Placer County Healthcare

Surge & Alternate Care Site Plan

 

March 7, 2008

Acknowledgements

Introduction & Background

SECTION I

Placer County Community Surge Plan

Hospital Surge Template

¨      DHS Licensing & Cert Temporary Permission for Increased Accommodations

SECTION II

Alternate Care Site Activation

¨      ACS Management Team Directory

¨      ACS Patient Charge Capture

¨      ACS Medical Record

¨      ACS Activation Checklist

SECTION III

ACS Staffing Plan

¨      Matrix for ACS Staffing Levels

SECTION IV

ACS Supply Plan

¨      ACS Equipment & Supply Matrix

SECTION V

ACS Security Plan

SECTION VI

Patient Movement Plan

¨      Patient Transportation Worksheet

APPENDICES

ACS HICS Organization Chart

ACS HICS Job Action Sheets

Command: IC

Command: PIO

Command: Liaison

Command: Security

Ops:  Operations Section Chief

Ops:  Staging Manager

Ops:  Medical Branch Director

Ops:  Infrastructure Branch Director

Ops:  Security Branch Director

Ops:  Hazmat Branch Director

Ops:  Business Continuity Branch Director

Planning:  Planning Section Chief

Planning:  Resources Unit Leader

Planning:  Situation Unit Leader

Planning:  Documentation Unit Leader

Planning:  Demobilization Unit Leader

Logistics:  Logistics Section Chief

Logistics:  Service Branch Director

Logistics:  Support Branch Director

Finance:  Finance Section Chief

Finance:  Time Unit Leader

Finance:  Procurement Unit Leader

Finance:  Compensation Unit Leader

Finance:  Cost Unit Leader

HICS Forms

hics 201- Incident Briefing

hics 202 - Incident Objectives

hics 203 - Organization Assignments

hics 204- Branch Assignments

hics 205- Incident Communications Log.

hics 206- Staff Medical Plan

hics 207- Organizational Chart

hics 213- Incident Message Form

hics 214- Operational Log

hics251-FacilityStatus

hics252-TimeSheet

hics253-VolunteerReg

hics254-PatientTracking

hics255-Evacuation

hics256-Procurement.

hics257-ResourceAccounting

hics258A-Staffing ResourceDirectory

hics258-ResourceDirectory

hics259-CasualtyReport

hics260-EvacuationTracking

hics261-SafetyAnalysis

OTHER FORMS

¨      Target ACS Facility Assessments

¨      SAMPLE MOU for Use of Facilities in the Event of a Mass Medical Emergency

¨      Medical Resource Request Form

¨      Placer County Healthcare MOU

 

 

COMPLETE PLACER SURGE / ACS MANUAL

PLACER SURGE / ACS MANUAL (Word)

 

 

 

 

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