Instruction Guide For Emergency Preparedness Plan Development

Transcription

1 Instruction Guide For Emergency Preparedness Plan Development This guide has been prepared as a reference tool to assist you in the development and implementation of a disaster procedure manual and an emergency preparedness plan for your specific facility. As long term care practitioners providing care for the frail elderly and persons with disabilities, we have a responsibility to our community to plan and prepare for emergency operations. Unfortunately, disasters, both man-made and natural, can impact long-term care facilities. Because long term care facilities may differ greatly in location, population, and structure, no single emergency management plan can be developed to fit all facilities. This guide, however, seeks to provide the framework for building your own individualized, comprehensive plan. Through proper instruction, preparation, and training for facility personnel in life safety, fire prevention, and disaster preparedness, the lives of the residents and co-workers may be saved and physical damage limited. Frequent drills and training will provide staff with a familiarity of emergency duties and actions to be taken. Disaster preparedness instructions should be incorporated into your current orientation training and be provided to all new employees during initial orientation. Refresher training should be provided for all staff on a routine basis. LNHA Emergency Preparedness Committee: Ron Goux - Chairman Mike Ford Vice Chairman Gwen Barringer Al Breaux Jeff Burch David Grotefend David Hargrave Tracy Hauver Mandy Henry Bob Laster Jack Sanders Delbert Wilbanks Joseph Donchess - LNHA Myron Chatelain LNHA Service Corporation LNHA Staff Joseph Donchess, Executive Director Mark Berger Lemmie Walker Lori Bond Julie Brady Dena Arnone Anne Shirley Acknowledgment Special acknowledgment is extended to the members and staff of the Florida Health Care Association Disaster Preparedness Committee who generously shared their time, knowledge, and expertise.

2 Introduction Hurricanes, flooding, wildfires and terrorism are examples of disasters that impact our lives. Louisiana has an exceptional risk rate for natural disasters. The importance of planning for a disaster becomes even more critical when we consider the number of long term care (LTC) facilities in Louisiana. It is essential that providers are ready to respond to a disaster that could endanger the lives and property of their residents, staff and facility. Studies demonstrate that preparation, knowing how to respond when a disaster strikes, and being calm and flexible saves lives and reduces physical damage. The time to prepare is now, before a crisis. This guide will help you in that process. Please use the Disaster Preparedness Guide as a reference tool. With this tool as your guide, we anticipate that you will be able to formulate or expand your individualized plan specific to the facility, residents, staff and community. The Louisiana Nursing Home Association (LNHA) Emergency Preparedness Committee and the LNHA Staff recommend this guide to supplement government provided disaster materials and education in order that you can best meet the needs of your residents and staff in times of crisis. What makes this guide different from parish or business disasters plans is that we deal with the unique problems that you may face as a long term care provider in a disaster situation. The frail nature of a nursing home patient or assisted living resident requires the adoption of specific emergency and disaster plans. 2

3 Table of Contents Louisiana Model Nursing Home Plan... 4 Steps to Follow to Complete Plan...5 Emergency Operations Plan... 6 I. Purpose Statement:... 6 II. Situation:... 7 A. Facility Description...7 B. Operational Considerations... 8 C. Hazards Analysis D. Assumptions III. Concept of Operations A. Preservation of life and safety B. Establish a command post C. In the event of a fast moving event D. Evacuation E. Return to the Facility IV. Organization and Responsibilities A. Organization and Staffing V. Administration and Logistics VI. Plan Development and Maintenance VII: Authentication VIII: Appendices 3

4 Louisiana Model Nursing Home Plan Emergency Operations of the (Facility) Dated Has been reviewed by the Parish Office of Emergency Preparedness Title Office of Emergency Preparedness Review Date 4

5 STEPS TO FOLLOW TO COMPLETE THE EMERGENCY PREPAREDNESS OPERATIONS PLAN 1. Complete, or work in concert with the Parish Office of Emergency Preparedness and Louisiana Department of Health and Hospitals (DHH) to complete the Model Nursing Home Emergency Operations Plan sent to you by LNHA (Per section VI, pp ) 2. Submit the completed plan to the Parish Office of Emergency Preparedness and DHH. Submit plan changes and revisions to the Parish OEP and DHH as they are made. 3. The State Fire Marshal s Office will review specifics of the plan as it relates to the Life Safety Code and other fire laws. 5

6 Name of Nursing Home Adult Congregate Living Facility Emergency Operations Plan I. Purpose Statement: The purpose of this plan is to describe the actions to be taken by the facility operator and facility staff in the event of an emergency or disaster that occurs at or otherwise threatens the lives or safety of the occupants. The key to effective emergency planning is flexibility, which is attained by contingency planning (i.e., consideration of all likely possibilities and development of options for action, which are effective under each possibility). The plan must compare disaster types and magnitudes with the potentially available resources in each given case, and present options for actions. 6

7 II. Situation: The situation is made-up of the physical location and characteristics of the facility and the people associated with it. Include the location, the neighborhood infrastructure, the number of people and type of clients, the facility staffing, the operational practices, and the natural and man-made hazards that are present. A. Facility Description 1. Number of buildings and floors, year and type of construction, well or city water, sewer or septic tank. Indicate location of smoke alarm/sprinkler system installed, and whether it is independent of public power. 2. Give the elevation of the lowest floor living space, geographical location and closest major street intersections. 3. Indicate whether the facility is located in a Flood Hazard Area or other designated evacuation area. 4. Attach as Appendix A a floor plan of the facility showing office, client, staff, utility spaces, locations of hazardous materials storage, and emergency exits. Include also a sketch map of the property with names of adjacent streets. 5. Show that the facility has auxiliary emergency power generator(s). Show whether the generator has the capacity to supply all the electric power to run the entire facility and all powered equipment. Indicate whether the generator is above the projected flood level. Show the location of a simple attachment point to which external generators could be connected if needed. Indicate whether the air conditioning and other critical utilities are above the flood level. Also, indicate how propane and/or diesel will be stored, where storage tanks are located, etc. 7

8 B. Operational Considerations In an emergency, the facility may be without telephone, electric power, or public water and sewer service. Utility outages may last for several days. The facility must be able to exist on its own for at least 72 hours, without outside assistance. Plans must provide for alternative sources of water, lighting, temperature control for medicines, waste disposal, etc. 1. Clients. Attach as Appendix B a current roster of clients, prior to June 1 st of each year. If the nursing home is threatened by an emergency, this list should be updated and sent to the local OEP regardless of the decision to evacuate or shelter-in-place. Specify room location and ambulatory condition. Include next of kin. Indicate whether clients have relatives or other persons who have agreed to recover or transport them, whenever called in an emergency. 2. Staff. Attach as Appendix C a list of live-in and non live-in, full and part time staff, prior to June 1 st of each year. If the nursing home is threatened by an emergency, this list should be updated and sent to the local OEP regardless of the decision to evacuate or shelter-in-place. Include name, address, and telephone/pager numbers of all personnel. Indicate where the official copy of the list will be posted. 3. Identify transport capabilities, including facility-owned and operated, routinely available on the premises, and non-owned resources contracted to provide transportation in an emergency. In the Concept of Operations section of the Plan, include the means of transporting all clients and support staff from the facility to a safe destination outside of the risk area. If staff-owned vehicles are to be used, attach Appendix D as a statement of agreement to this effect from each staff member involved. 4. Show how many days worth of non-perishable food means is always kept on hand for clients and staff. Include special diet requirements. There should be at least 3 days perishable and 7 days non-perishable at all times. 5. Identify medications stored at the facility, and note any special temperature or security requirements. 6. Indicate which staff members personal evacuation plan includes evacuating with the nursing home. 7. Indicate whether the facility has and uses a weather alert radio, or relies on local radio and television news and weather predictions and announcements. 8

9 8. Indicate whether the facility has lightning rods or other lightning protection devices installed. 9. Indicate addresses of administrative personnel that will monitor communications. List several alternate addresses. 10. Indicate cell phone numbers and home phone numbers of owners or management company personnel. 11. Indicate satellite phone numbers if available. 12. Consider methods to provide security should civil unrest occur that threatens the safety of patients and staff. 13. Indicate sources of volunteers that have agreed to offer assistance in loading and off-loading patients both on-site and at a host facility. 14. Identify the phone numbers of the local OEP for the host site in order to notify the local OEP at the host site of your pending arrival if a decision is made to evacuate. 9

10 C. Hazards Analysis It is vital to review the various types of disasters that are most likely to affect the facility. For example, a Gulf Coast facility will give primary emphasis to hurricane and flooding incidents, while a North Louisiana facility will plan primarily for tornados and winter storms. Indicate those hazards to which a Louisiana facility may be subject: 1. Tropical Storms, Hurricanes 2. Hailstorms 3. Winter Storms and Ice Storms 4. Tornadoes 5. Thunderstorms and Lightening 6. Floods 7. Epidemic Diseases 8. Drought and Extreme Summer Weather 9. Wildfires 10. Hazardous Materials 11. Terrorism, Bio-terrorism 10

11 D. Assumptions Assumptions are accepted as facts. As such, they will govern this plan. The following are considered to be generally necessary assumptions. The facility may have to exert more effort to meet assumptions. 1. Facility operators are responsible for their clients at all times in all emergencies and evacuations, government-ordered or otherwise. 2. The facility operator will continually update this plan to ensure that it reflects current operating circumstances, client characteristics, relevant hazards, and facility emergency resources. 3. Facility staff will perform as described in this plan. 4. Facilities shall develop mutual aid or other agreements as appropriate for care of evacuated clients. 5. In an emergency situation, hospitals may be able to admit only those who need life-saving treatment. 6. In an emergency situation, usual utilities and services could be available for 48 hours or less. 7. The time required to obtain a response from emergency services will increase in proportion to the severity, magnitude and nature of the emergency. 8. Local radio and TV stations will broadcast watches and warnings, and emergency public information provided to them by government authorities. 9. The projected or actual presence of several inches of floodwater in a facility is not necessarily a threat to life and does not in itself mandate that the facility be evacuated. 10. When the facility is evacuated to a host location outside the immediate area, the appropriate facility staff and staff families will accompany residents to the host location. 11. Evacuation of the facility may require special prearranged transportation agreements between the facility and contractors. 12. If the facility is sheltering in place, it must notify the local Office of Emergency Preparedness of this decision. 11

12 III. Concept of Operations This portion of the plan is used to describe what will be done and how it will be done in the event that an emergency occurs. A. Preservation of life and safety is dependent upon timely and full accomplishment of protective measures undertaken before, during, and after an emergency. 1. In preparation for the hazards facing the facility, precautionary actions are prudently required. They include, but are not limited to: a. Develop and maintain an emergency operations plan. Update it annually or more frequently as circumstances change. Ensure that all staff personnel are trained and tested in its use. Conduct fire drills at least once per shift per quarter and conduct separate tornado or hazardous materials in-place shelter exercises and hurricane or flooding evacuation exercises at least once a year. All new employees must be oriented on the emergency and disaster procedures and there must be continued education to current staff on preparedness plans. Send advance notice of annual practice exercises to the Parish Office of Emergency Preparedness. The Parish Office may be holding an exercise that would provide a vehicle for the facility exercise. b. Outfit the facility with sufficient emergency equipment and supplies to provide for at least 7 days survival without outside assistance. List the equipment and supplies to be stocked, such as emergency lighting, water storage containers, canned food, can openers, cooking and meal service supplies, sanitary supplies, first aid and medical treatment supplies, debris clearance and repair tools and supplies, etc. c. Since evacuation may be necessary, arrangements have been made to relocate facility. Clients and staff to (name of host facility(s) and location(s). Describe how facility staff will coordinate operations with staff at host location, if applicable. See Appendix E for signed agreements with host facility(s). Find a host facility(s) within the Parish or surrounding Parishes to take care of evacuations due to a fire at the facility or in the aftermath of a tornado, etc. (localized incidents). Evacuations caused by the threat of a catastrophic hurricane will require relocation to a host facility(s) outside of the risk area. Hospitals should be listed as host facilities only for category I patients, and there must be specific written agreements with the hospitals. 12

13 d. The administrator will compile a list of evacuation shelter sites for two types of events; local emergencies, and catastrophic emergencies. A local emergency is an emergency such as hazardous materials incident, a fire in the facility, or localized flooding, in which the nursing home s clients can be moved within the parish or to an adjoining parish. A catastrophic emergency is an emergency such as a hurricane or a parish-wide flood that is so wide spread that the entire parish must be evacuated outside the probable danger or risk area. (1.) Local Emergencies: Look for facilities in which clients can be kept for a short period and in which their condition can be maintained at as high a level as possible according to the following priority: (a) (b) (c) (d) (e) Hospitals; to be used only for Category I patients who require extensive care to maintain their current health status. An admit agreement must be prearranged and signed with the hospital, and must be updated annually. Nursing Homes owned by the same company: An inter-nursing home agreement must be signed by a corporate representative and the administrator of the accepting host home, and must be updated annually or when changes occur. Copies must be sent to the Parish OEP and DHH. Other nursing homes: An inter-nursing home agreement must be signed with the administrator of the accepting host home, and must be updated annually or when changes occur. Copies must be sent to the Parish OEP and DHH. Other types of congregate care facilities: An agreement must be signed with the administrator of the facility, and must be updated annually or when changes occur. Copies must be sent to the Parish OEP and DHH. Hotels, motels, and apartment buildings: An agreement must be signed with the host owner. The agreement must specify the conditions under which the nursing home can move its clients in, and must specify what will happen to the current lodgers when that happens. The agreement must be updated 13

14 annually or when changes occur. Copies must be sent to the Parish OEP and DHH. (f) (g) (h) Business facilities: A nursing home may be affiliated with a company that has facilities that could be converted into shelters in an emergency. If that option is to be used, the company must have the designated facility inspected by the Parish OEP or American Red Cross to determine what must be done to make it acceptable as a shelter. The company would get emergency power generators, cots, supplies, and other necessary provisions to outfit the contingency shelter, and make sure that everything that is needed is stored on site. Company personnel must be trained as shelter managers in approved shelter manager courses. Plans to accomplish this must be drawn up and sent to the Parish OEP and DHH. The facility must be inspected annually or when changes occur. Schools, churches, and other institutions: Facilities can be used for evacuees only in cases in which they are not already committed to being a public emergency shelter. An agreement must be signed with the person responsible for the facility, and must be updated annually or when changes occur. A copy of the agreement must be sent to the Parish OEP and DHH. Public Shelter: The public shelter is a last resort shelter. Conditions will be poor, and the health of clients may be endangered by the conditions. The nursing home administrator will report his failure to find other shelter to the Parish OEP and DHH and will provide the OEP a complete listing of the clients, and the staff, staff families, equipment, and supplies that will accompany the clients. The nursing home administrator will continue to look for other accommodations, and will report his or her success or failure to the Parish OEP and DHH annually. (2.) Catastrophic Emergencies: Many parishes in Louisiana are subject to catastrophic emergencies, such as hurricanes or widespread flooding that would require the evacuation of the entire parish, and relocation of the parish population to 14

15 a safe area. In South Louisiana, the safe area would be generally north of the I-10/I-12 highway. Nursing homes located in parishes that are subject to catastrophic emergencies will make arrangements to move out of the danger or risk area to safety. They will use the same criteria to select shelters listed in paragraph (1.) above. Nursing home administrators who are unsure about whether they are in a risk area will consult their Parish OEP for a determination of how far they would need to move their clients to be safe. e. Evacuation includes transportation and enroute support. Describe and document specific arrangements made for transporting clients and staff to host facilities. See Appendix F for signed transport agreements. 2. When warning is received that a specific hazardous event is expected, staff briefings are to be held, updated information obtained, external support services put on alert, and clients and their support requirements prepared. All employees will be alerted to the higher levels of preparedness as threatening weather or other potential hazards develop, and will review their functions and responsibilities for the hazard that is approaching. 3. The facility alert system will be activated. The following groups shall be put on the notification list: a. Internal Alert and Notification, including both on-duty and offduty personnel. b. External notification of host sites, including hospitals. c. Families of clients. d. External support services, including vendors, contractors, etc. e. Parish OEP where the host facility is located. f. Other organizations and individuals as appropriate. 4. During an unexpected event such as a tornado, plans and procedures must be specific to protect and monitor client condition throughout the emergency to the extent possible. 5. After the event has ended, recovery of public and on-site utilities and restoration of routine client services will be the first priority. The recovery period may be lengthy and require a large measure of selfreliance. 15

16 B. Establish a command post (CP) at a predesignated location in the facility suitable for the hazard, as severe weather or other hazards approach. Account for the location of all staff and clients and establish condition status according to preset procedures. C. In the event of a fast moving event, such as a tornado, a flash flood, or a hazardous materials incident, it may not be advisable to evacuate the facility. In that case, in-place sheltering will be used. Because hazardous materials incidents, tornados, and other like events can occur at any time of the day or night, the facility personnel shall be trained in the actions needed for in-place sheltering. The following considerations will apply: 1. Shelter In-Place, General: a. Make sure all clients and staff are inside. Monitor clients conditions. Assign at least one person per wing to ensure that it is done. b. Make sure all doors and windows are closed. Assign at least one person per wing to insure it is done. c. Close all air intake vents and units in bathrooms, kitchen, laundry, and other rooms. Turn off heating, cooling, and ventilation systems that take in outside air, both central and individual room units. Units that only recirculate inside air may have to be kept running during very cold or very hot weather to avoid harm to clients. d. Cover and protect food, water and medications from airborne contamination and from contact with waste materials, including infectious waste. e. Maintain contact with fire authorities regarding the hazard and internal conditions. Remain inside until notification of an All Clear. f. Obtain advice from public health authorities regarding the need for decontamination, and the means for doing it. g. Evaluate all clients, particularly those with respiratory problems, and provide oxygen or suitable assistance. h. Optimize security in and around facility to prevent disturbances from possible civil unrest in outside environment. 16

17 i. Notify the local Office of Emergency Preparedness of the decision to shelter in-place. 17

18 2. Shelter In-Place Tornado: 1. Move clients and staff to designated tornado shelter areas, or to small interior rooms and hallways, away from windows. Mattresses and blankets may be used to reduce injury from flying debris. 2. Remain in protective posture until declared safe by public authorities. 3. Assess injuries and damages suffered by clients, the facility, and utilities as soon as the tornado danger has passed. Compile injury and damage reports at the command post. 4. Optimize security in and around facility to prevent disturbances from possible civil unrest in outside environment 18

19 D. Evacuation 1. Give notice of the impeding evacuation to the local next of kin who have previously stated that they would recover the client and assume responsibility for their care in the event of an evacuation. 2. Review hurricane evacuation checklist, if applicable (See Appendix A). 3. Summon transport equipment and issue instructions to drivers. Assign any needed attendants, and load clients. Check with support organizations, fire and police departments for assistance in loading clients, equipment and supplies. 4. Describe arrangements for dispatching client medical records with evacuated clients. Send special foods and medications, in original containers, and other required support materials along with clients. Place identification armbands on each resident. Specify in a checklist as Appendix G what equipment and supplies are to accompany clients. Roads will be congested and traffic may move very slowly. Describe how clients will be fed and/or medicated enroute, should that become necessary. 5. Advise host sites and their local OEPs of estimated time of departure and arrival. 6. Advise the Parish Office of Emergency Preparedness of departure and destination in order to facilitate locator activities. 19

20 E. Return to the Facility 1. Contact the Parish Office of Emergency Prepardness to see if an All Clear has been issued for re-entry into the area, and all utilities have been restored. 2. Contact DHH for any instructions which must be complied with before returning. 3. Pre-determined staff personnel will be sent to the facility site to determine whether it is possible to return, and will prepare for the return. 20

21 IV. Organization and Responsibilities A. Organization and Staffing 1. Attached as Appendix H is an organization and staffing chart. It depicts functional responsibilities, organizational structure, and job titles, along with telephone numbers of staff personnel. Date the chart and keep it current. 2. Responsibilities of staff for implementation of the actions outlined in III. Concept of Operations are as follows: Someone, by job title, must have primary responsibility for every action covered in the Concept of Operations. Others may be given assistance roles. Some samples of responsibilities are provided as follows. Other positions, if applicable, should be added. a. Administrator (1) Brief all staff of their responsibilities in an emergency and maintain records of their briefings. (2) Implement the plan and supervise its execution. (3) Contract with and notify supporting agencies, evacuation hosts, and transport, food, and other service and material suppliers. (4) Notify the public officials (DHH and OEP) of evacuation decisions, destinations, and arrival, as facility official spokesperson. b. Charge Nurse (1) Develop and maintain client and staff status reports. (2) Prepare clients for the hazard concerned, whether in-place shelter or evacuation. (3) Supervise loading of clients, support staff, and any accompanying staff families into evacuation vehicles. Prepare vehicle manifests, and supervise preparation of care enroute. (4) Coordinate with dietary staff. 21

22 c. Food Service Supervisor (1) Arrange to have on hand foods that do not require refrigeration or cooking, for use in evacuation or in-place sheltering situations. (2) Supervise the packing for transport of foods, water and service supplies for use at host locations. (3) Provide ice and containers to preserve perishable foods and medicines in an evacuation. d. Maintenance Person (1) Develop procedures and provide for their implementation to secure the facility. Procure and keep on hand the needed supplies and equipment. (2) Secure utilities, tie down propane tanks, remove hazardous materials from the threat of floodwater, and secure anything that might be blown away in a high wind. (3) Close off all outside ventilation sources. 22

23 V. Administration and Logistics Appendix A: Appendix B: Appendix C: Appendix D: Appendix E: Appendix F: Appendix G: Appendix H: Appendix I: Appendix J: Appendix K: Appendix L: Appendix M: Appendix N: Facility floor plan and sketch map of area. Client roster with room location and ambulatory condition. Include names of next of kin. Indicate clients who have relatives or other persons who have agreed to recover them, when called, in an emergency. Staff roster, including live-in and non live-in, full and part time. Include name, address and telephone number. Transport agreements with staff members. Agreement with Host facilities. Agreements with evacuation transport services, dated and renewed annually. Include types of vehicles and indicate which clients, staff, equipment and supplies will go into each vehicle. Checklist of items to accompany clients, including medications and special foods. Include loading plan to indicate what goes in each vehicle. Organization and staffing chart, with responsibilities, job titles, and phone numbers of staff personnel. Telephone numbers of the emergency point of contact at the parent headquarters, if any, of this facility. List of emergency telephone numbers, such as law enforcement, fire, EMS, public works, utilities, fuels, evacuation host facility point of contact, Parish Office of Emergency Preparedness, host facility, Red Cross, etc. List of 24-hour telephone numbers for vendors of nursing supplies, dietary supplies, and pharmacy supplies. Resident census and conditions to be used for disaster evacuation planning form. Maps with evacuation routes highlighted. Transfer form authorizing admission of nursing facility resident into a hospital in time of emergency. 23

24 Appendix O: Hurricane evacuation checklist. 24

25 VI. Plan Development and Maintenance A. Development and maintenance of this plan in coordination with the Parish Office of Emergency Preparedness is the responsibility of the facility administrator. B. The supervisor of each functional area (e.g. administration, dietary, nursing, maintenance) is responsible for timely contributions to this plan and is to develop any Standard Operating Procedures needed in his or her functional area to ensure the effectiveness of this plan. C. The plan will be reviewed for possible shortcomings by the facility manager and supervisory personnel following every emergency and every emergency exercise. This will take place at least annually. D. All changes that affect external organizations will be coordinated with them, to mutual satisfaction. E. This plan and any revisions and changes shall be submitted to the Parish Office of Emergency Preparedness upon promulgation. A receipt will be used to verify delivery. The Office of Emergency Preparedness shall review the plan or any changes and advise the facility whether the plan has at least the minimum elements contained in the Louisiana Model Nursing Home Emergency Plan. If no notice is received within 60 days, the plan will be deemed to have been reviewed. 25

26 VII: Authentication This Emergency Operations Plan provides the operational procedures that this facility will follow during emergency events. This plan supersedes any previous emergency operations plans promulgated for this purpose. Facility Name Effective Date Facility Administrator s Signature 26

27 Appendix O HURRICANE EVACUATION CHECKLIST HURRICANE ENTERS GULF Contact vendors you have contracted with to provide assistance in emergencies: Transportation company Food vendor Water supplier Host sites Medical and Pharmacy Supplies Update Appendix B, client roster, Appendix L, Resident census and conditions. Update resident ID bracelets with facility contact information such as Administrator and DON cell phone numbers as well as family contact information. BEFORE PRECAUTIONARY EVACUATION IS IMMINENT Order emergency water supply. Order emergency food supply. Contact transportation company and convey intentions. Contract truck rental vendor, i.e., U-haul, Ryder. Order identification armbands for all residents Order Emergency Medical and Pharmacy Supplies THINGS YOU WILL NEED FOR EVACUATION Ramp to load residents on buses Medicine carts MAR (whole chart if possible) Clothing with their name on their bag Water supply for trip (long trip) Crash cart Emergency drug kit Bingo and/or other games Communication devices; cell phone, walkie talkie, weather radio, CB (bring all you have) Cigarettes Air mattresses or other bedding Facility checkbook Cash, including quarters (for vending machines, laundry machines, etc.) Important papers, i.e., insurance policies, titles to land and vehicles Computer backup tape, CD or USB Flash cards of patient records if electronic records are not available through software companies. List of important phone numbers/rolodex Contact information including cell phone numbers on next of kin for all residents 27

28 Emergency prep box (baggies, yarn, batteries, flashlights, duct tape, string, knife, hammer and nails, fix a flat, etc.) Non-perishable food items Dietary workers Disposable plates and utensils Diet cards Must include DNR and diabetic information stated for each resident on armbands. 28

29 Appendix E EVACUATION SHELTER SITES I. Selection General: The administrator will compile a list of evacuation shelter sites for two types of events; local emergencies, and catastrophic emergencies. A local emergency is an emergency such as a hazardous materials incident, a fire in the facility, or localized flooding, in which the nursing home s clients can be moved within the parish or to an adjoining parish. A catastrophic emergency is an emergency such as a hurricane or a parish-wide flood that is so wide spread that the entire parish must be evacuated outside the probable danger, or risk area. (1.) Local Emergencies: Look for facilities in which clients can be kept for a short period and in which their condition can be maintained at as high a level as possible according to the following priority: (a) (b) (c) (d) (e) Hospitals: to be used only for Category I patients who require extensive care to maintain their current health status. An admit agreement must be prearranged and signed with the hospital, and must be updated annually. Be aware that under existing emergency situations that the hospital may not admit your patients due to impending general population admission. Nursing homes owned by the same company: An inter-nursing home agreement must be signed by a corporate representative and the administrator of the accepting host home, and must be updated annually or when changes occur. Copies must be sent to the Parish OEP and DHH. Other nursing homes: An inter-nursing home agreement must be signed with the Administrator of the accepting host home, and must be updated annually or when changes occur. Copies must be sent to the Parish OEP and DHH. Other types of congregate care facilities: An agreement must be signed with the administrator of the facility, and must be updated annually or when changes occur. Copies must be sent to the Parish OEP and DHH. Hotels, motels and apartment buildings: An agreement must be signed with the host owner. The agreement must specify the conditions under which the nursing home can move its clients in, and must specify what will happen to the current lodgers when that happens. The agreement must be updated annually or when changes occur. Copies must be sent the Parish OEP and DHH. 29

30 (f) (g) (h) Business facilities: A nursing home may be affiliated with a company that has facilities that could be converted into shelters in an emergency. If that option is to be used the company must have the designated facility inspected by the Parish OEP or American Red Cross to determine what must be done to make it acceptable as a shelter. The company would get emergency power generators, cots, supplies, and other necessary provisions to outfit the contingency shelter, and make sure that everything that is needed is stored on site. Company personnel must be trained as shelter managers in approved shelter manager courses. Plans to accomplish this must be drawn up and sent to the Parish OEP and DHH. The facility must be inspected annually or when changes occur. Schools, churches, and other institutions: Facilities can be used for evacuees only in cases in which they are not already committed to being a public emergency shelter. An agreement must be signed with the person responsible for the facility, and must be updated annually or when changes occur. A copy of the agreement must be sent to the Parish OEP and DHH. Public shelter: The public shelter is a last resort shelter. Conditions will be poor, and the health of clients may be endangered by the conditions. The nursing home administrator will report his failure to find other shelter to the Parish OEP and will provide the OEP a complete listing of the clients, and the staff, staff families, equipment and supplies that will accompany the clients. The nursing home administrator will continue to look for other accommodations, and will report his or her success or failure to the Parish OEP and DHH annually. (2.) Catastrophic Emergencies: Many parishes in Louisiana are subject to catastrophic emergencies, such as hurricanes or widespread flooding that would require the evacuation of the entire parish, and relocation of the parish population to a safe area. In South Louisiana, the safe area would be parishes north of the I-10/I-12 interstate highways. Nursing homes located in parishes that are subject to catastrophic emergencies will make arrangements to move out of the danger, or risk area, to safety. They will use the same criteria to select shelters listed in paragraph (1), above. Nursing home administrators who are unsure about whether they are in a risk area will consult their Parish OEPs for a determination of how far they would need to move their clients to be safe. Extended stays at an evacuation site should be anticipated. 30

31 Appendix L NURSING HOME RESIDENT CENSUS AND CONDITIONS TO BE USED FOR DISASTER EVACUATION PLANNING Name of Facility: Address: City: State: Zip: Phone # Fax # Mobile Phone # for Administrator Address 1 Address 2 Facility Medicare # Medicaid # Total Resident Census: Please categorize your residents according to the Category I or Category II criteria listed below: Category I (Residents with special need(s) who will require hospitalization during an emergency evacuation of the facility) Intravenous therapies Tracheotomy/respiratory care Stage III and IV decubitus Tube feeding Kidney dialysis Other Total # Category II (Residents with limited needs and assistance who will require Special Needs Shelter during an emergency evacuation of the facility) Bladder/bowel incontinence Chairbound Indwelling catheter Contractures Injections Other Total # Signature of Person Completing Form Date 31

32 Title Appendix N TRANSFER FORM In the event of an emergency which necessitates the evacuation of (name of nursing facility) I, (name of Resident/Patient s Physician), hereby authorize the Medical Director or his designee at the receiving/host hospital the right to order the continuation of care for (name of patient), provided the host hospital has the physical and staffing capability to admit the evacuated nursing home patient. Resident/Patient s Physician Date Medical Director of Nursing Facility Date Resident/Patient or Legal Representative or Responsible Party Date 32

33 Appendix P Quick Steps to Fire Safety Make sure you know what to do in case of fire: Sound fire alarm system (Fire alarm alert will transmit automatically to Fire Department or the monitoring company which will in-turn notify the Fire Department). Close doors, windows and transoms. Report the fire to the person in charge. Avoid panic, don t alarm residents. Turn off gas, electric objects, oxygen and ventilation equipment as soon as possible and wherever possible. Know location, specific use, and operation of fire equipment. Know evacuation routes and exits. Use most secure and quickest way to safety. (See Evacuation Plan). Know how and where to get help if necessary. Help to prevent fires. Be alert for potential fire hazards. 33