Welcome to ZZ Memorial Sloan-Kettering Cancer Center

X. PATIENT MANAGEMENT

Clinical Capabilities Monitoring
During an emergency, the Center continually assesses its capability to maintain clinical activities and provide other patient support functions. The Incident Commander will conduct a 96 hour- Sustainability Assessment (Appendix B-4) to make the determination to either maintain, curtail or discontinue select clinical and business operations. Strategies include discontinuation of elective treatment, evaluation of patients for movement to other units, release to home or transfer to other facilities as space is needed.

Evacuation
Evacuation of the Center is a method of last resort, and will only be implemented to preserve life and safety. In the event that part(s) or all of MSKCC's main campus need to be evacuated there are plans to facilitate orderly and safe evacuations. The main focus of these evacuation plans is the safety and well being of the Center's population of highly critical patients.

Patients will generally be assigned to beds in the following manner:

Patients will be sent to the closest, most appropriate bed where the level of care they require can be maintained.

Patients with higher acuity will be sent to closer facilities (reducing travel time, and expediting turn-around of advanced life support ambulances).

Patients with lower acuity – particularly ambulatory and wheelchair mobility – will be sent to more distant locations.

The transfer of patient information will be coordinated by the HICS Patient Tracking Officer.   In the event of information systems failure, manual/downtime  procedures for the transfer of critical patient information  are outlined  in the Evacuation Plan, Appendix C-7.

Alternate Care Sites/Surge Strategy
Pre-established alternate care/surge locations have been identified on campus that could be used as patient care space in the event the normal patient care space is rendered unusable for any reason. If necessary, the Center will coordinate with offsite and Regional locations, partner healthcare facilities and public health and safety agencies to establish off-campus alternate care site(s).

a. Priority will be given to using alternate areas on the campus.

b. Second level priority will be given to using space in other hospitals in the community.

c. Third level priority will be given to using other health care facilities such as nursing homes.

d. The lowest priority will be given to using public or commercial buildings due to the need for transporting an extensive array of equipment and a large number of staff to the site to enable use as a patient care space.

Rapid discharge processes will be implemented to reduce the amount of patient's requiring transfer and/or evacuation to alternate care sites.  The HICS Safety Officer will survey alternate care space to evaluate the environment of care for life safety.

Activate emergency transportation resources by notifying:

1. NYC-OEM
2. Greater New York Hospital Association
3. FDNY-Emergency Medical Services (EMS)
4. NYPH- EMS
5. Commercial ambulances services (Transcare/Senior Care/Assist/Hunter)
6. MSKCC Jitney resources (53rd Street Jitney)
7. Trans Express (633 3rd Ave Jitney)

Notify the appropriate suppliers to deliver immediately to designated facilities if alternate location is a non-traditional health care environment:

1. medical gas supplies
2. pharmaceutical and medical supplies
3. food and water
4. laundry/linens
5. Refrigeration truck for a temporary morgue (see Fatality Management Plan – Appendix C-8)

Protective Equipment, & Infection Safety, Staff Hygiene and Sanitation
1. The Safety Officer will determine the appropriate level of protection based on the nature of the incident and recommendations from Infection Control if applicable.

2. The HICS Sanitation Systems Unit Leader will coordinate with Infection Control and Safety to determine the proper methods for personal hygiene and sanitation based on the nature of the incident.

Psychological Support
The Memorial Sloan Kettering Cancer Center, Psychological Support Surge Plan, (Appendix C- 22) provides an effective, organized system to manage the consequences of emergencies and disasters which could impact patients and staff.   The strategies may include immediate crisis intervention, short term and long-term support for emotional needs.

Fatality Management
The MSKCC Fatality Management Plan (Appendix C-8) ensures a rapid, coordinated, and efficient response to a large number of deaths that would exceed MSKCC's morgue capacity. Such a situation may arise when an event such as a pandemic, generates a large number of decedents prompting the NYC Office of the Chief Medical Examiner (NYC-OCME) to activate its NYC OCME Mass Fatality plan which includes all area hospitals.

Patient Tracking
In the event of a patient influx to the UCC or patient transfers resulting from an emergency at NYPH, the Center will utilize established patient identification and electronic medical record processes for patient tracking.  In the event of an Information System Failure affecting those electronic processes staff will utilize standard downtime procedures.

In the event of emergency evacuation, patient tracking procedures will be implemented as outlined in the MSKCC Evacuation Plan (Appendix C-7) and coordinated with Department of Heath and Public Safety and EMS transportation agencies.

The HICS Patient Tracking Officer or Admissions Department designee will coordinate with the Patient Information Officer and Public Information Officer regarding the gathering and dissemination of patient information.

Disaster Privileges / Credentialing Volunteers
If additional healthcare professionals (non-employees) are required to meet emergency response needs, the granting of disaster privileges may be enacted by the Medical Staff Director for volunteer Physicians, PA's,  NPs, RNs and certain allied health professionals.   All volunteer health professionals will be identified using the MSKCC Security ID system and be assigned to the Labor Pool under the auspices of the Labor Pool Unit Leader.    The Disaster Privileges policy is located in Appendix A of this plan.

US Patent Numbers 7,720,998 B2, 7,836,207