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Hospital Assessment and Recovery Guide

Public Health Emergency Preparedness

This resource was part of AHRQ's Public Health Emergency Preparedness (PHEP) program, which was discontinued on June 30, 2011, in a realignment of Federal efforts.

This information is for reference purposes only. It was current when produced and may now be outdated. Archive material is no longer maintained, and some links may not work. Persons with disabilities having difficulty accessing this information should contact us at: https://info.ahrq.gov. Let us know the nature of the problem, the Web address of what you want, and your contact information.

Please go to www.ahrq.gov for current information.

Hospital Assessment Assignments (continued)

BIOMED

Note: Do not dispose of unsalvageable equipment. Everything must be inventoried and evaluated for insurance purposes.

___ First: Unplug all medical equipment to protect against possible power surges when power is restored and power testing occurs. Coordinate with FACILITIES around power restoration.

Work with the MEDICAL team to return and reconfigure medical equipment that was moved or disconnected during the emergency event. Notes:

 

 

 

 

 

Identify any medical equipment that is missing. Alert MATERIALS team so they can have these returned or replaced.

Test functionality of all medical equipment throughout the hospital, and make needed repairs (except for equipment that is not normally maintained by biomedical engineering such as the MRI scanner, laboratory instruments, physical therapy equipment, cell savers, apheresis instruments). Notes:

 

 

 

 

 

Determine what equipment is damaged beyond repair and will need to be replaced. Work with MATERIALS team to contact vendors. Notes:

 

 

 

 

 

Determine what specialized equipment needs to be inspected and recertified by vendors prior to use (e.g., anesthesia machines)? Names of vendors:

 

 

 

 

Have vendors check the structural integrity of booms holding all mounted medical equipment. Locations of mounted equipment and names of vendors:

 

 

 

 

Test functionality of autoclaves and sterilization equipment. (Note: Prior to testing autoclaves, ensure that they have been properly cleared of any biomedical contamination that may have been left behind during the evacuation.) Notes:

 

 

 

 

 

Inventory existing usable cables and lines for connecting monitors and equipment to patients (such as spo2 probes); work with MATERIALS team to reorder needed items. Notes:

 

 

 

 

 

Other observations regarding medical equipment:

 

 

 

 

Estimated time to get medical equipment inspected and repaired:

 

 

 

Return to Contents

MEDICAL

General

Note: Do not dispose of unsalvageable equipment. Everything must be inventoried and evaluated for insurance purposes.

Work with ADMIN team and medical records/medical informatics to assure that all protected health information is secured. Determine if any laptops or desktop computers that may contain confidential information are missing. Ensure that all paper and electronic medical records are secured.

Inpatient Care

Work with the BIOMED team to identify missing or damaged medical equipment in inpatient care areas, including bedside monitors (blood pressure monitors, glucose monitors, etc.), ventilators, bronchoscopes.

Alert MATERIALS team about equipment that was sent with patients when they were evacuated. Notes:

 

 

 

 

 

Assist BIOMED team to return and reconfigure medical equipment that was moved or disconnected during the emergency event. Notes:

 

 

 

 

 

Work with BIOMED teams and vendors to ensure that any medical equipment and systems are functioning correctly.

Work with IT/COMM to identify missing or damaged computers or communications equipment. Notes:

 

 

 

 

 

Work with IT/COMM and vendors to ensure that any specialized computer and communications systems for inpatient care units are functioning correctly, including all unit computers and telephones/intercoms, etc. Notes:

 

 

 

 

 

Work with FACILITIES team to ensure that all gas and suction lines are working correctly. Notes:

 

 

 

 

 

Work with MATERIALS team create list of missing non-medical equipment (beds, commodes, televisions, phones, computers, etc.) and needed supplies, and create a resupply list. Notes:

 

 

 

 

 

Other observations regarding inpatient care areas:

 

 

 

Estimated time to get inpatient care areas fully up and running:

 

 

 

Intensive Care Units (ICUs)

Work with the BIOMED team to identify missing or damaged medical equipment in intensive care units including: point of care testing machines, smart pumps, blood gas machine, ventilators, bronchoscopes, echocardiogram machines, ultrasound machines, cardiac tear testing machines, etc.

Alert MATERIALS team about equipment that was sent with patients when they were evacuated. Notes:

 

 

 

 

 

Assist BIOMED team to return and reconfigure medical equipment that was moved or disconnected during the emergency event. Notes:

 

 

 

 

 

Work with BIOMED teams and vendors to ensure that any specialized medical equipment and systems are functioning correctly.

Work with MATERIALS team to inventory supplies and create a resupply list.

Work with IT/COMM to identify missing or damaged computers or communications equipment. Notes:

 

 

 

 

 

Work with IT/COMM and vendors to ensure that any specialized computer and communications systems for intensive care units are functioning correctly. This includes unit computers and telephones/intercoms, etc. Notes:

 

 

 

 

 

Work with FACILITIES team to ensure that all gas and suction lines are working correctly. Notes:

 

 

 

 

 

Other observations regarding intensive care areas:

 

 

 

Estimated time to get ICUs fully up and running:

 

 

 

Emergency Department (ED)

Work with the BIOMED team to identify missing or damaged medical equipment in ED including: portable monitors, portable x-ray machines, ventilators, bronchoscopes, etc.

Alert MATERIALS team about equipment that was sent with patients when they were evacuated. Notes:

 

 

 

 

 

Assist BIOMED team to return and reconfigure medical equipment that was moved or disconnected during the emergency event. Notes:

 

 

 

 

 

Work with BIOMED teams and vendors to ensure that any specialized medical equipment and systems are functioning correctly. Notes:

 

 

 

 

 

Work with IT/COMM to identify missing or damaged computers or communications equipment. Notes:

 

 

 

 

 

Work with IT/COMM and vendors to ensure that any specialized computer and communications systems for ED are functioning correctly. This includes unit computers and telephones/intercoms, etc. Notes:

 

 

 

 

 

Work with FACILITIES team to test decontamination units to determine if working properly. Notes:

 

 

 

 

 

Work with FACILITIES team to ensure that all gas and suction lines are working correctly. Notes:

 

 

 

 

 

Work with SAFETY team to test exterior doors/locks. Notes:

 

 

 

Work with BUILDING team to check ambulance bays, signage, and lighting. Notes:

 

 

 

Work with MATERIALS team to inventory supplies and create a resupply list.
Other observations regarding ED:

 

 

 

 

Estimated time to get ED fully up and running:

 

 

 

Operating Rooms (ORs)/Post-op/Post-anesthesia care unit (PACU)
Inpatient and outpatient

Work with the BIOMED team to identify missing or damaged medical equipment in OR and post-anesthesia recovery units, including portable monitors, portable x-ray machines, ventilators, bronchoscopes, etc.

Alert MATERIALS team about equipment that was sent with patients when they were evacuated. Notes:

 

 

 

 

 

Assist BIOMED team to return and reconfigure medical equipment that was moved or disconnected during the emergency event. Notes:

Work with BIOMED and vendors to ensure that any specialized electronic equipment and systems for ORs are functioning correctly, including:

  • Electronic monitors.
  • Anesthesia and heart-bypass machines.
  • Surgical equipment, including surgical microscopes.
  • Surgical video systems and equipment (scopes, cameras, displays).
  • Audio-recording systems.
  • Lights and equipment booms.
  • In-suite pathology and radiology.
  • Surgical autoclaves

Work with IT/COMM to identify missing or damaged computers or communications equipment. Notes:

 

 

 

 

 

Work with IT/COMM and vendors to ensure that any specialized computer and communications systems for OR and recovery are functioning correctly. This includes unit computers and telephones/intercoms, etc. Notes:

 

 

 

 

 

Work with FACILITIES team to ensure that all gas and suction lines are working correctly. Notes:

 

 

 

Work with MATERIALS team to inventory supplies and create resupply lists.

Other observations regarding ORs/post-op areas:

 

 

 

Estimated time to get ORs and post-op areas fully up and running:

 

 

 

Nuclear Medicine and Radiology
Inpatient and outpatient

Inventory areas throughout hospital that contain radioactive materials, especially radiation emission sources, to assure that none are missing. If there are any signs of vandalism or theft, or if any radioactive materials are missing, alert the SAFETY team immediately. Notes:

 

Have vendors inspect and repair/recalibrate/recertify equipment (e.g., CT scanner, PET scanner, x-ray machines) prior to use, if necessary.

  • If there was structural damage (in cases of earthquake or explosion) conduct 360o integrity test of lead lined rooms that contain radioactive equipment, material/solutions, or emission sources.
  • If hospital experienced extreme cold, check for cracks in sodium iodine crystals in handheld detectors.
  • If hospital experienced extreme heat, check for damage in crystal drone heads.

Work with the BIOMED team to identify missing or damaged medical equipment.

Work with BIOMED teams and vendors to ensure that any specialized medical equipment and systems are functioning correctly, including digital recording equipment. List of equipment and names of vendors:

 

 

 

Work with IT/COMM to identify missing or damaged computers or communications equipment. Notes:

 

 

 

 

 

Work with MATERIALS team to inventory supplies and create a resupply list.

If film radiography is used, ensure that stored films are undamaged and light boxes are functional.

 

Other observations regarding nuclear medicine and radiology areas:

 

 

 

Estimated time to get nuclear medicine and radiology up and running

 

Adult Respiratory Therapy
Inpatient and outpatient

Conduct an inventory of all ventilators and other medical equipment used in respiratory therapy (check things that may have been damaged or stolen, or may have gone with patients when they were evacuated).

___ Contact vendors as soon as possible to alert them if new ventilators will be needed. Name of vendors:

 

 

 

 

Work with MATERIALS team to determine if ventilators were sent out with patients when evacuating and, if so, where they went and if they can/should be retrieved. Notes:

 

 

 

Work with vendors to test condition and functionality of all ventilators and all other remaining respiratory therapy related medical equipment. Name of vendors:

 

 

 

Work with MATERIALS team to inventory supplies and create a resupply list.

 

Work with IT/COMM to identify missing or damaged computers or communications equipment. Notes:

 

 

 

Work with IT/COMM team and vendors to check that any specialized computer and communications systems for respiratory therapy are functioning correctly. Notes:

 

 

 

Other observations regarding adult respiratory therapy:

 

 

 

Estimated time to get respiratory therapy running again:

 

 

 

Outpatient Care Areas

This section refers to all outpatient care areas not already mentioned in this guide, including: clinics, urgent care, endoscopy, ob/gyn, chemotherapy, physical/occupational/speech therapies, etc.

Work with BIOMED team to identify missing or damaged medical equipment in outpatient care areas.

Work with BIOMED teams and vendors to ensure that any specialized medical equipment and systems are functioning correctly. Name of vendors:

 

 

 

Work with MATERIALS team to inventory supplies and create a resupply list.

Work with IT/COMM to identify missing or damaged computers or communications equipment. Notes:

 

 

 

Work with IT/COMM team and vendors to check that any specialized computer and communications systems for outpatient care are functioning correctly. Notes:

 

 

 

Other observations related to outpatient care:

 

 

 

Estimated time to get outpatient care areas up and running again:

 

 

 

 

Outpatient Dialysis/Apheresis

In addition to general outpatient care area assessment as outlined above:

Check that water lines for dialysis/apheresis machines are clear and tested for contaminants. Notes:

 

 

 

Have vendors check functioning of dialysis/apheresis machines. Names of vendors:

 

 

 

Estimated time to get outpatient dialysis/apheresis running again:

 

 

 

Return to Contents

ANCILLARY

General

Note: Do not dispose of unsalvageable equipment. Everything must be inventoried and evaluated for insurance purposes.

Pharmacy

Signs of damage/vandalism/theft/pests:

 

 

 

 

Note: Alert SAFETY team if any theft or vandalism is suspected (especially check secure areas [safe] containing controlled substances).

Identify drugs that should be disposed of due to exposure to heat/cold/humidity/water or because they have expired. Note: Prior to opening the hospital, all pharmaceuticals (e.g., vaccines) and biologicals will need to be approved for use by the appropriate governmental agency. Notes:

 

 

 

Determine if stored chemicals have been damaged or contaminated, and if they continue to be stored properly and according to accreditation/licensure requirements. Notes:

 

 

 

 

 

Determine if automated drug dispensing devices (e.g., Omnicells) throughout the hospital (if any) are missing or damaged, and whether contents should be disposed of. Work with vendors to make needed repairs. Notes and name of vendor:

 

 

 

 

Work with IT/COMM to identify missing or damaged computers or communications equipment. Notes:

 

 

 

 

 

Work with IT/COMM team and/or vendor to check that any specialized pharmacy computer and communications systems are functioning correctly, including interfaces with computerized physician order entry (CPOE), electronic medical record (EMR), and ePrescribing. Names of vendors:

 

 

 

 

Condition and functionality of any other pharmacy equipment, such as IV hoods:

 

 

 

 

Condition of sterile water and sterile products:

 

 

 

 

Work with MATERIALS team to inventory supplies and create a resupply list.

Other observations regarding pharmacy:

 

 

 

 

Estimated time to get pharmacy fully up and running again:

 

 

 

Morgue

___ First: Assure that any cadavers or tissues in the morgue when the hospital evacuated are still there. Identify any cadavers that were brought to the hospital while it was evacuated (e.g., by emergency responders). Contact the appropriate authorities (coroner or law enforcement) if any cadavers or tissues are lacking identification. If a temporary mass morgue was established in the hospital during the disaster, contact authorities and assist with relocation. Assure proper documentation of the location of all cadavers and tissues.

Signs of damage/vandalism/theft/pests:

 

 

 

 

Determine if stored chemicals have been damaged or contaminated, and if they continue to be stored properly and according to accreditation/licensure requirements.

Work with BIOMED team to identify and missing or damaged medical equipment in the morgue, including pathology and forensics equipment.

Work with BIOMED or vendors to test all equipment and repair, recalibrate, and recertify as needed. Names of vendors:

 

 

 

Work with IT/COMM to identify missing or damaged computers or communications equipment. Notes:

 

 

 

 

 

Check that any specialized computer and communications systems are functioning correctly. Work with IT/COMM team and/or program/system vendors to make needed repairs. Names of vendors:

 

 

 

 

Determine additional repairs/replacements needed prior to recertification. Notes:

 

 

 

 

 

Work with MATERIALS team to inventory supplies and create a resupply list.

Other observations regarding the morgue:

 

 

 

Estimated time to get morgue up and running:

 

 

 

Advanced diagnostic Technologies
(Non-Radiation Emitting—MRI/Ultrasound)

Signs of damage/vandalism/theft/pests:

 

 

 

 

Test all equipment, and work with program/system vendors to repair, recalibrate, and recertify equipment as needed. Names of vendors:

 

 

 

 

Work with IT/COMM to identify missing or damaged computers or communications equipment. Notes:

 

 

 

 

 

Check that any specialized computer and communications systems are functioning correctly. Work with IT/COMM team and/or program/system vendors to make needed repairs. Names of vendors:

 

 

 

 

Have vendors check if the structures around and beneath major technology installations were damaged (e.g., the floor beneath the MRI unit) or if major equipment must be replaced determine if additional building reconstruction is needed before installation.

Work with MATERIALS team to inventory supplies and create a resupply list.

Other observations regarding advanced diagnostic technologies:

 

 

 

 

Estimated time to get advanced diagnostic technologies up and running:

 

 

 

Blood Bank and Tissue Bank

The term "blood bank" here includes blood collection, blood testing, and blood product production as well as transfusion medicine. Some hospitals may separate these functions and will therefore need to adapt their assessments accordingly.

___ First: If any samples were left behind that may pose a biohazard, ensure that areas have been properly decontaminated.

Signs of damage/vandalism/theft/pests:

 

 

 

 

Determine if blood and biologicals left in freezers/refrigerators were maintained at safe temperatures and if they were exposed to flood water or other contamination. Notes:

 

 

 

 

 

Test low temp freezers (-65 degrees C) and ensure that liquid oxygen flow is functional.

Test backup power supply and temperature recording monitors of all applicable equipment.

Inventory equipment to identify missing or damaged items, and identify needed repairs/replacements.

Test all equipment, and work with program/system vendors to repair, recalibrate, and recertify equipment as needed. Name of vendors:

Work with IT/COMM to identify missing or damaged computers or communications equipment. Notes:

 

 

 

 

 

Check that any specialized computer and communications systems are functioning correctly. Work with IT/COMM team and/or program/system vendors to make needed repairs. Names of vendors:

 

 

 

 

Determine additional repairs/replacements needed prior to recertification. Notes:

 

 

 

 

 

Alert Medical Records/Medical Informatics if any laptops or other systems that contain confidential patient or employee information are missing (e.g., lab results, research subject databases).

Work with MATERIALS team to inventory supplies and create a resupply list.

Other observations regarding blood and tissue banks:

 

 

 

 

Estimated time to get blood bank and tissue bank up and running:

 

Medical Records/Medical Informatics

Determine if any laptops or other systems that contain confidential patient information are missing (e.g., research subject databases).

Test functionality of EMR, electronic patient registry, admissions, CPOE, pharmacy systems, and all other online hospital systems. (This may include checking separate, or non-integrated, systems in the emergency department, clinical labs, or other patient care areas). Test all interfaces between EMR and other systems (e.g., lab, pharmacy). Notes:

 

 

 

 

 

If offsite or vendor backup was used, restore databases. Names of vendors:

 

 

 

 

Determine if "original" paper medical records were damaged or destroyed during hospital closure, or sent with patients; if there are no backups, work with legal department to address requirements for record retention. Notes:

 

 

 

 

 

Other observations regarding medical records/medical informatics:

Estimate time to secure paper records and get electronic records systems up and running:

Clinical Laboratories/Pathology

___ First: If any samples were left behind that may pose a biohazard, ensure that areas are properly decontaminated.

Determine if samples or biologicals left in freezers/refrigerators were continuously maintained at safe temperatures and if they were exposed to flood water or other contamination. (For example, if the hospital conducts fertility treatment, check whether freezer temperature control was maintained for sperm, ova, and embryos. Check the status of any other 'irreplaceable' specimens and biologicals such as cell lines engineered for individual patients). Notes:

 

 

 

Test low temp freezers (-65 degrees C), and ensure liquid oxygen flow is functional.

Test backup power supply and temperature recording monitors of all applicable equipment.

Determine if stored chemicals have been damaged or contaminated, and if they continue to be stored properly and according to accreditation/licensure requirements.

Inventory equipment to identify missing or damaged items, and identify necessary repairs or replacements.

Test all equipment, and work with program/system vendors to repair, recalibrate, and recertify equipment. Names of vendors:

 

 

 

 

Work with SAFETY team to inspect and test fire suppression system. Determine additional repairs/replacements needed prior to recertification. Notes:

 

 

 

 

 

Alert Medical Records/Medical Informatics if any laptops or other systems that contain confidential patient or employee information are missing (e.g., research subject databases).

Work with MATERIALS team to inventory supplies and create a resupply list.

Work with IT/COMM to identify missing or damaged computers or communications equipment. Notes:

 

 

 

 

 

Test functionality of specialized computer and communications systems. Work with IT and/or program/system vendors to make needed repairs, including interfaces with CPOE and EMR. Names of vendors:

 

 

 

 

Determine additional repairs/replacements needed prior to recertification.

Work with MATERIALS team to inventory supplies and create a resupply list.

Other observations regarding clinical labs/pathology:

 

 

 

 

Estimated time to get clinical labs/pathology up and running.

 

Research Laboratories

___ First: If any samples were left behind that may pose a biohazard, ensure that areas are properly decontaminated. Also, check that research animals that were euthanized prior to evacuation were properly disposed of. Check on the condition of any animals left behind alive. Notes:

Determine if samples or biologicals left in freezers/refrigerators were maintained at safe temperatures and if they were exposed to flood water or other contamination. Notes:

 

 

 

 

 

Test low temp freezers (-65 degrees C), and ensure liquid oxygen flow is functional.

Test backup power supply and temperature recording monitors of all applicable equipment.

Determine if stored chemicals have been damaged or contaminated, and if they continue to be stored properly and according to accreditation/licensure requirements.

Test all equipment, and work with program/system vendors to repair, recalibrate, and recertify equipment. Names of vendors:

 

 

 

 

Work with IT/COMM to identify missing or damaged computers or communications equipment. Notes:

 

 

 

 

 

Test functionality of specialized computer and communications systems (work with IT/COMM team and/or program/system vendors to make needed repairs). Names of vendors:

 

 

 

 

Alert Medical Records/Medical Informatics if any laptops or other systems that contain confidential patient are missing (e.g., research subject databases).

Work with SAFETY team to inspect and test fire suppression system.

Work with MATERIALS team to inventory supplies and create a resupply list.

Other observations regarding research labs:

 

 

 

 

Estimated time to get research labs up and running:

 

 

 

Return to Contents

MATERIALS

General

Note: Do not dispose of unsalvageable equipment. Everything must be inventoried and evaluated for insurance purposes.

Use pre-existing order lists of products and supplies for each area to inventory supplies and create resupply lists.

Identify any equipment and/or supplies currently in storage that can be used to replace missing or damaged items. Notes:

 

 

 

 

 

Ensure that the environmental staff has the chemicals and cleaning supplies needed to begin clean up.

Patient Care Areas

Patient Care Areas include: inpatient care, ED, ICUs, ORs and post-op, radiology/ nuclear medicine, respiratory therapy, outpatient care, other specialty services.

Inventory medical supplies in each patient care area to identify anything that should be discarded, can still be used, or needs to be ordered. Notes:

 

 

 

 

 

Inventory non-medical items not covered by the BIOMED team, such as televisions, remote controls, commodes, etc. Notes:

Condition of supplies in the sterile materials storage rooms:

 

 

 

 

Work with MEDICAL and BIOMED teams to determine what equipment was sent out with patients when evacuating (e.g., ventilators, portable monitors, beds, etc.) and where the equipment went. Contact those facilities to determine if equipment can/should be returned. Notes:

 

 

 

 

 

Work with BIOMED team to determine what medical equipment will need to be replaced. Contact Vendors immediately to alert them of potential order (consider prioritizing the largest equipment, or equipment that must be built to specifications, which will take longer to receive and/or install). Names of vendors to contact:

 

 

 

 

Estimated time to resupply patient care areas:

 

 

 

Ancillary Service Areas

Ancillary Service Areas include: pharmacy, morgue, non-radiation emitting imaging technologies, medical records/medical informatics, blood bank/tissue bank, clinical laboratories, and research laboratories.

In ancillary service areas that are normally supported by materials management, inventory equipment and supplies, and create a resupply list. Notes:

 

 

 

 

 

Estimated time to resupply ancillary service areas:

Administrative Offices

Inventory office equipment and supplies, and create a resupply list. Notes:

 

 

 

 

 

Estimated time to resupply administrative offices:

 

 

 

 

Support Service Areas

Support Service Areas include: kitchen, linens/housekeeping, and patient transport.

Inventory existing usable goods, and create a resupply list. Notes:

 

 

 

 

 

Work with SUPPORT team to inventory wheelchairs, walkers, and gurneys throughout the hospital; determine if any were sent elsewhere with patients during the evacuation and can be retrieved, and if any need to be replaced. Notes:

 

 

 

 

 

Estimated time to resupply support service areas:

 

 

 

On-site Stockpiles

Check condition of storage or onsite stockpiles to determine level of damage to equipment and goods. Notes:

 

 

 

 

 

Check the condition and remaining supply of hospital emergency related supplies that may have been depleted during the evacuation (e.g., patient transport stretchers, respirators, ventilators). Notes:

 

 

 

 

 

Check supply of backup batteries for ventilators and other medical equipment. Notes:

 

 

 

 

 

Check condition of outdoor decontamination units. Notes:

 

 

 

 

 

Estimated time to resupply necessary onsite inventory:

 

 

 

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