**Emergency Management Program**

**DATE: SAMPLE**

**[OPERATING UNIT: Operating Rooms OPERATING UNIT
MANAGER:]{.underline}**

+-------+----------+------+---------------+-----------+--------------+
| **Mi  | ##### Po | *    | Preparations  | If there  |              |
| ssion | tential  | *Con | to Make to    | is an     |              |
| Cri   | Problems | tact | Minimize      | int       |              |
| tical |          | for  |               | erruption |              |
| Sys   |          | As   | **Potential   | in        |              |
| tem** |          | sist | Problems**    | o         |              |
|       |          | ance |               | perations |              |
|       |          | in   |               | due to    |              |
|       |          | P    |               | loss of   |              |
|       |          | repa |               | the       |              |
|       |          | ring |               | Critical  |              |
|       |          | for  |               | System,   |              |
|       |          | P    |               | then:     |              |
|       |          | oten |               |           |              |
|       |          | tial |               | **Assess  |              |
|       |          | Pr   |               | the       |              |
|       |          | oble |               | situation |              |
|       |          | ms** |               | for:      |              |
|       |          |      |               | Action    |              |
|       |          |      |               | re        |              |
|       |          |      |               | quired:** |              |
+=======+==========+======+===============+===========+==============+
| **1.  | *Staff   | Faci | 1.  Stock     | 1.        | 1.  Report   |
| Light | unable   | lity |               | Determine |     extent   |
| ing** | to see   | Eng  |   flashlights |           |     to       |
|       | in       | i­nee |     and       |    extent |     command  |
| **(E  | rooms.   | ring |               |     of    |     center   |
| merge | Unable   | and  |    batteries. |           |     with     |
| ncy** | to carry | Sa   |               |    outage |              |
|       | out      | fety | 2.  Review    |     (unit |   assessment |
| **Lig | duties.* | Of   |               |     or    |              |
| hts** |          | fice |    evacuation |     wi    | 2.  Begin    |
|       |          |      |               | despread) |     shutdown |
| **Av  |          |      |   procedures. |           |     of       |
| ailab |          |      |               | 2.        |              |
| le)** |          |      | 3.  Secure    | Determine |   procedures |
|       |          |      |     doorstops |           |     in       |
|       |          |      |     for       |   ability |     progress |
|       |          |      |     enclosed  |     of    |              |
|       |          |      |     rooms     |     staff | 3.  Evacuate |
|       |          |      |     (held by  |     to    |     patients |
|       |          |      |     CNM).     |           |     on       |
|       |          |      |               |  continue |     command  |
|       |          |      |               |     o     |     center   |
|       |          |      |               | perations |              |
|       |          |      |               |           | instructions |
|       |          |      |               | 3         |              |
|       |          |      |               | .  Assess |              |
|       |          |      |               |           |              |
|       |          |      |               |   patient |              |
|       |          |      |               |           |              |
|       |          |      |               | condition |              |
|       |          |      |               |     for   |              |
|       |          |      |               |     e     |              |
|       |          |      |               | vacuation |              |
+-------+----------+------+---------------+-----------+--------------+
| **2.  | *El      | Faci | 1.  See #1.   | 1.        | 1.  Report   |
| El    | ectrical | lity |     Lighting  | Determine |     extent   |
| ectri | and      | Eng  |               |           |     to       |
| cal** | el       | i­nee | 2.  Review    |    extent |     command  |
|       | ectronic | ring |               |     of    |     center   |
| **Po  | e        | and  |    evacuation |           |     with     |
| wer** | quipment | Sa   |     and       |    outage |              |
|       | is       | fety |     emergency |     (unit |   assessment |
| **(G  | una      | Of   |               |     or    |              |
| enera | vailable | fice |  interruption |     wi    | 2.  Begin    |
| tor** | (after   |      |               | despread) |     shutdown |
|       | battery  |      |   procedures. |           |     of       |
| **Po  | backup   |      |               | 2.        |              |
| wer** | fails).* |      |               | Determine |   procedures |
|       |          |      |               |           |     in       |
| **Av  |          |      |               |   ability |     progress |
| ailab |          |      |               |     of    |              |
| le)** |          |      |               |     staff | 3.  Evacuate |
|       |          |      |               |     to    |     patients |
|       |          |      |               |           |     on       |
|       |          |      |               |  continue |     command  |
|       |          |      |               |     o     |     center   |
|       |          |      |               | perations |              |
|       |          |      |               |           | instructions |
|       |          |      |               | 3         |              |
|       |          |      |               | .  Assess |              |
|       |          |      |               |           |              |
|       |          |      |               |   patient |              |
|       |          |      |               |           |              |
|       |          |      |               | condition |              |
|       |          |      |               |     for   |              |
|       |          |      |               |     e     |              |
|       |          |      |               | vacuation |              |
+-------+----------+------+---------------+-----------+--------------+
| **3.  | *St      | Faci | 1.  Obtain    | 1         | 1.  Discuss  |
| St    | erilized | lity |               | .  Assess |     stock    |
| eam** | tray and | Eng  |    disposable |     needs |     and      |
|       | in       | inee |               |     for   |     supply   |
| *     | strument | ring |   instruments |           |     with     |
| *Dist | availa   | and  |     and       |   sterile |              |
| ribut | bility.* | SPD. |     suture    |           |  appropriate |
| ion** |          |      |     trays.    |  supplies |     serv     |
|       |          |      |               |     and   | ice/section; |
|       |          |      | 2.  Insure    |           |     report   |
|       |          |      |     all trays |   laundry |     problems |
|       |          |      |               |           |     to ACOS  |
|       |          |      |    sterilized | 2.        |     Surgery  |
|       |          |      |     an        |   Ability |     for      |
|       |          |      |     available |     to    |              |
|       |          |      |     in        |           |   resolution |
|       |          |      |     advance   |   perform |     and      |
|       |          |      |               |           |     command  |
|       |          |      |               |  emergent |     center   |
|       |          |      |               |     cases |              |
|       |          |      |               |     with  |              |
|       |          |      |               |           |              |
|       |          |      |               |  existing |              |
|       |          |      |               |     stock |              |
|       |          |      |               |           |              |
|       |          |      |               |    levels |              |
+-------+----------+------+---------------+-----------+--------------+
| **4.  | *I       | Faci | 1.  Obtain    | 1.        | 1.  Report   |
| Heati | nability | lity |     extra     | Determine |     extent   |
| ng,** | to       | Eng  |     blankets  |           |     to       |
|       | control  | inee |               |    extent |     command  |
| **V   | tem­p     | ring | 2.  Discuss   |     of    |     center   |
| entil | erature, | and  |     portable  |           |     with     |
| ation | h        | Sa   |     heaters   |    outage |              |
| & Air | umidity, | fety |               |     (unit |   assessment |
| Co    | and air  | Of   | 3.  Discuss   |     or    |              |
| nditi | ex       | fice |     portable  |     wi    | 2.  Begin    |
| oning | changes; |      |     fans      | despread) |     shutdown |
| (HV   | patient  |      |               |           |     of       |
| AC)** | comfort  |      | 4.  Review    | 2.        |              |
|       | and      |      |               | Determine |   procedures |
|       | safety.* |      |    evacuation |           |     in       |
|       |          |      |               |   ability |     progress |
|       |          |      |    procedures |     of    |              |
|       |          |      |               |     staff | 3.  Evacuate |
|       |          |      |               |     to    |     patients |
|       |          |      |               |           |     on       |
|       |          |      |               |  continue |     command  |
|       |          |      |               |     o     |     center   |
|       |          |      |               | perations |              |
|       |          |      |               |           | instructions |
|       |          |      |               | 3         |              |
|       |          |      |               | .  Assess |              |
|       |          |      |               |           |              |
|       |          |      |               |   patient |              |
|       |          |      |               |           |              |
|       |          |      |               | condition |              |
|       |          |      |               |     for   |              |
|       |          |      |               |     e     |              |
|       |          |      |               | vacuation |              |
+-------+----------+------+---------------+-----------+--------------+
| **5.  | *I       | Faci | 1.  Obtain    | 1         | 1.  Report   |
| R     | ncreased | lity |     portable  | .  Assess |     failure  |
| oom** | staff    | Engi |     fans      |           |     to       |
|       | risk due | neer |               |    actual |     command  |
| *     | to waste | ing, | 2.  Plan for  |     need  |     center   |
| *or** | gases,   | Sa   |     possible  |     for   |     with     |
|       | smoke    | fety |     use of    |           |              |
| *     | plumes.  | Off  |     portable  |   exhaust |   assessment |
| *Hood | I        | ice, |     suction   |           |              |
| Exha  | ncreased | I    |     devices   |   systems | 2.  Begin    |
| ust** | i        | nfec |     to remove |           |     shutdown |
|       | nfection | tion |     gases,    | 2.        |     of       |
|       | risk.*   | Cont |     etc.      |   Prepare |              |
|       |          | rol. |               |     to    |   procedures |
|       |          |      |               |           |     in       |
|       |          |      |               | terminate |     progress |
|       |          |      |               |     cases |     if       |
|       |          |      |               |     or    |     needed   |
|       |          |      |               |     use   |              |
|       |          |      |               |           |              |
|       |          |      |               | alternate |              |
|       |          |      |               |           |              |
|       |          |      |               |   exhaust |              |
+-------+----------+------+---------------+-----------+--------------+
| **6.  | *Unable  | Faci | 1.  Provide   | 1         | 1.  Report   |
| Wa    | to       | lity |     for       | .  Assess |     failure  |
| ter** | provide  | Eng  |     bottled   |           |     to       |
|       | water    | inee |     water for |   patient |     command  |
| **    | for      | ring |     patients  |     needs |     center   |
| Deliv | patients | and  |     and       |     and   |     with     |
| ery** | needs,   | Mate |     sanitary  |           |              |
|       | staff    | rial |     needs     |    extent |   assessment |
|       | i        | Ma   |               |     of    |              |
|       | nfection | nage | 2.  Stock     |           | 2            |
|       | c        | ment |     waterless |   problem | .  Establish |
|       | ontrol.* |      |     soaps     |           |     bottled  |
|       |          |      |               |           |     water    |
|       |          |      |               |           |              |
|       |          |      |               |           |    center(s) |
|       |          |      |               |           |     with     |
|       |          |      |               |           |     control  |
+-------+----------+------+---------------+-----------+--------------+
| **7.  | *Unable  | Faci | 1.  Obtain    | 1         | 1.  Report   |
| Wa    | to use   | lity |     signs     | .  Assess |     failure  |
| ter** | water    | Eng  |     saying    |           |     to       |
|       | for      | inee |     \"Water   |   patient |     command  |
| *     | drinking | ring |     Unsafe to |     needs |     center   |
| *Cond | or       | and  |     Drink\"   |     and   |     with     |
| ition | patient  | Mate |     for       |           |              |
| ing** | needs.   | riel |     sinks,    |    extent |   assessment |
|       | Cannot   | Ma   |     etc.      |     of    |              |
| *     | scrub    | nage |               |           | 2            |
| *Or** | for      | ment | 2.  Provide   |   problem | .  Establish |
|       | cases.*  |      |     locations |           |     bottled  |
| *     |          |      |     for       |           |     water    |
| *Drin |          |      |     bottled   |           |              |
| kabil |          |      |     water for |           |    center(s) |
| ity** |          |      |     scrub     |           |     with     |
|       |          |      |     sinks.    |           |     control  |
+-------+----------+------+---------------+-----------+--------------+
| **8.  | *Cannot  | E    | 1.  Minimize  | 1         | 1.  Report   |
| Wa    | remove   | nvir |     sanitary  | .  Assess |     failure  |
| ste** | in       | onme |     system    |           |     to       |
|       | fectious | ntal |     usage     |    extent |     command  |
| **Str | and      | Ma   |               |     of    |     center   |
| eam** | other    | nage | 2.  Obtain    |           |     with     |
|       | waste;   | ment |     extra     |   problem |              |
| **    | i        | and  |     biohazard |     on    |   assessment |
| (Sani | ncreased | Faci |     boxes     |     unit  |     for      |
| tary, | i        | lity |               |     for   |              |
| S     | nfection | Eng  | 3.  Obtain    |           |    immediate |
| olid, | risk and | inee |     extra     | immediate |     problems |
| Li    | pest     | ring |     needle    |           |              |
| quid, | hazard.  |      |     boxes     |  problems | 2.  Keep EMS |
| &**   | Drains   |      |               |           |     informed |
|       | and      |      | 4.  Plan to   | 2.  C     |     of waste |
| **Bi  | toilets  |      |     minimize  | ontinuous |     status;  |
| ohaza | b        |      |     water use |     a     |     report   |
| rd)** | ack-up.* |      |               | ssessment |     problems |
|       |          |      | 5.  Plan for  |     for   |     to       |
|       |          |      |               |     waste |     Chief,   |
|       |          |      |   abbreviated |     and   |     Patient  |
|       |          |      |     scrubs    |           |     Care     |
|       |          |      |               |   similar |     Services |
|       |          |      |               |     items |              |
+-------+----------+------+---------------+-----------+--------------+
| **9.  | *Unable  | SPD, | 1.  Obtain 1  | 1.  C     | 1.  Discuss  |
| Criti | to       | P    |     month     | ontinuing |     stock    |
| cal** | supply   | harm |     extra     |     a     |     and      |
|       | patient  | acy, |     supply of | ssessment |     supply   |
| **    | needs    | and  |     necessary |     of    |     with     |
| Suppl | i        | W    |     stock     |           |              |
| ies** | ncluding | areh |     supplies; | situation |  appropriate |
|       | wound    | ouse |               |           |     serv     |
|       | care and |      |    discussion |           | ice/section; |
|       | pharmacy |      |     stock     |           |     report   |
|       | items.*  |      |     with SPD  |           |     problems |
|       |          |      |               |           |     to ACOS, |
|       |          |      | 2.  Locate    |           |     Surgery  |
|       |          |      |     alternate |           |     for      |
|       |          |      |     suppliers |           |              |
|       |          |      |               |           |   resolution |
+-------+----------+------+---------------+-----------+--------------+
| **10. | *Unable  | Busi | 1.  Insure    | 1         | 1.  Report   |
| Commu | to call  | ness |     backup    | .  Assess |     failure  |
| ni-** | for      | P    |     (2-way    |           |     to       |
|       | e        | ract |     radio) is |    extent |     command  |
| **ca  | m­ergency | ices |               |     of    |     center   |
| tions | as       | and  |    available. |           |     with     |
| (     | sistance | Te   |               |  problem, |              |
| Telep | or       | leco | 2.  Orient    |     check |   assessment |
| hone, | s        | mmun |     staff to  |           |              |
| R     | upplies. | icat |     act as    | emergency | 2.  Runners  |
| adio, | Unable   | ions |               |           |     to be    |
| I     | to       |      |   \"runners\" |    phones |              |
| nterc | contact  |      |               |           |   dispatched |
| om,** | ph       |      | 3.  Lay in    | 2         |     as       |
|       | ysicians |      |               | .  Insure |     needed   |
| **    | or       |      |    additional |           |     with     |
| Nurse | staff.   |      |     stock     | emergency |              |
| Call; | Unable   |      |     supplies  |     lines |    available |
| et    | to       |      |               |     are   |     co       |
| c.)** | contact  |      | 4.  Discuss   |           | mmunications |
|       | clinical |      |               |    manned |     (if      |
|       | l        |      | communication |           |              |
|       | ab/blood |      |     and       | 3.  Check |   available) |
|       | bank*    |      |     delivery  |           |              |
|       |          |      |     protocols |  staffing | 3.  Contact  |
|       |          |      |     with      |     and   |     PALMS    |
|       |          |      |     PALMS     |           |     directly |
|       |          |      |               |    report |              |
+-------+----------+------+---------------+-----------+--------------+
| **11. | *Cannot  | I    | 1.  Orient    | 1         | 1.  Report   |
| VISTA | order    | RMS, |     staff to  | .  Assess |     failure  |
| &**   | tests or |      |     act as    |           |     to       |
|       | receive  | Inf  |               |    extent |     command  |
| **    | results. | orma |   \"runners\" |     of    |     center;  |
| Other | Medical  | tion |               |           |     obtain   |
| Com   | records  | Secu | 2.  Check     |   problem |     patient  |
| puter | and      | rity |     function  |     on    |     records  |
| Appl  | images   | Off  |     of light  |     unit  |     if not   |
| icati | unav     | icer |     boxes     |           |     on unit  |
| ons** | ailable. |      |               | 2.  C     |              |
|       | Appo     |      | 3.  Print out | ontinuous | 2            |
|       | intments |      |     patient   |     a     | .  Institute |
|       | and      |      |     records   | ssessment |     runner   |
|       | staffing |      |               |     of    |     system   |
|       | s        |      | 4.  Manual    |           |              |
|       | chedules |      |     backup of |   records | ```{=html}   |
|       | inacce   |      |     schedules |           | <!-- -->     |
|       | ssible.* |      |               |    system | ```          |
|       |          |      | 5.  Plan for  |     and   | 3.  Utilize  |
|       |          |      |     portable  |           |     manual   |
|       |          |      |     radiology |    actual |              |
|       |          |      |               |     needs |    schedules |
|       |          |      | 6.  Test      |     of    |              |
|       |          |      |     backup    |     the   |              |
|       |          |      |     film      |     unit  |              |
|       |          |      |     printing  |           |              |
|       |          |      |     sys.      |           |              |
+-------+----------+------+---------------+-----------+--------------+
| **12. | *I       | Faci | 1.  Insure    | 1         | 1.  Report   |
| Ala   | nability | lity |     backup    | .  Assess |     status   |
| rms** | to call  | Engi |     (2-way    |           |     to       |
|       | or hear  | neer |     radio) is | situation |     command  |
| **(   | fire     | ing, |               |     for   |     center   |
| Fire, | alarm.   | Sa   |    available. |     each  |     with     |
| Code  | Unable   | fety |               |           |              |
| Blue, | to call  | Off  | 2.  Orient    |   system; |   assessment |
| Secu  | Code     | ice, |     and       |           |              |
| rity, | Blue.    | Mate |     review    |    insure | 2            |
| Me    | Cannot   | riel |     fire      |           | .  Institute |
| dical | tell     | Man  |     watch     |    alarms |     fire     |
| G     | when     | agem |               |     are   |     watch,   |
| ases, | medical  | ent, |    procedures |           |     alarm    |
| Nurse | gas      | Bi   |               |   checked |     watch,   |
| Call, | supply   | omed | 3.  Set up    |     for   |     and      |
| Refr  | is       | ical |     frequent  |           |     frequent |
| igera | compr    | Engi |               |  accuracy |     patient  |
| tion; | omised.* | neer |    walk-thrus |     on    |     rounds   |
| et    |          | ing, |     for alarm |     alarm |     with     |
| c.)** |          | An   |               |           |     co       |
|       |          | esth |    conditions | 2         | mmunications |
|       |          | esia |               | .  Assess |     backup   |
|       |          |      | 4.  Orient    |           |     (if      |
|       |          |      |     staff to  |    backup |     needed   |
|       |          |      |     act as    |           |     and      |
|       |          |      |               |    levels |              |
|       |          |      |   \"runners\" |     of    |   available) |
|       |          |      |               |           |              |
|       |          |      |               | available |              |
|       |          |      |               |     gases |              |
|       |          |      |               |     in    |              |
|       |          |      |               |           |              |
|       |          |      |               | cylinders |              |
+-------+----------+------+---------------+-----------+--------------+
| **13. | *Unable  | Faci | 1.  Plan for  | 1         | 1.  Report   |
| E     | to       | lity |     possible  | .  Assess |     patient  |
| levat | receive  | Engi |     emergency |           |     status   |
| ors** | s        | neer |     stairwell |   patient |     to       |
|       | upplies, | ing, |     usage     |     needs |     command  |
| **&   | or       | Sa   |     (litters, |     for   |     center   |
| Other | med      | fety |     etc)      |           |              |
| Ver   | ications | Off  |               |  possible | 2            |
| tical | by cart. | ice, | 2             |           | .  Institute |
| T     | Unable   | SPD, | .  Coordinate |  vertical |     runner   |
| ransp | to       | and  |     patient   |     ev    |     systems  |
| ort** | t        | Phar |     housing   | acuation. |              |
|       | ransport | macy |     in PACU,  |           | 3            |
|       | patients |      |     SICU, and | 2.        | .  Institute |
|       | on or    |      |     A4N       | Determine |              |
|       | off      |      |               |           |    emergency |
|       | floor.*  |      | 3.  Establish |   patient |     supply   |
|       |          |      |     r         |     needs |              |
|       |          |      | unner/courier |     for   |   procedures |
|       |          |      |     system    |     food, |              |
|       |          |      |               |           |              |
|       |          |      |               | pharmacy, |              |
|       |          |      |               |           |              |
|       |          |      |               |   linens, |              |
|       |          |      |               |     and   |              |
|       |          |      |               |     other |              |
|       |          |      |               |           |              |
|       |          |      |               |  supplies |              |
+-------+----------+------+---------------+-----------+--------------+
| **14. | *Minimal | Mate | 1.  Orient    | 1         | 1            |
| T     | direct   | riel |     staff to  | .  Assess | .  Institute |
| ransp | problems | Ma   |     act as    |     needs |     runner   |
| ort** | (admini  | nage |               |     for   |     system   |
|       | strative | ment |   \"runners\" |     mail  |     for      |
| *     | only).*  | (    |               |     and   |     pharmacy |
| *Syst |          | Mail | 2.  Plan for  |           |     items;   |
| ems** |          | R    |     manual    |  pharmacy |     ad       |
|       |          | oom) |     pickup    |     items | ministrative |
| *     |          | and  |     and       |           |     mail     |
| *(Rob |          | Phar |     delivery  |           |              |
| otic, |          | macy |     of mail   |           |    secondary |
| Pneu  |          |      |     and       |           |              |
| matic |          |      |     similar   |           |              |
| Tube, |          |      |     items     |           |              |
| Tr    |          |      |               |           |              |
| acked |          |      |               |           |              |
| Veh   |          |      |               |           |              |
| icle; |          |      |               |           |              |
| et    |          |      |               |           |              |
| c.)** |          |      |               |           |              |
+-------+----------+------+---------------+-----------+--------------+
| **15. | *Unable  | Ane  | 1.  Provide   | 1         | 1.  Contact  |
| Cent  | to       | sthe |     location  | .  Verify |              |
| ral** | continue | sia, |     for       |           |   anesthesia |
|       | s        | Engi |     backup    |    extent |     (with    |
| **Me  | urgery.* | neer |     oxygen    |     of    |     runners  |
| dical |          | ing, |               |           |     if       |
| Gases |          | Mate |    cylinders. |  failure; |     needed); |
| (Oxyg |          | riel |     Discuss   |     check |              |
| en)** |          | M    |     stock     |     alarm |    establish |
|       |          | gmt. |     level     |     panel |     sm       |
|       |          |      |     with      |           | all-cylinder |
|       |          |      |               | 2         |     therapy  |
|       |          |      |    anesthesia | .  Assess |              |
|       |          |      |               |           | 2.  Contact  |
|       |          |      | 2.  Insure    |    actual |     command  |
|       |          |      |     extra     |           |     center   |
|       |          |      |     supplies  |   patient |     with     |
|       |          |      |     available |     needs |              |
|       |          |      |               |           |    situation |
|       |          |      |               | 3         |     and      |
|       |          |      |               | .  Assess |              |
|       |          |      |               |           |   assessment |
|       |          |      |               |    backup |              |
|       |          |      |               |           |              |
|       |          |      |               |    levels |              |
|       |          |      |               |     of    |              |
|       |          |      |               |           |              |
|       |          |      |               | available |              |
|       |          |      |               |     gases |              |
|       |          |      |               |     in    |              |
|       |          |      |               |           |              |
|       |          |      |               | cylinders |              |
+-------+----------+------+---------------+-----------+--------------+
| **16. | *Co      | SPD, | 1.  Discuss   | Verify    | 1.  Contact  |
| Me    | mpressed | Faci |     air pump  | extent of |     SPD      |
| dical | air      | lity |     needs     | failure;  |     (with    |
| Air** | operated | Engi |     with SPD  | check     |     runners  |
|       | devices  | neer |     and       | alarm     |     if       |
|       | unava    | ing, |     provide   | panel     |     needed)  |
|       | ilable.* | Mate |     location  |           |     for air  |
|       |          | riel |     for       | 1         |     pumps    |
|       |          | M    |     storage.  | .  Assess |              |
|       |          | gmt. |               |           | 2.  Contact  |
|       |          | and  | 2.  Insure    |    actual |     command  |
|       |          | An   |     proper    |           |     center   |
|       |          | esth |     fittings  |   patient |     with     |
|       |          | esia |     available |     needs |              |
|       |          |      |               |           |    situation |
|       |          |      |               | 2         |     and      |
|       |          |      |               | .  Assess |              |
|       |          |      |               |           |   assessment |
|       |          |      |               |    backup |              |
|       |          |      |               |           |              |
|       |          |      |               |    levels |              |
|       |          |      |               |     of    |              |
|       |          |      |               |           |              |
|       |          |      |               | available |              |
|       |          |      |               |     gases |              |
|       |          |      |               |     in    |              |
|       |          |      |               |           |              |
|       |          |      |               | cylinders |              |
+-------+----------+------+---------------+-----------+--------------+
| **17. | *Unable  | SPD, | 1.  Discuss   | 1         | 1.  Contact  |
| Ce    | to       | Faci |     portable  | .  Verify |     SPD      |
| ntral | continue | lity |     suction   |           |     (with    |
| Vac   | suc      | Engi |     pump      |    extent |     runners  |
| uum** | tioning/ | neer |     needs and |     of    |     if       |
|       | draining | ing, |               |           |     needed)  |
|       | of       | Mate |  availability |  failure; |     for      |
|       | patients | riel |     with SPD  |     check |     suction  |
|       | and      | M    |               |     alarm |     pumps    |
|       | suction- | gmt, | 2.  Insure    |     panel |              |
|       | operated | and  |               |           | 2.  Contact  |
|       | devices  | An   |    large-bore | 2         |     command  |
|       | inop     | esth |     and large | .  Assess |     center   |
|       | erable.* | esia |     volume    |           |     with     |
|       |          |      |     syringes  |    actual |              |
|       |          |      |     (with     |           |    situation |
|       |          |      |     tubing)   |   patient |     and      |
|       |          |      |     are       |     needs |              |
|       |          |      |     stocked   |           |   assessment |
|       |          |      |               | 3         |              |
|       |          |      |               | .  Assess |              |
|       |          |      |               |           |              |
|       |          |      |               |    backup |              |
|       |          |      |               |           |              |
|       |          |      |               |    levels |              |
|       |          |      |               |     of    |              |
|       |          |      |               |           |              |
|       |          |      |               | available |              |
|       |          |      |               |     gases |              |
|       |          |      |               |     in    |              |
|       |          |      |               |           |              |
|       |          |      |               | cylinders |              |
+-------+----------+------+---------------+-----------+--------------+
| **18. | *Unable  | Ane  | 1.  Provide   | 1         | 1.  Contact  |
| Ce    | to       | sthe |     location  | .  Verify |              |
| ntral | continue | sia, |     for       |           |   anesthesia |
| Ni    | s        | Engi |     backup    |    extent |     (with    |
| trous | urgery.* | neer |     nitrous   |     of    |     runners  |
| Ox    |          | ing, |     oxide     |           |     if       |
| ide** |          | Mate |               |  failure; |     needed); |
|       |          | riel |    cylinders. |     check |              |
|       |          | M    |     Discuss   |     alarm |    establish |
|       |          | gmt. |     stock     |     panel |     sm       |
|       |          |      |     level     |           | all-cylinder |
|       |          |      |     with      | 2         |     therapy  |
|       |          |      |               | .  Assess |              |
|       |          |      |    anesthesia |           | 2.  Contact  |
|       |          |      |               |    actual |     command  |
|       |          |      | 2.  Insure    |           |     center   |
|       |          |      |     extra     |   patient |     with     |
|       |          |      |     supplies  |     needs |              |
|       |          |      |     available |           |    situation |
|       |          |      |               | 3         |     and      |
|       |          |      |               | .  Assess |              |
|       |          |      |               |           |   assessment |
|       |          |      |               |    backup |              |
|       |          |      |               |           |              |
|       |          |      |               |    levels |              |
|       |          |      |               |     of    |              |
|       |          |      |               |           |              |
|       |          |      |               | available |              |
|       |          |      |               |     gases |              |
|       |          |      |               |     in    |              |
|       |          |      |               |           |              |
|       |          |      |               | cylinders |              |
+-------+----------+------+---------------+-----------+--------------+
| **19. | *Cannot  | Bi   | 1.  Obtain    | 1         | 1            |
| I.V.  | autom    | omed |     manual    | .  Assess | .  Institute |
| Pumps | atically | ical |     I.V. and  |           |              |
| or    | infuse   | Eng  |     blood     | situation |  appropriate |
| Blood | me       | inee |     a         |     and   |     manual   |
| Warm  | dication | ring | dministration |     type  |     i        |
| ers** | or       | and  |     sets and  |     of    | nterventions |
|       | provide  | SPD  |     provide   |     pumps |              |
|       | properly |      |               |           | 2.  Contact  |
|       | warmed   |      |    inservices |  affected |     SPD and  |
|       | blood.*  |      |               |           |              |
|       |          |      | 2.  Nursing   |           |   Biomedical |
|       |          |      |               |           |              |
|       |          |      |    competency |           |  Engineering |
|       |          |      |     training  |           |     for      |
|       |          |      |               |           |     support  |
+-------+----------+------+---------------+-----------+--------------+
| **20. | *Unable  | Bi   | 1.  Insure    | 1         | 1            |
| Monit | to make, | omed |     manual    | .  Assess | .  Institute |
| oring | display, | ical |     B.P.      |           |              |
| S     | or print | Eng  |     units,    | situation |  appropriate |
| ystem | out      | inee |               |     and   |     manual   |
| Fail  | vital    | ring | thermometers, |     type  |     i        |
| ure** | signs.   | and  |     etc. and  |     of    | nterventions |
|       | Alarms   | SPD  |     supplies  |     pumps |              |
|       | will not |      |     are       |           | 2.  Contact  |
|       | fu       |      |               |  affected |     SPD and  |
|       | nction.* |      |    available; |           |              |
|       |          |      |     provide   | 2.  Use   |   Biomedical |
|       |          |      |               |     defi  |              |
|       |          |      |    inservices | brillator |  Engineering |
|       |          |      |               |           |     for      |
|       |          |      | 2.  Insure    |   monitor |     support  |
|       |          |      |     forms are |     for   |              |
|       |          |      |     available |     ECG   |              |
|       |          |      |               |     if    |              |
|       |          |      |               |           |              |
|       |          |      |               | warranted |              |
+-------+----------+------+---------------+-----------+--------------+
| **21. | *I       | Bi   | 1.  Identify  | 1.  Check | 1.  Continue |
| D     | nability | omed |     alternate |     defi  |              |
| efibr | to       | ical |     brands    | brillator |  appropriate |
| illat | defi     | Eng  |     and       |     for   |     CPR      |
| ors** | brillate | inee |               |           |              |
|       | or       | ring |    locations; |    proper | 2.  Contact  |
|       | ca       | and  |     provide   |           |     SPD for  |
|       | rdiovert | SPD  |               | operation |     delivery |
|       | life-thr |      |    inservices |     on    |     of       |
|       | eatening |      |               |     test  |              |
|       | heart    |      | 2.  Provide   |     mode; |    alternate |
|       | con      |      |     ACLS      |           |     d        |
|       | ditions* |      |     refresher |    report | efibrillator |
|       |          |      |     training  |     any   |              |
|       |          |      |               |           | 3.  Contact  |
|       |          |      |               |  problems |     Biomed   |
|       |          |      |               |     to    |     for      |
|       |          |      |               |     B     |     support  |
|       |          |      |               | iomedical |              |
|       |          |      |               |     En    |              |
|       |          |      |               | gineering |              |
|       |          |      |               |     im    |              |
|       |          |      |               | mediately |              |
+-------+----------+------+---------------+-----------+--------------+
| **22. | *Cannot  | Bi   | 1.  Plan to   | 1.  Test  | 1.  Utilize  |
| Elec  | utilize  | omed |     revert to |     for   |     manual   |
| trosu | electro  | ical |     manual    |           |              |
| rgery | cautery* | Eng  |               |    proper |   techniques |
| Unit  |          | inee |   techniques; |           |     for      |
| Fail  |          | ring |     refresher | operation |     surgery  |
| ure** |          | and  |     training  |     on    |              |
|       |          | SPD  |               |     cut   | 2.  Delay    |
|       |          |      | 2.  Stock     |     and   |     cases if |
|       |          |      |     O.R.s     |     coag  |     possible |
|       |          |      |     with      |           |              |
|       |          |      |               |  settings | 3.  Notify   |
|       |          |      |    additional |     prior |     Biomed   |
|       |          |      |     supplies  |     to    |     for      |
|       |          |      |               |           |     support  |
|       |          |      | 3.  Locate    | beginning |     or       |
|       |          |      |     alternate |     cases |              |
|       |          |      |     brands    |           |    alternate |
|       |          |      |               |           |              |
|       |          |      |               |           |    equipment |
+-------+----------+------+---------------+-----------+--------------+
| **23. | *Unable  | Bi   | 1.  Review    | 1         | 1.  Begin    |
| Anest | to       | omed |     emergency | .  Insure |     shutdown |
| hesia | perform  | ical |     surgery   |     that  |     of case  |
| Ma    | or       | Eng  |     plans     |           |              |
| chine | continue | inee |     with      |   machine | 2.  Transfer |
| Fail  | to       | ring |     A         |     is    |     to       |
| ure** | perform  | and  | nesthesiology |           |     manual   |
|       | surgery* | Ane  |               |  properly |              |
|       |          | sthe | 2.  Locate    |           |  ventilation |
|       |          | sia; |     alternate | connected |     and      |
|       |          | Det  |     brands    |     and   |              |
|       |          | roit |               |     that  |   medication |
|       |          | Med  | 3.  Discuss   |           |     for      |
|       |          | ical |     alternate |    tanks, |              |
|       |          | Ce   |     surgery   |     va    |   continuity |
|       |          | nter |     locations | porizers, |     of       |
|       |          |      |     with DMC  |     etc.  |              |
|       |          |      |               |     are   |   anesthesia |
|       |          |      |               |     full  |     level    |
|       |          |      |               |           |              |
|       |          |      |               | 2.        | 3.  Contact  |
|       |          |      |               |   Ability |     Biomed   |
|       |          |      |               |     to    |     for      |
|       |          |      |               |           |     support  |
|       |          |      |               |  continue |              |
|       |          |      |               |     the   |              |
|       |          |      |               |     case  |              |
+-------+----------+------+---------------+-----------+--------------+
| **24. | *Unable  | Bi   | 4.  Continue  | 3         | 1.  Cases in |
| Laser | to       | omed |               | .  Insure |     progress |
| Fa    | continue | ical |    procedures |           |     change   |
| ilure | laser    | Eng  |     with      | equipment |     to       |
| (In   | pro      | inee |     manual    |     is    |     manual   |
| traop | cedure.* | ring |               |           |              |
| erati |          |      |   techniques; |  properly |   techniques |
| ve)** |          |      |     refresher |           |     or begin |
|       |          |      |     training  | connected |     shutdown |
|       |          |      |               |     and   |     of       |
|       |          |      | 5.  Alternate |           |              |
|       |          |      |     brand if  |   enabled |    procedure |
|       |          |      |     available |           |              |
|       |          |      |               |    (keys, | 2.  Postpone |
|       |          |      |               |           |     elective |
|       |          |      |               |    codes, |     cases    |
|       |          |      |               |     etc.) |              |
|       |          |      |               |           | 3.  Contact  |
|       |          |      |               | 4.        |     Biomed   |
|       |          |      |               |   Ability |     for      |
|       |          |      |               |     to    |     support  |
|       |          |      |               |           |              |
|       |          |      |               |   perform |              |
|       |          |      |               |     case  |              |
|       |          |      |               |     using |              |
|       |          |      |               |           |              |
|       |          |      |               |    manual |              |
|       |          |      |               |     t     |              |
|       |          |      |               | echniques |              |
+-------+----------+------+---------------+-----------+--------------+
| **    |          |      |               |           |              |
| 25.** |          |      |               |           |              |
+-------+----------+------+---------------+-----------+--------------+
| **    |          |      |               |           |              |
| 26.** |          |      |               |           |              |
+-------+----------+------+---------------+-----------+--------------+
| **    |          |      |               |           |              |
| 27.** |          |      |               |           |              |
+-------+----------+------+---------------+-----------+--------------+
| **    |          |      |               |           |              |
| 28.** |          |      |               |           |              |
+-------+----------+------+---------------+-----------+--------------+