This document serves as an addendum to our current Emergency Operations Plan, H.P. 22.30.Purpose:To summarize Pulaski Memorial Hospital’s preparedness plan to prevent, treat, and manage the CoronavirusCOVID-19 pandemic.Activation:PMH has activated the Emergency Operations Plan (EOP) and the Hospital Incident Command System (HICS).This plan will continue to be updated to include the most current information and guidelines available from theCDC (Centers for Disease Control) and the ISDH (Indiana State Department of Health).The PMH Emergency Operations Plan will coordinate all of PMH’s efforts and resources on the eminentdangers of the COVID-19 Pandemic to focus on the following: Protection of PMH Associates in the fight against the COVID-19 Pandemic. Prevent the spread of COVID-19. Treat patients who develop COVID-19. Manage the COVID-19 Pandemic process and its aftermath.PMH’s CEO, Tom Barry, FACHE, was affirmed by the PMH Board as the Incident Commander. The HICS isdesigned to be flexible enough to accommodate a traditional hospital disaster such as a tornado strike withcasualties as well as a pandemic. The traditional Incident Command Center will be more of a “virtual concept”rather than the tradition “location”. For PMH’s EOP the Incident Command Center will be the combinedfunctions of the COVID-19 Pandemic Medical Task Force (CPMTF) and the COVID-19 Pandemic Task Force(CPTF). In the event that the CEO is not able to function as the Incident Commander, then the combination ofthe President of the Medical Staff (Dr. Anderson), the CNO (Linda Webb) and the CAO (Peg Madsen) willfunction as the Incident Commander.Incident Command Staff: Safety Officer – Mark BoerPublic Information Officer – Brian LedleyLiaison Officer – Erin Bonnell, RNMedical/Tech Specialist – Dr. Daniel Anderson, Chief of StaffGeneral Staff: Operations Section Chief – Linda Webb, CNOPlanning Section Chief – Lyndsey Ball, RN, Infection PreventionistLogistics Section Chief – Jason KletzFinance/Administration Section Chief – Gregg MalottResponse:- The COVID-19 Pandemic Task Force (CPTF) was developed on March 5th, 2020.

The CPTF meets daily at 11:00 AM to discuss plans and procedure for the Hospital’s response to thepandemic. Guidance for the plans/procedures are obtained from the Indiana State Department of Health (ISDH) andthe Center for Disease Control and Prevention (CDC). Team members view updates from the ISDH regularly and report out progress of planning at the dailymeeting. The CPTF includes Brian Ledley, Director of Communications, Erin Bonnell, RN, EmergencyDepartment Nurse Manger and Emergency Preparedness, Jason Kletz, Laboratory Manager, Laura Doty,Executive Assistance, Mark Boer, Director of Plant Engineering, Vicki White, RN, Associate HealthNurse, Bryson Minix, Director Patient Access, George Ellis, Infection Control, Lyndsey Ball, RN,Clinical Nursing Manager and Infection Preventionist, Linda Webb, CNO, Margaret Dalphond, RN,Population Health Nurse, Peg Madsen, CAO, Tom Barry, CEO, and Will Fox, Vice President forClinical Operations.- The COVID-19 Medical Task Force (CPMTF) was developed on March 23rd, 2020 Physicians and Executive Team Members meet three days a week (Monday, Wednesday, Friday) todiscuss plans and procedures in regards to caring for patients that are suspected of COVID-19 and thosewho have tested positive for COVID-19. The CMPTF task force is comprised of:o Dr. Daniel Anderson - As the Presidents of the Medical Staff and Chief of Surgery, Dr.Anderson will serve as the Medical Director/Chairman of the CPMTF.o Dr. Clint Kauffman – As the Chief of Med/Surg and the Chief of OB, Dr. Kauffman will serveon the CPMTF and function as the Assistant Medical Director/Vice Chairman.o Dr. Brad Healton – As the Medical Director for the Emergency Department, Dr. Healton willserve on the CPMTF.o At certain times other physicians and nurse practitioners will be asked to attend and participateon the CPMTF.o Administrative members of the CPMTF include Tom Barry, CEO, Linda Webb, CNO, and PegMadsen, CAO, Kelly Ortman, RN, Med/Surg Nurse Manager, Laura Doty, Linda Powers, RN,Clinical Nursing Leader, Laura Doty, Executive Assistant The team’s focus is clinical management of COVID-19 outpatients, inpatients, ventilator allocation,end-of-life care, resource availability (medication, equipment, supplies, PPEs), staff and communityeducation (CDC & ISDH guidelines, and Critical Guidelines). Revised the admission process for inpatients and set up a process to review all surgery cases beforeposting to the schedule to avoid elective cases (CDC & ISDH guidelines).- PMH’s Emergency Operations Plan (EOP) was implemented on March 13th, 2020 Daily meeting minutes will serve as a resource for actions and implementations. Staff will utilize HICS forms as well to document activity.Emergency Operations Plan (EOP)Communication Strategies1. Pulaski County Health Department (PCHD) Incident Command Center.Erin Bonnell, ED and Preparedness Manager and Liaison Officer for Pulaski Memorial Hospital andBrian Ledley, Public Information Officer for PMH serve on this team. Brian also serves as the deputyPublic Information Officer for PCHD’s Incident Command.

2. Indiana Public Health Preparedness Districts – District 2 (Figure 1).Erin Bonnell participates in weekly calls that include hospital, health departments, EMS and firstresponders in the district.3. Reporting - Daily reporting to Indiana State Department of Health (ISDH) Emergency ManagementResource (EMResource) and Centers for Disease Control and Prevention (CDC) database, NationalHealthcare Safety Network (NHSN). The reporting consists of patient impact and hospital capacity,healthcare worker staffing and healthcare supply status. This information is used at a district, state, andfederal level for epidemiological surveillance and public health decisions for the COVID-19 pandemic.4. Internal Communicationsa. Brian Ledley continues to provide staff with frequent updates via e-mail.b. Other methods of communication continue through CPSI, social media, flyers, departmentalcommunications, and COVID-19 Dashboard (Figure 2).c. Tom Barry sent out communications to the Physicians and nurse practitioners on 4-9-20, and staffmemos on 4-3-20 and 4-13-20 (included in Tom’s Board Report)5. Community Communicationsa. As the Public Information Officer, Brian Ledley continues to provide communication to the publicvia social media posts, radio interviews, PMH’s website, newspaper ads/press releases, and signage.The focus has been on explaining the disease of COVID-19, self-care at home, when to seekcare/treatment, visitor restrictions, the importance of social distancing, cough etiquette - includingwearing a mask, and hand-hygiene.b. Virtual screening tool – IT staff developed a virtual screening tool for public use. Links to thescreening tool are available on the Hospital’s homepage and through Facebook. Initially, the toolwas used often by community, but we have seen a decrease in traffic since implementation,averaging 1-2 hits per day.c. A hotline was established to triage patient calls about COVID-19. The hotline continues to be active.It is manned 24/7.d. MOB Leadership, Infection Control, and Emergency Preparedness developed an Outpatient “Care atHome Packet” to provide information to patients who are tested for COVID-19. The “Care at HomePacket” is available in Spanish as well.6. Cooperative planning with other healthcare organizationsa. We have received response plans and treatment guidance from the following organizations:i. Parkview Healthii. South Bend Memorial (Beacon)iii. Franciscan Health Western Indiana (St. Elizabeth)b. Local Hospitals (Logansport, Woodlawn, Dukes) continue to meet via conference call on a weeklybasis.7. Technology managementa. Methods of communication regarding patient care include a secure texting platform (QLIQ).b. Two way radios are being used in the isolation area and screening area to communicate with staff asneeded.

c. COVID-19 Shared folder accessed by the COVID-19 Pandemic Task Force and the LeadershipTeam.d. iPads are being used for patient and family engagement in the hospital and tele-health in the MedicalOffice Building. These iPads are on loan from the Winamac Public Library and WinamacCommunity School.Managing Resources and Assets1.Personal Protective Equipment (PPE)A PPE Sub-committee was developed to assess the current inventory of PPEs (N95 masks, surgicalmasks, gloves, gowns, face shields, hair covering and shoe covering). In addition, the committee hasbeen focusing on implementing re-use and extended use guidelines provided by the CDC, sanitizationand sterilization of surgical and N95 masks, identifying needed supplies and alternative ways to procuresupplies. We continue to have a shortage of N95 small masks. Approximately 40 of our direct carestaff require a small mask. N95 masks must be individually fit tested and the solution to fit testcontinues to be in short supply.Each day Kevin Kennedy counts the PPE supplies and updates his inventory. This is then sentelectronically to George Ellis Jr. at work or home to be complied into a house wide PPE inventory.Each day the task force is able to see, in real time, the amount of PPE we have on hand, what is onorder, how much has been used and any restock that has occurred that day.2.DonationsWe have received many donations from the community for PPEs and we have many communityseamstresses making homemade masks. Individuals with 3D printers are making mask extenders.Tippy’s, Edward Jones, Bennett/Shepherd Insurance, Winamac Coil Spring have provided meals for thestaff.Good Oil – gas cardsAlliance Bank – gift cardsMcDonalds – coupons for free meals3.Equipmenta. Ventilators - Currently we have 3 transport ventilators. One is our ventilator and two are rented.We have ordered a new ventilator but it will not be shipped until June.b. Powered air purifying respirator (PAPR) We currently have four. We have ordered an additionalfour, however, no delivery date has been set.c. UV light oven for sanitizing surgical masks4.Supplies – ordereda. High-flow oxygen tubingb. Dial-a-flow IV tubingc. Various cardiopulmonary supplies – receivedd. Spacers for Metered Dose Inhaler (MDI) – received and re-orderede. Fit test solutionsf. Varies PPEsg. Glidescope – blade covers ordered – received

5.Pharmaceuticalsa. Inventory assessment of medication to manage patients on a ventilator.b. Developed treatment order set for COVID-19 patients.c. Increased stock of MDISafety and Security1.While PMH continues to serve our communities, plans have been implemented to ensure all patientscan continue receiving excellent healthcare in the safest way possible. Upon entry to the hospital,patients can sanitize their hands and are given a handmade cloth mask. All admission points now have aglass or Plexiglas barrier to protect the patient and staff member during the registration process. PMHcontinues in its dedication of serving patients who have either tested positive for or are suspected ofhaving COVID-19. Protocols have been developed to ensure high-quality patient care while limitingunnecessary exposure to other patients and staff. Department staffs have worked together to restrictpatients who are positive or suspected of having COVID-19, to as few locations in the hospital aspossible. Along with how to bring them into the hospital and return them to their vehicle if needed.2.Decontaminationa. Appropriate cleaning solution was made available to each department. Staff have been encouragedto increase cleaning frequency and as well as completing an end of shift cleaning of their work areaand all high-touch areas.b. Continue to use CDC recommendations for terminal cleaning after a patient has occupied an area.3.PPE Usea. PMH continues to focus on associate safety through education and the appropriate use of PPE.Associates are receiving updates on changes in CDC guidelines and new protocols to conserve PPE.Stress and mental health issues are being addressed through our EAP and Behavioral HealthTherapist, Catherine Dywan, LCSW. PMH realizes its greatest asset in this pandemic is a healthyand educated staff to meet the needs of our patients.4.Isolation capabilities – facilitya. Converted the Scope Room in Surgery into an airborne infection isolation room (AIIR) room forintubation of ED patients, since it has negative pressureb. Designated Room 36 on Med/Surg as the AIIR for intubation of inpatients.c. Designated Room 34 on Med/Surg as a backup negative air room for intubation of inpatients. Thisroom does not meet all the requirements for an AIIR, so it will be used as an emergency backuponly.d. The Scope Room, Room 36, and Room 34 are monitored daily to ensure functionality of thenegative pressure.e. Converted east hall of the Med/Surg area into an isolation area with temporary walls to allow for anante-area for donning and doffing PPEs.This area has a high-efficiency particulate air (HEPA) filtered, negative air machine pulling air outof the hallway to the outside. This area has two private rooms and two semi-private rooms availablefor COVID-19 positive patients and persons under investigation (PUI) for COVID-19 (Figure 3).The temporary soft wall system and negative air machine are monitored daily to assure properoperation.f. The Progressive Care areas will be used for COVID-19 positive or highly probably patients onventilators.g. Plexiglas barriers have been installed at the Admission’s desk (Figure 4) and at the North Judsonclinic.

5.Lockdown – limited access pointsa. Entry points into the hospital have been limited to four. All other entry points have been locked.Patients can enter through the Emergency entrance, the north entrance and the MOB entrance. Thenorth entrance is only open between 7:00 a.m. and 5:00 p.m.b. Staff enter through those locations and the south entrance.c. A disaster tent has been acquired from our county’s Emergency Management Agency to be utilizedas an outpatient treatment/specimen collection area for possible COVID-19 patients. The purpose ofthis tent/testing location is to reduce the chance of spread of the virus inside the hospital frompossible COVID-19 patients. (figure 6)Medical Office Building and Clinics1.2.3.Tele-health visits continue in the MOBOutpatient screening and testing continues in the MOBPatient groupings (cohorting) have been established in the MOB. Each patient category will be seen indesignated suites and at designated times. The following categories are:a. Acutely ill adults,b. Acutely ill children 2-18 years of age,c. Chronically ill or acutely injured children form 2-18 years of aged. Chronically ill or acutely injured adultse. Acutely ill children under 2 years of agef. Pregnant and newborn patient.Staff Roles and Responsibilities1. Responsibilities – Memos from Tom Barry – See Tom’s Board Report2. COVID-19 Crisis pay was set up to pay associates up to their FTE, even if hours are not worked. Hoursworked as overtime will be paid as compensatory time at 1.5 times their base pay.3. Staffing Sub-Committee was developed to address scheduling, COVID-19 pay, available staff,contingency (dooms day) staffing model, and cross training.4. Emotional support provided by our behavior health specialist.5. A virtual personnel pool was developed to identify available staff.6. Screening stations were set up at three entrances to screen all patients and associates for symptoms ofillness. One at the north entrance, one at the Emergency Department entrance and one at the MOB.7. Daily schedule for couriers to take laboratory specimens to Indianapolis has been established.8. Training and education – Many educational opportunities have been made available to staff via on-linemeans (HealthStream), in-servicing with demonstration and return demonstration and validations ofskills, drills, cross-training to other departments to accommodate our surge plan. We have participatedin weekly updates/webinars from ISDH, CDC, Indiana Hospital Association, to name a few.Utilities1. Medical gas system – Oxygen levels and ice build-up on the vaporizers are monitored daily. Once we getto a point of increased oxygen use, ice build-up on the outside tank vaporizers could be an issue.Clinical & Support Activities1. COVID-19 Medical Staff Task Force continues to meet at 8:00 a.m. Monday, Wednesday, and Friday.Members include: Dr. Anderson, Dr. Kauffman, Dr. Healton, Dr. Bejes, Tom Barry, Peg Madsen, LindaWebb and an inpatient representative (Linda Powers or Kelly Ortman). Topics discussed have included:a. Ventilator allocation/managementb. End-of-life care

c.d.e.f.g.h.i.j.k.l.m.n.o.p.Patient placementCode Blue protocolOutpatient testingMedication protocols and availabilityEquipment and suppliesStaffingInfection ControlPatient educationEMS protocolsEducation/trainingTreatment protocolsDischarge planningAmbulatory careResuming non-urgent/non-emergent elective services2. Testing – Continue to do daily testing for COVID-19 at PMH (Figure 5). We have seen improved turnaround times with LabCorp and ISDH. As of this writing, we have had two positive cases, one in PulaskiCounty and one in Starke County. Figure 5 only represents the tests performed at PMH. As of today(Monday, April 27th), we have performed 143 tests for COVID-19, we have 18 Pulaski County residentswho have tested positive and we have 19 tests awaiting results. In addition to the Pulaski Countyresidents, we have seen positive test results for one Starke County resident, one Cass County resident, andone clinical COVID diagnosis for a Cass County Resident. Of the 143 tests, roughly two-thirds have beenPulaski County residents with one-third coming from patients who live in surrounding counties.COVID-19 TESTS50454440353330252018151910530Week 1Mar 166Week 2Mar 23Week 3 Week 4 Apr Week 5 Apr Week 6Mar 30613April 20Figure 5.3. Scheduling – Staff scheduling has been adjusted to decrease staff cross over. Each department hasdeveloped a team concept to cover the department.4. Servicesa. Continue to put elective surgeries and services on hold.b. Developed action plans/procedures for the Emergency Department, Medical/Surgical Unit,Progressive Care Unit, Medical Office Building, Surgery, Rehab Services, Cardiac and PulmonaryRehab, Senior Care, OB, Oncology and outlying clinics and RHCs.5. Transfers – Working with Pulaski County EMS for COVID-19 transfers. They have modified oneambulance as a COVID-19 transport unit.

Infection Control1. Visitor restrictions along with visitor screening has been implemented. Every visitor is given a homemademask upon entry.2. All associates are wearing surgical masks to protect themselves and others.3. Social distancing measures has been set up in the lobbies, cafeteria, dining room, and at screening stations.4. Donning/doffing observations have been put into place to ensure proper technique of PPE use.5. Patient surveillance – the number of persons under investigation, testing and positive cases are monitoredon a daily basis.6. Associate surveillance – associates who are under quarantine are monitored on a daily basis.Continuity of Operations1. Waivers and funding opportunities – See Tom Barry’s ReportNew Medical Director for LaboratoryThe below message was sent to Jason Kletz, Laboratory Manager:As you may be aware, Dr. Christian’s last day will be May 8, 2020. Dr. Jonathan Konopinski will serve as the interimmedical director for your facility (CLIA#15D0359044). You will have 30 days to report this change to your accreditingagency.Please feel free to contact me if you have any questions or need any assistance in this process.

Apr 29, 2020 · Medical/Tech Specialist – Dr. Daniel Anderson, Chief of Staff . Clinical Nursing Manager and Infection Preventionist, Linda Webb, CNO, Margaret Dalphond, RN, . ED and Preparedness Manager and Liaison Officer for Pulaski Memorial Hospital and Brian Ledley, P