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1 MRSE Hospital Performance Measures
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1 MRSE Hospital Performance Measures
Organization
(Required)
Contact Name
(Required)
First
Last
Contact Email
(Required)
PM 14
Qualitative Questions for Activation and Notification
1. What positions were part of your incident management and/or incident support team during the exercise?
Incident Commander
Ops Section Chief
Planning Section Chief
Logistics section Chief
Finance
PIO
Safety Officer
Liaison Officer
Others
2. What positions were activated for this response?
Incident Commander
Ops Section Chief
Planning Section Chief
Logistics section Chief
Finance
PIO
Safety Officer
Liaison Officer
Others
3. How long did it take you to activate your team
(Required)
5 Minutes
10 Minutes
15 Minutes
20 Minutes
25 Minutes
30 Minutes
35 Minutes
40 Minutes
45 Minutes
50 Minutes
55 Minutes
60 Minutes
4. What were the barriers/issues experienced with notification/activation/mobilization?
(Required)
PM 16
How many of these pre-identified critical required PERSONNELL category types were met by your facility to manage patient surge?
Critical Care Physicians
(Required)
N/A
Yes
No
Critical Care Nurses
(Required)
N/A
Yes
No
Advanced Practice Nurses
(Required)
N/A
Yes
No
Physicians Assistants
(Required)
N/A
Yes
No
Respiratory Therapists
(Required)
N/A
Yes
No
Pharmacists
(Required)
N/A
Yes
No
Dieticians, Physiotherapists, and Occupational Therapists
(Required)
N/A
Yes
No
Mental Health Clinicians, Social Workers, Chaplaincy, and Clinical Ethicists
(Required)
N/A
Yes
No
Trauma, Emergency Department, and Perioperative Services
(Required)
N/A
Yes
No
Pediatrics, Neonatal, and Obstetric Services
(Required)
N/A
Yes
No
Laboratory and Diagnostic Imaging Services
(Required)
N/A
Yes
No
Environmental Services Staff
(Required)
N/A
Yes
No
Clinical Supply Staff
(Required)
N/A
Yes
No
Sterile Processing Technicians
(Required)
N/A
Yes
No
Facilities and Information Technology
(Required)
N/A
Yes
No
Security
(Required)
N/A
Yes
No
Admin and Finance
(Required)
N/A
Yes
No
Other personnel (describe below)
(Required)
N/A
Yes
No
Other personnel
PM 17
How many of these, critical required RECEIVING FACILITY BED TYPES did your facility meet to manage patient surge?
Emergency department beds
(Required)
N/A
Yes
No
General Medical/Surgical or General Inpatient
(Required)
N/A
Yes
No
ICU beds (SICU, MICU, CCU)
(Required)
N/A
Yes
No
Post critical care (monitored/stepdown) beds
(Required)
N/A
Yes
No
Surgical unit beds (pre-op, post-op, and procedural)
(Required)
N/A
Yes
No
General pediatric unit beds
(Required)
N/A
Yes
No
Pediatric ICU beds
(Required)
N/A
Yes
No
Urgent care beds
(Required)
N/A
Yes
No
PM 17
How many of these Preidentified , Critical RECEIVING FACILITY PHARMACEUTICAL types did your facility meet to manage patient surge?
Analgesia and sedation medications (oral and injectable)
(Required)
N/A
Yes
No
Anesthesia medications
(Required)
N/A
Yes
No
Antibiotics (oral and injectable)
(Required)
N/A
Yes
No
Blood products
(Required)
N/A
Yes
No
Intravenous fluids
(Required)
N/A
Yes
No
Oxygen
(Required)
N/A
Yes
No
Other pharmaceuticals (describe below)
(Required)
N/A
Yes
No
Other pharmaceuticals
PM 17
How many of the preidentified, critical MEDICAL SUPPLIES AND EQUIPMENT types did your facility meet to manage patient surge?
Infusion pumps
(Required)
N/A
Yes
No
Ventilators
(Required)
N/A
Yes
No
Bedside monitors
(Required)
N/A
Yes
No
Airway suction (adult and pediatric)
(Required)
N/A
Yes
No
Surgical equipment and supplies
(Required)
N/A
Yes
No
Supplies needed to administer pharmaceuticals, blood products, and IV fluids
(Required)
N/A
Yes
No
PM 18
Qualitative Questions related to Resource Coordination
4a. Based on bed availability within the healthcare coalition, did you have sufficient bed resources for your patients or were you required to go outside of the healthcare coalition?
(Required)
Yes
Outside HCC
N/A
4b. If you had to go outside of the coalition, what beds did you have to look for?
5. Were there any bed types that you were not able to find during the exercise?
(Required)
7. Were you able to reach and successfully communicate effectively with the appropriate persons at each facility?
(Required)
N/A
Yes
No
8. Were you able to reach and communicate effectively with persons in EMS?
(Required)
N/A
Yes
No
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