Acute Care 21: Mobilization Checklist
Multiple systems are frequently affected by a single event. (Select from categories and response plans based on incident type.)
Advisory
Communicate special warnings and other important, but routine messages.
Notify appropriate team(s)/group(s) by pager, email, text message, or overhead paging.
________________________, ______________________, __________________
Alert
An incident is imminent, in
progress, or
has taken place; All Hazards Response Plan
activation is under
consideration.
Inform personnel of appropriate measures to prepare for All Hazards Response Plan activation.
Set up an Incident Management Post at: _______________________________________
Key Initial Details
Number Injured _______ Patient Census _______ Surge Capacity _____________
Need for partial evacuation: Unit evacuated _______ to ______________________
Essential Resources: _________________________________________________
Safety and Security—Safety Officer and Security Control at incident location.
Facility Management—power, electrical, gas, sewer, damage assessment.
Facility supplies/material management
Communications systems, including internal and external communications.
Estimate likely duration: ________________________________________________
Staff hold-over and call back: ____________________________________________
Determine potential secondary adverse events and impacts: ____________________
____________________________________________________________________
Alternate Care Sites: __________________________________________________
Activation
Intermediate Activation
Level 1: Resources/supplies present are adequate to handle the emergency.
Level 2: Limited additional resources and supplies from hospital or outside agencies need to be mobilized to adequately manage the emergency.
Full Activation
Level 3: All available resources within hospital and from outside are needed to manage the Emergency Incident-Disaster.
Key Positions for Assuming Initial Incident Command
Person elected to serve as Incident Commander: ___________________________
| House Nursing Supervisor Contacted | _____Yes | _____No |
| Security Supervisor Contacted | _____Yes | _____No |
| Safety Officer Contacted | _____Yes | _____No |
| On-Duty ED Staff Physician Contacted | _____Yes | _____No |
Query Incident Commander as to whom to notify for Levels 1 and 2 Emergency Responses or Alerts:
| On-Call Medical Center Administrator | _____Yes | _____No |
| Chief Nursing | _____Yes | _____No |
| On-Call Medical Chief of Staff | _____Yes | _____No |
| Public Affairs Officer | _____Yes | _____No |
| Chief Engineering/Facility Management | _____Yes | _____No |
| Chief Procurement/Materials Management | _____Yes | _____No |
| Other individuals, teams, or groups | _____Yes | _____No |
1 ____________________ 2 ____________________ 3 ____________________
Key contacts listed will be notified automatically on all Internal/External Alert Oranges (alert for Emergency Incident-Disaster) and all Level 3 Emergency Responses to Alerts.
Demobilization
The facility will begin transitioning back to lower levels of activation of the All Hazards Response Plan. The Incident Commander position should remain open until demobilization is completed and continue operating into the recovery phase. The planning section should plan for demobilization in advance, if possible.
Recovery
The goal is to restore essential services and resume normal operations as quickly and safely as possible. Returning to normal operations as quickly as possible is essential for financial survival. Remember, the resources and time necessary to recover adequately from an incident are often underestimated.
Determine who will direct recovery operations as well as procedures for initiating recovery operations (such as how, when, and by whom the recovery phase is to be activated).