closely with the state agencies for emergency management in their region.

Citizen Corps is an agency coordinated by FEMA that coordinates volunteer activities to prevent crime and respond to emergencies. It was created to allow a means of service at the local level after the events of September 11, 2001. Citizen Corps Councils and various partners register with Citizen Corps. Many communities have established community groups of volunteers called Community Emer­gency Response Terms (CERTs). These groups may be com­munity groups or affiliated in some other way (e.g., college, region). They receive disaster training to function as an extension of first responder services so that they can provide help in a disaster until professional services arrive.

A private agency that has a long history of disaster plan­ning and relief is the American Red Cross. Local chapters

Community Resources

The medical assistant should be aware of community resources for emergency preparedness (Procedure 49-3). The medical office may keep a list of local organizations with telephone numbers or other contact information in the following areas:

Emergency Management Services (911)

Poison Control Center Telephone numbers of local hospitals Telephone numbers of local and state health departments

Telephone number for the state HAZMAT response team (HAZMAT is an acronym constructed from “hazardous materials.” It refers to materials that pose a danger to health or the environment and require protective clothing for cleanup.)

The medical assistant should also be aware of commu­nity disaster plans and community organizations that might assist in a disaster. The website of the state emergency man­agement agency often includes helpful articles related to the disasters that occur most frequently in that state. It is helpful to develop a list of useful resources for the medical office and update it regularly.

Maintaining a List of Community Resources for Emergency Preparedness


Outcome Maintain a list of community resources for emergency preparedness.


                                                                                                                                                                           Local telephone book         • Telephone

                                                                                                                                                                           Computer and Internet       • Pen and paper





            Procedural Step. Prepare a list of community agencies for emergency response including EMS (911), the Poison Control Center, telephone numbers of local hospitals, telephone numbers of local and state health departments, and the telephone number for the state HAZMAT response team. This list should be posted by every telephone in a medical office.

Principle. In an emergency situation, easy access to emergency telephone numbers saves time.

            Procedural Step. Research and create a more detailed list of agencies to respond to a widespread disaster or emergency affecting the community. Locate telephone numbers and Web addresses of the local emergency management agency (LEMA) office, the local chapter of the American Red Cross, and any Citizen Corps council or Community Emergency Response Team

(CERT) in your community. The list may be created using pen and paper, but it should be transferred to a word processing file for ease of duplication. Procedural Step. Once the document file has been substantially completed, group resources by subject and/or age group served. Alphabetize resources within each group.

Principle. Arranging lists in alphabetic order facili­tates finding specific information and avoids any impression of favoritism or recommending one agency more than another.

Procedural Step. When the list is complete, save and print copies as needed.

Procedural Step. Update the list when information changes, when a new resource is identified, and on a periodic basis to be sure information is accurate.


A class-action lawsuit was filed against Tenet Healthcare Corpora­tion and a subsidiary after Hurricane Katrina in 2011, claiming that deaths and injuries of several patients resulted from insufficiencies in Memorial Medical Center’s backup electrical system and failed plans for patient care and evacuation. This lawsuit, brought on behalf of patients and visitors who were at the hospital during the hurricane, was eventually settled for $25 million. The problems experienced in New Orleans after Katrina stimulated nationwide reevaluation of institutional and community disaster plans. As this lawsuit demonstrates, medical facilities share in the responsibility to institute systematic policies and procedures to prepare as com­pletely as possible for catastrophic conditions.

What Would You Do? What Would You Not Do? responses

Case Study 1

What Did Beth Ann Do?

          Told Mrs. Manning to stop and breathe and encouraged her to take several deep breaths.

          Recognized that Mrs. Manning was showing signs of severe anxiety, which would make it difficult for her to focus on driving safely.

          Said to Mrs. Manning that she seemed very upset by the news, reassured her that the fire department would respond promptly, and encouraged Mrs. Manning to sit down and relax for a minute until she collected herself.

          Asked Mrs. Manning if there was a family member or friend she could call to pick her up and drive her to her son’s school.

          Listened attentively to Mrs. Manning’s concerns.

What Did Beth Ann Not Do?

          Did not allow Mrs. Manning to leave and drive an automobile while in a state of severe anxiety.

          Did not tell Mrs. Manning to calm down because she was overreacting.

□ Did not give Mrs. Manning a detailed explanation of the effects of anxiety.

What Would You Do/What Would You Not Do?

Review Beth Ann’s response and place a checkmark next to the information you included in your response. List the additional infor­mation you included in your response.

Case Study 2

What Did Beth Ann Do?

□ Spoke calmly but with authority when she requested that every­one in the waiting room come with her because it was neces­sary to evacuate the building.

What Would You Do? What Would You Not Do? responses—contd

         Instructed the woman who asked to use the rest room that she would have to wait because it was important to evacuate as quickly as possible.

         Allowed the patients to pick up their coats and personal items, but instructed them not to take time to put on coats or jackets.

         Looked at the posted sign containing evacuation routes, and led the patients along the nearest evacuation route using the stairs to reach the nearest emergency exit. Explained that this would leave the elevators available to any emergency personnel.

         Led the group to the designated meeting place and kept them there until all other staff arrived and everyone was accounted for.

What Did Beth Ann Not Do?

         Did not speak too quickly or in a high-pitched voice to avoid appearing upset.Did not guess about which evacuation route to use.

         Did not allow patients to spend unnecessary time making tele­phone calls, putting on coats or other clothing, or using the rest room.

         Did not allow patients to leave the parking lot area until every­one from the office had been accounted for.

What Would You Do/What Would You Not Do?

Review Beth Ann’s response and place a checkmark next to the

information you included in your response. List the additional infor­mation you included in your response.

Case Study 3

What Did Beth Ann Do?

           Helped Mrs. Williams to find information about preparation for tornados.

           Asked questions to let Mrs. Williams express her fears and assess Mrs. Williams’ anxiety level.

           Offered to ask the physician to recommend a counselor for Mrs. Williams to explore her feelings further.

           Reminded Mrs. Williams that serious disasters do happen, but they are not regular occurrences.

What Did Beth Ann Not Do?

           Did not say or imply that Mrs. Williams was overreacting or worrying for no reason.

           Did not push Mrs. Williams to accept her suggestions, but rather just offered information.

           Did not promise that the physician would make specific referrals.

What Would You Do/What Would You Not Do?

Review Beth Ann’s response and place a checkmark next to the

information you included in your response. List the additional infor­mation you included in your response.



Evacuation plan

Fire extinguisher HAZMAT

Man-made disaster

Natural disaster

Posttraumatic stress disorder (PTSD) Stress

Medical Term

Word Parts Definition

A feeling of worry or uneasiness, often triggered by an event with an uncertain outcome.

A plan that includes escape routes for all locations in a building or other facility. Diagrams of these routes are posted in multiple locations.

A portable device that discharges foam or another material to extinguish a fire.

A word constructed from the beginnings of the two words “hazardous materials.” A material that poses a danger to health or the environment. It must be handled with protective equipment.

Serious damage either directly or indirectly caused by intentional or negligent human actions or the failure of a man-made system (such as some fires, structural collapse, or terrorism).

Serious damage to the environment resulting from a natural hazard (such as volcanoes, earthquakes, or hurricanes) that leads to environmental, financial, and human losses.

A psychiatric condition that develops months or years after a traumatic, catastrophic life experience.

The body’s response to threat or change.


For Information on fire safety:

OSHA Fire Safety: www.osha.gov/SLTC/firesafety U.S. Fire Administration: www.usfa.dhs.gov For information on evacuation plans:

OSHA Evacuation Plans and Procedures: www.osha.gov/SLTC/etools/evacuation/eap.html For information on emergency and disaster planning:

American Red Cross: www.americanredcross.org

CDC Emergency Preparedness: www.bt.cdc.gov/preparedness

Citizen Corps: www.citizencorps.gov

FEMA (Federal Emergency Management Agency): www.ready.gov Business emergency response plan: www.ready.gov/business/implementation/emergency Disaster help and resources: www.disasterassistance.gov State agencies: www.fema.gov/about/contact/statedr.shtm Locate local emergency preparedness programs: www.citizencorps.gov/cc/searchCouncil.do?submitByZip