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Extreme Emergent Situation Policy

I. Purpose of Policy

To define the responsibilities specific to Graduate Medical Education (GME) following a Local Extreme Emergency Situation at the Dartmouth-Hitchcock (D-H) Lebanon Campus.

II. Policy Scope

The policy applies to all Residents participating in Accreditation Counsel for Graduate Medical Education (ACGME)-accredited programs at D-H.

III. Definitions

Resident: Any physician in an ACMGE-accredited graduate medical education program including residents and fellows.


Designated Institutional Official: The individual in a sponsoring institution who has the authority and responsibility for all of the ACGME-accredited Graduate Medical Education programs.


Local Extreme Situation: An event that affects Resident education or the work environment but does not rise to the level of an ACGME-declared disaster. An extreme emergent situation is localized to one sponsoring institution, a participating institution, or another clinical setting.


IV. Policy Statement

  1. Expectations of Residents During Local Extreme Situations
    • Decisions regarding a Resident’s involvement in Local Extreme Situations must take into account the following aspects of the multiple roles as student, physician, and employee:
      • The nature of the health care and clinical work that a Resident will be expected to deliver;
      • The Resident’s level of post-graduate education specifically regarding specialty preparedness;
      • Resident safety, considering the level of post-graduate training, associated professional judgment capacity, and the nature of the disaster at hand;
      • Board certification eligibility during or after a prolonged extreme emergent situation;
      • Self-limitations according to the Resident’s maturity to act under significant stress or even duress.

    • Residents with an advanced level of training and are fully licensed in the state of New Hampshire/Vermont may be able to provide care independent of supervision during a Local Extreme Situation. Residents will discuss scope of care with the Program Director, DIO or immediate Supervisor.

  2. Defined Responsibilities Concerning a Local Extreme Situation
    • D-H DIO
      • Serve as the point of contact for Program Directors.
      • Call the Executive Director, Institutional Review Committee (ED-IRC) if a Local Extreme Situation cause serious, extended disruption to Resident assignments, educational infrastructure or clinical operations that might affect D-H or any of its ACGME-accredited programs.
      • On behalf of D-H, the DIO will provide information to the ED-IRC regarding the Local Extreme Situation and status of the educational environment for its accredited programs resulting from the emergency.
      • At the ED-IRC’s request, the DIO will submit a written description of the disruption at the institution and provide details regarding activities undertaken in response. The DIO will provide updates as requested.
      • The DIO will receive electronic confirmation of this communication with the ED-IRC which will include copies to all Executive Directors of Review Committees (ED-RCs). The DIO will distribute this confirmation to D-H Program Directors.
      • The DIO will notify the ACGME when the Local Extreme Situation has been resolved.

    • Program Directors
      • Upon receipt of the electronic confirmation of the correspondence between the DIO and ED-IRC, Program Directors may contact the respective ED-RCs if necessary to discuss any specialty-specific concerns regarding interruptions to Resident education or effect on the educational environment.
      • Program Directors are expected to follow the institutional disaster policies regarding communication processes to update the DIO on the results of conversations with ED-RCs regarding program specific issues.

    • Other Responsibilities
      • The ED-IRC will alert ED-RCs when D-H reports a Local Extreme Situation. These communications will be included as interim correspondence in institutional and program files.
      • Program Directors from affected institutions may communicate directly regarding specialty-specific concerns once the Local Extreme Situation has been confirmed through the ED-IRC.
      • After communication between a Program Director and an ED-RC, the ED-RC will notify the ED-IRC if there is a perception of substantive institutional accreditation issues occurring within D-H during the event.
      • The ED-IRC will notify all ED-RCs when institutional Local Extreme Situation has been resolved.


D-H Policy ID: 11306

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