Emergency Preparedness Summit for Long-Term Care Facilities Evacuation

1
Emergency Preparedness Summitfor Long-Term Care
FacilitiesEvacuation Emergency Preparedness
Planning

• November 29, 2006

2
Why Are We Here?

• Virginia Statute requires long-term care
  facilities to have an evacuation plan.
• Long-term care facilities are regulated by the
  Office of Licensure and Certification, Virginia
  Department of Health.
• Due to the immediate need, VDH has charged its
  Emergency Preparedness and Response Program with
  ensuring effective evacuation plans exist for
  LTCs.

3
Evacuation Plan Timetable

• Emergency Preparedness Summit
• November 29, 2006
• Long-term care facility self-assessment
• Completed by December 31, 2006
• Site visit by Fairfax County Health Department to
  review individual facility plans
• January 1 February 28, 2007
• Sustainment
• On-going technical assistance by Fairfax County
  Fire and Rescue Department
• Transition to VDH Office of Licensure and
  Certification

4
Fundamental Considerations

• Does your facility have a written disaster plan?
• Does it include a building evacuation plan for
• Internal disasters, e.g., fires?
• External disasters, e.g., major storm events?
• Does it include plans to move patients to another
  facility if your facility becomes threatened or
  unusable?

5
Fundamental Considerations

• Have your facility staff
• Received training on the plan?
• Participated in a drill?
• Been provide access to a copy of the written
  plan?

6
Fundamental Considerations

• What is your plan development and maintenance
  process?
• Is there a disaster planning committee?
• Do you collaborate with the fire department,
  health department and emergency management
  department?
• Is the plan periodically reviewed and updated?

7
Key Facility Personnel

• How will key roles be staffed during an
  emergency
• Whos in charge?
• Who will give patient medical care?
• Who support the operation of the physical
  facility?
• Who will fill other essential support roles?

8
Key Facility Personnel

• How will key roles be staffed if needed
  continuously over an extended period?
• Have job action sheets been developed for
  employees?
• Have staff been pre-designated?
• Have staff been trained on their role in an
  emergency?
• How will staff be notified to report?
• Are there assembly points to which employees
  report when re-called?

9
Disaster Plan Activation

• Does the plan make clear
• Who has the authority to activate the plan?
• When it should be activated?
• The activation process
• Staff roles during activation?
• Staff notification procedure, including staff
  call-back?
• Access to equipment, supplies, and other
  resources needed for activation?
• Which staff prepare patients?
• Utilization of available staff based on patient
  care priorities and skill-level needed?

10
Alerting System

• Regardless of whether during normal business
  hours, evenings or weekends, does the alerting
  system permit
• Immediate implementation of the plan, if
  necessary?
• Off-site evacuation not later than two hours
  following the decision to do so?
• Does the plan specify how
• Staff, patients and visitors in the facility will
  be notified?
• External agencies, organizations, and vendors
  will be notified?
• Notice to alternate facilities is given?
• Are there back-up notification systems?

11
Response

• How will resources such as personnel and
  equipment be supplied during a disaster?
• Are equipment and supply inventories monitored to
  ensure sufficient readiness and amounts in case
  of an emergency?
• What communications system(s) back-up your
  primary means of communication?
• Are there special communications systems with
  local government established and, if so, are they
  regularly tested?
• Are there sufficient provisions for additional
  staff or other resources to operate in your
  facility, should the emergency they be brought in?

12
Security

• Has a security vulnerability analysis been done
  for your facility that takes into account
• Structural security of the physical plant
• Contents, including hazardous materials
• Proximity to external hazards

13
Security

• In an emergency
• Short of a lock-down how well can ingress/egress
  to the building be controlled?
• How do you control foot and vehicular traffic
  on/off your site?
• Building lock-down
• Do you have a lock-down procedure?
• Does it permit absolute access control to your
  facility?
• Have you tested your facility lock-down
  procedure?
• Can you communicate with staff physically located
  outside your facility?
• Can recalled staff gain access to the building
  during a lock-down?

14
Security

• What is the procedure for meeting emergency
  medical services responding to your facility?
• Whats the process for credentialing health care
  workers who may come to your facility to work?
• How are people be physically identified as being
  authorized to be in the facility, e.g., staff,
  visitors, patients, clergy, media, etc.

15
Communications

• What is the plan
• Should communications with the outside world,
  i.e., telephone, fax machine, cellular phone, and
  pager, become overloaded and unusable during an
  emergency?
• For communications within your facility e.g.,
  inside lines, intercoms, etc., should normal
  means become unusable?
• For relying on runners as a back-up communication
  method?

16
Resources for Evacuation

• Have you identified the resources (personnel,
  wheelchairs, ambulance cots, etc.) necessary to
  move patients from your facility?
• What if elevators are not usable?
• Have you pre-identified which patients need
  special equipment to be evacuated?
• Are these resources located in clearly
  identifiable locations accessible to staff?
• Is the equipment regularly checked and
  maintained?
• Have staff been trained on the use of this
  equipment?

17
Evacuation to An Alternate Facility

• Prior to evacuation to an alternate facility,
  have you considered
• A procedure for discharging patients to their
  homes or those of loved-ones?
• Moving patients from one area of the facility to
  another should a safe refuge be needed?

18
Evacuation to An Alternate Facility

• Are there agreements with one or more facilities
  to accept your patients should relocation be
  required?
• Is this agreement formalized, e.g., MOA, MOU,
  etc?
• Is there a system for prioritizing patient
  evacuation and concordant provision of
  accompanying staff?
• Transportation
• Have appropriate means of transportation been
  pre-identified to re-locate patients?
• Move in hospital beds?
• Ventilators?
• Remain connected to other special equipment?
• Have you pre-identified routes of travel between
  your facility and the receiving facilities?
• Is there a back-up transportation method
  identified?

19
Evacuation to An Alternate Facility

• Other important considerations
• Have you provided for the movement of patient
  charts and other records and is patient
  confidentiality protected?
• Have you identified what medication and medical
  supplies will need to be relocated with the
  evacuated patient?
• How will you ensure the secure transport of
  controlled pharmaceuticals?
• Is there a procedure for physically inspecting
  your entire facility to ensure that all patients,
  staff and visitors have been safely evacuated?

20
Patient Tracking
and Family Notification

• Which staff have been pre-designated to track
  patient movement to alternate sites?
• How are patient family members/guardians
  notified
• That their loved-one has been evacuated and their
  location?
• Is being returned to your facility?

21
Government Agency Notification

• Which agencies need to be notified?
• Fairfax County Office of Emergency Management
• Fairfax County Fire and Rescue Department
• Fairfax County Police Department
• Fairfax County Health Department
• Virginia Department of Health Office of Licensure
  and Certification
• Local Ombudsman
• Others?
• Have you included in your plan specific points of
  contact and their contact information?
• Do you frequently check the information by
  conducting a test?

22
Shelter-In-Place

• If your facility is cut-off from outside help and
  must shelter in place, have you made provisions
  for
• Immediate refuge inside the physical building
• Patient and staff
• Care and comfort
• Mental health well-being
• Rotation of staff
• Using able patients and visitors to assist with
  patient care
• Medication and medical supply rationing
• Auxiliary electrical power
• Potable water supply
• Food rationing
• Human waste handling if sanitary disposal is not
  available
• Solid waste management
• Laundering of bedding, patient gowns, etc.

23
Disaster Recovery

• After the emergency is over
• Who is in charge of the recovery at your
  facility?
• How will the emergency be documented?
• Financial matters
• Inventory and re-supply
• Record preservation
• Hazard removal and clean-up
• Salvage
• Garbage and waste disposal
• Servicing of utilities and equipment
• Physical plan restoration and renovation

24
Disaster Recovery

• Human factors
• Critical Incident Stress Debriefing Program
• Employee Assistance Program
• Group/Individual counseling services
• Support to families, staff and patients