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Relocation, sheltering and evacuation guideA guide to emergency planning for the health and human services sectors

2018

To receive this publication in an accessible format phone (03) 9096 8849, using the National Relay Service 13 36 77 if required, or email Emergency Management <[email protected]>

Authorised and published by the Victorian Government, 1 Treasury Place, Melbourne.

© State of Victoria, Department of Health and Human Services October 2018.

Available at Emergency preparedness on the Providers website <https://providers.dhhs.vic.gov.au/emergency-preparedness>.

Contents

mailto:[email protected]

1 Overview.......................................................................................................................................... 71.1 Introduction....................................................................................................................................... 7

1.2 Purpose............................................................................................................................................ 7

2 Before emergencies.......................................................................................................................82.1 Emergency planning......................................................................................................................... 8

3 During emergencies.......................................................................................................................93.1 Activating the emergency management plan....................................................................................9

3.2 Relocating clients and staff...............................................................................................................9

3.3 Sheltering options........................................................................................................................... 10

3.4 Evacuating clients and staff............................................................................................................10

3.5 Decision making – deciding whether to relocate, shelter or evacuate............................................11

3.6 Health and aged care facilities........................................................................................................14

4 After emergencies........................................................................................................................ 164.1 Health and wellbeing of clients and staff.........................................................................................16

4.2 Return to business as usual...........................................................................................................16

Attachments............................................................................................................................................ 17Attachment 1: Consultation, decision making and notification pathways..................................................17

Attachment 2: Operational responsibilities for health and aged care facilities relocating or evacuating................................................................................................................................................ 19

Document information

This document has been prepared by the Emergency Management Branch, Department of Health and Human Services.

This is a managed document and replaces the: Relocation, sheltering and evacuation guide October 2015.

Superseded versions should be removed from circulation.

Version Date Endorsed by Revisions Sections

1 October 2015 Deputy Director, Emergency Management, Department of Health and Human Services

Updated to reflect health and human services machinery-of-government changes. Emergency planning material has been added

All

2 October 2018 Deputy Director Strategy and Policy, Emergency Management branchDepartment of Health and Human Services.

Updated to reflect machinery-of-government change to youth justice services.References to Clients and Services policy and outdated government templates removed

1, 2, 3

1 Overview

1.1 IntroductionThis guide has been prepared for agencies in the health and human service sector that provide services in:

• facilities • health and community service centres, or• client’s homes.

This guide does not include advice for supporting the development of individual emergency plans for clients.

1.2 PurposeThis guide is intended to assist with planning and response to all emergencies, including but not limited to:

• bushfires, floods and storms• extreme heat and heatwaves and• smoke events • extended power supply disruption.

The guide supports facility managers in making decisions about relocating, sheltering or evacuating. It also provides emergency planning guidance to service providers who need to consider ceasing or altering services delivered from centres or in the home.

Relocation, sheltering and evacuation guide

2 Before emergencies

2.1 Emergency planningEmergency planning for agencies in the health and human services sector involves assessing the risks, and consequences of potential events that may impact on the health, safety and wellbeing of clients, and staff.

Agencies that provide services to clients in facilities, in community centres or in the home, are required to plan for emergencies that may impact on the safety and wellbeing of their clients and the staff who support them.

When developing emergency management plans, services must seek advice from appropriate agencies about potential risks and the services that may provide assistance. A list of resources can be found in the department’s Emergency preparedness reference guide and glossary.

Protection and preservation of life is paramount. Every service should have an emergency management plan that focuses on the safety and wellbeing of clients and staff.

A quality emergency management plan:

• is appropriate to the service type, location, physical environment, client profile, staff capacity, building type and other relevant factors

• includes emergency risk reduction activities such as site assessments and risk mitigation works • includes planned emergency responses for different emergency situations, such as options for

altering or ceasing services, relocation, sheltering and evacuation• includes clear triggers for activation, including processes for maintaining situational awareness and

sourcing accurate and up-to-date information through advisories, forecasts and warnings• is tailored to meet the particular needs of clients and communities, such as Aboriginal people and

communities, to ensure a culturally responsive approach• outlines clear authority for decision-making and communication arrangements.


Guidance for service providers when developing emergency management plans:• Think broadly and consider a range of options when planning client transport. All facility emergency

management plans should include a detailed section on how clients could be transported. It may not be possible for ambulances to relocate all clients.

• Take a collaborative approach to emergency planning. Meet with other services to discuss how you can support each other during emergencies, particularly when alternative accommodation or services are needed. A collaborative approach can increase capacity, enhance effectiveness and simplify coordination in an emergency.

• Identify options to reduce risk and improve resilience, as emergency services cannot guarantee to respond immediately during large-scale emergencies such as extreme bushfires. You should also determine your service’s capacity to manage a surge in demand from people who may need services or accommodation as a result of the emergency.

• Consider the potential timing, size duration and consequences of different emergencies. Emergency management plans should include planning for a broad range of hazards such as bushfires, floods and smoke that might impact on the service or facility. It is useful to work through various scenarios when developing plans.

• Review, exercise and update the emergency management plan regularly, preferably annually, with the involvement of local emergency service organisation.

3 During emergencies

3.1 Activating the emergency management planServices need to be prepared and ready to activate their emergency response plan. Emergencies can impact quickly with little time to prepare and gather resources.

If there is an immediate threat to life call triple zero (000).

The person with delegated authority1 needs to make decisions as soon as practicable. The process for delegating authority should be clearly outlined in your emergency management plan.

Facilities such as hospitals, residential aged care and residential institutions must plan for the potential need to relocate, shelter or evacuate in response to an emergency. The decision to implement any of these responses is complex and there are often multiple factors that need to be considered.

The decision to relocate, shelter or evacuate during an emergency includes an assessment of the following factors:

• the current client profile and care needs – mobility, health status and medical needs• the ability to reduce client numbers during periods of heightened risk, for example some clients may

be able to go home or may be able to stay with family• availability of staff - consider the possibility that staff and resources may be unavailable due to the

emergency • outcomes of risk assessments undertaken earlier or during the emergencies• level of facility preparedness and the resources needed to defend it• level of support available from emergency service organisations

1 The authority might be inherent in the position, such as a chief executive officer, or formally delegated to another person, so that appropriate decisions can be made at all times.


• availability of supplies, including essential services such as electricity, a safe drinking water supply and telecommunications

• availability of safe transport and road access, and • availability of suitable and safe alternative accommodation.

3.2 Relocating clients and staffRelocation is the planned movement of clients and an appropriate number of staff from a service or facility to alternative accommodation with a similar type of care available. Relocation is undertaken in response to a forecast or warning, such as the declaration of a code red day, or because of a potential or actual emergency.

Planned relocation is initiated by the service in response to a code red day or prior to an emergency impacting or posing a significant threat.

Planning for relocation should be done well in advance of any warning or emergency, and should take into account any special needs of clients, the required resources and the time it would take to relocate the facility.

Any decision to relocate, must ensure that there is enough time to relocate safely. For example, relocation for a Code Red day should occur on the day before.

3.3 Sheltering optionsThere are times when staying and sheltering during an emergency is safer than relocating or evacuating. Emergency management plans should consider potential scenarios where it might be necessary to shelter in place during an emergency in circumstances where it is not possible to leave safely. Services should consider what resources might be required and what steps can be taken to make the facility as safe and resilient as possible.

A decision to stay and shelter will be influenced by factors such as the type of emergency, the predicted timing of impact, property preparedness, capacity to actively defend the location and the safety of relocating or evacuating. Advice should be sought from emergency services and / or the department.

Service providers should consider the risks involved in sheltering compared with relocation or evacuation. Some facilities may have clients who are very fragile and difficult to move. A decision to relocate, evacuate or shelter must assess the risks and issues associated with moving clients who may be very frail, have a serious physical or mental health condition or disability, compared to the risks of staying.

There are two types of sheltering:

• shelter in place• shelter indoors.

3.3.1 Shelter in placeTo shelter in place is to remain on site within an existing facility or home during an emergency.

The decision to shelter in place should be based on information from a variety of trusted sources, such as VicEmergency or the department. Seek advice to confirm that this option is safer or more appropriate than relocation or evacuation.

Moving clients from one facility or home to another safer building within the same location is also considered sheltering in place.

Key considerations for sheltering indoors include:

• preparation of the property for the type of emergency


• emergency management capability and readiness of the service and staff on site to respond to an emergency threat if necessary

• resources needed to stay on site during an emergency or for the duration of potential isolation, such as staff, equipment, supplies and essential services, and

• potential impact on communication infrastructure.

3.3.2 Shelter indoorsTo shelter indoors is to remain inside a building and limit the exposure to unhealthy conditions in the air outside such as gas leaks, smoke and other air contaminants.

On receiving advice to shelter indoors, people should go indoors immediately, close all doors and windows, turn off heaters, air conditioners and exhaust fans, and listen to the radio or television or monitor emergency services websites for the all-clear message.

3.4 Evacuating clients and staffEvacuation is the urgent movement of clients and staff to a safer location using best endeavours from a facility or home to a safer place in response to a threat or imminent impact of an emergency. Depending on the emergency, an evacuation may involve a partial, progressive or full evacuation of the facility.

An evacuation without any prior warning is resource intensive and potentially detrimental to the health and welfare of clients, staff and emergency services personnel. The main priority when deciding to evacuate is the protection of life. An evacuation must be effectively planned and executed.

An evacuation of a facility without any prior warning or notice is the least-preferred emergency response option.

Given the unpredictable nature of emergencies, the Incident Controller may recommend that a service evacuate. If this occurs, the person with delegated authority must decide whether to implement the Incident Controller’s recommendation to evacuate. The department recommends that services follow the recommendation to evacuate unless a risk assessment demonstrates that it would not be possible to evacuate clients and staff safely with available resources, within the recommended time frame.

Victoria Police manages the planning and operational aspects of an evacuation during an emergency. Victoria Police will appoint an evacuation manager to perform a range of tasks and functions leading up to and during any evacuation.

3.5 Decision making – deciding whether to relocate, shelter or evacuate

All service providers must be ready and able to receive advice, notifications, alerts or warnings from the department or emergency services organisations, and be prepared to activate their emergency management plan. It is the responsibility of the organisation to maintain situational awareness, monitor emergency services for information and be prepared to act in a timely and effective manner.

If there is an emergency in the area that may necessitate evacuation, sheltering or a combination of both to protect life, each service must activate its emergency management plan. A consultation, decision-making and notification pathway is provided in Attachment 1.The diagram at Figure 1 shows the timing and triggers that influence the decision to relocate, shelter or evacuate. Decision making authority rests with the Chief Executive Officer or delegate of the service.


Figure 1- Timing of decisions to relocate, shelter or evacuate

Note that some disability and out-of-home care services must relocate on code red days. Refer to the Health and Human Services Emergency Preparedness Policy for further information and detail.

Guidance for service providers when deciding whether to relocate, shelter or evacuate:• Activate your emergency management plan / bushfire plan.

• Assess the situation – find out about the emergency and predicted conditions. It is important to seek information from trusted sources (refer to the Reference guide and glossary).

• Consider the client cohort –numbers of clients, mobility, level of frailty, medicines and resources required to move clients, client records and essential information that will need to accompany patient.

• Review the current staff availability - staff may be personally affected by the emergency and may not be able to support the emergency response.

• Seek advice from the department and consult with key stakeholders to assess available resources. Do not use triple zero (000) to discuss transport assistance with Ambulance Victoria.

• Consider how you will manage if emergency services are unable to access the facility or have limited resources available.

• Develop flexible plans for client transport – do not rely on one source of transport.

• Consider options for alternative accommodation.

• Be ready to make decisions – any decision to relocate, shelter or evacuate must be made on behalf of the service by a person with appropriate authority.

• Communicate with the department for information and advice and inform the department of a decision to relocate or evacuate (refer to Emergency management contacts).

• Maintain situational awareness and continue to revise risk assessments - be prepared to change plans if circumstances alter.

• Communicate with clients next-of kin and keep them as informed as possible.


The diagram at Figure 2 summarises the range of factors that should be considered when planning a response to an emergency.

Figure 2: Decision making criteria for responding to external hazards


3.6 Health and aged care facilitiesHealth and aged care facilities should contact the Regional or State Health Coordinator2 when considering a decision to relocate, shelter or evacuate

When an Ambulance Victoria response is required an Incident Health Commander (Ambulance Victoria) will be put in place to coordinate with the Incident Controller and the Evacuation Manager. This will ensure that the emergency services and the department can work together to protect life.

Where relevant, discuss client transportation plans with the Incident Health Commander before making a decision to relocate or evacuate. Based on geographical locations, the size of the emergency and available resources, it can take on average up to one hour to move one patient or resident in a hospital or aged care facility.

Health and aged care services should maintain communications with the Regional or State Health Coordinator throughout the emergency, to plan alternative accommodation and facilitate the movement of clients. It is important to inform the regional or state health coordinator if there is any alteration to the response plan due to a change in condition.

Refer to the flowchart outlining operational responsibilities for health and aged care facilities during a relocation or evacuation (Attachment 2).

Residential aged care facilities must notify the Commonwealth Department of Health – Victorian office, as soon as they have made the decision to evacuate and it is safe to do so, by telephoning the Emergency Advice and Response Line on 1800 078 709 or via email [email protected].

3.6.1 Altering or ceasing servicesA number of aged care, disability, health and mental health agencies provide services from health and community service centres, through programs and appointments, or services in the home. Organisations providing centre or home-based services to people living independently in the community, need to develop emergency plans for altering or ceasing these services in response to emergencies.

When developing an emergency management plan that includes a decision to alter or cease services, the following factors should be considered:

• the level of risk – consider the potential for bushfire and other emergency situations • options for providing services in alternative ways, such as changing the timing or location of service

delivery• communication plans – detail how clients, families of clients (where appropriate), staff and the

community will be provided information about services that may cease or be delivered in different ways, at different times or at different locations

• arrangements for informing relevant statutory bodies of any statutory clients who are unable to attend programs due to alteration or cancellation of a service

• triggers for altering or ceasing a service and• particular needs of clients and staff.

Guidance for service providers when making plans to alter or cease services:• Assess risk and make decisions on how to act in specific circumstances on specific days.• Determine whether your organisation is subject to directed actions by the department (refer to the

Emergency preparedness policy for clients and services).• Develop a plan for altering or ceasing services when appropriate or required, particularly if you

provide services in high bushfire risk areas. You should decide before the fire season if you will alter or cease all or some services on code red days.

2 Metropolitan health services consult directly with the State Health Coordinator


• Be prepared to act if an emergency threatens to impact on services, clients and staff


4 After emergencies

It is difficult to develop a recovery plan before an emergency happens, but it is useful to have done some planning to help guide the recovery process. For most service providers, recovery will be focused on the:

• health and wellbeing of clients and staff, and • return to business as usual.

It is important to learn from the emergency experience and increase preparedness for future emergencies.

4.1 Health and wellbeing of clients and staffThe first priority of service providers should be to check the health and wellbeing of clients and staff affected by the emergency and make sure that appropriate support, including psychosocial support, is provided as soon as possible. The recovery process may take a long time if the emergency was significant and people may need support months or even years after the emergency has passed.

4.2 Return to business as usualThe return to business as usual will depend on the nature of the emergency, the availability and capacity of staff, the type and extent of damage to buildings and infrastructure, and the availability of essential services after the emergency has passed.

Facilities that were required to shelter during the emergency may need to consider relocating if there has been damage to the building or if essential services such as power, water and telecommunications have been disrupted.

Facilities that have relocated or evacuated will need to assess the nature and extent of any damage incurred at the facility or in the surrounding area. After an emergency it is important to conduct a site assessment to determine if there are any safety issues that have occurred as a result of the emergency and to assess requirements for the clean-up. If work is required to restore the facility it will be necessary to make interim arrangements for clients and staff.

Services that provide care in the home should plan to resume services as soon as possible and plan for the immediate needs of clients who are without support. It may take some time before all areas affected by an emergency are accessible and safe to enter.

A communication plan will be required to ensure clients, families of clients (where appropriate), staff, the department and other stakeholders are kept informed.

Guidance for service providers after an emergency:• Prioritise the needs of clients and staff following an emergency and ensure they have adequate care

and support while they wait for services to return to normal.• Conduct site assessments and consider factors such as safe access and egress, communications,

electrical safety, water sanitation and other health and safety issues.• Communicate regularly with clients, families and staff to keep them informed while waiting for a

return to business as usual.


• Conduct a debrief with staff and relevant stakeholders as soon as possible to discuss the emergency, what worked well and what could be done differently next time.

Attachments

Attachment 1: Consultation, decision making and notification pathways


Text-based description of the consultation, decision making and notification pathways for health and aged care services

Emergency phase Responsibilities Sources of information and advice

Before an emergency • Develop an emergency management plan which outlines clear authority for decision making.

• Consult internally and externally to collect information on risks and assess response options.

• Maintain situational awareness and monitor potential risks

• Department of Health and Human Services

• VicEmergency (www.emergency.vic.gov.au)

• Emergency services• Local government• Local knowledge

During an emergency • Person with delegated authority seeks information from trusted sources and makes a decision to relocate, shelter or evacuate

• Notify the department of the decision• Residential aged care facilities to

also notify the Commonwealth Government Department of Health

• Consult with the department• Seek information and advice

from emergency services (Incident controller may recommend evacuation)

• Health and aged care facilities to contact Incident Health Commander (who will coordinate with the Incident Controller and Evacuation Manager)

After an emergency • Person with delegated authority to maintain situational awareness and make decisions – return to the facility or make plans for long-term relocation for the relief and re-establishment phase

• Regular contact with the department

• Residential aged care facilities to maintain communication with Commonwealth Department of Health


Attachment 2: Operational responsibilities for health and aged care facilities relocating or evacuating


Figure description of the operational responsibilities for health and aged care facilities relocating or evacuating

Key roles involved in relocation or evacuation operations:

• Incident Controller• Evacuation manager• Facility CEO• Incident Health Commander• Regional Health Coordinator• State Health Coordinator

Responsibilities

• The incident controller recommends evacuations.• The evacuation manager oversees execution of evacuation plans• The Facility CEO (or officer responsible for Emergency Management) is responsible for:

– all internal or organisational preparation and communication– ensuring patients, residents or clients are adequately prepared:

• accompanying medicines and care records• necessary clinical supplies and consumables• staff to accompany clients

• The Incident Health Commander is from AV and is responsible for:– operational implementation of evacuation plan as directed by Incident Controller– coordination of evacuation resources– reporting on progress of evacuations.

• Regional Health Coordinator responsibilities are to: – routinely liaise with department– maintain an awareness of decisions made– report on progress– connect with the Regional Control Centre.

• The State Health Coordinator responsibilities are to:– maintain a statewide awareness, – liaise with the department, – report and brief on progress and – connect with the State Control Centre

Communication pathways

In the context of evacuations, the following communications pathways apply

• The Incident Controller and Evacuation Manager communicates with the Incident Health Commander• The Incident Health Commander communicates with the Facility CEO

– The Incident Controller/Evacuation Manager– Regional Health Coordinator

• The Facility CEO Communicates with the Incident Health Commander• The Regional Health Coordinator communicates with the Incident Health Commander and the State

Health Coordinator.


• The State Health Coordinator communicates with the Regional Health Coordinator


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