INTER-REGIONAL BIOTERRORISM HOSPITAL AND ...champaignrhc.org/wp-content/uploads/2016/01/Champaign... · Web viewChampaign Region Hospital/Local Public Health HOSPITAL DISASTER PLAN

Champaign Region Hospital/Local Public Health

HOSPITAL DISASTERPLAN

Revised May 2009Revised May 2010

Revised February 2012Revised September, 2015

Revised September, 2015 1

Table of Contents

Pg. 3 Abbreviations and AcronymsPg. 4-5 Terms and DefinitionsPg. 6 1.0-PurposePg. 6-7 2.0-ApplicabilityPg. 7 3.0-Concepts of OperationPg. 7 3.01-Regional Planning AreaPg. 8 3.02-Authority for Direction and ControlPg. 9 IDPH OPR Public Health and Medical Services Response Regions MapPg. 10 3.03-Direction and Control PointsPg. 11 3.04-RHCC HospitalsPg. 12 Champaign Region RHCC Activation WorkflowPg. 13 3.05-Field Incident Command ComponentsPg. 13 3.06-Response ActionsPg. 14 3.07-Assessment and Deployment of Resources within the RegionPg. 14 4.0-Disaster RHCC HospitalPg. 14-15 A-Tier Level III HospitalPg. 15 B-Tier Level II HospitalPg. 15-16 C-Tier Level I HospitalPg. 16-17 4.01-Coordination of County Emergency Operations Center/EMAPg. 17-18 4.02-Stockpile AcquisitionPg. 18-20 4.03-Alternative Care FacilityPg. 20-21 4.04-Hospital Surge CapacityPg. 21 4.05-QuarantinePg. 21-22 4.06-Diversion and Alternate EMS CommunicationPg. 22-23 4.07-Hospital FacilityPg. 23 4.09-Response to a System Wide CrisisPg. 24 4.10-American Red CrossPg. 24 4.11-Provision of Emergency Services and SuppliesPg. 24-25 4.12-Disposal of Medical WastePg. 25 4.13-Blood CentersPg. 25 4.14-Law Enforcement (State, County, Municipal)Pg. 25-27 4.15-Ensuring Transportation/Movement of EquipmentPg. 27 4.16-Medical Examiners/CoronersPg. 27 4.17-Funeral Directors Association/Disaster Mortuary Services TeamPg. 27-28 4.18-Procurement of Real Property and Use of Commercial VendorsPg. 28 4.19-Emergency Services Disaster Agency PolicyPg. 28 4.20-Division of HighwaysPg. 28 4.21-Illinois Poison Control CenterPg. 29 4.22-Mutual Aid Box Alarm System (MABAS)Pg. 29 5.0-Plan Development and MaintenancePg. 29 6.0-Authorities and ReferencesPg. 30 7.0-Attachment Index (See Index for Attachment Page Numbers)


ABBREVIATION/ACRONYMS

CDC Centers for Disease Control

RHCC Regional Hospital Coordinating Center- Lead hospital in a specific region responsible for coordinating disaster medical response upon the activation of the Emergency Medical Disaster Plan by IDPH/IEMA.

ED Emergency Department

EMDP Emergency Medical Disaster Plan

EMSRPA Emergency Medical Services Regional Planning Area disaster medical response

EMA Emergency Management Agency

EMS Emergency Medical Services

EMSC Emergency Medical Services for Children

EMT Emergency Medical Technician

EOC Emergency Operations Center

HICS Hospital Incident Command System

HS Highway Safety

IDMS Illinois Disaster Management System

IDPH Illinois Department of Public Health

IMERT Illinois Medical Emergency Response Team

IEMA Illinois Emergency Management Agency

IPC Illinois Poison Control

MABAS Mutual Aid Box Alarm System

ME Medical Examiner

RHCC Regional Hospital Coordinating Center

SNS Strategic National Stockpile

SEOC State Emergency Operations Center

VA Veteran’s Administration


WMD Weapons of Mass Destruction

TERMS AND DEFINITIONS

Ambulance Service Providers: Individuals, groups of individuals, corporations, partnerships, associates, trusts, joint ventures, units of local government, or other public or private ownership entities that own and operate a business or service using one or more ambulances or EMS vehicles licensed by the Illinois Department of Public Health to transport emergency patients.

Associate or Participating Hospital: A hospital with an emergency department, but not overseeing an EMS System.

Bioterrorism: The use of bacteria, rickettsia, viruses or toxins utilized to inflict harm and/or death. These materials may cause harm to the body through contact, ingestions or inhalation.

Disaster RHCC: The Illinois Department of Public Health EMS regions used for the medical disaster plan, with each region having a designated hospital serving as the RHCC.

Emergency Medical Services Medical Director: The physician, appointed by the resource hospital and approved by the Illinois Department of Public Health, who has the responsibility and authority for total management of the EMS system.

EMS System: Is comprised of ambulance service providers and first responders in a geographic area. These responders are called for emergency medical assistance (usually by 911). The System is overseen by a resource hospital.

Illinois Emergency Management Agency): This is the IDPH command post set up specifically upon activation of the Emergency Medical Disaster Plan. IEMA will be based in Chicago or Springfield depending on what area of the state is affected by the disaster. IEMA personnel will be in direct contact with the activated emergency operation center (EOC) in Springfield. All Communication to and from the activated RHCC hospital(s) will be from IEMA.

IMERT: The Illinois Medical Emergency Response Team consists of four four-person groups serving North, Central, Chicago and Southern Illinois. If a mass casualty incident (MCI) occurs and a medical response team is needed, the on-call IMERT will be activated.

Hospital Incident Command System: A standardized organizational structure used to command, control and coordinate the use of resources and personnel that have responded to the scene or are participating in an emergency event.

Tier Level I Hospital RHCC Hospital -Tier Level II Hospital Non-RHCC hospitals – A resource hospital, associate hospital

and/or trauma center

Tier Level III (a) All hospitals participating in an approved EMS system. The Emergency Department (ED) must have at least one RN available in the ED, and a licensed physician on call at all times.

Tier Level III (b) Health Care Facilities, including outpatient facilities and referral centers that are not a hospital


Local Government Official: The official of the community who is charged with authority to implement and administer laws, ordinances and regulations for the community.

MABAS (Mutual Aid Box Alarm System): MABAS is an agreement among fire departments in the majority of counties to provide immediate extra manpower and equipment, systematic response of teams of personnel, access to specialized equipment that could not be justified for a single department, contractual responsibilities and liabilities, and broad area coverage.

Medical Disaster: Is an event that stresses resources (personnel and stockpile) of a hospital, EMS System, trauma region or state. Example would include, but are not limited to:

Weather event (tornado, snowstorm, flood) Terrorism event (bomb, biological agent release, chemical release) Hazardous Materials spill/release Hospital event (fire, evacuation, electrical failure, building collapse) Epidemic Mass Casualty Incident

Resource Hospital: Is a hospital that oversees an EMS system. Resource hospitals are responsible for the quality control, education and medical direction of a specific EMS System.

Weapons of Mass Destruction: Biological, Nuclear, Incendiary, Chemical and Explosive agents that are utilized to inflict harm and/or death.


1.0 Purpose

The overall goal of the Regional Hospital Preparedness Program (RHPP) is to enhance the Emergency Medical Disaster Plan (EMDP) for the State of Illinois and to upgrade the preparedness of regional hospitals, health care systems, and non-hospital health care facilities to respond to an act of bioterrorism or a large-scale catastrophic event.

2.0 Applicability

This plan applies to the Tier Level I, Tier Level II, and Tier Level III (a) and III (b) hospitals and health care facilities located in the Northern Illinois Regions.

This plan applies to all Hospitals that may be called upon to provide or support emergency medical assistance when local resources are overwhelmed. Other departments and agencies may include, but are not limited to:

County Emergency Management Agency County Sheriff’s Office County Health Department County Mental Health Department County government agencies, i.e. coroner’s office

environmental concerns public works division of transportation legal human resources

This plan works in conjunction with all community departments and agencies that may be called upon to support emergency medical assistance when local resources are overwhelmed. These departments and agencies may include, but are not limited to:

Red Cross Fire Departments Park District School District Private Educational Institutions Private Ambulance Services


Retail Pharmacy Veterinary Services Long Term Care Agencies Geriatric/Senior Service Organizations Public Transportation Agency Medical Reserve Corp. Chamber of Commerce Dental Agency Rehab/Specialized Care Agencies

3.0 Concept of Operations-

This section describes the direction of tasked organizations: command structure, specifying who will be in charge during emergency

medical operations, the authorities of, and limitations on, key response personnel;

how medical response organizations will be notified when it is necessary to respond;

the means used to obtain, analyze and disseminate information; the relationship between the control points; provisions made to coordinate and communicate among all the jurisdictions

and agencies that may be involved in the emergency medical response.

3.01 Regional Planning Area

Each organization that is called upon to provide or support the rendering of medical assistance will exercise direction and control of its staff and resources. In order to meet the public needs that could be generated by an incident, it is essential that the responding organizations coordinate their efforts within an overall direction and control system.

Response to a medical incident in Illinois will be coordinated and conducted utilizing the Illinois Disaster Management System (IDMS). This component of the Emergency Medical Service Regional Planning Area Plan (EMSRPA) provides a mechanism for identifying organizational roles and responsibilities for responding organizations, and also establishes a structure for information exchange and coordination among responding organizations.


3.02 Authority for Direction and Control

The overall authority for direction and control of Champaign Regional resources to respond to a disaster is the Emergency Medical Services (EMS) Medical Director or designee of the disaster RHCC hospital of the respective region. Carle Foundation Hospital is the Champaign Region RHCC hospital.

Illinois RHCC Hospitals


• Rockford Memorial• St. Francis, Peoria• St. John’s/Memorial Medical Center, Springfield• Memorial Hospital, Belleville• Memorial Hospital, Carbondale• Carle Foundation Hospital

• Christ Hospital, Oak Lawn

• Loyola University Medical Center

• Sherman Hospital, Elgin

• Highland Park Hospital

• Illinois Masonic, Chicago

3.03 Direction and Control Points


During an emergency medical incident, overall medical direction and control as well as coordination of input from all responding organizations will be accomplished through the staffing and operation of the following direction and control points.See Attachment A- Region 6 Contact List

Champaign Region /Emergency Contact Chart


Carle Foundation HospitalEmergency Department

217-383-3313House Officer217-383-3313

Carle Hoopeston Regional Health Center

217-283-8520

Crawford Memorial(618) 546-

2537

Lawrence County

Memorial Hospital

(618) 943-1000

Sarah Bush Lincoln Health Center

(217) 258-2551

St. Mary’s DecaturHospital

(217) 464-2973

Gibson Area Hospital &

Health Services

(217) 784-2555

Presence Covenant Medical Center

(217) 337-2911 Pro Disp.

(217) 337-2646

Kirby Medical Center

(217) 762-1600

Presence United

Samaritans Medical Center

(217) 443-5221

Paris Community

Hospital(217) 465-

4141

Decatur Memorial Hospital

(217) 876-3000

Shelby Memorial Hospital

(217) 774-3961

Dr. John Warner Hospital

(217) 935 – 9571

ext. 3315

Iroquois Memorial Hospital

(815) 432-5841

St. Anthony’s Hospital

(217) 342-2121

3.04 RHCC Hospitals

The RHCC hospital is the lead hospital in a specific region responsible for coordinating hospital disaster medical response upon the activation of the EMSRPA plan by the Illinois Emergency Management Agency (IEMA).

The RHCC hospital will serve as the primary point of contact for communication and coordination of hospital disaster response activities with the Illinois Department of Public Health (IDPH) duty officer, hospitals, health care systems and non-hospital health care facilities identified in the EMSRPA plan.

The RHCC hospital is the designated point of contact for coordination, receipt of inputs, and providing updates on the status of disaster medical response to the following organizations:

IEMA Tier Level II, Tier Level III (a) and Tier Level III (b) facilities Hospital public information County Emergency Operations Center (EOC)


Champaign Region RHCC Activation


Contact RHCC Coordinator Anita Guffey

217-377-3911-Office217-621-4654-Cell

If No Response in 10 Minutes, ContactSteve Peters

217-337-3911-Office217-369-9337-Cell

If No Response contact Arrow Ambulance217-337-3911 and

Request Emergency Management Staff be paged

Contact IDPH REMSCIrene Wadhams

217-278-5900-Office217-552-2891-Cell

3.05 Field Incident Command Components

Overall direction and control of the county’s response to the needs generated by an emergency medical incident will be exercised and maintained through the county EOC/Emergency Management Agency (EMA), when available. The incident commander assigned to the situation will provide status reports to and request additional resources from the county EOC/EMA. A unified command system will be established as the situation warrants.

3.06 Response Actions

Emergency Medical Service Regional Planning Area Plan Activation

The Director of the Illinois Department of Public Health, or designee, will determine whether the Illinois Emergency Medical Disaster Plan will be activated. If activated, the Director of the Illinois Department of Public Health, or designee, upon consultation with the Chief of the Division of EMS and Highway Safety, will activate the disaster RHCC hospital(s) and declare the situation a Phase I or Phase II emergency medical disaster.

The IDPH duty officer will notify the appropriate IDPH regional EMS Coordinator(s), upon consultation with the chief of the Division of EMS and Hospital Preparedness Program Manager, to report to the RHCC hospital(s). The IDPH regional EMS Coordinator will notify the IEMA when they are operational at the RHCC hospital.

The RHCC hospital will contact the Tier Level Resource hospitals and request initiation of the EMSRPA plan. The Tier Level II Resource hospitals will contact their designated Tier Level II associate hospitals, Tier Level III (a) and Tier Level III (b) health care facilities to elicit information on their response capabilities. The Tier Level II Resource Hospitals will provide verbal, telefax (fax), or StarCom radio notification of resource availability for all healthcare facilities to their respective RHCC hospital.


3.07 Assessment and Deployment of Resources within the Region A request for regional resources may be activated by contacting the Champaign Region RHCC Coordinator or designee. The affected hospital will provide a list of resources needed and the RHCC Coordinator will make every effort to supply needed items to the affected hospital/hospitals. The RHCC Coordinator notify the IDPH EMS Regional Coordinator and brief them on the situation. The RHCC Coordinator will give the affected hospital/hospitals an estimated time of arrival.

4.0 Disaster RHCC Hospital

The EMS Medical Director of the RHCC hospital has the overall authority for the activation and implementation of the EMSRPA in their respective region.The RHCC hospital will serve as the primary point of contact for communication and coordination of the EMSRPA with Tier Level II, Tier Level III and Tier Level III health care facilities.

A) Tier Level III – Participating Hospitals

1) Designate a contact person for disaster/emergency preparedness.

2) Have high speed internet access in the emergency department.

3) Participate in disaster planning and disaster drills on a regional basis.

4) Have reference information on treatment of biological agents on site or post phone number of Illinois Poison Center (IPC).

5) Agree to implement System-Wide Crisis Policy and State Emergency Medical Disaster Plan and provide ongoing education to staff on both.

6) Have functional medical emergency radio communication of Illinois (MERCI) radio.

7) Have functional Starcom 21 radio for communications between Champaign Region Hospitals and State resources.

8) Develop a plan to identify, receive and distribute the National Pharmaceutical Stockpile and/or the State Pharmaceutical Stockpile to hospital staff.


9) Make training in the recognition and treatment of weapons of mass destruction available to the hospital staff.

10) Maintain disaster bags and supplies as outlined in the State Emergency Medical Disaster Plan.

B) Tier Level IIThis level includes hospitals that are not RHCC hospitals as identified in the State Emergency Medical Disaster Plan. (The disaster RHCC hospital is the lead hospital in a specific EMS region responsible for coordinating disaster medical response upon the activation of the State Emergency Medical Disaster Plan by the IEMA.) These hospitals include resource hospitals, associate hospitals, participating hospitals and/or trauma centers as designated by the Department. These hospitals must meet Tier III capabilities and the following:

1) Have communication capability with pre-hospital care personnel.

2) Assist with disaster planning and drills.

3) Have policy on decontamination capabilities.

4) Resource Hospital Only – Act as a resource for disaster planning and actively participate in the development, education and implementation of the Regional Bioterrorism/All Hazards Response Plan.

C) Tier Level I

A Tier Level I hospital is the highest level for a disaster preparedness hospital. A Level I hospital shall be a Department-designated RHCC hospital as defined in the State Emergency Medical Disaster Plan. A Tier Level I hospital must meet all the requirements of Tier III and Tier II and additionally meet the following:

1) Identify a disaster preparedness coordinator to work with the State coordinator for disasters.

2) Perform as the lead hospital in a regional or State disaster preparedness exercise.

3) Perform as the lead in planning and developing a regional Disaster Medical Response Preparedness Plan, including but not limited to the following: inter-hospital transfers; intra-region transfers; disaster bags; medical response teams; and the dissemination of information as it pertains to EMS


System activities and the reporting and feedback of such information for EMS providers and emergency departments within the region. Identify members of this planning committee, including, as a minimum:

A) EMS coordinators from Resource and Associate Hospitals

B) Designated contact disaster person at Participating Hospitals

C) Local health department representative

D) Hospital administrator

E) Representative from a specialized hospital/rehabilitation center

F) Representative from police, fire and EMS

G) ED nurse manager

H) Infectious disease physician or registered nurse

4) Ensure availability of one portable or fixed decontamination unit.

5) Support training and educational programs for health professional staff in region.

The RHCC Hospitals, with the cooperation of their Regional Hospitals and health care facilities, will be required to develop policies and/or procedures that address preparedness issues in accordance with the Office of the Assistant Secretary for Preparedness and Response (ASPR).

4.01 Coordination of County Emergency Operations Center/Emergency Management Agency

The affected county EOC/EMA will coordinate resource support for regional response. This response will require the cooperative effort of all county agencies. When local governments determine that available resources are not adequate to respond to an emergency, they may request assistance through Illinois Emergency Management Agency (IEMA).


Initial requests for state assistance shall be made by the county emergency management agency through the State Emergency Operations Center (SEOC). If the county EOC/EMA is notified of a medical emergency, they shall notify their respective RHCC hospital.

4.02 STOCKPILE ACQUISITION

In the event of a disaster, the Illinois Department of Public Health will generate a request for additional equipment, supplies, and/or drugs as needed through the Director of Public Health.

The county EOC will designate a delivery point. The county Department of Public Health will be responsible for a distribution plan. This distribution plan will reside at the County Department of Public Health. To access needed items, utilize “Hospital Strategic National Stockpile (SNS) needs Form”.

See Attachment B - Hospital Strategic National Stockpile (SNS) Needs Form

Notify RHCC Hospital of request.

A. Illinois Pharmaceutical StockpileHospitals and health care facilities shall request additional equipment, supplies, and/or drugs as needed through their local EMA or IEMA.

B. Strategic National Stockpile

The Strategic National Stockpile (SNS) is a Federal cache of various medical equipment and medication. The SNS may be accessed once the Illinois stockpile has been utilized.

Hospitals requesting supplies from the SNS may make their request via their local Public Health authority. THE local PH will then contact their local EMA. The IDPH “Hospital Strategic National Stockpile (SNS) Needs Assessment Form” must be accessed in this manual or via the IDPH Hospital Health Alert Network (HHAN).

IEMA will then review the request and if approved, IEMA will make arrangements to have the supplies delivered to the requesting hospital.


C. Regional Cache

Affected Champaign Regional Hospitals may request Regional Assets through the RHCC. (See Champaign Region Activation Chart)

Supplies and equipment will be transported to the affected hospital via Champaign Region Disaster Cargo Trailers.

Carle Regional EMS and Arrow Ambulance staff will assist with loading of requested supplies and equipment.

Requesting hospital will identify a receiving location and will supply manpower to unload the supplies and equipment.

The RHCC hospital will document the supplies and equipment used for inventory tracking.

4.03 Alternative Care Facility

Facility

1. If an event occurs and the number of patients exceeds the immediate capacity of area hospitals, non-patient care areas within the hospital that can meet the specific requirements (separate ventilation, etc.) will be utilized. Once this capacity is overwhelmed, non-hospital facilities may be utilized for patient care. These facilities may be established to care for patients or may be staffed and equipped to house admissions. Establishment of such a facility should be accomplished with cooperation of the stricken community’s hospital, local and county health departments, the county office of Emergency Management and the municipal government. If a highly communicable outbreak occurs, hospital and non-hospital facilities will be designated by the Illinois Department of Public Health to receive suspected or confirmed cases.

2. The selected facility should have specific resources and equipment to minimize the exposure of susceptible individuals to contagious individuals. All persons entering or admitted to such a facility must receive appropriate prophylactic vaccines or medications and appropriate personal protective equipment.

3. Examples of potential surge facilities include an empty facility or one that is not in use for other purposes (e.g. motel, school, separate building of a hospital, college dormitory, etc.) that meets the requirements listed below. The treatment area should not have ventilation systems shared with other areas of the building or with other buildings. It must have controllable access (e.g. fence around building or monitored entrances) to


prevent entrance by susceptible or unauthorized individuals. Specific requirements include:

A. A structure with non-shared air conditioning, heating, and ventilating systems. If smallpox or other airborne disease is suspected, the ventilation system must exhaust 100% of air to the outside through HEPA filter OR the building must be located at least 100 yards from any other occupied building or area.

1. Adequate water, electricity, heating, cooling, and closed-window ventilation to maintain activities of daily living and the medical care of residents.

2. A communication system that allows for dependable communication within and outside of the facility (e.g. telephone, radio, or intercom system) and computer Internet access.

3. Ability to provide the following level of medical care within the facilities:1) Supportive care with IV fluids, antibiotics, etc.2) Skin care3) Oxygen monitoring (pulse ox) and oxygen (in-line or portable)4) Medical Vital signs monitoring5) Cardiac and respiratory resuscitation6) Ventilator support7) Suctioning Equipment8) Staffing resources (to be determined by severity of illness)9) Basic laboratory evaluations (blood chemistries, CBC) if possible10)Radiology (portable chest x-ray) for in-patient facilities

4. If sites are to be established by the local health department for distribution of prophylactic vaccines and/or medication to the public, establishment of a triage/outpatient treatment area at the same site should be considered. Individuals with mild symptoms may present to a distribution center rather than seeking treatment at a health care facility. Individuals without symptoms will be appropriately triaged at a health care facility and be directed to a distribution center. Requirements of the treatment area will be dictated by the nature of the infectious disease.

Reference: Centers for Disease Control, Type C (contagious) Facility


Staff

In order to staff an outpatient or inpatient treatment facility, the stricken community must be prepared to utilize employees of health care facilities assigned by their institution as well as volunteers. Verification of credentials must be completed prior to assignment of personnel to direct patient care. Inter-hospital credentialing should be a core component of a Region or Statewide hospital mutual aid system. Ideally, all medical credentials of volunteers would be verified through on-line contact with the Illinois Department of Professional Regulation. Any volunteer whose credentials cannot be verified will be assigned to support activities other than direct patient care.See Attachment C – Champaign Region Alternative Care Facility Activation Plan

Equipment

1. Equipment for establishing a non-hospital treatment facility will be coordinated by the affected hospital, RHCC, County Emergency Management Agency, Local Public Health Department and American Red Cross as well as other appropriate agencies. Equipment can be requested from the Central Management Agency through the Illinois Department of Public Health.

See Attachment D – Champaign Region Shareable Resource ListSee Attachment E - Alternative Care Facility Inventory in Urbana, ILSee Attachment F - Trailer Inventory

4.04 Hospital Surge Capacity

Every hospital must be prepared to provide care for the sudden, unexpected arrival of ill or injured patients. Hospital Emergency Preparedness Plans must include a plan for establishment of additional treatment areas. The hospitals should be prepared to triage and provide initial assessment and treatment for up to three times the daily Emergency Department census. Historically, the majority of patients will be treated and released. Hospitals should plan to increase hospital admission capacity by 20-25% over average daily census. In cooperation with area hospitals, this should provide or a Regional admission capacity increase in excess of 500 beds.

If an outbreak of infectious disease is confirmed or suspected, the Illinois Department of Public Health will make recommendations for appropriate transmission-based precautions. Negative airflow rooms may be necessary


if the causative agent is unknown or if the organism is spread by airborne transmission. Hospital preparation should include plans to cohort patients with like symptoms and isolate patients and personnel exposed to diseases. If the number of patients exceeds the isolation capacity of area hospitals, the Illinois Department of Public Health should be notified to implement the State Medical Disaster Plan and the RHCC Hospital should be notified to coordinate Regional response.Each hospital should maintain or otherwise provide for adequate equipment and resources to meet the initial needs of patients.

Isolation and Quarantaine

4.05 QUARANTINE

Definition

1. Quarantine Is defined as the restriction of activities or limitations of freedom of movement of those presumed exposed to a communicable disease in such a manner as to prevent effective contact with those not so exposed. Although quarantine measures may be instituted and enforced for both individual persons and populations, the term is more frequently used to discuss measures undertaken at a population-wide level.

2. State Quarantine LawAll quarantine measures must be in compliance with existing state quarantine law.

3. Federal Assistance in enforcement of state quarantine may be provided to state and local authorities pursuant to section 311 of the Public Health Service Act. In addition, CDC’s domestic quarantine regulations authorize Federal intervention “in the event of inadequate local control.”

4. Per section 361 of the Public Health Service Act, the Secretary of the Health and Human Services may issue regulations necessary to prevent the introduction, transmission, or spread of communicable disease from foreign countries into the United States and from one state or possession into another.

4.06 Diversion and Alternate EMS Communication

4.06.1.1 PurposeCommunication is a critical component in facilitating an effective

plan. Emergency management communication must be efficient, reliable and


properly maintained to function appropriately in an emergency. During times of disaster, many of the everyday communication methods may fail. Consequently, when technology is available, developing redundancy in communication methods must be a primary consideration. Other considerations should address the various agencies that need to communicate, such as hospitals (intra and inter), Public Safety (police, fire, Emergency Medical Services) and state and local governments. The importance of communication escalates when ambulance diversion becomes necessary due to hospital overcrowding and decreased resources, resulting in the need to proportionately reroute ambulances and distribute patients to facilities whose resources that may be better able to provide patient care.

See Attachment G - Hospital Public information

4.06.1.2 Ambulance Diversion

Ambulance diversion is the bypassing of the closest receiving hospital (in time) to transport to a further receiving hospital. This may be done for the appropriate use of a Trauma Center, patient facility preference, or if the intended receiving facility is on bypass due to a lack of monitored beds or an internal disaster. Ambulances will utilize established MERCI radio frequencies, or telemetry radio via UHF or cellular telephone to contact medical control at the hospital base station.

4.07 Hospital Facility

All hospital facilities will maintain an operational MERCI radio to communicate with ambulance providers. Resource and Associate Hospital facilities will also provide medical control by means of telemetry radio via ultra high frequency (UHF) or cellular telephone. Facilities that need to re-contact an ambulance will do so via the provider’s dispatch agency. Dispatch agency telephone numbers will be posted near the radio(s) for immediate access. Hospital facilities will maintain the ability to communicate with the Illinois Department of Public Health (IDPH) and it’s Resource Hospital via telephone and facsimile. All hospitals will establish and maintain–for hospital-to-hospital communication for use as back up when standard operational methods fail.


4.07.1 Personnel

Emergency Communications Registered Nurse (ECRN) trained nurses and/or base station trained physicians will be available 24 hours/day/seven days/week to respond to MERCI and or telemetry radios and serve as medical control for ambulance personnel. The Illinois State Medical Disaster Plan and the Inter-Regional Hospital Disaster Plan will be centrally located in or near the Base Station for quick access by staff.

4.07.2 Alternate Communication Devices

Hospitals should utilize StarCom 21 Radio, as the system allows, for communication with IDPH and other hospitals.

Hospital facilities should also develop a relationship with an amateur radio group that could establish communications inside a facility within two hours and maintain said communication 24 hours a day until commercial service is restored. As additional adjunct devices and methods of contact, consideration should be given to cellular telephone communication devices, those devices with a two-way walkie-talkie type feature and computerized technology such as email and the Internet.

407.3.1.1 Special Needs Populations

It is important for municipalities and families of people with special health care needs to have a plan in place should a disaster occur. We must be prepared to meet the needs of individuals with special health care needs both physically and emotionally. Municipalities and families should include people with special health care needs during planning whenever this is possible. All resources available should be included when a disaster plan is developed (police, fire, Prehospital and hospital services, physicians).

4.09 Response to a System Wide Crisis

See Attachment H - Response to a System Wide Crisis policy and reporting forms

See Attachment I - RHCC/Hospital/Local Health Department Crisis Communication Policy

See Attachment J - Region 6 Health Department Contacts


4.10 American Red Cross

Following notification and verification of a disaster, the local American Red Cross (ARC) will identify appropriate staff and volunteers to respond to the disaster. Initial response will be through the closest ARC unit. Time permitting; radio equipped Red Cross workers will be dispatched to the scene and to each receiving hospital. One (1) worker may report to the command post to act as the liaison between the scene and the chapter. This facilitates the gathering of information for the ARC Disaster Welfare Inquiry Service (DWI). Once at the scene, the Red Cross volunteers and/or staff will report to the IC.

4.11 Provision of Emergency Services and Supplies

Hospitals and health care facilities will contact their local EOC/EMA to facilitate the provision of essential goods and services, such as food, water electricity and shelter. The local EOC/EMA will contact the county EOC/EMA in the event that their resources are overwhelmed.

4.12 Disposal of Medical Waste

4.12.1 Purpose

A disaster or large-scale catastrophic event is likely to generate potentially infectious and/or hazardous materials wastes. Response plans for hospitals located should include processes for the safe handling and disposal of such materials.

4.12.2 Regulatory Compliance

Hospital medical waste disposal plans shall be compliant with federal and state statutes and regulations that govern medical waste, including those guidelines provided by OSHA, the Clean Air Act Amendments and the Department of Transportation.

4.13.3 Elements of the Plan

Responsibility The RHCC hospital will identify the department/committee assigned overall responsibility for all of the elements of the plan to include the


identification, handling, packaging collection, treatment and disposal of medical waste.

Education and Training The hospital will provide information about potentially infectious and/or hazardous materials during employee orientation, through systematic ongoing training programs, by the use of product labeling and by the use of Materials Safety Data Sheets. The hospital will provide training on the use of personal protective equipment and clothing.

Monitoring and Surveillance

The hospital will provide a policy for response to emergency spills and releases of hazardous materials. The hospital will not cause or allow the delivery of any potentially infectious medical waste for transport, storage, treatment or transfer except in accordance with federal and state guidelines.

4.13 Blood Centers

Hospitals that depend on outside blood banks must have an agreement governing the procurement, transfer and availability of blood and blood products, according to the blood banks’ established disaster protocol.

4.14 Law Enforcement (State, County, Municipal)

Hospitals and health care facilities will work in tandem with their host municipalities for assistance with security, traffic and crowd control concerns in the event of a bioterrorism/catastrophic event. The local law enforcement will contact their additional established resources if additional resources are needed.

4.15 Ensuring Transportation/Movement of EquipmentTransportation will be a critical element in the delivery of intra/inter-regional resources. These resources may be human, equipment, or as deemed necessary by IEMA.


4.15.1 PurposeTransportation will be a critical element in the delivery of intra/inter-regional resources. These resources may be human, equipment or as deemed necessary by IEMA.Movement of these resources will be a collaborative effort on behalf of the following entities:

IEMA RHCC Hospital (involved) Emergency Management Agency/Emergency Operations Center (involved)

Procedure4.15.2.1 Communication regarding the need of

additional resources will occur between the RHCC Hospital and IEMA.

4.15.2.2 The RHCC Hospital will contact the EMA/EOC Representative.

4.15.2.3 The EMA/EOC Representative and RHCC Hospital will determine the appropriate method of transportation for the resource involved. The following methods may be utilized:

4.15.2.3.1 County Sheriff Auxiliary personnel utilizing marked police vehicles.

4.15.2.3.2 County Public Works personnel utilizing marked public works vehicles.

4.15.2.4 The EMA/EOC Representative will contact the appropriate transportation entity requesting their assistance.

4.15.2.5 The EMA/EOC Representative or Transportation entity contact person will contact the RHCC hospital.

4.15.2.6 Additional details pertinent to the situation will be discussed between the RHCC hospital and transportation person.

4.15.2.7 The RHCC Hospital will then communicate with IEMA and regional hospitals involved. All details will be clearly communicated.


4.15.2.8 Any questions, changes in situation or difficulties will be immediately communicated with the RHCC Hospital. The RHCC Hospital will then expediently communicate this information to the appropriate entities and problem solve as necessary.

4.16 Medical Examiners / Coroners

In the event of a major emergency or disaster, a large number of fatalities may occur. The primary responsibility for emergency mortuary services rests with the medical examiners and coroners. The medical examiner or coroner of the area is in charge of the death scene and establishing the emergency morgue. Hospitals will notify their respective RHCC hospitals who will contact IEMA for support and direction in the disposition of a large number of fatalities within their respective region.

4.17 Funeral Directors Association / Disaster Mortuary Services Team

The County Coroner or Medical Examiner will notify the Funeral Directors Association. The Funeral Directors Association will request activation of mortuary services teams if additional resources are needed.

4.18 Procurement of Real Property and Use of Commercial Vendors

Host municipalities, local EOCs/EMA and the county EOC/EMA, as applicable, will coordinate the use of real property under its lease or ownership or lease agreement and the acquisition of additional leased property as necessary.


Requests for procurement of items not available with agreements with commercial vendors can be made to the local EOC and forwarded, if necessary, to the county EOC by the designated localEOC contact person.

See Attachment K –Champaign Region County EMA Contacts

4.19 EMERGENCY SERVICES DISASTER AGENCY POLICY

To enhance communication between the RHCC Hospital and the Local Emergency Services Disaster Agency (ESDA) and/or Emergency Management Agency (EMA)And/or Local Emergency Planning Committee (LEPC) regarding a potential or actual area-wide crisis. This crisis may include but not be limited to such events as overcrowding events due to “same like symptoms,” weather, special events, or other potential or real crisis situations.

4.20 Division of Highways

The county EOC/EMA or appropriate official shall notify the hospitals in that affected area of available access and egress routes, through the county division of transportation, will be responsible for providing information on structural integrity of roads and highways.

4.21 Illinois Poison Center

Hospitals and health care facilities may call the Illinois Poison Center (IPC) at their 24-hour access number: 1-800-222-1222. The IPC will be available for consultation and/or drug-related and/or Weapons of Mass Destruction questions.


4.22 Mutual Aid Box Alarm System (MABAS)

MABAS is a consortium of municipalities, fire districts, and EMS providers who have committed to an organization for the purpose of providing emergency service assistance.

5.0 Plan Development and Maintenance

The Champaign Region Hospital/LPH All Hazards Preparedness Plan will be reviewed annually and revised as needed by the participating Committee Members.

The committee will meet as needed with their agency and facility partners in their respective regional Hospital Preparedness Program/All Hazards Program to review their roles and responsibilities and to revise as needed.

6.0 Authorities and References

Illinois Department of Public Health, Emergency Medical Disaster Plan (2001) Emergency Medical Services System Act (210 ILCS 50) Emergency Medical Services and Trauma Center Code (77 Illinois

Administrative Code 515)

See Attachment L- Region 6 Transporting Ambulance Service

See Attachment M - Hospital MOU


7.0 Attachment Index

Attachment Description

A-Pg. 31 Region 6 Hospital Contact ListB-Pg. 32-33 Region 6 Coalition Member Contact ListC-Pg. 34 Hospital Strategic National Stockpile (SNS) Needs FormD-Pg. 35 Surge Activation PlanE-Pg. 36 Champaign Region Shareable Resource ListF-Pg. 37-38 Surge/RHCC InventoryG-Pg. 39-42 Trailer InventoriesH-Pg. 43 Hospital Public InformationI-Pg. 44-45 Response to a System Wide CrisisJ-Pg. 46-47 RHCC Hospital/Local Health Department Crisis Communication PolicyK-Pg. 48 Champaign Region Health Department ContactsL-Pg. 49 Champaign Region County EMA ContactsM-Pg. 50 Champaign Region Transporting AmbulancesN- Pg. 51-60 Hospital MOU


Attachment A – Region 6 Hospital Contact ListHospital Coalition Member Email Address Contact Number

Carle Foundation Hospital Anita Guffey [email protected] 217-621-4654

Carle Foundation Hospital Steve Peters [email protected] 217-369-9337

Carle Hoopeston Reg. Health Center Charlotte Strawser [email protected] 217-283-8440-W217-304-4855-C

Crawford Memorial Hospital Jed Holt [email protected] 618-546-2518

Dr. John Warner Hospital Margie Gehres [email protected] 217-937-5208-W

Gibson City Hospital Joe Higgins [email protected] 217-784-2228-W217-781-1931-C

Iroquois Memorial Hospital Lori Yates [email protected] 815-432-7755815-471-8044

Iroquois Memorial Hospital Georgia Woodby [email protected] 815-432-7760815-471-4510

Kirby Medical Center Crystal Alexander [email protected] 217-762-1801-W217-778-5122-C

Lawrence County Hospital Debbie Lemeron [email protected] 618-943-7266

Lawrence County Hospital Kathy Ketterman [email protected] 618-943-7250

Paris Community Hospital Daniel Bishop [email protected] 217-465-2606 x240Presence Covenant/

Presence USMC Bruce Ricketts [email protected] 217-359-6619-W217-202-5904-C

Sarah Bush Lincoln Hospital Joe Fehrenbacher [email protected] 217-238-4948

Shelby Memorial Hospital Rick Cook [email protected] 217-774-3961 x2712217-254-5589-C

St. Anthony's Hospital Danielle White [email protected] 217-347-1198

St. Mary's Hospital Bill Wood [email protected] 217-464-2708-W217-620-9893-C


mailto:[email protected]





Attachment B - Champaign Region Coalition Contact List

Hospital Coalition Member Email Address Contact Number

Carle Foundation Hospital Anita Guffey [email protected] 217-621-4654

Carle Foundation Hospital Steve Peters [email protected] 217-369-9337

Carle Hoopeston Reg. Health Center Charlotte Strawser [email protected] 217-283-8440-W217-304-4855-C

Crawford Memorial Hospital Jed Holt [email protected] 618-546-2518

Dr. John Warner Hospital Margie Gehres [email protected] 217-935-9571-W

Gibson City Hospital Joe Higgins [email protected] 217-784-2228-W217-781-1931-C

Iroquois Memorial Hospital Lori Yates [email protected] 815-432-7755815-471-8044

Iroquois Memorial Hospital Georgia Woodby [email protected] 815-432-7760815-471-4510

Kirby Medical Center Crystal Alexander [email protected] 217-762-1801-W217-778-5122-C

Kirby Medical Center Cole Hunt [email protected] 217-762-1800-W217-493-0314-C

Lawrence County Hospital Debbie Lemeron [email protected] 618-943-7266

Lawrence County Hospital Kathy Ketterman [email protected] 618-943-7250

Paris Community Hospital Daniel Bishop [email protected] 217-465-2606 x240

Presence Covenant/Presence USMC Bruce Ricketts [email protected] 217-359-6619-W

217-202-5904-C

Sarah Bush Lincoln Hospital Joe Fehrenbacher [email protected] 217-238-4948







Attachment B – Champaign Region Coalition Contact List

Shelby Memorial Hospital Rick Cook [email protected]

x2712217-254-5589-C

St. Anthony's Hospital Danielle White [email protected] 217-347-1198

St. Mary's Hospital Bill Wood [email protected]

W217-620-9893-C

Carle Clinic, Mattoon IL(Primary Healthcare Provider) Diane Kauffman [email protected]

217-258-5957-W

217-254-9956-C

Clark Lindsey Village, Urbana, IL (Long Term Health Care) Michele Heil [email protected] 217-239-6331

Effingham Fire Department (Fire) Joe Holomy [email protected] 217-342-5334217-342-2555

(Mental Health) Connie Castel [email protected] 309-824-2907

Champaign County (Coroner) Duane Northrup [email protected] 217-384-3888

Director of Ambulance Dept.Watseka, IL (EMS) Josh Sparling [email protected] 815-432-7760

815-471-4510

Coles County EMA(Emergency Management Agency) Dan Ensign [email protected] 217-348-0581

Local Public Health Jane Li [email protected]

W217-390-7294-C

REMSC Irene Wadhams [email protected] 217-278-5900

Attachment C- Hospital Strategic National Stockpile (SNS) Needs Form










Requesting Hospital___________________________________________

Total Additional Medication for Family Prophylaxis/Other__________

Contact Information:

Name of person completing request__________________________________________

Phone Number____________________ Fax Number___________________________

Alternate Number__________________ Email_________________________________

Delivery Location Information:

Drop Site Address (brief directions helpful, i.e. loading dock east side of facility)________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

For Treatment Prophylaxis number of patients with:

1. Clinical Diagnosis______________________________________________________

2. Lab Tests:

a) Confirmed______________________________________________________

b) Pending________________________________________________________

Estimated Number of persons needing treatment_________________________

Requested Assistance from IDPH:_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Directions: Fax completed form to Local Public Health Department/Jurisdiction


Attachment D – Surge Activation Plan

Champaign Region Disaster PlanChampaign/Urbana Alternative Care Facility Activation Request Policy

Subject: Alternative Care Facility Activation

Purpose: To provide guidance on how to activate an alternate facility to be used as a temporary hospital in the event of a crisis or disaster that overwhelms an affected Champaign Region hospital and other area hospitals with victims or patients.

Statement of Policy:

1. The Hospital Incident Commander or designee shall be the sole persons responsible for activation of the Surge Facility during a time of crisis or disaster that overwhelms the affected hospital’s ability to provide care to a large number of victims. All other means to provide care including declaring an external disaster, transferring patients to other hospitals and declaring a “System Wide Crisis” to Illinois Department of Public Health must be exhausted before activating the “Surge Facility” policy/plan.

Procedure:

1. The Incident Commander will declare a disaster and implement their Hospital Disaster plan.

2. A System Wide Crisis form will be completed and faxed to IDPH.

3. The Resource Hospital’s EMS Coordinator will notify IDPH of the disaster.

4. Contact Arrow Ambulance Service at 337-3911 to page the Disaster Preparedness Director (Anita Guffey) and the Regional Resource Specialist (Jimmy Zindars).

5. The Carle Foundation Hospital’s Logistics Chief will coordinate movement of supplies, equipment, staff, and pharmaceuticals to the Surge facility site.


Attachment E – Champaign Region Shareable Resource List

Hospital NamePo

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Uni

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obile

Cm

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Back

boar

ds&

Str

aps

Port

able

Venti

lato

rs

Gene

rato

rs

Addi

tiona

lRa

dios

PAPR

S

CBRN

Gas M

asks

SCBA

's

N-9

5's

Alte

rnat

eCa

re

Loca

tions

ALS

Bags

BLS

Bags

PEDS

Bags

Cipr

oflox

acin

Do

ses

Doxy

cycli

neDo

ses

Glov

es

Tyve

c/ch

emSu

its

Cots

Carle FoundationHospital

1 2 40 12 8 24 45 0 4 20K 3 3 3 3 77,500 102,000 12K 50 200

Carle HoopestonHospital

1 0 2 2 0 2 5 4 0 100 2 2 1 0 400 200 100 6 18

Crawford MemorialHospital

2 0 10 1 2 10 10 0 2 100 1 2 2 1 500 1,000 500 25 100

Decatur MemorialHospital

1 0 4 2 0 2 3 0 4 100 1 2 2 1 50 50 200 20 60

Dr. John WarnerHospital

2 0 2 10 1 8 4 0 0 1,100 1 0 0 0 3K 25 6

Gibson AreaHospital

1 0 10 1 1 22 14 0 0 2,500 3 2 0 0 350 350 7K 0 50

Iroquois MemorialHospital

1 0 0 0 0 14 6 0 0 40 1 2 2 0 14,400 13,900 50 6 20

Kirby MedicalCenter

1 1 2 1 2 2 7 20 0 250 2 2 2 0 4,000 500 100 12 60

Lawrence CountyMemorial

2 0 10 1 1 9 9 6 0 3,840 1 0 0 0 783 350 9K 24 10

Paris CommunityHospital

2 0 4 0 0 24 10 0 8 220 0 0 2 0 500 210 8,750pair

16 20

Presence CovenantMedical Center

2 0 6 2 1 20 12 0 0 900 3 0 2 0 9,000 0 300 27 10

Presence UnitedSamaritans

1 1 6 0 1 49 10 0 0 600 3 0 2 0 7,000 2,300 200 12 20

Sarah Bush LincolnHospital

2 0 2 2 0 15 20 0 0 2,000 1 0 0 0 340 180 5K 20 10

Shelby Memorial Hospital

1 1 0 0 0 3 1 0 0 95 1 0 0 0 185 185 200 0 100

St. Anthony's Hospital

1 0 4 1 1 0 15 0 0 6,490 0 0 0 2 31Boxes

76 80

St. Mary'sHospital

1 0 0 0 2 29 0 0 0 1,700 1 2 4 0 28,800 28,800 200 100 180


Attachment F – Surge/RHCC Inventory

Mobile Medical Assets -RHCC Inventory1 Tote of Misc. Supplies 1 Box Peds Trakes 1 Box mics RMERT shirts1 Tote of Heat Blankets (15) 1 Tote of Pillows 9 RMERT Job Shirts1 Green Cart cover 4 Cases of Paper Towels 6 Smith Para Pac Port. Ventilators

6Heavy Duty Cargo Straps in use on trailer 2 3 Cases of Lactated Ringers IV solution 1 Brothers 5 in 1 Copier

1 Box of White Duct tape (12 rolls) 3 Cases of Normal Saline IV solution 1 Box of Plain Paper 8 1/2 x 111 Stream Lite Box (flashlight) 1 Case of Sharps Containers 1 Skill 18v Drill w/charger and case

18 Smart Triage Packs (moved 8 to ED) 1 Tote of Laryngoscope Kits 2 Life Pac 3 lead monitors1 Smart Command Board 1 Case of Backboard Straps 1 Pelican case (containing)

1 Tote with Combi Tubes (50) 1 Ventilator System 6- UHF 16ch radios Motorola CT-250 with chargers

300 Sure vents 4 Black Containers with various supplies 1- Frequency List1 Tote ET tubes 30 ea. (2.5-8.5) 1 Tote of Misc supplies 1- Mini frequency list (for radios)

400 Baby Diapers 1 Case of 2x2's 1 Pelican case (containing)

1 Case of Facial Tissues 1 Case of 4x4's 8- UHF 16ch radios Motorola EX600 XLS with chargers

1 Case of Surviving Disasters handouts 1 Case of Coban Empty misc. totes1 Case of Trash Liners 1 Case of Burn Sheets 1 Box with GAI-Tronics Radio Console 12ch

20,410 N-95's 1 Tote of Safety Goggles (this belongs in the Admin Command Room)12 Boxes of Surgilube 10 Cases of Safety Goggles (20 per case) 4 Pedi Broslow Bags

300 ea. IV Catheters (14,16,18,20,22,24) 20 Laceration Trays 1 Case of Paper Towels2 Adult Fast IO's 20 23s 3/4 Butterfly Infusion 1 Small tool box (empty)

12 Pen Lights10 ea. Sterile Gloves (7, 7.5, 8, 8.5) 2 Boxes large Trash Liners

30 Retractable Syringes (1cc)20 ea. Staples (35 regular, 35 wide) 6 Overhead door openers (Busey warehouse)

10 Medical Sheers20 ea. Scotch Casting Tape 2" & 4" 1 Misc. tote with electrical supplies

400 Needles & Syringes (3cc) 75 Surgical masks (fog free) 2 Spray bottles (empty)200 IV sets 1300 Secure Gard Procedure masks 1 Gallon latex paint (white)

200 IV Drip Sets 4 ca2.75oz Hand Sanitzer (flip top) (48 per case) 4 Ready to assemble boxes


Attachment F - Mobile Medical Assets Inventory, cont.

4 Child Arm Boards 2 ca 8.5oz pump hand sanitizer (24 per case) 1 Pelican case (containing)5 Cases Small Gloves 4 ca 16oz pump hand sanitizer (12 per case) 2- CDM 1250 Mobile radios

2 Cases Medium Gloves 400Benzalkomiun Chloride Antiseptic Towelettes 1 Pelican case (containing)

4 Cases Large Gloves 2 Boxes of Orthopedic Stockinet 1- GR1225 Repeater Radio with coax cable & antenna

25 PEDS BVM 1 Staple Remover 2 Case containing TSI Porta Count Plus4 Adult BVM 12 Chest drains 1 Case containing Fit test adaptor

10 Pedi wheels 10 Pediatric Multi Lumen Central Caths TSI model 8025-cen/8025-40mm8 O2 Manifolds 5 Adult Multi Lumen Central Caths 2 Case containing N-95 Companion

13 Handheld Pulse-Oximeters 120 CBRN Masks 1 Pelican case (containing)

9 O2 Regulators 80 Dragor Filter 2- CDM 1250 Mobile radios with (repeater interface)

8 "E" O2 tanks 50 SEG 450 Gas masks 1 Pelican case (containing)

6 "E" O2 tanks on RMERT trailer 104 Safety Tech Cartridge 6- UHF 16ch radios Motorola EX600 XLS with chargers

13 "K" O2 Tanks 10 CBRN Masks in bags & Lapel mics4 "K" O2 Tanks on Surge trailer # 3 1 Case of EMS bags 1 Tool Box 2 Portable Lights and stands 180 Black Zip up bags 1 Motorola Battery Reconditioner

2Portable Generators 1-10,000w & 1-7,500w 35

MSA CBRN Gas masks (Storing for Arrow) 1 6' ladder

150 Cots on pallets located along east wall 5 PAPRS 1 hand truck100 Cots on pallets located in trailer 1 Dormadory Fridge 1 pallet truck500 Single Use Therometers 2 Pallets of Tyvek Suits 6 chest drains10 Cath Foley 1 straddle stacker 2,200 lb capacity 2 Boxes Elastic bandages 2" and 4" (10 per box)


Attachment G (RMERT Trailer 1)

Item Quantity Shelf 1: 1000 Watt Flood Light 1Rescue Helmets 6Safety Goggles (for rescue helmets) 5 Shelf 2: Broselow Pediatric Kit 3Blue Repsonse Bag (BLS) 6Smart Triage Command Pac 1Smart Triage Pacs 6 total - 4 in command pacBag of Backboard Straps 1 Shelf 3: O2 Manifolds (in clear container) 2Phillups AED (in red case) 1Safety Glasses (2 boxes) 40 pairRMERT Safety Vests 9Red Response Bags 2Ringers Extrication Gloves (in clear container) 17 pairShelf 4: Clear Container includes following: Sharps Container 2Tourniquets 4 boxes 25 ea.Alcohol Prep Pads 4 boxes 200ea.Tegaderms 2 boxes 100 ea.1" Tape 1 box 12 ea.14,16,18,20,22g Angio Caths 1 box each 50 in a boxSafety Guide 22 g Injection Needles 1 box 50 ea.Adult C-Collors (in a clear container) 17Emergency Isothermal Blankets (clear container) 72Clear Container includes following: ResQvacs soft yankour 1410fr 3.5" & 14" kits 5Clear Container includes following: Adult NRB's 70Pediatric NRB's 10Clear Container includes following: 3.0 ETT 104.0 ETT 105.0 ETT 46.0 ETT 107.0 ETT 157.5 ETT 158.0 ETT 109.0 ETT 414 fr Stylets 4010cc Syringe 1520cc Syringe 10

Item Quantity Revised September, 2015 39

Shelf 1: (Front Of Trailer) RMERT Extrication Suits 5Heavy Duty drop cords 50' 2Megaphones (hanging on shelf) 2 Shelf 2: Contender Bag (black) contains orange vests: 1morgue,operations,pio,rehab,rescue,staging,liason division,fireops,hazmat,law enfrcmnt,logistics Contender Bag (black) contains blue vests: 1Medical,Transport,Treatment,Triage orange vests: Command & Safety Clear box containing: Hearing Protection 15 setsUvex Safety glasses 8 pairRush Lite Intubation Kits (unopened) contains 2 boxesMiller blades 1,2,&3 Mac blades 1,2 & 3 Standard Medium Larngascope Handle Shelf 3: Green, Yellow, & Red tarps 1 eachClipboards 4Bag containing Extrication Suits 3Sleeping Bag 1Blue box containing: 1Case of Field worksheets 3 bottles of Bug Off Box of "D" cell batteries Box of "C" cell batteries 1 roll of Duct Tape 8 thermometers 2 boxes of probe covers 100 each 1 bag of electrical wiring devices Shelf 4: Clear container of Disposable Emer. Blankets 17Sleeping Bags 2 Shelf 5: Bottle water (cases) 2Box Large Gloves 1Box Medium Gloves 1Folding Chairs 2Front of trailer (Floor) O2 Bottles with regulators 6

Item Quantity


Passenger Side of Trailer Wall: Vulcan Lite Boxes/Handlights with chargers 2Cabinet (contains) CT250 Motorola radios 16ch 4Chargers for CT250's 4Spare Batteries for CT250's 5Motorola Talkabout T5720 w/chargers 2Have an extra charger no radios RMERT cooler 1Case of Water 1Stanley Utility Heaters 2Back Boards 29Body Bags Located in Aisle Way Premier Strecher Carrier 110,000 watt Portor Cable Generator 1Stryker Stair Chair 1Located next to Front Shelving O2 bottles with regulators 6

Surge Trailer #2

Item Quantity 2 Red Carts1 Yellow Cart1 Green Cart1 Red Room Divider1 Yellow Room Divider1 Green Room Divider2 1200 Watt Stand Up Lights4 3500 Watt Yamaha

100 Hand Held Suction1 50ft Extension Cord25 Urinals & Bed Pans

200 Emergency Blankets40 Cardboard Splints50 Peds BVM50 Adult BVM

100 Sure Vent1 Smart Command Bag25 Smart Packs1 Flag Kit1 Set of Command Vests1 Tool Box

Surge Trailer #3

Item QuanityK tanks 4


Tote containing: 11-Smart Triage Command Pac 20-Smart Triage Kits Tote containing: 155-Adjust. C-Collars 30-Head Beds II Storage Cart with 5 TEMPS Beds 2Premier Strecher Carrier 1Stair chairs 1Evacuation Chair 2Wheelcahirs 2Walker 1Flag Kit 1Triage Tarps in Black Bags (located on Strecher) 4Set of Command Vests 1Yellow Cart (Trauma & Burn Cart) 1Yellow Cart contains: Burn Sheets Trauma Dressings 4x4's 2x2's Coban Self Adherent Wrap Pillows Laceration Trays

Trailer #4

Item Quantity

Big Bear Cots 30

Cots stored on Pallets 70

Attachment H

Hospital Public Information

Public Information AnnexRevised September, 2015 42

1. PURPOSE:This annex is to insure public information is coordinated by a single Person to provide accurate and timely information to media and the Public in times of major emergencies, disasters, and threat conditions.

2. SITUATIONS:There are several situations that would activate the need for a Public Information Person including but not limited to severe weather events, hazardous material incidents, increased homeland security threats, air craft accidents, and school violence activities.

3. ASSUMPTIONS:In any major emergency, disaster, or threat of danger, citizens will need information to better prepare them to protect themselves or move to locations of shelter. It is also assumed that the media will require information on any incident to report to their viewers and readers. Rumors will need to be controlled by supplying the correct information.

4. CONCEPT of OPERATIONS:

A. Information will be required before, during, and after a disaster. While more than one information center may be established, it is the intent that agencies participating in the response and recovery efforts will utilize a single PIO for the main coordination and release of information. This will insure more accurate, consistent, and timely dissemination of information.

B. If the Emergency Operation Center is activated it will serve as the location Public Information Center, and may have a joint public information center as part of the disaster intelligence sector, but there will be a single person that will act as the PIO.

5. ORGANIZATIONAL RESPONSIBILITIES:A. A disaster will trigger media inquiries from responding agencies and will

require the Regional Hospital to appoint a PIO.B. In the case the Regional Hospital does not have a PIO, Carle Foundation

Hospital, the IDPH Champaign Region RHCC hospital, will designate a PIO to serve in this function.

C. It will be the responsibility of the PIO to:1. Develop and maintain media relations2. Schedule news conferences3. Coordinate rumor control4. Update and maintain annex5. Report to EOC if activated or joint information center.


Attachment I

Region wide/System wide Crisis Preparedness Policy

POLICY:

To enhance communication between the RHCC Hospital, the EMS System Resource Hospital, Associate Hospitals, EMS providers and community agencies. The crisis may be potential or actual, including, but not limited to, such events as surveillance of “like” symptoms, weather, special events, or other potential or real crisis situations.

PROCEDURE:

1. Any individual in the above named organizations may identify a potential or actual crisis and initiate this policy.

2. That individual should contact their supervisor (i.e. Charge Nurse, Medical Officer, etc.)

3. The supervisor shall contact the Resource Hospital EMS System Coordinator, or their designee and identify their concerns.

4. The EMS System Coordinator shall determine the need to activate this policy and notify the RHCC Hospital.

5. If deemed appropriate, the RHCC Hospital Coordinator or designee will contact an IDPH representative and discuss the situation.

6. Communications shall continue between applicable agencies per the specifics of the situation.

7. Once the crisis is determined to be over, the RHCC Hospital will recontact all involved agencies.

8. Appropriate documentation shall be maintained.

9. Discussion, critique and quality improvement measures regarding this policy and its activation will be conducted with the appropriate parties involved in a timely fashion.


Attachment I

RHCC HOSPITAL/ RESOURCE HOSPITAL WORKSHEETFOR

SYSTEM-WIDE CRISIS FORM

DATE: TIME:

Name of Resource Hospital Name of Person Filling in Report/Title

Telephone Number

Names of Associate Hospitals/Participating Hospitals Requesting Bypass or Who Have Seen an Increase in E.D. Visits:

Common Signs/Symptoms of Patients who are coming to the Emergency Department:

Name(s) of Provider(s) in the area who have seen an increase in Runs:

Name and Time of EMS Coordinator or EMS Medical Director Notification:

Date/Time/Name of Person Notified at the State (i.e., Chief of EMS)

Name How Contacted Time notified Date Notified

(Pager, Phone, Fax)


Attachment J

RHCC Hospital/Local Health Department Crisis Communication Policy

POLICY

To enhance communication between the RHCC and the Local Health Department regarding a potential or actual area-wide crisis. This crisis may include but not be limited to such events as overcrowding events due to “same like symptoms,” weather, special events, or other potential or real crisis situations.

PROCEDURE

1. An Official Designee from either the RHCC Hospital and/or local health department may identify a potential or actual crisis and initiate this policy.

2. The Official Designee will contact their colleague from the opposite entity (either the RHCC Hospital or the Local Health Department) and identify their concerns.

3. A mutual decision will then be agreed upon to notify IDPH personnel from their respective State entities.

4. Appropriate documentation shall be maintained. (RHCC Hospital/Local Health Department Worksheet)

5. Further communication to the respective region may occur upon notification of the respective State entities.


RHCC HOSPITAL/LOCAL HEALTH DEPARTMENT CRISIS COMMUNICATION WORKSHEET

Date: Time:

Name of Initiating Entity Name of Person Filling

In Report/Title

Telephone Number

Type of Situation Occurred/ing:

People/Facilities Involved:

Name and Time of Official Designee Notification:

Name/Time/Name of Person Notified at the State (i.e., Chief of EMS/Emergency Management Agency)

Name How Contacted Time Notified Date Notified

(Pager, Phone, Fax)

G:\bioterrorism\RHCChospitallocalemergencymanagementagencycrisis commworksheet5.03


Attachment K – Champaign Region Health Dept. Contacts

County Hospital Public Health Contact Phone # Public Health Address

Crawford Crawford Memorial Hospital Darla K. Tracy 618-562-8798 202 N. Bline Blvd., Robinson, IL, 62454

Lawrence Lawrence County Memorial Hospital Julie Parrott 618-554-3401 R.R. #3 Box 414 POB 516, Lawrenceville, IL

62439

Macon Decatur Memorial Hospital Tom Buckley 217-855-5592 1221 E Condit St. Decatur, IL 62523

Macon St. Mary's Hospital Decatur Tom Buckley 217-855-5592 1221 E Condit St. Decatur, IL 62523

Ford/Iroquois Gibson Area Hosp. & Health Services Christy Wallace 217-379-9281 235 N. Taft St. Paxton, IL 60957

Vermilion Carle Hoopeston Regional Health Center Shirley Hicks 217-431-2662 200 South College St., Suite A Danville, IL 61832

Vermilion Presence United Samaritans Medical Shirley Hicks 217-431-2662 200 South College St., Suite A Danville, IL 61832

Piatt Kirby Medical Center Lynn Carr 217-519-3405 1020 S. Market, Monticello, IL 61856

Jasper None Debbie Clark 618-783-4436 106 E. Edwards St., Newton, IL 62448

Edgar Paris Community Hospital Eddie McFarland 217-465-4166 502 Shaw Ave. Paris, IL 61944

Champaign Carle Foundation Hospital Jane Li 217-531-3386 201 W Kenyon St. Champaign, IL 61820

Champaign Presence Covenant Medical Center Jane Li 217-531-3386 201 W Kenyon St. Champaign, IL 61820

Coles Sarah Bush Lincoln Health Diana Stenger 1-800-412-8757 P.O. Box 1064, 825 18th St. Charleston, IL 61920

Cumberland Sarah Bush Lincoln Health Sheri Droctor 217-232-3211 P.O Box 130, 200 South Indiana St. Toledo, IL

62468

Shelby Shelby Memorial Hospital Stephen Melega 217-774-3941 1700 S Third St., Shelbyville, IL 62565

Iroquois Iroquois Memorial Dee Ann Schippert 815-432-2483 550 South 10th St., Watseka, IL 60970

Effingham St. Anthony Karen Feldkamp 217-821-5935 901 W. Virginia, Effingham, IL 62401

Dewitt/Piatt Dr. John Warner Hospital Lynn Carr 217-519-3405 5924 Revere Rd., Clinton, IL 61727


Attachment L – Champaign Region County EMA Contacts

County Hospital County EMA Contact Phone # EMA Address

Crawford Crawford Memorial Hospital Ken Pryor 618-562-0402 703 E Orlando Robinson, IL 62545

Lawrence Lawrence County Memorial Hospital Gerald "Jess" Angle 618-562-8500 PO Box 312, Bridgeport, IL 62417

Macon Decatur Memorial Hospital Jim Root 217-424-1327 282 E. Macon St. Decatur, IL 62523

Macon St. Mary's Hospital Decatur Jim Root 217-424-1327 282 E. Macon St Decatur, IL 62523

Ford Gibson Area Hosp. & Health Services Dennis Higgins 217-379-2741 200 West State St. Paxton, IL 60957

Vermilion Hoopeston Regional Health Center Ted Fisher 217-554-6060217-449-6010 2507 Georgetown Rd. Danville, IL 61832

Vermilion Provena United Samaritans Medical Ted Fisher 217-554-6060217-449-6010 2507 Georgetown Rd. Danville, IL 61832

Piatt Kirby Medical Center James Donaldson 217-671-2283 807 E Center Monticello, IL 61856

Christian Pana Community Hospital Michael Crews 820-0912 202 N Main St. Taylorville, IL 62568

Edgar Paris Community Hospital Duane Fidler 217-466-3180 P.O. Box 1002 Paris, IL 61944

Champaign Carle Foundation Hospital John Dwyer 217-384-3826 1905 E Main St. Urbana, IL 61801

Champaign Provena Covenant Medical Center John Dwyer 217-384-3826 1905 E Main St. Urbana, IL 61801

Coles Sarah Bush Lincoln Health Dan Ensign 348-9482 520 Jackson Charleston, IL

Shelby Shelby Memorial Hospital Jared Rowcliffe 217-774-5257 151 North Morgan St. Shelbyville, IL 62565

Dewitt Dr. John Warner Hospital Teresa Barnett-Hall 935-7790 201 W. Washington Clinton, IL 61727

Effingham St. Anthony Pam Jacobs 217-343-3062217-536-6169 311 Miracle Ave. Effingham

Iroquois Iroquois Memorial Eric Ceci 815-432-6997 550 South 10th. Watseka, IL 60970


Attachment M - Region 6 Transporting Ambulances

Ambulance ServicesEMS System Contact Phone # Address

ALS units

ILS units BLS Units

Arrow Ambulance Carle Larry Sapp 217-377-7911 210 E University, Champaign, IL 61820 6 2 Bismark Ambulance Carle Don Evans 217-759-7373 8 Wesley, Henning, IL 61848 1 Pro Ambulance Presence Tim Compton 217-377-2911 401 S. Neil St. Champaign, IL 61820 10 Carle Hoopeston Ambulance Carle Larry Sapp 217-377-7911 210 E. University, Champaign, IL 61820 3 Shelby Ambulance St. Mary's Jeanne Coventry 217-774-5519 310 N Cedar Street 2 Kirby Ambulance Presence Crystal Alexander 217-778-5122 1000 Medical Center Drive, Monticello 3 1-non transportGibson Area Ambulance Presence Joe Higgins 217-784-8281 1120 N. Melvin Gibson City, IL 60963 7 1-non transportPana Ambulance St.Mary's David Burkham 217-562-3300 510 Fair Avenue., Pana, IL 62557 2 Decatur Ambulance St. Mary's David Burkham 217-428-8641 417 West Wood St., Decatur, IL 62522 3 Nokomis/Witt Ambulance St. Mary's Gene Burdzilaskus 217-563-7111 Nakomis, IL 62075 Casey Ambulance SBLHC Brian Maschhoff 217-932-5202 203 E Edgar, Casey, IL 2 United Life Care Crawford Cliff Simpson 618-544-3696 301 S. Cross St., Robinson, IL 4 Clark County Ambulance Crawford Ronnie Poorman 217-822-3418 228 E. Donham, West Union, IL 1 2 Charleston Fire Dept. SBLHC Pat Goodwin 217-345-2133 1501 1st St, Charleston, IL 4 Dunns Amb, Service SBLHC George Davis 21-234-6999 1821 Marshall Ave, Mattoon, IL 61938 3 Greenup Amb, Service SBLHC Patti Corder 217-849-2571 PO Box 443, Greenup,IL 62428 3 Kansas Amb. Service SBLHC Holly Morgan 217-948-5966 South Front St., Kansas, IL 61933 1Mattoon Fire Dept. SBLHC Sean Grunge 217-235-0931 1812 Prairie Mattoon, IL 61938 1Mitchel Jerdan Amb. SBLHC Stacey Knox 217-234-8828 1200 Wabash, Mattoon, IL 61938 4 Neoga Amb. Service SBLHC Alan Baker 217-895-3654 PO Box 666, Neoga, IL 62447 2 Oakland Amb. Service SBLHC Casey Schmidt 217-948-5966 PO Box 704, Oakland, IL 61943 1 Shrader Amb. Service SBLHC Victor Jinkins 217-268-4848 204 N Locust St. Arcola, IL 61910 1 Toledo Ambulance SBLHC Donna Whitaker 217-849-2571 Courthouse Square, Toledo, IL 1 Westfield Ambulance Serv. SHLHC Richard Wheeler 217-967-5262 PO Box 183, Westfield, IL 62474 1 Windsor Ambulance SBLHC Sean McQueen 217-459-2291 City Hall, Windsor, IL 69571 2 Middlefork Ambulance Carle Shelly Birt 217-987-6560 125 Logan St., Potomac, IL 61865 2Altamont Ambulance Serv. SAMIC Terry White 618-483-6911 2 South Main Street, Altamont, IL 62411 7 0 2


Attachment M – Hospital MOU


“Disaster” means an incident that exceeds a facility's effective response capability or cannotappropriately resolve solely by using its own resources. Such disasters may require the loan of

medical and support personnel, pharmaceuticals, supplies, and equipment from another facility,or, the emergent evacuation of patients.

“Emergency Medical Services (EMS) System or System” is an organization of hospitals, vehicle

service providers and personnel approved by the Department in a specific geographic area,which coordinates and provides pre-hospital and inter-hospital emergency care and nonemergency

medical transports at a BLS, ILS and/or ALS level pursuant to a System ProgramPlan submitted to and approved by the Illinois Department of Public Health and pursuant to the

EMS Regional Plan adopted for the EMS Region in which the System is located.

“Emergency System for Advanced Registration of Volunteer Health Professionals” or ESAR-VHPis a national network of state-based programs that verify the identity, licenses, and

credentials before an emergency happens. It allows registered health care professionals toaccept or decline a request to respond, and streamlines the verification process so that once

on-site, health professionals can work at their highest capacity. The system in Illinois is knownas Illinois Helps.

“Homeland Security Presidential Directive-5” or HSPD-5 is a Presidential directive issued

February 28, 2003 on the subject of “Management of Domestic Incidents.” The purpose is to“enhance the ability of the United States to manage domestic incidents by establishing a single,comprehensive national incident management system.”

“Hospital Incident Command System” or HICS is a management system based on NIMS thatconsists of a flexible organization structure and time-proven management principles. The

system includes defined responsibilities and reporting channels and uses common language topromote internal and external communication and integration with community responders. HICS

can be utilized for emergency incidents or for planned events.

“Licensed Independent Practitioner” means any individual permitted by law and by the hospitalto provide care and services, without direction or supervision, within the scope of the individual’s

license and consistent with individually granted clinical privileges.

2Revised September, 2015 52

j:\capes\mous\2009 documents\il mou-2009.docx “National Incident Management System” or NIMS is a system mandated by HSPD-5 that

provides a consistent nationwide approach for Federal, State, local, and tribal governments; theprivate-sector, and nongovernmental organizations to work effectively and efficiently together to

prepare for, respond to, and recover from domestic incidents, regardless of cause, size, orcomplexity. To provide for interoperability and compatibility among Federal, State, local, and

tribal capabilities, the NIMS includes a core set of concepts, principles, and terminology. HSPD-5 identifies these as the incident command system; multiagency coordination systems; training;

identification and management of resources (including systems for classifying types ofresources); qualification and certification; and the collection, tracking, and reporting of incident

information and incident resources.

“Participating Hospital” means a hospital that has entered into this MOU.

“Regional Hospital Coordination Center” or RHCC (formerly known as the RHCC Hospital)”means the lead hospital in an Emergency Medical Services region, as designated by the Illinois

Department of Public Health.

“Small-Scale Disaster or Isolated Incidents” means a situation where affected hospital(s) needsome assistance. The magnitude is such that it is not necessary to implement the State

Medical Emergency Disaster Plan.

“State-Declared Disasters/Emergencies” mean a situation of significant magnitude whereimplementation of the State Medical Emergency Disaster Plan is required.

IV. MUTUAL AID RECEIVED BY OR PROVIDED TO A PARTICIPATING HOSPITAL

A. AUTHORITY AND COMMUNICATION

Only a senior hospital administrator or designee of a Participating Hospital which has a need for

staff or equipment (“Affected Hospital”) has the authority to initiate the request for transfer ofpatients or receipt of personnel or material resources pursuant to this MOU.

Small-Scale Disasters or Isolated Incidents

The request for assistance will be made by the senior hospital administrator or designee at theaffected hospital to the senior hospital administrator or designee at the Assisting Hospital.

3j:\capes\mous\2009 documents\il mou-2009.docx


State-Declared Disasters/Emergencies

The request for assistance will be made by the senior hospital administrator or designee at the

affected Hospital to the Regional Hospital Coordination Center (RHCC) for the EMS Region.

The request may be made verbally but must be followed by written documentation specifying

such information as the type and quantity of supplies or personnel needed, an estimate of how

quickly they are needed, the time period for which they will be needed and the location to which

they should report or be delivered. The RHCC will communicate this request to the other

Participating Hospitals and coordinate the response to the requesting hospital.

B. PERSONNEL

Personnel employed by, contracted with or on the staff of the Assisting Hospital who are

dispatched to an Affected Hospital shall be limited to staff who are certified, licensed, privileged

and/or credentialed at the Assisting Hospital, as appropriate, given such staffs’ professional

scope of practice. Assisting Hospital employees who are dispatched to an Affected Hospital will

act within their scope of practice in the capacity of assisting personnel with respect to the

Affected Hospital and for all purposes set forth herein will function as assisting personnel at the

Affected Hospital, but nothing in this MOU shall be construed as creating an employee-employer

relationship between the assisting personnel and the Affected Hospital for purposes of

worker’s compensation coverage or other labor laws.

The Assisting Hospital’s senior administrator or designee shall prepare and send to the Affected

Hospital’s senior administrator or designee a list that includes the name, licensure category and

any specialty training of the Assisting Personnel who are being dispatched to the Affected

Hospital. The Affected Hospital shall, if possible, then verify the identity of the Assisting

Personnel from the Assisting Hospital based on a current picture ID issued by the Assisting

Hospital or a state, federal or regulatory agency. The Illinois Helps system may be used to

verify the credentials of the Assisting Personnel.

If possible, licensed independent practitioner Assisting Personnel should be registered on the

Illinois Helps system so that their credentials may be verified. If they are not registered on

Illinois Helps, they should report to the Affected Hospital with a copy of their license, hospital

privileges and malpractice insurance coverage certificate. If this is not possible because of the

nature of the disaster, the Affected Hospital may verify this information independently and



depending on the nature of the emergency such verification may occur after the emergency is

determined to be under control. In compliance with Joint Commission standards, when the

Affected Hospital’s emergency management plan has been activated, the CEO, Medical Staff

President or their designee may grant emergency privileges to licensed independent

practitioners with evidence of appropriate identification. Acceptable sources of identification

include a current professional license in the State in which the Affected Hospital is located and a

valid picture ID, a current picture hospital ID or verification of the subject practitioner’s identity

by a current hospital or medical staff member.

The Affected Hospital’s senior administrator or designee (e.g. the incident commander) will

identify where and to whom emergency Assisting Personnel are to report and who will direct

and/or supervise them. This supervisor will brief the Assisting Personnel of the situation and

their assignments. The Affected Hospital shall maintain records of the hours worked by the

Assisting Personnel and will provide and coordinate any necessary demobilization and postevent

stress debriefing.

C. TRANSFER OF PHARMACEUTICALS, SUPPLIES OR EQUIPMENT

The Affected Hospital will utilize the Assisting Hospital’s standard order requisition forms as

documentation of the receipt of the requested materials. The Affected Hospital is responsible

for tracking the borrowed inventory and returning any non-disposable equipment in good

condition or paying for the cost of replacement. The Affected Hospital will either replace or

reimburse the Assisting Hospital for any consumable supplies or pharmaceuticals at actual cost

and will pay for all reasonable transportation fees to and from the transfer site. Unused supplies

may be returned, provided that they are unopened and in good and usable condition. The

Affected Hospital is responsible for appropriately tracking the use and necessary maintenance

of all borrowed pharmaceuticals, supplies and equipment during the time such items are in the

custody of the Affected Hospital in accordance with law.

V. TRANSFER/EVACUATION OF PATIENTS

A. COMMUNICATION AND DOCUMENTATION

The Affected Hospital must specify the number of patients needing to be transferred, the

general nature of their illness or condition and any specialized services or placement required.

The Affected Hospital is responsible for providing the Assisting Hospital with copies of the

5j:\capes\mous\2009 documents\il mou-2009.docxpatient’s pertinent medical records, registration information and other information necessary for

care.


B. Command StructureHospitals agree to meet all regulatory standards regarding training of personnel in the HICS and

NIMS incident command procedures for appropriate personnel.

C. TRANSPORTING PATIENTS

The Affected Hospital is responsible for triage and transportation of patients and any costs, not

otherwise reimbursable by the patient or the patient’s third-party payer, incurred for theirtransportation. Extraordinary drugs or special equipment utilized by the patient, if available, will

be transported with the patient. In a State-declared disaster, the RHCC is responsible forcoordinating the distribution of patients to Assisting Hospitals and may assist in coordinating

their transportation. Individual hospitals or local health departments may request the RHCC toassist to coordinate the above.

If feasible, the Affected Hospital should inventory the patient's personal effects and valuables

transported with the patient to the Assisting Hospital. The Affected Hospital should present theinventory list and the patient's valuables to the personnel transporting the patient, and receive a

receipt for such items. The Assisting Hospital should, in turn, acknowledge and sign a receiptfor the valuables delivered to it.

D. SUPERVISION

Once the patient arrives at the Assisting Hospital, such hospital and a member of its medicalstaff become responsible for the care of the patient. If requested, the Assisting Hospital that

assumes the care of transferred patients may grant temporary medical staff privileges oremergency privileges, in accordance with its medical staff bylaws, to the patient’s original

attending physician.

E. NOTIFICATION

The Affected Hospital is responsible for notifying and if applicable obtaining transfer

authorization from the patient or the patient’s legal representative, as appropriate, and fornotifying the patient’s attending physician of the transfer and re-location of patient as soon as

practical.

6j:\capes\mous\2009 documents\il mou-2009.docxVI. AUXILIARY HOSPITAL AND CASUALTY COLLECTION LOCATIONS

During a State-declared disaster/emergency or local/regional incident, Participating Hospitals

may be asked by the RHCC to contribute staff to an “auxiliary hospital” or casualty collection


location on an urgent basis. These are emergency locations designed to collect, triage or treat

casualties during an epidemic or other prolonged emergency situation with mass casualties. Ifan auxiliary hospital or casualty collection location is required, the RHCC hospital will coordinate

the required Assisting Personnel or resources.

VII. MEDIA RELATIONS AND RELEASE OF INFORMATION

During a State-declared disaster/emergency or local/regional incident, Participating Hospitals

may be requested to participate in a Joint Public Information Center that would be the primarysource of information for the media related to a disaster affecting more than one Participating

Hospital. Under the direction of IDPH, the Joint Public Information Center would be designatedto speak on behalf of the affected Participating Hospitals to assure consistent messages and

flow of information.

VIII. MISCELLANEOUS PROVISIONS

A. TERM AND TERMINATION – This Agreement shall continue in effect until terminated byeither party upon 30 days’ written notice of termination to the other party. Any Participating

Hospital may terminate its participation in this MOU at any time by providing written notice to theResource Hospital for the EMS System and all other Participating Hospitals in its EMS region.

B. REVIEW AND AMENDMENT – this MOU shall be reviewed periodically or upon written

request by a Participating Hospital and may be amended by the written consent of anauthorized representative for each of the Participating Hospitals.

C. CONFIDENTIALITY – each Participating Hospital shall maintain the confidentiality of all

patient health information and medical records in accordance with applicable State and Federallaws, including, but not limited to, the HIPAA privacy regulations.

D. INSURANCE – each Participating Hospital shall maintain, at its own expense,

professional, worker’s compensation and general liability insurance coverage for itself and itsrespective employees.


E. DEFENSE AND INDEMNIFICATION - the Affected Hospital and Assisting Hospital shallcollaborate on the defense of liability claims arising from or asserting the negligent acts and

omissions of Assisting Personnel who are employed or otherwise covered by the AssistingHospital. Assisting Personnel who are licensed independent practitioners and who are not


employees of a Participating Hospital will procure their own professional and general liability

coverage and the Affected Hospital shall not assume any liability, defense or indemnificationobligation for such independent Assisting Personnel arising out of participation in this MOU.

F. REIMBURSEMENT OF COSTS – all reimbursement for expenses associated with

Assisting Personnel employed by the Assisting hospital, equipment or supplies provided to theAffected Hospital pursuant to this MOU will be paid by the Affected Hospital within 45 days of its

receipt of an invoice from the Assisting Hospital.

G. This MOU is entered into by the Participating Hospitals and mutual aid is providedunder this MOU at the request of the State of Illinois under the Hospital Licensing Act and the

Illinois Emergency Management Agency Act.


S I G N A T U R E P A G E

I, agree to the terms and conditions of the Hospital Emergency Mutual AidMemorandum of Understanding (MOU).

NAME _________________________________________________________________________

TITLE _________________________________________________________________________

HOSPITAL _________________________________________________________________________

PHONE _________________________________________________________________________

E-MAIL _________________________________________________________________________

SIGNATURE _________________________________________________________________________

DATE _________________________________________________________________________

j:\capes\mous\2009 documents\il mou-2009.docx


Attachment N

Hospital MOUCarle Regional EMS System

Region 6

“Exhibit A”Hospital Emergency Mutual Aid Memorandum of Understanding

"MOU"Participating Hospitals

1. Carle Foundation Hospital James C. Leonard, President & C.E.O.

2. Crawford Memorial Hospital Melody Tedford, ER & EMS Coordinator

3. Decatur Memorial Hospital Kenneth L. Smithmier, President & C.E.O.

4. Gibson Area Hospital Rob Schmitt, C.E.O.

5. Hoopeston Regional Health Center Harry Brokus, C.E.O.

6. John & Mary Kirby Hospital Steven D. Tenhouse, C.E.O.

7. Lawrence County Memorial Hospital Doug Florkowski, President & C.E.O.

8. Pana Community Hospital Roland R. Carlson, President & C.E.O.

9. Paris Community Hospital Randy Simmons, President & C.E.O.

10. Provena Covenant Medical Center David A. Bertauski, President & C.E.O.

11. Provena United Samaritans Medical Center Jennifer Cord, Assistant V.P. of Operations

12. Sarah Bush Lincoln Health System Gary L. Barnett, President & C.E.O.

13. Shelby Memorial Hospital John Bennett, President & C.E.O.

14. St. Mary’s Decatur Kevin F. Kast, President & C.E.O.

j:\capes\mous\2009 documents\il mou-2009.docxRevised September, 2015 60

Documents

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