Management & Regulatory Compliance Department
EMERGENCY OPERATIONS PROGRAM &
PLAN – MANUAL Integrated Health Care System’s Incident-Specific – All Hazards Approach to EMERGENCY PREPAREDNESS PROGRAM COMPLIANCE
Catholic Health Services - Emergency Operations Program and Plan Manual
ORGANIZATIONAL REVIEW AND APPROVAL LOG This Emergency Operations Plan is reviewed and updated as necessary, and at least on an annual basis.
Board of Director’s Approval: Signature: ______Name: Joseph M. Catania Title: President and Chief Executive Officer Date: ______Chief Operating Officer’s Approval: Signature: ______Name: Aristides Pallin Title: Chief Operating Officer Date: ______Chief Medical Officer’s Approval: Signature: ______Name: Mark Reiner, MD Title: Chief Medical Director Date: ______Executive Director’s Approval: Signature: ______Name: ______Title: Executive Director Date: ______Administrator’s Approval: Signature: ______Name: ______Title: Administrator Date: ______Director of Engineering’s Approval: Signature: ______Name: George Saenz Title: Director of Plant Operations / Security Date: ______V.P of Risk Management and Regulatory Compliance’s Approval: Signature: ______Name: Lauretta Foster Title: VP, Risk Management and Regulatory Compliance Date: ______
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TABLE OF CONTENTS
1. EXECUTIVE SUMMARY & INTRODUCTION ...... 2
1.2. INSTRUCTIONS FOR USE ...... 2
1.3. DISCLAIMER ......
1.4. ORGANIZATIONAL REVIEW AND APPROVAL LOG ...... 3
2. RAPID RESPONSE INSTRUCTIONS ...... 4
3. EMERGENCY OPERATIONS PROGRAM AND PLAN ...... 10
3.1. HAZARD VULNERABILITY ASSESSMENT (HVA) ...... 19
3.2. RESIDENT PROFILE ...... 27
3.3. EMERGENCY OPERATIONS ...... 28
3.3B. STAFF ORGANIZATION CHART ...... 35
3.4. ACTIVATION OF THE EOP ...... 37
3.5. EMERGENCY STAFFING STRATEGIES ...... 40
3.6. RESOURCE MANAGEMENT ...... 46
3.7. RELOCATION SITES AND ALTERNATIVE CARE SITES UNDER 1135 WAIVERS ...... 51
3.8. DEMOBILIZATION AND TRANSITION TO RECOVERY ...... 55
3.9. COORDINATION WITH LOCAL RESPONSE AUTHORITIES ...... 55
3.10. TRAINING AND TESTING ...... 57
4. POLICIES AND PROCEDURES ...... 63 4.1 ACTIVE SHOOTER/ARMED INTRUDER ...... 64 4.2. BOMB THREAT ...... 67 4.3. EARTHQUAKE ...... 69 4.4. EMERGENCY ADMITS ...... 72 4.5. EVACUATION AND RESIDENT/STAFF TRACKING...... 75
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4.6. EXTREME WEATHER - HEAT OR COLD ...... 82 4.7. FIRE EMERGENCY – INTERNAL and EXTERNAL ...... 84 4.8. FLOOD ...... 91 4.9. HAZARDOUS MATERIALS ...... 92 4.10. INFECTIOUS DISEASE ...... 93 4.11. LOCK DOWN ...... 94 4.12. MEDICAL DOCUMENTATION ...... 98 4.13. MISSING RESIDENT ...... 99 4.14. POWER OUTAGE ...... 101 4.15. SHELTER- IN- PLACE ...... 104 4.16. SUBSISTENCE NEEDS ...... 106 4.17. LOSS OF FIRE/LIFE SAFETY SYSTEMS ...... 110 4.18. ALL HAZARD INCIDENT GUIDES AND MATRIX ...... 111 4.19 CRITICAL INCIDENTS
5. COMMUNICATION PLAN ...... 126
6. RAPID RESPONSE GUIDES ...... 27
7. APPENDICES ...... 43 8. JOINT COMMISSION EMERGENCY MANAGEMENT REVIEW & RESPONSE -
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Emergency Operations Plan Regulations – Authorities and References Licensure Rule Statute Licensure Authority Emergency Planning Emergency Plan Submission Provider Type Chapter/Part Rules Agency Criteria Regulations Review & Approval Time frame
Assisted 429, Part I & 58A-5, DOEA 429.41(1) FS 429.41(1)(b), FS Review Annually (Re-submit if 408, Part II, FAC 58A-5.026 FAC Local emergency substantive changes) Living FSLicensure Rule management agency Facilities Statute Licensure Authority Emergency Planning Emergency Plan Requires approvalSubmission prior to initial Provider Type Chapter/Part Rules Agency Criteria Regulations Review & Approval Time frame licensure and if a change of 429.41(1) FS 58A-5.036, FAC ownership occurs (Re-submit Emergency 58A-5.026 & 58A- Local Emergency annually as a supplement to the Environmental 5.036, FAC Management CEMP or when substantive Control Plan Emergency Plan Regulations and Review (CEMP Agency changes occur) Supplement) Home 400, Part III 59A-8, AHCA 400.492, FS 400.497(10)(c), FS Annually & 408, Part FAC 59A-8.027 FAC County Health Health II, FS Dept. Agencies Hospice 400, Part IV 58A-2, DOEA 400.610(1)(b), FS 400.610(1)(b), FS Not stated & 408, Part FAC 58A-2.005(1)(c)1.d., County Health II, FS 58A-2.026 FAC Dept. Hospitals (Class III IRF - 395, Part I & 59A-3 AHCA 395.1055(1)(c), FS 395.1055(1)(c ), FS Annually Rehab Hospitals 408, Part II, FAC 59A-3.078 FAC Local Emergency included) FS Management Agency Nursing 400, Part II 59A-4 AHCA 400.23(2)(g), FS 400.23(2)(g), FS Annually & 408, Part FAC 59A-4.126, FAC Local Emergency Homes / II, FS Management SNF Agency
400.23(2)(g), FS 59A-4.1265, FAC Requires approval prior to initial 59A-4.126 & 59A- Local Emergency licensure and if a change of Emergency 4.1265, FAC Management ownership occurs (Re-submit Environmental Control Plan Agency annually as a supplement to the (CEMP CEMP or when substantive Supplement) changes occur)
Federal E-Tags Emergency Preparedness Program and Plans
The below table offer a glance at the different categories the E-tags are placed in.
Establishing a Emergency Preparedness Emergency Preparedness Emergency Preparedness Emergency & Standby Comprehensive Policies Training Communication Power System Emergency Preparedness & & Plan Requirements Program & Plan Procedures Testing
E-0001 E-0013 E-0029 E-0036 E-0041
E-0004 E-0015 E-0030 E-0037 E-0042
E-0006 E-0018 E-0031 E-0039
E-0007 E-0019 E-0032
E-0009 E-0020 E-0033
E-0022 E-0034
E-0023 E-0035
E-0024 E-0025 E-0026
E -TAGS CROSS-REFERENCED TO EOP EXCEL TEMPLATE – E TAGS
AUTHORITIES AND REFERENCES
The Executive Director and / or Administrator of this facility have the authority to make all decisions to support the goals of our emergency operations plan and also the CEMP.
This Florida nursing home utilizes these federal and state laws and rules in developing our plan: Chapter 400.23 (2)(g), Florida Statutes Chapter 59A-4, Florida Administrative Code 42CFR 483.70(b)(1)-(2); (h) 42CFR 483.75 (l)(3); (m); (m)(2)
Other reference material includes: Agency for Health Care Administration’s Emergency Management Planning Criteria for Nursing Homes County All Hazard Guide – Miami-Dade and Broward Counties Florida Division of Emergency Management, http://www.floridadisaster.org Catholic Health Services Risk Management Department’s Emergency Operations Program & Plan / Manual American Red Cross - Hurricane Preparedness Seminar National Response Framework / NIMS FEMA Disaster Preparedness Training
COVER -EXEC SUMMARY TO THE EOP - CHS HEALTHCARE ENTITIES
Emergency Operations Plan Initiation Process
INCIDENT
CEO Facility Data Community COO Exec Director / Data Administrator
Stand-by Alert No Alert Initiation
Alert
Facility-wide Emergency Response Plans
Severe Bio- Mass Utility Electrical Hurricane Workplace All Violence Others Weather terrorism Casualty Failure Tornado System
Departmental Emergency Response Plans
Engineering Purchasing / Nursing Security Nutrition Environmental Human Social / Plant Ops Procurement Services Resources Services
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Catholic Health Services Emergency Operations Program and Plan - Manual 1. OVERVIEW 1.1 OVERVIEW This Emergency Operations Program and Plan (EOP) is provided by Catholic Health Services (CHS) Risk Management Department. As an integrated healthcare system, it is provided to all CHS healthcare entities as their Emergency Operations Plan (EOP), and incorporates various best practices in addition to regulatory requirements.
OVERVIEW - CHECKLIST FOR CMS EMERGENCY PREPAREDNESS RULE COMPLIANCE
RISK MANAGEMENT EM MANUAL #2 JOINT COMMISSION EMERGENCY MANAGEMENT REVIEW & RESPONSE -
1.2. INSTRUCTIONS FOR USE Each facility’s Emergency Operations Program and Plan address the specific nature of the facility’s geographical risks, unique population, organizational structure, community capabilities, and federal, state, and local regulatory requirements. For that reason, facility- specific information is inserted in several areas within this EOP. Also important to note is that significant customization is included for some facilities so that they accurately describe the facility’s specific policies. For succession planning, this Plan utilizes the Nursing Home Incident Command System (NHICS) as an organizational concept. The Plan is reviewed on an annual basis, as required by these CMS regulations.
Risk Management Note: Here are some key items addressed within the Plan:
Sections highlighted in yellow have facility-specific information attached. Some sections have documents attached such as the Facility Site Map, Disaster Meal Menus, Emergency Mutual Aid Agreements, Vendor List, etc. All potential hazards are addressed in this manual. Policies and procedures are added for hazards that are prominently identified and addressed in each facility’s risk analysis. Appendix A: Acronyms – will be reviewed and updated as needed Once completed and approved, signature pages are signed (including the Board of Directors) and dated initially and at the review, at least annually.
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1.3. ORGANIZATIONAL REVIEW AND APPROVAL LOG This document is Catholic Health Services’ Emergency Operations Program and Plan (EOP) and states our understanding of how we will prepare for, manage and conduct actions under emergency conditions. It will be reviewed and updated as necessary and at least on an annual basis. This EOP has been reviewed and approved by our organization’s leadership.
Board of Director’s Approval: Signature: ______Name: Joseph M. Catania Title: President and Chief Executive Officer Date: Chief Operating Officer’s Approval: Signature: ______Name: Aristides Pallin Title: Chief Operating Officer Date: ______Chief Medical Officer’s Approval: Signature: ______Name: Mark Reiner, MD Title: Chief Medical Director Date: ______Executive Director’s Approval: Signature: ______Name: ______Title: Executive Director Date: ______Administrator’s Approval: Signature: ______Name: ______Title: Administrator Date: ______Director of Engineering’s Approval: Signature: ______Name: George Saenz Title: Director of Engineering / Security / LSO Date: ______V.P of Risk Management and Regulatory Compliance / Safety Officer’s Approval: Signature: ______Name: Lauretta Foster Title: VP, Risk Management and Regulatory Compliance / Corporate Safety Officer Date: ______Section 2: Rapid Response Instructions | Pg. 3
Catholic Health Services Emergency Operations Program and Plan - Manual 2. RAPID RESPONSE INSTRUCTIONS
ACTIVATION Follow these steps if you recognize a potential or actual emergency that may threaten or impact:
• The health and safety of occupants (including residents, staff, and visitors) • The facility’s ability to provide care, or the physical environment or property
STEP 1 Protect yourself and those in the immediate area from harm. If appropriate, call 9‐1‐1 for emergency response and sound the facility’s alarm and/or overhead code if appropriate per the Emergency Operations Plan. (See Rapid Response Guides for hazard‐specific protocols.)
STEP 2 Take a deep breath and assess the situation. Gather basic facts: Type of incident, including specific hazard/agent, • Location of incident, • Number and types of injuries, and • What you have done so far. If the situation allows, begin to document your actions
STEP 3 Contact your immediate supervisor to report the incident and get further instructions. If you are unable to contact your supervisor, activate the Incident Commander (IC) position and the Emergency Operations Plan (EOP). Activate overhead codes or facility emergency alert system as appropriate.
STEP 4 Notify additional authorities if appropriate and indicated by protocols.
STEP 5 Follow facility policies and procedures for extended response, documenting actions and incident reporting. For quick reference, Rapid response guides for initial response to common threats can be found in Section 5.
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INTERNAL CRITICAL CONTACTS
Name/Title Primary Telephone Secondary Telephone
(See Staff Roster as attached)
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EXTERNAL CRITICAL CONTACTS
Type Tel #/ Email Contact Name Rescue 9 – 1 – 1 9-1-1 (Police / Fire / Ambulance) Police – Non Emergency:
Your Facility:
Fire Marshall:
Local State Survey Agency : AHCA Ombudsman’s Council:
Local Public Health Agency- County: Department of Health Local Emergency Management Agency: County’s Emergency Management Division Ambulance Company #1: (AMC) Ambulance Company #2: American Ambulance Transportation:
Light /Power Company: FP&L
Gas Company
Telephone Company
Water System
Sewer System
Other:
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Type Tel # / Email Contact Name
Fire Alarm System
Fire Protection – Sprinkler System
Security Alarm System
Emergency Water Supply
Emergency Food Supply
Additional Staff
Other:
FACILITY PROFILE Facility Name
Facility Address
Facility Location (Cross streets, map coordinates, landmarks)
Facility Telephone #
Facility Fax #
Facility Email
Facility Web Address
Administrator/Phone #
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DESCRIPTION CONTACTS
Alternative Emergency Executive /Phone #
Maintenance Coordinator/Phone #
Insurance Agent/Phone #
Owner/Phone #
Attorney/Phone #
Year Facility Was Built
# of Licensed Beds
Average # of Staff – Days
Average # of Staff – Evenings
Average # of Staff – Nights
Emergency Power Generator Type
Emergency Power Generator Fuel
Emergency Communication System
Like‐Facility #1 for Resident Evacuation1 (within 10 miles)/Phone #
Like‐Facility #2 for Resident Evacuation (within 10 miles) /Phone #
Like‐Facility for Resident Evacuation (beyond 25 miles) /Phone #
Like‐Facility for Resident Evacuation (beyond 25 miles) /Phone #
Other Emergency Contacts
1 Our facility has a Memorandum of Understanding (MOU) with at least one nearby “sister” CHS facility and one out‐of‐the‐immediate‐area facility to accept evacuated residents, if able to do so. Section 2: Rapid Response Instructions | Pg. 8
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FACILITY SITE MAP WITH EMERGENCY SHUT-OFF LOCATIONS
See Appendix _____
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3. EMERGENCY OPERATIONS PROGRAM & PLAN atholic Health Services (CHS) healthcare facilities are part of an Integrated Healthcare System, which consist of multiple separately-certified health care C facilities / service-lines (LTC / SNF / Class III IRFs (Rehab Hospitals) / Home Health / Catholic Hospice) that elect to have a unified and integrated emergency preparedness program, thus, each facility / service line choose to participate in the organization’s coordinated emergency preparedness program.
This document describes the Emergency Operations Program and Plan (EOP) for Catholic Health Services Health Care Entities as follows:
LONG TERM CARE / SNF:
o Villa Maria Nursing Center o Villa Maria West Skilled Nursing Facility o St. John’s Nursing Center o St. Anne’s Nursing Center o St. Anne’s Residence (ALF) o St. Joseph Residence (ALF)
REHABILITATION HOSPITALS:
o St. Catherine’s Rehabilitation Hospital o St. Catherine’s West Rehabilitation Hospital o St. Anthony’s Rehabilitation Hospital
Each facility’s EOP uses an “all-hazards” approach for emergency planning and response. This includes several elements:
An integrated approach to emergency preparedness planning with a focus on essential capabilities/capacities for effective response to a wide range of emergencies and disasters An Emergency Operations Plan based on a risk assessment that addresses the array of hazards that this facility may face Policies and procedures with strategies that reflect our population’s unique needs and vulnerabilities Collaboration with local, state and federal response partners Coordination with other health facilities A detailed communication plan Emergency operations strategies for response and recovery Training that applies to all members of program administration and staff in all departments and non-staff members who perform work at the site including clinical providers, technicians, contractors / vendors, students, volunteers, and ancillary staff Annual testing of the plan with the goal of identifying areas for further planning Annual review of the Plan Foster / CHS Risk Management Section 3: Emergency Operations Plan | Pg. 10
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This document states CHS’ understanding of how we will manage and conduct actions under emergency conditions. It is customized to our facilities and incorporates the response strategies of our communities. It is updated as needed, reviewed at least annually, and approved by our organization’s leadership (see Review Log, pg. 3).
The purpose of our Emergency Operations Plan (EOP) is to describe our all‐hazards approach to emergency management, and by so doing, support the following incident objectives: o Maintain a safe and secure environment for residents, staff and visitors o Sustain our organization’s functional integrity, including our essential services and business functions (emergency operations) o Coordinate with the community’s emergency response system
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4. Timeline for Disaster Preparedness Activities
The following activities will occur as discussed:
January: At the Risk / Safety Management meeting, we will establish a disaster preparedness timeline for the facility for the year. The previous year’s experiences will be critiqued / evaluated. Plan revisions for facility’s emergency management plan, and establish a deadline to submit the revised emergency management plan to the local office of emergency management. Procedures and timelines for consistently backing up facility electronic records on and off site should be reviewed, and any necessary changes implemented. Establish a training and exercise/drill schedule for the year.
February: Conduct a strict review of the physical plant (inventory equipment) and make replacements and/or upgrades if necessary. Perform all required and necessary maintenance/repair service on the facility’s generator(s); order any essential spare parts to stockpile to ensure availability in the event of an emergency. Ensure that electronic records are being consistently backed up.
March: Certify contracts with outside vendors, adjusting contracts to meet expected needs and to ensure adequate supplies. Contact dialysis providers and plan for emergency services. Continue evaluation and review of physical plant and equipment. Ensure that electronic records are being consistently backed up.
April: The revised disaster/emergency management plan should be submitted to local (county) emergency management department/office by now. Conduct annual facility staff education. Continue to certify and adjust contracts with outside vendors. Key facility staff should be in communication with and kept up-to-date by the local OEM. Ensure that electronic records are being consistently backed up.
May: Go to the state licensing agency’s electronic tracking system and make sure all of your pre-event information is up-to-date. Implement education for residents, resident’s family/relatives/caregivers, and the community. Involve local media. Continue to certify and adjust contracts with outside vendors. Ensure that electronic records are being consistently backed up.
June: Conduct internal and external drills, involving community members and local emergency services. Ensure that electronic records are being consistently backed up.
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July: Send notification to resident’s family/relatives/caregivers about the disaster plan and evacuation procedures. Ensure that electronic records are being consistently backed up.
August: Review and update resident information, including advance directives, mental health, and resident forms of identification. Update emergency staffing schedule (key staff listing), and get employee commitments. Ensure that electronic records are being consistently backed up.
September: Conduct ongoing reviews of disaster preparedness. Educate new staff and new residents and their families/relatives/caregivers on emergency protocols. Ensure that electronic records are being consistently backed up.
October: Conduct ongoing reviews of disaster preparedness. Educate new staff and new residents and their families/relatives/caregivers on emergency protocols. Ensure that electronic records are being consistently backed up. Review facility data listed on the state licensing agency’s electronic tracking system.
November: Conduct ongoing reviews of disaster preparedness. Educate new staff and new residents and their families/relatives/caregivers on emergency protocols. Ensure that electronic records are being consistently backed up.
December: Begin review of disaster preparedness plan. Review responsible parties’ checklists. Review evaluations and debriefing notes of exercises/drills and incorporate needed changes into the plan. Evaluate the EOP and CEMP. Ensure that electronic records are being consistently backed up
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RISK ASSESSMENT & PLANNING 1
1. Risk Assessment and Planning RISK ASSESSMENT& PLANNING
Emergency Preparedness Planning Checklist Facility Based Hazard Vulnerability Analysis (HVA) Emergency Operations Plan Activation 1 Essential Services Roles and Responsibilities Contact Grid
E
Emergency Preparedness Planning Checklist
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Alerting Residents
The plan addresses how residents will be alerted to emergencies. The facility’s command team, and in particular, the Public Information Officer is prepared to draft key information important to share with residents.
This information will include: the nature and scope of the threat whether or not the facility’s emergency plan has been initiated at what stage of the emergency plan activation the facility is in intent to evacuate and where they will be moved if their family has been notified how they will be protected how they will be kept informed how they can help or be involved how soon normalcy is expected to be reestablished whether there is an appropriate media outlet for cognizant residents to watch to help keep themselves informed Psychological First Aid Information about disaster response activities and services: To help reorient and comfort residents, the following information will be provided What to do next What is being done to assist them What is currently known about the unfolding event Available services Common stress reactions Self-care, family care, spiritual care, and coping Ask residents if they have any questions or concerns
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Alerting Family:
The emergency operations plan describes how and when family members are notified of the emergency status. The facility established a system for responding to family requests for information. The plan contains a list of the information the facility will share with family members. Some basic information includes: o the condition of family member’s resident o the nature and scope of the threat o whether or not the emergency management plan has been officially initiated o at what stage of the emergency management plan the facility is in o intent to evacuate at the point of the initial call receiving host facility information (in the case of an evacuation) as appropriate
Statement 3 – Alerting Family Members:
Depending upon the nature of the emergency, the Public Information Officer / Administrator, and / or selected department heads or designee will meet and decide the best available information to relay to family members. The resulting family call script will be distributed to our pre- designated, trained persons in the business office to begin the process of notifying family members regarding the facility’s current status and plans. In the event of a Category 3 or greater hurricane threatening to make landfall, the facility will evaluate which families may want to pick up residents should evacuation occur. All requests for information from family members will be referred to the designated, scripted persons in the business office.
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Alerting Host Receiving Facility
A host receiving facility is the destination for a partial or full facility evacuation. MOU’s with the Host receiving facilities are arranged in advance during non-emergency times. These facilities are geographically located in areas of close proximity, within-area proximity, and out- of-area proximity to give the nursing home the greatest probability of moving residents the shortest, yet, safest, distance. In the case of a partial evacuation, more vulnerable and at-risk residents may be moved to a hospital. When it appears likely that a partial evacuation will take place for certain residents, the Liaison Officer or Resident Services Branch Director will contact the hospital to communicate and organize admissions. It may be that the hospital is under stress as well and may have implemented their own emergency procedures, so it is best for there to be a prior understanding of how the hospital and nursing home may serve one another during times of crisis. (MOUs are needed) As a planned emergency event threatens (such as a hurricane), the nursing home / SNF will touch base early with their destination (host) facilities to alert them that an evacuation may be a possibility. As conditions worsen, the transferring facility will communicate regularly with the most likely (host destination facilities and verify departure and arrival times, resident records transfer, and the provision of staff and supplies. The status of the intended destination facility may also be impacted by the emergency event so regular communication will benefit both facilities in managing their evacuation response.
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See Memoranda of Understanding between facilities
Essential Services Roles and Responsibilities
Emergency Preparedness Planning Checklist
COMPLIANCE OVERVIEW EM CHECKLIST – CHS Facilities
The Emergency Preparedness Checklist will help the facilities in emergency
preparedness planning. The checklist reviews major topics that emergency ASSESSMENT RISK & PLANNING preparedness programs address, and provides information on details related to those topics.
RISK ASSESSMENTS:
ICRA IC PLAN INTERNAL CONTROLS APPRAISAL – RISK EXPOSURES NFPA-99 RISK ASSESSMENT HVA – VMNC HVA – VMWSNF HVA – SJNC HVA – SANC HVA – SCRH HVA – SARH FALL - FAILURE MODES AND EFFECTS ANALYSIS - GAP ANALYSIS 1
Comprehensive emergency management includes four phases: preparedness, mitigation, response and recovery. A critical component of the preparedness phase is assessing risks and vulnerabilities, and a common tool used for this purpose is the Hazard Vulnerability Assessment / Analysis (HVA). For this reason, each facility has completed an HVA that is reviewed annually. During this process we have considered both internal and external hazards that could result in:
Care-related emergencies Equipment and power failures Interruptions in communication Loss of a portion or all of a facility Foster / CHS Risk Management Section 3: Emergency Operations Plan | Pg. 18
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Interruptions in the normal supply of essentials resources ASSESSMENT RISK PLANNING &
Additionally, we have consulted with the local response authorities to ensure we are aware of all hazards specific to our respective community.
3.1. HAZARD VULNERABILITY ASSESSMENT (HVA) Facility-based Hazard Vulnerability Assessment (HVA)
HVA – VMNC HVA – VMWSNF / SCRH HVA – SJNC HVA – SANC HVA – SCRH HVA – SARH / SJNC
Developing polices and their supporting procedures are based on the facility’s Hazard Vulnerability Assessment (HVA).
A HVA is specific to each individual facility and the environment of the community they reside. It is a process of looking at various hazard scenarios (natural and man-made) and determining or estimating the probability and potential impact of each scenario. The level of current preparedness is also a factor. Much of this assessment is performed by facility staff; however, in addition to input from various response community partners such has the local health department, local emergency management, fire and law enforcement. 1
The results of the attached HVA rank scenarios by assigning each a “Risk Value” in percent such that a high percent “Risk Value” implies a high urgency scenario. Therefore, risk management concentrated on the highest 3-5 hazard scenarios to insure they are addressed first in the facility’s planning effort. Other hazard scenarios are currently addressed in the plan’s policies and procedures, and as needs are identified. We consulted with our respective local Emergency Management Divisions for unique or specific hazard scenarios for our community.
For our initial Hazard Vulnerability Assessment, we completed the following six‐step process:
1. Established the participants in the HVA process. We involved knowledgeable stakeholders, community emergency management partners and historical experiences, etc. in the HVA process. The community‐wide HVA, typically conducted by the local
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office of emergency management, was also used to identify threats external to our
facility. RISK ASSESSMENT PLANNING & 2. Identified the hazards. This step consisted of identifying all of the hazards that could significantly impact operations, the care of residents, or unusual service needs. Internal hazards (e.g., failure of HVAC) and external hazards (e.g., earthquake) were considered. 3. Assessed the hazard‐associated “risk” (probability and consequence). Risk is the product of probability and consequence. Each identified hazard was assessed according to its probability and impact (consequences). 4. Ranked the hazards by magnitude of risk. This step involved sorting the risks into categories: either high risk, moderate risk, or low risk. This judgment included information from emergency management officials aware of community vulnerabilities, such as flood zone information, seismic risk, etc.
5. Analyzed the vulnerability of “mission‐critical” systems to each hazard. This step assessed vulnerabilities relative to human impact, property and facility impact, and
operational impact.
6. Prioritized the vulnerabilities and implemented risk intervention activities (mitigation) as appropriate. Generally, our vulnerabilities are ranked by the following priorities: a. Life safety threat (injury/illness, death, short and long term health risk) b. Disruption of facility operations c. Business system failure 1 d. Loss of customer/community trust and/or goodwill e. Property and/or environment damage f. Liability and/or legal/regulatory exposure
Our most recent Hazard Vulnerability Assessment can be found in Appendix ___
Based on the results of the HVA, the mitigation strategies we considered and included, but are not limited to, the following:
The use of appropriate building construction standards. Relocation, retrofitting or removal of structures at risk. Segregation of the hazard from that which is to be protected. Provision of protective systems or equipment. Establishing hazard warning and communications procedures.
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Redundancy or duplication of critical systems, equipment, information, operations, or materials.
Top Five Risks (per the facility’s HVA): RISKASSESSMENT PLANNING & Our HVA process has determined that the top five risks facing this facility include those listed below:
Facility: Villa Maria Nursing Center
1. Hurricane 2. Active Shooter 3. Electrical Failure 4. Missing Resident / Elopement 5. Flood
Facility: Villa Maria West SNF
1. Hurricane 2. Active Shooter 3. Electrical Failure 4. Missing Resident / Elopement 5. Flood
Facility: St. Anne’s Nursing Center 1
1. Hurricane 2. Active Shooter 3. Flood 4. Bomb Threat 5. Radiologic Event
Facility: St. John’s Nursing Center
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Situation
The situation section of the plan brings into focus specific hazards, geographic characteristics, resident vulnerabilities, and planning assumptions unique to the facility.
Risk Assessment The emergency operations plan identifies the potential hazards for the local area and briefly describes the impact they could have on the facility. Past experiences and lessons learned are included in describing risks. Included are unique physical plant details improving or aggravating the facility’s vulnerabilities.
Potential Hazards and Impact:
A list of potential hazards and its brief impact statement follows:
Hurricanes: Hurricanes are catastrophic storms that bring torrential rains, high winds, squalls, and devastating storm surges over a geographic area several hundred miles across. All these hazards may impact a facility, disrupting normal operations, or even necessitate partial or complete evacuation. Severe Weather Events: Severe weather comes in many forms. While the potential for severe weather can be forecast, a specific severe weather event cannot be predicted until the event actually occurs or until a very short time right before impact. Facilities will have little time to react to a severe weather event. Severe weather can include hail, intense cloud-to-ground lightning, torrential rain, strong winds and tornadoes/waterspouts.
Biological Events: Biological events, either natural or man-made, pose a grave threat to the nursing home population as this population is already a frail, at-risk group. The compromised state of most nursing home residents can allow a normally minor
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pathogen to become lethal and can facilitate a rapid spread and escalation of the event.
Hazardous Materials Events: Hazardous materials disasters can occur externally, such as an explosion at a chemical processing plant, or from an accident involving trains or tanker trucks. Hazardous materials events can also occur within a facility, such as improperly mixed cleaning chemicals and solutions, industrial solvents necessary for mechanical systems, or even a lethal build-up of carbon monoxide. Hazardous materials disasters can occur without warning and may initially go unnoticed.
Fire: Fire threatens the residents of a facility as it could spread faster than frail, weak, and incapacitated individuals could evacuate. Individuals with compromised respiratory systems could be overcome by smoke and gasses much faster than healthy individuals.
Wildfire: Wildfires present a burning hazard in rural or low-density urban areas. The smoke from wildfires present respiratory hazards, but one does not have to be near the wildfire to receive negative impacts of the smoke. Wildfires may develop quickly (lightning strike, camp fire, cigarette butt), or may travel a distance over several days.
Extended Power Outages: Extended power outages can disrupt normal operations of the facility. Equipment not connected to emergency power will not operate. Heating, cooling, food preparation and other infrastructure may be impacted. An extended power outage lasting several days may exceed the life of battery backups and fuel supply.
Winter Storms: Winter storms can bring a geographic region to a complete standstill. All transportation (air, rail, highway, and river) may be stopped by ice. Facilities may be literally cut off from the rest of the world, unable to acquire supplies, move staff, or send residents to the hospital. Utilities may be disrupted for a lengthy period of time.
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Earthquake: Earthquakes are among the most unpredictable and devastating of natural disasters. The U.S. Geological Survey can issue warnings when the potential for an earthquake is significant, but exactly when, where, or if an earthquake will occur cannot be determined. Individuals and facilities within an area with earthquake potential must mitigate the threat through structural engineering, planning, and training. Much of the survivability for earthquakes relies upon two actions: 1) thorough staff training; and 2) structural engineering and construction to mitigate the threat from earth movements.
Sink Holes: The opening of a sinkhole may be a threat if a road, the facility or other structure is located in immediate proximity to the developing sinkhole. There may be a certain degree of risk the facility’s location being in a region with significant sinkhole potential. As groundwater levels drop in high-population areas, especially during times of drought, landscaping contractors and facility maintenance personnel will be asked to monitor the grounds for any potential emerging threats to both buildings and vehicle access on the property resulting from ground depressions or forming sinkholes. Zones and Local Points of Interest These geographic details are included in the facility’s emergency management or emergency operations plans and guides policy development and decision-making: hurricane evacuation zone as provided by the local office of emergency management flood zone as provided by the local office of emergency management (this info comes from the Flood Insurance Rate Map) surge zone as provided by the local office of emergency management (OEM)
Included is the facility’s proximity to any local points of interest that might affect or impact the facility in a unique way. Local points of interest are: Naval port Airport Railway Foster / CHS Risk Management Section 3: Emergency Operations Plan | Pg. 24
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Coastline Major transportation artery River Levee Chemical plant Nuclear energy facility such as Turkey Point
Planning Assumptions
Planning assumptions / elements of information used in developing the emergency operations plan which are sound assumptions, rather than fact.
Assumptions: o Emergency management activities are initiated and conducted using the facility’s comprehensive emergency management plan and the emergency operations plan. o The facility relies on the expertise and capabilities of local and state government to help prepare for, respond to, and recover from incidents of statewide public health significance. o The facility uses all available resources before requesting government assistance. o Facility’s evacuation and sheltering relies upon county and regional Emergency Management information, transportation agreements, MOUs, Contracts, Corporate directives and the best available options at the time. o Arrangements with regular vendors who provide food, water, medicine, etc. may be disrupted during an emergency; vendor contract for essential supplies contains a plan for how the supplies will be delivered during emergencies. o Dialysis centers may lose electrical services in the event of a major power outage, affecting residents who require routine dialysis services. Foster / CHS Risk Management Section 3: Emergency Operations Plan | Pg. 25
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o The nursing home will likely experience a disruption in utilities, including electrical services and water, for an extended period of time. o Facilities with whom the nursing home has a mutual aid agreement may also be negatively impacted and not be able to serve as a host receiving facility. o The delivery of contracted transportation services may be compromised depending upon heavy demand, impact of the emergency on the transportation provider, and condition of the roads. o The facility’s staff and their family members will also be affected by the ASSESSMENT RISK & PLANNING emergency and this may reduce the number of staff available to provide care and services to the residents. o Hospitals will likely experience increased demand for services along with a disruption in their supplies which may affect treatments and admissions. After an emergency which results in a power outage, the facility’s generator(s) will require close monitoring, may fail, or run out of fuel.
1
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3.2. RESIDENT PROFILE In our facility, all residents are at risk during emergencies due to their unique health needs. To ensure that we design procedures that will support these needs, we have completed a resident profile that identifies the common services our facility provides.
Capacity / Number of residents we are licensed to provide care for: _____. Our average daily census: _____.
We serve residents with the following common diseases, conditions, physical and cognitive
disabilities, or combinations of conditions that require complex medical care and management. ASSESSMENT RISK & PLANNING
SPECIAL TREATMENTS AND CONDITIONS COMMON IN THIS FACILITY Special Treatments Number/Average or Range of Residents Cognitive or Behavioral needs Intellectual Disabilities Daily nursing care Respiratory Oxygen therapy Treatments Suctioning Tracheostomy Care 1 BIPAP/CPAP Mental Health Behavioral Health Needs Other IV Medications
Injections
Dialysis Ostomy Care Hospice Care Isolation for Active Infectious Disease
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NEEDS FOR ASSISTANCE WITH ACTIVITIES OF DAILY LIVING Assistance with Number of Number of Number of Activities of Daily Living Independents Residents Needing Dependents Assist of 1-2 Staff Dressing Bathing Transfer Eating Toileting Mobility
Vulnerability Assessment for Residents:
The facility’s administrators, medical directors, nurses, and therapy directors understand all too well that the acuity of their residents increases the likelihood of injury or death in the event of an emergency. The presence of residents with complex clinical conditions requiring the regular use of oxygen, routine dialysis treatments, or tracheotomy care, etc. raises the stakes for emergency planning for each facility and the local emergency management system. Moving to a safe place is complicated by a resident population of non-ambulatory and bed-fast persons who require partial or total assistance with ADLs. Additionally, there may be unique needs related to a bariatric (morbidly obese) population requiring special equipment and lift and transfer techniques. Further, a large percent of the facility’s residents may suffer from cognitive disorders causing severe functional disability. We begin with the emergency planning vulnerability assessment by defining the facility’s resident characteristics. The EOP include the clinical condition of the residents served as well as the numbers of residents having certain conditions that will increase their risk of harm during an emergency event.
The facility’s emergency operations plan includes the clinical conditions represented in the facility, the number of residents which have each condition, and how the clinical conditions aggravate vulnerabilities.
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Residents with conditions requiring these clinical management programs are frequently cared for in our facilities: Dialysis Management: Residents with end stage renal disease are vulnerable to power outages, transportation delays, and closure of dialysis sites. This population requires acute management of their renal condition. Action Steps: o Identification of alternate sites and transportation venues. o Pharmacy will work with the facility to secure a 7 to 10 day supply of related medications and an expanded EDK kit or Pyxis supply that is adequate to address elevated potassium levels. o Dietary will coordinate a renal diet. o The Medical Director will assist in the development of alternative protocols for management of ESRD (Kaoexylate, etc.) Respiratory Management: This includes, but is not limited to, residents with respiratory conditions such as COPD, chronic and acute CHF, pneumonia, respiratory infections, asthma, and related disease state and problem conditions. They are oxygen dependent, may have tracheostomies, or require respiratory management via suction machines, nebulizers, bi-pap machines, or related respiratory equipment that requires electricity. Power outages could influence the ability to sustain an open airway and/or effective airway clearance and breathing capacity. This population is also more vulnerable to the effects of smoke inhalation or impaired air quality that occur secondary to a disaster. Action Steps: o The facility will sustain a 7 to 10 day inventory of suction catheters, oxygen masks and related equipment needed to treat condition s of the respiratory tract. o Transportation arrangements will include safety provisions for oxygen canisters or portable oxygen cylinders.
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Pain Management: This includes, but is not limited to musculoskeletal, orthopedic, and neurological conditions. Power outages could influence the ability to sustain I.V. pumps used for the management of pain, in addition to the provision of ultrasound, hot packs, electric stimulation, specialty bed utilization, and modalities provided through nursing or therapy. o Pharmacy will work with the facility to secure a 7 day supply of related medications and an expanded emergency medication kit that is adequate to address the titration of pain. Action Steps: . List of residents on around the clock (RTC) dosing and route of administration. . List of residents on hospice or palliative care programs. . Non-pharmacological approaches will be utilized as appropriate to individual needs. . Battery backup for specialty beds, or overlay mattresses. Behavior Management: This population includes, but is not limited to those with Alzheimer’s and related dementias, with psychiatric or mood disorders, or pre- existing conditions such as COPD or cardiac conditions that could be accelerated related to stress and anxiety. Power outages could accelerate behavioral manifestations, or declines in mood state. Outages also increase the risk for elopement within secured units or for those that use an electronic departure alert system. Action steps: o Exits will be monitored. o Permanent staff assignments as available for continuity. o Resident preferences/routines identified. o Pharmacy will work with the facility to secure a 7 to 10 day supply of related medications and an expanded EDK kit for use as indicated per individual assessment and physician recommendations. o Diversionary activities will be coordinated with staff/volunteers. Foster / CHS Risk Management Section 3: Emergency Operations Plan | Pg. 30
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Infection Control Management: This population includes those currently undergoing treatment of infection or those that develop acutely emerging infections. Vulnerabilities include those with communicable diseases such as clostridium difficile, MRSA, and VRE as well as respiratory infection, conjunctivitis, and related conditions. Power outages can impact the water supply, waste disposal, and the ability to operate electrical equipment used in the management of infections such as intravenous therapy, respiratory equipment, wound pumps, sanitizing equipment, etc. Action Steps: o HVAC / generator and fuel provisions will be coordinated. o The facility will provide a 7 day supply of gowns, gloves, gels, masks, Biohazardous supplies, and related infection control products and equipment. o List residents with ports or IV sites. o List residents on antibiotic therapy. o List residents with communicable conditions that may need to be cohorted or isolated. o Identify provision for waste management and biohazardous disposal. o Pharmacy will work with the facility to secure a 7 to 30 day supply of related medications and an expanded EDK kit for use as indicated per individual assessment and physician orders.
Hospice and End of Life Care Management: This population includes but is not limited to residents with an end stage condition, six months or less life expectation, or on hospice. Conditions vary and symptom management is dependent on the underlying conditions and co-morbidities. Loss of power could impact on the ability to provide respiratory support, pain management, nutritional support, and surface support. Foster / CHS Risk Management Section 3: Emergency Operations Plan | Pg. 31
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Action Steps: o The facility will provide a 7 day supply of supplies and equipment targeted to symptom management and comfort, in keeping with Advance Directives and resident wishes. o Pharmacy will work with the facility to secure a 7 to 30 day supply of related medications and an expanded emergency medication kit for use as indicated per individual assessment and physician orders / recommendations. o Current face sheets and list of Advance Directives/DNRO, and designated decision maker information and contact numbers. Falls Management: This population includes a wide selection of the diverse and complex resident population. Areas of vulnerability could be related to power loss, call light system failures, environmental and situational hazards, changes and alterations in care systems and routines to include factors such as loss of adequate lighting, failure of call light systems, and relocation, or a new arrangement to living areas. Additional risk factors may include chronic or acutely emerging factors such as: cardiac problems, muscle weakness and/or fatigue, transient ischemic attacks, seizures, stroke, Parkinson's disease, delirium, psychiatric or cognitive conditions, joint immobility, depression, unsteady gait, history of fractures, failure to use ambulatory aids, orthostatic hypotension, incontinence of bowel or bladder, impaired vision and/or hearing, dehydration, lower extremity swelling or edema, missing limb, illness such as infection. Action Steps: (See the Fall Program FMEA / Gap Analysis) o Provide consistency in routines and caregiver assignment as possible. o Involve in diversional or volunteer activities. o Provide for enhanced monitoring with call system failures secondary to power loss.
Nutritional Management: This is a need that addresses the entire resident population. Varied diseases and conditions can influence vulnerability and create a need for increased nutritional requirements. Conditions such as COPD increase caloric needs during times of stress. Among these are acute infections such as gastrointestinal influenza and/or related diseases that could emerge secondary to a
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disaster. Power failure could create vulnerability in populations that require: enteral or parenteral feedings, IV therapy, dialysis and those with the potential for unstable blood sugars, (often triggered by stress). Acutely emerging conditions may warrant enhanced IV support with increased risk for dehydration and related conditions. Evacuation from the facility creates the risk of prolonged travel time and risks associated with transfer. Action Steps: o Identify those residents on special diets, (diabetic, renal, no added salt, etc.) those receiving enteral feedings (especially bolus), those on supplements, and those at risk for weight loss or dehydration. o Review the inventory of fluid thickener products and resident specific feeding approaches for dysphagia management, and ensure 7 day supplies. o Identify residents receiving intravenous/parenteral nutrition or hydration.
Wound Care Management/Prevention: All residents are considered to be a risk. There are a variety of diagnoses, treatments and conditions that can present complications. Power failure and the risks associated with possible evacuation create vulnerabilities related to sustaining electric specialty beds, and related electricity dependent modalities associated with wound management and prevention. Action Steps: o It is important to maintain a list of residents with wounds, has the potential for developing pressure ulcers, on specialty beds and to have overlay mattresses or alternate surfaces available in the event of power failure. o List of those receiving enteral therapy or who have addition power dependent treatment modalities. o Gel cushions or seating devices for transport.
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3.3. CONCEPT OF OPERATIONS Authorities and Leadership
Our facility’s Staff Organization Chart (Section 3.3b.) outlines the general chain‐of‐command and principal roles of facility administrators and senior management staff during normal operations. Everyday decision‐making at the organizational level is typically conducted with deliberate, time‐consuming methods such as scheduled committee meetings, executive deliberations, and Board meetings. This approach may not be feasible in an emergency and so, as a concept of operations, this facility utilizes a modified version of the Incident Command
System called the Nursing Home Incident Command System (NHICS) RISK ASSESSMENT RISK & PLANNING and the Hospital Incident Command System (NHICS) (see Appendix P). The Administrator / Executive Director has legal authority for the day-to-day operations of 1 this facility and emergency response. In their absence, we have identified the following person(s) who is qualified and authorized to act as the legally responsible representative for our facility. (Unified Command Center: CEO / COO / CMO/Director of Plant Operations / VP of Risk Management.) Alternate legally authorized representative: Director of Nursing Other qualified person(s) are trained to assume Incident Commander Position during emergency response: 1. Director of Engineering 2.Risk Manager
In addition, the following staffs are trained to assume key leadership roles during an activation of our emergency response:
1. See Appendix _____ - Staff Roster
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Statement 1: Alerting Staff In the case of an impending emergency event, such as a hurricane, the following will occur:
A Team “A” (pre-event) and Team “B” (post event) schedule is previously established. Schedules will be handed out in advance and will be relied upon if telephones fail. Department heads will be called in to the facility 8-24 hours prior to projected landfall. Call in hourly staff who have agreed to work during emergencies and their families will be called in 8-24 hours before projected landfall (if hurricane). All personnel not required for implementation of the plan will be released to return to their homes or leave the area. If emergency staff is not sufficient, department heads may contact regular staff requesting that they volunteer for hurricane duty. Procedures for employees checking into work will be unchanged but additional procedures will be implemented to accommodate staff’s family members. The facility will remind staff with family that they will need to bring their own “survival kits or items.”
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3.3b. STAFF ORGANIZATION CHART
See Appendix ______RISK ASSESSMENT RISK & PLANNING
1
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3.4. ACTIVATION OF THE EMERGENCY OPERATIONS PLAN (EOP) Emergency Operations Plan Activation
Upon receiving information of either the occurrence of, or the potential for an emergency event, a staff is assigned to verify the actuality and potential scope of emergency prior to any additional reporting of the event.
Threat Confirmation
The nature and scope of the emergency influences how warnings are received, transmitted, and the type of content therein. In the case of a tornado, for example, there may only be minutes to receive warnings and initiate action(s). In this case, pre-scripted instructions will be transmitted
with the warning. For other hazards, such as a hurricane, the media will be used to transmit ASSESSMENT RISK & PLANNING warnings, information, and instructions. For other events, like an earthquake, there will likely be no warning. The event itself alerts people and the facility’s command team will begin collecting and transmitting information and instructions after the event to help mitigate the event’s negative impact.
Whenever an emergency has the potential to impact the safety and well‐being of residents, staff or visitors and/or significantly disrupt our ability to provide resident care, the EOP will be activated by a senior staff on duty who will act as the Incident Commander (IC). The IC has the authority to make staff assignments and initiate specific procedures as warranted by the threat or onset of an emergency. Any of trained and qualified staff can step into this role if necessary, but it will default to one of the individuals or positions listed above if they are present at the time of the activation. 1 Emergency Operations Plan Activation
The following grid documents a chain of responsibility for activating the emergency operations
plans. Individuals selected are responsible for assessing emergent situations and activating the emergency operations plan when appropriate. Individuals Responsible for Emergency Operations Plan Activation Name Position Contact Number
Primary Administrator
Backup 1
Backup 2
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non-emergency organizational chart. In some situations, the skills of a senior staff member may be critically needed in Operations, and so they would not be able to assume over-all command. (Risk Management Note: In the case of an incident that results in injuries on an evening shift, the nursing supervisor may be the senior staff present but will be needed to oversee the operation of resident care. The incident leadership in this case would fall to the next qualified staff on the organizational chart. Succession planning for key leadership roles in an emergency moves from the top down on this chart.)
Advance Notice vs. No Notice Incidents: In some cases, our facility may receive advance notice or warning of an eminent event such as severe weather. We will respond by taking protective actions to ensure the safety and wellbeing of our residents, staff and visitors. We may also elect to activate our EOP to support our preparatory actions.
In other cases, we may have no notice prior to an emergency. The element of surprise can significantly add to the stress of dealing with a sudden onset emergency, but practicing emergency response via drills and exercises has significantly improved our performance during the emergency.
Once an incident is recognized that may require activation of the EOP, the person who first recognizes the incident will immediately notify their supervisor or the senior manager on site.
Sources of warnings:
Emergency response organizations, such as fire and police Radio/TV Stations National Oceanic and Atmospheric (NOAA) Weather Radio Stations warnings issued through the National Weather Service Eyewitness accounts
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Alerting Staff
The emergency operations plan includes a system for alerting staff to the event. As soon as decision-makers can inform staff where the facility stands in terms of emergency response, the sooner staff enters a familiar, recognizable state of operations. That doesn’t mean uncertainty disappears, but it means it diminishes when staff understands that they are “32-hours out,” for example, and they know what they are expected to be doing at that time.
Statement 2: Alerting Staff
ALERTING STAFF
In the case of an impending emergency event, such as a hurricane, the following will occur:
A Team “A” (pre-event) and Team “B” (post event) schedule is previously established. Schedules will be handed out in advance and will be relied upon if telephones fail. Department heads will be called in to the facility 8-24 hours prior to projected landfall. Call in hourly staff who have agreed to work during emergencies and their families will be called in 8-24 hours before projected landfall (if hurricane). All personnel not required for implementation of the plan will be released to return to their homes or leave the area. If emergency staff is not sufficient, department heads may contact regular staff requesting that they volunteer for hurricane duty. Procedures for employees checking into work will be unchanged but additional procedures will be implemented to accommodate staff’s family members. The facility (include name of person responsible) will remind staff with family that they will need to bring their own “survival kits or items.”
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Alerting Residents
The plan addresses how residents will be alerted to emergencies. The facility’s command team, and in particular, the Public Information Officer is prepared to draft key information important to share with residents. This information will include: the nature and scope of the threat whether or not the facility’s emergency plan has been initiated at what stage of the emergency plan activation the facility is in intent to evacuate and where they will be moved if their family has been notified how they will be protected how they will be kept informed how they can help or be involved how soon normalcy is expected to be reestablished whether there is an appropriate media outlet for cognizant residents to watch to help keep themselves informed Psychological First Aid Information about disaster response activities and services: To help reorient and comfort residents, the following information will be provided What to do next What is being done to assist them What is currently known about the unfolding event Available services Common stress reactions Self-care, family care, spiritual care, and coping Ask residents if they have any questions or concerns
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Alerting Family:
The emergency operations plan describes how and when family members are notified of the emergency status. The facility established a system for responding to family requests for information. The plan contains a list of the information the facility will share with family members. Some basic information includes: the condition of family member’s resident the nature and scope of the threat whether or not the emergency management plan has been officially initiated at what stage of the emergency management plan the facility is in intent to evacuate at the point of the initial call receiving host facility information (in the case of an evacuation) as appropriate
Statement 3 – Alerting Family Members:
Depending upon the nature of the emergency, the Public Information Officer / Administrator, and / or selected department heads or designee will meet and decide the best available information to relay to family members. The resulting family call script will be distributed to our pre- designated, trained persons in the business office to begin the process of notifying family members regarding the facility’s current status and plans. In the event of a Category 3 or greater hurricane threatening to make landfall, the facility will evaluate which families may want to pick up residents should evacuation occur. All requests for information from family members will be referred to the designated, scripted persons in the business office.
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Alerting Host Receiving Facility
A host receiving facility is the destination for a partial or full facility evacuation. MOU’s with the Host receiving facilities are arranged in advance during non-emergency times. These facilities are geographically located in areas of close proximity, within-area proximity, and out-of-area proximity to give the nursing home the greatest probability of moving residents the shortest, yet, safest, distance. In the case of a partial evacuation, more vulnerable and at-risk residents may be moved to a hospital. When it appears likely that a partial evacuation will take place for certain residents, the Liaison Officer or Resident Services Branch Director will contact the hospital to communicate and organize admissions. It may be that the hospital is under stress as well and may have implemented their own emergency procedures, so it is best for there to be a prior understanding of how the hospital and nursing home may serve one another during times of crisis. (MOUs are needed) As a planned emergency event threatens (such as a hurricane), the nursing home / SNF will touch base early with their destination (host) facilities to alert them that an evacuation may be a possibility. As conditions worsen, the transferring facility will communicate regularly with the most likely (host destination facilities and verify departure and arrival times, resident records transfer, and the provision of staff and supplies. The status of the intended destination facility may also be impacted by the emergency event so regular communication will benefit both facilities in managing their evacuation response.
See Memoranda of Understanding between facilities
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Essential Services Roles and Responsibilities This grid tracks roles and responsibilities for essential services during emergency events. Services identified are essential during emergencies. Roles and responsibilities for identified services are clearly stated, and individuals providing these services are aware of their responsibilities. Primary and secondary points of contact are established for each service, so that in the case of an emergency, the service can be activated and coordinated appropriately.
Roles and Responsibilities Roles and Secondary Point of Essential Services Point of Contact Responsibilities Contact Administration
Dietary
Housekeeping
Maintenance
Nursing
Pharmacy
Safety and Security
Risk Management
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3.5. EMERGENCY STAFFING STRATEGIES Employee Preparedness It is the protocol of this facility to ensure that we have adequate staffing during emergencies. Our employees are expected to report to their work site and provide services related to emergency response and recovery operations in addition to their normally assigned duties if requested to do so. Supervisors, co‐workers, and residents share an expectation that medical services will proceed uninterrupted and that any medical needs generated by the incident impact will be addressed.
Preparedness planning in this facility is recognized as a shared responsibility between facility leadership and staff. All staffs are expected to have a current “family disaster plan” so that they can fulfil their work obligations knowing that their families are well prepared and safe. Staffs are encouraged to visit www.ready.gov/make‐a‐plan for guidance on personal disaster plans.
Staff Recall This facility’s staff will be called in, and/or availability may be requested by a pre-designated staff person as detailed in Appendix R – Staff Recall and Survey. The individuals contacted may be asked to report for duty immediately or be scheduled for future shifts during the emergency as determined by the Incident Commander / Administrator. The location of a detailed emergency contact list for staff is contained in Appendix R.
Emergency Employee Call‐ins All staff in regular and temporary or contracted positions (appropriate with their role) should contact their immediate supervisor or manager if they are unable to report to duty as scheduled due to an emergency.
All approved vacations / Paid Time-Off (PTO) days during an event may be cancelled. Employees should be available to report for duty if it is safe and feasible to do so.
Employees may be assigned to Team A or Team B and should report to duty as follows:
Team A will report to the facility as scheduled once the Emergency Operations Plan (EOP) is activated and travel is safe. Team A will remain at the facility for the duration of the disaster event and its effects until relieved by Team B.
Team B members are expected to report to duty to their department to relieve Team A as directed by the Incident Commander. Employees who do not provide direct patient / resident care and whose departmental functions can be halted until the emergency is over may be designated as either Team A or Team B and deployed to a specific department. Those employees will report directly to their department for re-assignment. Foster / CHS Risk Management Section 3: Emergency Operations Plan | Pg. 44
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Team A and Team B will be encouraged to bring the following to the facility:
Staff identification Medications/personal items Money: cash and change for vending Flashlight with extra batteries Critical personal phone numbers & battery‐operated cell phone charger
Staff Responsibility Team A and B employees will be deployed and rotated, as deemed appropriate by the Incident Commander / Administrator (IC), during the duration of the disaster; work in various assigned shifts; and/or provide non-routine but necessary duties that they are cross trained to perform. Team A and B employees will report as scheduled until an “All Clear” is called and normal operations are resumed. Staff Support Reasonable sleeping and showering areas will be assigned to off‐duty staff who are asked to stay or unable to return home. To the extent that the facility’s needs permit, space may be provided for families of working staff during the disaster. Childcare may be available if family caregivers are not available. Families should bring snacks, drinks, linens, personal items and children’s activities whenever possible. Food will be provided in the cafeteria from a limited menu to on-duty staff. Food for residents will be the priority, but if possible food will also be provided to families on the premises. Use of Volunteers It is the protocol of our facility to maximize our staff availability and utilize approved staffing registries if we are unable to cover our staffing needs during an emergency. If this strategy fails to meet our needs, our facility may request additional staff through the Catholic Home Health of Miami-Dade or Catholic Home Health of Broward. Through the emergency management protocols of our local area, we may integrate State and/or federally designated health care professionals to address surge needs during an emergency. We may also utilize emergent volunteers for non‐resident care if necessary. Before utilizing any volunteers however, we follow the steps outlined below if at all possible:
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On‐site training (as appropriate) and equipping as indicated for both safety and job efficacy Assign key staff to supervise the volunteers closely Reassignment as tasks are completed Demobilizing and out‐processing (return badges, receive feedback from volunteers, address medical and psychological issues and arrange after‐care, obtain contact information for any surveillance or medical follow‐up, and thank volunteers for their service)
3.6. RESOURCE MANAGEMENT FACILITIES RESOURCE DIRECTORY - RM FORM
Resource management is critical to maintaining safe and effective care of residents and staff. Emergencies can easily lead to unusual resource challenges like the disruptions to supply deliveries (see the P&P for Subsistence Needs).
Our facility has a robust supply of emergency equipment and materials (see Shelter in Place P&P, Disaster Supply Inventory Appendix E and Disaster Meal Menus Appendix G). We have a system for shelf‐life management that includes rotation through usual stock, and established agreements with a variety of vendors for our re‐supply and recovery needs (see Vendor List - Appendix F and Emergency Agreements - Appendix J).
Command and Coordination
Command Structure Under normal operating conditions, a facility is often hierarchal in organization with a clear chain of command. This existing model may be leveraged during emergency operations. An emergency event calls together staff from county offices of emergency management, staff from receiving facilities, the state’s regulatory body, temporary direct care staff, and CHS Corporate personnel. These new entities combine with the facility’s staff to create an unofficial “emergency team.” The assumed shared mission of all the team members is to reduce the risk of harm and to provide necessary care and medical services to the residents. Integrating the activities of this emergency team requires the best of interagency coordination and communication. Keeping this in mind, the emergency operations plan includes the facility’s emergency organizational structure and reflects the Nursing Home Incident Command System / Hospital Incident Command System .
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The Incident Command System (ICS)
Background
Homeland Security Presidential Directive (HSPD) 5 called for a single, comprehensive system to enhance the ability of the United States to manage domestic incidents. The National Incident Management System (NIMS) was rolled out in 2004 by the Department of Homeland Security, providing a template to enable all levels of government, the private sector, and nongovernmental organizations to work together during an incident. The U.S. Department of Homeland Security’s National Response Framework incorporates key concepts for incident management which includes a community response using the Incident Command System. The Incident Command System is simply a management system created to enable efficient incident management by integrating equipment, personnel, procedures, and communications operating within a common organizational structure. What makes the Incident Command System useful to health care entities is that it is a known system. Local, state, and federal emergency management offices know the vocabulary, the organization, and the activities associated with the Incident Command System. Police, fire, and rescue responders will be familiar with it. This facility is encouraged to integrate the Incident Command System into our emergency management plans, thereby unifying and strengthening a whole jurisdiction’s response and recovery efforts. It is vital for CHS nursing homes / SNF/RH to be incorporated into local community and state emergency response plans. Utilizing the Incident Command System within the CHS organization’s emergency operations plan will result in the facility better conforming to the State’s Emergency Management System and position it to be better integrated into formal emergency response plans. More importantly, the Incident Command System may serve as an effective tool in helping each facility assign staff for key emergency management duties and to designate needed equipment and supplies to carry out their assigned duties.
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The Incident Command System (ICS) Functions
The ICS features modular organization, which means the Incident Command System: o Develops in a top-down, modular fashion. o Is based on the size and complexity of the incident. o Is based on the hazard environment created by the incident.
The Incident Command System is structured to support five major functional areas: command, operations, planning, logistics, and finance/administration.
1. Incident Commander: The person who organizes and directs the facility’s emergency operations. This person gives overall direction for facility operations and makes evacuation and sheltering in place decisions. Always name an alternate Incident Commander, who will be responsible for Incident Command in the event the initial designee is unable to assume responsibility. The Incident Commander may assign or assume three special functions which round out the Command Team: a. Public Information Officer: Working directly with the Incident Commander as part of the Command Team, this is the person who is responsible for interfacing with the public and media with incident-related information requirements. The PIO’s role is to serve as a conduit for information flowing out from the facility regarding the emergency and the facility/resident status. The PIO will also supervise communications to residents and family members. The Incident Commander must approve the release of all incident-related information. Only one incident PIO should be designated. b. Liaison Officer: Working directly with the Incident Commander as part of the Command Team, the Liaison Officer is the point of contact for representatives of external agencies, organizations, and/or private entities that need to obtain the status of the facility or provide assistance or volunteers. This person will interact with the state’s licensing agency, the local office of emergency management, the
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Red Cross, and the police. Such assistance efforts should be coordinated through the Liaison Officer interacting with Logistics Section Chief. c. Safety Officer: Working directly with the Incident Commander as part of the Command Team, the Safety Officer monitors the impact of the emergency on facility operations and advises the Incident Commander on all matters relating to operational safety. While the ultimate responsibility for the safe conduct of incident management operations rests with the Incident Commander, the Safety Officer works to ensure the safety of residents, staff, and visitors, and to monitor and correct hazardous conditions. The Safety Officer has emergency authority to stop and/or prevent unsafe acts during incident operations. 2. Operations Section Chief: This person organizes and directs activities related to providing resident care and services, dietary services, and environmental services. These activities are hands-on, on-the-ground actions which serve to care for residents and staff, meet food service needs, and manage facility grounds during an incident. 3. Planning Section Chief: This person gathers and analyzes incident-related information across departments. This section chief obtains status and resource projections from all the other section chiefs for immediate and long range planning, helping the Incident Commander make decisions. From these projections, this chief compiles and distributes the facility’s Incident Action Plan, which is a written plan containing general objectives and strategies for managing the incident. The Incident Action Plan is revised at time intervals set by the Incident Commander, e.g. every 8 hours (See also Part IV The Incident Command System). 4. Logistics Section Chief: This person organizes and directs those operations associated with providing adequate levels of personnel, food, and supplies to support the facility during an incident. 5. Finance/Administration Section Chief: This person monitors the utilization of financial assets and the accounting for financial expenditures. This person also supervises the documentation of expenditures and cost reimbursement activities. This section chief also works to ensure business functions are maintained to the extent possible.
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See Part IV for more information on the Nursing Home Incident Command System.
Key Ideas about ICS Functional Areas
1. Only those functions which are needed should be activated. However, the Incident Commander is always assigned. 2. More than one position may be assigned to an individual. In small incidents, one person, the Incident Commander, may perform all management functions. 3. Each position represents a function, not a person. 4. There may not be enough people available to fill each position 5. The unique needs of an emergency will drive which function is assigned and when.
Even if a function is not assigned, the tasks within the function still need to be accomplished. For example, the event may not warrant the establishment of the Finance/Administration Section, yet payroll still has to be met, vendors paid, and expenses tracked. Local Office of Emergency Management (OEM) The facility’s emergency operations plan will recognize and employ the local office of emergency management (OEM). The facility and its local office of emergency management (OEM) will be in communication with each other outside the occurrence of an emergency event. Both the nursing homes / SNF and the Rehab Hospitals are required to submit an emergency management plan to their county office of emergency management each year for approval. Basic local office of emergency management information in the plan include: contact name street address phone number name and telephone number of the primary person responsible for communicating with the local OEM
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First responder information – law enforcement, fire department, Coast Guard (if the facility is near open water, intercoastal waterway), and emergency medical services – is also be provided in the plan. Statement 3: Emergency Coordination
This facility will coordinate with our county’s local office of emergency management (OEM) once a year for a review of the facility’s comprehensive emergency management plan and the Emergency Operations Plan. The Administrator will invite feedback with the county planners during this review process and department heads may be called upon to provide additional input during this review. Our local OEM has agreed to work with us to improve the effectiveness of our disaster training activities and provides county-wide training on conducting exercises for key staff.
3.7. RELOCATION SITES AND ALTERNATIVE CARE SITES UNDER 1135 WAIVERS Relocation Sites As part of our all hazard preparedness, this facility coordinates with our local response authorities and other health facilities to arrange for care at alternate locations should evacuation become necessary. These arrangements also address the receipt of residents, when feasible; from other facilities unable to continue their operations (see Evacuation P&P and Emergency Admits P&P). Our facility has also arranged to utilize the following location to conduct essential business functions at an alternative location when necessary:
See Mutual Aid Agreement / MOUs)
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ALERTING FAMILIES
Depending upon the nature of the emergency, the Public Information Officer / Administrator, and / or selected department heads or designee will meet and decide the best available information to relay to family members. The resulting family call script will be distributed to our pre-designated, trained persons in the business office to begin the process of notifying family members regarding the facility’s current status and plans. In the event of a Category 3 or greater hurricane threatening to make landfall, the facility will evaluate which families may want to pick up residents should evacuation occur. All requests for information from family members will be referred to the designated, scripted persons in the business office.
Shared Resources
The emergency operations plan indicates how the facility will benefit from its organizational structure which includes Catholic Health Services (the corporate headquarters), and affiliated / sister facilities within and outside geographic locales. If utilized capably during an emergency, this connectedness can relieve an Administrator’s feelings of isolation, ease the stress of emergency decision-making, and support crisis management. More importantly, the corporate headquarters serve as a more removed (physically and psychologically) command center with the responsibility of coordinating resources to facilities as they progress through the phases of an emergency event.
At a minimum, the emergency operations plan include basic information regarding the facility’s connection with the corporate office through which affiliated facilities share resources, such as the name and 24-hour telephone number of the designated corporate contact for emergency operations.
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Public Health Information System
The facility’s emergency plan describes how the facility connects with its state’s public health information system. Oversight includes emergency management functions of preparedness, recovery, mitigation and response with all agencies and organizations that carry out health or medical services. Assistance in pre-event evacuation may also be provided whenever patients or residents of the state are affected.
Statement 4: Public Health Integration
Catholic Health Services entities assume the information and direction provided by the Florida Department of Health’s ESF #8 operations is authoritative and we understand that the information flows to and from ESF #8 operations to the local county office of emergency managements. Each Facility interacts first and foremost with the local county office of emergency management. If a situation should arise wherein the local Office Of Emergency Management is not able to respond or give direction during an emergency event, the facility’s Administrator, Director of Nursing, or designee will contact the Agency for Health Care Administration or the ESF #8 operations unit directly.
(ESF #8: FLORIDA’S EMERGENCY SUPPORT FUNCTION 8 - PUBLIC HEALTH AND MEDICAL STANDARD OPERATING PROCEDURES)
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1135 Waivers (Federally Declared Disasters) In the event of a major disaster involving an 1135 Waiver, this facility will coordinate with and follow instructions from the local response authorities, State Survey Agency, and Federal authorities regarding alternate care sites, or other provisions applicable under that Waiver.
This facility has policies and procedures, which address the "role of the facility under a waiver declared by the Secretary, in accordance with section 1135 of the Act, in the provision of care and treatment at an alternate care site identified by emergency management officials." This include policies and procedures on what the facility would do if we had to provide care at an approved alternate site, as well as processes on how would we let the community know we are operating at a different care site and any reporting we may need to do if we were under an approved 1135 Waiver.
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3.8. DEMOBILIZATION AND TRANSITION TO RECOVERY Demobilization involves the release of resources used to respond to the incident. As the response phase transitions to the recovery phase, increasing numbers of resources will be demobilized, until the transition is complete (see the Return to Facility Form in Appendix L). A goal of our EOP is to respond to emergencies in a way that allows for a return to normal operations as soon as possible.
3.9. COORDINATION WITH LOCAL RESPONSE AUTHORITIES We recognize that most emergencies experienced by our facility will involve other response partners. Our facility has established relationships with the local emergency management response authorities and is familiar with local community’s plans relevant to our coordinated role in emergency response.
In Florida, the coordination of various public health and medical functions is accomplished at the local (county) and the state level. In our county, the response Emergency Management agency is the Office of Emergency Management (and its Operations Center) functions as the lead county agency for medical-health emergency response coordination. In addition, the Agency for Health Care Administration (AHCA) (State SURVEY agency local office) has the authority and responsibility for the licensing and certification of health facilities and oversight of resident health and safety during a disruption to their normal operations.
In the case of a facility-specific incident requiring evacuation and/or a widespread event involving single or multiple sites of impact, we will contact AHCA, the County’s EM Operations Center, the Fire Marshall and 9-1-1 (as our response agencies). This will ensure we are coordinating with our community response partners for resource requesting, situational awareness, and information sharing within the medical and health coordination network and the local emergency operations center. Updates will also be submitted to AHCA via the Emergency Status System (ESS).
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Emergency Tracking System – Emergency Status System (ESS)
The Emergency Status System is a web based information system used as a tool, whereby providers communicate with the Agency for Health Care Administration (AHCA) and the County, as RESPONSE agencies. Through this system, our facility responds to bed polls, reports facility status, and receives or gives other information. (see Facility System Status Report - Appendix S).
Florida has an electronic tracking system which includes nursing homes and serves to track the status of health care providers regulated by the state. Basic functions of the system may include the ability to find a specific provider, record a contact involving that provider, and record details of the contact related to damage, need for assistance, evacuation, and special medical patient’s / resident’s needs. Statement 5: Emergency Tracking System Agency for Health Care Administration (AHCA) requires all licensees providing residential or inpatient services to use an Agency approved database for reporting its emergency status, planning or operations. The Agency approved database for reporting this information is the Emergency Status System (ESS).
A user account is necessary for entry into ESS. In order to obtain an account, contact your facility’s Administrator.
CHS entities have trained on the new ESS system and created accounts per facility. Further, facilities will conduct the yearly update of the information on the Agency for Health Care Administration’s Emergency Status System (ESS) as part of the annual emergency management plan development. Additionally, prior to hurricane season, the Administrator will be responsible for making sure the information is refreshed. The emergency management plan provides additional instructions on how and when to feed real-time emergency data into Emergency Status System (ESS).
ESS – PRE-SEASON PLANNING ESS – ENTER EMERGENCY EVENT DETAILS
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3.10. TRAINING AND TESTING Education and training, including drills and exercises, are utilized in this facility to achieve proficiency during emergency response and ensure the effectiveness of our EOP. In compliance with state and federal regulations, our facility conducts initial training on the EOP during the orientation of new staff, and annually to all staff, individuals providing services under contract, and volunteers consistent with their role in the response.
Fire drills are done quarterly and a disaster drill is held every six months under varied conditions for each individual shift of facility personnel. A written report of drills and exercises is maintained and the critique and corrective actions are taken as indicated. (The actual evacuation of residents to safe areas during a drill is optional.)
Additionally, our facility participates in a Table Top Exercise and a Full-Scale Community Exercise if available, annually. If a Full-Scale Community Exercise is not available or feasible, we will document this and conduct an integrated system-based exercise instead to test specific aspects of our EOP and identify areas for improvement. Both exercises will follow a formal exercise plan with objectives and a scenario designed to meet those objectives.
An After Action Report (AAR) is completed following these exercises with identified areas for improvement, and a plan for the improvement activities to be completed in a specific time frame (see After Action Report/Improvement Plan - Appendix B). Documentation of these exercises includes sign-in sheets and is available for review upon request.
If our facility experiences an actual emergency event that results in an activation of our EOP, this may suffice for one of these exercises, and an AAR will be completed in a timely manner following the event.
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2 POLICIES AND PROCEDURES
Policies and Procedures
POLICIES& PROCEDURES Subsistence Needs
Resident and Staff Tracking
Evacuation and Sheltering in Place
Medical Documentation
Volunteers Use
Transfer Agreement
Memorandum of Understanding
1135 Waiver Information
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SUBSISTENCE NEEDS:
The policies and procedures address:
Number of residents this facility have on-site, on average
Number of staff members this facility have on-site, on average
Number of visitors this facility have on-site, on average POLICIES& PROCEDURES
How long this facility plans to sustain shelter-in-place:
What supplies, in what quantities, are needed to shelter in place over a 24-hour period for each of the following categories
o Food o Water (potable) o Water (non-potable) 2 o Medical (gowns, gloves, bedding, tubing, syringes, oxygen tanks, medical gas, etc.) o Pharmaceutical o Alternate sources of energy (maintain appropriate temperatures, emergency lighting, fire response, and sewage waste management) Location where inventories are stock-piled
Responsible party for maintaining these emergency inventories
How the facility access / distribute these supplies during an emergency
Mutual Aid Agreements to garner additional supplies when the facility’s inventories begin to run low
See the EOP Plan – E Tags Review
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Resident and Staff Tracking: See the MASTER RESIDENT EVACUATION TRACKING FORM
The policies and procedures address:
How will the facility track the name and location of residents during an emergency? (This includes residents who are sheltered in the facility, as well as residents transferred to other
locations during an evacuation.) POLICIES& PROCEDURES
How will the facility track the name and location of on-duty staff during an emergency?
Would these tracking policies and procedures differ during an emergency versus after an emergency?
If the means of tracking staff and residents is electronically-based, how would this be accomplished if such systems were compromised (e.g., power outage, cyber-attack, etc.)?
How is this information maintained during the emergency? 2
How often is it updated?
Which staff members are responsible for accomplishing these tasks?
How could this information be accessible and shared with partners upon request?
Evacuation and Sheltering in Place:
The policies and procedures address:
Criteria used to determine whether the facility will shelter in place or evacuate during an emergency
Who has decision-making authority to make this determination?
What procedures will the facility use to determine which residents can be discharged versus moved to another facility?
What procedures will the facility use to determine the order in which residents are evacuated?
How will the treatment needs of residents be identified and addressed during evacuations?
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Which staff members have what responsibilities during the execution of evacuation
procedures?
How will transport of residents be arranged?
How will you identify appropriate facilities to receive residents?
How will facilities ensure that primary and alternate means of communicating with external POLICIES& PROCEDURES
partners about evacuation are in place?
Medical Documentation:
The policies and procedures address:
What systems/policies/procedures exist to provide resident medical documentation on a 2
day-to-day basis?
Are there changes to these systems/policies/procedures in an emergency?
How would medical documentation be transferred during an evacuation to accompany a resident to a receiving facility?
How are standards of confidentiality maintained?
Where are these existing policies/procedures documented for the facility? (Including policies that have been developed to maintain compliance with HIPAA, The Joint Commission, local and state law, etc.)
If electronic medical records are used, what redundant processes exist in case such systems are compromised (power outages, cyber-attacks, etc.)?
Who is responsible for activating redundant systems?
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Transfer Agreement The Transfer Agreement document(s) (linked below) provides transfer agreement for the facilities. The transferring facility and receiving facility both completed and signed this form prior to the emergency event, so that in an emergency situation in which residents need to be transferred from the affected facility, a transfer agreement is already in place. The document outlines expectations between the facilities and the terms of agreement. (hyperlink the transfer agreement here)
Memorandum of Understanding (Mutual Aid Agreements) The Memorandum of Understanding document (linked below), provides a Memorandum of Understanding (MOU) for the facilities. The MOUs are used to establish a mutual understanding of the roles and responsibilities of participating entities during an emergency incident. MOUs include the scope of services to be provided and reimbursement considerations. MOUs are developed before emergency situations, so that in emergency events, a clear set of expectations exists between involved entities. (hyperlink the MOU’s here)
1135 Waiver Information When the President of the United States declares an emergency under the Stafford Act or National Emergencies Act, and the Health and Human Services Secretary declares a public health emergency under Section 319 of the Public Health Service Act, the Secretary is allowed to assume additional actions on top of their usual authorities. One of these actions is to waive or modify certain Medicare, Medicaid requirements, under section 1135 of the Social Security Act, to ensure that sufficient health care services are available to meet the needs of affected populations. The 1135 waivers may include adjustments to the conditions of participation or other certification requirements. Once an 1135 waiver is authorized at the federal level, our LTC facilities will submit requests to the State Survey Agency (AHCA) to operate under the authority of the waiver. Our LTC / SNF facilities will justify the use of the waiver, the expected modifications to usual standards, and the duration of the waiver use. The 1135 Waiver-At-A-Glance document (linked below) provides more detail on what 1135 waivers are, and when and how they may be implemented. 1135 WAIVER POLICY AND PROCEDURES https://www.cms.gov/Medicare/Provider-Enrollment-and
Certification/SurveyCertEmergPrep/Downloads/1135-Waivers-At-A-Glance.pdf
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TABLE OF CONTENTS
4.1 ACTIVE SHOOTER/ARMED INTRUDER ...... 64
4.2. BOMB THREAT ...... 67
4.3. EARTHQUAKE ...... 69
4.4. EMERGENCY ADMITS ...... 72 POLICIES& PROCEDURES
4.5. EVACUATION AND RESIDENT/STAFF TRACKING ...... 75
4.6. EXTREME WEATHER - HEAT OR COLD ...... 82
4.7. FIRE EMERGENCY – INTERNAL AND EXTERNAL ...... 84
4.8. FLOOD ...... 91
4.9. HAZARDOUS MATERIALS ...... 92
4.10. INFECTIOUS DISEASE ...... 93 2
4.11. LOCK DOWN ...... 94
4.12. MEDICAL DOCUMENTATION ...... 98
4.13. MISSING RESIDENT / ELOPEMENT ...... 99
4.14. POWER OUTAGE ...... 101
4.15. SHELTER IN PLACE ...... 104
4.16. SUBSISTENCE NEEDS ...... 106
4.17. ADDITIONAL P&PS FOR UNIQUE HAZARDS ...... 110
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4.1 ACTIVE SHOOTER / ARMED INTRUDER POLICIES& PROCEDURES
ACTIVE SHOOTER RESPONSE PLANNING - Checklist TABLE TOP EXERCISE – ACTIVE SHOOTER RESPONSE - MSEL ACTIVE SHOOTER RESPONSE PPT PRESENTATION –by: Lauretta Foster, VP, Risk management AAR - ACTIVE SHOOTER RESPONSE SITE SURVEILLANCE SAFETY REPORT - ACTIVE SHOOTER RESPONSE
SIGN-IN SHEETS / ATTENDANCE ROSTER 2
It is the policy of this facility to protect our residents, staff and others who may be in our facility from harm during emergency events. To accomplish this, we have developed procedures for specific hazards which build on the cross-cutting strategies in our emergency operations plan. While we did not have an “Active Shooter” event, we identified it as a high probability risk, because of the growing number of Active Shooter events recently, we believe it is important for the staff, volunteers and contracted employees of this facility to be trained on how to minimize their risk and their residents risk of injury should this unlikely event occur. Early and immediate recognition of an Active Shooter/Armed Intruder event is imperative to increase the survivability chances of staff and patients/residents.
Active Shooter as defined by the US Department of Homeland Security “…is an individual actively engaged in killing or attempting to kill people in a confined and populated area; in most cases, active shooters use firearms(s) and there is no pattern or method to their selection of victims.”
An Active Shooter, as defined, does not have a selected, specific victim and is looking to create the most amount of causality as possible. Another consideration of concern is the Armed Intruder. An Armed Intruder, not intending to create mass casualties, may have a specific target victim and an agenda to complete the act of violence toward that victim. Once that target is engaged by the Armed Intruder and the agenda realized, the act of violence brought on by an armed intruder may stop.
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Emergency response by staff should treat an Active Shooter and Armed Intruder event as ‘one in the same’ because an Armed Intruder event can transform into an Active Shooter event rapidly and without warning.
NOTE: If the facility is alerted that an armed suspect is in the area but they are not in the facility refer to the LOCKDOWN Policy and Procedure and initiate a full lockdown of the facility or as directed by Law Enforcement.
PROCEDURES POLICIES& PROCEDURES
(Due to urgent nature of this hazard, implementation of NHICS may not be feasible)
IMMEDIATE RESPONSE:
Because of the emergent nature of an Active Shooter Event, staff should immediately carry out this procedure without waiting for instructions from the Incident Commander or their supervisor. The first person to become aware of this threat should initiate the response by announcing the code and dialing 9-1-1 if it is safe to do so. 2 “ACTIVE SHOOTER” is announced overhead with the last known location of the shooter/intruder as soon as the event is recognized. Begin Resident Safety Protocol or Personal Safety Protocol depending on the location and actions of the Active Shooter/Armed Intruder.
RESIDENT SAFETY PROTOCOL:
If the active shooter is distant from your location:
Run: If opportunity allows you to safely direct and move patients/residents. The order of evacuation is: Ambulatory patients/residents
Patients/residents with assistive devices Patients/residents in wheelchairs Bedridden patients/residents Hide: If unable to evacuate patients/residents because of the active shooter’s location, hide them. Fight / Barricade: If you can hide the resident, barricade their position utilizing door locks, furniture, etc. to prevent the active shooter from breaching their position. If providing Resident Safety Protocols and the active shooter approaches, transition to Personal Safety Protocols.
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PERSONAL SAFETY PROTOCOL:
If the active shooter is close to your location, remember the FOUR OUTS:
RUN: Evacuate, if opportunity allows you to safely leave the facility. HIDE: If unable to evacuate because of the active shooter’s position hide FIGHT: If you are hiding, barricade your position by utilizing door locks, furniture, etc. to prevent the active shooter from breaching your position FIGHT: As a LAST resort, prepare to fight the active shooter by utilizing weapons of opportunity, surprise, diversion and committed actions
Contact 911: Anyone at any time can call 911 when it is safe to do so. Provide the 911 POLICIES & PROCEDURES dispatcher with as much relevant information as possible: o Facility name and location o Your name o Nature of the event o Description of the shooter (if known) o Type of weapon(s) o Persons injured: number and extent When Law Enforcement arrives, follow the officer’s directives. In addition: Empty your hands
Keep hands up and fingers spread 2 Do not scream or yell at arriving officers Do not run directly at officers and/or avoid quick movements or grab onto them Follow Law Enforcement instructions Provide information to officers The event will be deemed ‘All Clear’ after law enforcement authorities have concluded emergency operations and declared the situation ’safe’. If hiding/barricaded, wait for Law Enforcement to provide an “All Clear” before leaving your position. When the event becomes static, notify the on-call Administrator if after hours. Activate the Incident Command System to manage the event and follow all instructions from Law Enforcement regarding preservation of the crime scene.
Account for all staff, visitors and residents. RECOVERY: 1. Rapid assessment of residents, staff and visitors to identify possible ill effects suffered during the incident. 2. Care and treatment of residents, staff and visitors as indicated by the assessment including psychological first aid if needed. 3. Restoration of normal services including the unlocking of all exits and gates per normal operations. 4. Coordination with law enforcement and other emergency response authorities as appropriate for follow-up actions. 5. Notification of resident representatives and the State Survey Agency to report the incident. Foster / CHS Risk Management Section 4: Policies and Procedures |Pg. 66
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4.2. BOMB THREAT
It is the policy of this facility to protect our residents, staff and others who may be in our facility from harm during emergency events. To accomplish this, we have developed procedures for specific hazards which build on the cross-cutting strategies in our emergency operations plan. This facility will act to protect all resident, staff and visitors from harm in the event of a bomb threat through the immediate activation of the following actions:
(Due to urgent nature of this hazard, implementation of NHICS may not be feasible)
PROCEDURES
INITIAL RESPONSE: See Rapid Response Guide – Bomb Threat and Evacuation P&P (if applicable). IMMEDIATE RESPONSE:
Incident Commander and Planning Chief: Once the initial threat has been resolved, cooperate with law enforcement officials to provide information and preserve evidence. Provide law enforcement with a copy of the call details if the threat was made by phone (see Bomb Threat Worksheet - Appendix C). Activate the communication plan and brief staff, residents and families on situation as soon as possible. Communicate with local emergency response officials and State Survey agency to give info on the status of the facility. Operations Chief: Assess residents, staff and visitors for potential impacts from the incident and provide care as indicated by the assessment findings. Offer reassurance and psychological first aid if needed.
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RECOVERY: With approval of local response authorities and state survey agency resume normal operations. If there were evacuations, initiate the repatriation of all evacuated residents. Notify residents, staff, visitors, and families/representatives and external stakeholders of the return to normal operations. Resume clinical care, therapy and activities per pre-incident plan of care for specific residents. Continue to assess residents for adverse impacts from the incident.
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4.3. EARTHQUAKE
EARTHQUAKE INCIDENT RESPONSE – RISK MANAGEMENT PROTOCOL
It is the policy of this facility to protect our residents, staff and others who may be in our facility from harm during emergency events. To accomplish this, we have developed procedures for specific hazards which build on the cross-cutting strategies in our emergency operations plan. In the event of a significant earthquake, this facility is prepared to maintain essential care and services for a minimum of 96 hours and protect residents from harm through the following actions.
PROCEDURES
INITIAL RESPONSE: See Rapid Response Guide – Earthquake.
IMMEDIATE RESPONSE:
Incident Commander and Planning Chief: Activate the facility Command Center and NHICS positions as indicated based on assessment of the situation. Appoint a Safety Officer if required. Survey agency to give info on the status of the facility and impact on internal infrastructure and services. Gather external situational status (weather, impact to roads, utilities, scope of damage, evacuation routes) and infrastructure status through local officials and other channels for reliable information. Activate the communication plan and brief staff, residents and families on situation as soon as possible. As indicated by initial assessment of the situation, Activate Power Outage, Subsistence, Evacuation and/or Shelter in Place P&P.
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Safety Officer: Identify safety hazards and mitigation strategies based on nursing home assessment; (See Incident Action Plan (IAP) – Appendix M, and Facility Systems Status Report - Appendix S). Consider implementing Lock Down P&P. Ensure that unsafe areas are restricted by signage or barrier tape, or by posting staff to monitor entry points. Notify the Incident Commander and Operations Section Chief of any internal or external areas that are unsafe for occupancy or use.
Activate search teams if needed; integrate efforts with local public safety personnel. Communicate with local emergency operations center, response officials, and State Initiate requests for external inspection of the building integrity if damage is evident.
Operations Chief: Initiate response-specific resident care plans: Activate triage and treatment areas and teams Assess and treat injuries to current residents, visitors, and staff Conduct a census of residents, identifying those who are appropriate for discharge or who need transfer to acute care. Activate the fatality management procedures if there are causalities (see Handling of Remains - Appendix O). Assess damage to facility infrastructure, including: o Status of all utilities o Ability to sustain operations with current impact on infrastructure and utilities o Activate utility contingency plans o Activate Disaster Menus and dietary services if power failure o Activate Memorandums of Understanding as needed for generator and fuel support, water and sewage services, and medical gas deliveries o Safety status of external sites including, exterior shelter sites, all buildings on campus, parking structures, fences and gates, external lighting, roadways, and sidewalks (see Facility Systems Status Report - Appendix S). Initiate or arrangement for repairs if feasible.
Logistics Chief: Inspect all onsite supplies and equipment for inventory and for damage and necessary repairs. Obtain supplies, equipment, medications, food, and water to sustain operations. Assess all onsite communications equipment for operational status; activate contingency plans as needed
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Assess the status of information technology systems; initiate repairs and downtime procedures if necessary. Coordinate the transportation services (ambulance, air medical services, and other transportation) with the Operations to ensure safe resident relocation, if necessary. (See Evacuation P&P)
Finance/Admin Chief: Monitor staff and volunteer usage, track time. If needed, screen volunteers. Document all costs, including claims and insurance reports, lost revenue, and expanded services, and provide report to Incident Commander.
RECOVERY:
With approval of local response authorities and state survey agency resume normal operations. If there were evacuations, initiate the repatriation of all evacuated residents. Notify residents, staff, visitors, and families/representatives and external stakeholders of the return to normal operations. Resume clinical care, therapy and activities per pre-incident plan of care for specific residents. Continue to assess residents for adverse impacts from the incident. Complete repairs, cleaning and dietary and housekeeping resupply activities. Work with insurance, funding agencies, local, state, and federal emergency management to begin reimbursement procedures for resident billing and cost expenditures related to the event.
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4.4. EMERGENCY ADMISSIONS
It is the policy of this facility to protect our residents, staff and others who may be in our facility from harm during emergency events. To accomplish this, we have developed procedures for specific hazards which build on the cross-cutting strategies in our emergency operations plan. As part of the coordinated response system in our community, this facility has entered into arrangements with other health facilities which are reciprocal (see Evacuation Policy and Procedure). If we are not impacted by an event and it is feasible to do so, we are prepared to receive residents from evacuated facilities with whom we have made these arrangements. If resident movement is being coordinated by local response authorities, we will consider accepting residents from other facilities, if feasible. When receiving residents from a disaster stricken area or a single-facility evacuation, the following procedures will be followed to ensure our facility is ready to provide safe care.
PROCEDURES
Incident Commander and Planning Chief: Activate the facility Command Center and NHICS positions as indicated based on assessment of the situation. Communicate with the sending facility (if possible), the State Survey agency (AHCA), and local emergency responders, as appropriate. Assess available bed capacity and respond to polls via FLHEALTHSTAT or from the transferring facility coordinating resident movement. When deciding how many residents we can safely accommodate we consider the following: o Vacant beds o Possible space conversions. Suggested area is 45 sq. ft. per person (5ft x 9ft space) o Adequate power supply and outlets, and lighting. o Necessary emergency and routine supplies If needed contact the State Survey agency to obtain a waiver / permission to increase capacity and/or place residents in areas not previously approved for resident care such as the dining room. Foster / CHS Risk Management Section 4: Policies and Procedures |Pg. 72
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Operations Chief: Set up a site for processing incoming residents. Clear the hallways and entry. Prepare a triage area/admit area. Assess all residents for transfer trauma, etc. and keep records of vital signs. If there are injured residents – notify 911 for transfer to acute care. Do a temporary status admit on residents and set up temporary charts unless the decision is made to formally admit them. In this case follow routine admissions process. Keep an intake log of residents and an inventory of any medications, equipment or other possessions that arrived with them (see Emergency Admits: Master Tracking Form – Appendix I). Assist relocated residents to be as comfortable as possible. Obtain doctor’s orders as needed, and contact pharmacy and other vendors for necessary supplies. Provide continuous observation and immediate aid if necessary. NHICS 254: Master Emergency Admit Tracking Form (Appendix I)
Forms Requested from the Sending Facility May Include: Resident Evacuation Tracking Form (Appendix L) or the alternative NHICS 260, A Face Sheet (See Evacuation Forms - Appendix L), Medical Treatment Orders, Medication Record, Advance Directive, and/or Other resident identification documents (ex., resident’s representative and physician contact info).
Logistics Chief: Prior to arrival of individuals, assess staffing and call in additional employees (see Staff Recall and Survey - Appendix R) to ensure a safe staffing ratio. Confer with Operations to identify needed emergency and routine supplies (see Appendix F – Vendor List, and Appendix E - Disaster Supply Inventory).
Finance/Admin Chief: Monitor staff and volunteer usage, track overtime. If needed, screen volunteers including sending facility staff if providing direct care to residents. Document all costs, including claims and insurance reports, lost revenue, and expanded services, and provide report to IC.
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RECOVERY:
Coordinate with sending facility, local response authorities, and the State Survey agency (AHCA) to return residents to their home facility in a planned and orderly way. Assess all residents prior to their departure and prepare care records to send with residents as appropriate to ensure emergency care.
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4.5. EVACUATION AND RESIDENT/STAFF TRACKING
EVACUATION - INCIDENT RESPONSE – RISK MANAGEMENT PROTOCOL -
MASTER RESIDENT TRACKING LOG
It is the policy of this facility to pre‐plan for all anticipated hazards with a goal to minimize the stress and danger to our residents, staff and visitors. Recent research indicates there are increased risks of mortality and morbidity related to the evacuation of people who are elderly and/or suffer from chronic health conditions. For this reason, sheltering in place will always be our first response choice if it is feasible. When sheltering in place would put our residents at greater risk than evacuation, or when given a mandatory order to do so by appropriate authorities, the IC will activate this Evacuation P&P.
The following terms are important to understanding how we evacuate our facility.
There are two types of evacuation: emergent which unfolds in minutes to hours, and urgent/planned which unfolds in hours to days. Partial evacuation which can be horizontal - moving residents, staff and visitors to a safe area on the same floor or vertical - moving residents, staff and visitors either up or down stairs to a safe area within the facility. A partial evacuation can also involve moving some residents out of the facility to relocation sites while others remain to shelter in place. Complete evacuation involves moving all residents, staff and visitors to a pre‐designated area outside of the building, and if needed to relocations sites. Relocation involves moving residents to an alternate facility (also called a receiving facility) offsite. The staging area is the last place to move residents before leaving the building. Residents may be sent to a staging area based on level of acuity or as part of the transport loading process.
Transportation and Relocation Sites Agreements for transporting residents to evacuation sites have been made with the following transportation companies. Our facility also maintains agreements with at least two (2) evacuation sites for relocation. See table below for contact information. Foster / CHS Risk Management Section 4: Policies and Procedures |Pg. 75
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RESOURCE AGREEMENTS FOR EVACUATION TRANSPORT & RELOCATION FACILITIES
Non Ambulance Transportation Alternate Name of Company: Name of Company: Company Address: Company Address: Company Phone Number: Company Phone Number: Contact Person Phone: Contact Person Phone:
Ambulance Alternate Name of Company: Name of Company: Company Address: Company Address: Company Phone Number: Company Phone Number: Contact Person Phone: Contact Person Phone:
Relocation Facility 1 Name of Setting/Shelter: Facility Address: Facility Phone Number: Contact Person/Phone:
Relocation Facility 2 Name of Setting/Shelter: Facility Address: Facility Phone Number: Contact Person/Phone:
Relocation Facility 3 – Outside the Local Area Name of Setting/Shelter: Facility Address: Facility Phone Number: Contact Person/Phone:
Relocation Facility 4 – Outside the Local Area Name of Setting/Shelter: Facility Address: Facility Phone Number: Contact Person/Phone:
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In the event of a wide scale event resulting in evacuation of multiple sites in the area, transportation resources and relocation sites will be coordinated with the local response authorities. (See Communication Plan and Coordination with Local Response Authorities).
Triage Residents Based on Unique Needs
Based on the unique needs of our residents including mobility status, cognitive abilities, and health conditions, our SNF community has developed evacuation logistics as part of our plan.
Residents who have high acuity and/or unstable conditions: will be transferred by ambulance and will be transported as soon as possible to minimize transfer trauma (See Evacuation Forms - Appendix L). Residents who are independent in ambulation: may be evacuated first unless there are extenuating circumstances. They should load first on vehicles where there are multiple rows of seats and move to the back of the vehicle. They may be accompanied by a designated staff member. If safe and appropriate, families may be offered an opportunity to take their family member home for care during the anticipated period of disruption to services. Residents who require assistance with ambulation: will be accompanied by designated staff member. If safe and appropriate, families may be offered an opportunity to take their family member home for care during the anticipated period of disruption to services. This may include residents with assistive devices. Residents who are non‐ambulatory: will be transferred by designated staff members via wheelchair vans or ambulance. This may include residents in wheelchairs or those who are bedridden. Residents with equipment/prosthetics: essential equipment/prosthetics will accompany residents and should be securely stored in the designated mode of transportation.
Resident Care Information During an evacuation, all residents will wear an emergency wristband with their full name and date of birth and the facility’s name and contact info. Additional information regarding their care requirements will be sent to the intake facility, including: diagnosis, allergies, code status, physician’s name and contact info, and the next of kin or responsible party (see Resident Face Sheet in Evacuation Forms - Appendix L), a current medication administration record, a photo identification if possible. Confidentiality of this information will be protected through the following means: a sealed envelope or folder will be provided access to the electronic health record will be provided as needed
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Medications Each resident will be evacuated with a supply of medications if available. If medications require refrigeration, a cooler will be sent if available to keep medications cool.
Evacuation Supplies Water, snacks, sanitation supplies, and emergency equipment such as flashlights, cell phones, and first aid kits may be sent with staff accompanying residents in all non‐ambulance vehicles. Amounts will be sufficient to meet the basic health and safety needs of the vehicle passengers for a minimum of 4 hours.
Resident and Staff Tracking A log reflecting the transfer of residents will be maintained (see Master Resident Evacuation Tracking Log in Evacuation Forms - Appendix L) or a comparable documentation system. A log reflecting the location destination of on-duty staff will also be completed as soon as possible during the event. Designated nursing staff assigned to the Operations Branch will be responsible for ensuring this log is filled out, and to ensure all residents have been evacuated. The IC will assign staff to document the location of on-duty staff.
Important Safety Information 1. Monitor residents during transportation for change of condition. 2. The incident causing the evacuation – flood, fire, hazardous materials release – may continue to pose dangers to residents and staff being evacuated. Some conditions may pose significant risks to evacuated residents, such as smoke. This should inform evacuation route planning. 3. Keeping emergency lights activated may increase visibility that is poor (due to rain, nighttime, or smoke).
PROCEDURES
INITIAL RESPONSE: See Rapid Response Guide – Evacuation.
Phase One Evacuation - On Alert of Possible Evacuation
(Note – in an emergent evacuation when residents are in immediate danger, the IC direct all available staff to move residents out of the building to safety as soon as possible)
Incident Commander and Planning Chief: Confer with local response authorities and the State Survey Agency. Determine whether partial or complete evacuation is advisable.
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Work with Operations and local authorities to determine order of resident departures. Some details to consider include but are not limited to: o Available relocation sites and road conditions o Available types of transportation o Resident acuity and special needs that must be accommodated at the relocations site. Obtain information on weather or other conditions that might impact residents during transport. Inform Operations so they can dress residents appropriately. Delegate the duty to notify authorities, families, suppliers and corporate representatives to the Public Information officer or appropriate staff. Make logistical arrangements with relocation sites. Some details to determine include but are not limited to: o Will staff accompany their residents and be temporarily reassigned to work at relocation site? o What supplies and equipment will we send? (e.g. mattresses?) o Will this be considered a temporary relocation or a formal discharge and admission? o If a temporary relocation, who will work with funding and oversight agencies for reimbursement and record submission of resident care?
Operations Chief: Assess residents for adverse impacts related to the incident and notify physician of changes in residents’ conditions. Reassure residents and family if they are in communication. Try to minimize stress. Obtain physician orders as needed, prepare supplies, and documentation for transport. Begin triage of residents to determine transport needs and order of resident departure. Plan staff assignments for accompanying residents as instructed by IC.
Logistics Chief: Arrange for staffing (See Staff Recall and Survey Appendix R), transportation and critical equipment transport including bedding for relocation site if needed. Assist with preparation of medical information and critical supplies that will be sent. Work with Finance Admin to ensure preservation and accessibility to medical records.
Finance/Admin Chief: Track costs, screen volunteers, record keep for staff time and other expenditures. Arrange for relocation site for critical business operations if needed. Assist Logistics with preservation and accessibility of medical records.
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PRIMARY EVACUATION ROUTES Evacuation to / from the North Campus Evacuation to / from the East Campus Primary Route: Primary Route: ** See Map Quest printed document ** See Map Quest printed document
Alternative Route: Alternative Route: ** See Map Quest printed document ** See Map Quest printed document
Evacuation to / fromthe South Campus Evacuation to / from the West Campus Primary Route: Primary Route: ** See Map Quest printed document ** See Map Quest printed document
Alternative Route: Alternative Route:
IMMEDIATE RESPONSE:
Phase Two Evacuation - Decision Made to Evacuate
Incident Commander and Planning Chief: Work with local response authorities and the State Survey agency (AHCA) to finalize arrangements for relocation of residents, Determine plan for staffing including numbers, schedules and assignments. Manage critical communications with families, external stakeholders and media (See Communication Plan). Communicate with receiving facilities to ensure safe arrival of residents and staff if sent to accompany residents to relocation site. Operations Chief: Ensure critical care information and medications accompany residents. Oversee the loading and movement of residents to relocation sites in a safe and orderly fashion, fill out tracking logs for residents and on-duty staff. Prepare the physical plant for shut down (See Emergency Shutdown - Appendix K). Foster / CHS Risk Management Section 4: Policies and Procedures |Pg. 80
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Logistics Chief:
Provide communication devices to staff on non-ambulance transport for use during evacuation to contact entities providing assistance. Ensure water, sanitary supplies; flashlights and other emergency equipment are on board all non-ambulance transport vehicles that are carrying residents. Prepare medical records and other critical data for preservation and accessibility (See Medical Records Documentation P&P) Finance/Admin Chief: Oversee the implementation of mutual aid agreements, emergency vendor agreements and the execution of business continuity protocols as indicated. If instructed by IC, prepare to set up business operations at identified relocation site. Monitor all costs, including claims and insurance reports, lost revenue, and expanded services, and provide report to Command Staff.
EXTENDED RESPONSE:
Inform the State Survey Agency and other response authorities if any change in resident or facility status occurs. Assign staff to monitor relocated residents through regular communication with receiving facilities. Ensure staff, volunteers, residents and families or representatives are briefed on the status of the situation. Determine whether it is safe to return (See Return to Facility Appendix L –). Notify the State Survey Agency and other response authorities to obtain permission to return residents to facility. Notify family, vendors, ombudsman, and other appropriate contacts of situation and plan for return.
RECOVERY:
Obtain repairs and/or cleaning of facility as needed. Discard all food and other supplies that may have been damaged or expired during the incident. Resupply as needed to ensure the facility is “resident – ready”. Arrange for inspections from local and state authorities as instructed by State Survey agency. Coordinate return of residents with local authorities and vendors. Assess all residents for “transfer trauma” for a minimum of three days following return. Notify families, staff, and other appropriate entities of repopulation. Resume normal operations.
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4.6. EXTREME WEATHER - HEAT OR COLD
SEVERE WEATHER – COLD OR HEAT INCIDENT RESPONSE – RISK MANAGEMENT PROTOCOL It is the policy of this facility to protect our residents, staff and others who may be in our facility from harm during emergency events. To accomplish this, we have developed procedures for specific hazards which build on the cross-cutting strategies in our emergency operations plan. The priority of this facility to minimize the stress our residents could experience from extreme temperatures related to weather events. To mitigate this risk, we rigorously maintain our systems of heating, ventilation and air conditioning (HVAC) and generator. (See Subsistence Needs – Alternative Sources of Energy P&Ps). In the event of a disruption to these systems during extreme weather we will initiate the following actions:
INITIAL RESPONSE: See Rapid Response Guides: Extreme Weather – Cold/Heat, Power Outage, and Evacuation P&Ps.
IMMEDIATE RESPONSE:
Incident Commander and Planning Chief: Monitor and obtain updates on weather conditions, structural integrity, and nursing home conditions. Assign as staff to regularly check internal temperatures in resident areas. Contact utility company for restoration of power and/or vendors for needed equipment such as heaters or coolers. Monitor the situation in coordination with local response authorities. If indicated by conditions, initiate the Evacuation P&P, either partial to ensure safety of impacted residents, or full if situation is severe and anticipated to be prolonged. Communicate with local emergency management and state survey agency regarding nursing home situation status, critical issues, and resource requests. Inform staff, residents, and families/representatives of the situation and provide updates as needed. If indicated, assign staff to secure the nursing home and implement limited visitation policy.
Operations Chief: Assess residents frequently for comfort and any change of condition. Identify residents whose fragile condition may require transfer and inform IC. Ensure continuation of resident care and essential services. Distribute appropriate comfort equipment throughout the nursing home (e.g., portable fans and blankets), as needed. Provide increase hydration and implement cooling or warming measures as indicated.
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If unable to maintain safe temperatures in all resident areas, gather residents into the dining rooms, gymnasium, administration wing, etc where temperatures are able to be maintained within an acceptable range.
Logistics Chief: Support Operations with equipment and supplies as needed. If instructed by IC, obtain additional equipment such as portable coolers for use during emergency.
Finance/Admin Chief: Monitor all costs, including claims and insurance reports, lost revenue, and expanded services, and provide report to Command Staff.
RECOVERY:
Complete all repairs and restoration activities. Notify residents, families/representative, local response authorities and the State Survey agency of the return to normal operations. Continue to assess residents for adverse impacts from the incident. Document all costs, including claims and insurance reports, lost revenue, and expanded services, and provide report to Command Staff. Work with insurance, funding agencies, local, state, and federal emergency management to begin reimbursement procedures for resident billing and cost expenditures related to the event. Assess any damage to facility infrastructure, including: o Status of all utilities o Ability to sustain operations with current impact on infrastructure and utilities o Activate utility contingency plans o Activate arrangements as needed for generator and fuel support
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4.7. FIRE EMERGENCY – INTERNAL and EXTERNAL
4.7a. INTERNAL FIRE
FIRE INCIDENT RESPONSE – RISK MANAGEMENT PROTOCOL
Facility’s APPROVED FIRE PLAN
It is the policy of this facility to protect our residents, staff and others who may be in our facility from harm during emergency events. To accomplish this, we have developed procedures for specific hazards which build on the cross-cutting strategies in our emergency operations plan. This facility has a designated procedure for fires and explosions that shall be followed if such an emergency arises. Staff receives training at least annually on fire procedures (R.A.C.E.) and the use of fire extinguishers (see Site Map in Section 1: Rapid Response Instructions for location of all fire suppression equipment and emergency shut offs). We are prepared to minimize risk of harm to residents, staff and visitors related to internal fires by implementing the following actions:
PROCEDURE
(Due to urgent nature of this hazard, implementation of NHICS may not be feasible)
INITIAL RESPONSE: See Rapid Response Guide – Internal Fire.
RACE / PASS
If not already completed under Rapid Response:
If anyone is in immediate danger, rescue them while protecting your safety and that of your co‐workers. Alert resident and staff members by announcing over a loudspeaker; pull the fire alarm. Call 9‐1‐1 immediately to report a fire. Include the following information: Foster / CHS Risk Management Section 4: Policies and Procedures |Pg. 84
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o Name of facility o Address and nearest cross street o Location of fire (floor, room #, etc.) o What is burning (electrical, kitchen, trash, etc.) Activate facility’s EOP and appoint an IC, if warranted. Contain the fire if possible without undue risk to personal safety. Shut off air flow, including gas lines, as much as possible, since oxygen feeds fires and distributes smoke. Close all fire doors and shut off fans, ventilation systems, and air conditioning/hearing systems. Use available fire extinguishers if the fire is small and this can be done safely. (See Emergency Shutdown Appendix K). Oxygen supply lines (whether portable or central) may lead to combustion in the presence of sparks or fire. If possible, quickly re‐locate oxygen‐dependent residents away from fire danger. Utilize smoke doors to evacuate residents from the impacted area. Use this method when residents are in danger of smoke exposure In a large-scale fire, the IC will activate the Evacuation P&P Brief staff on the incident, check‐in on their well‐being and assignments. Initiate emergency staffing strategies as the situation changes (see Staff Recall and Survey Appendix R). Communicate with State Survey Agency as the situation allows. The “All‐Clear” will be communicated after the crisis is over and the Fire Department has deemed that re‐entry safe (see Return to Facility in Evacuation Forms - Appendix L).
INTERMEDIATE RESPONSE: (The following actions apply if evacuation was NOT initiated in the Initial Response due to the rapid containment of the fire and fire authorities have given the “All Clear” to continue occupancy.)
Incident Commander and Planning Chief: Ensure all staff members and residents are accounted for and safe Appoint a Safety Officer to assess for impacts to the physical environment or infrastructure that could pose risks to residents, staff or visitors. Supervise emergency operations (restoration, fire control, chart removal, etc.). Upon arrival of the Fire Department, establish contact with the officer in charge and relay all relevant information regarding the situation or designate someone to do so. Coordinate all emergency operations with the Fire Department. Continuously remind all staff to remain calm and in control so as to not upset the residents. Gather data on damage and projected impact on emergency operations (see Facility Status Report - Appendix S).
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Communicate with local emergency operations center, response officials, and State Survey agency to give info on the status of the facility and impact on internal infrastructure and services. Activate the communication plan and brief staff, residents and families on situation as soon as possible.
Safety Officer: Assess damage and projected impact on emergency operations (see Facility Status Report - Appendix S). Assess air quality impact due to smoke and advise Operations if there is a potential risk to residents. Determine the need for Personal Protective Equipment for staff involved in the clean- up tasks due to ash and smoke.
Operations Chief: Initiate response-specific resident care plans: Activate triage and treatment areas and teams Assess and treat injuries to current residents, visitors, and staff Conduct a census of residents, identifying those who are appropriate for discharge or who need transfer to acute care if needed. Continue routine care with frequent assessment of residents to ensure they are not suffering adverse effects from the incident. Assess damage to facility infrastructure, including: o Smoke damage/air quality issues o Status of all utilities o Ability to return to normal operations with current impact on infrastructure
Logistics Chief: Support Operations with equipment and supplies as needed to clean up impacted relocate residents to areas that are not impacted by the fire or smoke. Initiate emergency staffing procedure if needed.
Finance/Admin Chief: Monitor staff and volunteer usage, track time. If needed, screen volunteers. Document all costs, including claims and insurance reports, lost revenue, and expanded services, and provide report to IC. RECOVERY: Complete all repairs and restoration activities. Notify response authorities, the State Survey agency, residents and families/representatives of the return to normal operations. Continue to assess residents for adverse impacts from the incident. Document all costs, including claims and insurance reports, lost revenue, and expanded services, and provide report to Command Staff. Foster / CHS Risk Management Section 4: Policies and Procedures |Pg. 86
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4 .7b. FIRE EMERGENCY - EXTERNAL FIRE (WILDFIRE)
It is the policy of this facility to protect our residents, staff and others who may be in our facility from harm during emergency events. To accomplish this, we have developed procedures for specific hazards which build on the cross-cutting strategies in our emergency operations plan. We have mitigated our risks from fires that are external to our facility through maintaining a defensible space, and utilizing fire-resistant landscaping and building materials whenever possible. If an external fire threatens our facility we will protect the safety of our residents, staff and visitors by closely monitoring the evolving situation and communicating with local response authorities, in case there is a need to evacuate. If the external fire is far away and poses no burn threat to the facility, but air quality is poor, we use the following information to guide our response actions.
Air Quality Index (AQI) An air quality index (AQI) is a number used by government agencies to communicate to the public how polluted the air currently is or how polluted it is forecast to become. As the AQI increases, an increasingly large percentage of the population is likely to experience increasingly severe adverse health effects. Monitor the “Air-Now” website, at https://www.airnow.gov/. This resource is a multi-agency web site run by EPA that reports air quality using the AQI. The table below outlines the AQI index meanings and related concerns.
Air Quality Index Levels of Health Concern Numerical Value Meaning Good (green) 0 to 50 Air quality is considered satisfactory, and air pollution poses little or no risk.
Moderate (yellow) 51 to 100 Air quality is acceptable; however, for some pollutants there may be a moderate health concern for a very small number of people who are unusually sensitive to air pollution.
Unhealthy for Sensitive 101 to 150 Members of sensitive groups may experience
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Groups (orange) health effects. The general public is not likely to be affected.
Unhealthy (red) 151 to 200 Everyone may begin to experience health effects; members of sensitive groups may experience more serious health effects.
Very Unhealthy 201 to 300 Health alert: everyone may experience serious (purple) health effects.
Hazardous (brown) 301 to 500 Health warnings of emergency conditions. The entire population is more likely to be affected.
AQI Colors: EPA has assigned a specific color to each AQI category to make it easier for people to understand quickly whether air pollution is reaching unhealthy levels in their communities. For example, the color orange means that conditions are “unhealthy for sensitive groups,” while red means that conditions may be “unhealthy for everyone,” and so on. Note: Values above 500 are considered beyond the AQI. Follow recommendations from local authorities for actions during a “hazardous” level event. Visibility Index
In meteorology, visibility is a measure of the distance at which an object or light can be clearly discerned. The below visibility index is an easy way for the general public to assess risk of smoke from wildfires or other air quality concerns. When using the visibility index to determine smoke concentrations, it is important to face away from the sun, determine the limit of your visibility range by looking for targets at known distances (miles). The visible range is the point at which even high-contrast objects (e.g., a dark forested mountain viewed against the sky at noon) totally disappear.
Visibility Health Health Effects Range Category 10+ miles Good None
5 – 10 miles Moderate Usually sensitive people should consider reducing prolonged or heavy exertion.
3 – 5 miles Unhealthy for Sensitive people should reduce prolonged or heavy exertion. Sensitive Groups
1.5 – 2.5 miles Unhealthy Sensitive people should avoid prolonged or heavy exertion. Everyone else should reduce prolonged or heavy exertion.
1 – 1.25 miles Very Unhealthy Sensitive people should avoid all physical activity outdoors. Everyone else should avoid prolonged or heavy exertion.
<0.75 miles Hazardous Sensitive people should remain indoors and keep activity levels low. Everyone else should avoid all physical activity outdoors.
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EXTERNAL WILDFIRE PROCEDURES
INITIAL RESPONSE: See Rapid Response Guide – External (Wildfire).
IMMEDIATE RESPONSE:
Incident Commander and Planning Chief: Monitor the situation in coordination with local response authorities. Notify State Survey agency of status. Determine if air quality issues are the priority threat and initiate strategies to reduce in-door pollution and protect sensitive residents and staff from harm. Anticipate the need for evacuation if there is a risk of the fire reaching the surrounding area and activate the Evacuation P&P.
Operations Chief: Assess residents frequently for comfort and any change of condition. Discourage outside activities during smoke event. Identify residents whose respiratory condition may require transfer due to air quality and inform IC. Ensure continuation of resident care and essential services. Maintain measures to reduce indoor smoke pollution: o Windows closed o AC to recirculate o Limited activities that could contribute to indoor air pollution such as vacuuming.
Logistics Chief: Acquire equipment such as air scrubbers if needed and instructed to do so by IC. Initiate Emergency Staffing Strategy if staffing levels are impacted by the emergency. Ensure supply deliveries are on schedule. If disruptions occur due to road closures or other impacts, initiate the Subsistence Needs P&P.
Finance/Admin Chief: Monitor staff and volunteer usage, track time. If needed, screen volunteers. Document all costs, including claims and insurance reports, lost revenue, and expanded services, and provide report to IC. Foster / CHS Risk Management Section 4: Policies and Procedures |Pg. 89
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RECOVERY:
Complete all repairs and restoration activities. Notify external partners and stakeholders of the operational status, including the return to normal operations. Continue to assess residents for adverse impacts from the incident. Document all costs, including claims and insurance reports, lost revenue, and expanded services, and provide report to Command Staff. Work with insurance, funding agencies, local, state, and federal emergency management to begin reimbursement procedures for resident billing and cost expenditures related to the event. Document all costs, including claims and insurance reports, lost revenue, and expanded services, and provide report to Command Staff. Work with insurance, funding agencies, local, state, and federal emergency management to begin reimbursement procedures for resident billing and cost expenditures related to the event.
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4.8. FLOOD
FLOOD -INCIDENT RESPONSE – RISK MANAGEMENT PROTOCOL
It is the policy of this facility to protect our residents, staff and others who may be in our facility from harm during emergency events. To accomplish this, we have developed procedures for specific hazards which build on the cross-cutting strategies in our emergency operations plan. We have taken steps to mitigate of risk of localized flooding through aggressive maintenance of drainage systems around our facility and the integrity of pipes and plumbing. We have taken proactive measures to minimize potential damage to critical systems such as backup power, and supply storage through placement in areas least likely to flood. Should we be faced with a significant flood threat from external conditions we will protect our residents, staff and visitors through the following actions:
PROCEDURE
INITIAL RESPONSE: See Rapid Response Guide – Flood.
IMMEDIATE RESPONSE:
Depending on the flood situation, which will be monitored through coordination with local response authorities, the Incident Commander may initiate the Evacuation or Shelter in Place P&Ps.
RECOVERY:
Complete all repairs and restoration activities. Notify external partners and stakeholders of the operational status, including the return to normal operations. Continue to assess residents for adverse impacts from the incident. Document all costs, including claims and insurance reports, lost revenue, and expanded services, and provide report to Command Staff. Work with insurance, funding agencies, local, state, and federal emergency management to begin reimbursement procedures for resident billing and cost expenditures related to the event. Foster / CHS Risk Management Section 4: Policies and Procedures |Pg. 91
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4.9. HAZARDOUS MATERIALS
HAZARDOUS MATERIAL-WASTE INCIDENT RESPONSE – RISK MANAGEMENT PROTOCOL
It is the policy of this facility to protect our residents, staff and others who may be in our facility from harm during emergency events. To accomplish this, we have developed procedures for specific hazards which build on the cross-cutting strategies in our emergency operations plan. This facility minimizes the risk of an internal “HazMat” incident through rigorous staff training on the proper storage and use of hazardous materials. If we are threatened by an internal or external HazMat event, we will protect our residents, staff, and visitors by implementing the following actions:
INITIAL RESPONSE: See Rapid Response Guide – Hazardous Materials and Sewage P&P if applicable.
IMMEDIATE RESPONSE:
Depending on the situation, which will be monitored through coordination with local response authorities, the Incident Commander may initiate the Evacuation or Shelter in Place P&Ps.
RECOVERY:
Complete all repairs and restoration activities. Notify external partners and stakeholders of the operational status, including the return to normal operations. Continue to assess residents for adverse impacts from the incident. Document all costs, including claims and insurance reports, lost revenue, and expanded services, and provide report to Command Staff. Work with insurance, funding agencies, local, state, and federal emergency management to begin reimbursement procedures for resident billing and cost expenditures related to the event.
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4.10. INFECTIOUS DISEASE
INFECTIOUS DISEASE - INCIDENT RESPONSE – RISK MANAGEMENT PROTOCOL
It is the policy of this facility to protect our residents, staff and others who may be in our facility from harm during emergency events. To accomplish this, we have developed procedures for specific hazards which build on the cross-cutting strategies in our emergency operations plan. This facility has extensive Infection Prevention policies and procedures that direct our response to the threat of infectious disease outbreaks. If the community is impacted by a threat of an epidemic, we will activate our EOP and be guided by the following P&Ps in addition to our infection prevention/outbreak management procedures:
INITIAL RESPONSE: See Rapid Response Guide – Infectious Disease.
IMMEDIATE RESPONSE:
Depending on the situation which will be monitored through coordination with local public health authorities, the IC may initiate the Shelter in Place P&P and the Emergency Staffing Strategy. Additional actions to our Infection Prevention/Outbreak Management P&Ps will be taken as advised by the local and state public health departments and may include:
Closing to new admissions. Urgent prophylaxis and vaccination of all staff and residents. Limited visitation. Screening of staff, contracted entities, volunteers and visitors for signs of illness. Personal protective equipment for staff. Activation of the Subsistence P&P if disruptions to supply chain occur. (See ICRA and Infection Control and Prevention Plan) RECOVERY:
Complete all resupply and restoration activities. Notify local response authorities, the State Survey agency, residents, families/representatives and other stakeholders of the operational status, including the return to normal operations. Continue to assess residents for adverse impacts from the outbreak. Document all costs, including claims and insurance reports, lost revenue, and expanded services, and provide report to Command Staff. Work with insurance, funding agencies, local, state, and federal emergency management to begin reimbursement procedures for resident billing and cost expenditures related to the event. Foster / CHS Risk Management Section 4: Policies and Procedures |Pg. 93
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4.11. LOCK DOWN
LOCKDOWN PPT LOCKDOWN POLICY AND PROCEDURES
It is the policy of this facility to protect our residents, staff and others who may be in our facility from harm during emergency events. To accomplish this, we have developed procedures for specific hazards which build on the cross-cutting strategies in our emergency operations plan. The ability to lockdown the facility in the case of an emergency which threatens the safety of residents, staff and visitors and/or facility operations is of paramount importance. Lockdown is the process by which the facility is secured and staff and visitors are channeled to specific entry/exit points. The priority in a Lockdown is to protect the safety of the residents, staff, contracted employees and any visitors that may be in the building.
Incidents That May Necessitate Lockdown
Event Prevent Entry Prevent Exit Power Failure X Earthquake X Flooding X Fire X Bomb Threat X External HazMat X X Civil Disturbance X X Hostage Event X Active Shooter X Workplace Violence X
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Exit lockdown is for the purpose of preventing individuals from leaving due to an existing hazard outside, whether it is a civil disturbance, or the need to screen those leaving due to a missing resident.
Entry lockdown is for the purpose of preserving the facility’s ability to operate and respond to a possible emergency event such as a power outage, or keeping unauthorized individuals from entering the facility.
Full lockdown means no one can leave or enter the facility. This procedure may be employed during risk of exposure to a hazardous substance, especially an airborne contaminate. Depending on the event, entry and/or exit may be permitted with staff/security screening or decontamination procedures in place.
When a threat necessitating Lockdown has been identified, this facility will comply with all directives from law enforcement. In the absence of these instructions, the Incident Commander will conduct the response and make staff assignments.
PROCEDURE
(Due to the urgent nature of this hazard implementation of NHICS may not be feasible)
All staff, volunteers and contracted employees are trained regarding this facility’s Lockdown Policy and Procedure.
“FACILITY LOCKDOWN” is announced overhead with the instructions of Entry, Exit or Full Lockdown as soon the Incident Commander activates this procedure.
Contact 911: Anyone at any time can call 911 when it is safe to do so. Provide the 911 dispatcher with as much relevant information as possible: o Facility name and location o Your name o Nature of the event o Description of the threat (NOTE: if armed intruder is involved, see Armed Intruder P&P for specific response actions to this threat). o Persons injured: number and extent
Specific tasks and duties that may be assigned to staff members during a Lockdown Event. Incident Commander and Planning Chief: Instruct staff members, patients/residents and visitors of the nature and type of lockdown and to remain in the facility during an Exit or Full Lockdown. Activate EOP. Assign a law enforcement/emergency service liaison Foster / CHS Risk Management Section 4: Policies and Procedures |Pg. 95
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Instruct staff to close blinds and drapes, close interior doors and lock exterior windows and move patients/residents away from windows and doors. Safety Officer Report and respond to event location within or on the physical facility site and take actions as directed by IC. Lock all exterior doors and assign personnel to control ingress and egress in and out of the facility per the Lockdown requirements. If applicable and able to do such, close and secure roadways into the facility per lockdown requirements. Report to the Incident Command Post. Management Staff of All Departments Contact department employees due in to advise of lockdown event. Instruct staff members to close interior doors, lock exterior windows, close blinds and drapes and move residents away from doors and windows. Direct staff members to take census of residents, visitors and staff within the department. Staff Members of All Departments Follow Department Manager directives. Ensure residents and visitors follow lockdown requirements as announced. Remain calm as not to upset residents.
When Law Enforcement arrives, follow the officer’s directives: o Empty your hands o Keep hands up and fingers spread o Do not scream or yell at arriving officers o Do not run directly at officers and/or avoid quick movements or grab onto them o Follow Law Enforcement instructions o Provide information to officers
ALL CLEAR - Wait for Law Enforcement or other response authorities to provide an “All Clear” before leaving your position. The event will be deemed ‘All Clear’ after response authorities have concluded emergency operations and declared the situation ’safe’. If Law Enforcement or other response authorities are not involved, the determination of “All Clear” will be made by the Incident Commander
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RECOVERY:
Once the threat has been resolved, recovery activities will include: Assessment of residents, staff and visitors to identify possible ill effects suffered during the incident. Care and treatment of residents, staff and visitors as indicated by the assessment including psychological first aid if needed. Restoration of normal services including the unlocking of all exits and gates per normal operations. Coordination with law enforcement and other emergency response authorities as appropriate for follow-up actions. Notification of resident representatives and the State Survey Agency to report the incident.
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4.12. MEDICAL DOCUMENTATION
It is the policy of this facility to preserve resident information, protect the confidentiality of that information, and secure and maintain availability of medical records during an emergency. This is accomplished in compliance with all state and federal laws including the release of resident information as allowed under 45 CFR 164.510(b)(1)(ii) (see also Communication Plan and Evacuation P&P).
PROCEDURES
< Insert facility-specific procedure for securing and preserving accessibility to clinical records during emergencies>
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4.13. MISSING RESIDENT / ELOPEMENT
CODE GREEN -ELOPEMENT -MISSING RESIDENT - INCIDENT RESPONSE – RISK MGT PROTOCOL
It the policy of this facility to protect the safety of our residents through early assessment of their risk for exit seeking behaviors. Once identified we take steps to mitigate that risk through and individualized care plan and good communication between staff, visitors and families regarding supervision needs. If despite these efforts a potential missing resident is identified the following actions will be implemented immediately:
PROCEDURE
INITIAL RESPONSE: See (A) Rapid Response Guide – Missing Resident and (B) Code Green / Elopement Policy
IMMEDIATE RESPONSE:
Incident Commander and Planning Chief: In coordination with the Operations Section Chief, ensure completion of search procedure to ascertain whether or not the resident is actually missing. o Assign staff to double check resident’s medical record for explanation such as discharge or family leave. o Notify the Administrator o If no explanation in the record, continue the floor-to-floor, room-by-room, office by office and campus and perimeter search x 30 minutes. Coordinate all search results and provide information to law enforcement on arrival Provide all staff involved in search with basic information about missing resident Activate the Lockdown procedures as needed. Notify MD and Family / Next of Kin Notify law enforcement and provide details of the incident and provide them with the missing resident information including: o Height, weight, hair color, etc. o Any available photos
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o Distinguishing features o Clothing worn, articles carried o Medical equipment in use, etc. Provide law enforcement with surveillance camera footage, facility maps, blueprints, master keys, card access, search grids, and other data as requested Notify the resident’s representative, the Chief Executive Officer, State Survey agency, and other appropriate officials of situation status and continue to brief them as the situation evolves.
Operations Chief: Ensure continuation of resident care and essential services. Ensure the safety of residents, staff, and visitors during the closure of entry and exit points; coordinate with law enforcement as needed. Once missing resident is found, immediately assess for injuries or other harm that might have been sustained during the incident. Initiate medical exam in the facility or transfer to the ER for further assessment and treatment.
Logistics Chief: If the campus lockdown continues, consider the impact on scheduled deliveries and pickups. Notify operators of planned deliveries or pickups of the need to postpone or reschedule.
Finance/Admin Chief: Monitor staff and volunteer usage, track time. If needed, screen volunteers to help with search. Document all costs, including claims, lost revenue, and expanded services and provide report to IC. (See Code Green / Elopement Policy.)
RECOVERY: Develop information for release to the media with law enforcement. Ensure the resident’s representative is briefed on the status of the lost resident and is aware of the situation prior to the release of any information to media. Report final status to local response authorities and the State Survey Agency. Initiate a post incident review to determine if the plan of care and/or operating systems needs to be modified based on this event.
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4.14. POWER OUTAGE
UTILITY FAILURE INCIDENT RESPONSE PROTOCOL UTILITIES MAPPING EMERGENCY OPERATIONAL IMPACT ANALYSIS / CHART #1 96-HOUR SUSTAINABILITY MATRIX It is the policy of this facility to protect our residents, staff and others who may be in our facility from harm during emergency events. To accomplish this, we have developed procedures for specific hazards which build on the cross-cutting strategies in our CEMP. Our facility is prepared to safely manage resident care through effective and efficient facility operations during the loss of power in this facility. To mitigate the impact of a power outage we have contacted our electrical power provider and requested to be on the priority level for restoration should a major power outage occur in our community. We also have a rigorously maintained generator that cools the entire facility. (See Subsistence – Alternate sources of Power P&P).
Should a power outage occur in our facility, we will initiate the following actions:
INITIAL RESPONSE: (See Rapid Response Guide –Power Outage and Severe Weather Heat or Cold if applicable.)
IMMEDIATE RESPONSE:
Incident Commander and Planning Chief: Monitor emergency progress and obtain situational awareness through communication with local response authorities and the municipal power supplier to determine potential duration of power outage. Based on this projection:
Determine whether Shelter in Place or evacuation (partial or full) is advisable. Consider a partial evacuation of high risk residents such as those who are on life supportive treatments. Be proactive in identifying current generator fuel needs and procuring additional supplies.
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Obtain assessment of staffing, equipment, and supply needs and the overall impact from the ongoing utility outage on resident care, staff, and the nursing home operations. Communicate with local response the authority and State Survey agency regarding nursing home status, critical issues, and resource requests. Inform staff, residents, and families/representatives of situation and provide regular updates. In the event of a generator failure immediately implement our P&P for Loss of Fire/Life Safety Systems.
Safety Officer: Evaluate safety of residents, staff and visitors in relationship to power outage impact on physical plant. Assess the function of security devices, emergency lights, fire alarm and suppression systems. Work with Logistics to distribute appropriate emergency equipment such as flashlights. In coordination with Operations Section Chief, secure the nursing home and implement limited visitation policy. If indicated by the situation initiate Lock Down P&P
Operations Chief: Assess residents for risk, and prioritize care and resources, as appropriate. Report need for additional staffing to assist with care and supervision of residents. Ensure all critical resident care equipment plugs are connected to emergency outlets. Determine battery life on essential care equipment and notify IC. Set up portable oxygen as needed. Identify residents whose fragile condition may require transfer and inform IC. Ensure continuation of resident care and essential services. If resident call light system is down initiate frequent checks and provide hand bells to be used in facility during call light outage Provide reassurance to residents and visitors. Provide increase hydration and implement cooling or warming measures as indicated. Lighting and temperatures will be maintained within an acceptable range, as the generator will cool the entire facility. Ensure generator is functioning properly. Initiate Disaster Menus if power outage impacts meal time (see Appendix G).
Logistics Chief: Support Operations with equipment and supplies, including printed “downtime” forms as needed for resident care documentation during outage. Initiate emergency staffing strategy if appropriate (See Staff Recall Survey - Appendix R) Check communications, IT and report status to Incident Commander. Foster / CHS Risk Management Section 4: Policies and Procedures |Pg. 102
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Begin back up of essential records as directed by Command staff. Preserve power supplies by making sure all non-critical power needs are suspended. Obtain back up batteries for critical equipment from emergency supply or report needs to Incident Commander.
Finance/Admin Chief: Monitor all costs, including claims and insurance reports, lost revenue, and expanded services, and provide report to Command Staff.
RECOVERY:
Complete all repairs and restoration activities. Notify external partners and stakeholders of the operational status, including the return to normal operations. Continue to assess residents for adverse impacts from the incident. Document all costs, including claims and insurance reports, lost revenue, and expanded services, and provide report to Command Staff. Work with insurance, funding agencies, local, state, and federal emergency management to begin reimbursement procedures for resident billing and cost expenditures related to the event.
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4.15. SHELTER – IN – PLACE
SHELTER-IN-PLACE INCIDENT RESPONSE - RM PROTOCOL
It is the policy of this facility to protect our residents, staff and others who may be in our facility from harm during emergency events. To accomplish this, we have developed procedures for specific hazards which build on the cross-cutting strategies in our CEMP. The decision to shelter in place will be based on the best interests of the residents and whenever possible, the advice of local response authorities. It is the protocol of this facility to shelter in place as a preferred method over facility evacuation due to the stress to residents associated with evacuation to another facility or alternate care site. For this reason, we have mitigated our risks of impact from the most likely hazards we face through staff training, structural assessment, emergency supplies and redundant communication systems.
If the threat is fast moving (e.g., an emergent wildfire), the decision to shelter in place may need to be made rapidly, without the opportunity to consult with local fire, law, or county emergency management officials. In this case the decision would be made by the Incident Commander. Situations that may warrant shelter in place include: Severe weather that limits access to the facility Hazardous materials incidents Earthquakes Wildfires etc.
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PROCEDURES
INITIAL RESPONSE: See Rapid Response Guide – Shelter in Place, Subsistence Needs P&P, and Power Outage P&P.
IMMEDIATE RESPONSE:
Incident Commander and Planning Chief: Confer with local authorities and key leadership staff to gain situational awareness of the threat and the facility’s ability to maintain services during the event. Determine whether Shelter in Place is advisable based on this information. If conditions are unstable and the facility is at risk to lose power, consider a partial evacuation of high-risk residents. Assign staff to notify local response authorities, State Survey agency, families/representatives, suppliers and corporate representatives. If indicated by the situation, notify off-duty staff, volunteers, families/representatives and vendors of restricted access to the facility. If indicated by the situation, initiate Lock Down P&P. Monitor emergency progress, structural integrity of the facility and infrastructure systems. Maintain communication with local response authorities to obtain situational awareness including potential water or power outages. Brief staff and residents of the situation.
Operations Chief: Continue care and monitoring of residents. Assess residents for change in condition related to the incident. Inventory the supply of medications and other critical medical supplies and notify IC and Logistics of the projected supply duration. Continue support activities such as dietary and housekeeping. Immediately initiate building preparations to mitigate any airborne hazards if that is applicable. Monitor damage due to the incident and initiate repairs if feasible.
Logistics Chief: Inventory supplies and critical equipment; project the need for additional resources including staffing (See Disaster Inventory Supplies Appendix E). Ensure the facility’s alternate means of communication equipment is available if needed.
Finance/Admin Chief: Track costs, record keep for staff time and assist IC with communication and business concerns.
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EXTENDED RESPONSE:
If Shelter in Place is prolonged, activate supply plan and access emergency supplies (see the Subsistence P&P, the Disaster Supply Inventory - Appendix E, and the Disaster Meal Menus - Appendix G). Obtain briefings and provide updates on the facility’s status to local response officials. Coordinate with local response partners for resource requests as needed. Notify State Survey agency, families/representatives, suppliers and corporate representatives of facility status.
Consider evacuation if conditions indicate a need to vacate the facility.
RECOVERY:
Advise local response authorities and State Survey agency of the return to normal operations. Notify residents, staff, volunteers and visitors of the “All Clear”. Notify families, suppliers and corporate representatives of return to normal operations. Initiate resupply and repairs as needed. Restore normal business operations. 4.16. SUBSISTENCE NEEDS
FACILITIES RESOURCE DIRECTORY FORM
It is the policy of this facility to provide adequate subsistence during emergencies for all residents, on-duty staff, visitors and volunteers if present and unable to leave the premises. (If subsistence supplies are inadequate for the duration of the emergency and timely resupply is not feasible, the Incident Commander will activate evacuation procedures.)
PROCEDURES Emergency Food Our facility maintains food supplies suitable for our disaster meal menus. These menus are utilized when there is a disruption of services and/or outside resources are not available through the regular supply chain. Our facility has identified the minimal resources needed to provide food and water service to residents, staff and visitors during a shelter in place for 7 – 10 days.
See Disaster Supply Inventory - Appendix E, and Disaster Menus - Appendix G.
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Medication and Medical Supplies: Our routine pharmacy refill schedule enables us to have a minimum of seven (7) days of on hand medications for all residents. In addition, we have arrangements for timely emergency resupply through “Polaris” our pharmaceutical contractor, if needed. Should resupply not be feasible, the medications in our E Kit and stock supplies will be utilized as appropriate. If medication supplies are inadequate to meet specific residents’ needs, the IC will activate a partial evacuation of the impacted residents. Staff are trained and expected to bring a supply of personal medications for their use in the event of an emergency.
Pharmacy Supplier: POLARIS LISA KARSTEN, Director of Pharmacy Services, CHS O: 954 – 484 – 1515 x 5281 C: 561 – 703 – 3874 Medical Supplies: Our facility has calculated the type and amount of critical medical supplies that would be needed in an emergency. A minimum of a seven (7) days inventory of these items is maintained at all times and arrangements are in place with key vendors for emergency resupply when needed.
See Vendor List - Appendix F, and Emergency Agreements - Appendix J. Emergency Water
To ensure safe water for residents, staff and visitors during a crisis, our facility maintains:
An emergency water supply that is suitable and accessible; An emergency water supply consistent with applicable regulatory requirements; and Methods for water treatment when supplies are low. A Mutual Aid Agreement for Emergency Water Resource Quantity Location
Emergency water supply (minimum See MOU’s See MOU’s four-day supply of bottled water stored onsite) Emergency water supply which See MOU’s See MOU’s exceeds minimum three-day supply – via Mutual Aid Agreement
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Resource Quantity Location
Logistics, equipment and containers available to transport water supplies during evacuation Empty containers to store water onsite (barrels / drums) Water purification products (type used) On-site water storage (boilers, hot water tanks, ice makers)
See also Disaster Water - Appendix H.
Alternate Sources of Energy Our facility has developed procedures to ensure that we maintain safe temperatures for residents, sanitary storage of perishable provisions, emergency lighting, fire detection, extinguishing and alarms. These are described in the Power Outage P&P, Extreme Weather P&P, and Loss of Life Safety Systems - Appendix U.
We have mitigated the impact of a power outage on these systems through the use of a stand- by generator, etc. which complies with all federal, state and local regulations.
GENERATOR INFORMATION: ** **See the EMERGENCY ENVIRONMENTAL CONTROL PLAN
This generator is located on the outside of the building.
It is a <_Enter type and KW> fueled by
This generator powers the following systems in our facility:
< Enter appropriate information i.e. emergency plugs, fire alarms, emergency lights, HVAC>.
In the event of a generator failure that cannot be repaired in a timely way, the Incident Commander will determine whether a partial or full evacuation is necessary for resident safety (see Evacuation P&P).
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Sewage and Waste Disposal Our facility will take all possible measures, including collaboration with local response authorities and utilities, to restore the function of our sewage and waste disposal systems as soon as possible. If restoration of these systems cannot be accomplished in a timely manner, the Incident Commander will activate the Evacuation P&P.
While waiting for evacuation of residents, the following emergency waste management procedure may be employed:
Our facility has emergency supplies that include heavy duty waste disposal bags (see Disaster Supply Inventory - Appendix E). During a temporary disruption to our sewage system, immediate measures may be taken to minimize the flushing of toilet wastes using bedside commodes, adult briefs, and if possible, Port a Pots for staff. We will utilize these bags to store the wastes that accumulate. Staff trained in infection prevention, wearing personal protective equipment and using specified carts will gather the bags as needed, and transport them for temporary storage in a designated area which is isolated from traffic, pests, and risk to residents from contamination. Arrangements will be made for safe pick-up and disposal of these wastes in accordance with nationally accepted industry standards as soon as possible.
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4.17. LOSS OF FIRE/LIFE SAFETY SYSTEMS
In the event of a disruption to our facility’s fire and life safety systems (e.g. fire alarms, sprinklers, fire door) or commercial electricity with a concurrent generator failure, we will immediately reduce the risk to resident safety through the following actions:
(Also see Power Outage, “Evacuation, and Subsistence Needs P&Ps)
See the FIRE PLAN (hyperlink)
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See Critical Incidents Policy
See All Hazard Incident Guides and Matrix - HICS/NHICS
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3 COMMUNICATIONS PLAN
COMMUNICATION PLAN:
NS NS
External Contact Information Staff Contact Information Physicians’ Contact Information Volunteer Contact Information Primary and Alternate Means of 3 Communication HIPAA Decision Flowchart Facility Profile Information COMMUNICATIO Sharing Emergency Plan Information
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Facility Information
This facility’s Communication Plan address:
How does the facility determine which authorities to notify in the event of an emergency?
How do the authorities vary in different types of emergency situations?
How are occupancy levels communicated to local and state authorities during an
emergency?
How are supply and other needs communicated to local and state authorities during an
emergency?
How does the facility convey to local and state authorities their ability to help others?
How might the means of communication differ depending on the emergency or the
authorities being notified?
What redundant means of communication exist for providing this information?
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External Contact Information
This grid contains information for external contacts, which are updated so that in an emergency event, the appropriate individual(s) can be reached in a timely fashion.
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Staff Contact Information
External Contacts Agency Purpose for Contact Contact Name/Title Contact Info Local Emergency Management Staff Local Public Health – County’s Department of Health Healthcare Coalition State Emergency Management Staff State Public Health Department (Emergency Preparedness ) State Public Health Department (AHCA - Division of Quality Assurance) CMS ASPR FEMA AHCA (State Licensing and Certification Agency) Office of the State Long-Term Care Ombudsman Fire Power / Light EMS Police Sheriff Medical Examiner / Coroner Other LTC Facility(ies) Other Facilities w/ MOUs Entities Providing Services Sister Facilities
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COMMUNICATION PLAN:
External Contact Information Staff Contact Information NS Physicians’ Contact Information Volunteer Contact Information Primary and Alternate Means of 3 Communication HIPAA Decision Flowchart Facility Profile Information
Sharing Emergency Plan Information COMMUNICATIO
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Facility Information
This facility’s Communication Plan address:
How does the facility determine which authorities to notify in the event of an emergency?
How do the authorities vary in different types of emergency situations? NS NS How are occupancy levels communicated to local and state authorities during an
emergency?
How are supply and other needs communicated to local and state authorities during an
emergency?
How does the facility convey to local and state authorities their ability to help others? 3 How might the means of communication differ depending on the emergency or the authorities being notified? What redundant means of communication exist for providing this information?
COMMUNICATIO
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External Contact Information This grid contains information for external contacts, which are updated so that in an emergency event, the appropriate individual(s) can be reached in a timely fashion.
External Contacts Agency Purpose for Contact Contact Name/Title Contact Info Local Emergency Management Staff Local Public Health – County’s Department of Health Healthcare Coalition State Emergency Management Staff State Public Health Department (Emergency Preparedness ) State Public Health Department (AHCA - Division of Quality Assurance) CMS ASPR FEMA AHCA (State Licensing and Certification Agency) Office of the State Long-Term Care Ombudsman Fire Power / Light EMS Police Sheriff Medical Examiner / Coroner Other LTC Facility(ies) Other Facilities w/ MOUs Entities Providing Services Sister Facilities
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Staff Contact Information This grid maintains contact information for staff, so that they can be contacted during emergencies. Reasons for contact may include cancelling shifts, determining which staff are actually on duty or on site, or reaching out to staff to help with surge needs. When roles for staff are adjusted or increased during emergency events, those roles will be clarified and documented.
Staff Emergency Contact Roster Email Name Department Phone Emergency Staffing Role Address
** Staffing Roster and staff contact numbers will be printed at facility level, and attached.
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Residents’ Physicians’ Contact Information This grid maintains contact information for the residents’ physicians. The facility is able to contact residents’ physicians in a timely manner during emergency events. This facility maintains updated contact information for physicians and include multiple ways to reach the residents’ physicians.
Resident Physician Emergency Contact Roster Email Name Department Phone Pager Address
** Medical Staff Roster and contact numbers will be printed at facility level, and attached. Foster / CHS Risk Management Section 4: Policies and Procedures |Pg. 120
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Volunteer Contact Information This grid maintains contact information for volunteers. The facility is able to contact volunteers during emergencies. Reasons for contact may include cancelling shifts, determining which volunteers are actually on duty or on site, or reaching out to volunteers to help with surge needs.
Volunteer Emergency Contact Roster Email Emergency Staffing Name Department Phone Address Role
** Volunteers Roster and their contact numbers will be printed at facility level, and attached.
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Primary and Alternate Means of Communication This grid document primary and alternate means of communication with relevant individuals/partners. This facility has various methods of communicating with staff and relevant partners. The alternate method is easily accessible, in the event that the primary method becomes unavailable, and is also agreeable to both this facility and the entity we are communicating with. Primary and alternate methods of communication may vary based on who the facility is trying to contact (for example, primary and alternate methods of communication may be different for staff than they are for state emergency management staff), but will be decided and documented before emergency events occur so that communication expectations are clear in emergency events.
Means of Communication Contact Primary Method Alternate Method Local Emergency Management Staff Local Public Health – County’s Department of Health Healthcare Coalition State Emergency Management Office State Public Health Department (Emergency Preparedness ) State Public Health Department (AHCA - Division of Quality Assurance) & DOH CMS ASPR FEMA AHCA (State Licensing and Certification Agency) Office of the State Long-Term Care Ombudsman Fire Power / Light EMS Police Sheriff Medical Examiner / Coroner
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Catholic Health Services Emergency Operations Program and Plan - Manual Means of Communication Contact Primary Method Alternate Method Other LTC Facility(ies) Other Facilities w/ MOUs Entities Providing Services Sister Facilities (Additional Sources of Assistance)
HIPAA Decision Flowchart
HIPAA is not waived in emergency events, thus, this facility is aware of the need to protect resident information at all times. Certain information can be shared during emergency events if the protected health information is disclosed for public health emergency preparedness purposes. The At-A-Glance Disclosure Decision Flowchart (linked below) will help the facility staff to make choices about disclosing protected health information. https://www.cms.gov/Medicare/Provider-Enrollment-and- Certification/SurveyCertEmergPrep/Downloads/OCR-Emergency-Prep-HIPPA-Disclose.pdf
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5. COMMUNICATION PLAN
Our communication plan supports rapid and accurate communication both internally and externally. This section describes the elements of a basic communication plan incorporated into this EOP which is updated annually and whenever needed due to changes in contact information
Relative to internal communications, the facility maintains a contact list of all staff, including telephone numbers and email addresses (if available). This contact information may be used whenever it is necessary to notify staff of a threat or emergency that may impact or involve them. We have a regular schedule to update staff on critical information related to the emergency (see Staff Recall and Survey - Appendix R for details on the physical location of contact lists). Additionally, we maintain contact lists for entities providing services under arrangement, residents’ physicians, other in-kind facilities, the Office of the Long-Term Care Ombudsman, and our current volunteers (see Contact Lists – Appendix D, and Vendor List – Appendix F.
Once an incident is recognized that may require activation of the EOP, the person who first recognizes the incident will immediately notify their supervisor or the senior manager on site.
Our internal communication equipment includes:
Overhead paging system Hand-held radios Cell phones with texting Message board Public Information Officer Runner Other It is also important to communicate with relevant external partners to: 1) gather information relevant to the incident, and 2) share information regarding the facility’s status, activities and needs. Our facility will report incidents as required to jurisdictional authorities, e.g., report a fire to the local fire department. We also share relevant situational information with local response authorities and the State Survey agency (see Section 2: Rapid Response Instructions and Section 3: Emergency Operations Plan – Coordination with Local Response Authorities).
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Our external communication equipment includes: PRIMARY COMMUNICATION:
Land lines Cell phones with texting
ALTERNATE COMMUNICATION: Hand-held radios Satellite phones Amateur/Ham radio Internet Other
In the event of an emergency, family members/representatives will be notified and briefed on the status of the facility and the condition of their loved one as soon as it is feasible to do so. In case of an emergent situation, where time and conditions do not allow us to communicate with our resident’s families in a timely manner, we may utilize the Ombudsman, the Department of Health staff, the American Red Cross website, our website, and other methods as available to provide information on our status. We also will provide a phone number to families/representatives where they can call and obtain information on the status and location of their resident.
PUBLIC INFORMATION OFFICER (PIO)
Our facility has identified a responsible staff person (or her designee) to release information to the public during and after a disaster. Unless otherwise specified, it will be the facility’s Incident Commander (IC) who will be the PIO’s designee.
METHOD OF SHARING INFORMATION ABOUT RESIDENTS’ CONDITION
It is the policy of this facility to release resident information and various other forms that summarize critical care information as allowed under 45 CFR 164.510(b)(1)(ii). In a disaster, this is handled through the PIO and Health Information Department. (see Evacuation P&P).
PROVIDING INFORMATION REGARDING FACILITY NEEDS AND OCCUPANCY
This facility follows the local response protocols when responding to requests for facility status and bed availability. Emergency Status System is the coordinated information system used by AHCA, which in-turn is the method used by our facility to communicate with lead county agencies for medical health response. Through this system, our facility responds to bed polls,
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reports facility status, and receives or gives other information (see Section 3: Emergency Operations Plan - Coordination with Local Response Authorities).
Sharing Emergency Plan Information
Sharing emergency communication plan information:
What information from the emergency plan will be shared with residents and families/representatives?
Who will make the decision about the type of information provided?
In what format will this information be provided (e.g., fact sheet, brochure, website)?
Will the information be reviewed with residents and families/representatives?
When will this information be provided to residents and families?
Is there a system for reissuing this information when it is updated?
SHARING INFORMATION ON THE EOP WITH RESIDENTS AND FAMILIES
Our facility provides information to all residents and family or representatives regarding our EOP. This is done routinely as part of our admission orientation and periodically during Resident Council and family meetings. The method we use to share this information is
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Statement 6 - Alerting Family Members
Depending upon the nature of the emergency, the Public Information Officer / Administrator, and / or selected department heads or designee will meet and decide the best available information to relay to family members. The resulting family call script will be distributed to our pre- designated, trained persons in the business office to begin the process of notifying family members regarding the facility’s current status and plans. In the event of a Category 3 or greater hurricane threatening to make landfall, the facility will evaluate which families may want to pick up residents should evacuation occur. All requests for information from family members will be referred to the designated, scripted persons in the business office.
Communication
Communication is a critical function during emergency conditions and the facility’s emergency operations plan include its surveillance and communications capabilities to detect emergencies and communicate response actions. The plan also include alternate communication systems, an understanding of how to leverage external resources, and a clearly described communication structure.
Alternative methods of communication include:
Cellular telephones, though not always reliable depending on the nature of the emergency Two way radios (always kept in their chargers) Fax machine (if phones are operable). Internet or local area networks (if computer systems are operative) Through the media, TV and radio announcements, social media Satellite phone systems Runners; word of mouth (if conditions allow)
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A NOAA weather radio is included in the facility’s emergency response plan. During an emergency, National Weather Service forecasters will interrupt routine weather radio programming and send out the special tone that activates weather radios in the listening area. NOAA Weather Radio broadcasts National Weather Service warnings, watches, forecasts and other hazard information 24 hours a day. Known as the “voice of the National Weather Service,” NOAA Weather Radio is provided as a public service by the Department of Commerce’s National Oceanic and Atmospheric Administration. Most NOAA Weather Radio receivers are either battery-operated portables or AC-powered desktop models with battery backup. Some CB radios, scanners, short wave and AM/FM radios are capable of receiving NOAA Weather Radio transmissions.
Risk Communication Part of the facility’s emergency operations plan include a system for sharing and integrating hazard-specific actions which may be taken to reduce exposure to harm, such as:
Hurricanes (Tropical Cyclones) Monitor local media or official weather service forecasts Foster and maintain good relations with local emergency management Respond by sheltering in place or evacuation Secure facility openings and appendages Gather sufficient fuel, food, water, and medicines Keep individuals indoors If evacuating, contact receiving facility, transportation providers, and resident families If evacuating, prepare residents, medical records, and supplies for transport If evacuating, arrange transportation to occur when cool and to accommodate meals, medicine schedules, etc.
Severe Weather Events Monitor local media or official weather service forecasts, paying particular attention to “hazardous weather outlooks” or similar products Operate a weather radio with alarm 24/7/365 in a location where it will be heard Independently monitor local weather conditions as severe weather is often a very localized event Residents and staff should remain indoors Avoid windows, skylights, and extensive use of electrical equipment during severe weather
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Biological Events Contact the local health department, CDC, hospitals, Medical Director, CMO and regulatory agencies Restrict movement of all but necessary personnel to and from the facility Isolate and quarantine ill residents and impacted staff Initiate full infection control activities
Hazardous Materials Events Be aware of factories, plants, utilities, and transportation corridors Know if the facility is located near an active military facility, or is built on former military training land Have open communication with local industrial operations Staff should be trained on the proper use of chemicals and substances employed in the operation of the facility HVAC equipment is capable of disabling fresh air supply
Fire Sprinkler and alarm systems is properly maintained Staff regularly perform fire drills - Code Red / RACE / PASS Potential hazards are mitigated (smoking areas located away from the facility and infrastructure) Electronic devices used in the facility, both for medical purposes and regular business office applications, are monitored for wear and tear that could lead to electrocution or sparking hazards
Wildfire Maintain contact with local emergency management and forestry personnel Monitor local media, also monitor local conditions Shut down the HVAC (heating, ventilation, and air conditioning) fresh air exchange when smoke is noticed Contact transportation vendors if it appears that a rapid evacuation may be required
Extended Power Outages Establish and maintain open communication with the local power utility and local emergency management Contact the local health department, AHCA, Fire Chief and hospitals if the facility is experiencing extreme hot (or cold) temperatures (See also, Policy for Management of Environmental Temperatures within Appendix F) Ensure that generator(s) are operational and have an adequate supply of fuel onsite Ensure that all battery backups systems are fully operational and are attached to emergency power
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Contact vendors to supply additional fuel Contact resident families or representatives and, if necessary, discharge resident to responsible parties with functioning utilities
Winter Storms Monitor local media and official government weather forecasts; winter weather is rarely a surprise event Maintain backup emergency power systems and have sufficient fuel that is treated for cold weather Stock sufficient food and water for several days Make alternative staffing arrangements should the facility be cut-off
Risk communication is shared with residents and staff to help them take active steps to minimize the emergency’s impact on their lives.
Interagency Staff Communication Facility leaders can expect staff to need certain information during an emergency event. Every word and passing emotion is elevated in importance during an emergency and staff wants to know what the Administrator knows about the emergency.
Roles/Responsibilities The facility’s plan describes emergency responsibilities assigned to leadership, corporate representatives, administrators, medical directors, nurses, and all other staff. To help accomplish this goal, the plan includes specific policies which have been developed by department directors to be implemented during an emergency. These policies feed into and support the overall facility’s emergency preparedness plan and are reviewed by the facility’s command team, a group consisting of at least the Administrator and all Department Directors. The facility’s emergency plan reflects the assignment of key responsibilities to specific individuals and/or positions. Additionally, details that describe planning, equipping the facility, training and education, exercises and drills, and evaluation procedures are included in the Plan.
The plan identifies by name and title the person(s) responsible for: 1. developing the Comprehensive Emergency Management Plan (CEMP) 2. integrating the CEMP into facility operations 3. submitting the completed CEMP to the local office of emergency management for approval 4. maintaining compliance with Fire Prevention, Fire Protection, and the Life Safety Code 5. establishing and maintaining the various emergency transportation contracts 6. reviewing safety standards and certification or licensure of contracted transport companies
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7. establishing and maintaining mutual aid agreements for receiving evacuation destination facilities safekeeping resident and facility records during an emergency event Evacuation
Decision-Making The evacuation of this facility is an extremely serious undertaking involving risks to the residents the facility seeks to protect. The mass movement of persons during an emergency event who are often extremely frail, bed-ridden, comatose, cognitively impaired, etc. is daunting, yet, with their considerable health care needs, residents have higher disaster associated risks than other populations and moving them out of harm’s way may well become a community imperative.
The CEO/Executive Director / Administrator have the authority to call for an evacuation or to shelter in place, in collaboration with the county’s fire and emergency management officials. (While one person is indicated in the plan as the decision-maker, it is recognized that he/she will be part of a decision-making team which include internal sources as well as external partners and the local office of emergency management utilizing real-time data related to the emergency event and the clinical profiles of the facility’s residents.)
Physical Time Structure Nature of Event Resident Acuity Scope
Staff Rural
Location of External Decision to Internal Metropolitan Facility Factors Factors Supplies Evacuate or Shelter-in-Place Urban
Surge Zone Transportation
Flood Zone In the Zone Destination Hurricane Evacuation Zone
Figure 1: Thresholds excerpted from National Criteria for Evacuation Decision-Making in Nursing Homes.
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Retrieved from the internet on 8/4/2018 https://asprtracie.hhs.gov/technical- resources/resource/285/national-criteria-for-evacuation-decision-making-in-nursing-homes
Because of the unexpected nature of emergencies, there is no ready-made “evacuation formula” on which nursing home leaders may rely. Yet, through open dialogue with internal and external experts, at least certain thresholds may be identified and safeguards put into place to either initiate a well-executed evacuation or provide a stable care environment during and after an event. The successful execution of both evacuation and sheltering-in-place activities depend upon what has come before: preparedness and training. Resident acuity will direct the manner in which residents are evacuated. After consulting with the facility’s Medical Director or attending physician, the Administrator and Director of Nursing may select severely ill and certain heavy-care residents to be transferred to a pre-determined local hospital which is sheltering in place. A MOU or Mutual Aid Agreement will be prearranged and signed with the hospital, and will be updated annually. After the sickest and heaviest-care residents have been evacuated, the healthier general population will be moved to the staging area to be evacuated to the receiving facility. A clear delineation of internal roles and responsibilities related to evacuation activities is a key. The facility’s emergency operations plan includes the name and title of persons responsible for: deciding whether the facility will evacuate or shelter in place communicating with family members regarding the facility’s evacuation decision collecting resident records and ensuring they are transported according to the facility’s plan collecting medications and ensuring they are transported according to the facility’s plan gathering food and water for use by residents and staff during the evacuation movement collecting resident clothing and personal hygiene items and ensuring they are transported in accordance with the facility’s plan during an evacuation Foster / CHS Risk Management Section 4: Policies and Procedures |Pg. 8
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overseeing the resident evacuation (and name an alternate person for this role) overseeing resident care needs during transportation maintaining facility security during an emergency event Timeline addressing how long it is expected to take to complete a full scale evacuation.
The Administrator, in conjunction with the facility representatives and directors, determine how far in advance full-scale evacuation procedure will be initiated (for example 12 hours prior to the onset of tropical storm winds). Storm tracks and speeds will influence and may change this time frame. For more information on evacuation decision-making, see Appendix BB
Transportation Contracts
Transportation is one of the most important components of an emergency plan and is not always within the control of the facility. Transportation provider contact information is readily accessible from the facility’s emergency plan with contracts included. Responsibility for establishing and maintaining transportation contracts is assigned and included in the plan. The facility’s emergency transportation arrangements include prior arrangements with:
Non-emergency transport companies Emergency transport companies As applicable: Commercial buses / School buses /Municipal buses/vans Commercial rental truck companies for transporting supplies Corporate or company vehicles Employee autos Family autos
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The facility’s emergency preparedness plan provides a system for an annual assessment and revision of transportation contracts.
Transportation contracts include: The destination location to which the company will be asked to go (some local companies may not transport outside a certain geographical area) The response time the transportation vehicles are to be at the departure location from the time the facility contacts the company (ex: 1, 2, 3 hours, etc.) Some level of assuredness that the contracted transportation will be available as agreed The transportation company’s safety standards and certification or licensure verification is described in a transportation contract (See also Guidance for the Safe Transportation of Medical Oxygen for Personal Use on Buses and Trains, Appendix Z).
Mutual Aid Agreements
It is common for this facility to have mutual aid agreements with other sister facilities, etc. in which the residents from one may be moved to the other in the case of an evacuation. The plan includes the name and title of the person responsible for developing and maintaining mutual aid agreements. The receiving facility is the “host” facility and, as such, has certain responsibilities. The evacuating facility also has responsibilities and these are outlined in the mutual aid agreement. An example is that the evacuating facility will come to the host site with additional staff to help in the care of the additional residents. Both the host site and the evacuating site have included in their training how both staffs will work together in a new working environment. (Both facilities established procedures for processing the residents and staff from an evacuating facility and these procedures are integrated in the facility’s emergency training schedule.) This facility may also be asked by the local office of emergency management to shelter a person from the community whose care needs make him / her inappropriate for a public Foster / CHS Risk Management Section 4: Policies and Procedures |Pg. 10
Catholic Health Services Emergency Operations Program and Plan - Manual shelter. The facility will communicate ahead of time with the local Office of Emergency Management (OEM) to formalize this type of mutual assistance.
Moving Records
Facility records may be stored digitally on a computer’s hard drive, on CDs, and/or maintained in hard copy files. Computers will be unplugged and placed on tops of desks in case of flooding, or moved to a higher location in the building, or moved off site. Alternatively, digital records can be saved to a removable storage medium like a CD or a flash drive and carried off site. CHS corporate office I.T. department makes provision for electronic records storage. Assessing the back-up of electronic data retrieval systems will be a function of the annual review of emergency preparedness systems. Hard copies of records will be stored in such a way that the critical records can be gathered and transported. The facility has the ability to scan relevant hard copies. Critical data will include: Resident information (face sheets, clinical data, physician orders, care plans) Family information (contact information) Staff information (contact information) Financial information (payroll, accounts receivable/payable) Vendor information (supplies and utilities, emergency contacts) External partner information (licensing agency, local office of emergency management, fire and police) The medical chart at large
The person responsible for overseeing the safety of resident and facility records will make sure the resident’s medical records have been moved to the departure staging area and will accompany the appropriate resident on their transport vehicle.
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Destinations
Different emergencies may require different evacuation strategies. In the broadest sense, an evacuation may be simply moving from the ground floor to an upper floor or from one wing of a building to another. In case of a facility-wide fire, for example, residents would not have to be moved out of the geographic area; in this case, they may need to move only a short distance to another facility in close proximity until it is safe to return or they can be relocated. If storm surge is the concern, but without an accompanying dangerous wind speed, residents may need to only move out of the storm surge area; that is, to a safer facility within the area. If a Category 5 hurricane is bearing down and time allows, residents would be evacuated out of the geographic area and outside of the hurricane’s range. The terms close, within area, and outside of area are not linked to a specific number of miles. They represent the concept that residents need to be moved for as short a distance as possible to be safe, depending on the nature of the specific hazard. The farther frail residents must travel, the less safe the evacuation becomes for them. Distance traveled must be balanced with the harm extended travel causes such residents.
Close Proximity: serves an unplanned, immediate evacuation Within Area: serves an unplanned or planned evacuation Outside of Area: serves a planned evacuation
The facility identifies possible destination choices in close proximity, within the area, and outside the area. For each destination, the comprehensive emergency management plan include: name, street address, phone number distance (in miles) between facilities estimated travel time written directions and maps
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Sheltering in Place
Generator Details & Testing
The presence of an appropriately-sized, well-maintained generator stands in the gap when normal electrical services are interrupted and makes a big difference in how well the facility is able to serve its residents and staff. The generator supports critical care functions and maintains lights and air temperature throughout the facility. The facility’s emergency plan identifies the person responsible for maintaining the facility’s generator before and during an emergency event; this includes both a third party vendor as well as an on-site employee familiar with the generator.
** Other key generator information included in the plan is:
(**See the Emergency Environmental Control Plan) vendor company name and phone number generator fuel distributor name and phone number generator size (in KWs) phase (single or 3-phase) voltage (120, 208, 240, 480, or other) on-site fuel capacity (gallons or pressure) on-site fuel duration (hours) tank location (above or below ground) fuel type (diesel, unleaded gas, natural gas, LP gas) how and when generator is tested listing of all functions to which the generator provides power how a generator failure will be managed whether or not the generator has “quick-connect” capability description of how generator will be refilled and fuel resupplied during an emergency
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Generator Details & Testing
The National Fire Protection Association requires these tests for electrical power standby systems per the NFPA Life Safety Code – 101 (2012) Edition:
VI. Electrical Power Standby System: (EPSS) 110 (2002) 8.4.1
A. Emergency generator system Inspect weekly & test 99 (2002) 4.4.4.1.1 monthly
B. Emergency generator – run under load 30 min./month 110 (2002) 8.4.2
C. Emerg. Gen – diesel – not meeting 8-4.2 2 hrs. annually 110 (2002) 8.4.2.3
D. Main & feeder circuit breakers Exercise per manufacturer 99 (2002) 4.4.4.1.1.1 & inspect yearly
E. Storage batteries – inspect & Weekly 99 (2002) 4.4.4.1.3 maintenance
F. Emergency Lighting – inspect & 30 sec. Monthly----90 min. 101 (2003) 7.9.3.1 maintenance Annually
G. EPSS shall be test run continuously for 4 Every 3 years 110 (2002) 8.4.8 hours for Hospitals & SNF’s
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Utilities
Generally speaking, utility companies do not assign special priority to nursing homes in terms of power restoration. The priority customers are hospitals, police stations, and fire departments. Power company representatives may not fully understand and may not plan with the acuity levels of the persons residing in nursing homes in mind, including those who routinely require oxygen, tracheotomy, and enteral feeding/hydration services. Conversely, nursing home representatives may not understand the facility’s location on their community’s power grid and how that influences power restoration. Communications with local electrical and water utility companies is assigned to the administrator, who will also be responsible for providing status reports to administration, employees, residents, and families.
Other important utility information include:
Utility Company Name and Phone Number Utility Company Account Number Water Company Name and Phone Number Water Company Account Number Security
Security strategies are included in the EOP. The Safety Officer is responsible for maintaining facility security during an emergency event. Staff may be able to help in watching over facility resources and security. This is as simple as assisting in making rounds, alerting supervisors to areas of concern, and reporting unknown persons on the premises. Security protocols are reinforced with staff to ensure that only authorized people are in the facility. Security measures help to protect the facility and its residents and staff during a disaster when, due to emergency generator support requirements, the facility is probably one of few buildings with light, food, water and medical supplies. During a disaster, security needs will be coordinated as needed with local law enforcement agencies.
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Upon activation of the facility’s emergency management plan, security guards will be stationed at all unlocked entrances and exits, as necessary. In major disasters, the facility will consider establishing a visitor’s reception center away from the main facility. Entrance to the facility would be restricted to personnel bearing staff identification cards, staff from affiliated facilities, family members of staff as indicated in the plan, approved volunteers, state authorities, and to residents. Where feasible, photo identifications or other means will be used to assure positive identification. Visitors, including the media, volunteers, and clergy will be distinguishable from staff. Family members may want to check on their loved ones with a personal visit; the facility will ensure that they are signed in, wear a badge, and do not disrupt disaster management activities. The facility will adhere to the National Fire Protection Association’s recommendation, which is that normal visiting hours be suspended when possible. Facility will consider the development of traffic flow charts for internal traffic movement along corridors showing how pedestrian traffic will flow for movement of residents and equipment during an emergency or an evacuation. The facility will consider any special facility characteristics related to the availability of parking for staff, patients, and visitors, as well as normal vehicular, emergency vehicular, and pedestrian traffic flow patterns in and around the facility.
Basic Supplies
If the facility is not evacuating, it is - by default - sheltering in place. 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. The preparations, equipping, and training which have preceded the emergency event will now be reflected in how well the facility staff are able to provide care and services to residents. After an emergency event, facility designees will be communicating with all the external partners / external agencies that make up the unofficial emergency team and, internally, will be working their assigned emergency duties. Additionally, the facility may serve as a host site in which it is receiving evacuees from other sister facilities with which a mutual aid agreement is shared. There have also been times when the facility has
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Catholic Health Services Emergency Operations Program and Plan - Manual provided shelter for the family members of staff, extending concern for staff while providing for resident needs. Along with transportation, the provision of basic supplies such as food, water, and medication is critically important to any nursing home’s emergency management plan. Preparedness activities include equipping the facility to be self-sufficient at least during the first 96 hours after an extended emergency. The plan will include a description of how basic supplies will be provided for 4 - 7 days.
The plan identifies the name and title of the persons / departments responsible for:
food and water stores staffing alternate power supply, including maintenance linen stores and disposable product stores sanitation and cleaning supplies alternate communication hardware and services
Department heads will work from an inventory list of emergency supplies, routinely checking par levels and replenishing supplies to the desired levels.
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Catholic Health Services
Statement Statement Emergency Operations Program and Plan - Manual
NON-PERISHABLE FOODS: In accordance with Florida’s requirements, a one-week supply of a variety of non-perishable food and supplies, that represents a good diet, shall be maintained by the facility, s. 59A- 4.110(4), FAC.
7 Our dietary department will write a 7-day Emergency Menu which will be approved by the QA/PI Committee : Equipping Supplies for Sheltering in Place in Sheltering for Supplies Equipping : and the Command Team each year. This menu will be initiated by direction of the Command Team and will be sufficient to provide meals to our residents and staff for 7-days. For estimation purposes, we expect to provide meals for 250 – 300 persons for a period of 96 hours post event. Perishable foods will be used first and as deemed safe by the Director of Food Service, but are not included in the Emergency Menu (see attached sample). Our Emergency Menu consists of non-perishable packaged or canned food/juices and will be stored in the locked Resident Storage Area located in the Food and Nutrition Storage Areas. We will also have snack foods, paper plates and utensils sufficient for our sheltering period.
EMERGENCY WATER: We will store a water supply in anticipation of a post-emergency period in which the normal water supplies will be disrupted. We will provide for at least 96 hours of water for residents and staff using a ratio recommended by the Florida Division of Emergency Management of 1 gallon of potable (safe to consume) water per person per day. It is the responsibility of the Director of Food and Nutrition Services to maintain and rotate water stores each year and to make sure they are sufficient for the number of residents and staff. With a possible influx of __ additional residents (according to our existing mutual aid agreement with CHS Nursing Homes /Sister Facilities) we will have approximately 250 - 300 people sheltering at our facility. We have sufficient capacity for maintaining a _____ gallon water supply using ____ gallons of bottled water onsite. In addition, some of our facilities have ___-gallon water drums in storage which will be filled by the dietary department prior to the expected storm’s arrival. The Director of Food and Nutrition Services will report to the Command Team when this has been accomplished. In addition to this potable water supply, the nursing staff will fill all bathtubs with water to serve basic sanitation needs. Emergency water agreements are in place.
EMERGENCY MEDICATION SUPPLY: Our Director of Nursing is responsible for ensuring that we have at least 96-hours medication supply for our residents. When the Command Team first meets to assess the emergency threat, the Director of Nursing will do a medication inventory and contact the pharmacy to fill any gaps in the medication supply. The Nursing Department will verify and secure the medications, dispensing it as indicated in the Resident’s plan of care. We will also secure medical equipment such as stethoscopes,
glucometers, scissors, thermometers, oxygen e-tanks, etc. sufficient for the sheltering period. The Director of
(Subsistence Needs) (Subsistence Nursing will work with the Director of Food and Nutrition Services to plan for sufficient amounts of food supplements and thickening products, wet wipes, paper towels, etc.
In addition, our plan includes helping residents get a 30-day refill of their prescription medication under an Emergency Preparedness Prescription Refill prior to an imminent hurricane threat in accordance with Section 29 of House Bill No. 7121 which was signed into law June 01, 2006.
In order to receive an Emergency-Preparedness Prescription Medication 30- Day Refill:
1. The resident must live in the county they are seeking the prescription medication refill from and that county: A. Has been issued to be under a Hurricane Warning by The National Weather Service, or B. Has been declared to be under a “State of Emergency” in an Executive Order, issued by the Governor, or Foster / CHSC. Risk The Management local County Office of emergency managementSection 4: Policies has and activated Procedures their |Pg. 18 Emergency Operation Center and its Emergency Management Plan.
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Dependent Care
The facility’s emergency plan provide for sheltering the family members of staff persons. This decision is made each year when the plan is updated and carefully included in staff training. Facility administration ask staff each year about their availability to work during an impending weather event, such as a hurricane, and whether or not they would consider bringing family members with them when reporting to work during a sheltering in place event. NO PETS ALLOWED.
Sheltering staff and their immediate family members are advised to bring: sleeping bags toiletries three changes of clothing Backpacks for snack items, water bottle, books, games, etc.
Statement 8: Sheltering Staff Dependents
Our facility’s Recreational Activities Director will be responsible for organizing and setting up activities program. As part of our policy and training, we will collect information from our staff regarding the number and ages of family members they would expect to bring with them in this event.
The pre-determined volunteer staff of the facility will be allowed to bring personal belongings, their immediate family members to our facility to shelter in the event of a hurricane or similar extreme emergency event requiring sheltering in place.
NO PETS ALLOWED.
Foster / CHS Risk Management Section 4: Policies and Procedures |Pg. 19
Catholic Health Services Emergency Operations Program and Plan - Manual
Host Receiving Site
Status & Procedures
When the facility agrees to be a host site for other sister facilities, the emergency plan will indicate this and describes the processes for tracking and caring for its resident guests. These processes are coordinated with the other facilities with which the host site holds mutual aid agreements.
When the facility serves as a host site it will:
Consider reimbursement issues prior to accepting residents. Create a tracking system to receive all evacuees and their vital identifying information, such as insurance numbers, social security numbers, originating facility, date of birth, discharge date, face sheet, medical records, etc. Address accommodations for dependents and staff from evacuating facilities. Plan for increasing staff to match additional resident care needs. Determine and include the total number of evacuees that can be accommodated, including a decision about occupying only empty beds and bringing mattresses from the transferring facility or exceeding licensed bed capacity. Determine increased staffing needs for social services Establish and include the details in the emergency operations plan for an admission triage area which will include several work stations with all necessary paperwork and supplies to process the evacuees. o Facility will consider a nurse, a CNA, and a social worker per station to obtain the necessary resident history, assess current medical needs, obtain family contact numbers, assess need for durable medical equipment, sign consents and obtain advance directives information, and place or verify resident identification bands. The Medical Director should be on hand, if possible, to assist with diagnoses and identifying care needs. Foster / CHS Risk Management Section 4: Policies and Procedures |Pg. 20
Catholic Health Services Emergency Operations Program and Plan - Manual
Decide how a number of evacuees will be processed in a short amount of time. Consider security for a possible influx of large amounts of cash or jewelry which might accompany the guest residents. Create a process and method for tracking additional expenses for potential reimbursement and analyses. Decide if guest residents will be processed as new admissions or through a scaled down process. Address any limitation to the types of residents which may be served by the facility during the mutual aid agreement negotiations before the evacuating residents begin to arrive. Consider possibility of having to isolate arriving guest residents due to infection control issues. Prepare to offer showers, meals, snacks, emergency medications, and blankets when guest residents arrive. Arrange for pastoral care, volunteers, or social worker to visit and console guest residents upon arrival.
The emergency operations plan will also include a description of where the additional residents will be housed and a floor plan indicating the location.
Foster / CHS Risk Management Section 4: Policies and Procedures |Pg. 21
Catholic Health Services Emergency Operations Program and Plan - Manual
Statement 9: Notifying and Tracking
Processing Evacuees: This facility has a mutual aid agreement with our sister facility, ______, a ___ bed facility located in ______which is ___ miles from this facility’s physical location. The agreement provides that ______will be able to accept ____ of ______(facility’s) residents in the case of an evacuation. Our business office has created a tracking system to receive these evacuees and to capture their identifying information. This includes the residents’ names, insurance numbers, social security numbers, their dates of birth, etc. We have agreed that the evacuating facility will maintain the existing reimbursement stream and we will bill the evacuating facility for related host site expenses. We will be integrating one (1) nurse from ____ (transferring facility) per ____ evacuating residents into our workforce but the nurse will not change employers. We will increase our social service hours for the purpose of helping with family communications, addressing adjustment issues, and coordinating volunteers and/or donations. Our Administrator will be responsible for notifying the Agency for Health Care Administration of our intent to exceed licensed capacity to accommodate evacuees, and also update the status in AHCA’s Emergency Status System (ESS).
Bed Location: We will fill any unoccupied beds that we have available at the time of the event and will create dormitory style beds for up to ____ residents in our therapy gym and other areas as needed.
Foster / CHS Risk Management Section 4: Policies and Procedures |Pg. 22
Catholic Health Services Emergency Operations Program and Plan - Manual
Training and Exercises:
Exercise Design Checklist TRAINING & TESTING
Exercise Evaluation Guide
After Action Report / Improvement Plan 4 Instructions / Templates
Section 4: Communication Plan | pg 23
Catholic Health Services Emergency Operations Program and Plan - Manual
The emergency operations plan describes systems in place for conducting meaningful drills and exercises geared toward educating personnel, testing the plan, and putting equipment through its paces.
The emergency plan identifies the person(s) responsible for: creating emergency training materials for non-management personnel during non- emergency times scheduling the training sessions training non-management personnel using the written training materials documenting that the facility’s emergency training sessions were conducted training new employees on the emergency procedures and their role
Exercises and drills are scheduled to occur throughout the year. Key components of exercises and drills are the processes for evaluating weaknesses, how to correct plan weaknesses, and the process for integrating the corrections into the overall plan. Additionally, exercises and drills describe how staff feedback is received and analyzed for possible modification of the emergency operations plan.
The plan also include the title of the person responsible for: planning and executing exercises and drills documenting the implementation of exercise drills
Section 4: Communication Plan | pg 24
Catholic Health Services Emergency Operations Program and Plan - Manual
Recovery
Initiation and Communication The plan includes procedures for inspecting the facility to ensure it is structurally sound and provides a safe care environment before residents return after an off-site evacuation has occurred. The re-entry team will likely consist of Emergency Management Officials, CEO, COO, CMO, VP of Risk Management, Administrator, Maintenance Director, Director of Nursing, and Dietary Manager. Consultants such as air quality consultants or structural engineers may be called in to help make the decision to return.
Members of the team will conduct on-site assessments, with these considerations in mind: power has been restored or emergency electrical system is working with a high degree of stability life support equipment are functioning with a degree of certainty water has been restored and is safe to drink or access to reliable emergency water supply is secure risk of harm from structural damage is minimal call signals are operable fire alarm system has been tested and is functional phones are operable or alternate external communication system is reliable and adequate access to durable medical supplies is assured kitchen equipment operable, including refrigerators, freezers, and range hood exhaust fan along with selected essential kitchen lighting adequate access to sufficient medical supplies availability of staff to operate the nursing home and care for residents downed electrical power lines and other debris are cleared
Section 4: Communication Plan | pg 25
Catholic Health Services Emergency Operations Program and Plan - Manual
4 TRAINING AND TESTING
Training and Testing
Exercise Design Checklist TRAINING & TESTING
Exercise Evaluation Guide
After Action Report / Improvement Plan 4 Instructions and Template
Section 4: Communication Plan | pg 26
Catholic Health Services Emergency Operations Program and Plan - Manual
6. RAPID RESPONSE GUIDES
The following checklists are provided to the facility for a quick reference during the initial activation of the EOP. They describe the actions that should be taken during the first 2 hours of an incident and are to be used in conjunction with Section 2: Rapid Response Instructions. Detailed policies and procedures for these and other hazards that have been identified through our risk assessment can be found in Section 3: Emergency Operations Program and Plan and Section 4: Policies and Procedures.
TABLE OF CONTENTS
6.1. RAPID RESPONSE GUIDE: BOMB THREAT ...... 28
6.2. RAPID RESPONSE GUIDE: EARTHQUAKE ...... 29
6.3. RAPID RESPONSE GUIDE: EVACUATION ...... 31
6.4A. RAPID RESPONSE GUIDE: EXTREME WEATHER - COLD ...... 33
6.4B. RAPID RESPONSE GUIDE: EXTREME WEATHER - HEAT ...... 34
6.5A. RAPID RESPONSE GUIDE: FIRE - INTERNAL ...... 35
6.5B. RAPID RESPONSE GUIDE: FIRE - EXTERNAL ...... 36
6.6. RAPID RESPONSE GUIDE: FLOOD ...... 37
6.7. RAPID RESPONSE GUIDE: HAZARDOUS MATERIAL ...... 38
6.8. RAPID RESPONSE GUIDE: INFECTIOUS DISEASE ...... 39
6.9. RAPID RESPONSE GUIDE: MISSING RESIDENT ...... 40
6.10. RAPID RESPONSE GUIDE: POWER OUTAGE ...... 41
6.11. RAPID RESPONSE GUIDE: SHELTER IN PLACE ...... 42
(see instructions on how to update this table in the back of the manual)
ACCIDENTS AND SUPERVISION - RISK MANAGEMENT ANNUAL TRAINING
Section 6: Rapid Response Guides | pg 27
Catholic Health Services Emergency Operations Program and Plan - Manual
6.1. RAPID RESPONSE GUIDE: BOMB THREAT
Initial Actions Call 9‐1‐1 to report the threat.
Do NOT approach, disturb or touch the potential threat. Immediately evacuate anyone in the area surrounding the potential threat, saying: “We have an emergency in the building and must evacuate this area immediately according to our plan. This is not a drill.”
Instruct staff to calmly and safely evacuate residents to a safe area.
Activate facility’s Bomb Threat P&P and appoint a Facility Incident Commander (IC) if warranted. Notify your supervisor or facility administrator as specified in the EOP.
If a bomb threat is called in, be calm and courteous. If you are not in danger, attempt to collect information from the caller that will help to identify the location of the potential bomb, e.g., • Where is the bomb? • What does it look like? • When will it explode? • What kind of bomb is it? • What is your name? Record this and any other information you collect, such as whether the caller is male or female, characteristics of the caller’s voice and any background sounds you notice. It is best to write this information down. (See FBI Bomb Threat Worksheet - Appendix C).
Communicate relevant information with law enforcement.
Notify the local response agency and state survey agency to report an unusual occurrence and activation of facility’s EOP.
If facility evacuation is required, see EVACUATION Policy and Procedure.
See the “Bomb Threat Policy for other response actions consistent with our resident profile, risk assessment and coordination with local community plan
Section 6: Rapid Response Guides | pg 28
Catholic Health Services Emergency Operations Program and Plan - Manual
6.2. RAPID RESPONSE GUIDE: EARTHQUAKE
Initial Actions If you are physically able – DROP, COVER and HOLD ON • DROP to the ground. • Take COVER by getting under a sturdy desk or chair (cover your head and neck with your arms and hands). Keep away from glass, windows or anything that could fall near you. • HOLD ON to your shelter until the shaking stops. If a resident is in a wheelchair – • Tell/assist the resident to LOCK their wheels in a safe position. • Tell the resident to COVER their head and neck with their arms. If a resident is confined to a bed – • Tell the resident to HOLD ON and PROTECT their head with a pillow. Activate facility’s Earthquake P&P and appoint a Facility Incident Commander (IC) if warranted. Assign staff to assess residents for any injuries that require immediate attention. Assign staff to assess the facility for damage that requires immediate attention (e.g., gas leaks, fires, broken glass, spills, etc.) • If a gas leak is suspected (e.g., you smell gas or hear a blowing or hissing noise), shut off gas and contact the proper utility company for restoration. • Do not allow any flame source until you are certain the gas lines have not been affected. • Inspect the facility for small fires (a common hazard after an earthquake); extinguish as necessary and/or call 9‐1‐1. • Look for electrical system damage. If you see sparks or broken or frayed wires, or if you smell hot insulation, turn off the electricity at the main fuse box or circuit breaker. If you have to step in water to get to the fuse box or circuit breaker, call an electrician first for advice. • Check for sewage and water lines damage. If you suspect sewage lines are damaged, avoid using the toilets and call a plumber. If water pipes are damaged, contact the water company and avoid using water from the tap. • Heed public health notices/orders regarding water contamination (including the following notices: Boil Water, Do Not Drink Water, and Do Not Use Water). Consider all flood water contaminated. Avoid walking through flood waters and wash hands thoroughly after contact. Do not use pre‐packaged food and drink Section 6: Rapid Response Guides | pg 29
Catholic Health Services Emergency Operations Program and Plan - Manual
products that come into contact with flood water. When in doubt, throw it out! Report utility problems to appropriate utility company/agency. • Activate your emergency water plan. See Disaster Water – Appendix H for further information. If the facility has suffered structural damage, or if supporting utilities are compromised (e.g., power, water), consider the need for evacuation vs. shelter in place. Notify the local response authority and State Survey agency to report status and activation of facility’s EOP. If facility evacuation is required, see RAPID RESPONSE ‐ EVACUATION. If the decision is to shelter in place, see RAPID RESPONSE – SHELTER IN PLACE. See other response actions consistent with our resident profile, risk assessment and coordination with local community plan
Section 6: Rapid Response Guides | pg 30
Catholic Health Services Emergency Operations Program and Plan - Manual 6.3. RAPID RESPONSE GUIDE: EVACUATION
Initial Actions Activate facility’s EOP and appoint a Facility Incident Commander (IC) if warranted.
Activate the Evacuation P&P.
Notify the local response agency and state survey agency to report pending evacuation and activation of facility’s EOP
Assess which residents might be able to go to families and contact in advance.
Assess: • Number and types of beds needed • Available staff to support transferred residents (call in additional staff if needed) • Potential transportation requirements based on the number of residents, medical needs and mobility status
If residents need to be transferred to another facility, identify available beds by the following procedures: • Coordinate with other facilities in the healthcare system or neighbor/buddy facilities with whom you have a pre‐existing relationship • If the above resources are unavailable or inadequate, request assistance from the local response authority coordinating resident movement. Obtain transportation resources by contacting the contracted ambulance providers. If the above resources are unavailable or inadequate, request assistance from the local response authority. Prepare for evacuation: • Collect and package residents’ equipment and medications • Collect and package residents’ belongings for transport, including glasses, dentures, hearing aids, etc. • Prepare water and snacks to accompany residents during transport period • Prepare copy of medical chart to accompany resident If surrounding roads may be damaged, verify planned evacuation routes with the public safety agency.
Section 6: Rapid Response Guides | pg 31
Catholic Health Services Emergency Operations Program and Plan - Manual
Track residents to destinations and notify family members of evacuation and planned destination. If needed, additional tools and information on Evacuation are included in the following Appendices: • Appendix L – Evacuation Forms, which includes: o Resident Evacuation Tracking Form o Resident Evacuation Checklist o Resident Face Sheet o Resident Assessment Form for Transport and Destination
See other response actions consistent with our resident profile, risk assessment and coordination with local community plan
Section 6: Rapid Response Guides | pg 32
Catholic Health Services Emergency Operations Program and Plan - Manual 6.4a. RAPID RESPONSE GUIDE: EXTREME WEATHER - COLD2
Initial Actions Activate facility’s Extreme Weather P&P and appoint a facility Incident Commander (IC) if warranted. Assess residents for signs of distress and/or discomfort.
Initiate actions to safely increase resident comfort, e.g., utilize heating pads and electric blankets (be sure to carefully monitor the temperature of residents); offer warm liquids (keeping in mind relevant dietary modifications/restrictions), etc. Contact vendors for additional heating units if appropriate (See Appendix F – Vendor List). Do not leave residents unattended near a heat source.
If the internal temperature of the facility remains low and potentially jeopardizes the safety and health of residents, consider re‐location to a warmer part of the facility or evacuation to another facility. If the decision is made to evacuate the facility, see RAPID RESPONSE – EVACUATION.
Notify the State Survey agency (AHCA) to report an unusual occurrence and activation of facility’s EOP. See other response actions consistent with our resident profile, risk assessment and coordination with local community plan
2 The determination of what constitutes excessive cold should be tailored to the impact of the temperature and its duration on the health and well‐being of the facility’s residents. An informed decision should be made by responsible facility administrators. A suggested guideline to consider is a facility temperature of 65 degrees Fahrenheit or lower for a period of four hours. Section 6: Rapid Response Guides | pg 33
Catholic Health Services Emergency Operations Program and Plan - Manual 6.4b. RAPID RESPONSE GUIDE: EXTREME WEATHER - HEAT3
Initial Actions Activate facility’s Extreme Weather Heat P&P and appoint a Facility Incident Commander (IC) if warranted. Assess residents for signs of distress and/or discomfort.
Call 9‐1‐1 if any resident appears to be suffering from heat‐related illness such as heat cramps, heat exhaustion or heat stroke. Consider re‐locating residents to a cooler part of the facility.
If the outdoor temperature is cooler than the internal facility temperature, consider opening windows and using fans to bring cooler air into the building. If the outdoor temperature is not cooler, keep the windows closed and shades drawn. (Note: it may be necessary to increase security to accommodate open windows, etc.) If the internal temperature of the facility remains high and potentially jeopardizes the safety and health of residents, consider evacuation to another facility. Provide cool washcloths and cooling fans for air circulation.
Encourage residents to drink fluids to maintain hydration.
If the decision is made to evacuate the facility, see RAPID RESPONSE – EVACUATION.
Notify the State Survey agency to report an unusual occurrence and activation of facility’s EOP. See other response actions consistent with our resident profile, risk assessment and coordination with local community plan
3 The determination of what constitutes excessive heat should be tailored to the impact of the temperature and its duration on the health and well‐being of the facility’s residents. An informed decision should be made by responsible facility administrators. A suggested guideline to consider is a facility temperature of 85 degrees Fahrenheit or higher for a period of four hours.
Section 6: Rapid Response Guides | pg 34
Catholic Health Services Emergency Operations Program and Plan - Manual
6.5a. RAPID RESPONSE GUIDE: FIRE - INTERNAL
Initial Actions Rescue anyone in immediate danger while protecting the safety of the rescuing staff member(s). Follow the facility’s procedure for RACE, PASS and other urgent response to fire. Alert residents and staff members; pull the fire alarm.
Call 9‐1‐1 immediately to report a fire. Include the following information: Name of facility • Address and nearest cross street • Location of fire (floor, room #, etc.) • What is burning (electrical, kitchen, trash, etc.)? Activate facility’s Internal Fire P&P and appoint a Facility Incident Commander (IC) if warranted. Contain the fire if possible without undue risk to personal safety. Shut off air flow, including gas lines, as much as possible, since oxygen feeds fires and distributes smoke. Close all fire doors and shut off fans, ventilation systems, and air conditioning/heating systems. Use available fire extinguishers if the fire is small and this can be done safely. Oxygen supply lines (whether portable or central) may lead to combustion in the presence of sparks or fire. If possible, quickly re‐locate oxygen‐dependent residents away from fire danger. If the decision is made to evacuate the facility, see RAPID RESPONSE – EVACUATION.
Notify the local response authority and State Survey agency to report an unusual occurrence and activation of facility’s EOP. See the “Fire Plan” for other response actions consistent with our resident profile, risk assessment and coordination with local community plan
Section 6: Rapid Response Guides | pg 35
Catholic Health Services Emergency Operations Program and Plan - Manual 6.5b. RAPID RESPONSE GUIDE: FIRE - EXTERNAL
Initial Actions Monitor local alert system and local news for evacuation reports and instructions.
Monitor residents and staff for complications related to smoke exposure.
Activate facility’s External Fire P&P and appoint a Facility Incident Commander (IC) if warranted. Preemptive methods to mitigate smoke and fire risk: • Close all windows, doors, and vents • If using HVAC, set to re‐circulate indoor air • If possible, use a high efficiency particulate air (HEPA) filter • Prepare evacuation bags, records, and ID tags • Contact transportation companies to alert them you may need to evacuate In case of immediate threat: • Move residents to a pre‐designated staging area for rapid evacuation • If you smell gas, and it is safe to do so, shut off the gas. Do not do so unless need is certain as only the gas company can turn it back on. • Contact the transport companies and facilities you have agreements with • Notify resident families. • Leave a message on the facility phone with a contact number and information regarding facility status. If the decision is made to evacuate the facility, see RAPID RESPONSE – EVACUATION.
Notify the local response authorities and State Survey agency to report activation of facility’s EOP. See the “Fire Plan” for other response actions consistent with our resident profile, risk assessment and coordination with local community plan
Section 6: Rapid Response Guides | pg 36
Catholic Health Services Emergency Operations Program and Plan - Manual 6.6. RAPID RESPONSE GUIDE: FLOOD
Initial Actions Rescue anyone in immediate danger while protecting the safety of rescuing staff member(s). If the flood poses danger to residents, staff or visitors, call 9‐1‐1 immediately and include the following information: • Name of facility • Address and nearest cross street • Describe flood situation (basement, room #’s, etc.) Activate facility’s Flood P&P and appoint a Facility Incident Commander (IC) if warranted. Alert residents, staff and visitors.
Unplug non‐essential appliances, equipment and computers.
Check for gas leaks, water line ruptures, sewage contamination, etc. If you smell gas, and it is safe to do so, shut off the gas. Do not do so unless the need is certain as only the gas company can turn it back on. Report utility problems to utility company/agency.
If water lines are disrupted, consider the water supply to be contaminated and follow the facility plan for emergency water. Heed public health notices regarding water contamination (including the following notices: Boil Water, Do Not Drink Water, and Do Not Use Water). Consider all flood water contaminated. Avoid walking through flood waters and wash hands thoroughly after contact. Do not use pre‐packaged food and drink products that come into contact with flood water. Report utility problems to appropriate utility company/agency. If needed, activate your emergency water plan. See Appendix H - Disaster Water for further information. Gather critical supplies to take to higher ground/evacuation (e.g., medications, drinking water, health records, communication devices, blankets, etc.)
Do not allow electrical devices to come into contact with water.
If the decision is made to evacuate the facility, see RAPID RESPONSE – EVACUATION.
Notify the local response authorities and the State Survey agency to report an unusual occurrence and activation of facility’s EOP. See other response actions consistent with our resident profile, risk assessment and coordination with local community plan
Section 6: Rapid Response Guides | pg 37
Catholic Health Services Emergency Operations Program and Plan - Manual 6.7. RAPID RESPONSE GUIDE: HAZARDOUS MATERIAL
Initial Actions If a reportable hazardous material/waste spill or release occurs (or is threatened) on facility property, call 9‐1‐1 immediately to report the incident. The facility may also be required to notify local authorities. Include the following information: • Name of caller and facility • Exact location, date and time of spill, release or threatened release • Substance, quantity involved and isotope (if known) • Chemical name (if known) • Description of what happened
Alternately, the facility may be notified by authorities of an external hazardous materials/waste spill or release that may affect the facility. Activate facility’s HazMat P&P and appoint a Facility Incident Commander (IC) if warranted. Assess residents for signs of distress; keep residents, staff and visitors away from the site of the spill. Access the Safety Data Sheet (formerly named the Material Safety Data Sheet) for the material spilled or released on the facility’s property. Determine if the material/waste poses a safety or health risk to residents, staff or visitors. All SDS’s should be available on site, but if the SDS cannot be located on site, consider checking the internet. Utilize appropriate Personal Protective Equipment (PPE) if warranted.
Close windows, doors, and ventilation systems as needed to protect air quality by preventing the spread of dangerous fumes or smoke. Coordinate with public safety agencies (fire and law) and emergency management to determine if evacuation is necessary. If the decision is made to evacuate, see RAPID RESPONSE – EVACUATION.
Notify the local response authority and the State Survey agency to report an unusual occurrence and activation of facility’s EOP. Follow public health advice regarding water or air contamination (including the following notices: Boil Water, Do Not Drink Water, and Do Not Use Water). See other response actions consistent with our resident profile, risk assessment and coordination with local community plan
Section 6: Rapid Response Guides | pg 38
Catholic Health Services Emergency Operations Program and Plan - Manual 6.8. RAPID RESPONSE GUIDE: INFECTIOUS DISEASE
Initial Actions If either the volume or severity of an infectious disease significantly threatens or impacts day‐to‐day operations, activate facility’s Infectious Disease P&P and appoint a Facility Incident Commander (IC) if warranted. Notify the local public health department and the State Survey agency to report an unusual occurrence and activation of facility’s EOP. Obtain guidance from the local health department and the U.S. Centers for Disease Control and Prevention (CDC). Implement appropriate infection control policies and procedures.
Clearly post signs for cough etiquette, hand washing, and other hygiene measures in high visibility areas. Consider providing hand sanitizer and face/nose masks if practical. Consider advising visitors to delay visits if needed to reduce exposure risk to residents.
Advise staff to check for signs and symptoms of illness and to not work if sick. Activate emergency staffing strategies as needed. Limit exposure between infected and non‐infected persons; consider isolation of ill persons. Conduct recommended cleaning/decontamination in response to the infectious disease.
See the “Infection Prevention and Control Plan” for other response actions consistent with our resident profile, risk assessment and coordination with local community plan
Section 6: Rapid Response Guides | pg 39
Catholic Health Services Emergency Operations Program and Plan - Manual 6.9. RAPID RESPONSE GUIDE: MISSING RESIDENT
Initial Actions Record the time that the resident was discovered missing and when and where he/she was last seen. Verify that the resident has not signed out or been discharged.
Perform census verification and resident roll call to determine if there are any other missing residents Activate facility’s Missing Resident P&P and appoint a Facility Incident Commander (IC) if warranted. Search the facility’s grounds for the resident. If necessary, distribute copies of the resident’s photograph to the staff searching the grounds. Keep a record of the areas searched. Be sure to check: • Closets • Walk‐In Refrigerators/Freezers • Storage Rooms • Under Beds and Behind Furniture If the missing resident is not found following an expedient search, call 9‐1‐1 and provide: • Name and description of missing resident • Description of clothing, ambulation method, cognitive status Photo if available Notify: • Responsible party / next of kin that resident is missing and search is underway • Notify law enforcement and the State Survey agency to report an unusual occurrence and activation of facility’s EOP. Coordinate with public safety agencies in searching for the missing resident.
Once the resident is found, assess for injuries and notify the responsible party/next of kin, facility staff and public safety agency representative. See the “Elopement / Code Green” policy for other response actions consistent with our resident profile, risk assessment and coordination with local community plan
Section 6: Rapid Response Guides | pg 40
Catholic Health Services Emergency Operations Program and Plan - Manual 6.10. RAPID RESPONSE GUIDE: POWER OUTAGE
Initial Actions
Call 9‐1‐1 if the power outage causes or threatens a medical emergency (e.g., power is lost to a ventilator). If the power outage poses a risk to the safety of residents, staff or visitors, take actions to reduce/eliminate the threat without jeopardizing the safety of staff. Report the outage to the appropriate utility company or repair vendor.
Activate facility’s Power Outage P&P and appoint a Facility Incident Commander (IC) if warranted. Activate back‐up power and/or emergency lighting if necessary.
Comfort and assess residents for signs of distress.
Account for all residents.
Notify the State Survey agency to report an unusual occurrence and activation of facility’s EOP. To the extent possible, mobilize emergency back‐up power generators and necessary fuel for operation. Take all reasonable steps to protect food and water supplies and maintain a safe environment of care for residents and staff. If the decision is made to evacuate the facility, see RAPID RESPONSE – EVACUATION. If the decision is made to shelter in place, see RAPID RESPONSE – SHELTER IN PLACE. Consult other RAPID RESPONSE Guides as appropriate to the situation causing the power outage, e.g., flood. See the “Utilities Management Plan” for other response actions consistent with our resident profile, risk assessment and coordination with local community plan
Section 6: Rapid Response Guides | pg 41
Catholic Health Services Emergency Operations Program and Plan - Manual 6.11. RAPID RESPONSE GUIDE: SHELTER IN PLACE
Initial Actions Activate facility’s Shelter in Place P&P and appoint a Facility Incident Commander (IC) if warranted. Identify safe and unsafe areas of the facility relative to the specific threat.
Move residents from unsafe areas to safe areas. Be sure to include medications, important personal items, etc. Increase the safety of “safe areas” by reducing hazards, e.g., close, lock and move away from windows (during extreme winds), exterior doors, and other openings that may create hazards. Plan for the availability of food, water and other essential disaster supplies for residents and staff during the time period anticipated for sheltering in place. In addition to non‐perishable food and water and critical medications, consider battery powered radios, first aid supplies, extra blankets, flashlights, batteries, duct tape, plastic sheeting, plastic garbage bags, and eating utensils. Comfort and assess residents for signs of distress.
Notify the local response authorities to report an unusual occurrence and activation of facility’s EOP. Continually reassess the safety of sheltering in place and prepare to activate the facility evacuation plan if at any time the risk of sheltering in place is greater than the risk to evacuate (see Evacuation P&P). Keep the local authorities notified of any change in status. If needed, extended shelter in place guidance is contained in the Shelter in Place and Subsistence Needs P&Ps
Section 6: Rapid Response Guides | pg 42
7. APPENDICES
TABLE OF CONTENTS
APPENDIX A: ACRONYMS ...... 47
APPENDIX B: AFTER ACTION REPORT/IMPROVEMENT PLAN ...... 49
APPENDIX C: BOMB THREAT WORKSHEET ...... 58
APPENDIX D: CONTACT LISTS ...... 60
APPENDIX E: DISASTER SUPPLY INVENTORY ...... 61
APPENDIX F: DISASTER VENDOR LIST ...... 62
APPENDIX G: DISASTER MENUS ...... 65
APPENDIX H: DISASTER WATER SUPPLIES ...... 66
APPENDIX I: EMERGENCY ADMIT – MASTER TRACKING FORM ...... 69
APPENDIX J: EMERGENCY AGREEMENTS ...... 72
APPENDIX K: EMERGENCY SHUT DOWN ...... 73
APPENDIX L: EVACUATION FORMS ...... 78
APPENDIX M: INCIDENT ACTION PLAN QUICK START ...... 90
APPENDIX N: HAZARD VULNERABILITY ASSESSMENT FORM ...... 93
APPENDIX O: HANDLING OF REMAINS ...... 100
APPENDIX P: NURSING HOME INCIDENT COMMAND SYSTEM...... 102
APPENDIX Q: SITE MAP WITH FIRE EXTINGUISHERS ...... 105
APPENDIX R: STAFF RECALL SURVEY LOG ...... 106
APPENDIX S: FACILITY SYSTEMS STATUS REPORT ...... 107
APPENDIX T: LOCAL RESPONSE FORMS ...... 113
APPENDIX U: LOSS OF FIRE/LIFE SAFETY SYSTEMS ...... 114 (see instructions on how to update this table in the back of the manual)
Title: Management of Environmental Temperatures Regulatory s. 483.15 (h) (6), CFR
Objective:
Our objective is to provide comfortable and safe temperature levels. The temperature throughout this facility shall be maintained at between 71 degrees and 81 degrees F. Any temperature outside of this range for 4 hours or more requires specific intervention to avoid potential negative impact on the patients’ / residents well-being. Should the A/C or heating system fail, specific monitoring and safety measures should be activated.
Procedure:
A. General: Each patient / resident care unit shall maintain large thermometers in a visible spot near the nurse’s station. Central Air Coolers are maintained at a comfortable temperature range, generally between 72 – 78 degrees Fahrenheit.
B. AC/Heat Failure: In the event of AC/Heat failure the Administrator or designee should be notified in addition to the Director of Nursing and/or designee, and the Director of Maintenance. Should the temperature go below 71 degrees or above 81 degrees F, the Medical Director or designated alternate clinician should be notified.
Environmental temperatures are monitored by assigned person(s) every 4 hours throughout the facility.
Catholic Health Services Emergency Operations Program and Plan - Manual
If environmental temperature exceeds 81 degrees for over 4 hours a. Maintain a log of temperature monitoring b. Large fans are activated in patient / resident care areas. (It is suggested that cooling may be enhanced by having the fans blow over buckets of ice.) c. Medical Director or clinical designee is notified. d. Health Department and AHCA are notified. e. Fluids are encouraged with alert patients / residents and pushed with vegetative patients. f. Water and fluid passes are conducted hourly. Popsicles, gelatin, and other similar non liquid foods will be considered for patients / residents that require alternatives. g. Extra ice is made available to patients / residents h. If available, activate portable window AC units (that are hardwired into the generator) in designated cooling areas of the facility. Cooling centers could coordinate for patients / residents with fevers or other medical emergencies.
Patients / residents at risk may be identified by a facility review of the roster/sample matrix or alternate means of case mix review or through physician/Medical Director Recommendations.
High risk patients / residents should have their body temperature monitored every 4 hours, or more frequently as determined by clinical assessment or specific physician orders.
Maintain clinical documentation of those identified at risk in individual patient records. Include documentation for clinical interventions.
Keep a log of recorded temperatures every shift for those residents not determined to be at risk. If conditions change, notify the physician, and monitor per at risk guidelines or specific physician orders.
Notify families and/or responsible parties as indicated.
The nurse shall notify the physician/ARNP for increase fever or clinical signs of hyperpyrexia or fluid deficit, and move patient to an emergency-cooling area or transferred to the hospital if needed.
Section 6: Rapid Response Guides | pg 45
Catholic Health Services Emergency Operations Program and Plan - Manual
Those at risk may include those with:
• Coma/decreased sensorium • Fluid loss and increased fluid needs (e.g. diarrhea, fever, uncontrolled diabetes) • Functional or cognitive impairments that make it difficult to drink, reach fluids and communicate needs (e.g. aphasia) • Those being treated for infection, identified as immunocompromised, (e.g. AIDS patients / residents) • Those identified by a facility review of the roster/sample matrix or alternate means of case mix review or through physician/Medical Director recommendations.
If facility temperature drops below 71 degrees F.: a. Blankets are made available to all patients. b. Portable heaters are activated in all units. c. Health Department and AHCA are notified. d. Medical Director is notified. e. Warm fluids are encouraged or forced. f. Very ill and/or debilitated patients must have their vital signs monitored every 4 hours. g. Any drop in body temperature below 97 (R) shall constitute an emergent situation. Medical Director or ARNP is called and specific warming measures are executed (e.g. extra blanket, electric heater near patient, warm liquids) or transfer to hospital if unable to control.
Section 6: Rapid Response Guides | pg 46
Management of Environmental Temperatures Sample Policy Page 3 of 3 Catholic Health Services Emergency Operations Program and Plan - Manual APPENDIX A: ACRONYMS
AAR After Action Report ASPR Office of the Assistant Secretary of Preparedness and Response Cal OES Florida Governor’s Office of Emergency Services CDC U.S. Centers for Disease Control and Prevention CEO Chief Executive Officer COOP Emergency Operations (Plan) DOC Department Operations Center DRC Disaster Resource Center EOP Emergency Operations Program and Plan EMP Emergency Management Program EMS Emergency Medical Services FEMA Federal Emergency Management Agency HCF Healthcare Facility HEPA High Efficiency Particulate Air (Filter) HHS U.S. Department of Health and Human Services HICS Hospital Incident Command System HPP Hospital Preparedness Program HVA Hazard Vulnerability Analysis HVAC Heating, Ventilating and Air Conditioning IAP Incident Action Plan IC Incident Commander ICS Incident Command System IMT Incident Management Team IPG Incident Planning Guide IRG Incident Response Guide Section 6: Rapid Response Guides | pg 47
Catholic Health Services Emergency Operations Program and Plan - Manual
ACRONYMS (C0NT) LTC Long Term Care MOU Memorandum of Understanding NHICS Nursing Home Incident Command System PASS Pull, Aim, Squeeze and Sweep PTO Paid Time Off PPE Personal Protective Equipment RACE Rescue, Alarm, Confine and Extinguish RRG Rapid Response Guide SDS Safety Data Sheet SNF Skilled Nursing Facility TTX Table Top Exercise
Section 6: Rapid Response Guides | pg 48
APPENDIX B: AFTER ACTION REPORT/IMPROVEMENT PLAN
[Pick the date] [Incident/ Exercise/ Event Name]: [Year]
Catholic Health Services - Emergency Operations Program and Plan Manual After Action Report and Improvement Plan
[Author of the AAR] [Facility Report Completed: [Date] Name]
Section 7: Appendices | pg 50
Catholic Health Services - Emergency Operations Program and Plan Manual AAR REPORT FORM: ACRONYMS
Terms Used in this After Action Report
AAR After Action Report
CMS Centers for Medicaid/Medicare
EPP Emergency Preparedness Program
EOP Emergency Operations Plan
FSX Full Scale Exercise
HPP Hospital Preparedness Program
HSEEP Homeland Security Exercise Evaluation Program
HVA Hazard Vulnerability Assessment
IC Incident Command
ICS Incident Command System
IP Improvement Plan
MHOAC Medical Health Operational Area Coordinator
NIMS National Incident Management System
OEM Office of Emergency Management
PIO Public Information Officer
TTX Table Top Exercise
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Catholic Health Services - Emergency Operations Program and Plan Manual
AAR FORM: INTRODUCTION
Include brief synopsis of incident here.
Sequence of events:
Include detailed sequence of events here, if available.
AFTER ACTION REPORT OVERVIEW
This report is a compilation of information from the different departments and staff who participated in the response to [list incident/exercise/event here]. The information was gathered by [list departments here and various sources of information for the report]
The recommendations in this AAR should be viewed with considerable attention to the needs for providing safe care to residents. Each department should review the recommendations and determine the most appropriate action and time needed for implementation.
The issues outlined in this AAR will be addressed in the Improvement Plan and will list corrective actions to complete. This Improvement Plan will serve as a summary of the AAR and as a guide for corrective action over the course of the following year’s training program for staff.
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Catholic Health Services - Emergency Operations Program and Plan Manual
AAR FORM: OVERVIEW
Incident Overview: [Insert incident/exercise/event location here]
Duration: [Insert incident/exercise /event time]
Focus (Check appropriate area(s) below): Prevention Response Recovery Other
Activity or Scenario (Check appropriate area(s) below): Fire Severe Weather Hazardous Material Release Bomb Threat Medical Emergency Power Outage Evacuation Lockdown Special Event Exercise/Drill Other
Location: [Insert incident/exercise/event location here]
Participating Organizations: [Insert organizations here]
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Catholic Health Services - Emergency Operations Program and Plan Manual
AAR FORM: STRENGTHS List strengths here.
AREAS OF IMPROVEMENT List Areas of Improvement here.
RECOMMENDATIONS List Recommendations here.
CONCLUSION AND NEXT STEPS Insert Conclusion here.
Section 7: Appendices | pg 54
APPENDIX B: AFTER ACTION REPORT/IMPROVEMENT PLAN
IMPROVEMENT PLAN – CHS RISK MANAGEMENT DEPARTMENT SAMPLE Capability Observation Recommendation for Improvement Responsible Start Completion Department’s Date Date Contact Capability 1: 1.1 Staff did not print 1.1.a Have specific staff assigned to make Admissions 8/29/18 of all electronic health sure each resident has all of the records. Evacuation records for residents when transferred to 1.1.b Have a policy and procedure for Administrator 8/29/18 new location. printing off records and sending them securely with each resident.
1.1.c Update settings in ECS for one-click IT Dept. 8/29/18 printing of all vital records.
1.2 1.2.a
1.2.b
1.2.c
Catholic Health Services - Emergency Operations Program and Plan Manual
AAR IMPROVEMENT PLAN (CONT) Responsible Start Completion Capability Observation Department’s Date Date Recommendation for Improvement Contact Capability 2: 2.1 2.1.a
2.1.b
2.1.c
2.2 2.2.a
2.2.b
2.2.c
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Catholic Health Services - Emergency Operations Program and Plan Manual
AAR IMPROVEMENT PLAN (CONT) Capability Observation Recommendation for Improvement Responsible Start Completion Department’s Date Date Contact Capability 3: 3.1 3.1.a
3.1.b
3.1.c
3.2 3.2.a
3.2.b
3.2.c
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Catholic Health Services - Emergency Operations Program and Plan Manual
APPENDIX C: BOMB THREAT WORKSHEET
BOMB THREAT CALL CHECKLIST
Exact Wording of the Threat: ______
Questions to Ask:
When is bomb going to explode? Did you place the bomb? Where is it right now? Why have you done this? What does it look like? What is your address? What kind of bomb is it? What is your name? What will cause it to explode?
Sex of Caller Age Race Length of call
The Caller’s Voice: Is it…
Calm? Y/N Soft? Y/N Distinct? Y/N Raspy? Y/N Cracking Y/N voice?
Angry? Y/N Loud? Y/N Slurred? Y/N Deep? Y/N Disguised Y/N accent?
Excited? Y/N Laughing? Y/N Nasal? Y/N Ragged? Y/N Familiar? Y/N
Slow? Y/N Crying? Y/N Stutter? Y/N Clearing Y/N If familiar, who did throat? it sound like?
Rapid? Y/N Normal? Y/N Lisp? Y/N Deep Y/N Other: breathing?
Section 7: Appendices | pg 58
Facility Name: Emergency Operations Program and Plan Manual
BOMB THREAT CALL CHECKLIST
Background Noise
Street noises? Y/N House noises? Y/N Factory Y/N Long Y/N machinery? distance?
Dishes/glass? Y/N Motor? Y/N Clear/no Y/N Animal Y/N sounds? noises? Static? Voices? Y/N Office Y/N Y/N Music? Y/N machinery?
Pay phone Y/N PA system? Y/N Local? Y/N Other: booth?
Threat Language
Well Y/N Foul Y/N Incoherent? Y/N Message Y/N spoken/educated? language? read by threat maker?
Irrational? Y/N Taped Y/N Intoxicated? Y/N Other: message?
Remarks: ______
Report call immediately to: ______Phone Number: ______
FILL OUT IMMEDIATELY AFTER BOMB THREAT Date and Time of Incoming Threat: Phone Number of Incoming Threat:
Name of Staff that Received Call:
Staff Position:
Section 7: Appendices | pg 59
Facility Name: Emergency Operations Program and Plan Manual
APPENDIX D: CONTACT LISTS
STAFF AND VOLUNTEERS
Section 7: Appendices | pg 60
Catholic Health Services - Emergency Operations Program and Plan Manual
APPENDIX E: DISASTER SUPPLY INVENTORY
DISASTER SUPPLY INVENTORY FIRST AID KITS and trauma supplies easily accessible in every area of the building. WATER: 1 gal/person per 24 hours x 72 hours. Method track consumption of water. FOOD: Minimum of 1600 kcal/person per 24 hours with consideration for special diets x 72 hours.
KITCHEN SUPPLIES for preparation and distribution of food and water (e.g. plastic utensils, cups, paper plates, water containers).
RADIO WITH CELL PHONE CHARGER with extra working batteries and/or solar or crank operated.
GENERATOR with 24 hours of fuel for “red plugs.” EXTENSION CORDS (Heavy duty) BATTERY BACKUP for critical equipment (e.g. ventilators, IV pumps, cell phones). FLASH LIGHTS and battery operated exit signs. HEAT AND COOLING SUPPLIES for residents in severe weather (e.g. extra blankets, squirt bottles/ fans).
SANITARY SUPPLIES: • Bleach ‐ unscented for surface sanitizing and water purification • Extra briefs, pads and gowns; hand sanitizers and wipes • Trash bags to line toilets and store soiled wastes O2 TANKS AND TUBING BODY BAGS HEAVY DUTY PLASTIC (i.e. cover broken windows) CASH ON HAND ($500 small bills) RESCUE AND REPAIR TOOLS (E.G. crowbar, shovel, gloves, wrench for shutting off gas/water). ADDITIONAL CRITICAL SUPPLIES FOR EVACUATION RESIDENT TRANSFER INFORMATION SYSTEM (wrist bands, flash drive, fanny pack with face sheet; something that can be assured to go with them with basic id and care instructions) TRANSPORT METHOD FOR SURVIVAL SUPPLIES (e.g. water, snacks, critical medications)
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Catholic Health Services - Emergency Operations Program and Plan Manual
APPENDIX F: DISASTER VENDOR LIST
VENDOR CONTACT INFORMATION Food: Perishable Food: Non‐perishable Water Utility Name: Name: Name: Address: Address: Address: City: City: City: State/Zip Code: State/Zip State/Zip Code: Phone: Code: Phone: Phone: Fax: Fax: Fax: Email: Email: Email: Website: Website: Website: Potable Water Company Water Company Natural Gas Supplier Name: Name: Name: Address: Address: Address: City: City: City: State/Zip Code: State/Zip Code: State/Zip Code: Phone: Phone: Phone: Fax: Fax: Fax: Email: Email: Email: Website Website Website: Ice Generator Fuel Cell Phone Service Name: Name: Name: Address: Address: Address: City: City: City: State/Zip Code: State/Zip Code: State/Zip Code: Phone: Phone: Phone: Fax: Fax: Fax: Email: Email: Email: Website: Website: Website: Quick Connect Generator Generator Maintenance Electric Utility Supplier Name: Name: Name: Address: Address: Address: City: City: City: State/Zip Code: State/Zip Code: State/Zip Code: Phone: Phone: Phone: Fax: Fax: Fax: Email: Email: Email: Website: Website: Website: Vendor List is attached separately Section 7: Appendices | pg 62
Catholic Health Services - Emergency Operations Program and Plan Manual
VENDOR CONTACT INFORMATION (CONT) Pharmacy Sanitation Supplies Gas Utility Name: Name: Name: Address: Address: Address: City: City: City: State/Zip Code: State/Zip Code: State/Zip Code: Phone: Phone: Phone: Fax: Fax: Fax: Email: Email: Email: Website: Website: Website: Incontinence Supplies Paper Goods – Kitchen Telephone Company Name: Name: Name: Address: Address: Address: City: City: City: State/Zip Code: State/Zip Code: State/Zip Code: Phone: Phone: Phone: Fax: Fax: Fax: Email: Email: Email: Website: Website: Website: Paper Goods – Toiletries Linen Supplies Satellite Phone Provider Name: Name: Name: Address: Address: Address: City: City: City: State/Zip Code: State/Zip Code: State/Zip Code: Phone: Phone: Phone: Fax: Fax: Fax: Email: Email: Email: Website: Website: Website: Assistive Devices Fire Alarm System Sprinkler System Name: Name: Name: Address: Address: Address: City: City: City: State/Zip Code: State/Zip Code: State/Zip Code: Phone: Phone: Phone: Fax: Fax: Fax: Email: Email: Email: Website: Website: Website:
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Catholic Health Services - Emergency Operations Program and Plan Manual
VENDOR CONTACT INFORMATION
Transportation – Alternates Transportation – Truck, Amateur Radio Service Name: Cargo Van, Trailer Name: Address: Name: Address: City: Address: City: State/Zip Code: City: State/Zip Code: Phone: State/Zip Code: Phone: Fax: Phone: Fax: Email: Fax: Email: Website: Email: Website: Website:
Section 7: Appendices | pg 64
Catholic Health Services - Emergency Operations Program and Plan Manual
APPENDIX G: DISASTER MENUS
Section 7: Appendices | pg 65
Catholic Health Services - Emergency Operations Program and Plan Manual
APPENDIX H: DISASTER WATER SUPPLIES
To ensure safe water for residents, staff and visitors during a crisis, our facility maintains: An emergency water supply that is suitable and accessible; An emergency water supply consistent with applicable regulatory requirements; and Methods for water treatment when supplies are low.
See Subsistence P&P for amount and location of current emergency water supplies.
We maintain a supply of emergency potable water to meet our subsistence needs, however if we needed additional supplies, the follow methods may be used in an emergency to increase water resources.
WATER TREATMENT METHODS (adapted from the Federal Emergency Management Agency)
We treat all water of uncertain quality before using it for drinking, food washing or preparation, washing dishes, brushing teeth, or making ice. In addition to having a bad odor and taste, contaminated water can contain microorganisms (germs) that cause diseases such as dysentery, cholera, typhoid or hepatitis. If there is a suspected compromise of the water system (i.e. broken pipes) our facility will shut off the water supply as soon as possible to protect the integrity of supply in internal tanks and pipes.
Before treating, let any suspended particles settle to the bottom or strain them through coffee filters or layers of clean cloth.
We have the necessary materials in our disaster supplies kit for the chosen water treatment method as described below:
There are two water treatment methods. They are as follows:
These instructions are for treating water of uncertain quality in an emergency situation, when no other reliable clean water source is available, or we have used all of your stored water.
Boiling Boiling is the safest method of treating water. In a large pot or kettle, bring water to a rolling boil for 1 full minute, keeping in mind that some water will evaporate. Let the water cool before drinking. Boiled water will taste better if you put oxygen back into it by pouring the water back and forth between two clean containers. This also will improve the taste of stored water.
Section 7: Appendices | pg 66
Catholic Health Services - Emergency Operations Program and Plan Manual
Chlorination We use household liquid bleach to kill microorganisms. Only regular household liquid bleach DISASTER WATER SUPPLY (CONT) that contains 5.25 to 6.0 percent sodium hypochlorite is used. We do not use scented bleaches, color safe bleaches, or bleaches with added cleaners. Because the potency of bleach diminishes with time, we use bleach from a newly opened or unopened bottle. Add 16 drops (1/8 teaspoon) of bleach per gallon of water, stir, and let stand for 30 minutes. The water should have a slight bleach odor. If it does not, then repeat the dosage and let stand another 15 minutes. If it still does not smell of chlorine, discard it and find another source of water.
SAFE SOURCES OF POTABLE WATER
1. Melted ice cubes 2. Water drained from the water heater (if the intake pipes and/or water heater has not been damaged) 3. Liquids from canned goods such as fruit or vegetable juices 4. Water drained from pipes if deemed to be uncontaminated 5. Other: (i.e.) well water, water storage tanks, bottled water, canned water, etc.
For emergency re-supply, we may contact the following entities: SUPPLIERS Municipal Water Company:
______Name Emergency Contact Number
Water Vendor:
______Name Emergency Contact Number
SPECIAL NOTE: RESIDENT HYDRATION DURING EVACUATION
During evacuation, bottled water and/or necessary liquid thickeners for those individuals with swallowing restrictions will accompany residents and staff to maintain safe hydration levels.
Section 7: Appendices | pg 67
Catholic Health Services - Emergency Operations Program and Plan Manual
DISASTER WATER SUPPLIES (CONT)
STORAGE
Manufacturer’s guidelines for water storage method will be followed for water storage tanks, drums, or containers.
Name of Manufacturer: ______
Guidelines for use: ______
Location (ie: outside, storage room, etc.): ______
Surface Preparation (concrete, pallet, etc.): ______
Protection (covered, UV light safe, etc.): ______
Additional equipment (pump, spigot, hose): ______
Facility will follow manufacturer’s guidelines for filling water storage units including:
Cleaning prior to filling: ______
Source of water to fill: ______
How to fill: ______
Type and amount of preserver: ______
Length of time water may be used after adding preserver per manufacturer guidelines:
______
How to seal water storage device: ______
Facility will maintain a routine inspection of the water storage based on manufacturer recommended frequency, which is ______and will check for cracks in the container, leaks, broken seals, etc. and maintain documentation of these quality checks.
Facility will discard any water stored that has become compromised or outdated.
DISTRIBUTION OF WATER SUPPLIES TO POINT OF CARE: When necessary, this facility will use food grade hose and containers to move water supplies to the point of care for residents.
A food-grade (FDA approved) drinking water hose will be used to fill water containers from the water storage tank and to distribute water in an emergency.
Water will be transported in food-grade (FDA approved) emergency water containers.
The hose and containers are stored together in this location: ______
Section 7: Appendices | pg 68
Catholic Health Services - Emergency Operations Program and Plan Manual
APPENDIX I: EMERGENCY ADMIT – MASTER TRACKING FORM
EMERGENCY ADMIT TRACKING FORM | NHICS 254 2. OPERATIONAL PERIOD DATE: FROM: TO: 1. INCIDENT NAME
TIME: FROM: TO: 3. AREA TRIAGE TAG OR NAME (LAST, FIRST) SEX DOB/AGE ADMITTED FROM ADMITTED TO TIME MEDICAL RECORD #
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Catholic Health Services - Emergency Operations Program and Plan Manual
EMERGENCY ADMIT TRACKING FORM | NHICS 254 TRIAGE TAG OR NAME (LAST, FIRST) SEX DOB/AGE ADMITTED FROM ADMITTED TO TIME MEDICAL RECORD #
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Catholic Health Services - Emergency Operations Program and Plan Manual
EMERGENCY ADMIT TRACKING FORM | NHICS 254 TRIAGE TAG OR NAME (LAST, FIRST) SEX DOB/AGE ADMITTED FROM ADMITTED TO TIME MEDICAL RECORD #
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Catholic Health Services - Emergency Operations Program and Plan Manual
APPENDIX J: EMERGENCY AGREEMENTS
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APPENDIX K: EMERGENCY SHUT DOWN
There are several instances where deactivation of facility systems may be required during a disaster/crisis. Examples include:
Severe weather Earthquake Accidental event (power spike, outage, gas leak, over‐pressurization, etc.)
Specific steps need to be taken to ensure safe shutdown of a system. Mechanical equipment that may be shut down includes:
Water Natural Gas Electric Heating, Ventilating and Air Conditioning (HVAC) Equipment Boilers Computer Equipment
These procedures should only be completed with the approval of the Incident Commander (IC) at the time of the crisis. Shutdown should only be employed during the most extreme of situations, if time permits call in an expert.
See Contact List (Appendix D) or Vendor List (Appendix F) for detailed contact information for vendors; otherwise, 24‐hour emergency numbers are in the checklist below.
Vendors will be notified when their service is shut down by the facility. In addition, all staff members will be notified when services are shut down temporarily. A site map with the location of shutoffs, emergency exits, in‐facility evacuation routes, fire extinguishers, fire doors is included in Appendix Q: Site Map with Shutoffs, Fire Suppression and Emergency Supply locations; this is in addition to the checklist below which has a physical description of the location of various pieces of operational equipment (i.e., shutoffs, electrical breakers, switches, etc.)
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Catholic Health Services - Emergency Operations Program and Plan Manual
EMERGENCY SHUT DOWN (CONT)
IMPORTANT PRECAUTIONS
These procedures should be tested with key staff prior to being performed during an emergency, to ensure mechanical items are shut down securely and safely. The following precautions must be followed:
Never stand in water or any fluids when shutting down equipment. If you see smoke, fire, gas, or electrical voltage near the area, do not attempt a mechanical shutdown.
For ease of shutdown, our facility has created a checklist of items to be used while shutting down specific systems.
EMERGENCY SHUTDOWN CHECKLIST NATURAL GAS Vendor: 24‐hr Phone: Account #: Description of Location
• Meter: • Shutoff valves:
Action Steps for Shutdown ☐ Action 1: insert facility specific steps for shutdown, add as many steps as < appropriate to your equipment/system>
☐ Action 2: ☐ Action 3:
Comments:
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Catholic Health Services - Emergency Operations Program and Plan Manual
ELECTRICITY Vendor: 24‐hr Phone: Account #: Description of Location
• Main electrical panel: • Outside meter: • Main breaker: • Sub‐breakers and sub‐panels: Action Steps for Shutdown ☐ Action 1: ☐ Action 2: ☐ Action 3:
Comments:
WATER Vendor: 24‐hr Phone: Account #: Description of Location • Shut off valve(s): • Water meter:
Action Steps for Shutdown ☐ Action 1: ☐ Action 2: ☐ Action 3:
Comments:
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Catholic Health Services - Emergency Operations Program and Plan Manual
HVAC Vendor: 24‐hr Phone: Account #: Description of Location • Electric shutoff switch(s): • Gas Valves:
Action Steps for Shutdown ☐ Action 1: ☐ Action 2: ☐ Action 3: Comments:
BOILER Vendor: 24‐hr Phone: Account #: Description of Location • Main electric shutoff switch: • Boiler shutoff switches < indicate how many boilers, gas and electric, etc.>
Action Steps for Shutdown ☐ Action 1: ☐ Action 2: ☐ Action 3:
Comments:
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Catholic Health Services - Emergency Operations Program and Plan Manual
COMPUTER / INFORMATION TECHNOLOGY Vendor: 24‐hr Phone: Account #: Description of Location • Main controls: • Electrical breakers: • Media used as backup:
Action Steps for Shutdown ☐ Action 1: ☐ Action 2: ☐ Action 3:
Comments:
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Catholic Health Services - Emergency Operations Program and Plan Manual
APPENDIX L: EVACUATION FORMS
FACILITY EVACUATION - RESIDENT / PATIENT ASSESSMENT FORM FOR TRANSPORT AND DESTINATION Adapted from the Shelter Medical Group Report: Evacuation, Care and Sheltering of the Medically Fragile.
FACILITY DATE: NAME:
COMPLETED DATE: BY:
TRANSPORT NUMBER OF LEVEL OF CARE FACILITY TYPE RESIDENTS TYPE LEVEL I
Description: Patients/residents are usually transferred from in‐patient medical treatment facilities and require a level of care only available in hospital or Skilled Nursing or Subacute Care Facilities.
Examples:
Bedridden, totally dependent, difficulty swallowing Requires dialysis Ventilator‐dependent Requires electrical equipment to sustain life Critical medications requiring daily or QOD lab monitoring Requires continuous IV therapy Terminally ill
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Catholic Health Services - Emergency Operations Program and Plan Manual
TRANSPORT NUMBER OF LEVEL OF CARE FACILITY TYPE RESIDENTS TYPE LEVEL II
Description: Patients/residents have no acute medical conditions but require medical monitoring, treatment or personal care beyond what is available in home setting or public shelters.
Examples:
Bedridden, stable, able to swallow Wheelchair‐bound requiring complete assistance Insulin‐dependent diabetic unable to monitor own blood sugar or to self‐inject Requires assistance with tube feedings Draining wounds requiring frequent sterile dressing changes Oxygen dependent; requires respiratory therapy or assistance with oxygen Incontinent; requires regular catheterization or bowel care NOTE: It is unlikely that licensed health facilities such as SNFs will have residents that fall below Level II care needs. Evacuation planning must take this into consideration. Also, consider cognitive/behavioral issues in evaluating residents’ transport and receiving location needs. DESTINATION LEVEL III
Description: Residents able to meet own needs or has reliable caretakers to assist with personal and/or
medical care. RESIDENTASSESSMENTPATIENT / FORM FOR TRANSPORTAND
Examples: -
Independent; self‐ambulating or with walker Wheelchair dependent; has own caretaker if needed Medically stable requiring minimal monitoring (i.e., blood pressure monitoring) Oxygen dependent; has own supplies (i.e. O2 concentrator) Medical conditions controlled by self‐ administered medications (caution: refrigeration may not be available at public
FACILITY EVACUATION shelters)
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Catholic Health Services - Emergency Operations Program and Plan Manual
RESIDENT FACE SHEET Resident Name: Admission Date:
Date of Birth: ALLERGIES:
Medical Record #:
Physician:
WHOM TO NOTIFY WITH EMERGENCIES AND PROBLEMS
Contact Name Phone Alt. Phone Primary Representative/Contact
Secondary Contact #1
Any restrictions on notification:
MENTAL HEALTH STATUS Cognitive or Psychiatric/Behavioral Disorders: (please list)
FUNCTIONAL STATUS Ambulation Self ☐ Independent Bathing Other Incontinent Feeding Independent, Assisted: ☐ Urine Supervision Supervision ☐ Cane, Walker, ☐ ☐ ☐ Wheelchair Stool Assisted Assisted ☐ Confined to Bed or Chair ☐ ☐ ☐ ☐ TREATMENT STATUS ☐ Special ☐ Dysphagia ☐ Mech Soft ☐ Fluid restrictions Diet Contact Respiratory Other special care needs: ☐ Infection ☐ ☐ precautions Precautions CODE STATUS:
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Catholic Health Services - Emergency Operations Program and Plan Manual
RESIDENT EVACUATION CHECKLIST Check & Initial IMPORTANT ITEMS
☐ FACE SHEET WITH CURRENT EMERGENCY CONTACT INFORMATION
☐ HISTORY AND PHYSICAL
☐ MEDICATION AND TREATMENT ADMINISTRATION RECORD
☐ ADVANCE DIRECTIVE/PREFERRED INTENSITY OF CARE
☐ CARE PLAN AND DISCHARGE NOTE
☐ DISASTER ID TAG WITH PICTURE, ID INFO, AND MEDICAL ALERTS
☐ MEDICATIONS
☐ ESSENTIAL MEDICAL SUPPLIES & EQUIPMENT (E.G. TRACHEOTOMY, COLOSTOMY, O2, GLUCOSE MONITORING) ☐ NUTRITIONAL SUPPLIES OF SPECIAL DIET
☐ WHEELCHAIR/WALKER
☐ DENTURES/EYE GLASSES/HEARING AIDS/PROSTHESIS
☐ CHANGE(S) OF CLOTHING IN BAG LABELED WITH CLIENT’S NAME
☐ ACTIVITY SUPPLIES OF CHOICE (RESIDENT’S PREFERENCE)
☐ INCONTINENCE SUPPLIES
☐ OTHER (PLEASE SPECIFY):
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Catholic Health Services - Emergency Operations Program and Plan Manual
RESIDENT EVACUATION TRACKING FORM - INDIVIDUAL
NOTE: After completion of form, please make THREE copies: ONE for sending facility, ONE for EMS, and ONE for receiving facility.
Sending Facility: ______
Receiving Facility: ______
Patient Name: (PRINT) ______
Date of Birth: ____ /____/____ Gender: Male Female
Transferring Facility Medical Record Number: ______
Triage tag number (if used): ______
Transport Method: Ambulatory | Wheelchair | Basic Life Support | Advanced Life Support
Emergency Contact: ______Telephone #______
Notified of Transfer? YES NO
Attending Physician: ______Notified of Transfer: YES NO
Primary Diagnosis: ______
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RESIDENT EVACUATION TRACKING FORM - INDIVIDUAL
NOTE: After completion of form, please make THREE copies: ONE for sending facility, ONE for EMS, and ONE for receiving facility.
Do Not Yes (attach copy) NO Resuscitate:
Advanced Yes (attach copy) NO Directives:
Healthcare Proxy: Yes (attach copy) NO
Sent with patient: Face sheet YES NO
Patient identification YES NO
Medication list/administration record YES NO
Physicians orders YES NO
Date transferred: ______Time of departure: ______
Time of arrival at receiving facility: ______
Equipment owned by sending facility accompanying patient during transport: ______
COMMENTS:
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Catholic Health Services - Emergency Operations Plan Manual FACILITIES: LTC / SNF: Villa Maria Nursing Center / Villa Maria West SNF / St. John’s Nursing Center / St. Anne’s Nursing Center and Residence ALFs: St. Anne’s Residence / St. Joseph Residence REHAB HOSPITALS: St. Catherine’s RH / St. Catherine’s West RH / St. Anthony’s RH
MASTER RESIDENT EVACUATION TRACKING LOG | NHICS 255 OPERATIONAL PEROD INCIDENT NAME DATE: FROM: TO:
TIME: FROM: TO: RESIDENT EVACUATION INFORMATION
RESIDENT MEDICAL RECORD MED RECORD SENT YES NO NAME TIME# FACILITY TRANSFER INITIATED MODE OF ACCEPTING FACILITY MEDICATION SENT YES NO DISPOSITION CONTACTED & REPORT (TIME/ TRANSPORT MD/FAMILY TRANSPORT NAME & CONTACT INFO YES NO GIVEN CO.) NOTIFIED HOME FACILITY ARRIVAL YES NO TRANSFER CONFIRMED TEMP. SHELTER RESIDENT MEDICAL RECORD MED RECORD SENT YES NO NAME # TIME FACILITY TRANSFER INITIATED MODE OF ACCEPTING FACILITY MEDICATION SENT YES NO DISPOSITION CONTACTED & REPORT (TIME/ TRANSPORT MD/FAMILY TRANSPORT NAME & CONTACT INFO YES NO GIVEN CO.) NOTIFIED HOME FACILITY ARRIVAL YES NO TRANSFER CONFIRMED TEMP. SHELTER RESIDENT MEDICAL RECORD MED RECORD SENT YES NO NAME # TIME FACILITY TRANSFER INITIATED MODE OF ACCEPTING FACILITY MEDICATION SENT YES NO DISPOSITION CONTACTED & REPORT (TIME/ TRANSPORT MD/FAMILY TRANSPORT NAME & CONTACT INFO YES NO GIVEN CO.) NOTIFIED HOME FACILITY ARRIVAL YES NO TRANSFER CONFIRMED TEMP. SHELTER
PRINT NAME: SIGNATURE: PREPARED BY DATE/TIME: FACILITY:
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ON-DUTY STAFF EVACUATION TRACKING LOG
STAFF NAME DESTINATION DATE & TIME ARRIVAL DEPARTED CONFIRMED
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PERSONNEL TRACKING FORM 5. OPERATIONAL PERIOD 4. INCIDENT NAME DATE: FROM: TO: TIME: FROM: TO: 6. TIME RECORD EMPLOYEE (E)/ EMPLOYEE NHICS ASSIGNMENT DATE/TIME DATE/TIME TOTAL # VOLUNTEER (V) E/V SIGNATURE (TO VERIFY TIMES) NUMBER IN OUT HOURS NAME ( PRINT) 1
2
3
4
5
6
7
8
9
10 * MAY BE USUAL NURSING HOME VOLUNTEERS OR APPROVED VOLUNTEERS FROM COMMUNITY PRINT
NAME: SIGNATURE: 7. PREPARED BY DATE/TIME: FACILITY:
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FACILITY EVACUATION MAPS
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RETURN TO FACILITY
AUTHORITY TO CALL FOR RE‐ENTRY
Following an emergency evacuation, re‐entry into our facility must be preceded by the approval of appropriate jurisdictional authorities (local, county, state, etc.), including the State Survey agency. The CEO/ Administrator or designee notifies appropriate authorities to request approval for re‐entry once it is deemed safe. In addition to local and state authorities, notify personnel and local / state regulatory agencies regarding return to normal operations, which may include:
CHS Corporate Police Department Fire Department Emergency Management Agency Vendors Insurance Agent Other relevant agencies that provide clearance Notify residents, Medical Director, all attending physicians, families, and responsible parties of re‐entry. Notify Florida Long Term Care Ombudsman of re‐entry. Implement a return to normal process that provides for a gradual and safe return to normal operations.
POST EVACUATION RETURN TRANSPORTATION
Following a disaster, transportation resources are likely to be in high demand and may be difficult to find. Drivers may be limited or unavailable and the entire community may be competing for the same resources, including fuel and specialized vehicles for transporting persons who are frail or have disabilities. This demand will likely outpace resources.
Prior to an emergency, the local emergency management officials will be made aware of the type of transportation likely to be needed by facility residents so that they can receive the appropriate priority when assistance is needed with transport services. Agreements will be in place with public and private transportation agencies, ambulance services, wheelchair accessible services and other transportation options in the community, including family and volunteers.
Return transportation will be arranged by the facility in collaboration with the local EMS and/or emergency management agency. The post‐evacuation return to the facility may need to occur in shifts over days or weeks.
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RETURN TO FACILITY (CONT)
The CEO/ Administrator or his/her designee is responsible for determining the order in which residents are returned to the facility. The NHICS 254: Master Emergency Admit Tracking Form (See Appendix I) or the hosting facility's equivalent forms will be completed and returned with the resident.
POST DISASTER PROCEDURES FOR THE FACILITY
The Incident Management Team (IMT) may continue during the recovery phase to determine priorities for resuming operations, including:
Physically secure the property. Conduct Damage Assessment for residents and the facility and reporting using NHICS 251: Facility System Status Report (See Appendix S). Protect undamaged property. Close building openings. Remove smoke, water, and debris. Protect equipment against moisture. Restore power and ensure all equipment is functioning properly. Separate damaged repairable property from destroyed property. Keep damaged property on hand until insurance adjuster has visited the property. Report claim to insurance carrier. Take an inventory of damaged goods. (This is usually done with the insurance adjuster).
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APPENDIX M: INCIDENT ACTION PLAN
INCIDENT ACTION PLAN | NHICS 200 OPERATIONAL PERIOD INCIDENT NAME DATE: FROM: TO:
TIME: FROM: TO:
SITUATION SUMMARY
WEATHER/ENVIRONMENTAL IMPLICATIONS FOR PERIOD (INCLUDES AS APPROPRIATE: FORECAST, DAYLIGHT)
1.
2.
3.
4.
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IAP (CONT) CURRENT ORGANIZATION – THE INCIDENT MANAGEMENT TEAM CHART
INCIDENT COMMANDER (Fill in additional positions as appropriate)
LIAISON/PUBLIC INFORMATION OFFICER
(Maria Miranda)
SAFETY OFFICER
(Engineer)
CMO or MEDICAL DIRECTOR
OPERATIONS SECTION PLANNING SECTION LOGISTICS SECTION FINANCE/ CHIEF CHIEF CHIEF ADMINISTRATION SECTION CHIEF
RESIDENT SERVICES BRANCH DIRECTOR
INFRASTRUCTURE BRANCH DIRECTOR
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IAP (CONT) INCIDENT OBJECTIVES 6a. OBJECTIVES 6b. STRATEGIES/ TACTICS 6c. RESOURCES REQUIRED 6d. ASSIGNED TO
HEALTH AND SAFETY BRIEFING: IDENTIFY POTENTIAL INCIDENT HEALTH AND SAFETY HAZARDS AND DEVELOP NECESSARY MEASURES (REMOVE HAZARD, PROVIDE PERSONAL PROTECTIVE EQUIPMENT, WARN PEOPLE OF THE HAZARD) TO PROTECT RESPONDERS FROM THOSE HAZARDS
1.
2.
3.
4.
ATTACHMENTS (MARK IF EXTRA DOCUMENTATION IS ATTACHED)
NHICS 251: FACILITY SYSTEM STATUS REPORT INCIDENT MAP NHICS 254: EMERGENCY ADMIT TRACKING OTHER: NHICS 255: MASTER RESIDENT EVACUATION TRACKING NHICS 215A: INCIDENT ACTION PLAN (IAP) SAFETY ANALYSIS
TRAFFIC PLAN
PRINT NAME: SIGNATURE:
PREPARED BY DATE/TIME: FACILITY:
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APPENDIX N: HAZARD VULNERABILITY ASSESSMENT FORM
Hazard Vulnerability Assessment and Mitigation A thorough Hazard Vulnerability Assessment (HVA) is used to help determine what events or incidents may negatively impact its operations. While it is impossible to forecast every potential threat, it is important to identify as many potential threats as possible to adequately anticipate and prepare to manage a crisis or disaster situation. The Hazard Vulnerability Assessment utilizes a rating system for the probability, risk, and preparedness for various hazards and situations. Assumptions For the purpose of this Emergency Operations Plan, it is assumed that the following threats may potentially impact all facilities: Color Codes Incident Command 1. Medical Emergency 2. Active Shooter Response 3. Fire Emergency 4. Flood 5. Bomb Threat / Suspicious Package 6. Severe Weather / Natural Disaster 7. Power Failure/Utility Outage 8. Workplace Violence/Security Threat 9. Law Enforcement Activity 10. Missing Resident / Patient - Elopement 11. Hazardous Materials / Waste Spill / Leak / Release 12. Pandemic Episode 13. Terrorist Attack 14. Nuclear Power Incident
Unique Threats Based on the facility’s geographic location, past history, proximity to other structures and operations, proximity to transportation corridors, as well as other unique factors, it is essential to identify all threats that can potentially impact the facility. A risk assessment tool is used to determine hazards and vulnerabilities for its County and surrounding areas. The County Emergency Management Director should be contacted for guidance and assistance in determining the hazards and vulnerabilities for the facility.
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Catholic Health Services - Emergency Operations Program and Plan Manual
The following is a tool that will aid in completing the Hazard Vulnerability Assessment, as it takes into consideration the proximity of the facility location. (The bolded terms in the Geographic Hazardous Areas column pertain to events that could potentially pose as dangers, if the hazardous areas are close to the facility.)
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HAZARD VULNERABILITY ASSESSMENT FORM EVENT PROBABILITY RISK PREPAREDNESS TOTAL 5=LIFE THREAT 3=HIGH 4=HEALTH/SAFETY 3=POOR Probability x Risk x Preparedness = Score
2=MEDIUM 3=HIGH DISRUPTION 2=FAIR
1=LOW 2=MODERATE DISRUPTION 1=GOOD Focus on top 3-5 hazards 0=NONE 1=LOW DISRUPTION 0= NO N/A= NOT APPLICABLE with the highest scores DISRUPTION
NATURAL EVENTS Hurricane Winds
Tornado
Severe thunderstorm
Snow fall
Blizzard
Ice storm
Earthquake
Temperature extremes
Drought
Flood, external
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HVA (CONT) EVENT PROBABILITY RISK PREPAREDNESS TOTAL Wild fire
Landslide
Epidemic/pandemic
Dam failure
Explosion/munitions
Nuclear power plant incident
Other
HUMAN EVENTS Elopement
Work place violence
Security threat
Hazmat exposure, external
Terrorism, chemical
Terrorism, biological
Hostage situation
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HVA (CONT) EVENT PROBABILITY RISK PREPAREDNESS TOTAL Civil disturbance/ community violence
Labor action
Bomb threat
OTHER EVENTS Fire, internal
Electrical failure
Generator failure
Transportation failure
Fuel shortage
Natural gas failure
Water failure
Sewer failure
Steam failure
Fire alarm failure
Communications failure
Medical gas failure
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HVA (CONT) EVENT PROBABILITY RISK PREPAREDNESS TOTAL Medical vacuum failure
HVAC failure
Info. Systems failure
Flood, internal
Hazmat exposure, internal
Unavailability of supplies
Structural damage
Other:
TOP FIVE HAZARDS:
1. ______2. ______3. ______4. ______5. ______
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HAZARD VULNERABILITY ASSESSMENT FORM (C0NT) Geographic Hazardous Areas Proximity to Facility: Potential Hazard (Y/N) Busy Roadways—Elopement, Haz Mat Wooded Areas—Elopement, Fire
Bodies of Water—Elopement
Designated Truck Routes—Haz Mat
Railroad—Elopement, Haz Mat
Airport—Terrorism Target, Mass Casualty
Dam—Terrorism Target Mass Casualty
Military Bases/Installations—Explosion, Haz-Mat, Terrorism Target Pipelines—Explosion, Haz Mat
Gas Stations—Explosion, Haz Mat
Industrial Areas/Distribution Centers/Trucking Terminals—Explosion, Haz Mat Chemical Plants—Explosion, Haz Mat, Terrorism Target, Mass Casualty Nuclear Plants—Explosion, Haz Mat, Terrorism Target, Mass Casualty Bulk Fuel Storage/Tank Farms (Oil, Gasoline, Propane, Natural Gas, etc,)—Explosion, Haz Mat, Terrorism Target, Mass Casualty Refineries—Explosion, Haz Mat, Terrorism Target, Mass Casualty Sewage Treatment Plants—Haz Mat, Terrorism Target, Mass Casualty Agricultural Processing Plants/Storage Facilities (Grain Silos)—Haz Mat, Explosion Public Swimming Pools—Elopement, Haz Mat
Schools—Law Enforcement Activity
Jails/Prisons—Civil Unrest, Law Enforcement Activity
Any Immediately Adjacent Operation posing a threat
Any Operation in the general area posing a threat
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APPENDIX O : HANDLING OF REMAINS
ASSUMPTIONS
It is likely that fatalities will occur during a major disaster, e.g., an influenza pandemic.
Communications and transportation may be disrupted. The Coroner’s Division may not be able to provide assistance for many days following a major incident, or may lack resources to address a prolonged response such as an influenza pandemic.
In extreme circumstances, the public may need to take action to ensure the safe handling and storage of decedents until the Coroner or Coroner‐designated personnel can respond.
In this situation, the goal of healthcare facilities will be to protect the living and to identify and preserve the remains of those that are deceased.
While waiting for assistance from external partners, the methods for managing remains can be summarized in three short words:
TAG, WRAP AND HOLD
NOTE: When handling decedents, follow appropriate contact precautions for infection control. Always wash hands with antiseptic solution after handling decedents. Water and soap should be used if you do not have any other solutions.
Tag
Before moving the body, write on the ankle tags, toe tags, or body identification form identifying data – in addition keep a written log with this information in a notebook or on a log sheet that should be created as part of fatality planning for your facility:
1. Name (if known) – Document briefly how or who provided the ID (including that individual’s contact information for any required follow‐up) 2. Sex 3. Race 4. Approximate age 5. Location where the individual died 6. Number: Assign each body a unique number 7. Initials/signature of person tagging/logging in the body
NOTE: The same protocol should be applied for human body parts / tissue ‐ DO NOT COMINGLE TISSUE OR BODY PARTS.
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HANDLING OF REMAINS (CONT)
Wrap
The procedure for wrapping includes:
1. Place plastic under decedent 2. Wrap decedent in plastic 3. Wrap decedent with sheet, and tie ends 4. Tie ropes around decedent to secure limbs 5. Attach an identification tag
Hold
Identify a cool, private and if possible well‐ventilated area to use as a temporary morgue. Put signs up to alert staff and visitors that this area is restricted except for authorized personnel.
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Catholic Health Services - Emergency Operations Program and Plan Manual
APPENDIX P: NURSING HOME INCIDENT COMMAND SYSTEM
Nursing Home Incident Command System (NHICS)
Our facility utilizes the Nursing Home Incident Command System (NHICS) that provides the structure for optimized incident response. NHICS closely parallels the system used by hospitals (Hospital Incident Command System, HICS) and is aligned with the ICS used by governmental response agencies. By using a common platform during emergency response, the many entities that may be impacted by a disaster are united by a common operational framework.
When an emergency impacts our facility, the response is guided by Incident Action Planning as described in the NHICS Guidebook. Incident Action Planning is a core concept that takes place regardless of the incident size or complexity. Incident Action Planning involves six essential steps:
1. Understand nursing home policy and direction. In developing the response actions to undertake, the Incident Management Team (IMT)4 should understand the facility’s mission, EOP and policies.
2. Assess the situation. Situational intelligence is critical in developing the response actions, providing insight to the impact, and projecting the span of the event. Our facility has access to established mechanisms and systems within the community (city, county, regional, or state) that may provide and verify situational information. Another component in assessing the situation is determining the potential impact on the facility itself, based on current resident and employee status, the status of the building(s) and grounds, and the ability to maintain resident services.
3. Establish incident objectives. The Incident Commander (IC, leader of the IMT) sets the overall command objectives for the response. He/she sets the direction for the response actions consistent with the mission and policies of the organization.
For example, in an incident involving power failure, ensuring the safety of residents and employees is the highest priority. The Incident Response Guides (IRGs) provide examples of objectives that apply to the response based on the cause. These may be used in the Incident Action Planning process.
4 The Incident Management Team (IMT) is the group of individuals who are assigned roles to mitigate the impact of the emergency in a coordinated manner under the NHICS system. The number of people assigned to the IMT may vary from one (the Incident Commander) to many, depending on the scope and needs created by the emergency. Foster / CHS Risk Management Section 7: Appendices | pg 102
Catholic Health Services - Emergency Operations Program and Plan Manual
4. Determine appropriate strategies to achieve the objectives. After the IC has set the command objectives, the Section Chiefs then determine the appropriate strategies to undertake in the response. This provides a plan of action for each section, clearly identifying actions and duties while ensuring that there is no duplication of efforts. Objectives should be developed that provide clear direction and define what is to be done. For example, assessing the building for structural damage after an earthquake is a clear objective to be carried out.
5. Provide tactical direction and ensure that it is followed. Tactical directions provide the responders with the actions to be taken and identify the resources needed to complete the task. For example, assessing the facility after an earthquake will require the necessary tools such as protective equipment, checklists to document the assessment, etc. Actions undertaken should be assessed for their effectiveness, with the objectives and directions adapted if they are unsuccessful.
Provide necessary back‐up. When tactical direction is initiated, support is needed to meet the objectives. This may include revision of the actions taken in the response, the assignment of additional resources (personnel, supplies and equipment) as well as the revision of tactical objectives.
Incident Management Team (IMT)
NHICS is a flexible and adaptable system that can be “right‐sized” for any emergency. Some emergencies are minor and limited in scope, while larger disasters can have severe and prolonged impact to operations.
The IMT structure consists of the command, general, branch and unit staff, with sections clearly identified by the roles and responsibilities they carry out.
The only NHICS position that is activated for every emergency is the Incident Commander (IC). He/she determines what other positions are necessary to effectively manage the incident. If the IC is able to manage all response activities during a minor incident, then there is no need to activate other IMT positions. However, a key principle of NHICS is maintaining “span‐of‐ control”, which means that when a member of the IMT recognizes that additional personnel are needed to effectively manage response activities, additional position(s) are activated.
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There are five major management functions within the IMT structure:
1. Command establishes the incident objectives with an understanding of the mission and policies of the nursing home. The Command function is also responsible for ensuring safety and providing information to internal and external stakeholders. 2. Operations conducts the tactical operations (e.g., resident services, clean‐up) to carry out the Incident Action Plan (IAP) using defined objectives and directing all necessary resources. 3. Plans collects and evaluates information to support decision‐making, maintains resource status information, prepares documents such as the IAP, and maintains documentation for incident reports. 4. Logistics provides support, resources, and other essential services to meet the operational objectives set by the IC. 5. Finance monitors costs related to the incident while providing accounting, procurement, time recording, and cost analyses.
As previously stated, the IC is the only position that is activated for all emergencies. If the IC can accomplish all five management functions without the activation of additional positions, no other IMT positions need be activated. For large incidents, additional positions may be activated with the overall goal to maintain the span‐of‐control and meet the needs of the facility based on the available resources.
An important feature of the ICS is its scalability. NHICS positions are assigned to personnel as indicated by the situation, and may be activated or de‐activated as the emergency unfolds and incident needs change.
See Incident Action Plan Quick Start Form - Appendix M.
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Catholic Health Services - Emergency Operations Program and Plan Manual APPENDIX Q: SITE MAP WITH FIRE EXTINGUISHERS
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APPENDIX R: STAFF RECALL SURVEY LOG
The protocol for contacting staff in the event of a disaster/emergency may call for additional staff resources. Call lists include 24‐hour contact information for all key staff including home telephones, mobile devices, and email.
A list of staff telephone numbers for emergency contact is located in the CEMP.
During an emergency, Administrator or designee is responsible for contacting staff to report for duty. The backup/alternate contact is: the DON.
Instructions: List all department staff members and responses received.
RESPONSE (coming in, not EXPECTED NAME POSITION home, left message, etc.) ARRIVAL TIME
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APPENDIX S: FACILITY SYSTEMS STATUS REPORT
SYSTEM STATUS REPORT | NHICS 251 OPERATIONAL PERIOD
INCIDENT NAME DATE: FROM: TO:
TIME: FROM: TO:
COMMENTS SYSTEM STATUS (If not fully functional, give location, reason, and estimated time/resources for necessary repair. Identify who reported or inspected)
COMMUNICATIONS FULLY FUNCTIONAL PARTIALLY FUNCTIONAL FAX NONFUNCTIONAL NA
INFORMATION FULLY FUNCTIONAL TECHNOLOGY SYSTEMS PARTIALLY FUNCTIONAL (EMAIL/ECS/ KRONOS / NONFUNCTIONAL MEDILINKS, KEANE, ETC.) NA
FULLY FUNCTIONAL PARTIALLY FUNCTIONAL NURSE CALL SYSTEM NONFUNCTIONAL NA FULLY FUNCTIONAL PAGING – PUBLIC PARTIALLY FUNCTIONAL ADDRESS NONFUNCTIONAL NA FULLY FUNCTIONAL PARTIALLY FUNCTIONAL TELEPHONE SYSTEM NONFUNCTIONAL NA FULLY FUNCTIONAL TELEPHONE SYSTEM – PARTIALLY FUNCTIONAL CELL NONFUNCTIONAL NA VIDEO-TELEVISION- INTERNET-CABLE FULLY FUNCTIONAL OTHER PARTIALLY FUNCTIONAL (SATELLITE PHONES, RADIO NONFUNCTIONAL NA EQUIPMENT, ETC)
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INFRASTRUCTURE SYSTEMS STATUS REPORT (CONT)
SYSTEM STATUS COMMENTS
CAMPUS ACCESS FULLY FUNCTIONAL PARTIALLY FUNCTIONAL (ROADWAYS, BRIDGES, NONFUNCTIONAL SIDEWALKS) NA
FULLY FUNCTIONAL PARTIALLY FUNCTIONAL FIRE DETECTION SYSTEM NONFUNCTIONAL NA
FULLY FUNCTIONAL FIRE SUPPRESSION PARTIALLY FUNCTIONAL SYSTEM NONFUNCTIONAL NA
FULLY FUNCTIONAL FOOD PREPARATION PARTIALLY FUNCTIONAL EQUIPMENT NONFUNCTIONAL NA
FULLY FUNCTIONAL PARTIALLY FUNCTIONAL ICE MACHINES NONFUNCTIONAL NA
FULLY FUNCTIONAL LAUNDRY/LINEN SERVICE PARTIALLY FUNCTIONAL EQUIPMENT NONFUNCTIONAL NA
STRUCTURAL FULLY FUNCTIONAL PARTIALLY FUNCTIONAL COMPONENTS (BUILDING NONFUNCTIONAL INTEGRITY) NA
FULLY FUNCTIONAL PARTIALLY FUNCTIONAL OTHER NONFUNCTIONAL NA
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SYSTEMS STATUS REPORT (CONT)
RESIDENT CARE
SYSTEM STATUS COMMENTS
FULLY FUNCTIONAL PARTIALLY FUNCTIONAL PHARMACY SERVICES NONFUNCTIONAL NA
FULLY FUNCTIONAL PARTIALLY FUNCTIONAL DIETARY SERVICES NONFUNCTIONAL NA
ISOLATION ROOMS FULLY FUNCTIONAL PARTIALLY FUNCTIONAL (POSITIVE/NEGATIVE NONFUNCTIONAL AIR) NA
FULLY FUNCTIONAL PARTIALLY FUNCTIONAL OTHER NONFUNCTIONAL NA
SECURITY SYSTEM
SYSTEM STATUS COMMENTS
FULLY FUNCTIONAL DOOR LOCKDOWN PARTIALLY FUNCTIONAL SYSTEMS NONFUNCTIONAL NA
FULLY FUNCTIONAL SURVEILLANCE PARTIALLY FUNCTIONAL CAMERAS NONFUNCTIONAL NA
CAMPUS SECURITY FULLY FUNCTIONAL PARTIALLY FUNCTIONAL (LIGHTING, TRAFFIC NONFUNCTIONAL CONTROLS) NA
SYSTEMS STATUS REPORT (CONT)
FULLY FUNCTIONAL
PARTIALLY FUNCTIONAL OTHER NONFUNCTIONAL NA
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UTILITIES, EXTERNAL SYSTEM
SYSTEM STATUS COMMENTS
FULLY FUNCTIONAL ELECTRICAL POWER- PARTIALLY FUNCTIONAL PRIMARY SERVICE NONFUNCTIONAL NA
FULLY FUNCTIONAL PARTIALLY FUNCTIONAL SANITATION SYSTEMS NONFUNCTIONAL NA
FULLY FUNCTIONAL PARTIALLY FUNCTIONAL WATER NONFUNCTIONAL NA
FULLY FUNCTIONAL PARTIALLY FUNCTIONAL NATURAL GAS NONFUNCTIONAL NA
FULLY FUNCTIONAL PARTIALLY FUNCTIONAL OTHER NONFUNCTIONAL NA
UTILITIES, INTERNAL SYSTEM
SYSTEM STATUS COMMENTS
FULLY FUNCTIONAL PARTIALLY FUNCTIONAL AIR COMPRESSOR NONFUNCTIONAL NA
FULLY FUNCTIONAL ELECTRICAL POWER, PARTIALLY FUNCTIONAL BACKUP GENERATOR NONFUNCTIONAL NA
FULLY FUNCTIONAL PARTIALLY FUNCTIONAL FUEL STORAGE NONFUNCTIONAL NA
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UTILITIES, INTERNAL SYSTEM SYSTEMS STATUS REPORT (CONT)
SYSTEM STATUS COMMENTS
FULLY FUNCTIONAL PARTIALLY FUNCTIONAL ELEVATOR/ESCALATORS NONFUNCTIONAL NA
FULLY FUNCTIONAL HAZARDOUS WASTE PARTIALLY FUNCTIONAL CONTAINMENT SYSTEM NONFUNCTIONAL NA
HEATING, VENTILATION, FULLY FUNCTIONAL PARTIALLY FUNCTIONAL AND AIR NONFUNCTIONAL CONDITIONING (HVAC) NA
(NOTE BULK, H-TANKS, RESERVE SUPPLY STATUS) FULLY FUNCTIONAL PARTIALLY FUNCTIONAL OXYGEN NONFUNCTIONAL NA
FULLY FUNCTIONAL PARTIALLY FUNCTIONAL PNEUMATIC TUBE NONFUNCTIONAL NA
FULLY FUNCTIONAL PARTIALLY FUNCTIONAL STEAM BOILER NONFUNCTIONAL NA
FULLY FUNCTIONAL PARTIALLY FUNCTIONAL SUMP PUMP NONFUNCTIONAL NA
SYSTEMS STATUS REPORT (CONT) FULLY FUNCTIONAL PARTIALLY FUNCTIONAL WELL WATER SYSTEM NONFUNCTIONAL NA
FULLY FUNCTIONAL PARTIALLY FUNCTIONAL NONFUNCTIONAL VACCUM (FOR PATIENT NA USE)
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UTILITIES, INTERNAL SYSTEM
SYSTEM STATUS COMMENTS
FULLY FUNCTIONAL WATER HEATER AND PARTIALLY FUNCTIONAL CIRCULATORS NONFUNCTIONAL NA
FULLY FUNCTIONAL PARTIALLY FUNCTIONAL EXTERNAL LIGHTING NONFUNCTIONAL NA
FULLY FUNCTIONAL EXTERNAL STORAGE PARTIALLY FUNCTIONAL (EQUIPMENT) NONFUNCTIONAL NA
FULLY FUNCTIONAL EXTERNAL STORAGE PARTIALLY FUNCTIONAL (VEHICLES) NONFUNCTIONAL NA
(POWER, PANIC ALARMS, ACCESS, EGRESS, LIGHTING) FULLY FUNCTIONAL PARTIALLY FUNCTIONAL PARKING LOTS NONFUNCTIONAL NA
FULLY FUNCTIONAL PARTIALLY FUNCTIONAL OTHER NONFUNCTIONAL NA
8. REMARKS (CRACKED WALLS, BROKEN GLASS, FALLING LIGHT FIXTURES, ETC.)
SYSTEMS STATUS REPORT (CONT)
PRINT 9. PREPARED NAME: SIGNATURE: BY DATE/TIME: FACILITY:
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APPENDIX T: LOCAL RESPONSE FORMS
< FORMS OR PROTOCOLS THAT THE LOCAL EMERGENCY RESPONSE AUTHORITIES HAVE PROVIDED FOR FACILITY’S USE>
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Catholic Health Services - Emergency Operations Program and Plan Manual APPENDIX U: LOSS OF FIRE/LIFE SAFETY SYSTEMS
In the event of a disruption to our facility’s fire and life safety systems (e.g. fire alarms, sprinklers, fire door) or a commercial electricity with a concurrent generator failure, we will immediately reduce the risk to resident safety through the following actions:
Also see Power Outage, Evacuation, and Subsistence Needs P&Ps.
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RESOURCES / CONTACT INFORMATION
Broward County: Broward County Emergency Management Tracy Jackson - (954) 831-3908 201 Northwest 84 Avenue Plantation, FL 33324 Miami-Dade County: Miami-Dade County Office of Emergency Management Frank Rollason - (305) 468-5400 9300 NW 41st Street Miami, FL 33178
Contact Numbers Miami Dade County
Emergency 911
Administrative Headquarters 786-331-5000 (Non-Emergency Main Number)
Central Records 786-331-4900 (Fire & Medical Incident Reports, and Billing)
Emergency Management 305-468-5400 [email protected] Fax: 305-468-5401 EEAP [email protected] TDD: 305-468-5402
Fire Engineering & Water Supply 786-315-2771
Fire Marshal 786-331-4800 (Fire Prevention, Permits & Inspections)
Media Relations
Public Affairs Bureau 786-331-5212 Public Education & Community Outreach (School Presentations) 786-331-5200
Training Division 786-331-4800
ADA Public Records Custodian 786-331-4200 MARIA JOSE PUBLIC RECORDS CUSTODIAN 786-331-5116 FIRE RESCUE 9300 NW 41ST ST DORAL FL 33178 [email protected] 786-331-4902
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Catholic Health Services - Emergency Operations Program and Plan Manual Emergency Preparedness Links
Planning for Active Shooter Incidents
Active Shooter: Options for Consideration, Department of Homeland Security
Active Shooter: Lonewolf, Department of Homeland Security
Active Shooter: Pocket Cards
National Hurricane Center
Florida Division of Emergency Management
Miami-Dade County Emergency Management
Federal Emergency Management Agency (FEMA)
National Weather Service
Agency for Health Care Administration (AHCA) Emergency Preparedness Resources
American Hospital Association - Disaster Readiness
American Red Cross - Disaster Services
ASPR TRACIE
NEW CMS Crosswalk
Centers for Disease Control (CDC)
Emergency Sheltering, Relocation, and Evacuation Plan (ASPR)
Florida Department of Health
Health Resources & Services Administration
Homeland Security
Joint Commission on Accreditation of Healthcare Organizations
Medical Reserve Corps (MRC)
Miami-Dade County Department of Health
National Disaster Medical System (NDMS)
National Incident Management System (NIMS)
IMPORTANT TELEPHONE NUMBERS
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Catholic Health Services - Emergency Operations Program and Plan Manual
Agency Telephone Numbers EMERGENCY 911 FEMA 1-800-621-FEMA National Hurricane Center (305) 229-4523 (National Weather Service) FPL *See detailed info on page below AT&T 611 Windstream (network) 800-347-1991 Teleco So Florida 800-940-0944 Water and Sewer Broward (954) 765-4710 Miami - Dade County (305) 274-9272 EMERGENCY MANAGEMENT Broward County – (954) 831-3900 Miami - Dade County – (305) 274-9272 American Red Cross Broward (954) 763-9900 Miami - Dade County (305) 644-1200 Bus Information Broward (954) 831-4000 Miami - Dade County (305) 638-6700 / 311 Coast Guard Broward (954) 927-1611 Miami - Dade County (305) 536-5611 Agencies on Aging Broward (954) 745-9779 Miami - Dade County (305) 670-4357 Social Services Broward (954) 357-6344 Miami - Dade County (305) 375-5656 Animal Control Broward (954) 359-1313 x227 Miami - Dade County (305) 884-1101 Humane Society Broward (954) 463- 4870 Miami - Dade County (305) 696-0800 EPA Safe Drinking Water Hotline (800) 426-4791 USDA Hotline (800) 424-9121
Calixto Plasencia ……………….. FP&L - Business Account Consultant 305-442 5829 To report or track an outage: Call 1-800-4-OUTAGE (1-800-468-8243) or visit www.FPL.com/outage.
You can also contact John Daniel an FPL core team customer manager, at 954-321-2091 or [email protected].
For assistance with your accounts during a storm, contact your account specialist, Judith Williams at 386-254-2286 or Judith.Williams@ fpl.com.
For up-to-date news and information regarding our overall restoration progress, go to www.FPL.com/PowerTracker. You can also follow us on Twitter @insideFPL or on www.facebook.com/fplconnect.
Foster / CHS Risk Management Section 7: Appendices | pg 117
Catholic Health Services - Emergency Operations Program and Plan Manual
LOCAL HOSPITALS
Broward Hospitals Telephone Numbers Broward General Medical Center 954-355-4400 Cleveland Clinic Hospital 954-568-1000 Coral Springs Medical Center 954-344-3000 North Shore Medical Center-Florida 954-735-6000 Med Ctr Campus Memorial Regional Hospital South 954-966-4500 Holy Cross Hospital 954-771-8000 Imperial Point Medical Center 954-776-8500 Memorial Regional Hospital 954-987-2000 Memorial Hospital Miramar 954-538-5000 Memorial Hospital West 954-436-5000 Memorial Hospital Pembroke Pines 954-962-9650 North Broward Medical Center 954-786-6400 North Ridge Medical Center 954-776-6000 Northwest Regional Hospital 954-974-0400 Plantation General Hospital 954-587-5010 St. John‟s Rehabilitation Hospital 954-739-6233 Sunrise Rehabilitation Hospital 954-749-0300 University Hospital & Medical Center 954-721-2200 West Boca Hospital 561-488-8000
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Catholic Health Services - Emergency Operations Program and Plan Manual
LOCAL HOSPITALS
Miami – Dade Hospitals Telephone Numbers Aventura Medical Center 305-682-7000 Baptist Hospital 305-596-1960 University of Miami Hospital 305-325-5511 Coral Gables 305-445-8461 Deering 305-251-2500 Doctors Hospital 305-663-1380 Hialeah 305-693-6100 Homestead 305-248-3232 Jackson Memorial 305-585-1111 Jackson South 305-256-5022 Larkin 305-284-7500 Mercy Hospital 305-854-4400 Palmetto General 305-823-5000 Palm Springs 305-558-2500 Pan American 305-665-4614 South Miami 305-662-4000 Westchester 305-264-5252
Foster / CHS Risk Management Section 7: Appendices | pg 119
Catholic Health Services - Emergency Operations Program and Plan Manual
EXTERNAL CRITICAL CONTACTS FACILITIES
Villa Maria Villa Maria St. John’s St. Anne’s St. Cath. St. Cath. St. Nsg Center West SNF West Anthony’s
Type Tel #/ Email Contact Name
Emergency / Rescue 9 -1- 1 9-1-1 9-1-1 9-1-1 9-1-1 9-1-1 9-1-1 9-1-1 9-1-1 9-1-1 (Police / Fire /Ambulance) Police – Non Emergency: N. Miami PD / N. Miami PD Hialeah P.D. BSO: MDPD 305-891 Hialeah BSO: Hialeah P.D. / 305-891 305-953-5301 954-926- 305-474- 0294 P.D. 954-926- BSO / 0294 305-953- 2400 5423 2400 MDPD 5301
Your Facility: VMNC=Villa Maria 305-891- 305-351- 954-739- 305-252- 305-357- 305-351- 954-739- VMW=Villa M. West 8850 7181 6233 4000 1735 7181 6233 SJNC=St. John’s SANC=St. Anne’s
SCRH=St. Cath Nathaniel Sandra Pamela Rosemarie Jaime Jaime Pamela SCWRH=S.C.West Johnson, Cabezas, NHA Gambardella, Bailey, NHA Gonzalez, Gonzalez, Gambardella, SARH=St. Anthony’s NHA 305-793-9974 NHA 954-401- ED ED NHA 954-980- 954-684-1627 6788 305-308- 305-308- 954-684- 6806 8144 8144 1627
Fire Marshall: Dade: David Downey David Downey Miami- Miami- Broward: Miami- Miami- Miami- Broward: [email protected] Dade: Dade: Phone Dade: Dade: Dade: Phone Fire Chief 786-331- 786-331- Tel: 954-535- 786-331- 786-331- 786-331- Tel: 954- Broward: Phone 4800 4800 2770 4800 4800 4800 535-2770 Tel: 954-535-2770 Anthony P. Fax 954- Fax 954- Fax 954-714-9035 714-9035 714-9035 Stravino
Local State Survey Agency : Arlene Mayo- Tel: (305) Tel: (305) Tel: (561) Tel: (305) Tel: (305) Tel: (305) Tel: (561) Broward: Region 10- 593-3100 593-3100 381-5840 593-3100 593-3100 593-3100 381-5840 Tel: (561) 381-5840 Davis AHCA Fax: (305) Fax: (305) Fax: (561) Fax: (305) Fax: Fax: Fax: (561) Fax: (561) 496-5924
Dade: Region 11- 499-2190 499-2190 496-5924 499-2190 (305) (305) 496-5924 Fax: (305) 499-2190 Tel: (305) 593-3100 499-2190 499-2190
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Catholic Health Services - Emergency Operations Program and Plan Manual
CRITICAL CONTACTS Villa Maria Villa Maria St. John’s St. Anne’s St. Cath. St. Cath. St. Nsg Center West SNF West Anthony’s
Ombudsman’s Council: Tel: 305-273-3294 (Bwd) Ombudsman N. Dade: N. Dade: Broward: S. Dade N. Dade: N. Dade: Brwd: Fax: 786-336-1424 305-273- 305-273- 954-597-2266 305-273- 305-273- 305-273- 954-597- 3294 3294 3250 3294 3294 2266 Tel 954-597-2266 (Dade) Fax: 786- Fax: 786- Fax: 954-597- Fax: 305- Fax: 786- Fax: 786- Fax: 954- Fax: 954-597-2268 336-1424 336-1424 2268 671-7247 336-1424 336-1424 597-2268
Local Public Health Agency- Brwd: 954-734-3046 DOH 305- 305- 954-734-3046 305- 305- 305- 954-734-3046 (24hrs/7days) 324-2400 324-2400 324-2400 324-2400 324-2400 954-467-4700 County: 954-467-4700 Ext. 5582 Ext. 5582 Department of Health Dade: 305 - 324-2400
Local Emergency Miami Dade MDEM MDEM Broward MDEM MDEM MDEM BEM D Emergency 305-468- 305-468- 305-468- 305-468- 305-468- Management Agency: 954-831-3900 6400 6400 6400 6400 6400 County’s EM Division Management Fax: 954-382- (MDEM) 5805 EOC [email protected] EOC Hotline: Hotline: 954-831- 954-831- 4000. 4000 Broward County Emergency Management Department (BEMD)
Broward
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Catholic Health Services - Emergency Operations Program and Plan Manual
EXTERNAL CRITICAL CONTACTS FACILITIES
VMNC VMWSNF SJNC SANC SCRH SCWRH SARH
Type Tel #/ Email Contact Name Account Account Account Account Account Account Account
Ambulance Company #1: X X X X X X X (AMC) Ambulance Company #2: X X X X X X X American Ambulance Emergency Transportation: X X X X X X X American Ambulance Light /Power Company: Account Manager Calixto Plasencia Florida Power and Light O: (305)442 - 5829 C: (305)794-8448 Cali.Plasencia X X X X X X X F: (305)529-6123 @fpl.com
Gas Company: http://www.peoplesgas.co X X X X X X X m/ TECO People’s Gas (Natural Gas) (305) 940-0139 Telephone Company: X X X X X X X Teleco - Windstream - X X X X X X X
Emergency Drinking Water: Nestlé X X X X X X X
Sewer System: X X X X X X X __ County Water and Sewer Diesel Fuel: PetroCHOICE [email protected]] Marla Burgos X X X X X X X Cell: 305-401-2905 Fax: 866-221-2139
Foster / CHS Risk Management Section 7: Appendices | pg 122
Catholic Health Services - Emergency Operations Program and Plan Manual
Type Tel # / Email Contact Name VMNC VMWSNF SJNC SANC SCRH SCWRH
Fire Alarm System:
Fire Protection – Sprinkler System: Security Alarm System:
Emergency Water Supply: 305 – 525 – 1132 Kristina Nestlé Kristina.falcon@waters. Falcon nestle.com
Emergency Food Supply: Morrison’s Additional Staff
Internet: Direct: 954-895- Gary Comcast Business 8888 Endlich Mobile: 954-658- 0683 gary_endlich@co mcast.com
Other:
Foster / CHS Risk Management Section 7: Appendices | pg 123
Catholic Health Services - Emergency Operations Program and Plan Manual
VMNC / SCRH VMWSNF / SCWRH SJNC / SARH / SJR SANC
FPL Account #7974216462 Account #2371763828 Account #4072888581 (utility pole at St. Helen’s)
Metrocom Cable
Stericycle #8237995
Teco Peoples Gas
Account #211007085676 Account #211007085916
Account #211007086153
Waste Management #00014-95010-02009
#00003-60364-12006 #00003-57690-52008
#00010-78706-62009 #00003-60203-42005
Comcast Business | Strategic Enterprise Account Manager Direct: 954-895-8888 Mobile: 954-658-0683 Email: [email protected]
Foster / CHS Risk Management Section 7: Appendices | pg 124
Catholic Health Services - Emergency Operations Program and Plan Manual
VMNC / SCRH VMWSNF / SCWRH SJNC / SARH / SJR SANC
FP&L: Calixto Plasencia Account Manager O: (305)442-5829 C: (305)794-8448 F: (305)529-6123
St . Anne's Nursing Center, St. Anne's Residence, Inc. 11855 Quail Roost Drive, Miami, FL 33177
St. John's Rehabilitation Hospital and Nursing Center, Inc. d/b/a St. Anthony's Rehabilitation Hospital 3487 N.W. 30 Street, Lauderdale Lakes, FL 33311 d/b/a St. John's Nursing Center 3075 N.W. 35 Avenue, Lauderdale Lakes, FL 33311
Villa Maria Nursing and Rehabilitation Center, Inc. d/b/a St. Catherine's Rehabilitation Hospital d/b/a Villa Maria Nursing Center 1050 N.E. 125 Street, North Miami, FL 33161
Foster / CHS Risk Management Section 7: Appendices | pg 125
Catholic Health Services - Emergency Operations Program and Plan Manual
Villa Maria Nursing and Rehabilitation Center, Inc. d/b/a St. Catherine's West Rehabilitation Hospital d/b/a Villa Maria West Skilled Nursing Facility 8850 N.W. 122 Street, Hialeah Gardens, FL 33018
OMBUDSMAN:
BROWARD
8333 W. McNabb Road, Suite 231 Tamarac, FL 33321 954-597-2266 Fax: 954-597-2268 Serving: Broward County
NORTH DADE
9495 Sunset Drive, Suite B100 Miami, FL 33173 305-273-3294 Fax: 786-336-1424 Serving: N. Miami-Dade County– North of Flagler Street, Hialeah, northeast, and northwest addresses
Foster / CHS Risk Management Section 7: Appendices | pg 126
Catholic Health Services - Emergency Operations Program and Plan Manual
SOUTH DADE & THE FL KEYS
9495 Sunset Drive, Suite B100 Miami, FL 33173 305-273-3250 Fax: 305-671-7247 Serving: Miami-Dade County – Monroe and S. Miami-Dade - South of Flagler Street, southeast, southwest, and Florida Keys addresses
AHCA:
Regions 9 & 10
Delray Beach Field Office - Broward, Indian River, Martin, Okeechobee, Palm Beach and St. Lucie Arlene Mayo-Davis, Field Office Manager 5150 Linton Boulevard, Suite 500 Delray Beach, Florida 33484 (561) 381-5840 Phone (561) 496-5924 Fax Region 11
Miami Field Office - Miami-Dade Arlene Mayo-Davis, Field Office Manager 8333 N.W. 53rd St. Suite 300 Miami, Florida 33166 (305) 593-3100 Phone (305) 499-2190 Fax
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Catholic Health Services - Emergency Operations Program and Plan Manual
FACILITY PROFILE Facility Name
Facility Address
Facility Location (Cross streets, map coordinates, landmarks)
Facility Telephone #
Facility Fax #
Facility Email
Facility Web Address
Administrator/Phone #
Foster / CHS Risk Management Section 7: Appendices | pg 128
Catholic Health Services - Emergency Operations Program and Plan Manual
DESCRIPTION CONTACTS
Alternative Emergency Executive /Phone #
Maintenance Coordinator/Phone #
Insurance Agent/Phone #
Owner/Phone #
Attorney/Phone #
Year Facility Was Built
# of Licensed Beds
Average # of Staff – Days
Average # of Staff – Evenings
Average # of Staff – Nights
Emergency Power Generator Type
Emergency Power Generator Fuel
Emergency Communication System
Foster / CHS Risk Management Section 7: Appendices | pg 129
Catholic Health Services - Emergency Operations Program and Plan Manual
DESCRIPTION CONTACTS
Like‐Facility #1 for Resident Evacuation5 / Phone #
Like‐Facility #2 for Resident Evacuation / Phone #
Like‐Facility for Resident Evacuation /Phone #
Like‐Facility for Resident Evacuation / Phone #
Other Emergency Contacts
5 Our facility has a Memorandum of Understanding (MOU) with at least one “Sister” CHS facility and one out‐of‐ the‐immediate‐area Sister Facility (beyond 25 miles) to accept evacuated residents, if able to do so. Foster / CHS Risk Management Section 7: Appendices | pg 130