EMERGENCY PREPAREDNESS

Transcription

1 EMERGENCY PREPAREDNESS Vanessa Walker, MSN, RN, PHN Kenneth Lee, MD PVA Summit 2014

2 DISCLOSURES VANESSA WALKER MSN, RN, PHN and KENNETH LEE, MD have no financial interest to disclose.

3 LEARNING OBJECTIVES At the conclusion of this activity, the participant will be able to: 1. Identify challenges/barriers for persons with disability during disaster evacuation. 2. Describe emergency management exercises and processes to use prior to a disaster. 3. Identify ways to triage patients utilizing zones and categories. 4. Name the analysis each organization must identify in writing that scores potential disasters. 5. Prepare your own programs emergency plan

4 4 P S OF NATURAL DISASTER PREVENTION PEE POOP PREPERATION

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13 Help!

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16 TYPES OF DISASTERS

17 Natural Disaster

18 Natural Disaster

19 Natural Disaster

20 NAPA Earthquake

21 Northwest/east snowstorm

22 Minnesota

23 Kansas

24 Man made

25 West, Texas

26 Domestic Terrorism Boston Bombing

27 GLOBAL/DOMESTIC TERRORISM/MASSACRE

28 PERSONS WITH DISABILITY: CHALLENGES OF EMERGENCY DISASTER RESPONSE

29 PROTECTING PERSONS WITH DISABILITIES IN DISASTER SITUATION Unable to or disinclined to evacuate More likely to suffer injury Lose their medication/assistive device Disrupted or lost care-giver support At higher risk than usual for exploitation and abuse More likely to be left behind abandoned or unable to leave home without assistance Vulnerable for discrimination

30 PROTECTING PERSONS WITH DISABILITIES IN DISASTER SITUATION EVACUATION Clear communication messages At least two forms of means: radio, sms, phone, etc Quick ID of the location of those who need assistance Agency awareness Local EMS service fire department police department

31 PROTECTING PERSONS WITH DISABILITIES IN DISASTER SITUATION Access to Humanitarian Aid and Participation in Recovery Planning Have the right to safe, non-discriminatory and prioritized access to humanitarian assistance. Be part of the planning process Involve a person with disability in planning process

32 PROTECTING PERSONS WITH DISABILITIES IN DISASTER SITUATION SHELTERS Lack of physical access to the facilities Lack of accessible communication and communication in alternative languages and formats Blocked or nonexistent disabled parking Blocked accessible paths by parked law enforcement vehicles Lack of access to the facilities with Service Dogs. Lack of accessible bathrooms Lack of accessible sleeping equipment Lack of access to food and healthcare needs Lack of or loss of contact with the rest of the family Lack of facilities for Power for people who need to recharge power devices

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34 PROTECTING PERSONS WITH DISABILITIES IN DISASTER SITUATION HOUSING AND RECONSTRUCTION Temporary/permanent housing Physical accessibility, location, consider caregiver space, equipment/supplies Planning Planning appropriately will prevent denial of acceptance to an evacuation shelter

35 PROTECTING PERSONS WITH DISABILITIES IN DISASTER SITUATION PROTECTION FROM EXPLOITATION AND ABUSE Higher risk Especially women and children Need high level of vigilance PLANNING Resource allocation Placement consideration

36 PROTECTING PERSONS WITH DISABILITIES IN DISASTER SITUATION HEALTHCARE AND SOCIAL SERVICES Remember, they have baseline medical condition Trying to get the necessary special resources may be difficult Additional injuries Basic humanitarian aid (may forget about this due to concentrating on their disability)

37 PROTECTING PERSONS WITH DISABILITIES IN DISASTER SITUATION PSYCHOSOCIAL SUPPORT At higher/increased psychosocial stress and anxiety Newly injured may have difficulty adjusting to another catastrophy RETURN TO WORK LEGAL CAPACITY AND PROTECTION Rights protected POA

38 GENERAL THEME notification; evacuation; emergency transportation; sheltering; access to medications, refrigeration, and backup power; access to their mobility devices or service animals while in transit or at shelters; and access to information.

39 PREPARATION IS THE KEY! AND ADAPT!

40 SCI HOME CARE EMERGENCY MANAGEMENT PLAN Vanessa Walker, MSN, RN, PHN

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42 EMERGENCY MANAGEMENT SCI Home Care Emergency Management Plan The Joint Commission Integrated Plan Test Phases /Exercises Adjustment to Plan Leadership Role NOTE: One single emergency can adversely impact patient safety and the organization s ability to provide care, treatment or services.

43 HAZARD VULNERABILITY ANALYSIS Basis of evaluation: Probability of occurrence, risk to organization, and current status of preparedness. Scoring: 0 = Not applicable, 1 = Low risk2 = Moderate risk, 3 = High risk Type of event Probability Human Impact Property Impact Operational Impact Rank Likelihood this will occur within one year Possibility of Death or Injury Physical Losses and Damages Interruption of Services Score>2 requires inclusion in policy Earthquake Power Failure Fire Flash Flooding High Winds Terrorist Act Biological Exposure (Terrorist Attack) Civil Unrest Comment: Score>2 requires inclusion in policy. All other hazards have been assessed as 1 or 0 for Network level response and do not require inclusion in the policy.

44 DISASTER SIMILARITIES Evidence shows that most emergencies are alike and require similar preparation for example, disasters cause: Injury Destruction of property Loss of utilities

45 FOUR PHASES OF EMERGENCY MANAGEMENT Mitigation Preparedness Response Recovery

46 FOUR PHASES OF EMERGENCY MANAGEMENT Mitigation-actions taken before and after a disaster (identifying vulnerable patients, developed categories and zones). Preparedness-actions taken before an actual disaster (utilize the cascade call list, disaster drill, table top exercise, educate patients and staff, review the emergency supply list, assign duties to staff). Response- actions/activities taken during an actual disaster (call staff into office-cascade call list, assign duties, curtail visits, staff call patients-disaster drill-assist patients with emergency plan, shelter placements, call oxygen vendors, assist with hospitalization).

47 FOUR PHASES OF EMERGENCY MANAGEMENT Recovery-actions/activities after a disaster to return back to normal (resume visits, replenish Veteran with medication and supplies, assist with improved living quarters, etc.). When you mitigate and prepare well, response and recovery are easier.

48 Quadriplegia, totalmaximum assistance in activities of daily living (ADLs), bedbound, oxygen, ventilator, enteral feeding pump dependent Quadriplegia/Paraplegia requires moderate/ sporadic assistance with ADLs/motorized wheelchair bound CATEGORY 3 = Highest Risk CATEGORY 2 = Moderate Risk CATEGORIES OF RISK Paraplegia, lives alone, independent or minimal assistance with ADLs, manual wheelchair, walker, cane, (CNH, ALF, Group care homes-have emergency plans) CATEGORY 1 = Lowest Risk

49 EMERGENCY ZONES 1-North West-N 10/60 FWY, W 605 FWY 2-North East-N 60 FWY, E 605 FWY 3-South West- S 10/60 FWY, W 605 FWY 4-South East-S 60 FWY, E 605 FWY

50 Veteran Treatment Care Plan Map located in SCI Home Care Nurse / Social Worker Office EMERGENCY TRIAGE LOCATIONS Emergency Management Binder SCI Home Care Share Drive

51 CASCADE CALL LIST

52 HOME CARE DISASTER DRILL DATE: DISASTER TYPE: 1. Was Veteran/caregiver at home:? 2. Who did you speak with about the disaster drill? 3. What do you know about this type of disaster? 4. How would you respond to this type of disaster? 5. What are the limitations of the Veteran i.e., cant walk, wheelchair bound, bed bound, total patient care, etc.? 6. Do you have a Life Alert, emergency exit plan that provides a ramp for wheelchair access along with a manual wheelchair? 7. Does the Veteran have equipment such as oxygen, ventilator, feeding pump, etc. which could be affected by the disaster?_ 8. Do you have access to a battery operated radio, flashlight, cell phone, candles, matches, batteries, can opener? 9. Do you have a fire extinguisher and smoke alarms in your residence? 10. Do you have an emergency kit, if so contents includes (gauze, band aids, tape, cotton balls, CTA, rubbing alcohol, scissors)? 11. Do you have identifying family or friends in and out of town who may be of support in the event of a disaster? 12. Do you have a week supply of water, food and medication on hand if an emergency were to arise? Education provided to the Veteran/caregiver in response to answers provided: Call your local fire department or Red Cross. Call the utility companies and vendor for equipment issues such as oxygen, ventilator etc. Tune into your local TV/ radio for public announcements. Contact the SCI program to discuss any issues you may have. Keep cash on hand in case of an emergency. Education provided specific to the emergency: Verbalization of understanding of instructions provided: Good, Fair, Poor Comments or education provided by the SCI Home Care Staff addressed based on the responses: :

53 TABLETOP EXERCISE Key personnel discuss emergency management plan written and verbal scenario Rehearsal to coordinate: Communication Staff responsibilities Veteran care activities Medication / Supplies Resources / Equipment Goal: Protect life Prevent disability

54 EVALUATION OF DRILLS/CASCADE CALL PLAN, DO, STUDY, ACT MODEL 1. DISASTER DRILL - Analyze patient and staff knowledge deficits-consistency in staff education, (action)- educate patients via pamphlets, emergency supply check list, developed templates for staff-earthquake, power failure, fire, staff participate in drills biannually along with actual disaster occurrence(s) 2. CASCADE CALL LIST - Evaluate the timeliness of staff getting back to the coordinator, staff participation, (action)- staff read annually the emergency disaster policy, participate in cascade calls biannually along with actual disaster occurrence(s)

55 EARTHQUAKE EDUCATION TEMPLATE If you are inside, stay inside: If you are ambulatory, find cover under a desk, table or other solid piece of furniture, get under it. Hold on to it and protect your face and head with your arms. If you are not able to get under something, sit down on the floor against the wall and cover your head with your arms. If you are wheelchair bound, brace your chair against the wall, lock your wheels and cover your head with your arms If you are bedbound, stay there. Pull the covers up and protect your head with a pillow. If you are outside, stay outside: Don't go near any buildings, walls, power lines, trees, street lights and signs.

56 POWER FAILURE EDUCATION TEMPLATE If you are in a vehicle, stay inside the vehicle, pull over, stay away from buildings etc. until the shaking stops. After the shaking stops, wait a few minutes before moving, there may be aftershocks. If you are trapped, make noise and shine a flashlight if available. To help prepare your food, keep one or more coolers and ice in your home. Throw away unsafe food. Turn off and unplug all unnecessary electrical equipment, appliances and sensitive electronics. Leave one light on so you will know when the power comes back on. Eliminate unnecessary travel especially by car. Traffic lights will be out and roads will be congested. If you are on emergency life support equipment such as ventilator or oxygen that require electricity, use your portable oxygen tank. Report your power failure to your local utility company.

57 FIRE EDUCATION TEMPLATE Turn off oxygen equipment immediately if there is a fire. Use your fire extinguisher if it safe to do so. If you are able to get out right away: Stay calm, follow your exit plan. Feel the doors with your hand. If they feel warm or if smoke is seeping in, don't open the door. Use another way out. Report the fire to the fire department. Tell them what room you are in your residence. If you are caught in smoke, stay low and crawl to the door. Keep the doors closed if you can't get out: Stuff cloth around the doors and cover vents to keep smoke out. Phone the fire department. Tell them what room you are in your residence. Signal for help, open windows only if no smoke can come in. Stop, drop and roll if your clothes catch fire: Roll on the floor until the flames go out. Cover your face with your hands. If you can not roll, smother the flames with a blanket, towel or coat. Fire safety prevention: Turn the stove off when you leave the cooking area. Keep space heaters at least 3 feet away from any obstacles. Never smoke when you are tired or taking medication which may cause drowsiness. I f on oxygen, display a no smoking sign in your outside window/door or entrance to your door if you stay in a room.

58 EMERGENCY SUPPLY CHECK LIST Yes No NA SAFETY / SURVIVAL ITEMS: Battery-powered radio Cell phone and charger Flashlights Batteries Can opener Fire extinguisher (necessity) Smoke alarm (necessity) Candles Matches Whistle First aid kit (gauze, band aids, tape, cotton balls, cotton tip, applicators, rubbing alcohol, antibiotic ointment, scissors) Cash and credit cards Copies of documents (medical cards, passport, bank account numbers, birth and marriage certificates, insurance policies) Eye glasses, hearing aids Clothing, shoes LIVING SUPPLIES: Water (1 week supply) Food (canned, packaged) (1 week supply) Bowel care supplies Dressing supplies Catheter supplies Medications (List) (1 week supply) Insulin, syringes (glucometer supplies if indicated) (1 week supply) Walker, Cane Motorized wheelchair (need manual wheelchair backup) Manual wheelchair Oxygen concentrator, (Tanks) (Notify Electric Company) Ventilator, Suction machine (Notify Electric Company) CPAP, BIPAP (Notify Electric Company) Nebulizer (Notify Electric Company) Enteral feeding pump (Notify Electric Company) Blood pressure machine Life Alert OTHER: Emergency Exit Plan in place List of local contacts: Name, address, telephone number List of out of town contacts: Name, address, telephone number Local Shelter: Name, address, telephone number

59 ACCESS TO MANUAL WHEELCHAIR BACKUP FOR EVACUATION FISCAL YEAR UNIQUE VETERANS SERVED NUMBER OF MANUAL WHEELCHAIRS NEEDED (20%) (17%) TOTAL (18%) ACCESS TO MANUAL WHEELCHAIR BACKUP FOR EMERGENCY EVACUATION Findings: A total of 56 Veterans were served in FY 2012 and Of the 56 Veterans a total of 10 (18%)of the Veterans did not possess manual wheelchairs as a backup. Interventions: Recommendation to the SCI Primary Care Provider (PCP) to order manual wheelchairs. Outcome: A total of 10 (18%) of Veterans with motorized wheelchairs required manual wheelchairs. After the PCP ordered the manual wheelchair the results increased from 46 (82%) to 56 (100%) compliance.

60 MANUAL WHEELCHAIR BACKUP OUTCOMES Compliance rate 100% 80% 60% Before After 40% 20% 0% Veterans with back-up wheelchairs

61 ACCESS TO FIRE EXTINGUISHERS FISCAL YEAR UNIQUE VETERANS SERVED FIRE XTINGUISHERS NEEDED (40%) (22%) TOTAL (29%) ACCESS TO FIRE EXTINGUISHERS FOR EMERGENCY EVACUATION Findings: A total of 56 Veterans were served in FY 2012 and Of the 56 Veterans, (16)29% of the Veterans required fire extinguishers. Of the (16) 29% only (13) 23% purchased the fire extinguishers as they were instructed by the SCI Home Care Nurse, Social Worker during the visit, disaster drill along with instructions provided to the Veteran in the emergency supply list. Interventions: Instructed the Veterans to purchase fire extinguishers for emergency preparedness i.e. prevent fires. Outcome: Only 13 (23%) of the 16 (29%)Veterans requiring fire extinguishers were compliant with purchasing the fire extinguishers. A total of 53 (95%) of the 56(100%) Veterans were compliant with securing the fire extinguishers after instructed to purchase them.

62 SECURING FIRE EXTINGUISHER AFTER INSTRUCTION Non-Compliant 5% Compliant 95%

63 VA LONG BEACH SPINAL CORD INJURY HOME CARE EMERGENCY MANAGEMENT INFORMATION CARD Name Last Four DOB Primary Care Provider Telephone No. Emergency Contact No. //////////////////////////////////////////////////////FOLD/////////////////////////////////////////////////////////////////// // SCI Type Other Diagnosis Bladder Management Bowel Management Decubitus Ulcer Oxygen /Vendor No. Enteral Feeding Autonomic Dysreflexia DNR Other //////////////////////////////////////////////////////BACK/////////////////////////////////////////////////////////////////// / MEDICATION LIST ALLERGIES Date Medication Name/Strength Directions

64 MILWAUKEE EMERGENCY UN-PREPAREDNESS Only education provided Cited by CARF

65 WISCONSIN TORNADO 2013 C6 Tetraplegia ASIA A, unable to call for help, rescued after 8 hrs.

66 READY.GOV

67 READY.GOV

68 READY.GOV

69 MILWAUKEE EMERGENCY PREPAREDNESS

70 MILWAUKEE EMERGENCY PREPAREDNESS

71 VA Spinal Cord Injury/Disorder Services Emergency Preparedness Go Bag For Individuals with Spinal Cord Injury and Disorders (SCI/D) A Go Bag is a small supply of items you would have access to at all times in case there is an emergency or natural disaster. An emergency can be an event that takes place over a period of several hours to a day or more. Be prepared by relying on your own resources. Items to pack: Cell phone (include phone/vehicle charger) Contact information (include physician, family, friends, personal support network) Instructions on your injury and personal care Bottled water Medications (3 or more days of meds and a list with times taken and reason for use) Food (e.g.: energy bars, etc.) Small flashlight Hand sanitizer Catheters Suppositories Lubricants Gloves Emergency Blanket Whistle Add additional items to meet your individual needs MILWAUKEE EMERGENCY PREPAREDNESS

72 MILWAUKEE EMERGENCY PREPAREDNESS

73 Milwaukee VA Medical Center Spinal Cord Injury/Disorder Center Home Emergency Plan Please fill out and provide to your local Emergency Management Services. (ie: police, fire department, power company-if appropriate, neighbors, etc) Name Address where the Veteran reside: Contact Numbers: Home: MILWAUKEE EMERGENCY PREPAREDNESS Cell: Emergency Contact Information: Name: Association: Home Phone: Cell Phone: Medical condition and any special needs that you want them to be aware of: Milwaukee VA Medical Center

74 SUMMARY By educating Veterans, care givers, staff, and the community in emergency preparedness, both will be better prepared to respond in a proactive manner during an actual emergency.

75 PIVOTAL OUTCOMES Better prepared

76 REFERENCES The Joint Commission Accreditation Home Care Manual (2014) Standards for Home Health, Personal Care and Support Services, and Hospice VA Long Beach Healthcare System (2012) Emergency Operations Manual Emergency Preparedness Tips for Home Care Patients (2012) IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings (2007)