long term care facility emergency planning...
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LONG TERM CARE FACILITY
EMERGENCY PLANNING
GUIDE
MARCH 2014
CHATHAM EMERGENCY MANAGEMENT AGENCY
124 Bull Street, Suite 140
Savannah, GA 31401
A fundamental responsibility of government is to provide for the safety and welfare of its citizens. One of the most fragile and dearest components of our society are the residents of our nursing homes, assisted care facilities, and hospices. While these facilities are regulated by a variety of agencies and organizations, the following information is not intended to limit or exclude procedures that a facility needs to satisfy other requirements, or to address other arrangements that have been made for emergency preparedness.
Chatham County and the Chatham Emergency Management Agency have developed this guide to provide a consolidated yet comprehensive manual of how to prepare an evacuation plan. Because this information satisfies basic contingency requirements, this criteria serves as the format for a comprehensive evacuation plan. Long Term Care Facilities are encouraged to use this material to prepare for emergencies that may occur in or threaten our community. Please contact the Chatham Emergency Management Agency at (912) 201-4500 if you have questions, concerns, or requests for specialized assistance. Sincerely,
Clayton S. Scott
TABLE OF CONTENTS
SECTION PAGE
Long Term Care Facility Evacuation Plan Format 1 Transportation Guidelines 4 Long Term Care Facility Emergency Plan Checklist 6
Coastal Evacuation Transportation Option 10
Special thanks go to the State of New York for providing
Information essential to the development of this manual.
LONG TERM CARE FACILITY EMERGENCY PLAN FORMAT
Purpose
To provide guidance in the development of an evacuation plan containing detailed information, instructions, and procedures that can be applied in any emergency situation necessitating either a full or partial evacuation of the long term care facility. This plan must incorporate staff roles and responsibilities essential to this process. Staff must be educated in their role(s). Drills and reviews must be conducted to ensure that the plan is workable. The plan must include back up measures for all components.
Activation Criteria
• Identify the title, not name of the person that makes the decision to activate the plan.
• Identify the title, not name of the alternate person that activates the plan if the primary person is not available.
• Define how the plan is activated.
• Define the phases of implementation and the activation requirements for each (staff notification, accessing available resources and equipment, preparation of residents and essential resident supplies).
Identification of the Alternate Site(s)
• Identify alternate/receiving facilities.
• Identify and have on-hand, written documentation that confirms the commitment of these facilities such as a Memorandum of Understanding or Contract
• Explain the process for ensuring these facilities remain available at the time of the evacuation.
Explain the process of notifying identified facilities that a decision has been made to evacuate residents to their facilities.
Resources/Evacuation
• Identify resources and equipment that are available to move residents from rooms/floors, which include elevators that may not be in operation.
• Identify where this equipment is stored and ensure that the area is clearly marked for staff access during an evacuation.
• Explain how the staff can access this equipment 24/7.
• Explain the protocols for staff training on equipment use.
• Define the inventory protocol in place for this equipment.
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External Transportation Resources
• Indicate the transportation resources that have been identified.
• Provide written documentation that confirms the commitment of the transportation resources to the facility when needed such as a Memorandum of Understanding or Contract.
• Provide a means to keep these agreements current.
• List the secondary/alternate transportation resources identified and available if needed.
• Ensure transportation resources meet the resident’s needs (supine, wheelchair, ambulatory, life support, etc.).
• Define the protocols that ensure the recurrent assessment of residents for specific transportation needs.
• Identify the means by which resident’ transportation needs are identified (Interdisciplinary Care Plan) and explain how this information kept current.
Resident Evacuation Destination
• List any resident’s pre-determined destination (other nursing home, hospital, home with family).
Explain the protocols used to determine if the destinations are specific to individual resident’s care needs.
Explain where this information is maintained and how it is kept current.
Tracking Destination/Arrival of Residents
• Explain the process that is in place to track the pre-determined destination of each resident.
• List who (title[s], not names[s]) is responsible for tracking resident arrival at their destination.
• Provide instructions explaining the protocol for informing the resident and/or their emergency contact of this predetermined destination.
• Provide a written process to ensure the residents a well-organized return to the original facility at the conclusion of the situation requiring the evacuation.
Family/Responsible Party Notification
• Define the procedure for notification of the resident’s emergency contact of an evacuation.
• Explain the protocol that identifies those residents who are unable to speak for themselves. Provide instructions for the process for assigning staff members in this situation.
• Identify the person(s) (title, not name) responsible for this notification.
• Explain the process for creating the script for the notification process (where, why, when, etc.).
• Identify the person(s) (title, not name) responsible for composing the script.
• Explain the process for tracking completion of family/emergency contact notifications.
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Governmental Agency Notification
• Define the procedure for notifying regulatory authorities of an evacuation.
• Identify other governmental (local) agencies that will be notified of an evacuation (Chatham Emergency Management Agency, Ombudsman, etc.; list phone numbers).
Identify the person(s) (title, not name) responsible for these notifications.
Evacuation Confirmation
• Explain the protocol to verify that rooms have been evacuated (tags or markings on door).
• Explain the protocol for staff training and conducting drills on room evacuation.
• Identify the means to ensure that all facility staff are aware of this protocol.
• Ensure that this protocol is included in annual and orientation education.
• Define the means used to ensure the fire department and other facility first responders been made aware of the protocol.
Transport of Records and Supplies
• Explain the procedure for transport of Medication Administration Records and medical records.
• Explain how confidentiality will be maintained during transport and relocation.
• Explain how resident-specific specialized treatment supplies will be identified for transport.
• Define the protocol for transport of resident-specific medications (a minimum five day supply) to the receiving facility.
• Identify the protocol for transport of resident-specific controlled substances (a minimum three day supply) to the receiving facility.
• List the procedures are in place for controlled substances to record receipt, full count, and signatures of both transferring and receiving personnel.
• Identify how the elements outlined above will be kept current. And how this information will be maintained (Interdisciplinary Care Plan).
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TRANSPORTATION GUIDELINES
Purpose
To provide guidance in the development of transportation needs for residents and staff. These needs must be addressed prior to the onset of conditions requiring an evacuation. Hurricanes are not the only conditions requiring evacuation; fire, chemical spills and a myriad of other more localized events could initiate a requirement for evacuation. Every facility needs transportation agreements that include certificates of insurance and that identify potential travel restrictions.
General
Ensure the facility has approved emergency and evacuation plans.
Include Disaster Readiness as an ongoing topic at monthly training sessions.
The facility transportation plan should be aligned with the evacuation status of the facility transportation plan. If the facility has to evacuate, plan to be out of the facility for at least three days; this means that transportation has to be planned for the relocation of staff in order to continue to care for the residents at the receiving facility.
Contracts
Determine if there is adequate transportation available through contractual agreements and include the contracts as a part of the facility plan.
Renew contracts annually and make sure the contract defines return expectations.
Supplies
Supply transport is the method by which the supplies will be taken to a host facility. Determine if the vendors will assist with this requirement.
Have a complete list of the supplies being transported to a host site, supplies to be delivered to a host site, and as applicable, supplies the host facility will provide.
Check vendor agreements to ensure the delivery of emergency supplies, food provisions, nursing equipment, and laundry needs to host site. These agreements must be current and must include all supplies that might be needed.
Take all emergency medical and resident related supplies with the residents to the receiving facility. (Including documentation, assignment sheets, etc.).
Coordinate transporting medication carts by unit. Try to send the medication/treatment carts on the same bus as residents from that unit. If that is not feasible, have the vehicle transporting the medication/treatment supplies for designated units follow the bus with the residents. This helps ensure that supplies arrive at the correct location.
Use rental trucks to transport mattresses and wheel chairs. Make sure all equipment (walkers, chairs, etc.) is labeled with the resident's name and the facility name. Restorative aides should check this on a weekly basis during hurricane season.
Keep an updated list of rented equipment, as well as durable medical equipment provided through cooperative facilities. Decide if rental equipment should be transported.
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Residents
Send resident-specific supplies on the buses with the residents. Include an emergency drug kit, hydration, and snacks for the residents and staff.
Facility vehicles should be fully fueled when the area is threatened by a condition warranting a potential evacuation.
Bus staffing should have adequate staff.
Identify and plan for special needs residents such as residents on dialysis and oxygen, residents in need of special lifting equipment, etc.
Keep an updated copy of the Resident Roster; this will help in the management of resident specific needs. List the following:
Type of transportation required, recommended transferring and lifting techniques, and aligned staffing. Include a list of who may need oxygen during transport.
Fax the data sheets to the receiving facility if possible. Also, ambulances will need this information for transport.
Have identification bands for all residents with name, specific requirements, etc. Put the family contact name and number on both the face sheet and the identification bands.
Have name tags for all staff.
Communications
Notify regulatory authorities of the impending evacuation; these telephone numbers should be posted for easy access.
Maintain a roster of family contact person's name and telephone number from the sending facility so they can be updated with the latest information on their family member.
Notify families of relocation plans and provide families or resident representatives with the name and address of the receiving facility.
Consider that families/resident representatives may need to also evacuate. Obtain current information on where families/resident representatives will be located and their contact numbers.
Provide for back-up communications. Consider cell and/ or satellite phones. Ensure both vehicle and household battery chargers are available.
It is possible for the phone company to reroute a facility's telephone number to another number. Note that the receiving facility will not want to have their phone calls doubled with calls from sending facility family members. Consider an alternative number for this purpose.
Re-entry
Confirm that regulatory authorities have approved the facility for a return.
Reverse the process for returning the residents, medication carts, supplies, etc.
Emphasize the need for patience and stress management by staff and residents; everyone will be tired.
Ensure adequate replacement staff is available in all departments for return to the facility.
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LONG TERM CARE FACILITY
EMERGENCY PLAN CHECKLIST
Purpose
To provide guidance that is supplemental to but does not supersede or replace State or Federal requirements, in the development of an evacuation plan containing detailed information, instructions, and procedures that can be engaged in any emergency situation threatening or occurring at a long term care facility. This plan must incorporate staff roles and responsibilities essential to this process and must include back up measures for all components.
Reviewed By: _____________________ Title:____________________ Date:______________
Administrator: _____________________ Date:____________________
ITEM Item Complete Review / Revision Dates
PROGRAM MANAGEMENT Yes No Review Date Revision Date
Facility Chain of Command established & current
Emergency Management Committee established
Local partnerships established & renewed
a. Chatham Emergency Management Agency
b. Emergency Responders (Police, Fire, & EMS)
c. Health Care Network/Providers
Other public/private responders & resources
Plan activation triggers defined & understood
Staff assigned for implementation of an emergency management program
Able to respond to hazards based on existing plans & resources
Consistent with hazard analysis & risk reduction
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EMERGENCY PLANNING & RESPONSE Yes No Review Date Revision Date
Procedures to respond to the following hazards:
a. Hurricane & Tropical Storm
b. Disruption of essential services
c. Biological
d. Chemical/Hazardous Materials
e. Nuclear/Radiological
f. Catastrophic
Shelter in place plan & protocols
Shutdown of air handling equipment & implementa-tion of smoke, gas, dust dissipation facilities
Implementation of protocols for use of staff & re-sources
Plan for ID of responding staff & emergency workers
RECOVERY Yes No Review Date Revision Date
Plan for team to assess damage prior to reentry
Plan to restore services
Plan to restore/repair infrastructure
Plan to restore programs
Plan for continuity of staff & operations
EVACUATION PLAN Yes No Review Date Revision Date
Activation criteria established
Identification and mutual agreement of alternate sites
Transfer agreements established & current
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COMMUNICATION Yes No Review Date Revision Date
24/7 Communication capability with redundancy
Emergency power
Protocols for rapid notification of staff
a. Staff
b. Chatham Emergency Management Agency
c. Oversight agencies
d. Public & private resources
e. Facility Ombudsman Program
System & staff in place for communication with resident & staff families, media, etc.
24-hour contact info for above with numbers current & verified
HAZARD VULNERABILITY ANALYSIS Yes No Review Date Revision Date
Facility internal hazard analysis completed
Facility external hazard analysis completed
Communication & facility hazard analysis integrated
RISK REDUCTION FACTORS (Mitigation) Yes No Review Date Revision Date
Identification
Implementation plan established
CAPABILITY ASSESSMENT Yes No Review Date Revision Date
Able to respond to hazards based on existing plans & resources
Resources to physically move residents identified & available
External transportation arrangements & written contract
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Evacuation destination (specific to care needs) predeter-mined & current
System to identify & track resident’s destination arrival
Family/responsible party notification protocol
Government agency notification protocol
Confirmation of facility evacuation
Transport that medical records, meds & specialized treat-ment supplies are with residents
DRILLS & EXERCISES Yes No Review Date Revision Date
Emergency preparedness drills (min 2 times each year)
Written critique & review of each exercise
Written critique & review of actual incidents
Revisions initiated & corrective action completed
Participation in community wide exercise program
EDUCATION Yes No Review Date Revision Date
All staff educated within four weeks of plan revision
Staff familiar with Emergency Management Program &
Note: Any checklist has shortcomings in that it cannot measure the reality of a given event,
or actual capabilities of facility staff.
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LONG TERM CARE FACILITY COASTAL EVACUATION TRANSPORTATION OPTION
Through the Georgia Emergency Management Agency (GEMA) and the Chatham Emergency Management Agency (CEMA), Long Term Care Facilities (LTCF) have the option to participate in the Coastal Evacuation Transportation Program. Under this optional Program, a LTCF may contract with GEMA to provide certain transportation capabilities and assets established in the Vulnerable Population Coastal Evacuation Transportation Plan in the event that a manmade or natural disaster warrants full or partial evacuations from the Southeast Georgia coast and the LTCF has requested assistance through CEMA to safely evacuate residents threatened by the approaching threat. It is anticipated that a State of Emergency will be declared by the Governor in association with this event. The capabilities and transportation assets will be used to support the preparation, response and recovery efforts in to these events.
Selection to participate in this optional Program requires commitments from GEMA, CEMA and the LTCF. Responsibilities for the LTCF are defined on the following pages.
For the current year, the Schedule of Anticipated Transportation Assistance Fees for Evacuation Only are Listed Below
AMBULANCES PARA-TRANSIT VEHICLES FROM
COASTAL REGIONAL COMMISSION
To Be Determined at Time of Evacuation $20 Per Vehicle Per Hour Plus $0.56 Per Mile
1-2 Individual Passenger Capacity 8-12 Individual Passenger Capacity
$34.54 Per Person Plus Mileage Fees
NON-EMERGENCY TRANSPORTATION
(NET) VEHICLES MOTOR COACH BUS VEHICLES
7 Passenger Van ($258 or $40.71 Per Passenger) $2,500 Per Motor Coach Per Day / Three Day Min
15 Passenger Van ($365 or $24.33 Per Passenger) 40-44 Individual Passenger Capacity
Wheelchair Lift Van ($400 or $200 Per Passenger) $193.18 Per Person
Stretcher Van ($150 One Passenger Per Vehicle)
May Include Excess Mileage Surcharges
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LONG TERM CARE FACILITY COASTAL EVACUATION TRANSPORTATION OPTION
LTCF RESPONSIBILITIES IF ELECT TO PARTICIPATE IN THIS PROGRAM
Execute a Long Term Care Facility – EMA Hurricane Evacuation Preparation Memorandum of Agreement.
Provide CEMA with a copy of current facility Long Term Care Facility Disaster Preparation Plan on file with the Georgia Department of Community Health.
Provide point of contact(s) information to CEMA.
Participate in an Annual Hurricane Evacuation Review and Exercise with CEMA.
Conduct staff training for Hurricane Evacuation Procedures.
Participate in CEMA Hurricane Awareness and Preparation Conference Calls with CEMA.
Notify CEMA at H-72 of commitment to utilize Hurricane Evacuation Transportation Assistance and provide CEMA with number of residents to be evacuated and type of vehicles required.
Agree to provide location(s) for transfer of residents being evacuated and have executed Agreements with receiving facilities to accept residents being evacuated.
Agree during the evacuation activities to perform the following functions:
Provide a cursory medical evaluation of evacuees to determine which mode of transportation is appropriate based on medical and ambulatory conditions.
Provide the driver of the evacuation transportation vehicles with a manifest of the passengers, a map, directions to the specified receiving facility.
Notify evacuees and evacuee official emergency contacts of location of receiving facility and information on how to track evacuees status.
Assist with loading evacuees and their luggage onto assigned vehicles.
Notify receiving facility of all health care staffing, medical care and nutritional needs for evacuees.
Agree to provide all necessary health care staffing, medical care and nutritional needs for residents while being transported and sheltered during the evacuation.
Agree to reimburse the State of Georgia for Hurricane Evacuation Transportation Assistance provided through the Agreement.
Agree to coordinate actions with CEMA and GEMA during evacuation and re-entry using the GEMA WebEOC Situation Awareness tool.
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LONG TERM CARE FACILITY COASTAL EVACUATION TRANSPORTATION OPTION
COORDINATION TIMELINE
120 hours GEMA issues Advance Advisory Notice to all State Agency and Local EMAs. CEMA forward advisory
notice to LTCF with reminder of standard operating protocols.
96 hours GEMA conducts hurricane Advisory Conference Call. CEMA participate in conference call and puts
LTCFs on notice of potential evacuations and need to examine the availability of transportation assets to
support Vulnerable Populations Coastal Evacuation.
96-72 hours GEMA, DPH and DHS (ESF 8 Mass Care) engage in conversation with CEMA to determine the
likelihood of evacuations and preliminary counts of the residents to be evacuated and the type of
vehicles required.
72 hours LTCFs advise CEMA of the required number and type of evacuation transportation vehicles required to
support Vulnerable Populations Coastal Evacuation.
72 hours GEMA, at the request of CEMA and local Long Term Care Facilities, notifies appropriate vendors of the
required number and type of evacuation transportation assets that are required to support Vulnerable
Populations Coastal Evacuation.
72 hours GEMA and support vendors maintain a presence at the State Operation Center (SOC) to coordinate
vehicle management along with representatives of other transportation providers to develop deployment
pick-up and delivery plan and schedule.
50-48 hour All Coastal Evacuation Transportation Assistance Vehicles requested report to Vehicle Reception
Staging Area(s) for pick-up and delivery assignments.
48 – 36 hours All Coastal Evacuation Transportation Assistance Vehicles report to assigned Long Term Care Facility
for resident pick-up and delivery to evacuation shelter site.
24 hours All scheduled Vulnerable Populations Evacuations are completed. Coastal Evacuation Transportation
Assistance vehicles report back to home location.
24 – 0 hour General Population Evacuations
————(Post-Landfall hours expressed as after the conclusion of tropical force winds)————
0-24 hours GEMA, DPH, DCH, and DHS (ESF 8 Mass Care) engage in conversations with local EMAs to review
preliminary damage assessment reports from Long Term Care Facilities to determine feasibility and
timing of re-entry. GEMA puts Transportation Vendors on notice of potential deployment of
transportation assets to support Vulnerable Populations Coastal Re-Entry.
24 – 48 hours GEMA, at the request of local Emergency Management Agencies and Long Term Care Facilities,
notifies appropriate vendors of the required number and type of evacuation transportation assets that
are required to support Vulnerable Populations Coastal Evacuation Re-Entry.
48+ hours All Evacuation Transportation Vehicles report to assigned Vulnerable Population Shelter Locations for
resident pick-up and delivery to assigned Long Term Care Facility.
Chatham Emergency Management Agency
124 Bull Street, Suite 140
Savannah, Georgia 31401
Telephone (912) 201-4500
FAX (912) 201-4504
http://chathamemergency.org