Healthcare Risk Management Module5 Disc 2

Medical Emergency Action Plan Template

Abstract

In response to a tragic active shooter incident at a downtown football arena during a high-profile concert, Baptist Medical Center Jacksonville is positioned as the nearest hospital expected to receive multiple casualties. With its comprehensive infrastructure, including six acute care hospitals, satellite ERs, and extensive support services, Baptist Health is equipped to stabilize incoming patients before transfer to nearby trauma centers, as it is not a certified trauma facility itself. Baptist Health's emergency protocols include rapid triage, seamless coordination with local ambulance services, and structured patient intake managed by specialized staff teams. A robust alert and communication system ensures efficient mobilization and safety, while the Incident Command System oversees response coordination in collaboration with law enforcement and emergency services. Adhering to a mission of compassionate care, Baptist Health upholds its commitment to managing critical situations with meticulous operational readiness, ensuring that patients receive essential treatment and support in their time of need.

1. Company Information

Baptist Health Jacksonville, founded in 1955, has grown to become North Florida’s largest and most preferred health system. As the second-largest private employer in the region, it supports over 14,250 team members, including more than 2,000 credentialed medical providers across six acute care hospitals, three satellite ERs, and eighteen skilled nursing facilities and home health agencies. The organization operates over two hundred community points of care, such as outpatient surgery centers, physician offices, and imaging centers. In 2023, Baptist Health recorded 369,323 emergency room visits, 71,838 inpatient stays, and 25,675 observation stays. With 759,363 primary care visits, its Baptist Primary Care network is the largest primary care network in the area (Baptist Health, 2024).

Baptist Health’s main campus is located in downtown Jacksonville on Prudential Drive, adjacent to the St. Johns River. This campus includes several notable towers, such as the Borowy Family Children’s Critical Care Tower, which serves as the entryway to Baptist Medical Center Jacksonville and Wolfson Children’s Hospital, and the Wolfson Family Adult Tower, featuring an MRI, chapel, and patient rooms. Additional towers include the Legacy Tower, Weaver Tower with dedicated floors for pediatric and adult care, and the Heart Hospital specializing in cardiac care. The Women’s Pavilion offers maternity care, outpatient surgery, and a sleep center, while the Howard Building houses physician offices.

The organization’s mission is to make hope, healing, and well-being accessible to every person as an expression of God’s love. Their vision, "A lifetime of health, together," emphasizes a holistic approach to health (Baptist Health, 2024). Baptist Health’s core values, represented by the acronym CARES, include Community Advocacy, Respect, Excellence, and Stewardship. The organization is further guided by principles focused on the dignity of every person, promoting physical, mental, and spiritual well-being.

Baptist Health Jacksonville has received notable accolades, including Magnet designation for nursing excellence by the American Nurses Credentialing Center (ANCC), recognition as one of Forbes’ Best Employers for Diversity, and certification as a Comprehensive Stroke Center by The Joint Commission. Leading Baptist Health are President and CEO Michael Mayo, Executive Vice President and COO Matthew Zuino, Chief Medical Officer Dr. Timothy Groover, Chief Nursing Officer Dr. Tammy Daniel, Chief Treasury Officer Scott Finnegan, and Chief Human Resources Officer Kate McCann.

2. Risk Management Team Contact Information

Name	Position	Contact Number	Email	Role/Responsibilities
Dr. Emily Carter	Chief Medical Officer	555-1234	[email protected]	Oversees all medical operations during emergencies.
Sarah Lee	Risk Management Director	555-5678	[email protected]	Coordinates emergency risk management efforts.
Tom Mitchell	Security Director	555-9101	[email protected]	Ensures hospital security and crowd control.
Dr. Laura Nguyen	Trauma Lead Physician	555-1122	[email protected]	Leads trauma and emergency care for incoming casualties.
Kevin Brown	Emergency Operations Coordinator	555-3344	[email protected]	Coordinates with local law enforcement and emergency services.
Lisa Evans	Communications Officer	555-7788	[email protected]	Manages internal and external communication during crisis.

3. Alerts

The healthcare system is a complex network of people, institutions, and resources working together to provide medical services. At the heart of this system is the hospital alert system, a vital communication tool that facilitates the exchange of critical information between departments. This system sends emergency codes to staff, alerting nurses, doctors, and specialists of life-threatening situations like cardiac arrest or patient deterioration. The primary purpose of the hospital alert system is to save lives by ensuring patients receive the appropriate, high-quality care they need in a timely manner.

Hospitals have established a robust communication infrastructure to serve their operational needs. This includes two-way devices like pagers, walkie-talkies, and cell phones that allow medical staff to interact, coordinate treatment, and oversee operations. The hospital's communication system facilitates cooperation and support across various departments, enabling a coordinated response in emergency situations.

Emergency codes are used in hospitals and medical facilities to quickly alert staff of different crisis scenarios. A "code blue" or "code 333" indicates a life-threatening emergency like cardiac or respiratory arrest, requiring an immediate response from a trained rapid response team. Similarly, a "code rescue" signals serious patient deterioration, prompting the rapid response team to evaluate and intervene as needed. In the event of an "active shooter" or other threat on the premises, a "code silver" is called on to ensure patient and staff safety and security.

Mass Notification Systems are critical platforms that deliver emergency alerts to the right people at the right time. These systems collaborate to authorize a coordinated response, which is essential for preserving patient safety. This rapid emergency response can be transmitted through various channels, including desktop alerts, text messages, and phone calls. Within a single system, this method is helpful both within and outside of emergency situations.

4. Policy

The policy of Baptist Medical Center Jacksonville in the event of an Active Shooter or nearby mass shooting is to ensure the safety of staff, patients, and visitors, while sustaining critical operations wherever possible. Immediate notifications will be disseminated through the hospital’s emergency alert system, text alerts, and overhead announcements, providing essential information on the location and nature of the threat. Based on an ongoing assessment of the situation, departments may be directed to temporarily close, relocate to secure areas, or implement a partial lockdown.

The response will be overseen by the Chief Medical Officer or an appointed Incident Commander, supported by the Emergency Response Team (ERT). The Incident Commander or their designee is vested with the authority to initiate an immediate evacuation, lockdown, or complete facility shutdown, coordinating actions with security personnel and local law enforcement as required. Staff responsibilities are delineated by role: patient-care staff are expected to remain with and safeguard patients, relocating them to secure areas if feasible. Administrative staff will notify other departments, secure access points, and support communication efforts, while security personnel will coordinate with law enforcement, secure the facility, and oversee lockdown or evacuation measures. The ERT will assist with coordination and provide necessary support to all departments.

During patient and visitor evacuations, staff will direct individuals to designated exits and assembly areas, conducting thorough headcounts to confirm all persons are accounted for. Personnel designated for evacuation assistance will ensure the safety of those with disabilities or language barriers (Occupational Safety and Health Administration, 2024). Essential staff from critical departments, such as NICU and ICU, will remain with patients until they can be safely evacuated. Select technical and medical staff will oversee the shutdown of life-support equipment and other critical operations if circumstances permit. Evacuation routes and exits are clearly marked on each floor, and staff will guide patients and visitors along these routes to facilitate an orderly and secure exit. Designated assembly points outside the facility will serve as gathering locations, where department heads will verify the safety of all personnel.

Staff should reach out to security or the Incident Commander via designated emergency lines or internal hospital communication channels for instructions and updates. Staff are advised to communicate calmly and clearly with patients and visitors regarding the situation, while the public relations team will oversee external communications, including updates for patient families and media inquiries. Re-entry to the building will only be permitted once it has been deemed safe by law enforcement and the Incident Commander, and notifications of safe re-entry will be disseminated through the hospital’s emergency alert system.

If a nearby mass shooting occurs and evacuation is not required, security measures will be heightened, and access to the facility will be restricted. Instructions will be provided to staff based on the level of threat. In all situations, essential personnel, including selected medical, security, and support staff, will remain on-site to provide patient care, coordinate potential evacuations, and reschedule non-urgent procedures, as necessary.

5. Coordination

Baptist Medical Center Jacksonville is a dedicated and capable emergency response facility. There are many specialists on staff for an array of conditions. What Baptist Medical Center is not is a trauma center. This means the facility is not properly staffed with trauma teams. To properly treat these severe trauma cases, the patients must be transferred to the closest trauma center. In Jacksonville, there are two trauma centers. These facilities are UF Health on 8Th street and Memorial hospital off Beach Blvd. Baptist’s first transport would be to UF Health should the facility not be at capacity. “University of Florida trauma surgeons and specially trained support staff are available to help severely injured patients 24 hours a day, seven days a week.” (UF Health trauma one trauma center - UF health Jacksonville 2024) UF Health is the only certified Level 1 Trauma Center in Jacksonville. Once capacity is reached, patients will then be routed to Memorial Hospital. Memorial is a certified Level II Trauma Center.

Baptist Medical Center is not equipped with its own ambulance services. This leads the facility to have to contract other transport services, both private and public. In this case of mass casualty due to the concert shooting the patients will be brought into the emergency triage setup. The patients will be assessed for severity and treatment will be issued accordingly. Patients severely injured will be transported. It is the responsibility of Baptist Medical Center to stabilize patients to prepare them for safe transport to the neighboring trauma centers.

Patients who are less severely injured will be transported via ambulance. Jacksonville Fire rescue is the city’s ambulatory service. They will be fully involved in the emergency response both on scene at the concert venue and in transport to Baptist. JFRD is home to both fire and paramedic services. These teams are boots on the ground at the concert venue assessing patients and transporting them out to Baptist Medical Center. Police officers will be found controlling the crowd and securing the scene. This means that private ambulance services will be used. The most common companies used at Baptist Medical for medical transport is Liberty Ambulance, AmeriPro EMS, Medtrust Medical Transport, and Century Ambulance Services. There is no preference among the services in order of who is called first, transport is based on availability of the trucks.

The more critical patients are transported via life flight. The most common flight ambulance is TraumaOne that is associated with UF Health. Another service is Life Flight that stations at Baptist South located on Old St. Augustine Rd. Patients who use these flight services are too critical to be transported via land. It is possible for them to crash in the chopper and need to be brought back into the facility to stabilize again prior to takeoff. Once facility staff has stabilized the patient the flight team will take over for secure transport.

6. Shelter in Place (SIP) Plan

The emergency procedure known as "shelter in place" is applied when it is safer for people to stay inside rather than leave. This directive might be given in the event of mass casualties to safeguard patients, employees, and guests from outside dangers like a chemical spill, an active shooter, or severe weather while maintaining the ability of emergency services to function as usual. When a shelter-in-place order is issued for mass casualties excepted at the emergency room of the hospital, the medical emergency action plan for an active shooter scenario becomes active. Code 250 is then announced from the overhead paging system. Key individuals are notified including medical staff such as nurses, doctors, and certified nursing assistants.

Emergency medicine specialists and anesthesia providers may also be needed for critical situations. Everyone should be well-adapted and know their role in facilitating a coordinated response. Also, an effective communication channel should be established to relay critical information quickly and accurately. The hospital may use protocols to control the patient flow while ensuring patient safety when patients are directed to the Emergency Room (ER) during such an incident. This may entail guarding facility entrances, managing entry, and working with emergency personnel to give priority care to the most seriously injured patients The aim is to provide medical care while reducing exposure to the outside threat (DeNolf & Kahwaji, 2022).

Key details regarding sheltering in place would be to stay indoors, Locate a safe spot inside the structure, usually a room with few windows. Secure the area: If required, barricade, shut off lights, and close windows and doors.

Stay Informed: tune in to emergency broadcasts or news reports and wait for the all-clear instructions. Call 911 to report any suspicious behavior or activity around the premises. In some types of emergencies, you may need to stop outside air from coming in. If officials tell you to “seal the room,” you may need to. Businesses are strongly encouraged to develop a lockdown plan to ensure the safety of employees and others during hazardous situations. Your business lockdown plan should include follow instructions by checking with the local authorities for information on when it is safe to evacuate and when to shelter in place ( Shelter-in-Place for Active Shooter, 2021)

7. Operations

During emergencies, the organization utilizes remote personnel who can oversee operations and relay vital information to the team from their home offices. These off-site workers, with access to core office systems, collaborate with on-site staff to provide essential data - ensuring continuity even if the primary workplace becomes inaccessible. As a remote administrative support employee in Orange Park, Florida, Jasmine Johnson facilitates clear communication between healthcare providers and patients. This ensures patients receive the medical care they need, and the hospital's operations run smoothly.

As an IT specialist in Gainesville, Florida, Zion is responsible for remotely administering the hospital's network system. This includes providing IT support for operations and data analysis, as well as troubleshooting, testing, and analyzing the network. From his home office, he resolves problems, ensures clear access, and prevents issues within the hospital's operations systems.

As a remote health service patient coordinator in Saint Augustine, Florida, Kingston Marley focuses on meeting patients' needs in any situation. Working remotely, he coordinates the department's administrative duties while maintaining a patient-oriented approach.

During shelter-in-place orders, remote agents can safely supervise operations from home, which is more advantageous during crises. Even while working remotely, they collaborate with on-site colleagues to provide essential support as the backbone of the organization.

In the event of a medical emergency or natural disaster like a hurricane, tornado, or other catastrophic event, Baptist Health has comprehensive emergency preparedness measures and a disaster response plan to care for the community. Throughout the year, employees undergo emergency preparedness training through drills and instruction to ensure they are ready to respond calmly and effectively.

Baptist Health also has a mass communication system in place to assist during disasters or mass casualty incidents. This system includes designating a media staging area, facilitating communication and updates, establishing an emergency action plan, and providing the latest alerts about the status of hospitals, emergency centers, and other facilities.

8. Duties

Once the Baptist Medical Center Emergency department is alerted to the mass casualty event at the concert venue, they immediately activate their emergency response teams. There are two teams. Team A is the team on duty during the event. This team is required to stay in facility for the entirety of the event. Staff take shifts. For safety, if the casualty event goes over their shift the next group will relieve those on duty. Relieved staff members will be able to grab something to eat and nap in the physician lounges or other available staff areas that have beds set up. Rest helps to prevent medical errors. B team will come in once the emergency situation has been given the all clear. This team is responsible for cleanup. This is to relieve all staff members remaining on duty and get the facility back into standard operating order.

During the mass casualty event there are protocols that must be followed. All staff members have assigned jobs. All of these jobs align with all members of staff from every department. Charge nurses take the lead to organize all patients for intake and room assignment. In this case charge nurse Samantha Kaye, B.S.N. is our point person for example. Samantha’s contact email is [email protected]. As a charge nurse, Samantha commands her team in ensuring proper protocol. She is there to jump in where needed. If there is a code, she comes in to record everything that takes place. Samantha is the leader for her team.

After the charge nurse, we will look at Melvin Marsh R.N. Melvin is one of the triage nurses assigned to this mass casualty event. Melvin’s contact information is [email protected]. As a triage nurse it is Melvin’s duty to assess all patients as they are brought in via transport. Their assessment is not as in-depth as it would be should the patient come in on a normal basis. In the case of the shooting many of the thirty patients being transported are unconscious. Marvin will assess the patient’s condition and take vitals to assign patient who are most critical to be seen for immediate treatment. In a scenario of a full emergency room, the faster you are seen, the more critical you are.

The third member of staff we will look at is Kaylee Wood. Kaylee is a member of the registration team. Registration is a team that is often overlooked in these mass casualty scenarios, but they are equally important. Kaylee’s contact information is [email protected]. When patients are brought into the ambulance bay Kaylee will obtain any information, they can from the transport team. Most often the paramedics or EMS will have the patient’s ID readily available. If the patient’s information is available Kaylee will register the patient directly into the EMR. This will pull up the patient’s record if they have ever been a patient in the facility so medical staff can see the patient’s medical history. This is important for allergies as an example. If there is no identification available Kaylee will use Baptist’s palm scanner to scan the patient’s palm which identifies them if they have ever been a patient and automatically populates their information for registration. Having the patient registered gives them an armband for identification and medication scanning. If in the event there is no identification available and the patient has no saved palm scan, then Kaylee will follow Baptist’s John Doe registration process. There is a box of crayons. The patient’s name will be the color of the crayon as the first name and doe as the last name. Once the crayon color is registered the crayon will be broken in half and discarded into a designated box.

Beyond these three staff members, the emergency response team is comprised of cardio and radiography department members. Cardio will come in to help with tubing and heart monitoring like EKGs. The Rad department will come into the department with portable Xray machines to perform any necessary imaging at bedside if possible. If not possible, and the patient is able to be transported, they will be taken down to the department for other procedures such as CT. No department is more important than the other and they all work together as one to treat the patient. Afterall, they are all in the business of saving lives.

9. Assembly

The term "assembly" describes a prearranged site where people, tools, and resources are gathered and arranged to respond to the high number of casualties in a mass casualty incident. This area serves as a staging area to coordinate the deployment of assistance and support during the crisis. An assembly point is a well-known location, such as a parking lot or public area, where responders can rapidly gather.

This is where medical supplies, vehicles, specialized teams, and personnel such as first responders are brought together before being dispatched to the incident site. By assembling resources in one place, responders can be rapidly mobilized and assigned to different tasks based on the needs of the situation (Alpert &Kohn 2023).

Following first triage, victims are gathered and arranged to enable effective management of significant numbers of injured individuals, coordinated transportation to medical facilities, and better resource allocation to prioritize the most critical cases; it is a controlled gathering area to ensure everyone receives necessary treatment based on their injuries. Responders can be quickly mobilized and assigned to various tasks depending on the situation's requirements by gathering resources in one location. Employees can use the map from their mobile phones to navigate their assigned location for their team based on departments so that they all can be accounted for on a roster, they will remain with their team until they are all clear (Baptistjax n.d.).

10. Additional Emergency Plan and Procedures

The hospital will institute several emergency processes to manage the injured patients efficiently and ensure the safety of both the staff and the patients. First, there needs to be an Incident Command Center or ICC; this is the central station where command decisions are made and communication with law enforcement, fire departments, and EMS is maintained. Invoking the Mass Casualty Protocol would involve the activation of all departments, especially trauma and emergency, in preparation for receiving patients. Triage protocols immediately come into play to ensure that those with critical injuries are attended to first.

While doing this, the layers of security build upward, as the Security Director enacts a complete lockdown to prevent unauthorized entry into access points. Such a protocol is important to help protect the environment and to help reassure the public through the duration that the hospital is a safe place. Additional crisis counseling service areas will be provided for patients and families and will be managed by specifically trained personnel in areas set aside for loved ones awaiting news in a supportive space.

Another vital aspect is supply management. One will be quickly taking an inventory of the stores of IV fluids, dressings, PPE, and blood products to restock, as necessary. If decontamination would be necessary-for instance, if victims have been exposed to chemical agents-a decontamination area would be prepared ahead of time before the patients came into the main hospital, and staff would be geared up in appropriate protective gear.

In addition, casualties over the capacity of the hospital may further require the establishment of a temporary morgue to manage the deceased respectfully and safely. When the situation normalizes, the Communications Officer will provide updates internally to the staff and externally to the public, as necessary. After the incident is concluded, an after-action review will be conducted through which analysis of the response for future improvements in emergencies will take place. Also, the services of debriefing and emotional support during the event should be extended to the staff members involved in the response of the hospital.

In all, these additional emergency procedures will attempt to ensure the safety of the patient and staff, efficient distribution of resources, clear communication, and compassionate support so that managing this crisis by the hospital can be done sensitively as well as effectively. AI technologies (Stovall, 2021).

References

Alpert, E. A., & Kohn, M. D. (2023, August 8). EMS Mass Casualty Response. StatPearls - NCBI Bookshelf . https://www.ncbi.nlm.nih.gov/books/NBK536972/

Baptistjax. (n.d.-a). https://cdn.baptistjax.com/image/upload/v1696025555/Baptist%202.0/BMCJ_CampusMap_Brochure.pdf

Baptist Health. (2024, November 6). About Us. Retrieved from baptistjax.com: https://www.baptistjax.com/about-us

Baptist Health. (2024, August). Baptist Health System Fact Sheet. Retrieved from baptistjax.com: https://res.cloudinary.com/baptisthealth/image/upload/v1622569435/Baptist%202.0/Hospital%20Fact%20Sheets/Baptist_Health_System_Fact_Sheet.pdf

Baptist Health orientation. (n.d.-a). https://cdn.baptisthealth.net/Development/vol01/COV/Online_Baptist_Orientation.pdf 

Coiera, E. (2006, May). Communication Systems in Healthcare. The Clinical biochemist. Reviews. https://pmc.ncbi.nlm.nih.gov/articles/PMC1579411/

DeNolf, R. L., & Kahwaji, C. I. (2022a, October 10). EMS Mass Casualty Management. StatPearls –NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK482373/

Occupational Safety and Health Administration. (2024, November 8). Emergency Action Plan » Minimum Requirements. Retrieved from osha.gov: https://www.osha.gov/etools/evacuation-plans-procedures/eap/minimum-requirements

Shelter-in-Place for active shooter. (2021). https://www.fema.gov/sites/default/files/documents/fema_shelter-in-place_guidance.pdf

Stovall, S. (2021). Emergency management laws and mandates: What drives emergency management planning and policy.  Principles of Emergency Management and Emergency Operations Centers (EOC), 91-105.  https://doi.org/10.4324/9781315118345-6

University of Florida. (2024, November 4). UF Health traumaone trauma center - UF health Jacksonville. UF Health TraumaOne Trauma Center - UF Health Jacksonville. https://ufhealthjax.org/locations/uf-health-jacksonville/uf-health-traumaone-trauma-center

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