**EMERGENCY MANAGEMENT PLAN**

The LP Emergency Management plan describes more specific details as they
related to the objectives of Clinical Center Emergency Management Plan
and the NIH Occupant Evacuation plan.

**STANDARD POLICIES**

Standard policies remain in effect during an emergency. Details may be
found throughout the LP policy manual. The CC Emergency Management Plan
and NIH Occupant Evacuation Plan are also attached.

CLARIFICATION OF ALARMS & CODES

  ------------------ -----------------------------------------------------------------------------------------
  Fire Alarm Pull    Manually operated fire alarm pull stations are located in the corridors throughout the LP
  Station            and should be used by anyone to report fires, the odor of smoke, and other major
                     hazardous incidents. The pull stations should NOT be used to report bomb threats.\<\>

  Audiovisual Fire   The fire alarm system provides early notification system. It divides the building into
  Alarm System       zones based on the risk of fire. Zones are separated by fire rated barriers. The fire
                     alarm system is activated by fire alarm pull stations, smoke detectors, and water flow
                     switches in the sprinkler system. When activated, the fire alarm system automatically
                     flashes white strobe lights and broadcasts an electronic signal and instructions over the
                     fire evacuation speakers to occupants in the zone of the emergency only. Simultaneously,
                     it transmits the exact location of the emergency to the NIH Fire Department along with
                     other designated personnel in the NIH Emergency Communications Center.

  \"Page 100\"       Fire emergencies are announced on the central paging system to designate where the
  followed by the    emergency exists.
  room number or     
  zone               

  Vibrating Page     Emergency Vibrating Paging System is available through the Administration Office to
  System             Telecommunications for deaf or hard of hearing for notification of fire and related
                     emergencies.

  \"Code Blue\"      Medical emergencies are announced on the central paging system to designate where the
  followed by the    emergency exists.
  room number or     
  zone.              

  \"Code Yellow\"    In the event of activation of the Clinical Center Emergency Management Plan, \"Code
                     Yellow\" will be announced over the central paging system as well as via the fire alarm
                     announcement system.

  \"Red Alert\"      Federal Code Red Alert is activated if a severe condition reflects a severe risk of
                     terrorist attacks. Under most circumstances, the protective measures for a severe
                     condition are not intended to be sustained for substantial periods of time. See current
                     status at
                     [www.dhs.gov/dhspublic/display?theme=29](http://www.dhs.gov/dhspublic/display?theme=29)
  ------------------ -----------------------------------------------------------------------------------------

**COMMUNICATION**

+-----------------------------------------------+----------------------+
| Fire and Police Departments                   | 911                  |
|                                               |                      |
| (Fire, ambulance, police, chemical,           |                      |
| biological, radiological, human threat, bomb  |                      |
| threat, civil disturbance)                    |                      |
+-----------------------------------------------+----------------------+
| Medical \"Code Blue\" Team (Critical Medical  | 111                  |
| Situation)                                    |                      |
+-----------------------------------------------+----------------------+
| Engineering/Maintenance                       | 108                  |
+-----------------------------------------------+----------------------+
| STAT Overhead Page (Clinical Center only)     | 112                  |
+-----------------------------------------------+----------------------+
| Telecommunications failure                    | 611                  |
+-----------------------------------------------+----------------------+
| NIH Fire and Police Using Red Phones          | 116                  |
+-----------------------------------------------+----------------------+

Use the Emergency Red phone in 2N212 if there is a loss of telephone
communication. Emergency phone numbers are listed in the front of the
NIH phone book. Dialing on the red phones does not work the same as our
regular system. To dial:

-   Red phone to NIH police or fire, use \"116\"\
    NOTE: Red phone to \"911\" doesn\'t do anything

-   Red phone to red phone, use the full 7 digit \#

-   Red phone to an inside number, use the full 7 digit \#\
    NOTE: 496 and 402 exchanges work, 435 doesn\'t work

-   Red phone to an outside number, use \"9\" + area code + 7 digit \#

Regular inside phones lines (e.g., 496-) can dial to a red phone.
Someone calling from the outside will just hear normal ringing when the
Merlin phones are out of operation. Calls will not transfer to voice
mail. If phone disruption cannot be addressed immediately, notify all
customers to use emergency red phones for critical needs After regular
business hours, call the Admissions desk at 496-3315. A second level
notification to clinical staff can also be accomplished by posting a
message on the MIS \"hello\" screen. Call 496-8400 for assistance from
DCRI staff. If you are unable to contact them by phone, go to room
10/1C290 and ask to speak to a MIS Consultant.

**SPECIFIC EMERGENCY PLANS FOR LP CLINICAL SERVICES**

**General**

All employees are trained in emergency management by their section area
when hired. Documentation of training is done with the New Employee
Orientation worksheet.

Plans are part of the LP Policy manual and are reviewed by employees on
an annual basis.

Fire and evacuation drills are carried out annually. See Tab 6 of policy
manual.

Each section should have an adequate supply of flashlights and
batteries.

Emergency Power is limited, but is currently being addressed for
critical functions. Submit a Del Pro work order to request evaluation of
emergency power, if needed.

**Responsibilities During Code or Alarm**

A)  Medical Emergency

1.  Trained staff on the scene may administer first aid or Basic Life
    Support when appropriate. Emergency resuscitative equipment boxes
    containing gloves and Laerdal resuscitation masks are located at
    most elevator banks and in other public areas in the Clinical
    Center. When the members of the Clinical Emergency Response Team
    arrive, they will identify themselves and assume responsibility. The
    first CERT physician to arrive is responsible for initiating care of
    the victim. All individuals already on the scene should immediately
    relinquish care of the victim to the CERT.

2.  Call 111 for the Clinical Center Emergency Response Team (CERT)

3.  For all emergencies outside to the Clinical Center and for non-life
    threatening events in the hospital, call 911 for the NIH Rescue
    Squad. When off of the NIH campus, call 9-911, for local rescue
    services.

4.  When OMS is closed and an NIH employee has a blood or body fluid
    exposure, promptly call the Clinical Center operator at 496-1211 to
    contact an OMS physician immediately.

5.  If an NIH employee sustains a work-related injury or illness, it is
    the responsibility of the employee or his/her immediate supervisor
    to notify OMS of the incident.

6.  The CC Policy (M-95-1) regarding Emergency Medical Services can be
    found at <http://push.cc.nih.gov/policies/PDF/M95-1.pdf>.

B)  Emergency Evacuation

1.  Employees must follow evacuation policy 1430 See NIH Manual \# 1430
    "NIH Occupant Evacuation Plan" at
    <http://www1.od.nih.gov/oma/manualchapters/management/1430/>.

2.  The Occupant Emergency Coordinator (OEC) for LP is Jim Wilson

3.  The Designated Official is Lance Liotta.

4.  The LP Safety Committee Members and Chair, designated in Appendix A
    (Tab 11) work together to function as the Floor Team/Area Team
    Coordinators (FTC/ATC) for evacuation procedures.

5.  The FTC/ATC

    a.  Expedites evacuation

    b.  Assist individuals requiring assistance

    c.  Report conditions and evacuation status to the OEC

    d.  Advise the location of persons needing evacuation and/or
        assistance by the fire department.

    e.  Monitor stairways, restroom and elevators

6.  The designated meeting place for all LP employees (except Clinical
    Cytogenetics) evacuating the building is the parking lot behind
    Building 1. The designated meeting place for all Clinical
    Cytogenetics' employees evacuating the building is the parking lot
    near the Blood Bank.

7.  Specific plans for any persons with disabilities are established in
    appropriate sections as needed. The Safety Officer is responsible
    for notifying hearing impaired persons or alarm situations.

8.  Evacuation routes are posted in each section.

C)  Shelter in place

1.  In the event the NIH would need to react immediately to a crisis
    situation, the following \"Shelter-in-Place\" guidelines have been
    developed to aid NIH employees. These guidelines apply to any
    emergency or potential emergency caused by natural disasters,
    chemical, radiological, or biological incidents, terrorist threats
    and other crisis situations where the safest course of action for an
    employee would be to remain inside a building.

2.  Recent heightened security on campus due to potential terrorist
    threats to government employees and facilities emphasizes the
    importance of these guidelines. However, the NIH wants to assure
    employees, these guidelines are not being issued as a result of the
    recent elevation of the national threat level. Rather, these
    guidelines, created in consultation with the NIH Community Advisory
    Board for Security (CABS), are being issued to aid all employees in
    the event of any future emergency situation.

3.  In the event of an emergency during the workday, you may be advised
    to seek shelter-in-place. The term "shelter-in-place" means to seek
    immediate shelter inside a building and to remain there until an
    all-clear signal has been given. The term has historically been used
    in an instance of weather emergency, such as a hurricane. However,
    shelter-in-place will now be used in any situation when the safest
    course of action is to remain in place for a short period, such as
    when there is a phased dismissal of the campus following an
    emergency. Although such shelter should not last more than a few
    hours, you should make sure that you have available appropriate
    supplies, such as drinking water and any medications that you might
    need. In some situations, you may be asked to remain at your
    workstation, and in others, to relocate to a pre-determined location
    or area of refuge. In the event of an emergency that requires you to
    shelter-in-place, you will be provided more detailed instructions
    specific to the building in which you work.

4.  Some key points to keep in mind are:

    a.  Keep calm -- follow these directions.

    b.  If you are outdoors, go inside immediately to an area designated
        by your Safety Officer.

    c.  Do not attempt to leave campus to pick up children or other
        family members -- they will likely be sheltering in place
        wherever they are located.

    d.  Unless you have an emergency in your shelter, stay off the
        phones, including personal cell phones. It is critical to keep
        lines open for fire, police, medical and other responders, for
        people reporting emergencies to 911, and for other official
        communications.

    e.  Also note that shelter-in-place is the default mode of the
        Clinical Center in most emergencies because of the
        impracticalities of evacuating patients and the low likelihood
        of an emergency that would require evacuation of the entire
        building.

D)  Code Yellow

1.  To assure coordinated and timely communication of critical
    information during an emergency, the Clinical Center is implementing
    a new communication process using emergency e-mail notifications and
    walkie talkies set to the CC frequency .

2.  The emergency e-mails are sent to the Director of Clinical
    Operations and the Clinical Laboratory Manager. They will be
    forwarded to LP employees as appropriate. All emergency employees
    are included in the NCI CCR LP --Emergency e-mail list, located on
    the NIH global directory and may be used if needed.

3.  The Director of Clinical Operations reports to the CC Emergency
    Management Communication Center (EmaCC) and establishes
    communication between emergency leaders in LP.

4.  The Clinical Laboratory Manager assists with EMaCC, as needed.

5.  The EmaCC may establish a gathering place for displaced staff and
    visitors, most likely Lipsett and/or Masaurs Auditoriums.

6.  The Surgical Pathology Office (10/2N212) will become the central
    location for LP communications with a FAX machine (301-480-9488),
    e-mail, red phone, computers, walkie-talkie, emergency supplies
    (TBD), etc. (HOW DO WE GET WALKIE TALKIE?)

7.  Secondary location (back-up) will be Cytopathology Office (10/2A33).
    Back-up FAX is (301) 402 2585.

8.  Supervisors begin to assess their areas and advise Chiefs regarding
    support needs, assign staff responsibilities to support the
    situation or releases employees to CC labor pool.

9.  The Archivist would begin assessing the attendance of the
    department, using a roster log to determine clinical staff by each
    area to determine current staff, staff needed, and deployable staff.
    (Note: Need to make a roster to take attendance in room order so it
    can be taken as one person walks the hallways or calls remote
    areas.)

10. The Chief, Clinical Chiefs, PIs Director of Clinical Operations,
    Director of Research Operations, and Clinical Lab Manager will
    report to the central location if a code yellow is activated for
    emergency response meeting. This team does the following:

    a.  Designates staffing requirements for a disaster and determine
        who can be deployed to help the emergency labor pool.

    b.  Addresses operational issues surrounding staffing, equipment,
        and space to necessary for response or movement in the event of
        a disaster. Need to determine critical functions and
        requirements (staff, equipment, transportation, information
        technology, etc) to support patients during an emergency and/or
        disaster.

    c.  Determines ability and need to transfer or equip back-up
        location should we need to evacuate the area.

11. The Laboratory Information System Administrator monitors network and
    computer applications required for relief effort. Coordinates with
    CIT staff to provide support as needed.

E)  Emergency Phone Tree / Call back procedures

1.  Phone tree may be activated by the Director, Center for Cancer
    Research or Chief, Laboratory of Pathology.

2.  Red Alert Critical (RAC) employees start calling employees as
    specified in the phone tree.

3.  The Deputy Chief calls the Chief to confirm all secondary calls to
    RAC Staff were placed and report any problems.

4.  Red Alert Essential Staff (RES) are called by callers designated on
    the tree.

5.  All callers contact Clinical Laboratory Manager (Technical
    Laboratory Manager, as back-up), to confirm all secondary calls were
    placed, or report problems. Managers will relay summary of
    information to Chief.

F)  Department Disaster Response Team

1.  The morgue may be utilized if presented with a disaster with mass
    casualties.

    a.  In the event of a mass casualty the CC or NIH Leadership would
        notify the appropriate authorities (Medical Examiners Office,
        FBI, AFIP, etc).

    b.  The CC, NIH, and LP will take directions from the legal
        authority established at the time of the incident.

    c.  The CC or NIH Leadership would work with the appropriate
        authorities to arrange for transportation and security of
        remains and property of the deceased.

    d.  The Autopsy Section maintains an inventory of about one hundred
        body bags on site.

    e.  The LP will collaborate with the NIH leadership to identify
        additional space to place bodies after morgue capacity is
        exceeded.

    f.  The LP will work with the NIH Police department and CC
        Leadership and appropriate authorities to establish a security
        plan to guard bodies and personal belongings if morgue
        operations are used and/or relocated

G)  Red Alert

1.  Protective Measures for Red Alert

    a.  Increasing or redirecting personnel to address critical
        emergency needs;

    b.  Assigning emergency response personnel and pre-positioning and
        mobilizing specially trained teams or resources;

    c.  Monitoring, redirecting, or constraining transportation systems;
        and

    d.  Closing public and government facilities.

2.  Red Alert Critical (RAC) employees must report to work to assist
    with shut down of NIH.

3.  If CC maintains patient care, RAC employees work with security to
    bring Red Alert Essential Staff (RES) onto the campus to perform
    critical care functions.

4.  In the event of a Red Alert, only limited services can be provided
    that are deemed critical at the time, determined by the RAC team.

H)  Emergency Employees

1.  Emergency employees provide services that are vital for direct
    patient care or patient care support at NIH.

2.  Emergency employees are required to report for, or remain at work in
    emergency situations.

3.  Dismissal or closure announcements do not apply unless instructed
    otherwise.

4.  Refer to the memo regarding Emergency Employees in Appendix K of
    Tab 11. to determine employee classification and policy pertaining
    to emergency employees. The memo is issued on an annual basis. In
    general, all employees providing a clinical service will be
    classified as Emergency. However, employees hired in the interim of
    the annual memo notification may contact their supervisor to
    determine classification.

I)  Red Alert Critical Staff and Red Alert Essential Staff

1.  The Chief of LP will designate individuals as Red Alert Critical
    Staff (RAC) or Red Alert Essential Staff (RES) to have access to the
    NIH campus and facilities if a Federal Code Red Alert is activated.
    These are designated on the list of emergency employees.

2.  In the event of a Code Red, RAC employees must report to work an
    assist with an NIH shut down.

3.  RES employees are will be expected to report to work, if the CC
    maintains patient care operations. An emergency personnel phone tree
    has been established and is located in Appendix K of Tab 11.

4.  Employees designated to call others will maintain a confidential
    list of emergency phone numbers. Please report any changes in
    contact information to the Clinical Laboratory Manager so this list
    may be updated appropriately.

  ------------- ----------- -------------- ----------- ------------- -----------
  Description                              Counted by  Determined by 
                                           Archivist   Clinical      
                                                       Chiefs        

  Room          Phone       Section        \# Present  \# Needed for \# Avail
                                                       Clinical      for labor
                                                       Service       pool

  2N220         402-0434    Immuno                                   

  2N218         594-9532\   Clin Ops                                 
                496-0551                                             

  2N216         496-2441    Surg Path                                
                            Offices                                  

  2N214                                                              

  2N212                                                              

  2N208         496-8339\   Sign Out                                 
                435-8938                                             

  2N206\        594-2945\   Residents                                
  2N204         104-5196\                                            
                104-5491                                             

  2N202         496-0183    Hemepath                                 
                            Office                                   

  2N119         496-5282    ARC Purchasing                           

  2N113         496-4709    Hemepath                                 
                            Fellows                                  

  2N109/110     435-2627\   Molecular                                
                435-2632                                             

  2N108         402-1424    Flow Office                              

  2N100/ 2A19   496-6355    Cytology                                 

  2A22          496-3126\   Histology                                
                435-3543                                             

  2A33          402-3990    OOC Admin                                

  2A10/2A09     496-2164    EM                                       

  2A07          496-5658    Autopsy                                  

  6N109/110     435-2640\   Flow Lab                                 
                402-1716                                             

  3C731         435-3711\   Cytogenetics                             
                435-3712                                             
  ------------- ----------- -------------- ----------- ------------- -----------

**References**

[CC Emergency Management
Plan](http://intranet.cc.nih.gov/od/emergencyplan/)

[NIH Occupant Evacuation
Plan](http://www1.od.nih.gov/oma/manualchapters/management/1430/)

[US Department of Homeland Security](http://www.dhs.gov/dhspublic/)

[CC Policy (M-95-1), Emergency Medical
Services](http://push.cc.nih.gov/policies/PDF/M95-1.pdf)