Kentucky LTC Emergency Preparedness Manual€¦ · Emergency Preparedness for Aging and LTC, Kent...

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Kentucky LTC Emergency Preparedness Manual

Kentucky's disaster preparedness resources for long term care facilities

The revision of this manual was supported by the Kentucky Department for Public Health, U of L Vulnerable Populations, FY 16-17, Grant PO2 728 160000 5053 1

©2017. Betty Shiels, Diana Jester, Amanda Forsting, Rod Barber, Arleen Johnson, Diane Lockridge, The University of Louisville Research Foundation and the University of Kentucky Research Foundation may retain certain rights to the work.

KY LTC Emergency Preparedness Manual-University of Louisville KY Emergency Preparedness for Aging & LTC Program

KY LTC Emergency Preparedness Manual-University of Louisville KY Emergency Preparedness for Aging & LTC Program 2

CONTRIBUTORS

Rebecca Gillis, MPH, CHES Director, Division of Public Health Protection and Safety Kentucky Cabinet for Health and Family Services

Betty Shiels, PhD-C, LCSW Director, Kentucky Emergency Preparedness for Aging & LTC Program University of Louisville, Kent School of Social Work

Diana S. Jester, MSSW Program Manager Kentucky Emergency Preparedness for Aging and LTC Program University of Louisville, Kent School of Social Work

Amanda Stanley Forsting, MSSW Kentucky Emergency Preparedness for Aging & LTC Program University of Louisville, Kent School of Social Work

Rod Barber, PhD, MPH Professor Emeritus University of Louisville, Kent School of Social Work

Arleen Johnson, PhD Director Emeritus, OVAR/GEC University of Kentucky, College of Public Health

Diana Lockbridge, MS Program Director, Osher Lifelong Learning Institute University of Kentucky, College of Public Health

Kentucky Office of the Inspector General Cabinet for Health and Family Services

Janet Justice Senior Director of Government Relations Kentucky Association for Healthcare Facilities (KAHCF)

Tim Veno President LeadingAge Kentucky

Richard “Dick” Bartlett BS, MEd Emergency Preparedness/Trauma Program Kentucky Hospital Association & Kentucky Hospital Research and Education Foundation


Background of the Kentucky LTC Emergency Preparedness Manual The initial edition of the manual was published in 2006. Model plans were reviewed from ten states. Features most important for emergency preparedness for long term care facilities in Kentucky were combined to create the Kentucky Model Plan. Special recognition is given to the Florida Health Care Association, Mather Lifeways Institute on Aging PREPARE Program, Masonic Homes of Kentucky-Louisville, Mississippi State Department of Health, North Carolina Health Facilities Association, Pacific Northwest Preparedness Society, Virginia Department of Health, Washington Health Care Association and Wisconsin Department of Health Services. The Kentucky Emergency Preparedness Manual for LTC and Aging was revised by the University of Louisville, Kent School of Social Work with funding from the Kentucky Department of Public Health in 2017 to reflect the Centers for Medicare and Medicaid Programs; Emergency Preparedness Requirements for Medicare and Medicaid Participating Providers and Suppliers; Final Rule (42 CFR Parts 403, 416, 418, et al.) These regulations and the accompanying section/page of the manual are referenced in the crosswalk, found in the back of this manual. Customizing the Kentucky Model Plan for use by your facility begins the process of meeting the Emergency Preparedness for LTC Rule and Regulations established through the Centers for Medicaid and Medicare, effective November 2016 with implementation by LTC facilities required by November 2017. Present your customized emergency preparation manual to surveyors during your annual survey. For more information, contact Betty Shiels, PhD-C, LCSW, Program Director, Kentucky Emergency Preparedness for Aging and LTC, Kent School of Social Work, University of Louisville at [email protected] or 502/852-8003 or Diana Jester, MSSW, Program Manager, Kentucky Emergency Preparedness for Aging and LTC, Kent School of Social Work, University of Louisville at [email protected] or 502/852-3487. The revision of this manual was supported by the Kentucky Department for Public Health, U of L Vulnerable Populations, FY 16-17, Grant PO2 728 160000 5053 1


Table of Contents

Kentucky LTC Emergency Preparedness Manual Pages

I. Emergency Plan Adoption Statement 11

A. Record of Changes 12 B. Plan Maintenance 13 C. Annual Review Certification 14

II. CMS Standards

A. 2016 Final Rule on Emergency Preparedness for LTC 15-20 B. CMS Checklist (Revised 2017) 21-26 C. Crosswalk of Final Rule on Emergency Preparedness to

KY LTC Emergency Preparedness Manual 27-36

III. Basic Plan Elements A. Creating an Emergency Preparedness Plan 37-39 B. Mission 39 C. Purpose 39 D. Executive Summary 39-40 E. Applicability and Scope 41 F. Record of Distribution 42 G. Volunteer Assistance 42 H. Developing Relationships & Partnerships with Emergency Resources 42-43 I. Formalized Agreements and Contingencies 44 J. Coordinating with local Emergency Responders and Resources 45 K. Coordinating with County Emergency Plan & Health Care Coalitions 45-46 L. Kentucky Regional Health Care Coalitions 46

M. Community-Based Risk Assessment 47 N. Long-Term Care Subcommittees 47

1. Map of KY HPP/HCC Coalitions 48 2. Contact List of HPP/HCC Coordinators 49


IV. Operations Planning A. Employee List 50 B. Organizational Chart 51 C. Decision Making Authority/Chain of Command 52 D. Succession of Command 52 E. Residents Needs/Profile 53-54 F. Resident Tracking System 55 G. Facility Services to Residents 55

V. Hazard Vulnerability Analysis A. Hazard Vulnerability Analysis 56-59 B. Kaiser Permanente HVA Tool 60 C. Disaster Templates 62

1. Active Shooter 63-68 2. Bomb Treat/Suspicious Package 69-76 3. Earthquake 77-79 4. Epidemic/Pandemic Episode 80-84

a)USDHHS LTC Pandemic Influenza Checklist (rev. 7/2010) 85-91

5. Fire Emergency 92-96 6. Fire Watch/Fire System Disabled 97-101 7. Flood/Flash Flood 102-109 8. Hazard Material Spill/Release 110-113 9. Karst/Sinkholes/Caves 114-117 10. Landslide 118-119 11. Medical Emergency 120 12. Missing Resident 121-124 13. Nuclear Power/Hazardous Material Spill/Release 125-127 14. Severe Heat/Severe Cold 128-131 15. Snow Emergency 132-133 16. Terrorist Attack 134-142 17. Tornado Watch 143-144 18. Tornado Warning 145-146 19. Utility Outage 147-151

a) Boil Water Advisory 152-154 20. Wildland/Forest Fire 155-159 21. Workplace Violence/Threat of Violence 160-168


VI. Communication Plan A. Internal and External Communications 169

1. Internal Facility Communication Plan 169 2. External Facility Communication Plan 169

B. Facility Notification Procedure 169-170 C. Communication Plan with Staff 170

1. Call Tree Procedure 170 2. Call Tree Diagram 171-172

D. Primary and Alternate Means of Contact Families and Resident Representatives Communication Plan 172-173

E. Communicating with off-site Residents and Staff 173 F. Family/Resident Representative/Visitor Procedure 173 G. Contacting Family of Staff Members 173 H. Sample Letter to Resident/Family/Resident Representative 174-175 I. Sharing Personal Health Information (PHI) 176

1. HIPAA and Disasters 176 2. At a Glance – Algorithm for disclosing health information 176-180 3. HIPAA and Disasters-What Emergency Professionals Need to Know 181-187

J. Communication Plan to the Public 188 K. Contacting Federal, State, Regional and Local Emergency Preparedness Officials 188 L. Emergency Communication Tools 189

1. KY LTC Disaster Assessment Form Instructions 189-190 2. KY LTC Facility Disaster Assessment Form 191-192 3. Web-based Emergency Operations Center –WebEOC 193 4. Health Alert Network (HAN) 193

M. Communicating with the Media 193-194 N. Emergency Contact Listing 195-199


VII. Incident Command System A. National Incident Command System 200 B. Incident Command Systems (ICS) 200-203 C. Incident Command Center Organizational Chart 203-206 D. Incident Action Planning 206-207 E. Crosswalk for Nursing Home Positions and Nursing Home ICS Positions 208 F. Sample ICS Organizational Charts 209 G. Sample ICS Forms 210-213 H. NIMS Job Action Sheets 214-216 I. Plan Activation 217-218

VIII. Emergency Plan – Core Elements A. Preparedness Assessment – Food/Water 219

1. Guidelines on Bottled Water Storage 219-220 B. Preparedness Assessment – Dietary Considerations 221-222 C. Preparedness Assessment – Pharmaceuticals 223-224 D. Preparedness Assessment – Basic Supplies 225-226 E. Preparedness Assessment – Fuel Supplies 226-227

1. Generator 226-227 F. Fuel Supply and Vendor Agreements 227-228 G. Building Floor Plan 228 H. Emergency Shutdown Procedures

1. Electric 229-231 2. Natural Gas 231-232 3. Water Service Shutdown 233-234 4. HVAC 235-237 5. Boiler Shutdown 237-239 6. Computer System 239-21 7. Electronic Health Records 241-242

I. Preparedness Assessment – Security 243-244 J. Preparedness Assessment - Capacity for Deceased Residents 244-245 Morgue Log Sheet 245


IX. Continuity of Operations Planning (COOP) A. KY LTC Facility Disaster Assessment Form 246-248 B. Essential Staff Roles and Redundancy 249-250 C. Lines of Succession 250 D. Delegation of Authority 250-251 E. Alternate Locations/Facilities 251 F. Vital Systems and Equipment 251-252 G. Vital Records 252-253 H. Communication Systems Supporting Essential Functions 253 I. Restoration and Recovery 253-254

X. Disaster Response Planning A. Decision Tree: Shelter-in-Place or Evacuate 255 B. Shelter-In-Place (S-I-P) 256-261

1. Shelter-in-Place Procedures a) Weather-Related 258-260 b) Non-weather Related 260-261

2. Providing Adequate Supplies 261-264 3. Security and Lockdown 264 4. Managing visitors, clergy, vendors during S-I-P 264-265 5. Communication Plan with Families /Resident Representatives 265 6. Policy for Staff Sheltering 266 7. Policy for Staffing Shifts 266

C. Evacuation 1. Notification policy for owner, State Survey Agency, First Responders 267 2. Activating Mutual Aid Agreement/Memorandum of Understanding 267-268

a) Sample Transfer Agreement 268-270 b) Sample Memorandum of Agreement 270-278

3. Activating Community Alternate Care Sites 279-280


4. Evacuation Routes and Directions to Alternate Facilities 280-282 5. Implementing Facility Transportation Agreements 283

a) Sample Transfer Agreement 283-285 6. Evacuation Operations 286 7. Staff Assignments for Evacuation Procedures 286-288 8. Staff Assignments by Position 288-291 9. Resident Emergency Go-Bags 291-292 10. Resident Emergency Packets 292-293 11. Resident Evacuation Wristbands 293 12. Emergency Transfer Techniques 293-296 13. Facility Go-Box 297 14. Decision to Move or Discharge Residents 297-298 15. Resident Tracking 298 16. Resident Evacuation Checklist 299-300 17. Tracking Residents Off-site at Time of Emergency 301 18. Staff Tracking 301 19. Pharmaceutical and Medical Device Tracking 301-302 20. Transportation Assessment Tool 303-315

D. Hosting Evacuees from another LTC Facility 316

1. 1135 Waiver 317-320 2. Kentucky LTC Medical Surge Receiving Plan Template 321-334

XI. Training and Exercise 335

A. Staff Training 335 B. Fire Drills 335 C. Exercises 335 D. Community-Wide Exercises 336 E. Internal Exercises 336 F. Tabletop Exercises 336-337 G. Functional Exercises 337

1. Real World Emergency/Event 337 2. After Action Reports/Improvement Plan (AAR/IP) 337-338

H. Sample AAR/IP 339-348


XII. Employee Emergency Preparedness A. Implementing Emergency Planning Polices: Staff 349 B. Employee Personal Readiness 350 C. Employee Emergency Preparedness Information 350-351 D. Infant/Child/Dependent Preparedness Information 352 E. Adult Dependent Preparedness Information 353

1. Employee Communication Plan 354 2. Family Disaster Plan: Helping Staff Prepare at Work/Home 355-356 3. Pet Preparedness Plan 357-358 4. When Staff Return Home After a Disaster: Home Evaluation 359-360 5. Getting Kids Involved in Emergency Preparedness Activities 361

XIII. Mental Health Planning A. Psychological First Aid for Staff and Residents 362-363 B. Kentucky Community Crisis Response Board (KCCRB) 363-364 C. Additional Mental Health Resources 364-365 D. Tips for Retaining and Caring for Staff after a Disaster 366-369

XIV. Acronyms/Glossaries 370-378

XV. Additional Resources 379-385 Appendix: Excel Spreadsheet for KY LTC Medical Surge Receiving Plan Template 386-393


I. EMERGENCY PLAN

ADOPTION STATEMENT This plan is adopted as the __________________________________ (facility name) Emergency Preparedness Response Plan providing policies and procedures to be followed in the planning, response and recovery from emergencies and disasters. This plan addresses the 3 key essentials for maintaining access to healthcare services during emergencies and disaster events:

• Safeguarding human resources • Maintaining business continuity • Protecting physical resources

In keeping with the 2016 CMS Rule and Regulations effecting long-term care facilities nationwide, the plan incorporates the following key elements:

• Risk Assessment and Emergency Plan (community-based and facility-based) • Policies and procedures • Communications planning • Training and testing/exercises • Emergency and standby power systems • Integrated health system (if applicable)

This plan is adopted this ______________ day of _________________________, 20________ Administrator’s Name (printed): __________________________________________________ Administrator’s Signature: _______________________________________________________


Record of Changes

Change Number Date of Change Date Entered Changed by


Plan Maintenance 1. Security and Control of the Plan It is essential to maintain a master copy of the Kentucky LTC Emergency Preparedness Manual in a secure location within the facility. Copies of the plan should be distributed to appropriate units within the facility as well as to key members of the organization. A master copy of the plan should be kept filed in the following location within the facility: __________________________________________________________________________ 2. Remote/Off Site Access to the Plan It is essential to maintain a copy of the Kentucky LTC Emergency Preparedness Manual in a remote location that is secure and accessible in the event the facility is stricken by a crisis or disaster situation where copies of the plan are not accessible within the facility. A copy of the plan should be kept securely filed in the following remote location that is off-site: ____________________________________________________________________________ 3. Periodic Review and Updating The Kentucky LTC Emergency Preparedness Manual should be reviewed and updated at least annually to ensure its accuracy. However, the plan should be updated every time a portion of it is changed (i.e., contact information changes or additions to a policy or procedure). Updated materials are available on the Kentucky Emergency Preparedness for Aging and Long-Term Care website at www.kyepltc.com Updates may occur for, but not limited to, the following:

q Regulatory change q New hazards identified or changes in existing hazards q Drills/exercises identify the necessity to make changes q Actual disasters/emergency responses q Changes to infrastructure q Funding of budget-related changes q Other

______________________________________________________________________


Annual Review Certification I hereby certify that I have reviewed the Emergency Response Plan for ______________ (facility name). Necessary changes have been coordinated through the County Emergency Manager and incorporated into this plan. Distribution of changed pages has been made to recorded holders of the plan.

DATE Authorized Signature


II. CMS Standards A. CMS 2016 Ruling on Emergency Preparedness for LTC The final rule and regulations identifies 4 key elements identified in this manual: 1. Assess Risk and Create Emergency Plan 2. Develop and Implement Policies and Procedures 3. Communicate Plan 4. Train and Test Staff

[81 FR 64030, Sept. 16, 2016; 81 FR 80594, Nov. 16, 2016]

§483.73 Emergency preparedness.

The LTC facility must comply with all applicable Federal, State and local emergency preparedness requirements. The LTC facility must establish and maintain an emergency preparedness program that meets the requirements of this section. The emergency preparedness program must include, but not be limited to, the following elements:

(a) Emergency plan. The LTC facility must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least annually. The plan must do all of the following:

(1) Be based on and include a documented, facility-based and community-based risk assessment, utilizing an all-hazards approach, including missing residents.

(2) Include strategies for addressing emergency events identified by the risk assessment.

(3) Address resident population, including, but not limited to, persons at-risk; the type of services the LTC facility has the ability to provide in an emergency; and continuity of operations, including delegations of authority and succession plans.

(4) Include a process for cooperation and collaboration with local, tribal, regional, State, or Federal emergency preparedness officials' efforts to maintain an integrated response during a disaster or emergency situation, including documentation of the LTC facility's efforts to contact such officials and, when applicable, of its participation in collaborative and cooperative planning efforts.

(b) Policies and procedures. The LTC facility must develop and implement emergency preparedness policies and procedures, based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, and the communication plan at paragraph (c) of this section. The policies and procedures must be reviewed and updated at least annually. At a minimum, the policies and procedures must address the following:


(1) The provision of subsistence needs for staff and residents, whether they evacuate or shelter in place, include, but are not limited to the following:

(i) Food, water, medical, and pharmaceutical supplies.

(ii) Alternate sources of energy to maintain—

(A) Temperatures to protect resident health and safety and for the safe and sanitary storage of provisions;

(B) Emergency lighting;

(C) Fire detection, extinguishing, and alarm systems; and

(D) Sewage and waste disposal.

(2) A system to track the location of on-duty staff and sheltered residents in the LTC facility's care during and after an emergency. If on-duty staff and sheltered residents are relocated during the emergency, the LTC facility must document the specific name and location of the receiving facility or other location.

(3) Safe evacuation from the LTC facility, which includes consideration of care and treatment needs of evacuees; staff responsibilities; transportation; identification of evacuation location(s); and primary and alternate means of communication with external sources of assistance.

(4) A means to shelter in place for residents, staff, and volunteers who remain in the LTC facility.

(5) A system of medical documentation that preserves resident information, protects confidentiality of resident information, and secures and maintains the availability of records.

(6) The use of volunteers in an emergency or other emergency staffing strategies, including the process and role for integration of State or Federally designated health care professionals to address surge needs during an emergency.

(7) The development of arrangements with other LTC facilities and other providers to receive residents in the event of limitations or cessation of operations to maintain the continuity of services to LTC residents.

(8) The role of the LTC 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.

(c) Communication plan. The LTC facility must develop and maintain an emergency preparedness communication plan that complies with Federal, State, and local laws and must be


reviewed and updated at least annually. The communication plan must include all of the following:

(1) Names and contact information for the following:

(i) Staff.

(ii) Entities providing services under arrangement.

(iii) Residents' physicians.

(iv) Other LTC facilities.

(v) Volunteers.

(2) Contact information for the following:

(i) Federal, State, tribal, regional, or local emergency preparedness staff.

(ii) The State Licensing and Certification Agency.

(iii) The Office of the State Long-Term Care Ombudsman.

(iv) Other sources of assistance.

(3) Primary and alternate means for communicating with the following:

(i) LTC facility's staff.

(ii) Federal, State, tribal, regional, or local emergency management agencies.

(4) A method for sharing information and medical documentation for residents under the LTC facility's care, as necessary, with other health care providers to maintain the continuity of care.

(5) A means, in the event of an evacuation, to release resident information as permitted under 45 CFR 164.510(b)(1)(ii).

(6) A means of providing information about the general condition and location of residents under the facility's care as permitted under 45 CFR 164.510(b)(4).

(7) A means of providing information about the LTC facility's occupancy, needs, and its ability to provide assistance, to the authority having jurisdiction or the Incident Command Center, or designee.


(8) A method for sharing information from the emergency plan that the facility has determined is appropriate with residents and their families or representatives.

(d) Training and testing. The LTC facility must develop and maintain an emergency preparedness training and testing program that is based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, policies and procedures at paragraph (b) of this section, and the communication plan at paragraph (c) of this section. The training and testing program must be reviewed and updated at least annually.

(1) Training program. The LTC facility must do all of the following:

(i) Initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected roles.

(ii) Provide emergency preparedness training at least annually.

(iii) Maintain documentation of the training.

(iv) Demonstrate staff knowledge of emergency procedures.

(2) Testing. The LTC facility must conduct exercises to test the emergency plan at least annually, including unannounced staff drills using the emergency procedures. The LTC facility must do the following:

(i) Participate in a full-scale exercise that is community-based or when a community-based exercise is not accessible, an individual, facility-based. If the LTC facility experiences an actual natural or man-made emergency that requires activation of the emergency plan, the LTC facility is exempt from engaging in a community-based or individual, facility-based full-scale exercise for 1 year following the onset of the actual event.

(ii) Conduct an additional exercise that may include, but is not limited to the following:

(A) A second full-scale exercise that is community-based or individual, facility-based.

(B) A tabletop exercise that includes a group discussion led by a facilitator, using a narrated, clinically-relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan.

(iii) Analyze the LTC facility's response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the LTC facility's emergency plan, as needed.

(e) Emergency and standby power systems. The LTC facility must implement emergency and standby power systems based on the emergency plan set forth in paragraph (a) of this section.


(1) Emergency generator location. The generator must be located in accordance with the location requirements found in the Health Care Facilities Code (NFPA 99 and Tentative Interim Amendments TIA 12-2, TIA 12-3, TIA 12-4, TIA 12-5, and TIA 12-6), Life Safety Code (NFPA 101 and Tentative Interim Amendments TIA 12-1, TIA 12-2, TIA 12-3, and TIA 12-4), and NFPA 110, when a new structure is built or when an existing structure or building is renovated.

(2) Emergency generator inspection and testing. The LTC facility must implement the emergency power system inspection, testing, and maintenance requirements found in the Health Care Facilities Code, NFPA 110, and Life Safety Code.

(3) Emergency generator fuel. LTC facilities that maintain an onsite fuel source to power emergency generators must have a plan for how it will keep emergency power systems operational during the emergency, unless it evacuates.

(f) Integrated healthcare systems. If a LTC facility is part of a healthcare system consisting of multiple separately certified healthcare facilities that elects to have a unified and integrated emergency preparedness program, the LTC facility may choose to participate in the healthcare system's coordinated emergency preparedness program. If elected, the unified and integrated emergency preparedness program must do all of the following:

(1) Demonstrate that each separately certified facility within the system actively participated in the development of the unified and integrated emergency preparedness program.

(2) Be developed and maintained in a manner that takes into account each separately certified facility's unique circumstances, patient populations, and services offered.

(3) Demonstrate that each separately certified facility is capable of actively using the unified and integrated emergency preparedness program and is in compliance with the program.

(4) Include a unified and integrated emergency plan that meets the requirements of paragraphs (a)(2), (3), and (4) of this section. The unified and integrated emergency plan must also be based on and include—

(i) A documented community-based risk assessment, utilizing an all-hazards approach.

(ii) A documented individual facility-based risk assessment for each separately certified facility within the health system, utilizing an all-hazards approach.

(5) Include integrated policies and procedures that meet the requirements set forth in paragraph (b) of this section, a coordinated communication plan and training and testing programs that meet the requirements of paragraphs (c) and (d) of this section, respectively.

(g) The standards incorporated by reference in this section are approved for incorporation by reference by the Director of the Office of the Federal Register in accordance with 5 U.S.C. 552(a) and 1 CFR part 51. You may obtain the material from the sources listed below. You may inspect a copy at the CMS Information Resource Center, 7500 Security Boulevard, Baltimore,


MD or at the National Archives and Records Administration (NARA). For information on the availability of this material at NARA, call 202-741-6030, or go to: http://www.archives.gov/federal_register/code_of_federal_regulations/ibr_locations.html. If any changes in this edition of the Code are incorporated by reference, CMS will publish a document in the FEDERAL REGISTER to announce the changes.

(1) National Fire Protection Association, 1 Batterymarch Park, Quincy, MA 02169, www.nfpa.org, 1.617.770.3000.

(i) NFPA 99, Health Care Facilities Code 2012 edition, issued August 11, 2011.

(ii) Technical interim amendment (TIA) 12-2 to NFPA 99, issued August 11, 2011.

(iii) TIA 12-3 to NFPA 99, issued August 9, 2012.

(iv) TIA 12-4 to NFPA 99, issued March 7, 2013.

(v) TIA 12-5 to NFPA 99, issued August 1, 2013.

(vi) TIA 12-6 to NFPA 99, issued March 3, 2014.

(vii) NFPA 101, Life Safety Code, 2012 edition, issued August 11, 2011.

(viii) TIA 12-1 to NFPA 101, issued August 11, 2011.

(ix) TIA 12-2 to NFPA 101, issued October 30, 2012.

(x) TIA 12-3 to NFPA 101, issued October 22, 2013.

(xi) TIA 12-4 to NFPA 101, issued October 22, 2013.

(xii) NFPA 110, Standard for Emergency and Standby Power Systems, 2010 edition, including TIAs to chapter 7, issued August 6, 2009.

(2) [Reserved]


B. CMS Assessment Check List (2017) ASSESSMENT CHECKLIST

Revised based upon U.S Department of Health and Human Services Centers for Medicare and Medicaid Services as of 1/18/2017 This checklist includes various requirements for all 17 Health Care Providers

Meets Standard Review Required

Responsible Party Measures

Develop Emergency Plan: Gather all available relevant information when developing the emergency plan. This information includes, but is not limited to:

• Copies of any state and local emergency planning regulations or requirements

• Facility personnel names and contact information • Contact information of local and state emergency managers • A facility organization chart • Building construction and Life Safety systems information • Specific information about the characteristics and needs of the individuals

for whom care is provided

All Hazards Continuity of Operations (COOP) Plan: Develop a continuity of operations business plan using an all-hazards approach (e.g., hurricanes, floods, tornadoes, fire, bioterrorism, pandemic, etc.) that could potentially affect the facility directly and indirectly within the particular area of location. Indirect hazards could affect the community but not the facility and as a result interrupt necessary utilities, supplies or staffing. Determine all essential functions and critical personnel.

Collaborate with Local Emergency Management Agency: Collaborate with local emergency management agencies to ensure the development of an effective emergency plan.

Analyze Each Hazard: Analyze the specific vulnerabilities of the facility and determine the following actions for each identified hazard:

• Specific actions to be taken for the hazard • Identified key staff responsible for executing plan • Staffing requirements and defined staff responsibilities • Identification and maintenance of sufficient supplies and equipment to

sustain operations and deliver care and services for 3-10 days, based on each facility’s assessment of their hazard vulnerabilities. (Following experiences from Hurricane Katrina, it is generally felt that previous recommendations of 72 hours may no longer be sufficient during some wide-scale disasters. However, this recommendation can be achieved by maintaining 72-hours of supplies on hand, and holding agreements with suppliers for the remaining days.).

• Communication procedures to receive emergency warning/alerts, and for communication with staff, families, individuals receiving care, before, during and after the emergency

• Designate critical staff, providing for other staff and volunteer coverage and meeting staff needs, including transportation and sheltering critical staff members’ family

Collaborate with Suppliers/Providers: Collaborate with suppliers and/or providers who have been identified as part of a community emergency plan or agreement with the health care facility, to receive and care for individuals. A surge capability assessment should be included in the development of the emergency plan. Similarly, evidence of a surge capacity assessment should be included if the supplier or provider, as part of its emergency planning, anticipates the need to make housing and sustenance provisions for the staff and or the family of staff.


ASSESSMENT CHECKLIST Revised based upon U.S Department of Health and Human Services Centers for Medicare and Medicaid Services as of 1/18/2017



Decision Criteria for Executing Plan: Include factors to consider when deciding to evacuate or shelter in place. Determine who at the facility level will be in authority to make the decision to execute the plan to evacuate or shelter in place (even if no outside evacuation order is given) and what will be the chain of command.

Communication Infrastructure Contingency: Establish contingencies for the facility communication infrastructure in the event of telephone failures (e.g., walkie-talkies, ham radios, text messaging systems, etc.). • Develop Shelter-in-Place Plan: Due to the risks in transporting vulnerable

patients and residents, evacuation should only be undertaken if sheltering-in- place results in greater risk. Develop an effective plan for sheltering-in-place, by ensuring provisions for the following are specified:

• Procedures to assess whether the facility is strong enough to withstand strong winds, flooding, etc.

• Measures to secure the building against damage (plywood for windows, sandbags and plastic for flooding, safest areas of the facility identified.

• Procedures for collaborating with local emergency management agency, fire, police and EMS agencies regarding the decision to shelter-in-place.

• Sufficient resources are in supply for sheltering-in-place for at least 7 days, including:

- Ensuring emergency power, including back-up generators and accounts for maintaining a supply of fuel

- An adequate supply of potable water (recommended amounts vary by population and location)

- A description of the amounts and types of food in supply - Maintaining extra pharmacy stocks of common medications - Maintaining extra medical supplies and equipment (e.g., oxygen,

linens, vital equipment) • Identifying and assigning staff who are responsible for each task • Description of hosting procedures, with details ensuring 24-hour operations

for minimum of 7 days • Contract established with multiple vendors for supplies and transportation • Develop a plan for addressing emergency financial needs and providing

security

Develop Evacuation Plan: Develop an effective plan for evacuation, by ensuring provisions for the following are specified:

• Identification of person responsible for implementing the facility evacuation plan (even if no outside evacuation order is given)

• Multiple pre-determined evacuation locations (contract or agreement) with a “like” facility have been established, with suitable space, utilities, security and sanitary facilities for individuals receiving care, staff and others using the location, with at least one facility being 50 miles away. A back-up may be necessary if the first one is unable to accept evacuees.

• Evacuation routes and alternative routes have been identified, and the proper authorities have been notified Maps are available and specified travel time has been established

• Adequate food supply and logistical support for transporting food is described.





• The amounts of water to be transported and logistical support is described (1 gal/person).

• The logistics to transport medications is described, including ensuring their protection under the control of a registered nurse.

• Procedures for protecting and transporting resident/patient medical records.

• The list of items to accompany residents/patients is described. • Identify how persons receiving care, their families, staff and others will be

notified of the evacuation and communication methods that will be used during and after the evacuation

• Identify staff responsibilities and how individuals will be cared for during evacuation and the back-up plan if there isn’t sufficient staff.

• Procedures are described to ensure residents/patients dependent on wheelchairs and/or other assistive devices are transported so their equipment will be protected and their personal needs met during transit (e.g., incontinent supplies for long periods, transfer boards and other assistive devices).

• A description of how other critical supplies and equipment will be transported is included.

• Determine a method to account for all individuals during and after the evacuation

• Procedures are described to ensure staff accompany evacuating residents. • Procedures are described if a patient/resident becomes ill or dies in route. • Mental health and grief counselors are available at reception points to talk

with and counsel evacuees. • Procedures are described if a patient/resident turns up missing during an

evacuation: o Notify the patient/resident’s family o Notify local law enforcement o Notify Nursing Home Administration and staff

• Ensure that patient/resident identification wristband (or equivalent identification) must be intact on all residents.

• Describe the process to be utilized to track the arrival of each resident at the destination.

• It is described whether staff’s family can shelter at the facility and evacuate.

Transportation & Other Vendors: Establish transportation arrangements that are adequate for the type of individuals being served. Ensure the right type of transportation has been obtained (e.g., ambulances, buses, helicopters, etc.). The plan must include contact information for other hospitals and CAHs; method for sharing information and medical documentation for patients. In the event of an evacuation, method to release patient information consistent with the HIPAA Privacy Rule.





Train Transportation Vendors/Volunteers: Ensure that the vendors or volunteers who will help transport residents and those who receive them at shelters and other facilities are trained on the needs of the chronic, cognitively impaired and frail population and are knowledgeable on the methods to help minimize transfer trauma.

Facility Reentry Plan: Describe who will authorizes reentry to the facility after an evacuation, the procedures for inspecting the facility, and how it will be determined when it is safe to return to the facility after an evacuation. The plan should also describe the appropriate considerations for return travel back to the facility.

Residents & Family Members: Determine how residents and their families/guardians will be informed of the evacuation, helped to pack, have their possessions protected and be kept informed during and following the emergency, including information on where they will be/go, for how long and how they can contact each other.

Resident Identification: Determine how residents will be identified in an evacuation; and ensure the following identifying information will be transferred with each resident:

• Name • Social security number • Photograph • Medicaid or other health insurer number • Date of birth, diagnosis • Current drug/prescription and diet regimens • Name and contact information for next of kin/responsible person/Power

of Attorney) Determine how this information will be secured (e.g., laminated documents, water proof pouch around resident’s neck, water proof wrist tag, etc.) and how medical records and medications will be transported so they can be matched with the resident to whom they belong.

Trained Facility Staff Members: Develop and maintain a training and testing program for all new and existing employees including initial training policies, procedures and the ability to demonstrate knowledge of the plan. Training must be completed annually and links to requirement of ongoing training and exercises.

Informed Residents & Patients: Ensure residents, patients and family members are aware of and knowledgeable about the facility plan, including:

• Families know how and when they will be notified about evacuation plans, how they can be helpful in an emergency (example, should they come to the facility to assist?) and how/where they can plan to meet their loved ones.

• Out-of-town family members are given a number they can call for information. Residents who are able to participate in their own evacuation are aware of their roles and responsibilities in the event of a disaster.




Responsible Party Measures Needed Provisions: Check if provisions need to be delivered to the

facility/residents -- power, flashlights, food, water, ice, oxygen, medications -- and if urgent action is needed to obtain the necessary resources and assistance.

Location of Evacuated Residents: Determine the location of evacuated residents, document and report this information to the clearing house established by the state or partnering agency. Tracking during and after the emergency applies to on-duty staff and sheltered patients.

Helping Residents in the Relocation: Suggested principles of care for the relocated residents include:

• Encourage the resident to talk about expectations, anger, and/or disappointment

• Work to develop a level of trust • Present an optimistic, favorable attitude about the relocation • Anticipate that anxiety will occur • Do not argue with the resident • Do not give orders • Do not take the resident’s behavior personally • Use praise liberally • Include the resident in assessing problems • Encourage staff to introduce themselves to residents • Encourage family participation

Review Emergency Plan: Complete an internal review of the emergency plan on an annual basis to ensure the plan reflects the most accurate and up-to- date information. Updates may be warranted under the following conditions:

• Regulatory change • New hazards are identified or existing hazards change • After tests, drills, or exercises when problems have been identified • After actual disasters/emergency responses • Infrastructure changes • Funding or budget-level changes

Refer to FEMA (Federal Emergency Management) to assist with updating existing emergency plans. Review FEMA’s new information and updates for best practices and guidance, at each updating of the emergency plans.

Emergency Planning Templates: Healthcare facilities should appropriately complete emergency planning templates and tailor them to their specific needs and geographical locations.

Collaboration with Local Emergency Management Agencies and Healthcare Coalitions: Establish collaboration with different types of healthcare providers (e.g. hospitals, nursing homes, hospices, home care, dialysis centers etc.) at the State and local level to integrate plans of and activities of healthcare systems into State and local response plans to increase medical response capabilities.




Responsible Party Measures Communication with the Long-Term Care Ombudsman Program: Prior to any

disaster, discuss the facility’s emergency plan with a representative of the ombudsman program serving the area where the facility is located and provide a copy of the plan to the ombudsman program. When responding to an emergency, notify the local ombudsman program of how, when and where residents will be sheltered so the program can assign representatives to visit them and provide assistance to them and their families.

Conduct Exercises & Drills: Conduct exercises that are designed to test individual essential elements, interrelated elements, or the entire plan:

• A full-scale exercise that is facility or community based. • An additional exercise of the facility’s choice

Loss of Resident’s Personal Effects: Establish a process for the emergency management agency representative (FEMA or other agency) to visit the facility to which residents have been evacuated, so residents can report loss of personal effects.

Generators—Develop policies and procedures that address the provision of alternate sources of energy to maintain:�

1. temperatures to protect patient health and safety and for the safe and sanitary storage of provisions;�

2. emergency lighting; and� 3. fire detection, extinguishing, and alarm systems.

Share with resident/family/ representative appropriate information from emergency plan.

Communication- Develop and maintain a communication plan that complies with both federal and state laws. Patient care must be well- coordinated within the facility, across health care providers and with state and local public health departments and emergency systems. The plan must include contact information for other hospitals and CAHs; method for sharing information and medical documentation for patients. Ensure the ability to contact ALL staff, patients, visitors, clients, contractors as appropriate based upon facility location, event, and hazard.


2016 Final CMS Emergency Preparedness Rule Crosswalk to KY LTC Emergency Preparedness Manual

Emergency Plan – Final Rule (Part a) Table of Contents

Section

Emergency Plan, The LTC Facility must develop and maintain an emergency preparedness plan that must be reviewed, and updated at least annually. The plan must do the following:

I. Emergency Plan Adoption (A-C)

II. CMS Standards III Basic Plan Elements

(A-B) (1) Be based on and include a documented, facility-based and community-based risk assessment, utilizing an all-hazards approach.

III Basic Plan Elements (E) V HVA (A-B)

(2) Include strategies for addressing emergency events identified by the risk assessment. V HVA (A-B)

(3) Address resident population, including, but not limited to, persons at risk; the type of services the facility has the ability to provide in an emergency; and continuity of operations, including delegations of authority and succession plans.

IV Operations Planning (C-G) Incident Command (A-

G) VII COOP (A-D)

(4) Include a process for cooperation and collaboration with local, tribal, regional, State, and Federal emergency preparedness officials' efforts to maintain an integrated response during a disaster or emergency situation, including documentation of the facility's efforts to contact such officials and, when applicable, its participation in collaborative and cooperative planning efforts.

III Basic Plan Elements (H-N)



Policies and Procedures – Final Rule (Part b) Table of Contents Section

The LTC Facility must develop and implement emergency preparedness policies and procedures, based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, and the communication plan at paragraph (c) of this section. The policies and procedures must be reviewed and updated at least annually. At minimum, the policies and procedures must address the following:

III Basic Plan Elements

(1) The provision of subsistence needs for staff and residents whether they evacuate or shelter in place, including, but not limited to, the following:

X Response Planning (A-C)

(i) Food, water, medical and pharmaceutical supplies. VIII Core Elements (A-C) (ii) Alternate sources of energy to maintain: VIII Core Elements (E-F)

(A) Temperatures to protect resident health and safety and for the safe and sanitary storage of provisions.

(B) Emergency lighting. VIII Core Elements (D) (C) Fire detection, extinguishing, and alarm systems. VIII Core Elements (D)

(D) Sewage and waste disposal. VIII Core Elements (D)



Policies and Procedures – Final Rule (Part b) Table of Contents Section

(2) A system to track the location of on-duty staff and residents in the facility's care both during and after the emergency. If on-duty staff and sheltered residents are relocated during the emergency, the staff must document the specific name and location of the receiving facility or other location.

XII Employee Preparedness (A-E)

(3) Safe evacuation from the facility that includes consideration of care and treatment needs of evacuees; staff responsibilities; transportation; identification of evacuation location(s); and primary and alternate means of communication with external sources of assistance.

X Response Planning (C)

(4) A means to shelter in place for residents, staff, and volunteers who remain in the facility. VIII Core Elements (A) X Response Planning (B)

(5) A system of medical documentation that preserves medical information, protects confidentiality of resident information, and ensures records are secure and readily available. X Response Planning (C)

(6) The use of volunteers in an emergency and other emergency staffing strategies, including the process and role for integration of State and Federally designated health care professionals to address surge needs during an emergency.

X Response Planning (D)

(7) The development of arrangements with other LTC facilities and other providers to receive residents in the event of limitations or cessation of operations to ensure the continuity of services.




Table of Contents Section

(8) 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.


Communication Plan – Final Rule (Part c) VI Communication Plan

(c) Communication plan. The LTC facility must develop and maintain an emergency preparedness communication plan that complies with Federal, State and local law, and must be reviewed and updated at least annually. The communication plan must include all of the following:

VI Communications Plan

(1) Names and contact information for the following:

(i) Staff. VI Communication Plan (C)

(ii) Entities providing services under arrangement. II Basic Plan Elements (H-I)

(iii) Residents' physicians. VI Communications Plan (K)

(iv) Other LTC Facilities VI Communications Plan (K)

(v) Volunteers. II Basic Plan Elements (G) VI Communications Plan

(K)

(2) Contact information for the following: VI Communication Planning

(i) Federal, State, tribal, regional, and local emergency preparedness staff.

II Basic Plan Elements (H-J)

VI Communications Plan (E, K)



Communication Plan – Final Rule (Part c)

Table of Contents

Section

(ii) Other sources of assistance including State Licensing and Certification Agency. The Office of the State Long-term Care Ombudsman.

VI Communication Planning (K)

(3) Primary and alternate means for communicating with: VI Communication Plan

(i) Facility staff. VI Communications Plan (K

(ii) Federal, State, tribal, regional, and local emergency management agencies. VI Communications Plan (K,E)

(4) A method for sharing information and medical documentation for residents under the facility's care, as necessary, with other health care providers to maintain continuity of care. VI Communication Plan (I)

(5) A means, in the event of an evacuation, to release personal information as permitted under 42 CFR § 483.73(c)(5) VI Communication Plan (I)

(6) A means of providing information about the general condition and location of residents under the facility's care as permitted under 42 CFR § 483.73(c)(5) VI Communication Plan (I)

(7) A means of providing information about the facility's occupancy, needs, and ability to provide assistance, to the authority having jurisdiction, the Incident Command Center, or designee. Also includes a method for sharing information from the emergency plan that the facility has determined is appropriate, with residents and their families or representatives.

VI Communications Plan (I-K)



Training and Testing – Final Rule (Part d) Table of Contents

Section

The facility must develop and maintain an emergency preparedness training and testing program that is based on the emergency plan set forth in paragraph (a) of this section, risk assessment at paragraph (a)(1) of this section, policies and procedures at paragraph (b) of this section, and the communication plan at paragraph (c) of this section. The training and testing program must be reviewed and updated at least annually.

XI Training and Testing/Exercises

(1) Training program. The LTC facility must do all of the following: XI Training and Testing/Exercises

(i) Initial training in emergency preparedness policies and procedures to all new and existing staff, individuals providing services under arrangement, and volunteers, consistent with their expected role.

XI Training and Testing (A)

(ii) Provide emergency preparedness training at least annually. XI Training and Testing (A)

(iii) Maintain documentation of the training. XI Training and Testing (A)

(iv) Demonstrate staff knowledge of emergency procedures. XI Training and Testing (A)

(2) Testing XI Training and Testing/Exercises



Training and Testing – Final Rule (Part d) Table of Contents

Section

The facility must conduct exercises to test the emergency plan at least annually including running unannounced staff drills using emergency procedures. The LTC Facility must do all of the following:

XI Training and Testing (B-C)

(i) Participate in a full-scale exercise that is community-based or when a community-based exercise is not accessible, an individual, facility-based. If the facility experiences an actual natural or man-made emergency that requires activation of the emergency plan, the facility is exempt from engaging in a community-based or individual, facility-based full-scale exercise for 1 year following the onset of the actual event.

XI Training and Testing (B-E)

(ii) Conduct an additional exercise that may include, but is not limited to the following: (A) A second full-scale exercise that is community-based or individual, facility-based. (B) A tabletop exercise that includes a group discussion led by a facilitator, using a narrated, clinically relevant emergency scenario, and a set of problem statements, directed messages, or prepared questions designed to challenge an emergency plan.

XI Training and Testing (B-E)



Training and Testing – Final Rule (Part d)

Table of Contents Section

(iii) Analyze the facility’s response to and maintain documentation of all drills, tabletop exercises, and emergency events, and revise the facility's emergency plan, as needed.

XI Training and Testing

(B-E)

Emergency and standby power systems (e) VIII Core Elements (E)

The LTC facility must implement emergency and standby power systems based on the emergency plan set forth in paragraph (a) of this section and in the policies and procedures plan set forth in paragraphs (b)(1)(i) and (ii) of this section.

VIII Core Elements (E-G)

(1) The generator must be located in accordance with the location requirements found in the Health Care Facilities Code (NFPA 99 and Tentative Interim Amendments TIA 12–2, TIA 12–3, TIA 12–4, TIA 12–5, and TIA 12–6), Life Safety Code (NFPA 101 and Tentative Interim Amendments TIA 12–1, TIA 12–2, TIA 12–3, and TIA 12–4), and NFPA 110, when a new structure is built or when an existing structure or building is renovated.


(2) The facility must implement the emergency power system inspection, testing, and maintenance requirements found in the Health Care Facilities Code, NFPA 110, and Life Safety Code.

VIII Core Elements (I); XI Training and Testing (B)

(3) LTC facilities that maintain an onsite fuel source to power emergency generators must have a plan for how it will keep emergency power systems operational during the emergency, unless it evacuates.




Integrated Healthcare Systems – Final Rule (Part f) Table of Contents

Section

If a LTC facility is part of a healthcare system (i.e. hospital) consisting of multiple separately certified healthcare facilities that elects to have a unified and integrated emergency preparedness program, the LTC facility may choose to participate in the healthcare system’s coordinated emergency preparedness program. If elected, the unified and integrated emergency preparedness program must—

I Emergency Plan II CMS Standards

(1) Demonstrate that each separately certified facility within the system actively participated in the development of the unified and integrated emergency preparedness program.


(2) Be developed and maintained in a manner that takes into account each separately certified facility’s unique circumstances, resident populations, and services offered.


(3) Demonstrate that each separately certified facility is capable of actively using the unified and integrated emergency preparedness program and is in compliance with the program.


(4) Include a unified and integrated emergency plan that meets the requirements of paragraphs (a) (2), (3), and (4) of this section. The unified and integrated emergency plan must also be based on and include the following:


(i) A documented community-based risk assessment, utilizing an all-hazards approach.


III Basic Plan Elements (J-N)

(ii) A documented individual facility-based risk assessment for each separately certified facility within the health system, utilizing an all-hazards approach. I Emergency Plan

II CMS Standards



Integrated Healthcare Systems – Final Rule (Part f) Table of Contents

Section

(5) Include integrated policies and procedures that meet the requirements set forth in paragraph (b) of this section, a coordinated communication plan and training and testing programs that meet the requirements of paragraphs (c) and (d) of this section, respectively.


Crosswalk used with permission of the Healthcare Association of New York State, November 2016


III. BASIC PLAN ELEMENTS

Emergency Preparedness Planning (EPP) – Getting Started

A. Creating an Emergency Preparedness Plan An essential component of an All Hazards Emergency Preparedness Plan is to utilize the skills of

diverse staff members who can contribute to the planning process as well as the implementation

of the plan should an emergency occur. The 3 Key Essentials for maintaining access to

healthcare services during emergencies are:

• Safeguarding human resources

• Maintaining business continuity (COOP)

• Protecting physical resources

The following recommendations address each of these key essentials, drawing expertise from

facility and community human resources.

1. Form a committee with representatives from key areas:

• Administration/finance • Nursing • Certified Nursing Assistants • Maintenance/Plant Operations • Dietary • Security • Environmental Services • Social Services

2. An existing Safety Committee could take on Emergency Preparedness Planning responsibilities or a new team/committee could report to the Safety Committee. 3. Share copy of CMS Rule with committee members. 4. Complete Facility Information/“Quick Look” Profile

Facility Name:

___________________________________________________________________

Facility Address:

___________________________________________________________________


Facility Longitude/Latitude Coordinates:

_______________________________________________ ___________________________

Facility Phone Number & Fax Number:

________________________________________________ __________________________

Facility Email & Website: _____________________________________________________

___________________________________________________________________________

Facility Emergency Cell Phone/Pager Numbers:

___________________________________________________________________________

Administrator & Contact Numbers:

___________________________________________________________________________

Maintenance Coordinator & Contact Numbers:

___________________________________________________________________________

___________________________________________________________________________

Director of Nursing & Contact Numbers:

___________________________________________________________________________

___________________________________________________________________________

Owners:

___________________________________________________________________________

Owner Phone Number & Fax Number:

___________________________________________________________________________

Owner Email & Website:

___________________________________________________________________________

Insurance Agent, Contact Number, Fax Number, E-mail, Website & Policy Number:

____________________________________________________________________________

____________________________________________________________________________

Number of Beds/Breakdown of Types of Beds:

____________________________________________________________________________

_____________________________________________________________________________

Number of Staff per Shift:

Day: ____________________ Evening: ______________________

Weekend Day: ____________ Weekend Evening: ______________

Number of Direct Care Staff per Shift:

Day: ____________________ Evening: ______________________

Weekend Day: ____________ Weekend Evening: ______________

Building Construction Type/Year Built: __________________________________________


Number of Stories: _________________ Number of Buildings: ____________________

Water System—Well q or City Water q Sewer System—Sewer q or Septic Tank q

Elevation of Facility: ____________________ Located in a Flood Hazard Area q Yes or q No

Fire Protection—Sprinkler System, q Yes or q No, Type: ___________________________

Fire Alarm System—Name of Monitoring Service, Website & Phone Number: ___________

_____________________________________________________________________________

Emergency Generator—q Yes or q No Location of Nearest Helicopter Landing Zone -Longitude/Latitude Coordinates:

__________________________________________________________________________

Fire Department Jurisdiction: _______________________ Telephone No: ______________

Police Jurisdiction: ________________________________ Telephone No: ______________

EMS Jurisdiction: _________________________________ Telephone No: ______________

County EM Agency Jurisdiction: _____________________ Telephone No: ______________

B. Mission The mission of ____________________________________ (facility name) in respect to

protecting the safety and well-being of the residents is to plan, prepare, and respond to

emergency situations and disaster scenarios; to ensure that casualties and property damage are

minimized; to restore normal operations; to assist other facilities that may be stricken by an

emergency situation or disaster scenario with available capabilities and resources; and to

coordinate all emergency activities with the _________________________________________

(county name) County Emergency Management agency, as well as with other local emergency

response agencies.

C. Purpose Purpose of this plan is to provide an All-Hazards approach to guide

___________________________ (facility name) in the event of an emergency, crisis, or disaster

scenario that would affect the safety and well-being of our residents, employees, as well as

community members stricken by the situation. The specific procedures for addressing various

emergencies are detailed in the Kentucky LTC Emergency Preparedness Manual and should be

used as a model for planning and implementation. The desired outcome is to protect and preserve

the residents, employees, and entity from such emergencies.

D. Executive Summary (Briefly describe specific information about the facility, including the characteristics and needs of the individuals for whom care is provided. See samples below and customize for

your facility.)


Sample 1: **XYX Facility is a 120-bed skilled nursing facility providing care and services to a medically complex population, including parental nutrition(intravenous nutrition), IV therapy, respiratory therapy services, wound care, and other rehabilitation services. The facility is certified for Medicare and Medicaid. Average occupancy is 118. Twenty beds are dedicated for the needs of residents with head traumas. The majority of those residents are under 40 years of age. Ten beds are dedicated to a unit for those residents dependent upon ventilators. The overall average age of the residents is 67 years old. A physician and nurse practitioner are employed by the facility to monitor medical care daily. Only 20 percent of the facility is ambulatory with or without devices. Sample 2: ABC facility is an 80-bed nursing facility providing long term nursing care and memory support for those residents with Alzheimer’s disease and other related dementias. The facility is completely private pay and operates at full occupancy. Forty of the beds are located in a secure unit with an electronic locking system. All of the residents residing on the secure unit are ambulatory with assistance. Fifty percent of the remaining residents are ambulatory with or without assistive devices. All residents are 65 years and older. The average age for the entire facility is 88 years old.

E. Applicability and Scope The Kentucky LTC Emergency Preparedness Manual should be applicable in all disaster and

emergency situations.

_________________________________________________ (facility name) has completed a

Hazard Vulnerability Assessment and has determined that the following are the significant

potential hazards to the safety and welfare of the residents and employees:

Top Three Hazards of ____________________________ (facility name)


The Kentucky LTC Emergency Preparedness Manual was developed within the scope of the following

legal authorities:

§ Federal Register, Centers for Medicare and Medicaid Services: Final Rule Emergency

Preparedness, 9/16/2016

https://www.federalregister.gov/documents/2016/09/16/2016-21404/medicare-and-medicaid-

programs-emergency-preparedness-requirements-for-medicare-and-medicaid

§ 2017-2022 Health Care and Response Capabilities, Office of the Asst. Secretary for Preparedness

and Response, 11/2016

https://www.phe.gov/preparedness/planning/hpp/reports/documents/2017-2022-healthcare-pr-

capablities.pdf

§ KY Operations Manual, Appendix PP - Guidance to Surveyors for Long Term Care Facilities see

http://www.globalaging.org/health/us/2005/unnecessary%20drug.pdf

§ https://www.cms.gov/Regulations-and-

Guidance/Guidance/Manuals/downloads/som107ap_pp_guidelines_ltcf.pdf

§ MS Provider Guidelines and Guidance: http://www.cms.hhs.gov/Emergency/

§ KY Revised Statutes Chapter 216B00: Rules for the Licensing of Nursing Homes:

http://www.lrc.ky.gov/KRS/216B00/CHAPTER.HTM

§ KY Revised Statutes Chapter 209, Adult Abuse, Neglect and Exploitation:

http://www.lrc.state.ky.us/KRS/209-00/Chapter.htm

• KY Revised Statues Chapters 39A-39F: KY Emergency Management:

http://www.lrc.ky.gov/Statutes/chapter.aspx?id=37202

§ Homeland Security Presidential Directive-5:

http://www.dhs.gov/xabout/laws/gc_1214592333605.shtm

http://www.dhs.gov/publication/homeland-security-presidential-directive-5

§ Emergency Support Function 8—Public Health and Medical Services, Department of Homeland

Security 42 CFR 483.70 & 483.75 (m): Medicare and Medicaid Requirements for Long Term

Care Facilities

§ Occupational Safety and Health Administration (OSHA) 29 CFR 1910.38

§ National Fire Protection Agency (NFPA) 101, Life Safety Code, NFPA 99, Chapter 11, Health

Care Emergency Preparedness

The plan also complies with the Centers for Medicare and Medicaid Services (CMS) Rule and

Regulations as well as elements of the National Incident Management System (NIMS) and Incident

Command System (ICS). Place copies of state or local emergency planning regulations or requirements

pertinent to this plan in this manual.


F. Record of Distribution The Kentucky LTC Emergency Preparedness Manual has been distributed to individual

administrative personnel and departments within the facility and corporation (if applicable), as

well as other relevant organizations, including but not limited to local emergency responders,

municipal, township, county, ombudsman program office and state agencies. Tracking

distribution help ensure the reliability, continuity, and security of this Plan. Use the following

chart to maintain a record of distribution.

Record of Distribution Individual Name/Facility Department/Outside Organization Date Distributed

G. Volunteer Assistance

If a disaster strikes a LTC facility, volunteers with various degrees of skills may be necessary to

provide continuity of care during Shelter-in-Place or evacuation situations. Consider the

following volunteer groups and how their skills and human resources might serve during an

emergency. Facility policies and procedures will include a system for utilizing volunteer

assistance.

Volunteer Type Potential Service

Facility specific who know residents, layout,

and or structure

Calming residents, serving food, delivering

blankets (examples)

Community citizens living adjacent to facility

Local Health Department Professional

State and/or Federal health care professionals


H. Developing Relationships and Partnerships with Emergency Resources ______________________________________ (facility name) acknowledges that it is essential

to identify, individuals, agencies, and organizations within the community that may be beneficial

during a crisis or disaster situation. The development of formal relationships and partnerships

may assist _________________________ (facility name) in the continuation of services or help

with the reinstatement of services following a crisis or disaster situation.

The following relationships have been developed by __________________________ (facility name).

Phone/Contact name Community Support

Medical Assistance Health clinics

Pharmaceutical—bulk supply suppliers

Local pharmacies

Medical supplies and equipment suppliers

School district administration

Transportation Private ambulance transport companies

Transportation agencies (bus services)

Taxi services

Rental car and truck services

Airport- shuttle service vans

Hotels/Motels: Vans

Individuals with four-wheel drive vehicles

Vendors Moving/storage companies/UHAUL trailers

Local grocery stores

Water service suppliers

Ice service suppliers

Food service suppliers

Sanitation companies

Portable toilet suppliers

Board-up services

Emergency construction/demolition services

Communication CB/HAM radio operators

Sheltering Options Other healthcare facilities—long term care Hospitals

Assisted living facilities

Churches

Schools/Universities near the facility

Large facility for temporary shelter


Transportation arrangements will be adequate and appropriate for the residents being served.

Agreements with transportation vendors and other suppliers/contractors identified in the facility

emergency plan that they have established the ability to fulfill their commitments in case of a

disaster affecting an entire area. See Section on Evacuation and Transportation.

I. Formalized Agreements and Contingencies ______________________________________ (facility name) has formalized the following agreements and emergency contingencies with alternate facilities and service providers during

the management of a crisis or disaster situation. Formalized agreements and contracts are to be

reviewed and updated at least annually. The following formalized agreements are included in the

Emergency Preparedness Plan. Add additional categories as needed.

Community Support

Water service supplier

Food service supplier

Ice service supplier

Pharmacy service supplier

Medical supply service supplier

Short term evacuation relocation site (temporary evacuation)

Long term evacuation facility (in same region)

Long term evacuation facility (at least 50 miles away)

CB/HAM radio operators

Ambulance transportation (private vendors)

General transportation (private vendors—bus service, taxi service)

Individuals with four-wheel drive vehicles

Hotels/Motels – vans

Airport – shuttle service vans

Moving service/U-HAUL trailers supplier

Emergency construction/demolition services


J. Coordinating with Local Emergency Responders and Resources ______________________________________ (facility name) has developed a working relationship with

______________________________________ (city or town name) emergency responders in

advance of a crisis or emergency situation. A good relationship with _____________________

(city or town name) local emergency responders and resources will be an asset during planning

for, response to, and recovery from a crisis or disaster situation. The development of such

relationships will help the facility better manage an event as well as allow local emergency

responders and resources to better coordinate the situation.

Working relationships have been developed with the following agencies (please check applicable

agencies and add additional agencies as needed):

Fire department

Law enforcement agency (whatever is applicable—municipal police, sheriff, state police, etc.)

Emergency medical services

Local emergency management agency

Local disaster task force

Local citizens corps

Local community emergency response team (CERT)

Local health department

Local flood control agency

Local utility companies

Regional Healthcare Preparedness Coordinator

Regional Public Health Emergency Preparedness Coordinator

Regional Health Care Coalitions

Other

A copy of all agreements currently in place at the facility should be maintained and regularly

updated. See information on Agreements/Mutual Aid.

K. Coordinating with the County Emergency Plan and Regional Health Care Coalitions ______________________________________ (facility name) has established and will maintain

an ongoing relationship with the ______________________________________ (county name)

County Emergency Management Office in order to keep abreast of the resources the county can

and will provide in a crisis or disaster situation. It is equally important for the County to

understand the emergency preparedness needs of the facility.

______________________________________ (facility name) will consider the following points

regarding its coordination with the ______________________________________ (county name) County Emergency Plan:

• Obtaining copies of the ______________________________________ (county name)

County Emergency Plan and becoming familiar with the document in order to understand

what services are available and what actions are expected of the facility during a crisis or

disaster situation.


• Keeping abreast of changes in the County plan. • Inviting appropriate ______________________________________ (county name)

County Emergency Management personnel to visit and assess the facility to help identify

ways to prepare for crisis or disaster situations. • Arranging to have the facility represented on communication lists that will inform the

community of emergency plans and directives. • Participating in ______________________________________ Regional Health Care

Coalition meetings to participate in community-wide assessment and understand regional

plans regarding emergency provisions of food, water, medicines, and necessary supplies

during a crisis or disaster situation that may last for several days. • Participating in ______________________________________ (county name) County

training, exercises, drills, and simulations of a crisis or disaster situation to become

familiar with its policies and procedures.

• Cooperate and collaborate with local, tribal, regional, State, or Federal Emergency

Preparedness officials in order maintain an integrated response during a disaster or

emergency situation. Document any attempts to collaborate, including name of

personnel, date, and method of contact.

L. Kentucky Regional Health Care Coalitions In 2003, the Hospital Preparedness Program (HPP) was funded by the Department of Health and

Human Services, Assistant Secretary for Preparedness and Response through the KY Department

for Public Health to enhance the ability of hospitals and health care systems to prepare for and

respond to bioterrorism and other public health emergencies.

Current program priority areas include:

• bed tracking

• fatality management planning

• healthcare evacuation planning

• interoperable communication systems

• medical surge

• personnel management

Hospital Preparedness Program funds have increased bed and personnel surge capacity,

decontamination capabilities, isolation capacity, pharmaceutical supplies, and supported training,

education, and exercises. The KY Hospital Association manages the Hospital Preparedness

Program, now called the Health Care Preparedness Program.

Responsibilities of the Health Care Preparedness Program include working with the 15

established Health Care Coalitions (HCC) located throughout the Commonwealth. Each coalition

consists of representatives from hospitals, emergency medical services, local health departments,

emergency management, mental health, long term care facilities, and other organizations. Each

region receives funding through the Health Care Preparedness Program to 1) purchase equipment

and supplies and 2) to provide training and exercises to ensure that the community is prepared in

the event of a disaster.


M. Community-Based Risk Assessment Individual long term care facilities partner with community organizations to complete a

community-based risk assessment. This assessment compliments the facility-based risk

assessment, and ensures that partnerships are forged in planning for an emergency or disaster

situation. N. Long-Term-Care Subcommittees

In 2008, an effort was initiated to encourage all long-term care facilities to participate in the

emergency planning process. Long Term Care Subcommittees, open to all LTC providers in

Kentucky, were formed in many of the 15 health care coalition regions. Representatives from

these Subcommittees meet regularly with the Health Care Coalitions to bring long-term care

issues to the table.

LTC needs are reflected in the regional plans of the Health Care Coalitions. LTC facilities

qualify to receive funds, 1) by documenting completion of the National Incident Command

System training modules and 2) by participating in their region’s LTC Subcommittee and/or

HCC meeting.

The National Incident Command System training, accessible through the Kentucky Emergency

Preparedness for Aging and LTC website, https://kyaging-ltcpreparedness.louisville.edu/nims-

ics/ is essential for understanding the terminology and structure of disaster response efforts.

See NIMS/ICS Section.

Funding through and participation in the Health Care Coalitions can greatly enhance the ability

of long term care facilities to prepare for and respond to disasters.

See map inserted on next page


HPP/HPC Regional Coordinators (As of August 2018)

Region 1: Thomas Hales, Purchase Dist Health Department, PO Box 2357

916 Kentucky Ave. (42003), Paducah, KY 42002-2357, 270/444-9625, Ext. 175

[email protected]

Region 2: Raymond Giannini, Caldwell Co. EM/EMS, 102 Northfield Dr. Princeton KY 42445,

270/963-1052 (cell), [email protected]

Region 3: Jeff Rascoe, Green River District Health Department, 1501 Breckenridge Street,

Owensboro KY 42303, 270/686-7747 Ext 3062, [email protected]

Region 4: Janarae S Conway, Barren River District Health Department, 1109 State Street,

Bowling Green KY 42420, 270/781-8039, [email protected]

Region 5: Fred Singleton, Lincoln Trail District Health Department, 108 New Glendale Road,

Elizabethtown, KY 42702. 270/769-1601, [email protected]

Region 6: Amanda Hunter, Louisville Metro Health Department, 400 East Gray Street

Louisville, KY 40202, 502/574-6859 [email protected]

Region 7: Jessica McElroy, Northern KY Health District, 610 Medical Village Drive

Edgewood, KY 41017, 859/363-2009, [email protected]

Region 8/9: Jacquelyn Campbell, Gateway District Health Department, PO Box 555,

42 Treadway, Owingsville, KY 40360, 606/674-6396, [email protected]

Region 10/11: Gina M. Porter, Floyd Co. Health Department, 283 Goble St., Prestonsburg, KY

41653, 606/886-2788, Ext 242, [email protected]

Region 12: Cory Waddell, Knott County Health Department, 880 West Main Street, Hindman,

KY 41822, 606/785-3144, [email protected]

Region 13: Lonnie T. Saylor, Bell County Health Department, 310 Cherry Street, Pineville, KY

40977, 606/337-7046 Ext 236, 606/273-4506, [email protected]

Region 14: Amy Tomlinson, Lake Cumberland District Health Department, 500 Bourne Ave.,

Somerset, KY 42501, 606/678-4761 Ext 1148, [email protected]

Region 15: Barrett Shoeck, Lexington-Fayette Co Health Department, 650 Newtown, 2nd

floor, Lexington, KY 40508, 859/899-4236, [email protected]


IV. Operations Planning

A. Employee List Insert a current list of employees, including phone and backup phone numbers. Update as

needed, at least quarterly.

B. Organizational Chart The following is a snapshot of the daily operation and levels of authority within

___________________________ (facility name). The organizational chart will also serve as a

recall roster/call structure, and should be updated regularly.

(See Chart on Following Page)


Insert Facility Organizational Chart here

(Sample)

http://www.fhca.org/emerprep/orgchartblank.pdf


C. Decision Making Authority/Chain of Command

Every person participating in the incident has a designated supervisor. There is a clear line of

authority within the incident command organization, and all lower levels connect to higher

levels, eventually leading back to the Incident Commander. The Chain of Command follows an

established organizational structure that adds layers of command as needed. The basic outline of

command layers are command, sections, branches, divisions/groups, units, resources.

D. Succession of Command __________________________________________ (facility name) has developed the following list

of key personnel, based on job title, to identify the order of succession of command. The

Succession of Command structure considers the facility’s ability to manage and direct an

emergency situation during normal hours of operation as well as during hours when key

administrative staff may not be at the facility (evening and overnight shifts.)

Succession of Command 1. Name: _____________________________________________________________________________

Job Title: __________________________________________________________________________

Contact Information: _________________________________________________________________

__________________________________________________________________________________

2. Name: _____________________________________________________________________________

Job Title: __________________________________________________________________________


3. Name: _____________________________________________________________________________

Job Title: __________________________________________________________________________


4. Name: _____________________________________________________________________________

Job Title: __________________________________________________________________________


__________________________________________________________________________________


E. Resident Needs/Profile (name/position) will be responsible for insuring

that all residents have a current Emergency Information Profile including a photo which is

updated annually. Depending on the level of care, residents will be identified by an arm-band or

instructed to keep a photo ID on their person at all times during an emergency. A template on the

following page may be used as a sample resident identification profile.

RESIDENT EMERGENCY PROFILE

Resident Name: AKA:

DOB: HT: WT: MALE/FEMALE

Assistive Devices Used (circle all that apply): Dentures partial or full

Cane

Walker

Wheelchair

Eyeglasses

Hearing aid

Oxygen Indicate concentration: _______

Continued on next page

Resident

Current Photo


Emergency Contact Information

Name: Relationship:

Address: Phone:

Physician Name:

Address: Phone:

Pertinent Medical Conditions:

Medications: Name: Dosage: Frequency:

Name: Dosage: Frequency:






Allergies:

Medical Devices: ________________________

Insurances:

Date: Completed by

Pet: Name: Age:


F. Resident Tracking System

During a disaster/emergency situation a list of all residents and their locations will be developed

and updated by: (name/position) and kept at:

(location).

Admission and Discharge Protocols

In the event that the facility needs to discharge residents or accommodate displaced residents, or

discharges from hospitals (name/position) will be

responsible for reviewing a roster of current residents and developing a list of those who are

appropriate for discharge.

Discharge criteria:

1.

2.

3.

4.

5.

G. Facility Services Provided to Residents

List all services provided to residents in keeping with emergency protocols. These could include

occupational therapy, physical therapy, mental health/psychological first aid, spiritual services,

social/behavioral supports.

1.

2.

3.

4.

5.


V. Hazard Vulnerability Analysis – All Hazards Approach

A. Hazard Vulnerability Analysis (HVA) __________________________________________ (facility name) should conduct a thorough Hazard Vulnerability Analysis (HVA) to 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 HVA Risk Assessment should be updated at least annually. We recommend that __________________________________________ (facility name) use the HVA quantitative tool developed by the American Society of Healthcare Engineering (ASHE) of the American Hospital Association (©2001). The HVA uses a rating system for the probability, risk, and preparedness for various hazards and situations. If a LTC facility is part of an integrated healthcare system (such as a hospital) the facility must develop a separate HVA based on the unique needs of the resident population, and be prepared to carry out the plan, as developed, for the LTC facility. Furthermore, the facility should take part in the development of the integrated healthcare system preparedness plan, including testing and training of the plan in accordance with the needs of LTC facility residents, staff and volunteers. Assumptions: For the purpose of this Kentucky LTC Emergency Preparedness Manual, it is assumed that the following threats may impact facilities:

§ Bomb Threat § Fire/Explosion § Flood § Forest Fires § Ice Storm § Internal Hazardous Materials Spill/Leak § Law Enforcement Activity § Missing Resident (Elopement) § Pandemic Episode § Power Failure/Utility Disruption § Suspicious Mail/Packages § Tornado/Hurricane/Severe Weather § Wildland Fires § Unknown Acts of Terrorism § Workplace Violence/Security Threat/Active Shooter

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.


___________________________ (facility name) should utilize a HVA to determine hazards and vulnerabilities for its County and surrounding areas.

Membership in one of Kentucky’s 13 Regional Health Care Coalitions is essential for conducting a Community-based Risk Assessment. A Community-based Risk Assessment is an assessment developed outside the facility with community partners, not an individual facility’s assessment of their community. The _______________________ (county name) County Emergency Management Coordinator will be contacted for guidance and assistance in determining the hazards and vulnerabilities for the facility. The following tool can aid in completing the Hazard Vulnerability Analysis, as it takes into consideration the proximity that __________________________________________ (facility name) is within specific probable hazardous areas. (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.)

Geographic Hazardous Areas/Relates to Hazard 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 adjacent operation posing a threat:

Any operation in the general area posing a threat:

Instructions to Complete the Hazard Vulnerability Analysis (HVA) 1. Evaluate every potential event in each of the categories for probability, risk, and

preparedness. Add events as necessary. Probability: Evaluate each event as the likelihood of it occurring. Issues to consider in determining probability are:

§ Known risk § Historical data § Manufacturer/vendor statistics

Risk: Evaluate the potential impact that any given hazard may have on the facility. Issues to consider are:

§ Threat to life and/or health § Disruption of services § Damage/failure possibilities § Loss of community trust § Financial impact § Legal issues

Preparedness: Evaluate the current level of preparedness to manage each disaster. Issues to consider are:

§ Status of current plans § Training status § Insurance § Availability of backup systems § Community resources

2. Multiply the ratings for each event in the area of probability, risk, and preparedness to give a total score for each hazard. A hazard that does not have a probability of occurring is scored zero and will result in a zero for the total score.

3. List the hazards in descending order of the total scores will prioritize the hazards most in need of attention and resources for emergency planning.

_________________________ (Facility) will evaluate the final prioritization and determine a cutoff value, where no action will be taken for particular hazards. There will be some risk associated with low priority hazards.


The HVA should be updated at least annually. Once risks are identified, the next step of the planning process it to determine strategies for addressing emergency events.

B. Kaiser Permanente HVA Tool Kaiser Permanente has developed a revised Hazard Vulnerability Analysis tool and instruction sheet. Available as a planning resource only; if sharing publicly please credit Kaiser Permanente. This tool is not meant for commercial use. It is accessible at the following link: http://www.calhospitalprepare.org/hazard-vulnerability-analysis


Hazards - Enter name of LTC Hazard and Vulnerability Assessment Tool Naturally Occurring Events

Event

SEVERITY = ( MAGNITUDE - MITGATION )

PROBABILITY ALERTS ACTIVATIONS HUMAN IMPACT

PROPERTY IMPACT

BUSINESS IMPACT

PREPARED- NESS

INTERNAL RESPONSE

EXTERNAL RESPONSE

RISK

Likelihood this will occur

Possibility of death or injury

Physical losses and damages

Interruption of services

Preplanning Time, effectiveness, resources

Community/Mutual Aid staff and supplies

* Relative threat

SCORE

0 = N/A 1 = Low 2 = Moderate 3 = High

Number of Alerts

Number of Activations




0 = N/A 1 = High 2 = Moderate 3 = Low

0 = N/A 1 = High 2 = Moderate 3 = Low

0 = N/A 1 =High 2 = Moderate 3 = Low

0 - 100%

Rank Alert Type

Flood

Flood Earthquake

Earthquake

Karst/Sinkhole

Karst/Sinkhole Mine/Land Subsidence

Mine/Land Subsidence

Landslide

Landslide Dam Failure

Dam Failure

Forest fire

Forest fire Drought

Drought

Extreme Temperature

Extreme Temperature Hail Storm

Hail Storm

Severe Storm

Severe Storm Severe Winter Storm

Severe Winter Storm

Tornado

Tornado Hazmat

Hazmat

Epidemic

Epidemic

B. Kaiser Permanente HVA Tool Emergency Management


Using the Disaster Templates

The following twenty-one (21) templates are alphabetically arranged by disaster or

emergency situations. The purpose of the templates is to provide staff clear action

steps to take based on the particular disaster or emergency situation. Although

some actions may be common among all disaster situations, particular roles and

responsibilities evolve as an emergency develops.

The templates are organized identically by:

• Definition – details about a specific disaster or warning signs

• Immediate Action – for staff to take at the onset of a disaster

• General Staff Assignments – that apply to all staff members

• Specific Staff Assignments – that indicate action steps for individuals with

particular staff assignments based on their role within the LTC Facility

• Preparing Ahead/Training – provides training opportunities and facility

updates or precautions to take before an emergency occurs

• See Also – refers to sections of the manual that include related information

• Resources – provide links to agencies and entities that share additional

perspectives or experience in facing the particular type of emergency

situation identified in the disaster template.


Defined: An active shooter is an individual actively engaged in killing, or

attempting to kill people, in a confined and populated area, typically through the

use of firearms.

Immediate Action: “Run, Hide, Fight.”

General Staff Assignments: A. While personal safety is the primary consideration in any emergency,

helping others to safety increases the survivability for all potential victims.

Rendering aid can be as simple as rallying likely victims to “Follow me!” or

aiding non-ambulatory persons and performing immediate first aid in safer

areas. Consideration should be given to residents who have difficulty

evacuating without assistance.

B. Active shooter incidents are unpredictable and evolve quickly. Because of

this, individuals must be prepared to deal with an active shooter incident

before law enforcement personnel arrive on the scene. Shooters generally

arrive with more ammunition than they could ever use, increasing the

urgency for everyone to have a plan and act on it as quickly as possible.

C. When an incident occurs, follow the emergency plans and any instructions

given, taking into consideration their particular circumstances. The safety

of residents, other staff, visitors, and vendors is the most important factor

to consider when making decisions.

D. Staff closest to the public address or other communications system should

communicate the danger and necessary action.

E. As the situation develops, it is possible that those present will need to use

more than one option. While they should follow the “Run, Hide, Fight” plan

and any instructions given by appropriate facility representatives during an

incident, they will often have to rely on their own judgment to decide which

option will best protect lives.

Disaster Template #1

ACTIVE SHOOTER

Code: Silver


Run – Best option A. Run out of the facility or away from the area under attack and move as far away

as possible until in a safe location. Simply exiting the building and going to an

evacuation site via practiced fire drill routes may put individuals at risk.

B. Recent research shows the best method to reduce loss of life in an active

shooter incident is for people to immediately evacuate or be evacuated from the

area where an active shooter may be located or attempting to enter.

C. Leave personal items behind.

D. Visualize possible escape routes, including physically accessible routes for

residents, visitors, or staff with disabilities and others with access and

functional needs.

E. Avoid escalators and elevators.

F. Take others if possible, but do not stay behind because others will not go.

G. Call 911 when safe to do so.

Call 911 to Report:

A. Location and description of attackers.

B. Types of weapons, methods and direction of attack, and flight of attackers.

C. Don’t assume that someone else has called.

Hide – if Exits are Inaccessible

A. If running is not a safe option, hide in a safe space with thick walls and few

windows. For residents who cannot “run” because of mobility issues (e.g., they

are unable to leave their bed) hiding may be their only option.

B. Lock the doors.

C. Barricade doors with heavy furniture or wedge items under the door.

D. Secure the unit entrance(s) by locking the doors and/or securing the doors by

any means available (e.g., furniture, cabinets, bed, and equipment).

E. Close and lock windows and close blinds or cover windows.

F. Turn off lights.

G. Silence all electronic devices.

H. Remain silent.

I. Look for other avenues of escape.

J. Identify items (fire extinguishers, chairs, lamps) that could be used as weapons.

Communicate Nonverbally with First Responders


In rooms with exterior windows, make signs to silently signal law enforcement and

emergency responders to indicate the status of the room’s occupants).

A. Hide along the wall closest to the exit but out of view from the hallway (which

would allow the best option for ambushing the shooter and for possible escape

if the shooter enters or passes by the room).

B. Remain in place until given an all clear by identifiable law enforcement.

Fight – If Running and Hiding aren’t Options A. Disrupt or incapacitate the shooter by using aggressive force and items in their

environment, such as fire extinguishers, chairs, etc.

B. Research shows the strength in numbers; potential victims themselves disrupted

17 of 51 active shooter incidents before law enforcement arrived.

Interacting with First Responders Police officers, firefighters, and EMS personnel (i.e., first responders) who come

to the facility because of a 911 call involving gunfire face a daunting task. Though

the objective remains the same—protect residents, visitors, vendors and staff—the

threat of an active shooter incident is different than responding to a natural

disaster or many other emergencies. Information coming in can be inaccurate and

conflicting. This violence might be directed not only in or at facilities, staff,

residents, visitors and vendors, but also at nearby buildings off site.

Law enforcement’s first priority is to locate and stop the person or persons

believed to be the shooter(s); all other actions are secondary.

A. Do not interfere with the law enforcement response.

B. Follow directions and display empty hands with open palms.

C. Law enforcement may instruct everyone to get on the ground, place their hands

on their heads

D. Individuals may be searched. Don’t resist.

Specific Staff Assignments/following the active shooter situation: After the active shooter has been incapacitated, management should engage in

post-event assessments and activities:

A. Account for all individuals at one or more designated assembly points to

determine who, if anyone, is missing or potentially injured.


B. Coordinate with first responders to account for any residents, visitors, vendors

and staff who were not evacuated.

C. Determine the best methods for notifying families of individuals affected by

the active shooter, including notification of any casualties; this must be done in

coordination with law enforcement.

D. Assess the behavioral health of individuals at the scene. Provide information to

victims, victim families, staff and others about distress helplines, Office for

Victims of Crimes counselors or employee assistance personnel (EAP).

Substantial resources and processes are in place to aid victims and their

families, most notably through state agencies, the Department of Justice, and

the FBI’s Office for Victim Assistance.

E. Ensure equal access to all such resources and programs for people who are

deaf, hard of hearing, blind, have low vision, low literacy and other

communication disabilities and individuals with limited English proficiency.

F. Activate a staff family unification plan, communicating this to staff and

providing a safe place, away from press for families to gather.

G. Identify and fill any critical personnel or operational gaps left in the

organization as a result of the active shooter.

H. Determine when to resume full services.

I. Nothing should be touched unless it involves tending to the wounded. The

situation and the location are an active crime scene.

J. Plan for an extended, evolving situation and the mass casualty or internal

disaster plan to be activated to manage the continuing situation. This may

include altering daily activities in order for law enforcement and first

responders to adequately investigate and clear the scene.

Preparing Ahead/Training: K. Train staff, appropriate residents, and volunteers the “Run, Hide, Fight”

response.

L. Train staff to overcome denial and to respond immediately. For example, train

staff to recognize the sounds of danger, act, and forcefully communicate the

danger and necessary action (e.g., “Gun! Get out!”).

M. Repetition in training and preparedness shortens the time it takes to orient,

observe, and act.


N. Training provides the means to regain composure, recall at least some of what

has been learned, and commit to action. Training to “Run, Hide, or Fight”

prevents inaction.

O. In many instances, an individual might first need to hide and then run to safety

when able.

P. It is not uncommon for people confronted with a threat to first deny the possible

danger rather than respond, hearing firecrackers when, in fact, they are hearing

gunfire. Q. Speaking with staff about confronting a shooter may be daunting and

upsetting for some people, but great comfort can come from the knowledge

that their actions could save lives. To be clear, confronting an active shooter

should never be a requirement of any health care provider’s job; how each

individual chooses to respond if directly confronted by an active shooter is up

to him or her.

See Also: Kentucky Community Crisis Response Board (KCCRB), Mental

Health Resources, Psychological First Aid, Workplace Violence

Resources: Information taken from “Incorporating Active Shooter Incident Planning into Health Care Facility

Emergency Operations Plans”, U.S. Department of Health and Human Services, U.S. Department of

Homeland Security, U.S. Department of Justice, Federal Bureau of Investigation Federal Emergency

Management Agency, 2014. Access at http://www.phe.gov/HCF-Plans/Pages/default.aspx

Other Active Shooter resources include:

http://www.activeshooter.lasd.org/

The Los Angeles County Sheriff's Department created this video to help people answer the question

"What would you do?" in the event of a sudden attack by a gunman while at work, at school, or in public.

The video contains graphic content of a violent nature. Viewer discretion is advised.

Access a free webinar, “The Active Shooter in Long Term Care and Assisted Living Communities.” (1

hour, 29 minutes) at https://www.youtube.com/watch?v=HgDeTFLZMPU This webinar was

produced by the Stanford Geriatric Education Center.

The MESH Coalition (Managed Emergency Surge for Healthcare), based in Indianapolis, IN has a

training video: http://vimeo.com/meshcoalition/review/108575641/dd69fdb233


Defined: The U.S. Dept. of Homeland Security reports that “bomb threats are

most commonly received via phone, but are also made in person, via email, written

note, or other means. Every bomb threat is unique and should be handled in the

context of the facility or environment in which it occurs. Facility supervisors and

law enforcement will be in the best position to determine the credibility of the

threat.” Immediate Action: Treat all bomb threats as serious dangers, even though

many prove to be false. Begin filling out the Bomb Threat Telephone Procedure Form as soon as the call is identified as a threat.

General Staff Assignments: A. If telephone threats or warnings about bombs in the facility are received.

Individuals should try to keep the caller on the phone as long as possible by

asking the questions outlined in the Bomb Threat Telephone Procedure Form.

B. Keep a copy of the Bomb Threat Telephone Procedure Form within reach of

the person answering the general facility phone line.

• If the caller does not give the location of the bomb or possible detonation

time, the person receiving the call should ask the caller to provide this

information.

• Do not hang up, even if the caller does.

• It may be helpful to inform the caller that the building is occupied and that a

bomb exploding could kill or seriously injure many innocent people.

Disaster Template #2 (A/B)

BOMB THREAT (2A) Code: Black


Bomb Threat Telephone Procedure Form Bomb Threat Telephone Procedure Form adapted from Bomb Threat Call Procedures, Dept. of Homeland Security

1. LISTEN - Keep on the phone for as long as possible

2. DO NOT interrupt caller except to ask questions below

3. Call 911 - as soon as possible while on the line, or immediately after.

4. DO NOT CALL the BOMB SQUAD

Person receiving call: _______________________ Phone # call was received on: (____) __________

Date: _________Time Call Received: _______am/pm End of Call: ______am/pm

EXACT WORDING OF THREAT: __________________________________________________________________

__________________________________________________________________

Ask the caller to repeat the message (rewrite it):

__________________________________________________________________

1. When will the bomb go off? ________________________________________

2. Time remaining? _________________________________________________

3. Where is the bomb located right now? ________________________________

4. What kind of bomb is it? __________________________________________

5. What does the bomb look like? _____________________________________

6. What will cause it to explode? ______________________________________

7. Is there more than one bomb? How many? ____________________________

8. Did you place the bomb? _________Why? ___________________________

9. Where are you calling from? _______________________________________

10. What is your name? _____________________________________________

11. What is your address? ____________________________________________


CALLER’S IDENTITY/CHARACTERISTICS

Gender: � Male �Female � Unsure

Approximate Age: _____________

Is the caller’s voice familiar to you?

________________________________________

Voice Characteristics

�Loud � Soft

� High pitch � Deep

� Raspy � Pleasant

� Intoxicated � Distinct

� Nasal � Foul

� Fast � Excellent

� Slow � Good

Diction: � Stutter � Fair

� Slurred � Poor

� Good � Nasal

� Lisp

Origin of Call

� Local � Long distance

� Caller ID shown _____________

� Internal (from within building)

Accent

� Local � Not Local

� Regional � Foreign Country

Language � Angry � Calm

� Message Read � Taped

� Foul Language � Well-spoken

� Irrational/not logical

� Incoherent/unclear

Background Sounds

� Quiet � Voices

� Music � Animals

� Mixed � Party

� Airplanes � Trains

� PA � Radio/TV

� Office machines � Factory machines

� Street traffic � Cafe

� Glassware � Chaos

� Household appliances

� Weather: Rain/Thunder

� Other (Please specify :)

Other Aspects of Voice/personality/questions or

communication style that may help identify this

individual

________________________________________

________________________________________

________________________________________

Does caller seem familiar with building by

description of bomb location?

� Much � Some � None

Describe:________________________________

Was the caller familiar with the general

location/area?

� Much � Some � None

Describe:

________________________________________

Local Health Dept. notified: Time:_________am/pm By: ________________

Time this form completed: ___________am/pm By: _________________________________

KY LTC Emergency Preparedness Manual-University of Louisville Kentucky Emergency Preparedness for Aging & LTC Program 72

C. Notify:

1. Administrator and/or the highest-ranking staff member on duty (Incident

Commander), will activate the Incident Command System (ICS)

Time: ____am/pm By: _________________

2. Police Department or local law enforcement (call 911)

Time: _____am/pm By: ____________________

D. If staff member(s) receive written threats or warnings about bombs notify:

1. Administrator and/or the highest-ranking staff member on duty

2. Police Department or local law enforcement (call 911)

Specific Staff Assignments: A. Activate the Incident Command System (ICS). The most qualified staff member

(in regard to the Incident Command System) on duty at the time will assume the

Incident Commander position. If severity of incident warrants, then appoint

other positions of ICS structure.

B. Facility management staff report to the Incident Command Post for a briefing

and instruction.

C. Be prepared to activate Evacuation Procedures.

D. Activate recall roster, if necessary.

E. Administrator or Incident Commander instructs staff members to discreetly and

quietly conduct a thorough search of their respective areas and departments.

1. If caller mentions a location for the device, staff will be instructed to search that

location first.

2. If the bomb threat is not for a specific area or floor, the (insert job/IC title) in

each area of the facility shall assign personnel to begin the search of the

entire facility.

3. If the bomb threat occurs during a time when personnel on duty are limited,

the facility Incident Commander will assign which staff to search which

areas.

4. Staff members look for any unusual or extraneous items, such as boxes,

packages, bags, etc.

5. If any unusual item is found, staff members are not to disturb it.

6. Residents should NOT be involved in the search.

7. Staff should remain calm to not upset the residents.


F. Do not approach or touch a suspicious package/device and immediately

evacuate everyone from such discoveries and report all findings to the

Administrator or Incident Commander.

G. Coordinate all actions with law enforcement officials.

1. Assign a staff member to meet the responding agency at (location,

example: front entrance) and direct/escort to facility Incident

Command Center.

2. If a suspected bomb is located within the building, the responsibility

for investigation will be that of the law enforcement officials having

jurisdiction over such matters.

3. Establish contact with the officer in charge and relay all relevant

information regarding the situation.

4. Provide keys for complete facility access (public and private spaces

including staff lockers)

5. Administrator or designee remains with Search Commander during

search to provide assistance and counsel

6. Should be responsible for making the decision regarding evacuation,

which would be activate via Evacuation Emergency Procedures.

7. Ensure staff members and residents are accounted for and safe.

8. Ask visitors to leave the premises.

H. Do NOT turn on/off lights or other electrical equipment – use flashlights if

necessary.

I. Do NOT use 2-way radios, cell phones, or other cellular/transmitting

equipment.

J. Do NOT TOUCH OR MOVE anything unusual or suspicious. If anything

suspicious or unusual is discovered, staff are to contact the Incident Command

Center and clear the area immediately of all residents, staff, and wait for

instructions.

K. LOOK for anything you cannot IMMEDIATELY identify or that appears to be

unusual or out of place. The device may/may not be labeled “bomb” or

“danger.”

L. The responding agency will provide direction to the facility Incident Command

Center Officer dependent upon the scenario:

1. A bomb has been found.

2. A bomb has not been found, but the threat remains credible.

3. The threat is declared to be unfounded.


M. Only the responding agency can declare an “All Clear.”

1. Based on directives from the responding agency, the facility Incident

Command Center will then communicate the appropriate message(s)

to staff.

Preparing Ahead/Training:

• Train all staff on the Bomb Threat Procedure

• Teach staff members who normally receive telephone calls from the general

public the Bomb Threat Telephone Procedure

It is recommended that a report be made to OIG, local Emergency management, local Public Health

Department, KCHFS Adult Services Division, KY Association of Health Care Facilities and/or

LeadingAge KY and other agencies as directed by facility policy.

Although this template checklist and policy has been developed and reviewed by topic experts, this

template is not intended to provide legal advice. The information contained in this checklist and policy is

information only to assist the facility in developing emergency response polices and plans based on the

uniqueness of each facility.

It is recommended that the facility define specifically the time-frame for words such as “immediately,”

and “periodically,” etc. The time-frame for these words may differ with each policy. For example, in one

policy instead of using “periodically,” the facility may use “quarterly;” in another policy, instead of using

“periodically,” the facility may use “monthly.”

See also: Evacuation, Suspicious Package


Defined: Packages and letters that may contain explosives or chemical or

biological agents.

Immediate Action: Identify typical characteristics (identified by postal

inspectors) which ought to trigger suspicion, including parcels that:

A. Are unexpected or from someone unfamiliar to you

B. Have no return address, or have one that can’t be verified as legitimate

C. Have protruding wires or aluminum foil, strange odors, or stains

D. Show a city or state in the postmark that doesn’t match the return address

E. Are of unusual weight given their size, or are lopsided or oddly shaped

F. Are marked with threatening language

G. Have inappropriate or unusual labeling

H. Have excessive postage or packaging material, (masking tape and string)

I. Have misspellings of common words

J. Are addressed to someone no longer with your organization or otherwise

outdated

K. Have incorrect titles or titles without a name

L. Are not addressed to a specific person

M. Have hand-written or poorly typed addresses

General Staff Assignments: § Be particularly cautious in the mail handling area and refrain from eating or

drinking in that area.

§ Do not open any mail item that appears suspicious.

§ Isolate the suspicious mail item and place it in a plastic bag or container and

seal it.

§ If you do not have a bag or container, then cover the mail item with anything

(e.g. clothing, paper, trash can, etc.) and do not remove this cover.


SUSPICIOUS PACKAGE (2B) Code: Black


§ Ensure that all persons who have touched the mail item wash their hands

with soap and water.

§ Activate your emergency plan and notify a supervisor.

§ Preparing Ahead/Training: • Train staff and volunteers who handle mail about characteristics of

suspicious packages.

• Post list of characteristics of suspicious packages in mail room.

See also: Bomb Threat, Evacuation


Defined: According to the U.S. Geological Survey, “Earthquake is a term used to

describe both sudden slip on a fault, and the resulting ground shaking and radiated

seismic energy caused by the slip, or by volcanic or magmatic activity, or other

sudden stress changes in the earth.”

Immediate Action:

1. Drop where you are, onto your hands and knees. This position protects you

from being knocked down and also allows you to stay low and crawl to

shelter if nearby.

2. Cover your head and neck with one arm and hand

• If sturdy table or desk is nearby, crawl underneath for shelter

• If no shelter is nearby, crawl next to an interior wall away from

windows

• Stay on your knees; bend over to protect vital organs

3. Hold on until shaking stops

Under shelter: hold on to it with one hand; be ready to move with your

shelter if it shifts

• No shelter: hold on to your head and neck with both arms and hands.

Information taken from -- http://www.shakeout.org/dropcoverholdon/

Common Staff Assignments: A. Inspect the facility for potential fire. Evacuate if building is not safe using

RACE system.

R: RESCUE – Rescue residents in immediate danger.

A: ALARM – Sound nearest alarm if not already activated.


EARTHQUAKE Code: Plain Speech/Text


C: CONFINE – Close doors behind you to confine the fire. Crawl low if the exit

route is blocked by smoke.

E: EXTINGUISH – Utilize fire extinguisher as situation permits or

evacuate following evacuation procedures.

Specific Staff Assignments:

A. Activate the Incident Command System (ICS). The most qualified staff member

(in regard to the Incident Command System) on duty at the time will assume the

Incident Commander position. If severity of incident warrants, then appoint

other positions of ICS structure.

B. Facility management staff report to the Incident Command Post for a briefing

and instruction.

C. Put out small fires quickly. If not handled by one extinguisher, or it is larger

than a wastepaper basket, evacuate the building.

D. Check on residents, staff and visitors. Check restrooms or vacant rooms for

visitors or stranded residents.

E. Take care of injured or trapped persons. Provide medical treatment as

appropriate. Call 9-1-1 only for life-threatening emergencies.

F. Turn off gas only if you smell gas or think it may be leaking. (Natural gas line

cannot be turned on again except by the gas company.) Alert the local Fire

Department.

G. Be prepared for after-shocks and re-evaluate building safety after additional

seismic activities.

H. Help injured or trapped persons until emergency assistance arrives.

I. Give first aid where appropriate. Do not move seriously injured persons unless

they are in immediate danger of further injury. Call for help.

J. Listen to a battery-operated radio or television for latest emergency information.

K. Use the telephone only for emergency calls.

L. Stay away from damaged areas

M. Unless police, fire, or relief organizations have specifically requested your

assistance, stay away from damaged areas. Return to the facility only when

authorities say it is safe.

N. Open cabinets cautiously. Beware of objects that can fall off shelves.

O. Clean up spilled medicines, bleaches, gasoline or other flammable liquids

immediately. Leave the area if you smell gas or fumes from other chemicals.

P. Inspect utilities

Q. Check for gas leaks. If you smell gas or hear blowing or hissing noise, start

evacuation procedures quickly. Turn off the gas at the outside main valve if you

can.


R. Look for electrical system damage. If you see sparks, broken or frayed wires, or

smell hot insulation, turn off the electricity at the main fuse box or circuit

breaker. Begin evaluation procedures.

S. 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.

T. Inspect the entire length of chimneys for damage.

Expect aftershocks. These secondary shockwaves are usually less violent than the main quake but can

be strong enough to do additional damage to weakened structures and can occur in

the first hours, days, weeks, or months after the quake.


A. Evaluate the facility for potential dangers and fix the problems.

B. Remove potential fire hazards

C. Secure furniture or equipment/appliances to the wall (may fall and cause

injuries)

D. Store large and/or heavy items low to the ground

E. Repair any deep cracks in walls, ceilings or foundation of building

F. Bolt and strap the water heater to the wall and ground

G. Affix pictures and/or mirrors securely

H. Brace overhead light fixtures

I. Train and exercise on “Drop, Cover and Hold.”

J. See website, http://www.dropcoverholdon.org/ for more earthquake preparedness

information

K. See website for the Great American Shakeout, which is held each October.

This website also has earthquake preparedness information,

http://www.shakeout.org/dropcoverholdon/

L. The Central US Earthquake Consortium website, http://www.cusec.org/ has

information about the New Madrid fault, the seven states including

Kentucky that would be affected by an earthquake on the New Madrid fault

and earthquake preparedness.

See also: evacuation, fire warning, fire watch, severe storm.


Defined: According to the Centers for Disease Control, “an influenza pandemic is

a global outbreak of a new influenza A virus. Pandemics happen when new (novel)

influenza A viruses emerge which are able to infect people easily and spread from

person to person in an efficient and sustained way.”

Immediate Action: The Facility Administrator or his/her designate is responsible

for the decision to declare a facility “staffing crisis” and to initiate appropriate

emergency staffing alternatives consistent with state law.

A. The facility will collaborate with organizations such as the:

a. Public Health Department’s Medical Reserve Corps

b. KY Community Crisis Response Board (KCCRB)

c. American Red Cross, the County Emergency Manager

d. Local government Community Emergency Response Teams (CERT)

B. To secure trained non-facility staff for a pandemic emergency

C. To coordinate staffing needs with local and regional planning and response

groups to address widespread healthcare staffing shortages during a crisis.

General Staff Assignments: The facility administrator or her/his designee is

authorized to implement the facility’s Pandemic Influenza Plan and determine the

organizational structure that will be used.

A. In this facility, ___________________________________________ (name, title and contact information) is responsible for monitoring federal and state

public health advisories, and updating the facility’s Pandemic Response

Coordinator and members of the facility’s pandemic influenza planning

committee when pandemic influenza has been reported in the United States

and is nearing the geographic area.

B. In this facility, ___________________________________________ (name, title and contact information) is responsible for communicating with the

public health authorities during a pandemic influenza episode.

Specific Staff Assignments: A. In this facility, ___________________________________________ (name,

title and contact information) is responsible for communicating with the


EPIDEMIC/PANDEMIC EPISODE

Code: Plain Speech/Text


staff, residents, and their families/representatives regarding the status and

impact of pandemic influenza in the facility.

B. In this facility, ___________________________________ (name, title and contact information) is responsible for:

a. coordinating training, identifying and publicizing training

opportunities, tracking training on pandemic influenza

b. securing appropriate infection control and other educational materials

to staff, residents and their families/representatives.

c. communicating with staff, residents, and family

members/representatives about the implications and basic prevention

and control measures used within the facility to deal with a pandemic

outbreak.

Preparing Ahead/Training: A. The facility has established a multi-disciplinary planning committee/team

named the _________________________ to plan for pandemic influenza.

The Pandemic Influenza Response Coordinator’s name and title are

_________________ _____________________________________ and the

members of the planning committee include the following:

Name Title Contact Information

B. Contacts have been made with others in the community who are planning for

pandemic influenza and plans have been shared to assure that a community-

wide approach is being implemented. These community contacts include:

a. Emergency Management responders at local and state health

departments

b. Emergency Management

c. KY Long Term Care Associations

d. Local/regional pandemic influenza planning groups

e. Ombudsman Program and local hospitals.

C. Relevant sections of the HHS Pandemic Influenza Plan have been reviewed

and additional references are available.

D. A written protocol which is located ____________________________has

been developed for weekly or daily monitoring of seasonal influenza-like

illness in residents and staff that provides:


a. Evaluation and diagnosis of residents and/or staff with symptoms of

pandemic influenza.

b. Assessment for seasonal influenza evaluation of incoming residents.

c. Approved admission policy or protocol to determine the appropriate

placement and isolation of residents with an influenza-like illness.

E. The following system is in place to monitor and internally review

transmission of influenza among patients and staff in the facility in order to

implement prevention interventions:

______________________________________________________________________________________________________________________________________________________________________________________________________

F. The facility’s Communication Plan identifies the process for communicating

with the public, the residents and their families/representatives during an

emergency.

G. Contact information for families and guardians of residents are regularly

updated for the Resident Emergency Packets.

H. Agreements with other health care facilities are in place.

I. In order to expand qualified staffing during a pandemic influenza, the

facility will:

a. Pre-certify volunteers

b. Collaborate with organizations such as the Public Health

Department’s Medical Reserve Corps, KY Community Crisis

Response Board, American Red Cross and local government

Community Emergency Response Teams (CERT) to secure other

trained non-facility staff for a pandemic emergency.

J. An Infection Control Plan is in place that includes:

a. Managing residents and visitors with pandemic influenza

b. Provisions for direct care staff to use Standard and Droplet

Precautions with symptomatic residents

c. Use of Respiratory Hygiene/Cough Etiquette throughout the facility

d. Strategies for grouping symptomatic residents or groups by

1. confining symptomatic residents and their exposed

roommates to their room

2. placing symptomatic residents together in one area of the

facility

3. closing units where symptomatic and asymptomatic

residents reside


4. recommendations that, where possible, staff who are

assigned to work on affected units will not work on other

units.

e. Criteria and protocols for closing units or the entire facility to new

admissions and for enforcing visitor limitations are in place when

pandemic influenza is in the facility.

K. A vaccine and antiviral use plan is in place for personnel and residents

utilizing federal, state and local guidance that includes:

a. expediting delivery of influenza vaccine or antiviral prophylaxis to

residents and staff as recommended by the state health department

b. A system for monitoring influenza vaccination of personnel

L. This facility has plans for continuity of operations.

M. A sick leave policy is in place that addresses the needs of symptomatic

personnel and facility staffing and considers such criteria as:

a. handling personnel developing symptoms while at work

b. returning to work after having pandemic influenza

c. working when symptomatic, but well enough to work

d. provisions for staff who need to care for ill family members

e. education for staff to self-assess and report symptoms of pandemic

influenza before reporting for duty.

N. Plans for accessing mental health and faith-based resources to provide

counseling to staff during a pandemic.

O. Strategies for managing staff who are at increased risk for influenza

complications (e.g., pregnant women, immunocompromised workers) by

placing them on administrative leave or altering their work location.

P. A contingency staffing plan has been developed that:

a. identifies the minimum staffing needs

b. prioritizes critical and non-essential services based on residents’

health status, functional limitations, disabilities, and essential facility

operations.

c. (name, job title) has been assigned responsibility for conducting a

daily assessment of staffing status and needs during an influenza

pandemic.

Q. Surge facility space has been identified that could be adapted for use as

additional beds and information provided to local and regional planning

contacts.

R. A contingency plan is in place for managing an increased need for post

mortem care, and an area in the facility that could be used as a temporary

morgue.


S. Local plans for expanding morgue capacity have been discussed with local

and regional planning contacts including the local health department and

County Emergency Manager.

T. Estimates have been made of the quantities of essential materials and

personal protective equipment that would be needed during a six-week

pandemic.

U. Procedures are in place to address likely supply shortages, including

strategies for using normal and alternative channels for procuring needed

resources.

V. Agreements with alternative care sites are in place for facility residents who

need acute care services when hospital beds become unavailable.

W. Signed agreements have been established with area hospitals for admission

to the long-term care facility of non-influenza individuals to facilitate

utilization of acute care resources for more seriously ill individuals.

See also: Resource list for additional information on Pandemic Flu.

Copies have been obtained of relevant sections of the HHS Pandemic Influenza

Plan (available at http://www.flu.gov/planning-

preparedness/federal/hhspandemicinfluenzaplan.pdf ) and available state, regional, or local

plans are reviewed for incorporation into the facility's plan.


U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES LONG TERM CARE AND OTHER RESIDENTIAL FACILITIES PANDEMIC

INFLUENZA CHECKLIST

Planning for pandemic influenza is critical for ensuring a sustainable healthcare response. The

Department of Health and Human Services (HHS) and the Centers for Disease Control and Prevention

(CDC) have developed this checklist to help long-term care and other residential facilities assess and

improve their preparedness for responding to pandemic influenza. Based on differences among facilities

(e.g., patient/resident characteristics, facility size, scope of services, hospital affiliation), each facility will

need to adapt this checklist to meet its unique needs and circumstances. This checklist should be used as

one tool in developing a comprehensive pandemic influenza plan. Additional information can be found at

www.pandemicflu.gov. Information from state, regional, and local health departments, emergency

management agencies/authorities, and trade organizations should be incorporated into the facility’s

pandemic influenza plan. Comprehensive pandemic influenza planning can also help facilities plan for

other emergency situations.

This checklist identifies key areas for pandemic influenza planning. Long-term care and other residential

facilities can use this tool to self-assess the strengths and weaknesses of current planning efforts. Links to

websites with helpful information are provided throughout this document. However, it will be necessary

to actively obtain information from state and local resources to ensure that the facility’s plan

complements other community and regional planning efforts.

Pandemic influenza has been incorporated into emergency management planning and exercises for the facility.

Ø See Section V (C4): Hazard Vulnerability Analysis-Epidemic/Pandemic Episodes

A multidisciplinary planning committee or team has been created to specifically address pandemic influenza preparedness planning. (List committee's or team's name.)


A person has been assigned responsibility for coordinating preparedness planning, hereafter referred to as the pandemic influenza response coordinator. (Insert name, title and contact information).


Members of the planning committee with the name, title, and contact information for each personnel category in the plan: Facility administration, Medical director, Nursing administration, Infection control, Occupational health, Staff training and orientation, Engineering/maintenance services, Environmental (housekeeping) services, Dietary/food services, Pharmacy services , Occupational/rehabilitation/physical therapy services, Transportation services, Purchasing agent, Facility staff representative, Other member(s) (e.g., clergy, community representatives, department heads, resident and family representatives, risk managers, quality improvement, direct care staff, collective bargaining agreement union representatives.

Ø See Section III (H-K): Basic Plan Elements


Local and state health departments and provider/trade association points of contact have been identified for information on pandemic influenza planning resources. (Insert name, title and


contact information for each: local health department; state health department contact; state long-term care associations)


Local, regional, or state emergency preparedness groups, including bioterrorism/ communicable disease coordinators points of contact have been identified. (Insert name, title and contact information for each.)


Area hospitals points of contact have been identified in the event that facility residents require hospitalization or facility beds are needed for hospital patients being discharged in order to free up needed hospital beds. (Attach a list with the name, title, and contact information for each hospital.)


The pandemic influenza response coordinator has contacted local or regional pandemic influenza planning groups to obtain information on coordinating the facility's plan with other plans.


Copies have been obtained of relevant sections of the HHS Pandemic Influenza Plan (available at www.hhs.gov/pandemicflu/plan/) and available state, regional, or local plans are reviewed for incorporation into the facility's plan.


Ø See Section III (J): Coordinating with local Emergency Responders and Resources

Ø See Section III (K): Coordinating with County Emergency Plan and Regional Health Care

Coalitions

The plan identifies the person(s) authorized to implement the plan and the organizational structure that will be used.

Ø See Section IV (B): Operations Planning – Organizational Chart

Ø See Section IV (C): Decision Making Authority/Chain of Command

Ø See Section IV (D): Succession of Command


A plan is in place for surveillance and detection of the presence of pandemic influenza in residents and staff. A person has been assigned responsibility for monitoring public health advisories (federal and state), and updating the pandemic response coordinator and members of the pandemic influenza planning committee when pandemic influenza has been reported in the United States and is nearing the geographic area. See www.cdc.gov/flu/weekly/fluactivity.htm.


A written protocol has been developed for weekly or daily monitoring of seasonal influenza-like illness in residents and staff. (Having a system for tracking illness trends during seasonal influenza will ensure that the facility can detect stressors that may affect operating capacity, including staffing and supply needs, during a pandemic.) See www.cdc.gov/flu/professionals/diagnosis/.

Ø See Administrator for written protocol for seasonal influenza-like illness.


A protocol has been developed for the evaluation and diagnosis of residents and/or staff with symptoms of pandemic influenza.

Ø See Administrator for written protocol for seasonal influenza-like illness/pandemic influenza

Assessment for seasonal influenza is included in the evaluation of incoming residents. There is an admission policy or protocol to determine the appropriate placement and isolation of patients with an influenza-like illness. (The process used during periods of seasonal influenza can be applied during pandemic influenza.)

Ø See Administrator for written protocol for seasonal influenza-like illness/pandemic influenza.

A system is in place to monitor for, and internally review transmission of, influenza among patients and staff in the facility. Information from this monitoring system is used to implement prevention interventions (e.g., isolation or cohorting) and is necessary for assessing pandemic influenza transmission.

Ø See Administrator for written protocol for seasonal influenza-like illness/pandemic influenza.

A facility communication plan has been developed. Key public health points of contact during an influenza pandemic influenza have been identified. Name, title and contact information available for local health department contact, state health department contact. For more information, see www.hhs.gov/pandemicflu/plan/sup10.html.

Ø See Section VI (I-L): Communication Plan/Internal and External Communications


A person has been assigned responsibility for communications with public health authorities during a pandemic: name, title and contact information.

Ø See Section VI (I): Communication Plan/Sharing Personal Health Information


A person has been assigned responsibility for communications with staff, residents, and their families regarding the status and impact of pandemic influenza in the facility.

Ø See Section VI (C-H): Communication Plan


Contact information for family members or guardians of facility residents is up-to-date.

Ø See Section V (CD): Communication Plan

Communication plans include how signs, phone trees, and other methods of communication will be used to inform staff, family members, visitors, and other persons coming into the facility (e.g., sales and delivery people) about the status of pandemic influenza in the facility.




A list has been created of other healthcare entities and their points of contact (e.g., other long-term care and residential facilities, local hospitals' emergency medical services, relevant community organizations [including those involved with disaster preparedness]) with whom it will be necessary to maintain communication during a pandemic. (Insert location of contact list and attach a copy to the pandemic plan.)

Ø See Section VI (K-L): Communication Plan/Internal and External Communications


A facility representative(s) has been involved in the discussion of local plans for inter-facility communication during a pandemic.


A plan is in place to provide education and training to ensure that all personnel, residents, and family members of residents understand the implications of, and basic prevention and control measures for, pandemic influenza. A person has been designated with responsibility for coordinating education and training on pandemic influenza (e.g., identifies and facilitates access to available programs, maintains a record of personnel attendance). Insert name, title, and contact information.


Ø See Section XI (A-C): Training and Exercise

Current and potential opportunities for long-distance (e.g., web-based) and local (e.g., health department or hospital-sponsored) programs have been identified. See www.cdc.gov/flu/professionals/training/.



Ø See Section XII (A-D): Mental Health Planning

Language and reading-level appropriate materials have been identified to supplement and support education and training programs (e.g., available through state and federal public health agencies such as www.cdc.gov/flu/groups.htm and through professional organizations), and a plan is in place for obtaining these materials.



Education and training includes information on infection control measures to prevent the spread of pandemic influenza.

Ø See Administrator for written infection control plan.

The facility has a plan for expediting the credentialing and training of non-facility staff brought in from other locations to provide patient care when the facility reaches a staffing crisis.


Informational materials (e.g., brochures, posters) on pandemic influenza and relevant policies (e.g., suspension of visitation, where to obtain facility or family member information) have been developed or identified for residents and their families. These materials are language and reading-level appropriate, and a plan is in place to disseminate these materials in advance of the actual


pandemic. For more information, see www.cdc.gov/flu/professionals/infectioncontrol/index.htm and www.cdc.gov/flu/groups.htm.


An infection control plan is in place for managing residents and visitors with pandemic influenza (for information on infection control recommendations for pandemic influenza, see www.hhs.gov/pandemicflu/plan/sup4.html.) The infection control policy requires direct care staff to use Standard and Droplet Precautions (i.e., www.cdc.gov/ncidod/dhqp/gl_isolation_standard.html and www.cdc.gov/ncidod/dhqp/gl_isolation_droplet.html.

Ø See Administrator for written infection control plan

An infection control plan for implementing Respiratory Hygiene/Cough Etiquette throughout the facility. (See www.cdc.gov/flu/professionals/infectioncontrol/ resphygiene.htm.)


A plan for cohorting symptomatic residents or groups using one or more of the following strategies: 1) confining symptomatic residents and their exposed roommates to their room, 2) placing symptomatic residents together in one area of the facility, or 3) closing units where symptomatic and asymptomatic residents reside (i.e., restricting all residents to an affected unit, regardless of symptoms). The plan includes a stipulation that, where possible, staff who are assigned to work on affected units will not work on other units.


A liberal/non-punitive sick leave policy that addresses the needs of symptomatic personnel and facility staffing needs. The policy considers: The handling of personnel who develop symptoms while at work; When personnel may return to work after having pandemic influenza; When personnel who are symptomatic, but well enough to work, will be permitted to continue working; Personnel who need to care for family members who become ill.

Ø See Administrator for sick leave policy

Ø See Section IX (B): Essential Staff Roles and Redundancy

Ø See Section XII (A-C): Employee Emergency Preparedness

Ø See Section XII (A,D): Psychological First Aid for Staff; Tips for Retaining Staff after Disaster

A plan to educate staff to self-assess and report symptoms of pandemic influenza before reporting for duty.

Ø See Administrator for sick leave policy

Ø See Section IX (B): Essential Staff Roles and Redundancy

Ø See Section XII (A-C): Employee Emergency Preparedness

A list of mental health and faith-based resources that will be available to provide counseling to personnel during a pandemic.

Ø See Section XII (A-D): Mental Health Planning

A system to monitor influenza vaccination of personnel. Ø See Administrator for plan for monitoring influenza vaccination of personnel.


A vaccine and antiviral use plan has been developed. CDC and state health department websites have been identified for obtaining the most current recommendations and guidance for the use, availability, access, and distribution of vaccines and antiviral medications during a pandemic. For more information, see www.hhs.gov/pandemicflu/plan/sup6.html and www.hhs.gov/pandemicflu/plan/sup7.html. HHS guidance has been used to estimate the number of personnel and residents who would be targeted as first and second priority for receipt of pandemic influenza vaccine or antiviral prophylaxis. A plan is in place for expediting delivery of influenza vaccine or antiviral prophylaxis to residents and staff as recommended by the state health department. For information, see www.hhs.gov/pandemicflu/plan/sup6.html and www.hhs.gov/pandemicflu/plan/sup7.html. A plan for managing personnel who are at increased risk for influenza complications (e.g., pregnant women, immunocompromised workers) by placing them on administrative leave or altering their work location.

Ø See Administrator for plan for delivery of influenza vaccination of personnel and residents.

Issues related to surge capacity during a pandemic have been addressed. A contingency staffing plan has been developed that identifies the minimum staffing needs and prioritizes critical and non-essential services based on residents' health status, functional limitations, disabilities, and essential facility operations. A person has been assigned responsibility for conducting a daily assessment of staffing status and needs during an influenza pandemic. (Insert name, title and contact information.)


Ø See Section X (A,B): Hosting Evacuees

Ø See Section X: Surge Assessment Form

Legal counsel and state health department contacts have been consulted to determine the applicability of declaring a facility "staffing crisis" and appropriate emergency staffing alternatives, consistent with state law.


The staffing plan includes strategies for collaborating with local and regional planning and response groups to address widespread healthcare staffing shortages during a crisis.

Ø See Section IV (A-D): Operations Planning



Estimates have been made of the quantities of essential materials and equipment (e.g., masks, gloves, hand hygiene products, intravenous pumps) that would be needed during a six-week pandemic.

Ø See Section V (A-B): Hazard Vulnerability Analysis


Ø See Section VIII (A-F): Core Elements/Preparedness Assessment

A plan has been developed to address likely supply shortages, including strategies for using normal and alternative channels for procuring needed resources.

Ø See Section VIII (A-F): Core Elements/Preparedness Assessment

Alternative care plans have been developed for facility residents who need acute care services when hospital beds become unavailable.


Ø See Section X (C): Evacuation


Surge capacity plans include strategies to help increase hospital bed capacity in the community. Signed agreements have been established with area hospitals for admission to the long-term care facility of non-influenza patients to facilitate utilization of acute care resources for more seriously ill patients.



Facility space has been identified that could be adapted for use as expanded inpatient beds and information provided to local and regional planning contacts.



A contingency plan has been developed for managing an increased need for post mortem care and disposition of deceased residents. An area in the facility that could be used as a temporary morgue has been identified.

Ø See Section VIII (J): Core Elements/Capacity for Deceased Residents

Local plans for expanding morgue capacity have been discussed with local and regional planning contacts.

Ø See Section VIII (J): Core Elements/Capacity for Deceased Residents

Ø See Section VI (K): Communications/Contacting regional and local planning officials


Defined: Outbreak of fire in facility, and/or facility grounds

Immediate Action: RACE R Rescue Rescue/Evacuate persons in immediate danger.

A Alarm Pull nearest “pull station.” Announce “CODE RED”

and fire location over loud speaker. Repeat the

announcement.

C Confine Confine the fire by closing doors to isolate the fire

and smoke.

E Extinguish Attempt to extinguish the fire only if the first three

parts of the R.A.C.E. Procedure have been completed

and the fire appears to be manageable.

General Staff Assignments: A. Call 911.

B. Notify Administrator and Director of Nursing and

___________________________________ (facility to fill in appropriate titles/positions) if not on the premises. The Recall Roster should be

activated, if warranted.

C. Activate the Incident Command System (ICS). The most qualified staff

member on duty at the time will assume the Incident Commander position. If

severity of fire warrants, then appoint other positions of the ICS structure.

D. Shut down elevators.

E. Stay calm and reassure residents—do not mention fire.

F. Evacuation in this plan may mean moving to a safe Area of Refuge. This

does not necessarily mean emptying the building unless each wing/section is

expected to be evacuated beyond fire doors or to the nearest exit.

G. Keep all smoke/fire doors closed. Limit passage through smoke partitions.


FIRE EMERGENCY Code: Red


H. Keep all doors closed in resident rooms and functional rooms (storage,

pantry, linen, etc.).

I. Keep all stairwell doors closed.

J. Close all windows.

K. Understand that the sprinkler system (if present) will likely control the fire.

L. Shut off oxygen or other medical gasses that could contribute to the spread

of the fire.

M. Connect O2 concentrators to all residents requiring oxygen.

N. Coordinate all internal emergency operations with the Fire Department. The

Fire Department can quickly assist in controlling the situation provided that

a good line of communication is established between the Incident

Commander and the Fire Officer in charge.

O. The situation should be deemed “under control” only after the Fire

Department has concluded its emergency operations and the Incident

Commander has declared the situation “safe.”

P. Communicate an “All Clear” after the situation is declared safe by the Fire

Department.

If Evacuation is required:

Q. Evacuate residents according to the size of the fire and the volume of smoke

production. The Incident Commander will give guidance on evacuation type.

1. Phase I: Evacuate the rooms on either side and directly across from

the room that is on fire. Move residents to an area away from the fire.

This type of evacuation should be used during the initial stages of a

small fire.

2. Phase II: Evacuate all residents from the smoke compartment where

the fire has occurred to the opposite smoke compartment (through the

smoke doors). This type of evacuation should be used when moderate

smoke conditions are present or the welfare of the residents is in

jeopardy based on the situation.

3. Phase III: FIRE DEPARTMENT ORDERED EVACUATION.

Evacuate all residents from the building by whatever means possible.

This type of evacuation should only be used during a major fire or

severe smoke conditions within the building as ordered by the Fire

Department.


R. Determine the order of evacuation by resident type. Examples are:

1. Ambulatory residents

2. Residents with assistive devices

3. Residents in wheelchairs

4. Bedridden residents

S. Assign a staff member(s) to stay with each resident group to prevent panic

and re-entry into dangerous areas.

T. Coordinate all internal emergency operations with the Fire Department. The

Fire Department can quickly assist in controlling the situation provided that

a good line of communication is established between the Incident

Commander and the Fire Officer in charge.

U. The situation should be deemed “under control” only after the Fire

Department has concluded its emergency operations and the Incident

Commander has declared the situation “safe.”

V. Communicate an “All Clear” after the situation is declared safe by the Fire

Department.

Specific Staff Assignments: 1. Administrator/Incident Commander

a. Report to the fire alarm panel and determine the location of the activation.

b. Report to the area of activation and assess the situation.

c. Supervise emergency operations (evacuation, fire control, chart removal,

etc.).

d. 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.

e. Coordinate all emergency operations with the Fire Department.

f. Ensure all staff members and residents are accounted for and safe.

2. Director of Nursing


b. Report to the area of activation and provide instruction to staff members

regarding the location to remove residents, starting with the residents who

are closest to the area of the fire.

c. Ensure that all windows and doors are closed.

d. Coordinate operations with the Incident Commander to determine the type

of evacuation that will be necessary for the situation.


e. Instruct Certified Nursing Assistants to remain with residents in an attempt

to keep them calm and prevent them from returning to the fire area. Perform

a complete head count to ensure that all residents are accounted for.

3. Nursing Staff

a. Report to the area of fire alarm activation.

b. Quickly assess the magnitude of the situation.

c. Initiate Evacuation Procedures.

d. Close all doors and windows, as residents are evacuated.

e. Connect O2 concentrators to all residents requiring oxygen.

f. Shut off oxygen or other medical gasses that could contribute to the spread

of the fire.

g. Secure medical records.

h. Perform a complete head count to ensure that all residents are accounted for.

i. Be prepared to assist where needed at the direction of the Incident

Commander and/or Fire Department.

4. Certified Nursing Assistants

a. Initiate Evacuation Procedures and close all doors and windows of resident

rooms.

b. Be prepared to assist where needed at the direction of the Incident

Commander.

5. Office Staff/Medical Records

a. Secure all records by storing them in the appropriate metal cabinets.

b. Back up electronic medical records system to off-site storage site.

c. Close all doors and windows in your work area.

d. Be prepared to assist where needed at the direction of the Incident

Commander.

6. Activity Staff

a. Report to the area of fire alarm activation, providing that staff are not in the

middle of a supervised activity.

b. If conducting an activity during alarm activation, stay with residents and

remain calm.

c. Relocate all residents from immediate danger.

d. If available, assist with other emergency operations at the direction of the

Incident Commander.

7. Maintenance Personnel


b. Immediately respond to the area of activation.


c. While in route, retrieve a fire extinguisher that is in the path of response in

order to provide additional fire extinguishing capacity at the fire scene.

d. Ensure that the appropriate Evacuation Procedures are in progress and

attempt to control the fire if required.

e. Once the fire is under control, attempt to de-power the fire area by shutting

down circuit breakers for the fire area.

f. Assist the Fire Department in whatever way required.

g. NEVER shut down the fire sprinkler system during a fire unless ordered to

do so by the Fire Department.

8. All Other Employees (housekeeping, laundry, dietary, etc.)

a. Report to the area of fire alarm activation after securing your individual

work area and assist with emergency operations per the direction of the

Incident Commander.

b. Secure your individual work area by shutting down all machinery (kitchen

equipment, laundry equipment, computers, etc.) and storing all vital papers

or currency in a metal container (desk, cabinet, etc.).

c. When leaving your individual work area, ALWAYS close all doors and

windows to help reduce the effects of potential smoke damage.

d. Do not return to your work area until the situation is under control.

Preparing Ahead/Training: A. ____________________________________ (facility name) employees

should be trained to utilize the R.A.CE. Procedure and notify the Fire

Department of the exact circumstances of the situation. B. All staff should receive training in the proper use of fire extinguishers. Fire

extinguishers are located in every corridor of the facility. The extinguishers,

type A, B, or C, can be utilized in any type of fire.

C. Facility must track and record staff training including date, trainer name,

roster of attendees, focus of training.

See Also: Bottled Water Emergency, Fire System Disabled, Evacuation, Shelter in Place,

Utility Outage, Wildland Fires


Defined: A plan of action should the power system fail to work properly. Fire

alarm system outages can occur during construction, renovation, electrical storms,

or other unplanned events that eliminate part or all of the fire alarm system. A fire

alarm system could include but is not limited to:

• fire alarm panel

• fire department notification system

• smoke or heat detection system

• sprinkler system

A fire watch tour is a periodic walking tour of the facility by one or more assigned

and trained staff. The tour monitors the facility through direct observation of all

rooms, including resident rooms, mechanical and electrical rooms, kitchen,

laundry, etc. for possible signs of fire.

CMS Guideline (2016) regarding Fire Watch -- 483:70 Physical Environment

When a sprinkler system is shut down for more than 10 hours, the facility must:

• evacuate the building, or portion of the building by the system is back in

service, or

• establish a fire watch until the system is back in service

Immediate Action: A. Contact the Administrator, Director of Nursing, and Maintenance Director

and ______________________________________________________

(facility to fill in appropriate titles/positions) when any problems are

identified with the fire alarm system.

B. Contact the fire alarm company if the Maintenance Director

__________________ __________________ (or other responsible position)

is unable to correct the problem.

C. Notify the ________________________ (Fire Department) at

____________________ (phone number) and Kentucky Office of Inspector

General____________________ (phone number) that the fire alarm system


FIRE WATCH/FIRE SYSTEM DISABLED Code: Plain Speech/Text


is not working correctly, and that procedures are in place until the system is

restored.

General Staff Assignments: D. Facility management staff report to the Incident Command Post for

instruction. If necessary, activate the Incident Command System (ICS) to

manage the incident. The most qualified staff member on duty at the time

will assume the Incident Commander position.

E. Fire watch tours will be initiated throughout the facility. Fire watch tours

should occur at one-half hour intervals, 24 hours a day.

F. Fire watch tours will be documented with findings noting date, time, and

staff initials.

G. Fire watch tours should be performed by personnel solely dedicated to the

fire watch with no other facility-related activities or events.

H. Maintenance staff report on site or on call for equipment emergency shut-

down situations.

I. Distribute additional fire extinguishers facility-wide and inform staff of

locations.

J. Do not terminate the Fire Watch until all fire protection equipment has been

restored to normal operating condition and upon the authority of the

Administrator or designee.

Specific Staff Assignments: 1. Administrator/Incident Commander

a. Determine the problem with the system.

b. Establish contact with the fire alarm company.

c. Contact Kentucky Office of Inspector General to notify of the

situation and what actions are being taken to rectify.

d. Notify the Fire Department.

e. Activate the Incident Command System (ICS) to manage the incident.

The most qualified staff member on duty at the time will assume the

Incident Commander position.

f. Alert management staff to report to the Incident Command Post.

g. Select personnel to conduct fire watch tours and supervise.

h. Ensure construction or renovation work areas are monitored.

i. Supervise emergency operations if necessary (evacuation, fire control,

chart removal, etc.).

2. Management Staff of all Departments

a. Report to the Incident Command Post

3. Director of Nursing


a. Report to the Incident Command Post.

b. Ensure ALL SMOKING IS TO OCCUR OUTSIDE with a staff

member present.

c. Ensure all exits are unobstructed.

d. Ensure fire doors remain closed.

e. Ensure all windows are closed.

f. Be prepared to assist where needed at the direction of the Incident

Commander.

4. Nursing Staff

a. Remove smoking materials and extension cords from resident rooms.


member present.



e. Ensure windows remain closed.


Commander.




member present.





Commander.

6. Office Staff/Medical Records

a. Secure all records by storing them in the appropriate metal cabinets.

b. Back up electronic medical records system to off-site storage site

c. Close all doors and windows in your work area.

d. Be prepared to assist where needed at the direction of the Incident

Commander.

7. Activity Staff



member present.






Commander.

8. Maintenance Personnel

a. Report to the Incident Command Post.

b. Ensure all combustible/flammable items are stored properly and

removed from mechanical and electrical rooms.

c. Ensure dryer vents are clean.

d. Ensure Fire Department/EMS access to the facility is clear from snow,

ice, etc.

e. Ensure Fire Department access to hydrants, sprinkler connections,

standpipes, and fire extinguishers.

f. Ensure exits are unobstructed.

g. Ensure fire doors remain closed.

h. Ensure unnecessary machinery that runs continuously is turned off.

1. Ensure sprinkler valves are open and sealed, gauges indicate normal

pressure, and sprinkler heads are unobstructed.

i. Monitor construction or renovation work areas.

j. Be prepared to shut down equipment as necessary.

k. Be prepared to assist where needed at the direction of the Incident

Commander.

9. All Other Employees (housekeeping, laundry, dietary, etc.)

a. Remove lint from dryers.

b. When leaving the individual work area, ALWAYS close all doors and

windows.

c. Ensure exits are unobstructed.


e. Be prepared to assist where needed at the direction of the Incident

Commander.


A. Train all staff in the proper use of fire extinguishers. Fire extinguishers are

located in every corridor of the facility. The extinguishers, type A, B, or C,

can be utilized in any type of fire.

B. Select and train appropriate staff to preform fire watch tours and document

findings noting date, time, and staff initials.

C. Facility must track and record staff training including date, trainer name,


See Also: Bottled Water Emergency, Fire Emergency, Evacuation, Shelter in Place, Utility

Outage, Wildland Fires


Defined: Floods are the most common and widespread of all natural disasters.

Most communities in the United States can experience some degree of flooding

after spring rains, heavy thunderstorms, or winter snow thaws. Flash floods and

floods are the #1 cause of death associated with thunderstorms, more than 90

fatalities each year.

Flash flood -- occurs within a few hours (usually less than 6) of heavy or excessive

rainfall, a dam or levee failure, or the sudden release of water impounded by an ice

jam. Flash floods are like walls of water that develop in a matter of minutes.

Flood -- is the inundation of a normally dry area caused by abnormal high water

flow. Floods develop more slowly than flash floods, normally greater than 6 hours.

Flash Flood Watch -- is issued when conditions are favorable for flash flooding. It

does not mean that flash flooding will occur, but it is possible.

Flash Flood Warning -- is issued when flash flooding is imminent or occurring.

Flood Watch -- is issued when conditions are favorable for flooding. It does not

mean flooding will occur, but it is possible.

Flood Warning -- is issued when flooding is imminent or occurring.

River Flood Watch -- is issued when river flooding is possible at one or more

forecast points along a river.

River Flood Warning -- is issued when river flooding is occurring or imminent at

one or more forecast points along a river.

Immediate Action:

A. Monitor facility’s weather alert radio, television, and broadcast radio

for changing conditions, alerts, and warnings.

B. Be prepared to relocate residents to safe areas well in advance of a

storm; be proactive in planning and do not wait for the situation to

become dire.

C. Ensure windows and draperies are closed and distribute appropriate

equipment to staff members (flashlights, first aid supplies etc.).

D. Secure the outside of the facility and cancel any outside activities.

E. Activate the facility’s ICS, if needed.


FLOOD/FLASH FLOOD Code: Plain Speech/Text


Common Staff Assignments: A. Close all interior doors.

B. Shut down non-essential equipment.

C. Relocate residents, staff members, and visitors to safe, pre-designated

locations.

D. Monitor residents closely.

E. Remain calm to not upset the residents.

F. Brace for storm impact.

Specific Staff Assignments: A. Notify Administrator and Director of Nursing if not on the premises.

B. Activate the Incident Command System (ICS) to manage the incident. The most

qualified staff member (in regard to the Incident Command System) on duty at

the time will assume the Incident Commander position.

C. Facility management staff should report to the Incident Command Post for a

briefing and instruction.

D. Evaluate the need to shut off electricity/utilities/water main/collect fresh water.

E. Incident Commander must decide whether to flood proof or evacuate based on

geographical location and history of flooding of the facility. If evacuation is

necessary, Evacuation Emergency Procedures will be followed.

F. It is essential that all internal emergency operations are coordinated with the

local authorities. They will be able to quickly assist in controlling the situation

provided that a good line of communication is established between them and

the Incident Commander.

G. Account for all staff members and residents.

H. Activate the Recall Roster, if needed.

I. Ensure that the fire department and County Emergency Manager have been

notified and are responding following storm impact.

J. Ensure that the specific procedures defined in the facility’s Severe Weather

Response Plans are utilized to internally manage the incident.

K. Utilize appropriate sections of the Kentucky LTC Emergency Preparedness

Manual to manage the incident as needed.

L. Maintain all operations in accordance with the ICS until the incident is

officially terminated.

M. The situation should only be deemed “under control” after the local authorities

have concluded emergency operations and the Incident Commander has

declared the situation “safe.”



A. Consult with _______________________________ (county name)

Emergency Management officials if facility is located in a flood plain and to

review the history of flooding in the area.

B. Purchase a National Oceanic and Atmospheric Administration (NOAA)

Weather Radio with a warning alarm tone and battery backup. Listen for

flood watches and warnings.

C. Review the community’s emergency plan. Learn the community’s

evacuation routes. Know where to find higher ground in case of a flood.

D. More than half of all flood-related drownings occur when a vehicle is driven

into hazardous flood water. Educate staff about vehicle use and rising water:

• Six inches of fast-moving water can knock you off your feet.

• Two feet of rushing water can carry away most vehicles, including

SUVs and pickups.

• Many flash flood fatalities occur at night when streets are less visible.

E. Show National Weather Service video Turn Around, Don’t Drown.

http://www.nws.noaa.gov/os/water/tadd/

F. Inspect areas that may be subject to flooding. Identify records and

equipment that can be moved to a higher location. Decide where to move

records and equipment in case of flood.

G. Ensure insurance policy provides coverage for flooding. Evaluate the

feasibility of flood proofing your facility.

H. Permanent flood proofing measures are to be taken before a flood occurs and

require no human intervention when floodwaters rise. They include:

• Filling windows, doors, or other openings with water-resistant

materials such as concrete blocks or bricks. This approach assumes

the structure is strong enough to withstand floodwaters.

• Installing check valves to prevent water from entering where utility

and sewer lines enter the facility.

• Have sand and sand bags on hand and train on sandbagging

techniques.

• Reinforcing walls to resist water pressure and sealing walls to prevent

or reduce seepage.

• Building watertight walls around equipment or work areas within the

facility that are particularly susceptible to flood damage.

• Constructing floodwalls or levees outside the facility to keep flood

waters away.


I. Elevating the facility on walls, columns, or compacted fill. This approach is

most applicable to new construction, though many types of buildings can be

elevated.

J. Emergency flood proofing measures are generally less expensive than those

listed above, though they require substantial advance warning and do not

satisfy the minimum requirements for watertight flood proofing as set forth

by the National Flood Insurance Program (NFIP). They include:

• Building walls with sandbags.

• Constructing a double row of walls with boards and posts to create a

“crib,” then filling the crib with soil.

• Constructing a single wall by stacking small beams or planks.

• Participating in community flood control projects.

K. Evaluating the need for backup systems, such as:

• Portable pumps to remove flood water.

• Alternate power sources such as generators or gas-powered pumps.

• Battery-powered emergency lighting.

L. Contingent flood proofing measures are also taken before a flood but require

some additional action when flooding occurs. These measures include:

• Installing watertight barriers (flood shields) to prevent the passage of

water through doors, windows, ventilation shafts, or other openings.

• Installing permanent watertight doors.

• Constructing movable floodwalls.

• Installing permanent pumps to remove flood waters.

Clean Up and Reentering Facility: Prior to reopening a healthcare facility that has undergone extensive water and

wind damage; inspections need to be conducted to determine if the building is

salvageable. If the decision is made to proceed with recovery and remediation,

building and life safety inspections must be completed before any restoration work

is done to the facility. See section on guidance for infection control review of facilities to be performed before reopening. Prior to opening any portion of a facility, adequate support services need to be

available to provide quality care in a safe environment. Contracting with outside

services could be considered.

Certification for occupancy must be obtained prior to reopening the facility.

Regulations regarding healthcare facility certification and licensing differ from


state to state. Refer to specific state and local government resources for more

information.

Before and while entering the facility • Be cautious around electrical lines, downed lines, outlets and appliances.

Do Not assume that the electricity has been turned off.

• Avoid floodwaters – water may be contaminated by oil, gas, raw sewage.

Water may also be electrically charged from underground or downed power

lines.

• Note where floodwaters have receded. Roads may have weakened and

could collapse under the weight of a car

• Boil drinking water before using. Wells should be pumped out and the water

tested for purity before drinking. Call your local public health authority or

listen for reports on community’s water supply safety.

• Watch for animals. Small animals like rats and snakes that have been

flooded out of their homes may seek shelter in yours. Use a pole or stick to

poke and turn items over and scare away small animals.

• Look before you step. After a flood, the ground and floors are covered with

debris including broken bottles and nails. Floors and stairs that have been

covered with mud can be very slippery.

• Wear face mask and gloves.

1. Safety Evaluation The following should be evaluated by facilities experts:

§ Structural integrity and missing structural items

§ Assessment of hidden moisture

§ Electrical system damage, including high voltage, insulation, and

power integrity

§ Water distribution system damage

§ Sewer system damage

§ Fire emergency systems damage

§ Air handling system damage

§ Medical waste and sharps disposal system


2. Water Removal • Water should be removed as soon as possible once the safety of the structure

has been verified.

• Pump out standing water.

• Wet vacuum residual wetness from floors, carpets, and hard surfaces.

• Clean wet vacuums after use and allow to dry.

3. Water Damage Assessment and Mold Remediation • Open the windows in the damaged areas of the building during remediation.

• Remove porous items that have been submerged or have visible mold

growth or damage.

• Minimize dispersion of mold spores by covering the removed items and

materials with plastic sheeting (dust-tight chutes leading to dumpsters

outside the building may be helpful). Dispose these items as construction

waste.

• Seal off the ventilation ducts to and from the remediation area and isolate the

work area from occupied spaces, if the building is partially occupied.

• Scrub and clean hard surfaces with detergents to remove evidence of mold

growth (if a biocide is used, follow manufacturer’s instructions for use and

ventilate the area. Do not mix chlorine-containing biocides with detergents

or biocides containing ammonia).

4. Cleaning • Get rid of mud as soon as possible.

• Clean everything that got wet.

• Don’t risk contamination. “If in doubt, throw it out.”

• A solution of one part household bleach and four parts water will kill surface

mildew and, if used as part of a regular maintenance program, will prevent

mildew from returning.

• Dry the area and remaining items and surfaces.

• Evaluate the success of drying and look for residual moisture in structural

materials (Moisture-detection devices [e.g., moisture meters] or borescopes

could be used in this evaluation).

• Remove and replace structural materials if they cannot be dried out within

48 hours.


5. Inspect, Repair, Disinfect where Appropriate, or Replace Facility Infrastructure. Include:

• HVAC system (motors, duct work, filters, insulation)

• Water system (cold and hot water, sewer drainage, steam delivery, chillers,

boilers)

• Steam sources (if piped in from other places, e.g., utility companies, it will

impact autoclaves)

• Electrical system (wiring, lighting, paging and patient call systems,

emergency generators, fire alarms)

• Electronic communication systems (telephones, paging and resident call

systems, computers)

• Medical gas system

• Hazardous chemicals/radioactive storage

6. General Inventory of Areas with Water and Wind Damage • What furniture can be salvaged? Discard wet porous furniture that cannot be

dried and disinfected (including particle board furniture). Disinfect furniture

with non-porous surfaces and salvage. Discard upholstered furniture,

drapery, and mattresses if they have been under water or have mold growth

or odor. Discard all items with questionable integrity or mold damage.

• What supplies can be salvaged? Salvage linens and curtains following

adequate laundering. Salvage pre-packaged supplies in paper wraps that are

not damaged or exposed to water or extreme moisture, or in a molded

environment. Discard items if there is any question about integrity or mold

exposure. Dry essential paper files and records (professional conservators

may be contacted for assistance).

• Electrical medical equipment. Check motors, wiring, and insulation for

damage. Inspect equipment for moisture damage. Clean and disinfect

equipment following manufacturer’s instructions. Do not connect wet

electronic equipment to electricity.

• Structures. Inspect, repair, or replace wallboard, ceiling tiles, and flooring.

Repair, replace, and clean damaged structures.

7. Disposal of Contaminants • Dispose of all foods and canned goods that came in contact with flood

waters.

• Do not dispose of hazardous chemicals and materials (those marked "danger,

caution, poison, warning, flammable, toxic, keep out of reach of children

and hazardous") in the trash, down the drain or into standing water as they


can contaminate groundwater and sewer lines. Take these items to the

designated hazardous materials waste site.

8. Review Issues for Reopening Facilities • Requirements needed prior to opening a facility: potable water, adequate

sewage disposal, adequate waste and medical waste management.

• Have all areas to be opened been thoroughly dried out, repaired, and

cleaned?

• Does the number of air exchanges in areas of the facility meet recommended

standards?

• Are negative-pressure rooms functioning properly?

9. Post-Reoccupation Surveillance

• Focused microbial sampling may be indicated to determine if:

• The water in the facility’s water distribution system meets the microbial

standards of the Safe Drinking Water Act (see:

http://www.epa.gov/safewater/sdwa/index.html); See information on Boil Water Advisory.

• Mold remediation efforts were effective in reducing microbial

contamination in the affected areas of the facility (see:

http://www.epa.gov/mold/mold_remediation.html);

• Residents who are receiving care in the reopened facility acquire

infections that are potentially healthcare associated and that may be

attributed to Aspergillus spp. or other fungi, non-tubercular

mycobacterium, Legionella, or other waterborne microorganisms above

expected levels.

See also: Evacuation, Shelter-in-Place, Severe Weather, Tornado


Defined: Hazardous materials are substances that are flammable or combustible,

explosive, toxic, noxious, corrosive, oxidizable, an irritant, or radioactive. A

hazardous material spill or release can pose a risk to life, health, or property.

A warning of a hazardous accident or incident is usually received from the Fire

and/or Police Departments or from Emergency Management officials or by social

media. An overturned tanker, truck, or train, a crashed airplane, a broken fuel line,

or an accident in a chemical plant are all potential hazards.

There are a number of federal laws that regulate hazardous materials, including:

the Superfund Amendments and Reauthorization Act of 1986 (SARA), the

Resource Conservation and Recovery Act of 1976 (RCRA), the Hazardous

Materials Transportation Act (HMTA), the Occupational Safety and Health Act

(OSHA), the Toxic Substances Control Act (TSCA), and the Clean Air Act.

Title III of SARA regulates the packaging, labeling, handling, storage, and

transportation of hazardous materials. The law requires facilities to furnish

information about the quantities and health effects of materials used at the facility,

and to promptly notify local and state officials whenever a significant release of

hazardous materials occurs.

Detailed definitions as well as lists of hazardous materials can be obtained from the

Environmental Protection Agency (EPA) and the Occupational Safety and Health

Administration (OSHA) https://www.osha.gov/SLTC/hazardoustoxicsubstances/ or from

the Centers for Disease Control and Prevention:

http://www.cdc.gov/niosh/topics/emres/business.html

Local authorities and the Emergency Management Office will typically warn the

facility of such an accident occurring within the community. Some communities

may utilize a county siren or scanner to notify the community of a hazardous spill.


HAZARDOUS MATERIAL

SPILL/RELEASE Code: Orange


HAZARDOUS MATERIAL

SPILL/RELEASE Code: Orange


Immediate Action: “CODE ORANGE” should be communicated to staff with

the location of the incident, if it occurs within the facility premises.

A. Call 911 to alert the emergency response system that a hazardous materials

incident is in progress. Provide the 911 dispatcher with as much relevant

information as possible.

B. Contact County Emergency Management Director. C. Tune into Emergency broadcasts on the radio/TV or weather radio for

additional information and guidance D. If an explosion is possible outdoors, close drapes, curtains or shades over

windows. Stay away from windows to prevent injury from flying glass.

Common Staff Assignments: A. Shut windows and doors.

B. Ensure residents and visitors remain in the facility until further notice from

the local authorities.

C. Keep doors CLOSED.

D. Be prepared to activate Evacuation Procedures.

E. Remain calm to not upset the residents.

F. Account for all staff members and residents.

Specific Staff Assignments: A. Administrator and Director of Nursing, Safety Officers/Maintenance Director

will be notified if not on the premises. The Recall Roster activated, if

warranted.

B. Activate the Incident Command System (ICS) to manage the incident. The most

qualified staff member (in regard to the Incident Command System) on duty at

the time will assume the Incident Commander position. If severity of incident

warrants, then appoint other positions of ICS structure.

C. Facility management staff report to the Incident Command Post for instruction.

D. Incident Commander:

• Instruct all staff members, residents, and visitors to stay in the facility until

further notice from local authorities.

• Coordinate internal emergency operations with local authorities who will

assist in controlling the situation provided that a good line of communication

is established with the Incident Commander.

• Upon arrival of authorities, establish contact with the officer in charge and

relay all relevant information regarding the situation.

• Based on the magnitude of the incident/accident, evacuation may be

necessary. Fire Department, Police, and Emergency Management will assist

in determining if evacuation is necessary.


• Should be responsible for making the decision regarding evacuation, which

would be activated via Evacuation Emergency Procedures.

• Determine if a hazardous chemical or gas leak might endanger the residents.

• The situation should only be deemed “under control” after the local

authorities have concluded emergency operations and the Incident

Commander has declared the situation “safe.” At that point an “All Clear”

can be announced.

E. Maintenance

• Set ventilation systems to 100% recirculation so that no outside air is

drawn into the building. When this is not possible, ventilation systems

should be turned off. This is accomplished by pulling the fire alarm.

• Shut down outside intake ventilation/air conditioners. Close all doors to

the outside and close and lock all windows.

• Turn off heating systems.

• Turn off air conditioners and switch inlets to the "closed" position. Seal

any gaps around window type air conditioners with tape and plastic

sheeting, wax paper or aluminum wrap.

• Turn off all exhaust fans in kitchens and bathrooms.

• Close as many internal doors as possible.

• Use tape and plastic food wrapping, wax paper or aluminum wrap to

cover and seal bathroom exhaust fan grills, range vents, dryer vents, and

other openings to the outside.

• If the gas or vapor is soluble or partially soluble in water, hold a wet

cloth over your nose and mouth if gases start to bother you. For a higher

degree of protection, go into the bathroom, close the door and turn on the

shower in a strong spray to wash the air.


A. Compile a list of hazardous materials located on facility property.

Material Quantity Location Stored MSDS Sheet


B. Identify and label all hazardous materials stored, handled, produced, and

disposed of by your facility. Follow government regulations that apply to

your facility. Obtain material safety data sheets (MSDS) for all hazardous

materials at your location.

C. Train employees to recognize and report hazardous material spills and

releases.

D. Train employees in proper handling and storage.

E. Identify any hazardous materials used in facility processes and in the

construction of the physical plant.

• Identify other facilities in your area that use hazardous materials.

Determine whether an incident could affect your facility.

F. Identify potential for an off-site incident affecting operation.

• Identify highways, railroads, and waterways near the facility used for

the transportation of hazardous materials. Determine how a

transportation accident near the facility could affect your operations.

See also: Evacuation, Shelter-in-Place


Defined: A karst landscape is one where permeable rock, primarily limestone,

allows surface water (rain water, storm overflow) to quickly access ground water.

For most Kentucky cities, ground water is the primary source of drinking water.

Karst areas move water rapidly, without allowing for the natural filtration that

occurs when the water moves more slowly over the surface and into the ground.

Immediate Action: • The most damaging risk factor in karst regions is the contamination of

ground water in rivers and streams. The surface water enters the river or

streams by seeping quickly into the ground and taking with it fertilizers,

pesticides, bacteria, pet waste, debris, sediment, and automobile products.

Pouring chemicals down sewers, drains or onto the ground in a karst region

is much the same as pouring contaminants into the water supply. A

compromised water supply creates a significant risk to the continued

operations of a long-term care facility.

• A second potential risk in karst regions is the creation of sinkholes, similar

to the one that formed in Bowling Green KY, in 2014, creating a massive

hole inside the National Corvette Museum. Sinkholes result when water

erodes the porous rock at the surface and the land collapses into the hole.

Common Staff Assignments:

A. Inspect facility for potential fire. If warranted, evacuate using RACE system.

R: RESCUE – Rescue residents in immediate danger. A: ALARM – Sound nearest alarm if not already activated. C: CONFINE – Close doors behind you to confine the fire. Crawl if the

exit route is blocked by smoke.

E: EXTINGUISH – Utilize fire extinguisher as situation permits or

evacuate following evacuation procedures.


KARST/SINKHOLES/CAVES Code: Plain Speech/Text



A. Activate the Incident Command System (ICS). The most qualified staff

member (in regard to the Incident Command System) on duty at the time

will assume the Incident Commander position. If severity of incident

warrants, then appoint other positions of ICS structure.

B. Facility management staff report to the Incident Command Post for a


C. Put out small fires quickly. If not handled by one extinguisher, or it is larger

than a wastepaper basket, evacuate the building.

D. Check on residents, staff and visitors. Check restrooms or vacant rooms for

visitors or stranded residents.

E. Take care of injured or trapped persons. Provide medical treatment as

appropriate. Call 9-1-1 only for life-threatening emergencies.

F. Turn off gas only if you smell gas or think it may be leaking. (Natural gas

line cannot be turned on again except by the gas company.) Alert the local

Fire Department.

G. Be prepared for after-shocks and re-evaluate building safety after additional

seismic activities.

H. Help injured or trapped persons until emergency assistance arrives.

I. Give first aid where appropriate. Do not move seriously injured persons

unless they are in immediate danger of further injury. Call for help.

J. Listen to a battery-operated radio or television for latest emergency

information.

K. Use the telephone only for emergency calls.

L. Stay away from damaged areas

M. Unless police, fire, or relief organizations have specifically requested your

assistance, stay away from damaged areas. Return to the facility only when

authorities say it is safe.

N. Open cabinets cautiously. Beware of objects that can fall off shelves.

O. Clean up spilled medicines, bleaches, gasoline or other flammable liquids

immediately. Leave the area if you smell gas or fumes from other chemicals.

P. Inspect utilities

Q. Check for gas leaks. If you smell gas or hear blowing/hissing noise, start

evacuation procedures. Turn off the gas at the outside main valve if you can.

R. Look for electrical system damage. If you see sparks, broken or frayed

wires, or smell hot insulation, turn off the electricity at the main fuse box or

circuit breaker. Begin evaluation procedures.


S. 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.

T. Inspect the entire length of chimneys for damage.


A. When evaluating hazards in the facility-based assessment, consult

Kentucky’s topographical maps to identify karst areas within the region.

• If located in a karst region, communicate with county officials to

understand the topography surrounding and beneath the facility and/or

campus and the degree of risk

• Explore means of creating porous parking areas to limit runoff when

considering new construction

• If located in a region with a high risk factor, include a strategy for

evaluating the land surface on a regular basis

B. According the Kentucky Geological Survey at the University of Kentucky:

• About 55 percent of Kentucky is underlain by rocks that could develop

karst terrain, given enough time.

• About 38 percent of the state has at least some karst development

recognizable on topographic maps, and 25 percent of the state is known

to have well-developed karst features.

Kentucky Cities located on Karst include: Inner Bluegrass Western Pennyroyal Eastern Pennyroyal

Frankfort Bowling Green Monticello

Georgetown Elizabethtown Mount Vernon

Lawrenceburg Fort Knox Somerset

Lexington Hopkinsville

Louisville Munfordville

Nicholasville Princeton

Paris Russellville

Winchester

Versailles


C. Detailed maps of Kentucky and counties most prone to damage due to karst

landscape are included in the following sites:

• University of Kentucky http://www.uky.edu/KGS/karst/karst_location.php

• Bowling Green http://underbgky.org/

• US Department of Geological Survey resource https://water.usgs.gov/ogw/karst/

See also: Boil Water Advisory, Earthquake, Evacuation, Fire Watch, Fire

Warning, Severe Weather, Utility Outage


Defined: The term landslide includes a wide range of ground movement, such as

rock falls, deep failure of slopes, and shallow debris flows. Although gravity acting

on an over-steepened slope is the primary reason for a landslide, there are other

contributing factors including:

• erosion by rivers, glaciers, or ocean waves create over-steepened slopes

• rock and soil slopes are weakened through saturation by snowmelt or heavy

rains

• earthquakes create stresses that make weak slopes fail

• earthquakes of magnitude 4.0 and greater have been known to trigger

landslides

• excess weight from accumulation of rain or snow, stockpiling of rock or ore,

from waste piles, or from man-made structures may stress weak slopes to

failure and other structures

§ Slope material that become saturated with water may develop a debris flow

or mud flow. The resulting slurry of rock and mud may pick up trees,

houses, and cars, thus blocking bridges and tributaries causing flooding

along its path.

Immediate Action: A. If inside, take cover under desk, table, or other heavy piece of furniture.

B. If outdoors, get out of the path of the mudflow. Try to get to high ground. If

escape is not possible, curl into a ball and protect your head.

Common Staff Assignments: A. Stay away from the slide area. There may be danger of additional slides.

B. Remain calm to not upset the residents.

C. Look for trapped persons near – but do not go into slide area. Direct

emergency response personnel to possible victims.

D. Watch for flooding, which may occur after a landslide or debris flow. Floods

sometimes follow landslides and debris flows.


LANDSLIDE



E. Be prepared to relocate residents to safe refuge, if necessary.

F. Listen to local radio or television stations for the latest emergency

information.


A. Activate the facility’s ICS if needed.

B. Contact County Emergency Manager.

C. Monitor facility’s weather alert radio, television, and broadcast radio for

changing conditions, alerts, and warnings.

D. Notify fire department and local authorities.

E. Ensure that the specific procedures defined in the facility’s Severe Weather

Response Plans are utilized to internally manage the incident.

F. Maintain all operations in accordance with the ICS until the incident is


G. Be prepared to relocate residents to safe areas well in advance of a serious

situation; be proactive and do not wait for situation to become dire.

H. Ensure windows and draperies are closed and distribute appropriate


I. Secure the outside of the facility and cancel any outside activities or events.

J. Look for and report broken utility lines and damaged roadways and railways

to appropriate authorities. Reporting potential hazards will get the utilities

turned off as quickly as possible, preventing further hazard and injury.

K. Check the building foundation, chimney, and surrounding land for damage.

L. Damage to foundations, chimneys, or land may help assess the area safety.

M. Replant damaged ground as soon as possible as erosion can lead to flash

flooding and additional landslides.

Preparing Ahead/Training: A. Kentucky's landslides occur in all regions of the state, mostly in the Ohio

River Valley, the Knobs, the Outer Bluegrass, and Eastern Kentucky.

B. Evaluate facility for landslide hazard(s).

C. Plant slopes with ground cover.

D. Learn to recognize landslide warning signs. See link below:

E. Check policy to see if landslide is covered by flood insurance.

See Also: boil water advisory, earthquake, evacuation, flooding, karst, severe

weather

Resources: landslide warning signs available from U.S. Geological Survey:

http://landslides.usgs.gov/learn/prepare.php

Kentucky landslide information: http://www.uky.edu/KGS/landslide/


Defined: Hospital emergency codes are used worldwide to alert staff for various

emergency situations in hospitals and health care facilities. The use of codes is

intended to convey essential information quickly with a minimum of

misunderstanding to staff, while preventing stress or panic among residents and

visitors.

“Code Blue” is generally used to indicate a patient requiring resuscitation or

otherwise in need of immediate medical attention, most often as the result of a

respiratory or cardiac arrest.

Immediate Action: Place your facility medical emergency procedure here:

Resources:

The previous information is was taken from the National Institute of Health

referenced in the following: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4129865/

https://www.jointcommission.org/assets/1/6/EM-

2014_RECOMMENDATIONS_FOR_HOSPITAL_EMERGENCY_CODES_FINAL_(2).pdf


MEDICAL EMERGENCY Code: Blue


Defined: Elopement is defined by the National Institute for Elopement Prevention as

“When a … resident who is cognitively, physically, mentally, emotionally and/or

chemically impaired wanders away, walks away, runs away, escapes or otherwise leaves a

caregiving facility or environment unsupervised, unnoticed and/or prior to their scheduled

discharge.”

Immediate Action: A. Announce or communicate to staff within the resident’s unit.

B. Note the time that the resident was discovered to be missing.

C. Staff members assigned to the resident’s unit report to nursing station to verify

that resident is not signed out.


A. Share any personal knowledge that you may have with the Administrator or

Director of Nursing that may help to locate the resident.

B. Remain calm to not upset the residents.

Specific Staff Assignments: A. Contact Administrator and Director of Nursing __________________________

(facility to fill in appropriate titles/positions) if not on the premises.

B. Activate the Incident Command System (ICS) to manage the incident, if

necessary. The most qualified staff member (in regard to the Incident Command

System) on duty at the time will assume the Incident Commander position. If

severity of incident warrants, then appoint other positions of ICS structure.


MISSING RESIDENT Code: Plain Speech/Text


C. Facility management staff should report to the Incident Command Post for

instruction.

D. The Administrator/Incident Commander will assign each staff member a section

when searching to minimize overlapping or overlooking of an area.

• Systemically search facility, grounds, and neighboring streets.

• When conducting a search, look under beds and furniture, in walk-in

refrigerators/freezers, in closets, under desks, behind doors, as well as in

storage rooms, behind boxes, in boxes, and on shelves. A resident who has

eloped may be frightened and may be hiding.

• Thoroughness is extremely important.

• When finished searching a section, staff members report back to the

Administrator/Incident Commander.

E. If the resident has not been found after a period of ________ minutes of the

search, the Administrator/Incident Commander will call the police to report the

resident missing.

F. When the police arrive the Administrator/Incident Commander will provide a

picture and pertinent information such as:

• What the resident was wearing.

• How the resident was ambulating, i.e., with a cane, walker, etc.

• The resident’s cognitive status, i.e., confused, alert.

• Information as to where the resident may be going, if known.

• Resident’s previous address and family’s address.

G. Notify the resident’s family/representative and attending physician if the

resident is not found in the facility or grounds.

H. Report the incident to Division of Health Service Regulation.


Specific Staff Assignments: When the Resident has been located A. The Administrator/Incident Commander should notify all staff members that

the resident has been found.

B. Examine the resident for injuries.

C. Notify the attending physician concerning resident’s status.

D. Contact family/responsible person and inform her/him of resident’s status

(ensure all the above steps are documented in the nursing notes).

E. Notify the police.

F. Update the care plan.

• Consider implementing additional measures such as the addition of a

wander bracelet if not in current use.

• 15-minute safety checks

• Document in resident record.

G. Complete an incident report and follow the facility’s incident reporting

process.

H. Ensure the incident and events are documented objectively in the resident

record, including:

• Circumstances and precipitating factors

• Interventions utilized to return the resident to the unit

• Resident’s response to the interventions

• Results of reassessment upon the resident’s return and the condition of

the resident

• Care rendered

• Notification of police, family, and physician

• Physician orders following notification

• Additional prevention strategies implemented

I. Administrator should report the incident to the KY Office of the Inspector

General, http://chfs.ky.gov/os/oig/, and the local Ombudsman’s Office, see

http://chfs.ky.gov/dail/ltcoDistricts/


J. Contact the local law enforcement office for a Golden Alert, see

http://www.lrc.ky.gov/statutes/statute.aspx?id=40536

K. Contact KY CHFS Adult Protective Services Branch :

http://chfs.ky.gov/dcbs/dpp/adult+safety+branch.htm

L. Report elopement in Quality Assurance/Risk/Safety Committee.

Preparing Ahead/Training: A. Obtain information during pre-admission/admission conferences with family

regarding history of, or potential for, wandering.

B. Make a list of all residents known to be at risk of wandering; update list as

necessary based on resident care plan.

C. Include resident name, picture, and physical description in wander book

located at nurses’ station.

D. Ensure that staff know all residents on the list and are able to intervene as

necessary.

E. Include missing resident policy in new employee orientation.

F. Routinely check door alarms.

See Also: Medical Emergencies


Defined: Nuclear power plants use heat generated from nuclear fission in a

contained environment to convert water to steam, which powers generators to

produce electricity. Nuclear power plants operate in most states and produce about

20 percent of the nation’s power. Nearly three million Americans live within ten

miles of an operating nuclear power plant.

According to the U.S. Nuclear Regulatory Commission:

• 0 facilities in Kentucky

• 5 facilities in Tennessee

• 0 in West Virginia

• 5 facilities in Virginia

• 6 facilities in Missouri

• 1 facility in Indiana

Check https://www.nrc.gov/info-finder/region-state/indiana.html when completing facility

risk assessment to determine risk associated with nuclear energy facilities or

testing/research/production sites near facility.

Although construction and operation of nuclear facilities is closely monitored and

regulated by the Nuclear Regulatory Commission (NRC), accidents are possible.

An accident could result in dangerous levels of radiation that could affect the

health and safety of the public living near the nuclear power plant.

The risk of a chemical accident is slight. However, knowing how to handle these

products and how to react during an emergency can reduce the risk of injury.

Immediate Action: A. Minimize Exposure to Radiation by the following:

Disaster Template #13 NUCLEAR POWER

HAZARDOUS MATERIAL SPILL/RELEASE Code: ORANGE


• Distance—the greater the distance between humans and the source of the

radiation, the better. This could be evacuation or remaining indoors to

minimize exposure.

• Shielding—the more heavy, dense material between humans and the source

of the radiation, the better.

• Time—most radioactivity loses its strength fairly quickly.

Staff members and residents exposed to nuclear radiation:

• Change clothes and shoes

• Put exposed clothing in plastic bag

• Seal the bag and place it out of the way

• Take a thorough shower

B. Communicate “CODE ORANGE.”

C. Sirens will be sounding in the community. Radio announcements will give

instructions concerning evacuation.

Common Staff Assignments: C. Remain calm to not upset the residents.

D. Turn off the air conditioner, ventilation fans, furnace, and other air intakes.

E. Close and lock doors and windows.

Specific Staff Assignments: A. Administrator/Incident Commander

• Listen to battery-operated radio for information regarding the incident

and for specific instructions.

• Contact County Emergency Management Office.

• Activate the Incident Command System (ICS) to manage the incident.

The most qualified staff member (in regard to the Incident Command

System) on duty at the time will assume the Incident Commander

position.

• Instruct staff members, residents, and visitors to remain in the facility

until further notice from the local authorities.

• Activate Recall Roster, if warranted.

• Activate Evacuation Emergency Procedures, if evacuation is ordered by

local and state officials.

• Activate Shelter-in-Place Procedures, if facility is told to remain indoors.

• Account for all staff members and residents.

• Continue to monitor radio announcements for further instruction. The

situation should only be deemed “under control” and safe by local and


state authorities. At that point, the Incident Commander can declare the

situation “safe” for re-entry and/or normal operations.

B. Management Staff of All Departments

• Report to the Incident Command Post.

• Instruct staff members, residents, and visitors to remain in the facility

until further notice from the local authorities.

• Instruct staff members to lock doors and windows.

• Remain calm to not upset the residents.

• Ensure food items are kept in covered containers or in the refrigerator.

Uncovered food items should be washed before being put into containers.

• Be prepared to activate Evacuation or Shelter-in-Place Procedures.


Preparing Ahead/Training: A. Obtain public emergency information materials from the power company that

operates nuclear power plant or facilities in the local/region. Facilities located

within 10 miles of the power plant, receive materials annually from the power

company, or from state and/or local government.

B. Familiarize staff members with the following terms to help identify a nuclear

power plant emergency:

• Notification of Unusual Event: A small problem has occurred at the plant.

No radiation leak is expected. No action at the facility will be necessary.

• Alert: A small problem has occurred, and small amounts of radiation could

leak inside the plant. This will not affect the facility and no action is

required.

• Site Area Emergency: Area sirens may be sounded. Listen to your radio or

television for safety information.

• General Emergency: Radiation could leak outside the plant and off the

plant site. The sirens will sound. Tune to local radio or television station for

reports. Be prepared to follow instructions promptly.

See Also: Evacuation, Hazardous Material/Spill/Release, Shelter-In-Place


Defined: Severe Heat conditions are present when there is a loss of cooling

functions during hot weather and facility temperature reaches 85 degrees

Fahrenheit and remains so for four (4) hours.

Immediate Action: To prevent hyperpyrexia, move residents to another air

conditioned part of the facility, if available.

Common Staff Assignments: A. Open windows to let cooler outside air in and utilize fans to move air – keep

air circulating.

Specific Staff Assignments: A. Keep the residents hydrated. Force fluids if necessary and record fluid

intake.

B. Make sure an adequate supply of ice is available.

C. Provide cold wash cloths as needed.

D. Draw shades, blinds, curtains in rooms/areas exposed to direct sunlight.

E. Remove residents from areas of direct sunlight.

F. Keep outdoor activities to a minimum.

G. Check to see that residents are appropriately dressed.

H. Monitor body temperatures of the residents and notify attending physicians

if necessary, edema, shortness of breath, skin hot or dry, etc.

I. Notify 911 if a resident/staff member appears to be in danger of heat-related

stress.

J. Evacuate residents if necessary.

K. Monitor environmental thermometers on 24 hour basis.

L. Notify Medical Director.

Planning Ahead/Training: A. Take inventory to determine necessary supplies to support facility when

managing severe heat for an extended period.

B. Train staff on identifying signs of heat stress.

See Also: Evacuation


SEVERE HEAT (14A) Code: Plain Speech/Text


Defined: When the facility temperature reaches 65 degrees Fahrenheit and remains

so for four (4) hours.

Immediate Action: Monitor facility’s weather alert radio, television, and

broadcast radio for changing conditions, alerts, and warnings.

Common Staff Assignments: § Be prepared to relocate residents to safe areas in advance of a serious

situation; be proactive and do not wait for the situation to become dire.

§ Ensure windows and draperies are closed and distribute appropriate


Specific Staff Assignments: A. As severe weather potential develops, announce the appropriate alerts based on

developing conditions:

B. Secure the outside of the facility.

C. Activate the facility’s ICS if needed.

D. As severe weather arrives or warnings are issued for the area, communicate

alerts based on developing conditions:

• Activate the facility’s ICS.

• Relocate residents, staff members, and visitors to safe, pre-designated

locations.

• Close all interior doors.

• Shut down non-essential equipment.

• Monitor residents closely.

E. Notify fire department and local authorities.

F. Ensure residents are dressed warmly and have enough blankets/coverings.

G. Cover the heads of the residents and protect other extremities.

H. Force fluids, if necessary.

I. Monitor body temperatures.

J. Monitor environmental thermometers.

K. Evacuate residents if residents’ safety and welfare is jeopardized.


SEVERE COLD (14B) Code: Plain Speech/Text


L. Notify Medical Director

M. Utilize appropriate sections of the Kentucky LTC Emergency Preparedness

Manual to manage the incident as needed.

N. Maintain all operations in accordance with the ICS until the incident is


Planning Ahead/Training: Understand National Weather Service weather terminology so that appropriate

action can be taken when required. http://www.weather.gov/bgm/WinterTerms

A. Blizzard Warning—Blizzard event is anticipated within 24-36 hours.

B. Blizzard Watch—Sustained wind or gusts of 35 mph accompanied by snow

or snow drifts make conditions favorable for a blizzard event. Visibility of

less than ¼ mile for a period of three – four hours is possible.

C. Freezing Rain Advisory—an accumulation of freezing rain of below ½”

(warning criteria) is anticipated within 12-36 hours.

D. Ice Storm Warning—Storm with the potential of bringing ½” or more of

ice within 12-36 hours and covering at least 50% of zone or population

concentration area.

E. Wind Chill Advisory—Conditions suggest that wind chill temperatures

exceeding -15 degrees F are possible during the next 24-72 hours.

F. Wind Chill Warning-- Conditions suggest that wind chill temperatures

exceeding -25 degrees F are likely during the next 24-72 hours.

G. Wind Chill Watch—Conditions suggest that wind chill temperatures

exceeding -25 degrees F are possible during the next 24-72 hours.

H. Winter Storm Warning—Likelihood that heavy sleet, heavy snow, ice

and/or blowing snow will develop within 24-72 hours. Criteria for snow: 7

inches of accumulation within 12 hours; 9 inches or more within 24 hours,

that covers 50% or more of the zone or population concentration area.

Criteria for ice is ½” or more covering 50% or more of the zone.

I. Winter Storm Watch—Potential that heavy sleet, heavy snow, ice and/or

blowing snow will develop within 24-72 hours. Criteria for snow: 7 inches


of accumulation within 12 hours; 9 inches or more within 24 hours, that

covers 50% or more of the zone or population concentration area. Criteria

for ice is ½” or more covering 50% or more of the zone.

J. Winter Weather Advisory—Greater than 80% that winter storm (snow,

ice, sleet or a combination) will occur within 12-36 hours, but stay less than

warning threshold.

See Also: Evacuation, Severe Weather (Watch Or Warning), Shelter-In-Place,

Snow Emergency Plan, And Utility Outage


Defined: Snow Emergency Classifications

LEVEL 1: Roadways are hazardous with blowing and drifting snow. Roads may

also be icy. Motorists are urged to drive cautiously.

LEVEL 2: Roadways are hazardous with blowing and drifting snow. Roads may

also be icy. Only those who feel it is necessary to drive should be out on the roads.

Contact employer to see if criteria for reporting to work. Motorists should use

extreme caution.

LEVEL 3: All roadways are closed to non-emergency personnel. No one should

be driving during these conditions unless it is absolutely necessary to travel or a

personal emergency exists. All employees should contact their employer to see if

they should report to work. Those traveling on the roads may be subject to arrest. Information taken from Ohio Committee for Severe Weather Analysis and the

National Centers for Environmental Education.

Immediate Action: A. Keep posted on all area weather bulletins and relay to others.

B. Be prepared for isolation at the community.

C. Re-check heating system/emergency generator.

D. Check emergency and alternate utility sources.

Common Staff Assignments: A. Travel only when necessary, and only during daylight hours. Never travel

alone. Travel only on assigned routes.

B. Properly dress if outside trips are necessary to maintain the facility, safety of

residents, or report to work.

C. Avoid overexertion by doing only what is required.

Specific Staff Assignments: A. Conserve utilities – maintain low temperatures consistent with health needs.

B. Plug critical equipment into surge protectors.

C. Secure facility against frozen pipes.


SNOW EMERGENCY Code: Plain Speech/Text


D. Retrieve extra blankets and keep residents as warm as possible.

E. Make sure adequate staff is available.

F. Keep flashlights handy, and extra batteries available.

G. Set up sleeping area for staff who can’t go home after storm hits, or for staff

that report to work prior to the storm.

H. Review transportation plan to get staff to and from work. Facility

trucks/buses? Volunteers with 4-wheel drive vehicles? Staff that have 4-

wheel drive vehicles?

I. Close drapes on cloudy days and at night.

J. Be prepared to evacuate residents if necessary.

K. Do not panic; remain calm.

Planning Ahead/Training:

A. Purchase portable/weather radio with extra batteries.

B. Make sure emergency power supply is operable.

C. Check emergency generator – Fueled? How much of facility is powered by

generator? What is not included?

D. Make sure emergency:

• equipment and supplies are on hand, or can be readily obtained.

• food supplies and equipment are on hand.

• water supply is available.

• extra blankets are accessible.

E. Evaluate facility for potential dangers and complete needed adjustments.

F. Identify potential fire hazards.

G. Remove dead trees/limbs.

H. Purchase chains/snow tires for essential vehicles.

I. Review policy about staff reporting to work during a winter weather event.

J. Review policy with all staff prior to the winter weather event.

See Also: evacuation, severe cold, shelter-in-place, utility outage References: Information taken from the Ohio Committee for Severe Weather Analysis,

http://www.weathersafety.ohio.gov/SnowEmergencyClassifications.aspx

and the National Centers for Environmental Education https://www.ncdc.noaa.gov/snow-and-ice/


Defined: The following are examples of terrorist activity:

Explosions Terrorists have use explosive devices as a common weapon. Information about

making explosive devices is readily available in books and other information

sources. They are easily detonated from remote locations or by suicide bombers.

Conventional bombs have been used to damage and destroy financial, political,

social, and religious institutions. Attacks have occurred in public places and on city

streets.

Potential targets include:

• Strategic missile sites and military bases

• Centers of government and state capitals

• Important transportation and communication centers

• Manufacturing, industrial, technology, and financial centers

• Petroleum refineries, electrical power plants, and chemical plants, major

ports and airfields

Radiological Dispersion Device (RDD) Terrorist use of an RDD—often called “dirty nuke” or “dirty bomb”—is

considered far more likely than use of a nuclear explosive device. An RDD

combines a conventional explosive device—such as a bomb—with radioactive

material. It is designed to scatter dangerous and sub-lethal amounts of radioactive

material over a general area. RDDs appeal to terrorists because they require limited

technical knowledge to build and deploy compared to a nuclear device. Also, the

radioactive materials in RDDs are widely used in medicine, agriculture, industry,

and research, and are easier to obtain than weapons grade uranium or plutonium.


TERRORIST ATTACK



The primary purpose of terrorist use of an RDD is to cause psychological fear and

economic disruption. Some devices could cause fatalities from exposure to

radioactive materials. Depending on the speed at which the area of the RDD

detonation was evacuated or how successful people were at sheltering-in-place, the

number of deaths and injuries from an RDD might not be substantially greater than

from a conventional bomb explosion.

The size of the affected area and the level of destruction caused by an RDD would

depend on the sophistication and size of the conventional bomb, the type of

radioactive material used, the quality and quantity of the radioactive material, and

the local meteorological conditions—primarily wind and precipitation. The area

affected could be placed off-limits to the public for several months during cleanup

efforts.

Biological Threat Biological agents are organisms or toxins that can kill or incapacitate people,

livestock, and crops. The three basic groups of biological agents that would likely

be used as weapons are bacteria, viruses, and toxins. Most biological agents are

difficult to grow and maintain. Many break down quickly when exposed to

sunlight and other environmental factors, while others, such as anthrax spores, are

very long lived. Biological agents can be dispersed by 1) spraying them into the

air, 2) infecting animals that carry the disease to humans, and 3) by contaminating

food and water. Nuclear Blasts A nuclear blast is an explosion with intense light and heat, a damaging pressure

wave, and widespread radioactive material that can contaminate the air, water, and

ground surfaces for miles around. A nuclear device can range from a weapon

carried by an intercontinental missile launched by a hostile nation or terrorist

organization, to a small portable nuclear devise transported by an individual. All

nuclear devices cause deadly effects when exploded, including blinding light,

intense heat (thermal radiation), initial nuclear radiation, blast, fires started by the

heat pulse, and secondary fires caused by the destruction.

Decay rates of the radioactive fallout are the same for any sized nuclear device.

However, the amount of fallout will vary based on the size of the device and its

proximity to the ground. The heaviest fallout would be limited to the area at or

downwind from the explosion, and 80 percent of the fallout would occur during the

first 24 hours.


Hazards of Nuclear Devices The extent, nature, and arrival time of these hazards are difficult to predict. The

geographical dispersion of hazard effects will be defined by the following:

§ Size of the device – A more powerful bomb will produce more distant

effects.

§ Height above the ground the device was detonated – This will determine

the extent of blast effects.

§ Nature of the surface beneath the explosion – Some materials are more

likely to become radioactive and airborne than others. Flat areas are more

susceptible to blast effects.

§ Existing meteorological conditions – Wind speed and direction will affect

arrival time of fallout; precipitation may wash fallout from the atmosphere.

Radioactive Fallout Even if individuals are not close enough to the nuclear blast to be affected by the

direct impacts, they may be affected by radioactive fallout. Blasts that occur near

the earth’s surface create much greater amounts of fallout than blasts that occur at

higher altitudes. This is because the tremendous heat produced from a nuclear blast

causes an updraft of air that forms the familiar mushroom cloud. When a blast

occurs near the earth’s surface, millions of vaporized dirt particles also are drawn

into the cloud. As the heat diminishes, radioactive materials that have vaporized

condense on the particles and fall back to Earth. The phenomenon is called

radioactive fallout. This fallout material decays over a long period of time, and is

the main source of residual nuclear radiation.

Fallout from a nuclear explosion may be carried by wind currents for hundreds of

miles if the right conditions exist. Effects from even a small portable device

exploded at ground level can be deadly.

Nuclear radiation cannot be seen, smelled, or otherwise detected by normal senses.

Radiation can only be detected by radiation monitoring devices. This makes

radiological emergencies different from other types of emergencies. Monitoring

can project the fallout arrival times, which will be announced through official

warning channels. However, any increase in surface build-up of gritty dust and dirt

should be a warning for taking protective measures.

Electromagnetic Pulse (EMP) In addition to other effects, a nuclear weapon detonated in or above the earth’s

atmosphere can create an electromagnetic pulse (EMP), a high-density electrical

field. An EMP acts like a stroke of lightning but is stronger, faster, and shorter. An

EMP can seriously damage electronic devices connected to power sources or


antennas. This includes communication systems, computers, electrical appliances,

and automobile or aircraft ignition systems. The damage could range from a minor

interruption to actual burnout of components. Most electronic equipment within

1,000 miles of a high-altitude nuclear detonation could be affected. Battery-

powered radios with short antennas generally would not be affected. Although an

EMP is unlikely to harm most people, it could harm those with pacemakers or

other implanted electronic devices.

Immediate Action: A. The three factors for protecting oneself from radiation and fallout are

distance, shielding, and time.

• Distance – The more distance between you and the fallout particles, the

better. An underground area such as a home or office building basement

offers more protection than the first floor of a building. A floor near the

middle of a high-rise building may be better, depending on what is

nearby at that level on which significant fallout particles would collect.

Flat roofs collect fallout particles, so the top floor is not a good choice,

nor is a floor adjacent to a neighboring flat roof.

• Shielding – The heavier and denser the materials—thick walls, concrete,

bricks, books, and earth—between people and the fallout particles, the

better. While seeking shelter from any location (indoors or outdoors) and

there is visual dust or other contaminants in the air, breathe though fabric

to limit exposure.

• Time – Fallout radiation loses its intensity fairly rapidly. In time, you

will be able to leave the fallout shelter. Radioactive fallout poses the

greatest threat to people during the first two weeks, by which time it has

declined to about one percent of its initial radiation level.

B. Communicate that an explosion has occurred in the area. Initiate Take Cover Procedure.

§ Instruct staff and residents to get under or next to a sturdy table or desk if

things are falling. If directed to Take Cover in a hallway that has a door or

window at the end of the corridor, maintain a distance of at least thirty feet

(30') from the door or window and stay near the center of the building.

• Avoid areas with large ceiling spans. Small rooms or interior hallways away

from windows and doors are suitable for “taking cover” when an immediate

threat is present.

• When items stop falling, watch for weakened floors and stairways.


• Stay away from damaged areas and areas marked “Radiation Hazard” or

“HAZMAT.” Radiation cannot be seen, smelled, or otherwise detected by

human senses.

• See additional details at end of this section.

Common Staff Assignments: • Relocate residents to an area of refuge.

• Remain calm to not disturb the residents.

• Recognize stairwells as safe areas and use these to relocate residents and

visitors whenever possible.

Individual Staff Assignments: • Notify Administrator and Director of Nursing if not on the premises.

• Activate the Recall Roster if warranted.

• Activate the Incident Command System (ICS) to manage the incident. The

most qualified staff member (in regard to the Incident Command System) on

duty at the time will assume the Incident Commander position. If severity of

incident warrants, then appoint other positions of ICS structure.

• Contact first responders and county emergency managers.

• Facility management staff report to the Incident Command Post for a


• Upon relocating all residents to a safe refuge, staff members should stay in

close proximity of the residents while “taking cover.”

• Maintenance staff prepare to activate Shutdown Procedures if warranted by

the situation.

• All other staff members should immediately secure their work areas by

securing records, closing drawers and cabinets, shutting down electronic

appliances, etc., and reporting to the nearest Area of Refuge away from all

windows and doors.

• All residents, staff, and visitors should remain in their refuge area until the

danger has passed. This determination should be made by the Incident

Commander.

• Upon issuance of the “All Clear” announcement, residents should be

escorted to their rooms.



• If the explosion occurs in or adjacent to the facility, the Incident Commander

may decide to activate Emergency Activation Procedures.

• If evacuation occurs, staff members, residents, and visitors must be mindful

of falling debris and not utilize elevators. They must not stand in front of

windows, glass doors, or other potentially hazardous areas.

Preparing Ahead/Training: A. Determine if public buildings in the community have been designated as

fallout shelters.

• If none have been designated, make a list of potential shelters.

• Choose basements or the windowless center area of middle floors in

high-rise buildings, as well as subways and tunnels.

B. Protection from radioactive fallout requires taking shelter in an underground

area or in the middle of a large building.

C. Teach the 3 protective factors: distance, shielding, and time.

D. During periods of increased threat increase your disaster supplies to be

adequate for up to two weeks.

E. Consider installing a high efficiency particulate air (HEPA) filter in the

furnace return duct. These filters remove particles in the 0.3 to 10 micron

range and will filter out most biological agents. If you do not have a central

heating or cooling system, a stand-alone portable HEPA filter can be used.

F. HEPA filters are useful in biological attacks. If you have a central heating

and cooling system with a HEPA filter, leave it on if it is running or turn the

fan on if it is not running. Moving the air in the facility through the filter will

help remove the agents from the air. If you have a portable HEPA filter, take

it with you to the internal room where you are seeking shelter and turn it on.

G. HEPA filters will not filter chemical agents.

H. Modern, central heating and cooling system’s filtration should provide a

relatively safe level of protection from outside biological contaminants.

I. Teach strategies if caught outside during an attack:

• Do not look at the flash or fireball—it can blind you.

• Take cover behind anything that might offer protection.

• Lie flat on the ground and cover your head. If the explosion is some

distance away, it could take 30 seconds or more for the blast wave to hit.


Additional precautions for biological/chemical attacks:

Outdoors Indoors • Seek shelter indoors

immediately in the

nearest undamaged

building.

• If appropriate shelter is

not available, move as

rapidly as is safe

upwind and away from

the location of the

blast. Seek shelter as

soon as possible.

• Listen for official

instructions and follow

directions.

• If you have time, turn off ventilation and heating

systems, close windows, vents, exhaust fans, and

clothes dryer vents. Retrieve your disaster supplies

and a battery-powered radio and take to shelter.

• Seek shelter immediately, preferably underground

or in an interior room of a building, placing as

much distance and dense shielding as possible

between people and outdoors.

• Seal windows and external doors that do not fit

snugly with duct tape to reduce infiltration of

radioactive particles. Plastic sheeting will not

provide shielding either from radioactivity or from

blast effects of a nearby explosion.

• Listen for official instructions; follow directions.

After an RDD After finding safe shelter, those who may have been exposed to radioactive

material should decontaminate themselves. To do this, remove and bag clothing

(isolating the bag away from you and others), and shower thoroughly with soap

and water. Seek medical attention after officials indicate it is safe to leave shelter.

Contamination from an RDD event could affect a wide area, depending on the

amount of conventional explosives used, the quantity and type of radioactive

material released, and meteorological conditions. Thus, radiation dissipation rates

vary, but radiation from an RDD will likely take longer to dissipate due to a

potentially larger localized concentration of radioactive material.

Biological Threat Delivery methods include:

• Aerosols—Biological agents are dispersed into the air, forming a fine mist

that may drift for miles. Inhaling the agent may cause disease in people or

animals.

• Animals—Some diseases are spread by insects and animals, such as fleas,

mice, flies, mosquitoes, and livestock


• Food and water contamination—Some pathogenic organisms and toxins may

persist in food and water supplies. Most microbes can be killed, and toxins

deactivated, by cooking food and boiling water. Most microbes are killed by

boiling water for one minute, but some require longer. Follow official

instructions.

• Person-to-person spread of a few infectious agents is also possible—Humans

have been the source of infection for smallpox, plague, and the Lassa

viruses.

Children and older adults are particularly vulnerable to biological agents.

Filtration in Buildings

Determine the type and level of filtration in the facility and the level of protection

it provides against biological agents. The National Institute of Occupational Safety

and Health (NIOSH) provides technical guidance on this topic in their publication

Guidance for Filtration and Air-Cleaning Systems to Protect Building Environments from Airborne Chemical, Biological, or Radiological Attacks. To

obtain a copy, call 1 (800) 35NIOSH or visit the National Institute for

Occupational Safety and Health Web site and request or download NIOSH

Publication 2003-136.

After a Biological Attack In some situations, such as the case of the anthrax letters sent in 2001, people may

be alerted to potential exposure. If this is the case, pay close attention to all official

warnings and instructions on how to proceed. The delivery of medical services for

a biological event may be handled differently to respond to increased demand. The

basic public health procedures and medical protocols for handling exposure to

biological agents are the same as for any infectious disease. It is important for you

to pay attention to official instructions via radio, television, and emergency alert

systems.

Chemical Attack Chemical agents are poisonous vapors, aerosols, liquids, and solids that have toxic

effects on people, animals, or plants. They can be released by bombs or sprayed

from aircraft, boats, and vehicles. They can be used as a liquid to create a hazard to

people and the environment. Some chemical agents may be odorless and tasteless.

They can have an immediate effect (a few seconds to a few minutes) or a delayed

effect (two to 48 hours). While potentially lethal, chemical agents are difficult to

deliver in lethal concentrations. Outdoors, the agents often dissipate rapidly.

Chemical agents also are difficult to produce.


Signs of a chemical release include:

• difficulty breathing

• eye irritation

• losing coordination

• nausea

• burning sensation in the nose, throat, and lungs.

• the presence of dead insects or birds After a Chemical Attack Decontamination is needed within minutes of exposure to minimize health

consequences. Do not leave the safety of a shelter to go outdoors to help others

until authorities announce it is safe to do so.

A person affected by a chemical agent requires immediate medical attention. If

medical help is not immediately available, decontaminate using the following

guidelines:

• Use extreme caution when helping others who have been exposed to

chemical agents.

• Contaminated clothing normally removed over the head should be cut off to

avoid contact with the eyes, nose, and mouth. Put contaminated clothing and

items into a plastic bag and seal it.

• Decontaminate hands using soap and water.

• Remove eyeglasses or contact lenses. Put glasses in a pan of household

bleach to decontaminate them, and then rinse and dry.

• Flush eyes with water.

• Wash face and hair with soap and water before thoroughly rinsing.

• Decontaminate other body areas likely to have been contaminated. Blot (do

not swab or scrape) with a cloth soaked in soapy water and rinse with clear

water.

• Change into uncontaminated clothes. Clothing stored in drawers or closets is

likely to be uncontaminated.

• Proceed to a medical facility for screening and professional treatment.


Defined: A tornado is a violently rotating column of air extending from a

cumuliform cloud, such as a thunderstorm, to the ground. A watch indicates that

conditions are favorable for a tornado to develop. According to the Kentucky

Climate Center, the month of April produces an average of one quarter of all

Kentucky tornado activity.

Tornadoes may appear transparent until dust and debris are picked up or a cloud

forms within the funnel. The average tornado moves from southwest to northeast,

but tornadoes can move in any direction and suddenly change direction. The

average forward speed is 30 mph but may vary from nearly stationary to 70 mph.

The strongest tornadoes have rotating winds of over 200 mph. Waterspouts are

tornadoes that form over warm water. Water spouts can move onshore and cause

damage to coastal areas.

Immediate Action: When conditions are warm, humid, and windy, or skies are

threatening, monitor for severe weather watches and warnings by listening to

NOAA Weather Radio, logging onto www.weather.gov or tuning to a trusted

television or radio station.

A. A watch indicates that tornadoes may potentially develop as reported by

the National Weather Service or through other reports (television, radio,

community warning sirens, etc.).

B. This procedure should work in tandem with the Take Cover procedure

during an emergency situation that requires the relocation of residents,

staff, and visitors to a Safe Refuge.

C. Announce that a tornado watch has been issued for this area effective until

_________ (time watch ends). A tornado watch means that current weather

conditions may produce a tornado. Close draperies and blinds throughout the

facility and await further instructions. Continue with regular activities.


TORNADO WATCH (17A) Code: Plain Speech/Text


D. Repeat the above message after five (5) minutes and then hourly until the

watch has terminated.

Common Staff Assignments: A. Notify Administrator and Director of Nursing

______________________________________ (facility to fill in appropriate titles/positions) if not on the premises. Activate the Recall Roster if needed.

B. Facility management staff should report to the Incident Command Post for

instruction to be prepared for Take Cover Procedures. C. Activate the Incident Command System (ICS) to manage the incident. The

most qualified staff member on duty at the time will assume the Incident

Commander position.

D. Monitor weather alert radio and television for changing conditions.

E. Close all window drapes and blinds.

F. Distribute flashlights, towels, and blankets to staff and residents.

G. Ensure first aid and medical supplies are secured and taken to central area

for refuge.

H. Secure all outside furniture, trash cans, etc.

I. Once the Tornado Watch has been cancelled and the Incident Commander

has determined the dangerous situation has passed communicate, “All Clear,

Repeat, All Clear.”

J. Account for all staff members and residents.

Specific Staff Assignments: G. Remain calm to not upset the residents.

H. Be prepared to relocate residents to safe refuge, if necessary.

Preparing Ahead/Training: D. Select and train appropriate staff to preform tornado safety drills.

E. Facility must track and record staff training including date, trainer name,


F. Participate in community exercises and drills that focus on tornado

preparedness activities.

G. Participate in facility exercises that focus on tornado preparedness activities.

H. Designate Areas of Refuge within facility.

See Also: Boil water advisory, Evacuation, Tornado Warning


Defined: A warning indicates that a tornado has been sighted in the immediate

area as reported by the National Weather Service or through other reports

(television, radio, community warning sirens, etc.). Immediate Action: A. This procedure works in tandem with the Take Cover Procedure during an

emergency situation that requires the relocation of residents, staff, and

visitors to a safe Area of Refuge.

B. A tornado warning has been issued for our area. Immediately implement the

Take Cover Procedure. Repeating—“a tornado warning has been issued for

our area. Immediately implement the Take Cover Procedure.”

C. Repeat the above message after five (5) minutes and then hourly until the

warning has terminated.

General Staff Assignments:

D. Notify the Administrator and Director of Nursing

______________________________________ (facility to fill in appropriate titles/positions) if not on the premises. Activate the Recall Roster if needed.

E. Activate the Incident Command System (ICS) to manage the incident. The most

qualified staff member on duty at the time will assume the Incident Commander

position.

F. Upon hearing this announcement, all personnel should refer to the Take Cover

Procedure and follow it in its entirety to help ensure the safety of the residents,

visitors, and themselves.

G. Once the Tornado warning is over and the Incident Commander has determined

the dangerous situation has passed, “All Clear, Repeat, All Clear” should be

communicated to signal the Take Cover situation has ended.

H. Upon issuance of the All Clear announcement, escort residents to their rooms.

Disaster Template #17(A/B) TORNADO WARNING (17B)



I. Account for all staff members and residents.

Specific Staff Assignments: A. Remain calm to not upset the residents.

B. Be prepared to relocate residents to safe refuge, if necessary.

Preparing Ahead/Training: A. Select and train appropriate staff to preform tornado safety drills.

B. Facility must track and record staff training including date, trainer name,


C. Participate in community exercises and drills that focus on tornado

preparedness activities.

D. Participate in facility exercises that focus on tornado preparedness activities.

E. Designate Areas of Refuge within facility.

See also: Boil water advisory, Evacuation, Tornado Watch


Defined: Emergencies which include any interruption or loss of a utility service,

power source, information system, or equipment needed to keep the residents and

employees safe, and maintain facility operations. Immediate Action: Determine if the loss of a utility (electric, gas, propane, water,

etc.) is due to an incident occurring at the facility like a rupture, leak, fire, and/or

collision (vehicle striking meter, etc.).

A. Notify appropriate utility company(s) of the outage and contact 911 if there

is an emergency situation. B. Review SEVERE WEATHER templates to prevent hypopyrexia during loss

of heating functions and hyperpyrexia during loss of cooling functions.

C. For Gas Line break:

• Evacuate the building immediately. Follow evacuation procedures. • Shut off the main valve. • Open windows. • Re-enter building only at the direction of utility officials.


A. Remain calm not to upset the residents.

B. Be prepared to activate emergency procedures.

Specific Staff Assignments: Administrator/Incident Commander


UTILITY OUTAGE

Electrical/Gas/Water/Technology



A. Determine the impact of service disruption and projected duration.

B. Record Emergency Agency contacted: ______________________________

Contact person: ________________________________________________

When: ___________am/pm

C. If warranted, activate the ICS to manage the incident. The most qualified

staff member (in regard to the Incident Command System) on duty at the

time will assume the Incident Commander position. Appoint other positions

of the ICS structure as necessary.

D. Initiate Severe Cold and Hot Weather Procedures if necessary.

E. Activate the Recall Roster if warranted.

F. Protect human life, facility, supplies by relocating residents to other floors or

areas, removing items from floor that may be in harm’s way.

G. Initiate Evacuation Emergency Procedures, if outage is long-term and

threatens resident safety and welfare.

H. Ensure staff members and residents are accounted for and safe.

Director of Nursing

A. Ensure back-up systems (emergency generators, emergency lighting,

additional blankets, flashlights, emergency water, etc.) are available and

operating as designed in accordance with requirements.

B. Monitor safety of the residents and staff during severe cold and hot weather

during a power outage.

• Activate severe weather procedures.

• Monitor oxygen & other medical equipment – create policy as needed


D. Be prepared to assist where needed at the direction of the Incident

Commander.

Nursing Staff

A. Initiate proactive and preventative measures to safeguard and isolate

resources to help preserve said resources (keep doors to refrigerators and

freezers closed, keep outside doors closed to maintain air conditioning, etc.).

B. Monitor resident safety.


D. Be prepared to assist where needed at the direction of the Incident

Commander.


Maintenance Personnel

A. Determine if the loss of a utility (electric, gas, propane, water, etc.) is due to

an incident occurring at the facility like a rupture, leak, fire, and/or collision

(vehicle striking meter, etc.).

B. Contact utility providers.

C. Check to see that fire alarm & response system is operational.

D. Determine the impact of service disruption and projected duration.

E. Turn off power at main control point if short is suspected.

F. Ensure back-up systems (emergency generators, emergency lighting,

additional blankets, flashlights, emergency water, etc.) are available and

operating as designed in accordance with requirements.

G. Continuously monitor equipment that may be adversely impacted due to the

failure itself (electrical grounding, failure of other systems, etc.) and/or

negative circumstances that may occur upon sudden resumption of utility

(over-pressurization, power surge, etc.).

H. Assist with Severe Weather Procedures if necessary.

I. Be prepared to activate Evacuation Procedures.

J. Be prepared to assist where needed at the direction of the Incident

Commander.

All Other Employees

A. Ensure back-up systems (emergency generators, emergency lighting,

additional blankets, flashlights, emergency water, emergency food, etc.) are

available and operating as designed in accordance with requirements.

B. Initiate Severe Weather Procedures if necessary.

C. Keep refrigerator storage units for food and medicines closed to retard

spoilage.

D. Be prepared to activate Evacuation Procedures.

E. Be prepared to assist where needed at the direction of the Incident

Commander.

Preparing Ahead/Training: A. Review emergency utility blueprints, contact info and shutdown procedures.

B. Identify security and alarm systems, fire, elevators, lighting, life support

systems, heating, ventilation and air conditioning systems, electrical

distribution system, emergency generators, medical gas delivery systems,

and other critical systems.


• Breaker Panel Card copied and attached to emergency plan on (date)

____________________________.

C. Determine need for backup systems.

D. Identify communication systems, both data and voice computer networks.

E. Create/keep an accurate blueprint of all utility lines and pipes associated

with the facility and grounds.

F. Evaluate backup generator needs. Disseminate info to facility staff

regarding what can be run on backup generators

G. Consider power needs for critical safety and medical equipment,

refrigeration, temp control, etc.

H. List day and evening phone numbers of emergency reporting and repair

services of all serving utility companies and maintenance personnel for day

and evening notification.

I. Arrange for private contract to serve as an added backup source for

generator, gas and diesel.

J. Ensure that safety and maintenance personnel are thoroughly familiar with

building systems.

• Master Keys Control:

__________________________________________________

• Master Key Holders:

___________________________________________________

• Location of Emergency Keys:

___________________________________________________

• Procedure for Use:

___________________________________________________

K. Establish procedures for restoring systems.

L. Establish preventive maintenance schedules for all systems and equipment.

M. Train Staff on course of action to follow on elevator safety and use when

stuck between floors/power outage.

N. Request that maintenance staff inspect all personal electrical appliances prior

to use in the facility.

O. Test generators based on current NCPA codes (NFPA® 99 and NFPA® 110

and NPFA® 101) and manufacturer requirements.

P. Arrange walk through of facility by Emergency Management, Fire, Police

and emergency transport services:


• Determine location/s where each group will park/place their

emergency equipment to assist residents.

• Share facility design and plans for moving residents to area of refuge

in emergency.

• Share evacuation route within the facility and determine which doors

will be used for residents, Emergency management, Fire and Police to

avoid evacuation over/around equipment and workers.

See Also: Disaster Plan, Evacuation, Severe Heat/Cold, Shelter-in-Place, Snow

Emergency


a) Boil Water Advisory

To boil water • Fill a pot with water.

• Heat the water until bubbles come from the bottom of the pot to the top.

• Once the water reaches a rolling boil, let it boil for one minute.

• Turn off the heat source and let the water cool.

• Pour the water into a clean container with a cover for storage.

Disinfecting water If you are unable to boil water, disinfect instead.

If tap water is clear: • Use unscented bleach (bleach that does not have an added scent).

• Add 1/8 teaspoon (8 drops or about 0.75 milliliters) of unscented household

liquid bleach to 1 gallon

• (16 cups) of water.

• Mix well and wait 30 minutes or more before drinking.

• Store disinfected water in clean container with a cover.

If tap water is cloudy: • Filter water using clean cloth.

• Use unscented bleach (bleach that does not have an added scent).

• Add 1/4 teaspoon (16 drops or 1.5 milliliters) of unscented household liquid

bleach to 1 gallon (16 cups) of water.

• Mix well and wait 30 minutes or more before drinking.

• Store disinfected water in clean container with a cover.

To sanitize containers: • Use unscented bleach (bleach that does not have an added scent).

• Make a sanitizing solution by mixing 1 teaspoon (5 milliliters) of unscented

liquid bleach in 1 quart water.

• Pour this sanitizing solution into a clean storage container and shake well,

making sure that the solution coats the entire inside of the container. Let the

clean storage container sit at least 30 seconds, and then pour the solution out

of the container.

• Air dry empty container OR rinse with clean water that has already been

made safe, if available. Never mix bleach with ammonia or other cleaners.


• Open windows and doors to get fresh air when you use bleach.

Water filters • Boil tap water even if it is filtered. Most kitchen and other household water

filters typically do not remove bacteria or viruses.

Preparing and cooking food • Wash all fruits and vegetables with boiled water that has cooled or bottled

water.

• Bring water to a rolling boil for 1 minute before adding food to cook.

• Use boiled water when preparing drinks, such as coffee, tea, and lemonade

• Wash food preparation surfaces with boiled water.

Ice • Do not use ice from ice trays, ice dispensers, or ice makers.

• Throw out all ice made with tap water.

• Make new ice with boiled or bottled water.

Bathing and showering • Be careful not to swallow water when bathing or showering.

• Use caution when bathing residents. Consider giving them a sponge bath to

reduce the chance of them swallowing water.

Brushing teeth

• Brush teeth with boiled or bottled water.

• Do not use untreated tap water.

Washing dishes • Dishwashers are safe to use if the water reaches a final rinse temperature of

at least 150 degrees or if the dishwasher has a sanitizing cycle.

To wash dishes by hand:

• Wash and rinse the dishes as you normally would using hot water.

• In a separate basin, add 1 teaspoon of unscented household liquid bleach for

each gallon of warm water.

• Soak the rinsed dishes in the water for at least one minute.

• Let the dishes air dry completely.


Laundry • It is safe to do laundry as usual.

Resources: Water from Private Wells, Cisterns, Storage Tanks, Tankers, and Rain-Catchment Systems: CDC provides guidance on water from various sources.

http://emergency.cdc.gov/disasters/foodwater/

Personal Preparation and Storage of Safe Water: CDC provides guidance on

the amount of water needed for good health, as well how to prepare and store safe

water before and during an emergency.

http://www.cdc.gov/healthywater/emergency/safe_water/personal.html

Hygiene and Handwashing: CDC provides guidance on alternative hygienic

practices when water is not available or is contaminated.

http://www.cdc.gov/healthywater/emergency/hygiene/index.html

A Guide to Water Filters: CDC maintains a guide for filters that remove

Cryptosporidium or Giardia.

http://www.cdc.gov/parasites/crypto/gen_info/filters.html

EPA Safe Drinking Water Hotline: 1-800-426-4791

Consumer Information: EPA provides information and guidance about drinking

water quality, emergencies, contaminants, public health issues, and treatment and

storage. http://water.epa.gov/drink/emerprep/

Information gathered from the Centers for Disease Control and Prevention and the

American Water Works Association in collaboration with the U.S.

Environmental Protection Agency and other partners.

March 2013 - http://www.cdc.gov/healthywater/emergency/dwa-comm-toolbox/tools-templates-main.html


Defined: Kentucky is particularly susceptible to wildland fires because nearly half

of the state is covered by forest. Also, the percentage of watershed acreage has

declined steadily over the decades depleting over 80% of original wetlands.

Kentucky’s state borders include 12.4 million acres (48% of total land mass) of

forest. Kentucky’s deciduous vegetation makes wildland fires a significant and

growing threat particularly in eastern regions. The KY Department of Natural

Resources Division of Forestry manages wildfires, assisted by local and state fire

departments.

During the spring and fall Forest Fire Hazard Seasons, it is unlawful to burn within

150 feet of a woodland or brush land boundary between 6:00 am – 6:00 pm:

• February 15 – May 30

• October 1 – December 15

Information adapted from the Kentucky Division of Forestry.

http://forestry.ky.gov/wildlandfiremanagement/Pages/default.aspx

Immediate Action: A. Contact Emergency Manager and First Responders.

B. Secure windows and doors.

C. Remain calm to not disturb the residents.

Common Staff Responsibilities: W. Evacuate residents according to the size of the fire and the volume of smoke

production. The Incident Commander will give guidance on evacuation type.

1. Phase I: Move residents to an area away from the fire. This type of

evacuation should be used during the initial stages of a small fire.

2. Phase II: Evacuate all residents from the smoke compartment where

the fire has occurred to the opposite smoke compartment (through the


WILDLAND/FOREST FIRE

Code: Red


smoke doors). This type of evacuation should be used when moderate

smoke conditions are present or the welfare of the residents is in

jeopardy based on the situation.

3. Phase III: FIRE DEPARTMENT ORDERED EVACUATION.

Evacuate all residents from the building by whatever means possible.

This type of evacuation should only be used during a major fire or

severe smoke conditions within the building as ordered by the Fire

Department.

X. Determine the order of evacuation by resident type. Examples are:

1. Ambulatory residents

2. Residents with assistive devices

3. Residents in wheelchairs

4. Bedridden residents

Specific Staff Responsibilities: A. Administrator/Incident Commander

a. Communicate with local authorities to determine risk.

b. Initiate NIMS/Incident Command Center.

c. Initiate rapid decision-making regarding implementation of wildland fire

plan.

d. Consider continuity of care implications due to a loss of power

e. Shut down air intakes to prevent smoke from entering facility.

f. Determine whether evacuation is necessary, and if so, according to what

timeframe.

g. Utilize appropriate sections of the Kentucky LTC Emergency

Preparedness Manual to manage the incident as needed.

B. Management Staff of All Departments

a. Report to Incident Command Center.

b. Secure windows, doors and any areas where smoke could enter.

c. Activate the facility’s communications plan with:

i. State, regional and local emergency managers

ii. Residents, family members, resident representatives

iii. Residents and staff currently off-site

iv. Facilities with agreements for evacuation

v. Internal and external radios/auxiliary phones


C. Director of Nursing

a. Coordinate operations with the Incident Commander to determine the

potential for shelter-in-place or evacuation.

b. Prepare nursing staff to gather required medical and personal supplies to

prepare for evacuation.

c. Instruct Certified Nursing Assistants to remain with residents in an

attempt to keep them calm.

d. Perform a complete resident head count.

e. Prepare for loss of power in regards to safety and continuity of care

D. Nursing Staff

a. Report to the area of fire alarm activation.

b. Initiate Evacuation Procedures.

c. Close all doors and windows, as residents are evacuated.

d. Connect O2 concentrators to all residents requiring oxygen.

e. Shut off oxygen or other medical gasses that could contribute to the

spread of the fire.

f. Secure medical records.

g. Perform a complete resident head count.

h. Prepare “go bags” for residents.

i. Be prepared to assist where needed at the direction of the Incident

Commander and/or Fire Department.

E. Maintenance Personnel

a. Assist the Fire Department in whatever way required.

b. Prepare back-up generators in case of loss of power

c. Ensure that the appropriate Evacuation Procedures are in progress and

attempt to control the fire if required.

d. Attempt to de-power the fire (if active) by shutting down circuit breakers

for the fire area.

e. NEVER shut down the fire sprinkler system during a fire. The shutting

down of the fire sprinkler system must be ordered by the Fire

Department.

F. All Staff

a. Prepare for loss of power and impact on resident continuity of care

b. Review plan elements in regards to severe cold/heat in case of power

outages

c. FIRE DEPARTMENT ORDERED EVACUATION. Evacuate all

residents from the building by whatever means possible. This type of

evacuation should only be used during a major fire or severe smoke


conditions within the building or surrounding area as ordered by the Fire

Department.

Planning Ahead/Training:

To limit the potential of damage/destruction due to wildland fires Long-Term Care Facilities must:

A. Assess the potential of wildland fire risk when completing the initial and

annual risk assessments

B. Create defensible space around all structures

a. Defensible space is a double circle that surrounds buildings and

determines the likelihood of a facility surviving a wildland fire.

Defensible space that is clear of combustible materials reduces the

chance of wildland fires moving across the property and up to the

walls of a building.

b. Two zones make up the defensible space.

c. The inner circle (zone 1) extends 30 feet from the structures, decks,

buildings

• Remove all dead plants, grass and weeds

• Remove dead or dry leaves and pine needles from the yard,

roof, gutters

• Trim trees regularly to create a distance of at least 10 feet

between trees

• Remove branches that hang over the roof and keep dead

branches at least 10 feet from chimneys

• Remove or prune flammable plants and shrubs near windows

• Remove vegetation and items that could catch fire from around

and under decks

• Create a separation between trees, shrubs and items that could

catch fire, such as patio furniture and planters

d. The outer circle (zone 2) extends 100 feet from the structure.

• Cut or mow annual grass to a maximum height of 4 inches

• Create horizontal spacing between shrubs and trees


1. Horizontal space is dependent on the slope of land and

the height of trees or shrubs

2. The greater the slope and taller the shrub or tree, the

greater the distance between the two

• Create vertical spacing between grass, shrubs and trees

3. Remove all tree branches so that the lowest branches are

6 feet (or higher) from the ground

4. Allow extra vertical space between shrubs and trees.

Lack of vertical space can allow a fire to move from

ground to brush to tree tops like a ladder

5. To determine how much space is required between a

shrub and the lowest limbs of a tree, measure the height

of the shrub and multiply by three. This is the required

distance between the shrub and the lowest tree branch.

e. Remove fallen leaves, needles, twigs, bark, cones and small branches.

A depth of 3 inches or less is not problematic.

C. Document a strategy to contain or remove on-site hazardous materials

D. If located in a high-risk area, consider performing a community-based or

facility-based wildland fire exercise to complete one of the two CMS

required annual emergency preparedness training exercises

E. Keep abreast of weather-related risks during the Forest Fire Hazard Seasons

and anytime drought conditions are present

F. Monitor

http://forestry.ky.gov/wildlandfiremanagement/Pages/AdvisoriesandRedFlagWarnings.as

px for updated information about potential wildland fires.

Go to http://www.readyforwildfire.org/Defensible-Space/ for training materials provided

through CAL FIRE, the Dept. of Forestry and Fire Protection at CA.gov

See Also: evacuation, fire, severe weather, shelter-in-place, utility outage


Defined: Workplace violence is defined as “violent acts (including physical

assaults and threats of assaults) directed toward persons at work or on duty”

(National Institute for Occupational Safety and Health (NIOSH).

Actions or words that endanger or harm employees or that result in others having a

reasonable belief that they are in danger include:

§ Verbal or physical harassment

§ Verbal or physical threats

§ Assaults or other violence made directly/indirectly by words, gestures, or

symbols

§ Any other behavior that causes others to feel unsafe (e.g. bullying, sexual

harassment)

§ Use or possession of a weapon on the facility premises

Workplace violence incidents can be categorized by the relationship of the

assailant and the worker/workplace. They are as follows:

§ Violence by strangers—persons who have no connection to the workplace

§ Violence by customers, clients, residents, etc.

§ Violence by co-workers—former or current employment relationship.

Incidents that occur outside the workplace, but which resulted or arose from

the employment relationship

§ Violence by personal relations—incidents committed by someone who has a

personal relationship with the worker, such as a current or former spouse or

partner, relative or friend

Immediate Action: “Run, Hide, Fight.”


WORKPLACE VIOLENCE

THREAT OF VIOLENCE



General Staff Assignments: A. While personal safety is the primary consideration in any emergency,

helping others to safety increases the survivability for all potential victims.

Rendering aid can be as simple as rallying likely victims to “Follow me!” or

aiding non-ambulatory persons and performing immediate first aid in safer

areas. Consideration should be given to residents who have difficulty

evacuating without assistance.

B. Workplace violence incidents are unpredictable and evolve quickly.

Because of this, individuals must be prepared to deal with an incident

before law enforcement personnel arrive on the scene.

C. When an incident occurs, follow the emergency plans and any instructions

given, taking into consideration their particular circumstances. The safety

of residents, other staff, visitors, and vendors is the most important factor

to consider when making decisions.

D. Staff closest to the public address or other communications system should

communicate the danger and necessary action.

E. As the situation develops, it is possible that those present will need to use

more than one option. While they should follow the “Run, Hide, Fight” plan

and any instructions given by appropriate facility representatives during an

incident, they will often have to rely on their own judgment to decide which

option will best protect lives.

Run – Best option A. Run out of the facility or away from the area under attack and move as far away

as possible until in a safe location. Simply exiting the building and going to an

evacuation site via practiced fire drill routes may put individuals at risk.

B. Recent research shows the best method to reduce loss of life in an active

shooter incident is for people to immediately evacuate or be evacuated from the

area where an active shooter may be located or attempting to enter.

C. Leave personal items behind.

D. Visualize possible escape routes, including physically accessible routes for

residents, visitors, or staff with disabilities and others with access and

functional needs.

E. Avoid escalators and elevators.

F. Take others if possible, but do not stay behind because others will not go.

G. Call 911 when safe to do so.


Call 911 to Report:

A. Location and description of attackers.

B. Types of weapons, methods and direction of attack, and flight of attackers.

C. Don’t assume that someone else has called.

Hide – if Exits are Inaccessible

A. If running is not a safe option, hide in a safe space with thick walls and few

windows. For residents who cannot “run” because of mobility issues (e.g., they

are unable to leave their bed) hiding may be their only option.

B. Lock the doors.

C. Barricade doors with heavy furniture or wedge items under the door.

D. Secure the unit entrance(s) by locking the doors and/or securing the doors by

any means available (e.g., furniture, cabinets, bed, and equipment).

E. Close and lock windows and close blinds or cover windows.

F. Turn off lights.

G. Silence all electronic devices.

H. Remain silent.

I. Look for other avenues of escape.

J. Identify items (fire extinguishers, chairs, lamps) that could be used as weapons.

Communicate Nonverbally with First Responders

In rooms with exterior windows, make signs to silently signal law enforcement and

emergency responders to indicate the status of the room’s occupants).

A. Hide along the wall closest to the exit but out of view from the hallway (which

would allow the best option for ambushing the shooter and for possible escape

if the shooter enters or passes by the room).

B. Remain in place until given an all clear by identifiable law enforcement.

Fight – If Running and Hiding aren’t Options A. Disrupt or incapacitate the shooter by using aggressive force and items in their

environment, such as fire extinguishers, chairs, etc.

B. Research shows the strength in numbers; potential victims themselves disrupted

17 of 51 active shooter incidents before law enforcement arrived.

Interacting with First Responders Police officers, firefighters, and EMS personnel (i.e., first responders) who come

to the facility because of a 911 call involving gunfire face a daunting task. Though


the objective remains the same—protect residents, visitors, vendors and staff—the

threat of an active shooter incident is different than responding to a natural

disaster or many other emergencies. Information coming in can be inaccurate and

conflicting. This violence might be directed not only in or at facilities, staff,

residents, visitors and vendors, but also at nearby buildings off site.

Law enforcement’s first priority is to locate and stop the person or persons

believed to be the shooter(s); all other actions are secondary.

A. Do not interfere with the law enforcement response.

B. Follow directions and display empty hands with open palms.

C. Law enforcement may instruct everyone to get on the ground, place their hands

on their heads

D. Individuals may be searched. Don’t resist.

Specific Staff Assignments/following the workplace violence situation: After the active shooter has been incapacitated, management should engage in

post-event assessments and activities:

A. Account for all individuals at one or more designated assembly points to

determine who, if anyone, is missing or potentially injured.

B. Coordinate with first responders to account for any residents, visitors, vendors

and staff who were not evacuated.

C. Determine the best methods for notifying families of individuals affected by

the active shooter, including notification of any casualties; this must be done in

coordination with law enforcement.

D. Assess the behavioral health of individuals at the scene. Provide information to

victims, victim families, staff and others about distress helplines, Office for

Victims of Crimes counselors or employee assistance personnel (EAP).

Substantial resources and processes are in place to aid victims and their

families, most notably through state agencies, the Department of Justice, and

the FBI’s Office for Victim Assistance.

E. Ensure equal access to all such resources and programs for people who are

deaf, hard of hearing, blind, have low vision, low literacy and other

communication disabilities and individuals with limited English proficiency.


F. Activate a staff family unification plan, communicating this to staff and

providing a safe place, away from press for families to gather.

G. Identify and fill any critical personnel or operational gaps left in the

organization as a result of the active shooter.

H. Determine when to resume full services.

I. Nothing should be touched unless it involves tending to the wounded. The

situation and the location are an active crime scene.

J. Plan for an extended, evolving situation and the mass casualty or internal

disaster plan to be activated to manage the continuing situation. This may

include altering daily activities in order for law enforcement and first

responders to adequately investigate and clear the scene.

Preparing Ahead/Training: A. Train staff, appropriate residents, and volunteers the “Run, Hide, Fight”

response.

B. Train staff to overcome denial and to respond immediately. For example, train

staff to recognize the sounds of danger, act, and forcefully communicate the

danger and necessary action (e.g., “Gun! Get out!”).

C. Repetition in training and preparedness shortens the time it takes to orient,

observe, and act.

D. Training provides the means to regain composure, recall at least some of what

has been learned, and commit to action. Training to “Run, Hide, or Fight”

prevents inaction.

E. In many instances, an individual might first need to hide and then run to safety

when able.

F. It is not uncommon for people confronted with a threat to first deny the possible

danger rather than respond, hearing firecrackers when, in fact, they are hearing

gunfire. G. Speaking with staff about confronting a shooter may be daunting and

upsetting for some people, but great comfort can come from the knowledge

that their actions could save lives. To be clear, confronting an active shooter

should never be a requirement of any health care provider’s job; how each


individual chooses to respond if directly confronted by an active shooter is up

to him or her.

See Also: Kentucky Community Crisis Response Board (KCCRB), Mental

Health Resources, Psychological First Aid, Workplace Violence

Resources: Guidelines for Preventing Workplace Violence for Healthcare and Social Service

Workers

https://www.osha.gov/Publications/osha3148.pdf

OSHA website with resources on Workplace Violence.

https://www.osha.gov/SLTC/workplaceviolence/index.html

Items listed below are a few from the OSHA website.

Risk Factors The following references provide information on risk factors and scope of violence

in the workplace and may help increase awareness of workplace violence:

Federal Agency Guidance:

Violence on the Job. National Institute for Occupational Safety and Health

(NIOSH) Publication No. 2004-100d, (2004). Discusses practical measures for

identifying risk factors for violence at work, and taking strategic action to keep

employees safe. Based on extensive NIOSH research, supplemented with

information from other authoritative sources.

Violence Occupational Hazards in Hospitals. US Department of Health and Human

Services (DHHS), National Institute for Occupational Safety and Health (NIOSH)

Publication No. 2002-101, (2002, April). Increases employee and employer

awareness of the risk factors for violence in hospitals and provides strategies for

reducing exposure to these factors.

Prevention Programs

The following references provide guidance for evaluating and controlling violence

in the workplace.

OSHA Guidance:


Updated Guidelines for Preventing Workplace Violence for Healthcare and Social

Service Workers (PDF* | EPUB** | MOBI**). OSHA Publication (OSHA-3148),

(2015).

Workplace Violence (PDF*). OSHA Fact Sheet, (2002). A Spanish version (PDF*)

is also available. Provides basic information about vulnerable occupations,

employer/employee roles in prevention and protection, and recommendations for

response to violent incidents.

Hospital. OSHA eTool.

http://www.osha.gov/SLTC/etools/hospital/hazards/workplaceviolence/viol.html#saferroom

Workplace Violence. Includes recommendations for establishing a violence

prevention program.

Training

Workplace Violence. OSHA. Contains links to a variety of training and reference

materials, including presentations, publications, and handouts.

Workplace Violence Prevention for Nurses. Centers Disease Control and

Prevention (CDC), National Institute for Occupational Safety and Health (NIOSH).

Provides training to healthcare workers on how to recognize the elements of a

workplace violence prevention program and develop skills for preventing and

responding to workplace violence.

Other Federal Agency Guidance

Workplace Violence Prevention. Minnesota Department of Labor & Industry.

Provides links to prevention resources including workplace violence videos, links

to other organizations and training resources

A Comprehensive Guide for Employers and Employees (PDF). Provides guidance

to develop and implement a workplace violence prevention program. Includes

model policy, sample forms, threat and assault log, five warning signs of escalating

behavior, sample workplace weapons policy, sample policy about domestic

violence in the workplace and personal conduct to minimize violence.

Violence Prevention Brochure: Maintaining a Safe Workplace. University of

California - Davis (UC Davis). Presents information designed to highlight stresses

and risks in the work environment, to enhance workplace safety, and to reduce and

prevent disruption and violence.


MINCAVA Electronic Clearinghouse - Workplace Violence. Minnesota Center

Against Violence and Abuse (MINCAVA), University of Minnesota (UM).

Provides resources identified by the Minnesota Center Against Violence and

Abuse specific to workplace violence.

Most Workplace Violence on Women Hidden, Says Center Report. University of

Albany (UA), Center for Women in Government. Summarizes and comments on a

report addressing workplace violence, emphasizing data specific to women. Two-

thirds of the nonfatal attacks on women are committed by patients or residents in

institutional settings. Husbands, boyfriends and ex-partners commit 15 percent of

all workplace homicides against women. Women are more likely to suffer serious

injury from workplace violence than men. Women who are victims of violent

workplace crimes are twice as likely as men to know their attackers.

Enforcement

There are currently no specific standards for workplace violence.

However, under the General Duty Clause, Section 5(a)(1) of the Occupational Safety

and Health Act (OSHA) of 1970, employers are required to provide their

employees with a place of employment that "is free from recognizable hazards that

are causing or likely to cause death or serious harm to employees." The courts have

interpreted OSHA's general duty clause to mean that an employer has a legal

obligation to provide a workplace free of conditions or activities that either the

employer or industry recognizes as hazardous and that cause, or are likely to cause,

death or serious physical harm to employees when there is a feasible method to

abate the hazard.

An employer that has experienced acts of workplace violence, or becomes aware of

threats, intimidation, or other indicators showing that the potential for violence in

the workplace exists, would be on notice of the risk of workplace violence and

should implement a workplace violence prevention program combined with

engineering controls, administrative controls, and training.


OSHA Enforcement Standard Interpretations

Staff-to-resident ratio in a nursing home and workplace violence. (2006, August 14).

Request for OSHA national policy banning guns from the workplace and OSHA enforcement

policy regarding workplace violence. (2006, September 9).

OSHA's guidelines are advisory, do not create new employer obligations, and are not basis for

citations. (2004, June 7).

OSHA's policy for scheduling occupational fatality investigations. (1997, March 12).

OSHA policy regarding violent employee behavior. (1992, December 10).

Search all available standard interpretations for workplace violence.


VI. Communication Plan

A. Internal and External Communications

______________________________________ (facility name) should establish methods of communicating both internally and externally during a crisis or disaster situation. Traditional communication systems may be unavailable (failure) or may be overwhelmed (overload) during a critical event.

Examples of alternate communication methods include cellular phones (possibly cellular phones with outside area codes), satellite phones (both of which may not always be reliable), the internet (if computer systems are operable), two-way radios, CB, or HAM radios. Mass notification systems are another option.

1. Internal Facility Communication Plan:

Landlines ___________________ Cell Phones ________________ Walkie Talkies _____________ MGZ Radios __________________

_______________________ (facility name) has identified and secured __________________ as the primary communication method for internal usage in the event of a disaster event. In the event that the primary system is inoperable ______________________________________ has been designated as the alternate and supplemental method of communication.

2. External Facility Communication Plan:

Landlines ________________ Cell Phones ___________________ Email ________________________ Fax Machine ______________________________ Satellite Phone _____________________________ HAM Radio _____________________________Social Media _________________________________

______________________________________ has been identified as the primary means of external usage communications in the event of a disaster. ______________________________________ has been designated as the alternate and supplemental method of communication in the event of a disaster.

_________________________________________________________ (facility position) is responsible for the testing and maintenance of the above devices to ensure proper functioning when needed.

B. Facility Notification Procedure

In an emergency, it is recommended that the facility designate two cell phone numbers to contact residents’ families/resident representative. One cell number will accept calls (incoming only) and the second will place (outgoing only) calls. One staff member will be assigned to receive calls from families/resident representatives and a second employee assigned to place calls to families/resident representatives. This process will allow the facility’s main numbers to remain open to communicate with emergency responders. A list of telephone numbers of resident emergency contacts is located at (location).


During an emergency, (name/position) is responsible for contacting family members/representatives using the dedicated (outgoing only) cell phone number__________________. Alternate staff member to make outgoing calls: (name/position). During an emergency, (name/position) is responsible for receiving calls from family members/representatives using the dedicated (incoming only) cell phone number ____________. Alternate staff member to take incoming calls: (name/position). C. Communication Plan with Staff

1. Staff Call Tree Procedures A phone tree identifies staff, medical partners, and safety and health officials. Share contact information with your communication team. See form on next page.

• Limit the number of people each person must call. • Leave a message for unavailable contacts. The caller should continue down the phone tree and

continue attempting contact with unavailable persons. • Each unit should have provisions for getting the information to a person who was not contacted. • The last person called should report back to a designated person to signal the end of the calling

process. • Keep the message short and concise. Only the facts should be given and each caller should avoid

speculation. Confidentiality should be stressed. • Update the phone tree at least annually to ensure accurate phone numbers and inclusion of all

staff.


2. CALL TREE TEMPLATE

Template adapted from California Department of Health. http://www.bepreparedcalifornia.ca.gov/CDPHPROGRAMS/PUBLICHEALTHPROGRAMS/EMERGENCYPREPAREDNESSOFFICE/EPOPROGRAMSANDSERVICES/RISKCOMMUNICATION/Pages/CrisisandEmergencyRiskCommunicationToolkit.aspx

Designated Staffing Authority

Name:

Function:

Phone:

Cell Phone:

Email:

Name:

Function:

Phone:

Cell Phone:

Email:

Name:

Function:

Phone:

Cell Phone:

Email:

Name:

Function:

Phone:

Cell Phone:

Email:

Name:

Function:

Phone:

Cell Phone:

Email:

Name:

Function:

Phone:

Cell Phone:

Email:

Name:

Function:

Phone:

Cell Phone:

Email:

Name:

Function:

Phone:

Cell Phone:

Email:

Name:

Function:

Phone:

Cell Phone:

Email:

Name:

Function:

Phone:

Cell Phone:

Email:

Name:

Function:

Phone:

Cell Phone:

Email:

Name:

Function:

Phone:

Cell Phone:

Email:


Staff Member Primary Number Alternate Number Department

D. Primary and Alternate Means of Contacting Families and Resident Representatives Communication Plan 1. ______________________________________ (facility name) should maintain emergency contact numbers in addition to primary telephone numbers for family members and resident representatives in order to notify them as quickly as possible.

Staff members will be briefed to the following elements to share with residents and family members as assigned:

• Safety status of residents (see HIPPA tab and link under Resources)

• Type of threat

• Estimated time and severity of impact

• General outlook at the current time

• Expected disruptions to services or routines


• What the facility administration has done and is doing right now to lessen negative outcomes

• When to expect updated status reports

• What family members can do to help • When and how for families and residents to contact each other and/or meet

1(Florida Health Care Association Emergency Guide for Nursing Homes, Part I Comprehensive Emergency Management Plan, 2007, p 15):

E. Communicating with off-site Residents and Staff Residents could be off-site during an emergency or disaster attending an activity or visiting family. A facility’s emergency preparedness plan should include a procedure to account for and contact residents and accompanying staff when off-site. In the following space, describe the procedure and facility plans to contact residents off-site during an emergency. F. Family/Resident Representatives/Visitor Procedures Designate an area and develop a plan to address the needs of families and visitors who may be in the facility during an emergency, including a provision of support services such as counseling and information updates. _______________________will be designated as the family/resident representative visitor waiting area. (name/position) will be assigned to the role of providing support during the emergency/disaster. If the facility has a policy to shelter employees’ families during an emergency, the following area will be designated as the shelter area for families of staff . G. Contacting Family of Staff Members In the event of a disaster/emergency, staff will be allowed to contact their families as soon as possible following the disaster at the direction of the Incident Commander.


H. Sample Letter to Resident/Family/Resident Representative Printed on Facility Letterhead (For mailing or emailing)

DATE Dear Residents, Family Members and Resident Representatives: We are including this letter in your welcome packet to let you know that the administration at (facility name) is prepared, not only for the daily care of our residents, but also for the unlikely event that we are faced with an emergency. In advance of an impending crisis or disaster situation, including an epidemic/pandemic episode, it is important for ________________________________ (facility name) staff members, residents, family members/resident representatives, and the community-at-large to understand that the facility has developed a relationship with local emergency responders to properly plan, prepare, respond, and recover from such situations.

The County Emergency Manager, First Responders and the (county name) Health Department are aware of our Emergency Preparedness Plan. Our primary concern is resident safety and comfort. Therefore, we plan to remain in our facility should an emergency occur. However, if the building is damaged or we cannot remain on our grounds for other reasons, we have made arrangements for residents and staff to relocate to another location. Family members and resident representatives will be contacted if evacuation is necessary. If possible, staff can assist in coordinating arrangements for residents who want to stay with family members/resident representatives during an evacuation rather than move to another long-term-care facility. Please do not call our main line during an emergency because we need to leave the line open to communicate with emergency responders. The call-in number during an emergency is (____) ________________. Additionally, it may not be safe or possible for anyone other than emergency providers to visit our facility at the onset of a disaster. ____________________ (facility name) intends to contact family members/resident representatives in the event of an emergency, and will do so as soon as we have taken care of critical safety issues. Please complete the following information so we can reach family/resident representative during an emergency: Resident’s Name____________________________________________________________

Family Member/Resident Representative_________________________________________

Primary Phone: (_____)___________________ Secondary Phone (_______)____________

Emergency Contact: _________________________________________________________


Primary Phone: (_____)___________________ Secondary Phone (_______)____________

Emergency Contact: _________________________________________________________

Primary Phone: (_____) ___________________ Secondary Phone (_______)____________

If you must contact the facility during a disaster, again we ask you to call our designated cell phone number at _(______)_________________________. If you have questions about ________________________________ (facility name) Emergency Preparedness Plan, please feel free to contact me directly at ( ) _______. Sincerely, NAME OF ADMINISTRATOR


I. Sharing Personal Health Information (PHI)

Maintaining and sharing resident medical documentation with other health care providers may be necessary during an emergency. If evacuation is required (see evacuation tab) a receiving facility will need documentation on each resident in order to provide for their safety and continued care during transport or relocation. Although staff from the sending facility may accompany residents, accessing PHI is essential to provide continuity of care. Having an external and internal storage location for medical documentation is recommended. 1. HIPPA and Disasters Knowing what information can be released, to whom, and under what circumstances, is critical for healthcare facilities in disaster response. Administrators can release Personal Health Information (PHI) about individuals living in Long-Term-Care facilities (designated covered entities) without resident authorization under certain circumstances. The goal is to provide continuity of care for each resident while releasing only the essential PHI to the individuals/organizations who are in a need-to-know position. The Facility Emergency Preparedness Plan must include a system of documentation that:

1. Preserves resident information 2. Protects confidentiality 3. Secures and maintains availability of records

2. At A Glance – Algorithm for disclosing health information

See form on next page


Long-Term-Care Facilities may release PHI without resident permission: • When information is necessary to treat a resident or a different individual (e.g., roommate

of a resident who has been diagnosed with an infectious disease)

• To individuals at risk of contracting or spreading a disease or condition

• To staff and contracted professionals involved in resident care

• When there is imminent threat to public health/safety (outbreak of pandemic)

• To family/resident representative, or others involved in resident care, or to identify,

locate or notify family members/resident representatives

• If public individuals are necessary to locate family/resident representative, resident’s

location, general condition or death may be released to police, press or public-at-large

• With disaster relief organizations such as the American Red Cross for the purpose of

coordinating notification of family members/resident representative, or person’s involved

in resident care

• If gathering the PHI permission would interfere with a relief organization’s ability to

respond to an emergency

• When facing imminent danger, PHI may be shared with anyone as necessary to prevent

or lessen a serious or imminent threat to the health and safety of person(s) or public

• When permission is not possible due to incapacitation, or the individual is not available,

PHI can be shared for the above listed purposes if, in administration’s professional

judgement, doing so is in the resident’s best interest

• To a public health authority that is authorized by law to collect or receive information for

purpose of preventing or controlling disease, injury or disability. Examples include:

o Reporting disease or injury

o Vital events such as birth or death

o Conducting surveillance, investigations, or interventions

Do not release PHI: • If written permission is possible, administrative staff of the LTC Facility (covered entity)

should obtain before disclosing

• Beyond necessary degree of detail. Limit information as to general terms of resident’s

condition (e.g., critical or stable, deceased, treated and released) unless the resident has

not objected or restricted release of PHI

• If resident identification isn’t mandatory; provide minimum necessary to accomplish the

purpose

• When the provider’s standards of ethical conduct are violated, unless

emergency/circumstances and/or imminent danger warrants release

• Without regard during an emergency unless 1) the Secretary of U.S. Department of

Health and Human Services and 2) the President declares an emergency or disaster

Release to Law Enforcement without authorization when: • The official is reasonably able to prevent or lessen a serious or imminent threat to health

or safety of individual or public


• A suspicious death suggests criminal conduct

• An off-site emergency suggests criminal activity

• PHI is evidence of a crime that occurred at the facility

Information was taken from the following website: https://asprtracie.hhs.gov/documents/aspr-

tracie-hipaa-emergency-fact-sheet.pdf

Department of Health and Human Services Healthcare Emergency Preparation Gateway (ASPR

Tracie). August 31, 2016


3. HIPAA and Disasters: What Emergency Professionals Need to Know (August 31, 2016)

Disasters and emergencies can strike at any time with little or no warning and the local

healthcare system in the midst of an emergency response can be rapidly inundated with patients,

worried family and friends looking for their loved ones, and media organizations requesting

patient information. Knowing what information can be released, to whom, and under what

circumstances, is critical for healthcare facilities in disaster response. This guide is designed to

answer frequently asked questions regarding the release of information about patients following

an incident.

NOTE: This guide does NOT replace the advice of your facility Privacy Officer and/or legal

counsel who should be involved in planning for information release prior to an event, developing

policy before a disaster that guides staff actions during a disaster, and during an emergency when

contemplating disclosures.

This guide does address what information can be disclosed and under what circumstances.

Covered entities can disclose needed patients’ protected health information (PHI) without

individual authorization:

• If necessary to treat the patient or a different patient or if the information would help treat

a different patient

• To a public health authority, as outlined below

• At the direction of a public health authority, to a foreign agency acting in collaboration

with the public health authority

• To persons at risk of contracting or spreading a disease or condition (if authorized by

other law)

• With certain people involved with patient’s care/ responsible for the patient

• When there is imminent threat to public health/ safety

Covered entities: • Health plans

• Healthcare clearinghouses

• Healthcare providers (e.g. hospitals, clinics, pharmacies, nursing homes) who conduct

one or more covered healthcare transactions electronically.

Business associates: • Persons or entities that perform functions or activities on behalf of, or provide certain

services to, a covered entity that involve creating, receiving, maintaining, or transmitting

PHI.

• Subcontractors that create, receive, maintain, or transmit PHI on behalf of another

business associate.


What is HIPAA and the Privacy Rule? The Health Insurance Portability and Accountability Act (HIPAA) of 1996 and its implementing

regulations, the HIPAA Privacy, Security, and Breach Notification Rules, protect the privacy and

security of patients’ PHI, but is balanced to ensure that appropriate uses and disclosures of the

information may still be made when necessary to treat a patient, to protect the nation’s public

health, and for other critical purposes.

Does HIPAA Apply to Me or My Organization? The HIPAA Privacy Rule applies to disclosures made by employees, volunteers, and other

members of a covered entity’s or business associate’s workforce. Covered entities are health

plans, healthcare clearinghouses, and those healthcare providers that conduct one or more

covered healthcare transactions electronically, such as transmitting healthcare claims to a health

plan.

Business associates generally include persons or entities (other than members of the workforce

of a covered entity) that perform functions or activities on behalf of, or provide certain services

to, a covered entity that involve creating, receiving, maintaining, or transmitting PHI. Business

associates also include subcontractors that create, receive, maintain, or transmit PHI on behalf of

another business associate.

HIPAA does not apply to disclosures made by those who are not covered entities or business

associates (although such persons or entities are free to follow the standards on a voluntary basis

if desired).

When Can PHI Be Shared? Patient health information, or PHI, can be shared under the following circumstances:

Treatment. Under the HIPAA Privacy Rule, covered entities may disclose, without a patient’s

authorization, PHI about the individual as necessary to treat the patient or to treat a different

patient. Treatment includes the coordination or management of healthcare and relate services by

one or more healthcare providers and others, consultation between providers, providing follow-

up information to an initial provider, and the referral of patients for treatment.

Public Health Activities. The HIPAA Privacy Rule recognizes the legitimate need for public

health authorities and others responsible for ensuring public health and safety to have access to

PHI that is necessary to carry out their public health mission. Therefore, the HIPAA Privacy

Rule permits covered entities to disclose needed PHI without individual authorization:

• To a public health authority that is authorized by law to collect or receive such

information for the purpose of preventing or controlling disease, injury or disability, or to

a person or entity acting under a grant of authority from or under contract with such

public health agency,. This could include, for example: the reporting of disease or injury;

reporting vital events, such as births or deaths; and conducting public health surveillance,

investigations, or interventions.

• At the direction of a public health authority, to a foreign government agency that is acting

in collaboration with the public health authority.


• To persons at risk of contracting or spreading a disease or condition if other law, such as

state law, authorizes the covered entity to notify such persons as necessary to prevent or

control the spread of the disease or otherwise to carry out public health interventions or

investigations.

Covered entities can disclose needed PHI without individual authorization:

• If necessary to treat the patient or a different patient

• To a public health authority authorized by law to collect or receive such information

• At the direction of a public health authority, to a foreign agency acting in collaboration

with the public health authority

• To persons at risk of contracting or spreading a disease or condition (if authorized by

other law)

• With certain people involved with patient’s care/ responsible for the patient for

reunification or when in the patient’s best interest

• When there is imminent threat to public health/ safety

Disclosures to Family, Friends, and Others Involved in an Individual’s Care and for Notification.

A covered entity may share PHI with a patient’s family members, relatives, friends, or other

persons identified by the patient as involved in the patient’s care. A covered entity may also

share information about a patient as necessary to identify, locate, and notify family members,

guardians, or anyone else responsible for the patient’s care, of the patient’s location, general

condition, or death. This may include—if necessary to notify family members and others—the

police, the press, or the public at large.

The covered entity should get verbal permission from individuals or otherwise be able to

reasonably infer that the patient does not object, when possible; if the individual is incapacitated

or not available, covered entities may share information for these purposes if, in their

professional judgment, doing so is in the patient’s best interest.

In addition, a covered entity may share PHI with disaster relief organizations such as the

American Red Cross, which are authorized by law or by their charters to assist in disaster relief

efforts, for the purpose of coordinating the notification of family members or other persons

involved in the patient’s care, of the patient’s location, general condition, or death. It is

unnecessary to obtain a patient’s permission to share the information in this situation if doing so

would interfere with the organization’s ability to respond to the emergency.

Imminent Danger. Healthcare providers may share patient information with anyone as

necessary to prevent or lessen a serious and imminent threat to the health and safety of a person

or the public – consistent with applicable law (such as state statutes, regulations, or case law) and

the provider’s standards of ethical conduct.


Disclosures to the Media or Others Not Involved in the Care of the Patient/Notification.

Upon request for information about a particular patient by name, a hospital or other healthcare

facility may release limited facility directory information to acknowledge an individual is a

patient at the facility and provide basic information about the patient’s condition in general terms

(e.g., critical or stable, deceased, or treated and released) if the patient has not objected to or

restricted the release of such information or, if the patient is incapacitated, if the disclosure is

believed to be in the best interest of the patient and is consistent with any prior expressed

preferences of the patient. Reference 45 CFR 164.510(a). In general, except in the limited

circumstances described elsewhere, affirmative reporting to the public or media of specific

information about treatment of an identifiable patient, such as specific tests, test results or details

of a patient’s illness, may not be done without the patient’s written authorization (or the written

authorization of a personal representative who is legally authorized to make healthcare decisions

for the patient).

General or aggregate information in mass casualty events that does not identify an individual or

meets the requirements of the HIPAA Privacy Rule’s de-identification provisions is not

considered PHI (e.g., X number of casualties were received by the hospital with the following

types of injuries).

Minimum Necessary. For most disclosures, a covered entity must make reasonable efforts to

limit the information disclosed to that which is the “minimum necessary” to accomplish the

purpose. (Minimum necessary requirements do not apply to disclosures to health care providers

for treatment purposes.) Covered entities may rely on representations from a public health

authority or other public official that the requested information is the minimum necessary for the

purpose.

Note: The disclosures listed above are at the discretion of the covered entity and are not required

disclosures under the Rule. Some of these disclosures may be required by other federal, state or

local laws (for example, mandatory reporting of positive infectious disease test results).

Does the HIPAA Privacy Rule Permit Disclosure to Public Officials Responding to a Bioterrorism Threat or other Public Health Emergency? Yes. The HIPAA Privacy Rule recognizes that various agencies and public officials will need

PHI to deal effectively with a bioterrorism threat or emergency. The public health threat does not

have to reach a declared emergency status. If information is needed by a government agency to

protect the health of the public (e.g., a food-borne outbreak), the agency may request and receive

appropriate clinical and other information about the patient’s disease, care, and response to

treatment. To facilitate the communications that are essential to a quick and effective response to

such events, the HIPAA Privacy Rule permits covered entities to disclose needed information to

public officials in a variety of ways. Further, if the covered entity has obligations to report test

results and other information to public health agencies by statute, rule, or ordinance, the HIPAA

Privacy Rule generally permits these disclosures.

Covered entities may disclose PHI, without the individual's authorization, to a public health

authority acting as authorized by law in response to a bioterrorism threat or public health


emergency (reference 45 CFR 164.512(b)), public health activities). The HIPAA Privacy Rule

also permits a covered entity to disclose PHI to public officials who are reasonably able to

prevent or lessen a serious and imminent threat to public health or safety related to bioterrorism

(reference 45 CFR 164.512(j)), to avert a serious threat to health or safety). In addition,

disclosure of PHI, without the individual's authorization, is permitted where the circumstances of

the emergency implicates law enforcement activities (reference 45 CFR 164.512(f)); national

security and intelligence activities (reference 45 CFR 164.512(k)(2)); or judicial and

administrative proceedings (reference 45 CFR 164.512(e)).

Is the HIPAA Privacy Rule “Waived” or “Suspended” During an Emergency? The HIPAA Privacy Rule is not suspended during a public health or other emergency; however,

under certain conditions the Secretary of the U.S. Department of Health and Human Services

may waive certain provisions of the HIPAA Privacy Rule section 1135(b)(7) of the Social

Security Act, if such a waiver is deemed necessary for the particular incident when the Secretary

declares a public health emergency and the President declares an emergency or disaster under the

Stafford Act or National Emergencies Act. For more information, access “Is the HIPAA Privacy

Rule suspended during a national or public health emergency?”

Does the HIPAA Privacy Rule Permit Disclosure to Law Enforcement? A HIPAA-covered entity may disclose PHI to law enforcement with the individual’s signed

HIPAA authorization. A covered entity may disclose directory information as mentioned above

to law enforcement upon request. Further disclosures to law enforcement for purposes of re-

unification and family notification are permitted as discussed above.

A HIPAA-covered entity also may disclose PHI to law enforcement without the individual’s

signed HIPAA authorization in certain incidents, including:

• To report to a law enforcement official reasonably able to prevent or lessen a serious and

imminent threat to the health or safety of an individual or the public.

• To report PHI that the covered entity in good faith believes to be evidence of a crime that

occurred on the premises of the covered entity.

• To alert law enforcement to the death of the individual, when there is a suspicion that

death resulted from criminal conduct.

• When responding to an off-site medical emergency, as necessary to alert law enforcement

about criminal activity.

• To report PHI to law enforcement when required by law to do so (such as reporting

gunshots or stab wounds).

• To comply with a court order or court-ordered warrant, a subpoena or summons issued by

a judicial officer, or an administrative request from a law enforcement official (the

administrative request must include a written statement that the information requested

• is relevant and material, specific and limited in scope, and de-identified information

cannot be used).

• To respond to a request for PHI for purposes of identifying or locating a suspect, fugitive,

material witness or missing person, but the information disclosed must be limited to

certain basic demographic and health information about the person.


• To respond to a request for PHI about an adult victim of a crime when the victim agrees

(or in limited circumstances if the individual is unable to agree). Child abuse or neglect

may be reported, without a parent’s agreement, to any law enforcement official

authorized by law to receive such reports.

How Does the HIPAA Privacy Rule Apply to Disclosures Involving Foreign Nationals? Covered entities may disclose PHI for all persons, regardless of nationality, according to the

disclosures listed in the Privacy Rule and discussed above. Disclosure of PHI to embassies,

consulates or other third parties, such as the American or International Red Cross acting in a

capacity to facilitate notifications or repatriation following an emergency, is permitted under the

existing disclosures of the HIPAA Privacy Rule, as referenced above.

For More information

• Bulletin: HIPAA Privacy in Emergency Situations

https://www.hhs.gov/sites/default/files/emergencysituations.pdf

• Can healthcare information be shared in a severe disaster?

https://www.hhs.gov/hipaa/for-professionals/faq/1068/is-hipaa-suspended-during-a-

national-or-public-health-emergency/index.html

• Health Information Privacy – Is HIPAA Privacy Rule Suspended during a National or

Public Health Emergency?

https://www.hhs.gov/hipaa/for-professionals/faq/1068/is-hipaa-suspended-during-a-

national-or-public-health-emergency/index.html

• Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule: A Guide for

Law Enforcement

https://www.hhs.gov/sites/default/files/ocr/privacy/hipaa/understanding/special/emergenc

y/final_hipaa_guide_law_enforcement.pdf

• HIPAA Privacy Rule: Disclosures for Emergency Preparedness – A Decision Tool

https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-

preparedness/decision-tool-overview/index.html

• Hurricane Katrina Bulletin: HIPAA Privacy and Disclosures in Emergency Situations

https://www.hhs.gov/sites/default/files/katrinanhipaa.pdf

• Incorporating Active Shooter Incident Planning into Health Care Facility Emergency

Operations Plans. Appendix A: Information Sharing. (Page 29 of 33)

https://www.phe.gov/Preparedness/planning/Documents/active-shooter-planning-

eop2014.pdf


• When does the Privacy Rule allow covered entities to disclose PHI to law enforcement

officials?

https://www.hhs.gov/hipaa/for-professionals/faq/505/what-does-the-privacy-rule-allow-

covered-entities-to-disclose-to-law-enforcement-officials/index.html

• HIPAA Policy Brief

https://www.phe.gov/about/OPP/dhsp/Pages/hipaa-policybrief.aspx

For more information on HIPAA and Public Health:

http://www.hhs.gov/ocr/privacy/hipaa/understanding/special/publichealth/index.html

For more information on HIPAA and Emergency Preparedness and Response:

http://www.hhs.gov/ocr/privacy/hipaa/understanding/special/emergency/index.html

General information on understanding the HIPAA Privacy Rule may be found at:

http://www.hhs.gov/ocr/privacy/hipaa/understanding/index.html

Retrieved from: https://asprtracie.hhs.gov/documents/aspr-tracie-hipaa-emergency-fact-sheet.pdf

Department of Health and Human Services Healthcare Emergency Preparation Gateway (ASPR

Tracie). August 31, 2016


J. Communication Plan to the Public

In advance of an impending crisis or disaster situation, including an epidemic/pandemic episode,

it is important for ________________________________ (facility name) staff members,

residents, family members/resident representatives, to know that the facility has developed an All

Hazards Emergency Plan to prepare for, respond to, and recover from any emergency situation.

Establishing relationships with local emergency responders and the ___________ County

Emergency Management Agency are essential components of this plan.

The following person serves as the Public Information Officer (Official Spokesperson) for

___________ (facility name) with alternates designated:

Name/Contact Information Title Department

K. Contacting Federal, State, Regional and Local Emergency Preparedness

Facility must maintain: For the following persons/entities:

Primary and alternate means of contact Facility staff

Primary and alternate means of contact Federal, state, tribal, regional and local EP Staff

Names and contact information Entities providing services under agreement (dietary,

therapists, housekeeping, etc.)

Names and contact information LTC Ombudsman, State Licensing & Certification

Agency

Names and contact information Physicians, Medical Directors, Nurse Practitioners

Names and contact information, directions

and transportation provisions

LTC Receiving facilities (if evacuating)

Names and contact information Volunteers (key to operations), Kentucky Health

Emergency Listing for Professionals for Surge (K

HELPS)

Names and contact information Other forms of support (transportation, supplies vendors,

etc.)


L. Emergency Communication Tools The Kentucky LTC Facility Disaster Assessment Form is an emergency communication tool for

sharing the status of a facility during an emergency or an exercise.

1. Instructions for completing the KY LTC Disaster Assessment Form

The Kentucky LTC Disaster Assessment Form is used to produce a snapshot of the status of a

facility during and after a disaster or during an exercise.

Prior to an emergency, complete the facility identification section and sections B, D and E.

• Complete the Facility Identification section

o Facility Name

o Address

o City

o County

o 24-hour telephone number

o HPC Region

o KYEM Region

o GPS Latitude

o GPS Longitude

• Complete Section B: Communications Section

o B-5 – Satellite Radio

o B-6 – Access to a Ham Radio

o B-7 – Other forms of communication

• Complete Section D: Structural Assessment/HVAC

o D-1 – More than one floor

o D-2 – More than one building

• Complete Section E: Electrical Power

o E-2 – Generator; include what type/wattage of generator in the comments area.

o E-4 – Generator run 100% of facility; if not, list what it does run in the comments

area

o E-6 – Type of fuel for generator

• Save as MASTER Disaster Assessment Form

During the emergency, complete the entire form, updating Sections B,D,E and adding Sections A,C,F,G, H and person report section.

The first time the form is completed during a disaster, check the Report Status as “Initial

Report.” Always include the date and time the form is completed, including AM or PM and your

time zone.


Each time the form is updated, check the “Update” box as well as update the date and time

section and other information on the form.

Use the comments area to clarify/report any additional information.

The staff member completing the report should complete the last section of Page 2. It is

important to list several phone numbers or other means of communication so that the staff

member could be contacted regarding the information reported.

• Maintain the facility’s MASTER Disaster Assessment Form for future use.

Reporting Bed Availability – Section H: Bed Census/Health Care

In the event that another LTC facility or facilities have to evacuate, it is important to know what

beds are available in other facilities across the state. Due to high census rates in each region,

evacuating facilities will depend upon facilities in other counties or regions to house evacuees.

When reporting bed census/health care availability, beds are reported according to their

categories: Skilled Nursing Facility (SNF), Nursing Facility (NF), Nursing Home (NH),

Intermediate Care Facility (ICF), Alzheimer’s (ALZ), Person Care (PC), or Intermediate Care

Facility/Mental Retardation (ICF/MR).

Example:

Current Bed Census/Available Beds

Occupied beds # in your facility now/available beds now

SNF: 85/4

Facilities can report other information about their bed availability in the Comments area.

Examples are: male beds, female beds, number of personal care apartments, single or shared

rooms, etc.

The KY LTC Facility Disaster Assessment Form can be submitted:

• Via WebEOC. https://webeoc.chfs.ky.gov/eoc7/

• Information can be submitted to [email protected]

The KY LTC Facility Disaster Assessment Form is also available at: https://kyaging-

ltcpreparedness.louisville.edu/ky-ltc-facility-disaster-assessment-form/


Long Term Care Facility Disaster Assessment Form

REPORT STATUS (check one) � Initial Report � Update Date: _____/_______/___

Time: ____________

NATURE OF THE EVENT: ____________________________________________________________________________

FACILITY IDENTIFICATION

Facility Name: _______________________________________ Address: ______________________________________________

City: ____________________________ County: ________________ 24 Hour Telephone Number: (_______) _______-_________

HPC Region: _______KYEM Region: _______ GPS Latitude: ___________________ GPS Longitude: _____________________

SECTION A

IMMEDIATE NEEDS Y N COMMENTS

A-1: Does your facility have any immediate needs, i.e., staffing?

A-2: Are there any immediate health and medical needs?

� Minor Injuries

� Serious Injuries

� Life Threatening Injuries

� Fatalities

� Behavioral Health

� Crisis Standards of Care

A-3: Is your facility accessible by normal routes?

SECTION B

COMMUNICATIONS Y N LIST CONTACT INFORMATION

B-1: Are landline telephones available?

B-2: Are cell phones available? – Is Texting Available?

B-3: Can you access the internet?

B-4: Are email services available?

B-5: Is there a Satellite Radio located near your facility?

B-6: Does your facility have access to a Ham Radio?

B-7: Other:____________________________________________

SECTION C

SECURITY Y N COMMENTS

C-1: Do you have security in place?

C-2: Is your facility currently on lockdown?

C-3: Is there a security risk from outside people or patients/clients?

C-4: Can all outside access sites (doors/windows) be locked?

C-5: Does your facility need security assistance?

SECTION D

STRUCTURAL ASSESSMENT/HVAC Y N COMMENTS

D-1: Does your facility have more than one floor?

D-2: Does your facility have more than one building?

D-3: Is there structural damage to your facility? If yes, what % of

building is damaged?

� Walls: __________

� Roof:__________

� Floor:__________

� Windows: __________

� Doors:__________

� Other:__________

D-4: Can your facility maintain normal operations? If no, do you

need to evacuate?


D-5: Is the heating and air (HVAC) system operational? If no, is

there adequate ventilation?

SECTION E

ELECTRICAL POWER Y N COMMENTS

E-1: Is your facility currently using commercial electrical power?

E-2: Does your facility have a generator?

E-3: Is the generator currently being used?

E-4: Can the generator run 100% of the facility? If no, what does

the generator supply power to?

E-5: How many days can your generator currently run based upon

current fuel supply?

E-6: What type of fuel does the generator use?

Diesel _____Gasoline _____Natural Gas _____Propane

SECTION F

WATER AND SEWER Y N COMMENTS

F-1: Are hot and cold running water available?

F-2: If yes, is this water safe to drink? If no, is there an adequate

water supply onsite of at least 1 to 2 gal/day/person for 3-5 days?

F-3: Are ice supplies available from an approved source?

F-4: Are there an adequate # of hand washing stations?

F-5: Is the sewage system operational? If no, does your facility

require assistance with sewage disposal?

SECTION G

FOOD SERVICE Y N COMMENTS

G-1: Is there a safe food source for staff /residents/visitors?

G-2: Can foods be held at proper temperatures (<41°F - >145°F)

G-3: Is there an adequate supply of food (3-5 days)?

SECTION H

BED CENSUS/HEALTH CARE Y N COMMENTS

H-1: Bed H-1: Current Bed Census/Available Beds

SNF: ____ ______

NF: _____ ______

NH: _____ ______

ICF:_____ ______

ALZ: ____ _____

PC: _____ _____

ICF/MR: _____ _____

H-2: Does your facility require transportation assistance for

movement/evacuation of patients? (check all that apply)

� Ambulatory: #_____

� Non-ambulatory: #_____

� Bedfast: #_____

� Bariatric: #_____

� Memory Disorders: #_____

� Other: #_____

H-3: Does your facility have refrigeration for medications?

H-4: Is there adequate number medications, clinical supplies, i.e.,

O2, sharps containers, biohazard bags, etc?

H-5: Is there adequate number of facility supplies, i.e, cleaning

supplies, trash bags, etc

PERSON REPORTING (Please Print Legibly)

Name: ____________________________________________________ Job Title: _____________________________________

Phone: (_______) _______-_________ Mobile Phone: (_______) _______-_________ Alt Phone: (_______) _______-__________

Fax: (_______) _______-_________

Email:_______________________________________________________________________


3. Web-based Emergency Operations Center (WebEOC)

Please note that as of July 2017, there is no longer a way for LTC to report on WebEOC WebEOC is an online situational awareness software program whereby facilities can enter status reports,

request resources and share bed availability. Each KY LTC facility is listed under their HPP/HPC Region

number. Each KY LTC has their own page to report their status. The questions are based on the KY LTC

Facility Disaster Assessment Form.

WebEOC is password protected. Set up or change passwords via the WebEOC helpdesk at

[email protected]

WebEOC training videos can be accessed at the Kentucky Emergency Preparedness for Aging and Long-

Term Care website at www.kyepltc.com under the “Resources” section. There is also a Quick Reference

Guide for WebEOC.

Please use the form under “Contacts” on the www.kyepltc.com site to request the password for WebEOC

training.

4. Health Alert Network (HAN) Please note that as on 7/1/18, the HAN system has been replaced by ReadyOps. Contact your HPP/HPC Coordinator to be included in the Regional ReadyOps system. The Health Alert Network (HAN) sends messages prior to and/or during emergencies. The system is

administered by the Kentucky Department for Public Health (KDPH) at the state level and the Local Health

Departments at the county level. HAN alerts report area incidents that could impact a facility’s operation,

resident or workforce safety. HAN provides the most detailed, original source information about an

emergency situation as it develops.

HAN accounts need to be set up prior to an emergency/disaster. Administrators and leadership can receive

alerts via text, email or phone. HAN security ensures that only registered users receive alerts.

Setting up a HAN account is easy via:

• Resources Tab of the Kentucky Emergency Preparedness for Aging and Long Term Care website:

http://www.kyepltc.com

• http://www.chfs.ky.gov/dph/ephrs/newpgHAN.htm

• https://emergency.cdc.gov/han/

E. Communicating with the Media

• Public Information Officer, along with Administrator (if not the designated PIO) will identify

standardized ways of sharing information (regular briefings, scheduled press conferences, etc.), with

the media as well as what to release, when to release it, whom to release it to, and why to release

information

• Consider the following factors about the content released to the media:

o Protection of the privacy, health, and welfare of the residents (see HIPPA tab and link under

Resources)

o When the information cannot be released, an explanation should be shared, when possible. If

delays are encountered, the media should be so advised

o Address the public’s need for information and reassurance, including:

• Requesting that the public be advised not to come to the facility

• Methods of apprising interested parties of the situation

• Anticipated “next steps”


• Coordination of messages for handling the “worried well” (volunteers, separate

locations, family members)

Provide appropriate training to anyone in the organization who may deal with the media or perform

public relations duties, keeping in mind:

o Residents want to know--

• How will they be protected

• How they will be kept informed

• How they can help or be involved

• How soon normalcy will be reestablished

o Family Members/Resident Representatives want to know--

• How their loved ones will be protected

• Who is in charge

• Who will be providing the most accurate information about the facility’s status

• Their own responsibility during an emergency event

• The decisions the facility is making that effect their loved ones

• How their loved ones are doing

• How they can help or be involved

• How soon normalcy will be reestablished1

• Instruct staff to direct all media questions and sightings of media personnel on the facility

grounds to the Public Information Officer, who will coordinate media relations on behalf

of the facility.

• Clearly define responsibilities and limitations regarding contact with the media and the

release of information as part of the employees’ conditions of employment including

texting, Facebook, Twitter, Instagram and other social media.

• Draft a policy regarding the use of social media by employees, visitors, volunteers,

residents and others associated with the facility. This policy should be communicated to

all parties prior to an emergency/disaster.

Include ongoing communication with partners such as the KY Association of Health Care

Facilities (KAHCF) and LeadingAge Kentucky whose staff can assist with communications

during times of disasters.


EMERGENCY CONTACT LISTING

Record of Changes

Contacts Updated/Changed Date of Change Date Entered Changed by


EMERGENCY CONTACT LISTING Last Updated:

Organization Name Phone # Alternate #/Cell/Text FAX E-mail Address City/State/Zip Account #

LTC Designated Emergency Number for Families & Staff

FACILITY ADMINISTRATOR FACILITY OWNER CORPORATE OFFICE OF OIG REGIONAL OFFICE OIG ATLANTA MED. DIRECTOR

EMERGENCY MANAGEMENT/RESPONDERS

County Emergency Manager CERT Area Emergency Mgr. KY Emergency Mgt. State Fire Marshal Local Fire Dept. Local Police Dept. State Police Dept. State Police Missing Persons Sheriff Dept. Fire Alarm Monitor Co. Local Health Dept.

State Health Dept.


Organization Name Phone #

Alternate #/Cell Text FAX E-mail Address City/State/Zip Account #

State Epidemiologist WebEOC Contact HAN Contact Am Red Cross KCCRB Medical Reserve Corp County Coroner Funeral Home Dir Civil Defense UTILITIES Electric Co. Electric Co. #2 Gas Company Water Company Sanitation/Waste Fuel Oil Mobile Generator Telephone: Land Line Satellite Phones Cell Phone Co. EVACUATION Evacuation Site #1 Evacuation Site #2 Evac Site 50 miles Ambulance Ambulance #2 Ambulance #3 Air Amb/Helicopter Bus Company Bus Company #2 Alternate Transport



VENDORS Pharmaceutical Operations

Pharmaceutical Vendors/Supplies

Facility Operations

Fuel Generator Fuel

Building Supplies (hardware/lumber)

Tool/Equipment Rental HVAC Medical Supplies

Oxygen Medical supplies Infection Control Supplies Environmental Services Linens/Laundry Supplies Water and Food

Food Vendor Water Vendor Ice Vendor Aging Resources

KY LTC Ombudsman Area Agency Aging Alzheimer’s Assoc. Senior Citizen Center


KY Dept. Aging and Independent Living KAHCF Leading Age Health Resources Hospital Hospital #2 VA Medical Center


KY Region Poison Center Nat'l Response Center Disease Rprt Hotline Toxic Subst Disease Reg RECOVERY Media

OSHA Coroner's Office Funeral Homes Trash Removal Public Works Railroad Transport Dept. of Transport/HAZMAT


VII. Incident Command System

A. National Incident Management System In 2004, the President of the United States ordered the Department of Homeland Security to

institute a National Incident Management System (NIMS) to provide a comprehensive and

nationwide approach for federal, state, tribal, and local governments “to align command, control,

organization structure, terminology, communication protocols, resources, and resource-typing for

synchronization of response efforts at all echelons of government.” NIMS establishes a uniform

set of processes and procedures that emergency responders at all levels of government will use to

conduct response operations.

NIMS will enable responders at all levels to work together more effectively and efficiently to

manage domestic incidents no matter what the cause, size or complexity, including catastrophic

acts of terrorism and disasters. Federal agencies also are required to use the NIMS framework in

domestic incident management and in support of state and local incident response and recovery

activities.

B. Incident Command System (ICS) While it is required for federal, state, tribal, and local governments to use the Incident Command System (ICS) in a nationally declared emergency, there is a great benefit to ensuring

more rapid external response and consistency when all organizations use this system.

ICS is a standardized on-scene incident management concept designed specifically to allow

responders to adopt an integrated organizational structure equal to the complexity and demands

of any single incident or multiple incidents without being hindered by jurisdictional boundaries.

Incident Command System (ICS) is:

• A proven management system based on successful business practices

• The result of decades of lessons learned in the organization and management of emergency

incidents

• Represents organizational “best practices”

• The standard for incident management across the country across all levels


Training Requirements

ICS-

100.HC ICS-

200.HC IS 300 IS 400 IS-700.a IS-800.B Administrator X X

Not Required

Not Required

X Dir of Nursing X X X Plant Ops Dir X X X Environ Serv Dir X X X Soc Serv Dir X X X Dir of Dietary X X X Other Super X X X Aides X Public Info / Media Contact X

X

One of these Three Should Take

IS-700.a

X Safety/Security X X X

Risk Management

X


The ICS is a management system used to organize emergency response to a crisis or disaster

situation within the facility as well as a system used by emergency responders across the county.

ICS offers a scalable response to an emergency (incident) of any magnitude, and provides a

common framework within which people can work together. These people (human resources)

may be drawn from multiple agencies that do not routinely work together. The system is

designed to grow and shrink along with the incident, allowing more resources to be smoothly

added into the system when needed and released when no longer needed. This is achieved

because, in essence, ICS is a special case of “role playing.” Authorities and responsibilities are

inherent in roles (positions); individuals are assigned more or less temporarily to those roles, and

can be reassigned, replaced, or released as needed. This key aspect of ICS helps to reduce or

eliminate the “who’s in charge” problem.

There are five major management functions that are the foundation upon which the ICS

organization develops. These functions apply whether you are handling an internal emergency,

organizing for a major non-emergency event, or managing a response to a major disaster.

• Incident Command

• Finance/Administration

• Logistics

• Operations

• Planning

The major management positions always apply and are always filled, no matter the size of the

incident, and represent five sections of staff: 1) Command, 2) Finance/Administration, 3)

Logistics, 4) Operations, and 5) Planning. (These are sometimes remembered as FLOP.) Three

other Incident Command positions are: A) Information Officer, B) Safety Officer, and C) Liaison

Officer. The staff positions can be performed by the same person or by multiple people.

Incident Command — The Incident Commander is the single person in charge of the incident at

the facility and initially fills all five command staff positions. As the incident grows the tasks

covered by other sections can be delegated, and those new positions take the title of Section

Leader. The Incident Commander is responsible for all activity on the incident as well as creating

the overall incident objectives.

Finance/Administration — The Finance Leader is tasked with tracking incident related costs,

personnel records, requisitions, and administrating procurement contracts required by Logistics,

including:

• Contract negotiation and monitoring

• Timekeeping

• Cost analysis


• Compensation for injury or damage to property

Logistics — The Logistics Leader is tasked with providing all resources, services, and support

required by the incident, including:

• Ordering, obtaining, and maintaining essential personnel, equipment, and supplies

• Providing communication planning and resources

• Setting up food services

• Setting up and maintaining incident facilities

• Providing transportation

• Providing medical services to incident personnel

Operations — The Operations Leader is tasked with directing all actions to meet the incident

objectives.

Planning — The Planning Leader is tasked with the collection and display of incident

information, primarily consisting of the status of all resources and overall status of the incident,

including:

• Collecting, evaluating, and displaying intelligence and information about the incident

• Preparing and documenting Incident Action Plans

• Conducting long-range and/or contingency planning

• Developing plans for demobilization

• Maintaining incident documentation

• Tracking resources assigned to the incident

Public Information Officer serves as the conduit for information to internal and external

stakeholders, including the media or other organizations seeking information directly from the

incident or event.

Safety Officer monitors safety conditions and develops measures for assuring the safety of all

assigned personnel.

Liaison Officer serves as the primary contact for supporting agencies assisting at an incident.

C. Incident Command Center Organizational Chart The Incident Command Center is an area designated where the Incident Commander,

management team, and other staff members convene to review the situation and strategize the

course of action.

_________________________________ (facility name) has determined

______________________ (Insert specific location) as the Incident Command Center during an

emergency or disaster situation. The phone number in the Incident Command Center is:

_______________________________ and the fax number is______________________.

If the disaster occurs in the _________________________________, the Alternate Incident

Command Center is the _______________________________________. The phone number in

the Alternate Incident Command Center is ______________________ and the fax number is

___________________.


If both Incident Command Center locations are involved in the emergency, the Incident

Command Center will be determined by the Emergency Management/Fire/EMS personnel and/or

evacuation site.

In accordance with available staff at the time of the crisis or disaster situation, it is essential to

establish an incident commander and designate tasks in accordance with this model or as specific

needs dictate.

Expansion of an incident may require the delegation of authority for the performance of the other

management functions.

As an incident grows, the Incident Commander may delegate authority for performance of

certain activities to Command Staff and General Staff. The Incident Commander adds positions

as needed.

Chain of Command: The “Chain of Command” is an essential part of controlling incidents,

regardless of size and magnitude. Every person participating in the incident has a designated

supervisor. There is a clear line of authority within the incident command organization, and all

lower levels connect to higher levels, eventually leading back to the Incident Commander.

The principles clarify reporting relationships and eliminate the confusion caused by multiple,

conflicting directives. Incident managers at all levels must be able to control the actions of all

personnel under their supervision. These principles do not apply to the exchange of information.

Although orders must flow through the chain of command, members of the organization may

directly communicate with each other to ask for or share information.

The command function may be carried out in two ways:

• As a Single Command in which the Incident Commander will have complete responsibility for

incident management. A Single Command may be simple, involving an Incident Commander

and single resources, or complex with an Incident Management Team.

• As a Unified Command in which responding agencies and/or jurisdictions with responsibility

for the incident share incident management.

A Unified Command may be needed for incidents involving:

o Multiple jurisdictions

o A single jurisdiction with multiple agencies sharing responsibility

o Multiple jurisdictions with multi-agency involvement


o During a large-scale crisis or disaster situation, a representative of the facility

would likely be involved in a Unified Command structure.

The Chain of Command follows an established organizational structure that adds layers of

command as needed. The basic outline of command layers follows:

• Command

• Sections

• Branches

• Divisions/Groups

• Units

• Resources

A role of responsibility can be transferred during an incident for several reasons: As the incident

grows, a more qualified person is required to take over as Incident Commander to handle the

growing needs of the incident, or in reverse when an incident reduces in size, command can be

passed down to a less qualified person (but still qualified to run the now-smaller incident) to free

up highly qualified resources for other tasks or incidents. Other reasons to transfer command

include jurisdictional change if the incident moves locations or area of responsibility, or normal

turnover of personnel due to extended incidents. The transfer of command process always

includes a transfer of command briefing, which may be oral, written, or a combination of both.

Flexibility: The ICS is a flexible organizational system that reflects only what is required to fill

the planned incident objectives. The efficient use of all resources on an incident is a high

priority, reducing incident clutter and costs. A single person may be in charge of more than one

unit if the span of control for that single person has not yet been exceeded, but in all cases an

element of the incident must have a person in charge of that element. Elements of the system that

have been expanded but are no longer needed are contracted and the resources released from the

incident. ICS Key Management Concepts: Many agencies and organizations modify ICS to fit their

needs. Yet without the application of the ICS management concepts, ICS becomes ineffective.

While the picture of the response organizational tree may look like the ICS, without applying the

management concept and principles, the organizational charts and models will resemble the

original ICS model in title alone. Furthermore, problems and conflicts experienced during some

incidents will indicate that fundamental ICS management concepts either are missing or are not

functioning as designed. Therefore, to avoid such difficulties, agencies/organizations using an

ICS design should incorporate the following basic management concepts:

Span of Control: Span-of-control is the most fundamentally important management principle of

ICS. It applies to the management of individual responsibilities and response resources. The

objective is to limit the number of responsibilities being handled by, and the number of resources

reporting directly to, an individual. ICS considers that any single person’s span of control should

be between three and seven individuals, with five being ideal. In other words, one manager

should have no more than seven people working under him/her at any given time.

When span-of-control problems arise around an individual’s ability to address responsibilities,

they can be addressed by expanding the organization in a modular fashion. This can be

accomplished in a variety of ways. An Incident Commander can delegate responsibilities to a

deputy and/or activate members of the Command Staff. Members of the Command Staff can

delegate responsibilities to Assistants, etc.


There may be exceptions, usually in lower-risk assignments or where resources work in close

proximity to each other.

D. Incident Action Planning: “Consolidated Incident Action Plans” means that for the specific event, the response is

coordinated and managed through one plan of action. The consolidated Incident Action Plan

(IAP) can be verbal or written (except for hazardous material incidents, where it has to be

written), and is prepared by the Planning Section. The consolidated IAP means that everyone is

working in concert toward the same goals set for that operational time period. The purpose of

this plan is to provide all incident supervisory personnel with direction for actions to be

implemented during the operational period identified in the plan. Incident Action Plans include

the measurable strategic operations to be achieved and are prepared around a time frame called

an Operational Period. Incident Action Plans provide a coherent means of communicating the

overall incident objectives in the context of both operational and support activities. The

consolidated IAP is a very important component of the ICS that reduces freelancing and ensures

a coordinated response.

At the simplest level, all Incident Action Plans must have four elements:

• What do we want to do?

• Who is responsible for doing it?

• How do we communicate with each other?

• What is the procedure if someone is injured?

Unity of Command: Unity of Command means that each individual participating in the

operation reports to only one supervisor. This eliminates the potential for individuals to receive

conflicting orders from a variety of supervisors, thus increasing accountability, preventing

freelancing, improving the flow of information, helping with the coordination of operational

efforts, and enhancing operational safety. Unity of Command also means that that all personnel

are managed and accounted for.

Accountability: Effective accountability during incident operations is required at all levels

within the facility. The following guidelines are adhered to:

• Check-In: All employees and responders must report in to receive an assignment in

accordance with the procedures established by the Incident Commander.

• Incident Action Plan: Response operations must be directed and coordinated as outlined

in the IAP.

• Unity of Command: Each individual involved in incident operations will be assigned to

only one supervisor.

• Span of Control: Supervisors must be able to adequately supervise and control their

subordinates, as well as communicate with and manage all resources under their

supervision.

• Resource Tracking: Supervisors must record and report resource status changes as they

occur.


Incident Commander

The most qualified staff member (in regard to the Incident Command System) on duty at the time of the

emergency will assume the Incident Commander position until the Housing Manager or his/her designee

arrives at the facility. The Housing Manager or his/her designee can then assume the role of Incident

Commander, if he/she is more or equally qualified.

____________________________________ (facility name) should educate leadership to the

ICS, so that in the event of an emergency of significant magnitude, other Incident Command

positions can be designated as needed. It may not be practical for all positions to be filled due to

lack of positions at any given time, so some sections may be covered by the same individual.

(Facility should consider purchasing an Incident Command Vest for the commander to wear

during an emergency situation. Visit www.safetygearonline.com for further information.) ____________________________________ (facility name) should utilize an Incident

Management Sheet to document the incident and pertinent details surrounding the disaster. The

Incident Management Sheet also lists the employees who assume the ICS functions during the

incident.

Transfer of Command

Transfer of Command is the process of turning over responsibility from one Incident

Commander to another.

There are five steps in transferring command:

1. The incoming Incident Commander should, if at all possible, personally perform an

assessment of the situation with the existing Incident Commander.

2. The incoming Incident Commander must be adequately briefed by the existing Incident

Commander face-to-face if possible. The briefing should include:

• Priorities and objectives

• Current plan

• Resource assignments

• Incident organization

• Resources ordered/needed

• Status of communications

• Any constraints or limitations

• Incident potential

• Delegation of authority

3. The incoming Incident Commander should determine a time for transfer of command

after the incident briefing.

4. At the appropriate time, notification of a change in Incident Commander should be made.

5. The incoming Incident Commander may give the previous Incident Commander another

assignment, as he/she retains first-hand knowledge of the incident and would be able to

observe the progress of the incident.

Resources: http://www.fema.gov/emergency/nims/

IS-700.a National Incident Management System (NIMS), An Introduction

IS-800.B National Response Framework, An Introduction


E. Crosswalk for Nursing Home Positions and Nursing Home ICS Positions

Nursing Home ICS POSITION NURSING HOME POSITION

Incident Commander Administrator

Medical Director/Specialist Medical Director/Nurse Consultant

Public Information Officer Media Relations/Administrator

Liaison Officer Assistant Administrator

Safety Officer Maintenance

Operations Section Chief Director of Nursing

Resident Services Branch Director Director of Staff Development

Nursing Unit Leader Charge Nurse

Psychosocial Unit Leader Activities Director

Admit/Transfer & Discharge Unit Leader Charge Nurse or Rehab Director

Infrastructure Branch Director Housekeeping supervisor

Dietary Unit Leader Cook

Environmental Unit Housekeeper

Physical Plant/Security Unit Leader Maintenance

Planning Section Chief Assistant/Associate Administrator

Situation Unit Leader Director of Admitting

Documentation Unit Leader Medical Records Staff

Logistics Section Chief Assistant/Associate Administrator/Director of Dietary Services

Service Branch Director Accounts Manager

Communication Hardware Unit Leader Maintenance Staff/Rehab Director

IT/IS Unit Leader Business Office Staff

Support Branch Director Director of Social Services

Supply Unit Leader Housekeeping or Central Supply

Staffing/Scheduling Unit Leader Lead CNA

Transportation Unit Leader Maintenance or Activity Staff

Finance/Admin Section Chief Business/Finance Director

Time Unit Leader Payroll/Biller

Procurement /Costs / Claims Unit Leader Risk Manager / Quality Management

https://www.ahcancal.org/facility_operations/disaster_planning/Documents/NHICSGuidebook_F

inal2011.pdf


F. Organizational Chart (Example)

https://www.ahcancal.org/facility_operations/disaster_planning/Documents/NHICSGuidebook_F

inal2011.pdf

Within the Incident Management Team chart, positions are demonstrated for optimal staffing.

When positions cannot be activated due to staffing, the roles and responsibilities are rolled into

the highest position activated. For example, if the position of Liaison Officer cannot be

activated, the tasks for that position become the responsibility of the Incident Commander.


G. Sample ICS Forms

Emergency Incident Action Plan

Date: _____________________________________ Time of Incident: ____________________________

Name of Facility: __________________________________________________________________________

Address of Facility: _________________________________________________________________________

Phone Number of Facility: ___________________________________________________________________

Name of Person in Command: ________________________________________________________________

Type of Incident: ___________________________________________________________________________

Is the Fire Alarm activated? ___________________________________________________________________

Is Evacuation in progress? ____________________________________________________________________

Has the Fire Department been contacted? ________________________________________________________

Has the Police been contacted? ________________________________________________________________

Has EMS been contacted? ____________________________________________________________________

I.C.S. Assignments Section Name of Section Leader

Finance/Administration

Logistics

Operations

Planning

Information

Liaison

Time of Fire Department arrival: ______________________________________________________________

Time of Police arrival: _______________________________________________________________________

Time of EMS arrival: ________________________________________________________________________

Name of Administrator notified: ______________________________________________________________

Time of Administration notification: ___________________ Arrival Time: ________________________

Name of Maintenance Person notified: __________________________________________________________

Time of Maintenance notification: _____________________ Arrival Time: ________________________


Objectives Objectives


Incident Log Time Document Important Information


General Notes

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

Time of Incident Termination: __________________________________________________

Signature of Command: _______________________________________________________

Signature of Corporate Representative: ___________________________________________


H. NIMS Job Action Sheets/Facility Action Cards

Incident Commander (IC)

An Incident Commander (IC) should be established for every crisis or disaster situation

occurring within the facility.

1. The facility’s IC is the single person in charge of the incident within the facility and initially

has the responsibility of all command staff positions in accordance with the plan.

2. As human resources become available, the facility’s IC should delegate the following

positions:

• Operations Leader

• Planning Leader

• Logistics Leader

• Finance Leader

3. As human resources become available, the IC should delegate the following positions:

• Public Information Officer

• Safety Officer

• Liaison Officer(s) to coordinate with outside agencies

4. The facility’s IC should establish an Incident Action Plan (IAP) and appropriately

communicate the IAP to everyone managing the incident to ensure that that all staff members

are working toward the same operational goals.

5. The facility’s IC should manage the incident in accordance with the plan and in coordination

with all other agencies (fire, police, EMS, etc.) responding to the crisis or disaster situation.

6. If required, the facility’s IC should become part of a Unified Command System as directed

by the IC in charge of emergency response (fire, police, county emergency manager, etc.)

and be responsible for overall incident management.

7. The facility’s IC should not relinquish command of the incident unless command is properly

transferred to another qualified IC within the facility or corporation.

8. The facility’s IC should remain active until the incident has been terminated.

Operations Leader (Ops) The facility’s Operations Leader is appointed by the Incident Commander (IC).

1. The facility’s Operations Leader reports directly to the IC.

2. The facility’s Operations Leader is tasked with directing all actions to meet the incident

objectives.

3. The specific details of the facility’s Operation Leader can only be determined by the type of

incident that is being managed.

4. The facility’s Operations Leader may work directly with emergency responders (fire, police,

EMS, etc.) while managing the incident.


5. The facility’s Operations Leader position should remain active until terminated by the

facility’s IC.

Planning Leader

The facility’s Planning Leader is appointed by the Incident Commander (IC).

1. The facility’s Planning Leader reports directly to the IC.

2. The facility’s Planning Leader is tasked with the collection and display of incident

information, primarily consisting of the status of all resources and overall status of the

incident:

• Collecting, evaluating, and displaying intelligence and information about the incident.

• Preparing and documenting Incident Action Plans.

• Conducting long-range and/or contingency planning.

• Developing plans for demobilization.

• Maintaining incident documentation.

• Tracking resources assigned to the incident.

3. The specific details of the facility’s Planning Leader can only be determined by the type of


4. The facility’s Planning Leader may work directly with emergency responders (fire, police,


5. The facility’s Planning Leader position should remain active until terminated by the facility’s

IC.

Logistics Leader The facility’s Logistics Leader is appointed by the Incident Commander (IC).

1. The facility’s Logistics Leader reports directly to the IC.

2. The Logistics Leader is tasked with providing all resources, services, and support required by

the incident.

• Ordering, obtaining, and maintaining essential personnel, equipment, and supplies.

• Providing communication planning and resources.

• Setting up food services.

• Setting up and maintaining incident facilities.

• Providing transportation.

• Providing medical services to incident personnel.

3. The specific details of the facility’s Logistics Leader can only be determined by the type of


4. The facility’s Logistics Leader may work directly with emergency responders (fire, police,


5. The facility’s Logistics Leader position should remain active until terminated by the facility’s

IC.


Finance/Administration Leader The facility’s Finance/Administration Leader is appointed by the Incident Commander (IC).

1. The facility’s Finance/Administration Leader reports directly to the IC.

2. The facility’s Finance Leader is tasked with tracking incident related costs, personnel

records, and requisitions, and administrating procurement contracts required by Logistics.

• Contract negotiation and monitoring

• Timekeeping

• Cost analysis

• Compensation for injury or damage to property

3. The specific details of the facility’s Finance/Administration Leader can only be determined

by the type of incident that is being managed.

4. The facility’s Finance/Administration Leader may work directly with corporate leadership

and applicable regulators (local, county, state and federal) while managing the situation.

5. The facility’s Finance/Administration Leader position should remain active until terminated

by the facility’s IC.


I. Plan Activation

In the event of a crisis or disaster situation (or notification of the potential for one) the

Administrator/ Designee or Highest Ranking Staff Member on Duty at the time of the incident

should:

1. Communicate the appropriate code that has been adapted from the KY Hospital Association

Emergency Codes for Kentucky hospitals:

• Code Silver Active Shooter/Person with a Weapon/Hostage Situation

• Code Black: Bomb Threat/ Suspicious Package

• Plain Speech/Text Earthquake

• Plain Speech/Text Epidemic/Pandemic Episode

• Code Red: Fire Emergency

• Plain Speech/Text Fire Watch/Fire System Disabled

• Plain Speech/Text Flood/Flash Flood

• Code Orange: Hazardous Material/ Spill/Release

• Plain Speech/ Text Karst/Sinkholes/Caves

• Plain Speech/Text Landslide

• Code Blue: Medical Emergency

• Plain Speech/Text Missing Resident

• Code Orange: Nuclear Power/Hazardous material/Spill/Release

• Plain Speech/Text Severe Heat/Severe Cold

• Plain Speech/Text Snow Emergency Plan

• Plain Speech Text: Terrorist Attack

• Plain Speech/Text Tornado Watch

• Plain Speech/Text Tornado Warning

• Plain Speech Text Utility Outage

• Plain Speech Text Wildland Fire/Forest Fire

• Plain Speech Text Workplace Violence/Threat of Violence

2. Activate the Incident Command System (ICS).

3. Ensure an appropriate emergency response has been coordinated with appropriate outside

resources, such as:

• Fire Department

• Emergency Medical Services

• Law Enforcement

• Transportation Services

• Service Contractors for Utility/Equipment Failures

• Other Essential Resources to Handle the Incident


4. Direct all leadership staff on duty to the pre-established Incident Command Center.

5. Call back essential leadership staff that is not on duty at the time of the incident.

• Administrator

• Assistants Administrators

• Director of Nursing

• Director of Maintenance/Environmental Services

• Director of Human Resources

• Corporate Management

• Other Key Individuals

6. Activate appropriate sections of the facility’s Emergency Response Disaster Templates.

7. Utilize appropriate sections of the Kentucky LTC Emergency Preparedness Manual to

manage the incident.


VIII. Emergency Plan -- Core Elements A. Preparedness Assessment – Food/Water A continual supply of food and water should be maintained in quantities that can accommodate

the needs of the resident census, staff members, and (and family members if included in EP Plan)

in case of a shelter-in-place or evacuation situation. The food and water supplies are stored in the

following location (s): ______________________________________. They should be labeled

as Emergency Supplies and, where needed, stored together according to the emergency (e.g. non-

perishable food). Staff members are aware of the location of food/water supplies and location of

keys. In epidemic/pandemic emergencies, food and water may be needed for 6 weeks or longer.

Procedures are in place for securing and storing needed additional resources.

Sealed Emergency

Water Supply

Number of Supplies Needed

(Residents and Employees)

Total Number of Supplies on _______

(date)


(date)

Total Number of Supplies on

_______ (date)


(date)

Location of Emergency Water Supply:

One Gallon of Potable Water per Person per Day is the Suggested Minimum

Example:

1 x 110 residents

+ 90 employees =

200 gallons needed per day

Two-Day Supply of One-Gallon Jugs of Water

Example:

7 days x 200

gallons =

1,400 gallons needed for 7 days

Bulk Water Storage (Five Gallon Jugs or Greater)

Ability to Shelter/Evacuate and Offer Nutrition/Hydration to Staff Family Members

______________________________ (facility name) has the following policy regarding its

ability to feed and provide water to staff family during Shelter-in-Place or evacuation of the

facility:

q Yes q No Staff family will be allowed to shelter-in-place in the facility for ____________days.

Special food/water considerations include the following:

_____________________________________________________________________________

______________________________________________________________________________

q Yes q No Staff family will be allowed to evacuate with the facility staff/residents.

Special food/water considerations include the following:

______________________________________________________________________________


1. Guidelines on Bottled Water Storage

Emergency preparedness guidelines issued by the U.S. Department of Homeland Security

recommend at least one gallon per person per day for three days -- for drinking, cooking and

personal hygiene.

The International Bottled Water Association (IBWA) advises consumers to store bottled water at

room temperature or cooler, out of direct sunlight and away from solvents and chemicals such as

gasoline, paint thinners, household cleaners, and dry cleaning chemicals.

Some consumers have asked why these conditions are best for bottled water storage.

First, when water (bottled water or tap water) is exposed to extended periods of direct sunlight or

heat sources, algae or mold may develop. Although not a general concern for public health,

storing water in a cool place out of direct sunlight helps minimize the chance that algae and/or

mold growth could develop in bottled water.

Second, bottled water and other beverages are packaged in sanitary and highly protective, sealed

plastic containers that maintain the quality and freshness of the product. However, plastic

containers – whether used for bottled water or other beverages – are slightly permeable, which

may allow ambient air gases such as vapors from household solvents, petroleum-based fuels and

other chemicals, to affect the taste and odor of the beverage. Proper storage will help ensure

product quality.

The U.S. Food and Drug Administration (FDA), which regulates bottled water as a packaged

food product, has determined that there is no limit to the shelf life of bottled water. The FDA

does not require an expiration date for bottled water products.

Because it is packaged under sanitary, manufacturing processes; is in a sanitary sealed container;

and does not contain substances (such as sugars and proteins) typically associated with food

spoilage, bottled water can be stored for extended periods of time without concerns.

Information taken from the International Bottled Water Association website (7/2015).

http://www.bottledwater.org/education/bottled-water-storage


B. Preparedness Assessment -- Dietary Considerations Dietary considerations during a crisis or disaster situation may require facility evacuation or

long-term Sheltering in Place without the support of outside resources (food, water, and food

service supplies.)

A disaster menu should be developed and updated regularly based on the needs of the residents.

See Sample Menus. The menu should be created considering the following:

• Vulnerabilities that may exist if the crisis or disaster situation occurs near the end of a

delivery cycle

• Identification of minimal resources needed to provide food and water service (gas,

electricity, refrigeration, lighting in kitchen, etc.)

A minimum of food and water to last for a minimum of 2 days should be maintained at the

facility in a specific location. This minimal amount of food and water should be determined

based on the number of residents, employees, vendors, volunteers, and visitors in the facility at

any given time. The estimate should also include consideration of the facility’s policy regarding

whether staff family members might Shelter-in-Place or evacuate with staff and residents during

a crisis or disaster situation.


Sealed Food Supply


(Residents and

Employees)


(date)


(date)


________ (date)


(date)

Location of Emergency Food Supply for 2 Days:

Ready-to-Eat Canned Meats

Ready-to-Eat Canned Soups/Stews

Ready-to-Eat Canned Vegetables

Ready-to-Eat Canned Fruits

Juices/Gatorades

Powdered Drinks (Kool-Aid, Tang, etc.)

Carnation Instant Breakfast

Dry Cereals

Peanut Butter

Crackers

Coffee and Tea

Powdered Milk

Evaporated Milk

Instant Potatoes

Instant Puddings

Macaroni and Cheese

Nonfood Items: Paper Plates, Cups, Napkins, and Plastic Utensils

Plastic Bags

Ice

Other


C. Preparedness Assessment -- Pharmaceuticals

• Identify the amount of pharmaceuticals and medical supplies that would be needed during

a SIP scenario in accordance with regulations and practical needs ________________

____________________________________________________________________

____________________________________________________________________

• Identify any vulnerability that may exist if the crisis or disaster situation occurred near

the end of a delivery cycle _______________________________________________

____________________________________________________________________

____________________________________________________________________

• Identify ways to adjust the delivery cycles to better ensure available supplies of

pharmaceuticals and medical supplies in a consistent manner for emergency purposes

____________________________________________________________________

____________________________________________________________________

• Identify the minimal resources needed to provide medication distribution (minimal

lighting, record keeping, tracking, etc.) during an evacuation or SIP ______________

____________________________________________________________________

____________________________________________________________________

• Identify all areas in the facility where additional emergency pharmaceutical and medical

resources can be stored in accordance with regulations.

________________________________________________________________________

________________________________________________________________________


Preparedness Assessment Equipment and Medical Supplies

Number of

Supplies Needed


(date)


(date)


________ (date)

Total Number of Supplies on ________

(date)

Wheelchairs

Walkers & Canes

Portable/Folding Chairs (for Staging Area)

Oxygen Concentrators

IV Poles

Feeding Pumps

Suction Machines

Bedside Commodes

Adaptive Devices

A 5-7 Day Supply Should be Maintained:

First Aid Supplies

Band-Aids

Gauzes and Bandages

Alcohol/Hydrogen Peroxide

Neosporin

Disposable gloves

Disposable gowns

Surgical masks

Eyewash Saline Solution

Incontinence Products

Barrier Cream

Sanitizing Wipes

Hand Sanitizer

Medication Cups/Straws

Nutritional supplements

Catheter supplies

Ostomy supplies

Sterile 4X4s

Alcohol/Peroxide

First Aid Tape

Syringes

Kling/Ace Bandages

Glycerin swabs

Normal saline

Insulin supplies


D. Preparedness Assessment Basic Supplies

Supplies List


(Residents and

Employees)


(date)


(date)


________ (date)


(date)

Flashlights and Batteries

Headlamp flashlights and Batteries

Whistles

Portable Radio, NOAA Radio, and Batteries

Mechanics Tool Box

Utility Knife

Non-Electric Can Openers

Blenders/Food Processors

Coolers

Digging Tools: Shovels, Picks

Supply of Duct Tape

Heavy-Duty Plastic Sheeting

Tarps

Garbage Bags for Sanitation

Cleaning Disinfectants

Extra Supply of Bleach

Approved Heavy-Duty Extension Cords

Fire Extinguishers

Fire Blankets

Extra Sleeping Provisions (Pillows, Blankets, etc.)

Matches in Waterproof Container

Portable Emergency Generators

Fans

Toilet Paper

Hand Washing Soap

Wind-up Alarm Clock

Two-way Radios

Storage Bags–Red Bags

Chemical Light Sticks (breakable light sticks)


Supplies List

Number of Supplies Needed (Residents/ Employees)

Total Number of Supplies on (date)




Box Cutters, Packing Tape, and String

Hardhats and Work Gloves

Caution Tape- Caution Cones

Chainsaw (s)

Reflective Vests

Resident ID Bracelets

Writing Utensils, Note Pads, Scissors, and Tape

Spools of Twine

Portable Cots

Air Mattresses

Cleaning Materials: bleach, sponges, mops, rags, etc.

Analog Telephone

Cell Phone Battery Charger

Minimum 3 Days Fuel for Generator

Minimum 3 Days Fuel for Vehicles

Other:

Other:

E. Preparedness Assessment – Fuel Supplies

1. Generator

Vendor name, contact information, and account number:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Fuel distributor, contact information, and account number:

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________


What areas of the facility are supplied with power by the generator? (Front Lobby, Hallways,

Break room, Laundry Room, Boiler Room, Stairways, Dietary)

_________________________________________________________________________________

_________________________________________________________________________________

_________________________________________________________________________________

Type, size, phase, and voltage of generator:

__________________________________________________________________________

__________________________________________________________________________

Location where an external generator could be connected if needed (simple plan):

F. Fuel Supply and Vendor Agreements

Fuel type ___________________________________________________________________

Fuel capacity (gallons or pressure) ______________________________________________

Fuel duration (hours) _________________________________________________________

Is the fuel tank above or below ground? __________________________________________

Is the generator above the projected flood level?

__________________________________________________________________________

How and when is generator tested? _____________________________________________

Description of how generator will be refilled and fuel resupplied during an emergency event:


__________________________________________________________________________

__________________________________________________________________________

__________________________________________________________________________

Does the generator have “quick-connect” capability? _______________________________

__________________________________________________________________________

What does the generator support? (i.e. heat, water, power to laundry or kitchen, fire alarm,

phone, fax, computers, etc.)

___________________________________________________________________________

G. Building Floor Plan

I. Actual Floor Plans showing offices, utility spaces, location of hazardous

materials, storage, and emergency exits. Also include location of fire protection/fire

alarm system and location of generator(s).


H. Emergency Shutdown Procedures

Deactivation of equipment within the facility may be required during a natural disaster (tornado,

severe weather, earthquake, etc.), civil disturbance, terrorism attack, accidental event (power

outage, power spike, over-pressurization, gas leak, etc.) or other circumstances that may require

the immediate and safe shutdown of equipment.

The guidelines below describe the basic steps that must be taken to perform an emergency

shutdown of the following mechanical items:

• Electric

• Natural Gas

• Water

• Heating, Ventilating and Air Conditioning (HVAC) Equipment

• Boilers

• Computer Equipment

NOTE: The guidelines described should only be utilized at the direction of the person in charge

of the facility at the time of an emergency. These guidelines are not intended for routine or non-

emergency situations and should only be utilized under the safest possible conditions.

DO NOT take any unnecessary risks when shutting down mechanical equipment.

DO NOT subject staff to a hazardous environment (smoke, gas, electrical voltage, etc.).

DO NOT stand in water or any liquid when shutting down mechanical equipment.


1. Electric Shutdown Location of the Outside Meter:

_________________________________________________________________________________

Location of the Main Electrical Panel:

_________________________________________________________________________________

Location of the Main Breaker:

_________________________________________________________________________________

Location of any Significant Sub-breakers or Sub-panels:

_________________________________________________________________________________

Vendor Information:

_________________________________________________________________________________

Vendor Account Number:

_________________________________________________________________________________

Step #1:

_________________________________________________________________________________

_________________________________________________________________________________

Step #2:

_________________________________________________________________________________

_________________________________________________________________________________

Step #3:

_________________________________________________________________________________

_________________________________________________________________________________

Step #4:

_________________________________________________________________________________

_________________________________________________________________________________


Step #5:

_________________________________________________________________________________

_________________________________________________________________________________

Miscellaneous Comments:

_________________________________________________________________________________

_________________________________________________________________________________

Notify the Electric Company:

_________________________________________________________________________________

_________________________________________________________________________________

Notify Key Staff Members:

_________________________________________________________________________________

_________________________________________________________________________________

Location of the Outside Meter:

_________________________________________________________________________________

Location of the Outside Main Shutoff Valve:

_________________________________________________________________________________


2. Natural Gas Shutdown

Location of the Inside Main Shutoff Valve:

_________________________________________________________________________________

Location of any Significant Sectional Valves:

_________________________________________________________________________________

Vendor Information:

_________________________________________________________________________________


__________________________________________________________________________

Step #1:

_________________________________________________________________________________

_________________________________________________________________________________

Step #2:

_________________________________________________________________________________

_________________________________________________________________________________

Step #3:

_________________________________________________________________________________

_________________________________________________________________________________

Step #4:

_________________________________________________________________________________

_________________________________________________________________________________

Step #5:

_________________________________________________________________________________

_________________________________________________________________________________



_________________________________________________________________________________

_________________________________________________________________________________

Notify the Gas Company:

_________________________________________________________________________________


_________________________________________________________________________________

_________________________________________________________________________________


3. Water Service Shutdown

Location of the Outside Buffalo Box (City Shutoff Valve):

_________________________________________________________________________________

Location of the Water Meter:

_________________________________________________________________________________

Location of the Main Shutoff Valve:

_________________________________________________________________________________

Location of any Significant Sectional Valves:

_________________________________________________________________________________

Vendor Information:

_________________________________________________________________________________


_________________________________________________________________________________

Step #1:

_________________________________________________________________________________

_________________________________________________________________________________

Step #2:

_________________________________________________________________________________

_________________________________________________________________________________

Step #3:

_________________________________________________________________________________

_________________________________________________________________________________

Step #4:

_________________________________________________________________________________

_________________________________________________________________________________


Step #5:

_________________________________________________________________________________

_________________________________________________________________________________


_________________________________________________________________________________

_________________________________________________________________________________

Notify the Water Department or Public Works Department:

_________________________________________________________________________________

_________________________________________________________________________________


_________________________________________________________________________________

_________________________________________________________________________________


4. HVAC Shutdown

Location of the HVAC System’s Main Electric Shutoff Switch:

_________________________________________________________________________________

Location of the HVAC System’s Gas Valves:

_________________________________________________________________________________

Location of RTU #1 Electric Shutoff Switch:

_________________________________________________________________________________


_________________________________________________________________________________


_________________________________________________________________________________


_________________________________________________________________________________

Vendor Information:

_________________________________________________________________________________


_________________________________________________________________________________

Step #1:

_________________________________________________________________________________

_________________________________________________________________________________

Step #2:

_________________________________________________________________________________

_________________________________________________________________________________


Step #3:

_________________________________________________________________________________

_________________________________________________________________________________

Step #4:

_________________________________________________________________________________

_________________________________________________________________________________

Step #5:

_________________________________________________________________________________

_________________________________________________________________________________


_________________________________________________________________________________

_________________________________________________________________________________

Notify the HVAC Service Contractor:

_________________________________________________________________________________

Notify Director Facility Operations:

_________________________________________________________________________________


_________________________________________________________________________________

_________________________________________________________________________________


5. Boiler Shutdown

Location of the Boiler System’s Main Electric Shutoff Switch:

_________________________________________________________________________________

Location of the Boiler System’s Gas Shutoff Valves: _________________________________________________________________________________

Location of Boiler #1 Electric and Gas Shutoff Switch:

_________________________________________________________________________________


_________________________________________________________________________________


_________________________________________________________________________________


_________________________________________________________________________________

Vendor Information:

_________________________________________________________________________________


_________________________________________________________________________________

Step #1:

_________________________________________________________________________________

_________________________________________________________________________________

Step #2:

_________________________________________________________________________________

_________________________________________________________________________________

Step #3:

_________________________________________________________________________________

_________________________________________________________________________________


Step #4: _________________________________________________________________________________

_________________________________________________________________________________

Step #5: _________________________________________________________________________________

_________________________________________________________________________________

Miscellaneous Comments: _________________________________________________________________________________

_________________________________________________________________________________

Notify the Boiler Service Contractor: _________________________________________________________________________________

Notify Key Staff Members: _________________________________________________________________________________


6. Computer System Shutdown

Location of the Computer System’s Main Controls:

_________________________________________________________________________________

Location of the Computer System’s Electrical Breakers:

_________________________________________________________________________________

Location of Computer Back-Up Media:

_________________________________________________________________________________

Vendor Information:

_________________________________________________________________________________


_________________________________________________________________________________

Step #1: _________________________________________________________________________________

_________________________________________________________________________________

Step #2:

_________________________________________________________________________________

_________________________________________________________________________________

Step #3:

_________________________________________________________________________________

_________________________________________________________________________________

Step #4:

_________________________________________________________________________________

_________________________________________________________________________________

Step #5:

_________________________________________________________________________________

_________________________________________________________________________________



_________________________________________________________________________________

_________________________________________________________________________________

Notify the Technical Support Supervisor:

_________________________________________________________________________________


_________________________________________________________________________________


7. Computer System Shutdown: Electronic Health Records (EHR) Vendor Information:

_________________________________________________________________________________


_________________________________________________________________________________

Location of EHR Back-Up Media:

_________________________________________________________________________________

Step #1: _________________________________________________________________________________

_________________________________________________________________________________

Step #2:

_________________________________________________________________________________

_________________________________________________________________________________

Step #3:

_________________________________________________________________________________

_________________________________________________________________________________

Step #4:

_________________________________________________________________________________

_________________________________________________________________________________

Step #5:

_________________________________________________________________________________

_________________________________________________________________________________


_________________________________________________________________________________

_________________________________________________________________________________

Notify the Technical Support Supervisor:

_________________________________________________________________________________


_________________________________________________________________________________


I. Preparedness Assessment -- Security

______________________________________ (facility name) realizes it is essential to plan for

security issues that may arise during a crisis or disaster situation. Due to the nature of the critical

event, local law enforcement or other community resources may be unavailable. Evacuation or

long-term shelter-in-place (SIP) without support requires a security component included in the

facility’s emergency plan.

______________________________________ (facility name) has identified the following

security needs in advance of a crisis or disaster scenario and identified measures that should be

taken to address potential security breaches in the facility during an evacuation or SIP situation:

• Identify the minimal security needs for an evacuation where the facility is completely

evacuated and may be vulnerable to theft and vandalism.

• Identify the minimal security needs of residents being evacuated while they are still on

the stricken facility’s property.

• Identify measures that will be needed to provide security that is beyond daily security

operations/requirements should SIP be required.

• Identify access points into the facility that will be shut down during SIP without violating

life safety code requirements and emergency evacuation capabilities.

• Identify all controlled access points that will need to be constantly monitored.

• Identify the use of technology (security cameras, alarm systems, intercom systems, etc.)

that can be used in a special capacity (outside the realm of normal usage) to enhance

security.

• Identify any special identification systems (I.D. badges, sign-in procedures, entry log,

etc.) that can be utilized to help maintain accountability and enhance security.

1. Outline a plan to minimize points of egress and access to the building(s).

2. During an emergency/disaster, the point of access is:

3. All staff will be required to show a staff photo Identification Badge to gain entry to

building(s).

4. The entry point designated for staff, emergency responders and volunteers is:

_____________________________________________________________________

5. Security staff will be provided with a list of designated family members who will be

allowed access to building(s) with photo identification.

6. Security staff will be provided with a list of designated volunteers who will be allowed

access to building(s) with photo identification.

7. Emergency vehicles will have access at: ______________________________________

8. Support agency vehicles will have access at:

9. Delivery vehicles will have access at:


J. Preparedness Assessment - Capacity for Deceased Residents ______________________________________ (facility name) is aware of the community plan

for a death surge relative to a disaster. The facility has planned for the potential of deceased

residents, staff, and visitors following a crisis or disaster situation when support of local

emergency responders or other community resources is delayed or unavailable. These scenarios

may require the facility to temporarily handle and hold the remains of deceased individuals

during emergencies including: flu epidemic, pandemic, catastrophic natural disaster, or similar

unprecedented event. Such an event may impact hospitals, funeral homes, mortuaries, and

morgues to the point where the volume of deaths is overwhelming and public service assistance

is not immediately available.

______________________________________ (facility name) should consider the following in

handling, processing, and storing human remains on a temporary basis:

• Identify the facility’s normal capacity, if any, to store deceased residents/occupants

____________________________________________________________________

____________________________________________________________________

• Identify any refrigeration capacity that may be available to store human remains safely

separated from emergency food supply _____________________________________

____________________________________________________________________

____________________________________________________________________

• Identify suitable areas on the periphery of the facility to store human remains without

refrigeration __________________________________________________________

____________________________________________________________________

____________________________________________________________________

• Identify any equipment (ice making, etc.) or materials/supplies needed (storage bags for

ice, deodorizers, body bags, heavy duty plastic wrap, tarps, pallets, etc.) to provide

temporary storage of human remains _______________________________________

____________________________________________________________________

____________________________________________________________________

• Identify ways to control and isolate temporary morgue provisions away from facility

occupants (residents, staff, and visitors)

________________________________________________________________________

________________________________________________________________________

See next page for Morgue Log Sheet


Morgue Log Sheet

Name of Deceased Gender Time In

Items/Jewelry Received with

Deceased Deceased Released to

(Name/Time)

Items/ Jewelry Released to

(Name/Time)

Family Notified (Yes/No)

Names of Persons Notified (Date/Time)

Discharge Completed By

(Name/Date/Time)


VII. Continuity of Operations Planning (COOP)

A. KY LTC Facility Disaster Assessment Form

Planning for continuity of operations during an emergency is good business practice. Having and exercising a Continuity Of Operations Plan (COOP) is important in protecting the welfare of residents and staff, making certain that key systems and documents are not lost, and ensuring that the facility can continue to serve residents and staff during and after an emergency. As with other sections of the Emergency Preparedness Plan, a facility’s COOP should be updated at least annually. Completion of the KY LTC Facility Disaster Assessment Form during the disaster or emergency provides a snapshot of the status of a facility. This snapshot can aid in planning for continued operation of the facility. A COOP describes how the essential functions will be managed during any situation or emergency that may interrupt normal operations or leave facilities damaged or inaccessible. The main objectives of a COOP are as follows:

• Reduce loss of life and minimize damage and losses. • Ensure the continuous performance of essential functions and operations during an

emergency. • Protect essential facilities, equipment, records, and other assets. • Reduce or mitigate disruptions to operations. • Achieve a timely and orderly recovery from an emergency and resumption of service

to residents and staff.

The eight components of a COOP: 1. Essential functions and operations 2. Lines of succession 3. Delegation of authority 4. Alternative locations/facilities 5. Vital systems and equipment 6. Vital records 7. Communication systems supporting essential functions 8. Restoration and recovery

(See next page)


Long Term Care Facility Disaster Assessment Form

REPORT STATUS (check one) � Initial Report � Update Date: _____/_______/___

Time: ____________

NATURE OF THE EVENT: ____________________________________________________________________________

FACILITY IDENTIFICATION

Facility Name: _______________________________________ Address: ______________________________________________


HPC Region: _______KYEM Region: _______ GPS Latitude: ___________________ GPS Longitude: _____________________

SECTION A

IMMEDIATE NEEDS Y N COMMENTS

A-1: Does your facility have any immediate needs, i.e., staffing?

A-2: Are there any immediate health and medical needs?

� Minor Injuries

� Serious Injuries

� Life Threatening Injuries

� Fatalities

� Behavioral Health

� Crisis Standards of Care

A-3: Is your facility accessible by normal routes?

SECTION B

COMMUNICATIONS Y N LIST CONTACT INFORMATION

B-1: Are landline telephones available?

B-2: Are cell phones available? – Is Texting Available?

B-3: Can you access the internet?

B-4: Are email services available?

B-5: Is there a Satellite Radio located near your facility?

B-6: Does your facility have access to a Ham Radio?

B-7: Other:____________________________________________

SECTION C

SECURITY Y N COMMENTS

C-1: Do you have security in place?

C-2: Is your facility currently on lockdown?

C-3: Is there a security risk from outside people or patients/clients?

C-4: Can all outside access sites (doors/windows) be locked?

C-5: Does your facility need security assistance?

SECTION D

STRUCTURAL ASSESSMENT/HVAC Y N COMMENTS

D-1: Does your facility have more than one floor?

D-2: Does your facility have more than one building?

D-3: Is there structural damage to your facility? If yes, what % of

building is damaged?

� Walls: __________

� Roof:__________

� Floor:__________

� Windows: __________

� Doors:__________

� Other:__________

D-4: Can your facility maintain normal operations? If no, do you

need to evacuate?


D-5: Is the heating and air (HVAC) system operational? If no, is

there adequate ventilation?

SECTION E

ELECTRICAL POWER Y N COMMENTS

E-1: Is your facility currently using commercial electrical power?

E-2: Does your facility have a generator?

E-3: Is the generator currently being used?

E-4: Can the generator run 100% of the facility? If no, what does

the generator supply power to?

E-5: How many days can your generator currently run based upon

current fuel supply?

E-6: What type of fuel does the generator use?

Diesel _____Gasoline _____Natural Gas _____Propane

SECTION F

WATER AND SEWER Y N COMMENTS

F-1: Are hot and cold running water available?

F-2: If yes, is this water safe to drink? If no, is there an adequate

water supply onsite of at least 1 to 2 gal/day/person for 3-5 days?

F-3: Are ice supplies available from an approved source?

F-4: Are there an adequate # of hand washing stations?

F-5: Is the sewage system operational? If no, does your facility

require assistance with sewage disposal?

SECTION G

FOOD SERVICE Y N COMMENTS

G-1: Is there a safe food source for staff /residents/visitors?

G-2: Can foods be held at proper temperatures (<41°F - >145°F)

G-3: Is there an adequate supply of food (3-5 days)?

SECTION H

BED CENSUS/HEALTH CARE Y N COMMENTS

H-1: Bed H-1: Current Bed Census/Available Beds

SNF: ____ ______

NF: _____ ______

NH: _____ ______

ICF:_____ ______

ALZ: ____ _____

PC: _____ _____

ICF/MR: _____ _____

H-2: Does your facility require transportation assistance for

movement/evacuation of patients? (check all that apply)

� Ambulatory: #_____

� Non-ambulatory: #_____

� Bedfast: #_____

� Bariatric: #_____

� Memory Disorders: #_____

� Other: #_____

H-3: Does your facility have refrigeration for medications?

H-4: Is there adequate number medications, clinical supplies, i.e.,

O2, sharps containers, biohazard bags, etc?

H-5: Is there adequate number of facility supplies, i.e, cleaning

supplies, trash bags, etc


Name: ____________________________________________________ Job Title: _____________________________________

Phone: (_______) _______-_________ Mobile Phone: (_______) _______-_________ Alt Phone: (_______) _____________

Fax: (_______) _______-_________

Email:_______________________________________________________________________


B. Essential Staff Roles and Redundancy:

Identify the facility's essential functions and operations, and then determine whether the loss of each essential function would have a minor, moderate, or catastrophic effect on facility operations. Plan for the facility to be self-sufficient for 72 - 96 hours. This planning will require identifying the facility's essential functions, such as resident care, billing, and record keeping. Complete the tasks listed below. Determine how long the facility can provide essential functions without its normal information

or telecommunications support.

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

List the resources (e.g., vendors, partners, or software) required to complete each essential function. ______________________________________________________________________________ ______________________________________________________________________________

______________________________________________________________________________

Prioritize the list of essential functions. ______________________________________________________________________________ ______________________________________________________________________________

______________________________________________________________________________

Indicate if the loss of each essential function would have a minor, moderate, or catastrophic effect on the facility's operations. ______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________


C. Lines of Succession

Identifying lines (or orders) of succession is the procedure for automatically replacing a leader. In terms of the facility, the lines of succession would dictate who runs the facility if the administrator does not have the capacity to fulfill the role as leader. The lines of succession would dictate further who would fill in for the second-in-command should he or she be unable to fulfill the role. These lines of succession would continue so that, in the face of an emergency, control of the facility would be transitioned in an orderly manner to a pre-established leader. As a result, continuity of business operations would be maintained. List the order of succession for the facility by the position (not name) of staff, and then list the designated successor (by position) of each listed position. ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ List the conditions (e.g., in the absence of the administrator or inability to contact other administration staff) under which designated successors would assume authority or responsibility and how they would assume it. Listing these conditions eliminates confusion with regard to leadership roles and responsibilities during an emergency situation. ______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________


D. Delegation of Authority

Lines of succession refers to individuals who would assume responsibility if a key personnel member was no longer able to carry out her or his functions. Delegation of authority refers to positions in which a key personnel member has the authority to complete a particular task (e.g., declaring an emergency). These authorities may be invoked on a temporary basis, such as during an emergency. Often those individuals listed in the facility's line of succession have pre-delegated authorities. List the types of authority to be delegated (e.g., authority to issue isolation or quarantine orders; put facility in lock-down; contact staffing agency to fill shifts; authorize overtime for staff) during an emergency. ______________________________________________________________________________ ______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

List the position title associated with each type of authority listed. ______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________ Identify the trigger(s) for activating each of the listed authorities. ______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________


E. Alternate Locations/Facilities

An alternate facility refers to a building or place that is a substitute for the existing facility. During an emergency, administrators may need to shut down the facility and move to an alternate location/facility. Planning for alternate facilities is an essential component of a COOP. Choose at least two alternate facilities; one within close proximity, and another approximately 50 miles from the facility, to which residents and staff can evacuate if necessary. List the name, street address, contact information, and any special circumstances or conditions that may exist for use of the alternate facility (ies). ______________________________________________________________________________ ______________________________________________________________________________

______________________________________________________________________________

Document the location of alternate facilities and existing issues associated with each location/facility. ______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Identify the requirements of the alternate facilities (e.g., personnel, special needs, power, communication, physical space). Consider the essential functions listed earlier to determine what would be required to maintain those same functions at an alternate facility. ______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________


F. Vital Systems and Equipment

List the systems and equipment that are necessary for the continued operation of critical processes or services for a minimum of 72 hours (e.g., computer systems and software). Systems and equipment are vital if they are essential to emergency operations or to continuing critical services during a crisis. When identifying vital systems and equipment, do not include systems or equipment that may be useful but are not essential to performing a critical service. ______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Identify the location, frequency of maintenance, and method of protection for each identified system or piece of equipment. Location will determine ease of access. Frequency of maintenance will determine staffing needs. Method of protection will determine vulnerability to damage or theft. ______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Assess the method of protection listed for each system or piece of equipment. If the method is insufficient or if no method of protection is in place, identify an appropriate method to protect the system or equipment. Some systems and equipment may be in high demand during an emergency and therefore may be at risk for theft. Systems and equipment also may be vulnerable to damage from natural disasters, such as flooding and high winds. Make sure the assessment covers all vulnerabilities. ______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________


G. Vital Records

Use the essential functions information to list records that are necessary for the continued operation of the facility's critical processes or services for a minimum of 72 hours. A vital record is any record (electronic or hard copy) needed to complete a process. For a long-term care facility, a vital record may be a medical chart or financial or legal records. The previously identified essential functions will help identify the facility's vital records. ______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

List the location, frequency of backup, and method of protection for each identified vital record. Location will determine ease of access. Frequency of backup will determine vulnerability to loss of data. Method of protection will determine vulnerability to damage or theft. ______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Assess the method of protection for each listed vital record. If the method is insufficient or if no method of protection is in place, identify an appropriate method to protect the record. ______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

As with vital systems and equipment, make sure the assessment covers all vulnerabilities.


H. Communication Systems Supporting Essential Functions

Review the information previously collected on vital systems and equipment to identify communication systems that support critical processes and services and their associated essential function(s). Most facilities conduct business primarily through telecommunication (e.g., telephone or e-mail). Fax machines and two-way radios are other forms of communication systems used by businesses. For each identified communication system, list the current vendor and contact information, the services the vendor is providing, and any emergency services the vendor offers. ______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

In addition to collecting the information described above, determine whether the vendor provides services to other long-term care or healthcare agencies and organizations, and if so, what priority the vendor will give the facility during an emergency. Identify the controls or measures in place for each communication system to provide uninterrupted service. Not only is it important to identify key communication systems, it is also necessary to ensure controls or measures (e.g., redundancy) are in place to provide uninterrupted service to the facility’s residents. ______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Assess each uninterrupted service control or measure. If the method is insufficient or if no control or measure is in place, determine an appropriate control or measure for the communication system. ______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________


I. Restoration and Recovery

Identify the actions and resources needed to restore essential functions to pre-event operating conditions. The recovery stage of the facility's COOP includes actions and resources needed to restore essential functions, vital systems and equipment, vital records, and communication systems to pre-emergency operating conditions. Resources could be internal personnel or external vendors. When identifying human resources, be sure to include contact information for regular business hours and for evenings, holidays, and emergencies. Include the services offered by the resource. Identify the actions and resources needed to restore vital systems and equipment to pre-event operating conditions. ______________________________________________________________________________ ______________________________________________________________________________

______________________________________________________________________________

Identify the actions and resources needed to restore vital records to pre-event status. ______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Identify the actions and resources needed to restore communication systems to pre-event operating conditions. ______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

Identify the timeframes needed to complete each of the above tasks. Listing these timeframes will help to see where the facility may encounter issues with restoration to normal operations. ______________________________________________________________________________ ______________________________________________________________________________

______________________________________________________________________________

Information for this section on COOP Planning was based on the Centers for Disease Control and Prevention Health Care Preparedness Activity. (2016). Long-Term, Home Health, and Hospice Care Planning Guide for Public Health Emergencies. This document can be accessed at www.cdc.gov/phpr/healthcare/planning2.htm


X. Disaster Response Planning

National Criteria for Evacuation Decision-Making in Nursing Homes

A. Decision Tree

Key Considerations

The decision to evacuate or to shelter-in-place is a part of any facility’s comprehensive emergency management plan and will be a major focus when the plan is activated. The National Criteria for Evacuation Decision-Making in Nursing Homes identifies key decision-making markers which may be used in any emergency event, with a special focus on tropical cyclones (i.e., hurricanes, tropical storms or tropical depressions).

The process for evacuation decision-making for nursing homes must be framed as a flexible and responsive cause and effect diagram from:

http://www.cahfdownload.com/cahf/dpp/NationalCriteriaEvacuationDecisionMaking.pdf

Time

Scope

Nature of Event

Destination

Transportation

Rural

Urban

Metropolitan

Location of Facility

External Factors

Decision:

Evacuate or

Shelter-in-Place

Internal Factors

Supplies o

Staff

Hurricane

Evacuation Zone

Resident Acuity

Storm Surge Zone Flood Zone

In the Zone

Physical Structure


__________________________________________ (facility name) has developed the following list of key personnel, based on job title, to identify the order of succession of command. The Succession of Command structure considers the facility’s ability to manage and direct an emergency situation during normal hours of operation as well as during hours when key administrative staff may not be at the facility (evening and overnight shifts.)

Succession of Command

1. Name: _______________________________________________________________ Job Title: _____________________________________________________________ Contact Information: ___________________________________________________ ____________________________________________________________________

2. Name: _______________________________________________________________ Job Title: _____________________________________________________________ Contact Information: ___________________________________________________

3. Name: _______________________________________________________________ Job Title: _____________________________________________________________ Contact Information: ___________________________________________________

4. Name: _______________________________________________________________ Job Title: _____________________________________________________________ Contact Information: ___________________________________________________ ____________________________________________________________________


B. Shelter-in-Place (SIP)

Depending on circumstances and the nature of the emergency, one of the first important decision administrators must make is whether to stay in place or evacuate the facility. It is important to understand and plan for both possibilities. In any emergency, local authorities may or may not immediately be able to provide information about what is happening and what action the facility should take. Therefore, closely monitoring local television and radio stations, the NOAA weather radio and reliable internet sources may provide the most accurate, breaking information about a situation as it develops. Shelter-in-Place – Weather Related Reasons

There are several weather related reasons to Shelter-in-Place: • flooding in the immediate area around the facility or locally • flash flood watches and warnings • tornado watches and warnings • severe winter weather event (ice and/or snow storm) • fire in the immediate area around the facility or locally

Shelter-in-Place – Non-Weather Related Reasons

Hazards in the environment could make Shelter-in-Place necessary: • chemical, biological, or radiological contaminants may be released into the environment

in such quantity and/or proximity that it is safer to remain indoors rather than to evacuate. Examples include:

o explosion in an ammonia refrigeration facility nearby o a derailed and leaking tank car of chlorine on the rail line o release or spill of hazardous materials from a tanker truck on a highway or

expressway • law enforcement activity such as an active shooter event or a bomb threat in the

immediate area around the facility or locally Information taken from: https://www.ready.gov/protection-options https://www.osha.gov/SLTC/etools/evacuation/shelterinplace.html


1. Shelter-in-Place Procedures

______________________________________ (facility name) realizes it is essential to plan for Shelter-in-Place well in advance of a crisis or disaster situation when partial or complete evacuation is unsafe or unwarranted. The facility should identify and assess the length of time it can realistically support SIP before a decision is made to fully evacuate. Hospitals may have to transfer patients to LTC facilities during catastrophic events if they reach overcapacity. This is integrated into the Surge Plans for hospitals. The following potential situations have been identified, in which Shelter-in-Place might be necessary: List top two potential situations based on Facility and Community Risk Assessment.

• _______________________________________________________________ • _______________________________________________________________

The following areas within the facility have been identified as suitable spaces that are structurally sound and away from potential exposure areas for residents, staff, and visitors to seek shelter (Area of Refuge): List primary and alternate spaces.

____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________

• Consider all factors that may cause a secondary event following the initial need to SIP. Example: building collapse post-tornado.

• Identify all SIP-specific materials and inventory items that may be needed to facilitate the SIP procedure due to a contaminated or hazardous environment outside of the facility. Examples: plastic sheeting, tarps, duct tape, extra blankets and pillows, etc.

• Identify all aspects of the facility’s physical plant and infrastructure that need to be evaluated during the SIP procedure, and immediately following the SIP, to ensure the safety of residents, staff, visitors, volunteers and vendors.

• Identify any roles that volunteers could play to assist in SIP based on: o Skills and training o Emergency Plan Policies enabling volunteers to take on non-medical tasks during

an emergency


a. Shelter-in-Place Procedures—Weather Related

________________________ (facility name) has emergency Shelter-in-Place policies and procedures that guide decision making when SIP is necessary due to weather related conditions: A. Activate Incident Command System (ICS), discuss preparations for the emergency and make

staff assignments. B. Notify staff, residents, visitors, volunteers and vendors to remain in the facility in order to

ensure safety. C. Notify Division of Health Services, County Emergency Manager, Medical Director, LTC

Ombudsman of the decision to Shelter-in-Place. (See Communication Tab for required contacts).

D. Notify residents’ family members and resident representatives of administration’s decision to Shelter-in-Place.

E. Department heads contact employees to determine who will be available to work during the Shelter-in-Place, if time warrants such planning. Consider how employees might be transported to work if they are unable to drive themselves. Confirm expected availability, as well as the number of family members, if policy permits, joining the staff members:

• Before the emergency strikes • During the emergency • After the emergency

F. Unless there is an imminent weather threat, allow staff, volunteers, visitors, and vendors to communicate with family members.

G. Close and lock all windows, exterior doors, and any other openings to the outside. H. If danger of damaging winds is suspected, close the window shades, blinds, and/or curtains. I. Create water supply—rule of thumb is three gallons per person, per day for seven days.

a. Fill tubs, pitchers, and as many containers as possible with water b. Bag up as much ice as possible and place in the freezers c. Purchase ice (if possible) and place in freezers

o Gallon Ziploc bags can cool individuals during a severe heat emergency, then be used as drinking water as the ice melts

J. Be prepared to access essential disaster supplies, such as nonperishable food, battery-powered radios, first aid supplies, flashlights, batteries, duct tape, plastic sheeting, and plastic garbage bags.

K. Implement facility check of emergency heating and lighting systems (conventional and alternate) to ensure resident health/safety and safe storage of provisions

L. Check fire detection, extinguishing and alarm systems M. Determine how facility will process sewage and waste disposal

a. Identify and access support systems b. Need not treat on-site


N. For flooding, designate an Area of Refuge on the highest level of the facility, and move residents to the area.

a. Track residents, staff, visitors, and volunteers assigned to various SIP locations within facility.

b. Avoid overcrowding by selecting several rooms as necessary. Consider large storage closets, utility rooms, pantries, and office and conference rooms.

c. Avoid selecting rooms with mechanical equipment like ventilation blowers or pipes, because this equipment may not be able to be sealed from the outside, as water could enter through these spaces.

d. When possible, locate landline in the area of refuge. Cellular telephone equipment may be overwhelmed or damaged during an emergency. With cellular service, texting can sometimes get through when phone calls cannot.

e. Do not leave the Area of Refuge until instructed to do so by the Facility Administrator or designee.

f. See Disaster Template: Flooding O. For tornado watch or warning, designate interior spaces on the lowest level of the facility as

an Area of Refuge. a. Avoid overcrowding by selecting several rooms as necessary. Consider large storage

closets, utility rooms, pantries, and office and conference rooms without exterior windows.

b. Avoid selecting a room with mechanical equipment like ventilation blowers or pipes, because this equipment may not be able to be sealed from the outside.

c. It is ideal to have a landline telephone in the relocation areas. Cellular telephone equipment may be overwhelmed or damaged during an emergency. With cellular service, texting can sometimes get through when phone calls cannot.

d. Do not leave the Area of Refuge until instructed to do so by the Facility Administrator or designee.

e. See Disaster Template: Tornado P. Be alert for leaking water or gas, broken windows, fire hazards, and electrical wires. Q. Evaluate resident status changes and needs, especially if power is lost. Activate hot or cold

weather procedures if necessary. R. See Disaster Template: Severe Heat/Severe Cold


b. Shelter-in-Place Procedures—Non-Weather Related ________________________ (facility name) has emergency Shelter-in-Place policies and procedures that guide decision making when SIP is necessary due to non-weather related conditions:

A. Activate Incident Command System (ICS), discuss preparations for the emergency and make staff assignments.

B. Notify staff, residents, visitors, volunteers and vendors to remain in the facility in order to ensure safety.

C. Notify Division of Health Services, County Emergency Manager, Medical Director, LTC Ombudsman of the decision to Shelter-in-Place. (See Communication Tab for required contacts).

D. Notify residents’ family members and resident representatives of administration’s decision to Shelter-in Place.

E. Unless there is an imminent threat, allow staff, volunteers, visitors, and vendors to communicate with their family members.

F. Close and lock all windows, exterior doors, and any other openings to the outside. G. If danger of explosion is suspected, close the window shades, blinds, and/or curtains. H. Create water supply—rule of thumb is three gallons per person, per day for seven days.

a. Fill tubs, pitchers, and as many containers as possible with water b. Bag up as much ice as possible and place in the freezers c. Purchase ice (if possible) and place in freezers

o Gallon Ziploc bags can cool individuals during a severe heat emergency, then be used as drinking water as the ice melts

I. Turn off all fans, heating, and air conditioning systems. Activate other shut-down procedures if necessary due to a chemical, biological or radiological event.

J. Be prepared to access essential disaster supplies, such as nonperishable food, battery-powered radios, first aid supplies, flashlights, batteries, duct tape, plastic sheeting, and plastic garbage bags.

K. Implement facility check of emergency heating and lighting systems (conventional and alternate) to ensure resident health/safety and safe storage of provisions

L. Check fire detection, extinguishing and alarm systems M. Determine how facility will process sewage and waste disposal

a. Identify and access support systems b. Need not treat on-site

N. Designate an Area of Refuge with the fewest windows or vents available, and move residents there.

a. Track residents, staff, visitors, and volunteers assigned to various SIP locations within facility.

b. Avoid overcrowding by selecting several rooms as necessary. Consider large storage closets, utility rooms, pantries, and office and conference rooms without exterior windows.


c. Avoid selecting rooms with mechanical equipment (ventilation blowers or pipes) because this equipment may not be able to be sealed from the outside.

d. When possible, locate landline in the area of refuge. Cellular telephone equipment may be overwhelmed or damaged during an emergency. With cellular service, texting can sometimes get through when phone calls cannot.

O. Use duct tape and plastic sheeting (heavier than food wrap) to seal all cracks around the doors and any vents into the room.

P. Be alert for leaking water or gas, broken windows, fire hazards, and electrical wires. Q. Evaluate resident status changes and needs, especially if power is lost. R. Do not leave Area of Refuge until instructed to do so by Facility Administrator or

designee S. See Disaster Templates: Bomb/ Bomb Threat, Epidemic/Pandemic Episode, Hazardous

Material/Spill/Release (Internal or External), Nuclear Power

2. Providing Adequate Supplies

Specific tasks should be assigned to staff members during an emergency to ensure adequate supplies and maintain operational continuity.

1. Administrator/Incident Commander a. Meet with management team to activate Incident Command System (ICS) and

discuss preparations to Shelter-in-Place. b. Notify ownership, Corporate Contact, Division of Health Service Regulation, County

Emergency Manager, Medical Director, and Ombudsman of the decision to Shelter-in-Place (see Communications Tab for complete list).

c. Notify staff members, residents, and residents’ family members/resident representatives.

d. Remain calm to not upset the residents. e. Move residents to Area of Refuge.

2. Director of Nursing a. Ensure doors, blinds, drapes are closed. b. Guide staff in creating water supply. c. Notify pharmacy and vendors. d. Assist in moving residents to Area of Refuge and frequently monitor their conditions. e. Connect O2 concentrators to all residents requiring oxygen. f. Shut off oxygen or other medical gasses. g. Remain calm to not upset the residents. h. Ensure all residents and staff are accounted for. i. Be prepared to assist where needed at the direction of the Incident Commander.

3. Nursing Staff a. Initiate preparations by closing doors, blinds, and drapes, and filling tubs and sinks

with water.


b. Assist in moving residents to the Area of Refuge and frequently monitor their conditions.

c. Close doors and windows. d. Connect O2 concentrators to all residents requiring oxygen. e. Shut off oxygen or other medical gasses. f. Remain calm to not upset the residents. g. Be prepared to assist where needed at the direction of the Incident Commander.

4. Certified Nursing Assistants a. Initiate preparations by closing doors, blinds, and drapes and filling up tubs and sinks

with water. b. Prepare to move residents to Area of Refuge. c. Remain calm to not upset the residents. d. Be prepared to assist where needed at the direction of the Incident Commander.

5. Medical Records a. Protect and gather resident records to relocate to centralized Area of Refuge if

necessary. b. Ensure complete data backup. c. Remain calm to not upset the residents. d. Be prepared to assist where needed at the direction of the Incident Commander.

6. Office Staff a. Protect and gather vital employee and facility records for transport if necessary. b. Ensure complete data backup. c. Unplug all computers and equipment. d. As directed by Incident Commander, continue to notify families/resident

representatives of decision to Shelter-in-Place. e. Document all emergency actions taken and notifications. f. Ensure telephone/emergency phone coverage for facility. g. Remain calm to not upset the residents. h. Be prepared to assist where needed at the direction of the Incident Commander.

7. Social Services/Activities a. Notify families/resident representatives of decision of Shelter-in-Place. b. Remain calm to not upset the residents. c. Work closely with nursing staff to meet the needs of the residents. d. Be prepared to assist where needed at the direction of the Incident Commander.

8. Maintenance a. Make final rounds of the facility and grounds. b. Make emergency repairs of the facility. c. Secure windows and other building openings. d. Ensure that all windows are closed. Pull shades and close all drapes. e. Check equipment for functionality. f. Secure the facility and ensure all electronics and computers have been turned off and

unplugged. g. Activate shut-down procedures, if warranted. h. Secure all potential flying debris (above, below, around, and in the facility). i. Secure supplies, such as radios, flashlights, batteries, etc.


j. Remain calm to not upset the residents. k. Be prepared to assist where needed at the direction of the Incident Commander.

9. Food Services a. Set refrigerator and freezers on the coldest setting. b. Unplug non-essential equipment. c. Secure emergency food, water, cooking utensils, and food disposal supplies for

transport. d. Secure vital resident and departmental records. e. Fill zip top bags with ice and place in freezers. f. Notify vendors to deliver supplies, including ice and water. g. Determine the number of residents, visitors, volunteers, employees, and their family

members for whom food service will be provided. h. Remain calm to not upset the residents. i. Be prepared to assist where needed at the direction of the Incident Commander.

10. Housekeeping/Laundry a. Secure an adequate supply of linens. b. Unplug all equipment. c. Notify vendors to deliver supplies. d. Secure supplies, such linens, blankets, trash can liners, mops, rags, buckets, trash

cans, cleaning supplies, toilet paper, etc. e. Create water supply. f. Assist in moving residents to Area of Refuge. g. Remain calm to not upset the residents. h. Be prepared to assist where needed at the direction of the Incident Commander.

11. Transportation a. Check fuel, oil, and water levels for each vehicle. b. Move vehicles away from trees. c. Remain calm to not upset the residents. d. Be prepared to assist where needed at the direction of the Incident Commander.

12. Medical Director a. Will be notified and will assist if available.


3. Security and Lockdown

1. The Incident Commander, in collaboration with County Emergency Managers determine the need to secure and lock the facility during a SIP situation.

______________________________________ (facility name) realizes it is essential to plan for security issues that may arise during a crisis or disaster situation. Due to the nature of the critical event, local law enforcement or other community resources may be unavailable. Therefore the facility must plan for long-term shelter-in-place (SIP) without support. This requires a security component included in the facility’s emergency plan. ______________________________________ (facility name) has identified the following security needs in advance of a crisis or disaster scenario and identified measures that should be taken to address potential security breaches in the facility during an evacuation or SIP situation:

a. Identify the minimal security needs for an evacuation where the facility is completely evacuated and may be vulnerable to theft and vandalism.

b. Identify the minimal security needs of residents being evacuated while they are still on the stricken facility’s property.

c. Identify measures that will be needed to provide security that is beyond daily security operations/requirements should SIP be required.

d. Identify access points into the facility that will be shut down during SIP without violating life safety code requirements and emergency evacuation capabilities.

e. Identify all controlled access points that will need to be constantly monitored. f. Identify the use of technology (security cameras, alarm systems, intercom systems, etc.)

that can be used in a special capacity (outside the realm of normal usage) to enhance security.

g. Identify any special identification systems (I.D. badges, sign-in procedures, entry log, etc.) that can be utilized to help maintain accountability and enhance security.

4. Managing visitors, clergy, vendors during SIP

a. Outline a plan to minimize points of egress and access to the building(s).

b. During an emergency/disaster, the point of access is:

c. All staff will be required to show a staff photo Identification Badge to gain entry to building(s).

d. Identify any special identification systems (I.D. badges, sign-in procedures, entry log, etc.) that can be utilized to help maintain accountability and enhance security.

e. The entry point designated for staff, emergency responders and volunteers is:


f. Security staff will be provided with a list of designated family members who will be allowed access to building(s) with photo identification.

g. Security staff will be provided with a list of designated volunteers who will be allowed access to building(s) with photo identification.

h. Emergency vehicles will have access at:__________________________________

i. Support agency vehicles will have access at:

j. Delivery vehicles will have access at:

5. Communication Plan with Families/Resident Representatives

______________________________________ (facility name) should maintain emergency contact numbers in addition to primary telephone numbers for family members and resident representatives in order to notify them as quickly as possible when the facility enters a SIP situation. Staff members will be briefed to the following elements to share with residents and family members as assigned:

a. Safety status of residents (see HIPPA tab and link under Resources) b. General outlook at the current time c. Expected disruptions to services or routines d. What the facility administration has done and is doing right now to lessen negative

outcomes e. When to expect updated status reports f. What family members can do to help g. Process for discharging residents to family/resident representative during SIP, if

requested

Information adapted from: Florida Health Care Association Emergency Guide for Nursing Homes, Part I Comprehensive Emergency Management Plan, 2007


6. Policy for Staff Sheltering

Dealing with an emergency resulting in long term Sheltering-in-Place can result in a high level of mental and emotional stress for staff. Staff working additional hours may be resistant to taking a break or acknowledging the high level of exhaustion that accompanies stressful situations.

As part of Emergency Preparedness Planning, it could be helpful for facilities to develop a system by which staff members can identify co-workers who may need a break. A procedure that helps staff members communicate and deal with stress brought on by fatigue, loss, or other disaster-related issues can help ensure that staff members maintain the ability to meet the needs of residents and ensure a healthy workforce following an emergency.

Employees reporting to work or remaining at work during an emergency will need essential items from home in order to remain focused on caring for residents. The following list includes the basics needed for each staff member and, if policy permits, family members sheltering at the facility or relocating to an evacuation site:

a. Sleeping bag/air mattress b. At least 3 changes of clothing c. Toiletries, prescription medications d. Flashlights and extra batteries e. Special items for infants, children, adult dependents and/or pets

7. Policy for Staffing Shifts

___________________ (include name of facility) has developed a policy that addresses the following elements when staff participate in a Shelter-in-Place Situation:

a. Scheduling (work, sleep, breaks)

b. Sheltering family members/pets

c. Sustaining meals and snacks (hydration/nutrition)

d. Rotation of duties for non-essential staff

e. Chain of Command/administration relief


C. Evacuation

1. Notification of policy owner, State Survey Agency, First Responders

Facility must maintain: For the following persons/entities:

Names and contact information County Emergency Manager, Police, Fire, Health Department

Names and contact information LTC Ombudsman, State Licensing & Certification Agency

Names and contact information, directions and transportation provisions

LTC Receiving facilities (if evacuating)

Names and contact information Volunteers (key to operations), Kentucky Health Emergency Listing for Professionals for Surge (K HELPS)

Names and contact information Other forms of support (transportation, supplies vendors, etc.)

2. Activating Mutual Aid Agreement (MOA), Memorandum of

Understanding (MOU)

Mutual-aid agreements are the means for one long-term-care facility to provide resources, space, services, and other required support to another facility during an emergency event. Each facility should be party to a mutual-aid agreement with appropriate facilities/entities from which they expect to receive or to which they expect to provide assistance during an emergency. This would normally include all neighboring long-term care facilities, as well as relevant private-sector and nongovernmental organizations.

At a minimum, mutual-aid agreements should include the following elements or provisions:

• definitions of key terms used in the agreement • roles and responsibilities of individual parties • procedures for requesting and providing assistance • procedures, authorities, and rules for payment, reimbursement, and allocation of costs • notification procedures • protocols for interoperable communications • workers compensation • treatment of liability and immunity • recognition of qualifications and certifications


• sharing of agreements, as required See https://www.nh.gov/safety/divisions/hsem/Planning/planning_muni_nims_faq.html #A17

Memorandum of Agreement

A Memorandum of Agreement (MOA) is a written document describing a cooperative relationship between two parties wishing to work together on a project or to meet an agreed upon objective. An MOA serves as a legal document and describes the terms and details of the partnership agreement. An MOA is more formal than a verbal agreement and less formal than a contract. It should include, but not be limited to: purpose of agreement; roles and responsibilities of partners; payment schedule if applicable; duration of the agreement; signatures of both parties.

Memorandum of Understanding

A Memorandum of Understanding (MOU) is less formal than a MOA. “A Handshake on Paper.”

MOAs and MOUs for Long Term Care should include at least the following elements:

• Staffing

• Equipment

• Pharmaceuticals

• Transportation

• Transfer (Relocation) of residents

• Payment/Reimbursement


a. Transfer Agreement - Example

This agreement is made and entered into by and between YOUR FACILITY NAME, CITY, STATE, a nonprofit corporation (hereinafter called “YOUR FACILITY”) and RECEIVING FACILITY NAME, CITY, STATE, a nonprofit corporation, (hereinafter called “RECEIVING FACILITY”):

WHEREAS, both YOUR FACILITY and RECEIVING FACILITY desire, by both means of this Agreement, to assist physicians and the parties hereto in the treatment of trauma patients (e.g., burn, traumatic brain injuries, spinal cord injuries, pediatrics); and whereas the parties specifically wish to facilitate: (a) the timely transfer of patients and information necessary or useful in the care and treatment of trauma patients transferred, (b) the continuity of the care and treatment appropriate to the needs of trauma patients, and (c) the utilization of knowledge and other resources of both facilities in a coordinated and cooperative manner to improve the professional health care of trauma patients.

IT IS, THEREFORE, AGREED by and between the parties as follows:

1. PATIENT TRANSFER: The need for transfer of a patient from YOUR FACILITY to RECEIVING FACILITY shall be determined and recommended by the patient’s attending physician in such physician’s own medical judgment. When a transfer is recommended as medically appropriate, a trauma patient at YOUR FACILITY shall be transferred and admitted to RECEIVING FACILITY as promptly as possible under the circumstances, provided that beds and other appropriate resources are available. Acceptance of the patient by RECEIVING FACILITY will be made pursuant to admission policies and procedures of RECEIVING FACILITY.

2. YOUR FACILITY agrees that it shall:

a. Notify RECEIVING FACILITY as far in advance as possible of transfer of a trauma patient.

b. Transfer to RECEIVING FACILITY the personal effects, including money and valuables and information relating to same.

c. Make every effort within its resources to stabilize the patient to avoid all immediate threats to life and limbs. If stabilization is not possible, YOUR FACILITY shall either establish that the transfer is the result of an informed written request of the patient or his or her surrogate or shall have obtained a written certification from a physician or other qualified medical person in consultation with a physician that the medical benefits expected from the transfer outweigh the increased risk of transfer.

d. Affect the transfer to RECEIVING FACILITY through qualified personnel and appropriate transportation equipment, including the use of necessary and medically appropriate life support measures.


3. YOUR FACILITY agrees to transmit with each patient at the time of transfer, or in the case of emergency, as promptly as possible thereafter, pertinent medical information and records necessary to continue the patient’s treatment and to provide identifying and other information.

4. RECEIVING FACILITY agrees to state where the patient is to be delivered and agrees to provide information about the type of resources it has available.

5. Bills incurred with respect to services preformed by either party to the Agreement shall be collected by the party rendering such services directly from the patient, third party, and neither party shall have any liability to the other for such charges.

6. This agreement shall be effective from the date of execution and shall continue in effect indefinitely. Either party may terminate this agreement on thirty (30) days notice in writing to the other party. If either party shall have its license to operate revoked by the state, this Agreement shall terminate on the date such revocation becomes effective.

7. Each party to the Agreement shall be responsible for its own acts and omissions and those of their employees and contractors and shall not be responsible for the acts and omissions of the other institutions.

8. Nothing in this Agreement shall be construed as limiting the right of either to affiliate or contract with any hospital or nursing home on either a limited or general basis while this agreement is in effect.

9. Neither party shall use the name of the other in any promotional or advertising material unless review and written approval of the intended use shall first be obtained from the party whose name is to be used.

10. This agreement shall be governed by the laws of the State of INSERT STATE. Both parties agree to comply with the Emergency Medical Treatment and Active Labor Act of 1986, and the Health Insurance Portability and Accountability Act of 1996 and the rules now and hereafter promulgated thereunder.

11. This Agreement may be modified or amended from time to time by mutual agreement of the parties, and any such modification or amendment shall be attached to and become part of the Agreement.

YOUR FACILITY RECEIVING FACILITY

SIGNED BY: SIGNED BY:

DATE: DATE:

Retrieved from: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/Downloads/Facility-Transfer-Agreement-Example.pdf


b. SAMPLE Memorandum of Agreement

SAN DIEGO County Area

Skilled Nursing and/or Long Term Care Facilities Emergency Mutual Aid

Memorandum of Agreement

Recitals:

This Memorandum of Agreement (MOA) is a voluntary agreement among the San Diego Skilled Nursing and/or Long Term Care Facilities for the purpose of providing mutual aid at the time of a disaster. Nothing in this MOA is intended to create any legal relationship among the organizations other than that of independent entities agreeing with each other solely for the purpose assisting each other during a disaster or other critical situation.

This MOA is not a legally binding contract but rather a voluntary agreement. It signifies the belief and commitment of the undersigned facilities that as a result of any emergency or disaster, regardless of cause, which exceed the effective response capabilities of the impacted facility, the affected participant may request assistance from another participant as is more generally set forth herein.

This document is intended to augment, not replace, each facility’s disaster plan. No participant shall be required to provide medical supplies, equipment, services or personnel to another facility that are needed to meet its own internal needs. The document supplements the rules and procedures governing interaction with other organizations during a disaster.

The disaster may be an “external” or “internal” event for one or more facilities and assumes that each affected facility’s emergency management plan has been fully implemented. The terms of this MOA are to be incorporated into the facility’s emergency management plan.

By signing this MOA, each facility is evidencing its intent to abide by the terms of the MOA in the event of a disaster. The facilities participating in this MOA agreement of mutual-aid concur to make a reasonable attempt to comply with the following:

Failure to comply with the MOA does not give rise to legal liability or cause of action.

1. Evacuation of an Undersigned Facility:

1.1 If a disaster affects an undersigned facility(s) resulting in partial or complete facility evacuation, the other undersigned facilities agree to participate in the distribution of patients from the affected facility.


1.2 In the event of an evacuation, the evacuating facility will contact their agreed- upon area coordinator, who will in turn contact EMSDOC (Emergency Medical Services Disaster Operations Center), Medical Operations Center (aka MOC), per established protocol, policy and/or guidelines.

1.3 Request for the transfer of patients; The request for the transfer of patients initially can be made verbally. The request however must be followed up with a written document of communication. This documentation can occur on the Web EOC via the Area Coordinators. The transferring facility, to the extent possible in an emergency situation, will identify to the accepting hospital the following information:

• The number of patients needing to be transferred

• The general nature of their illness or condition

• Any type of specialized services required

• Patient medications, and/or specialized equipment needed

1.4 Documentation: The transferring facility, to the extent possible in an emergency situation is responsible for providing the receiving facility with:

• The patient’s medical record and/or accepted completed report form (including emergency/family contact information and physician contact information.)

• Insurance information

• Other patient information necessary for the care of the patient

• Patient medications and medication schedule with times of last meds given

• Specialized equipment necessary for the care of the patient

1.5 Transfer of Patients: The transferring facility is responsible for tracking the destination of all patients transferred out. The transferring facility is responsible for notifying both the patient’s family or guardian and the patient’s attending or personal physician of the situation. (In the event a patient is routed to a different facility than originally assigned, the final receiving facility will notify the original transferring facility of the change. This will help ensure proper patient tracking.)

1.6 Supervision: The recipient facility will designate the admitting service, the admitting physician for each patient, and, if requested, will provide at least temporary courtesy privileges to the patient’s original attending physician, per the recipient facility’s policy and procedure. (Emergency privileges for physicians and other health care providers will be granted in accordance with The California Association of Health Facilities standards)


2. Medical Supplies and Pharmaceuticals:

2.1 In the event that medical supplies and/or pharmaceuticals and equipment are requested, the undersigned facilities will share, to the extent possible, the requested supplies to help ensure that patients in the San Diego area receive necessary treatment during a disaster. Reusable equipment will be returned to the facility of origin as soon as possible – dependent upon termination of event and return of transferred patients.

2.2 The above supply sharing will occur, in cooperation with the MOC, at the involved undersigned facilities. Requests initially can be made verbally but must be followed up with a written request.

2.3 Documentation: Documentation should detail the items involved in thetransaction condition of the material prior to the loan (if applicable), and the party responsible for the material. Details can be provided to Area Coordinators for documentation.

2.4 Authorization: The recipient facility will have supervisory direction over all the donor borrowed medical supplies, pharmaceuticals and equipment, once they are received by the recipient facility, until returned to the donating facility. Items lost or damaged in transit will be the divided responsibility of both donor and receiving facility.

3. Medical Operations/Loaning Personnel:

3.1 Communication of Request: The request for the transfer of personnel can initially be made verbally and should be followed by written or Web Emergency Operations Center (Web EOC) documentation of the request. [Web EOC is an internet-based documentation and communication tool used by multiple systems throughout the County of San Diego collaboratively with the MOC (Medical Operations Center) and EOC (Emergency Operations Center)]. Web EOC will be used primarily by area coordinators to facilitate information provision and updates. Requests will be made in a standardized format. A request and documented response will occur prior to the arrival of personnel at the recipient facility. The recipient facility will identify to the donor facility the following:

• The type and number of requested personnel

• An estimate of how quickly the request is needed

• The location where they are to report

• An estimate of how long the personnel will be needed


3.2 Documentation: The arriving personnel will be required to present their donor facility identification badge at the check-in site designated by the recipient facility’s command center. The recipient facility will be responsible for the following:

• Meeting the arriving donated personnel (usually by the recipient facility’s security department or a designated employee).

• Providing adequate identification, e.g., “visiting personnel” badge, to the arriving donated personnel.

• Directing arriving personnel to where they will be working and what they will be doing.

• Providing arriving personal with minimal but adequate orientation to facility and equipment to be able to function within their scope of practice.

3.3 Staff Support: The recipient facility shall provide food, housing and/or transportation for donor healthcare facility personnel asked to work for extended periods and for multiple shifts. The costs associated with these forms of support will be borne by the recipient healthcare facility.

3.4 Financial Liability: The recipient facility will reimburse the donor facility for the actual salaries and benefits of donated personnel if the personnel are not being employed for the care of transferring (donor) facility patients, and are employees being paid by the donor facility. The reimbursement will be made within ninety (90) days following receipt of the invoice.

The following fixed rate components for the evacuee’s use of site and facilities will be charged by receiving facility on a per day basis. “Day” is defined as a 24 hour period, or any part thereof, beginning at 12:00 a.m. and ending at 11:59 p.m.

Daily use of facility and grounds: $175.00 per day Related services: $ negotiable

TOTAL DAILY RATE: $175.00 per day

Note: Additional expenses may be incurred by patients with extensive needs and shall be billable accordingly.

3.5 The Medical Director/Medical Staff: The recipient facility will be responsible for providing a mechanism for granting emergency privileges for physicians, nurses, and other licensed healthcare providers to provide services at the recipient facility.


3.6 Demobilization procedures: The recipient facility will provide and coordinate any necessary demobilization procedures and post-event stress debriefing.

4. Miscellaneous Provisions:

4.1 In the event of an emergency situation the undersigned facilities will voluntarily provide staff assistance, if feasible, to participating facilities.

4.2 Any party may propose amendments to this MOA by providing written notice.

4.3 An undersigned facility may at any time terminate its participation in the Mutual-Aid Agreement by providing thirty-day (30-day) written notice to the administrator at each of the undersigned facilities.

4.4 All compensation for equipment or supplies provided to the recipient facility pursuant to this Mutual-Aid agreement will be paid by the recipient facility within 90 days of its receipt of an invoice from the transferring facility for such supplies.

5. Financial & Legal Liability:

5.1 The recipient facility will assume legal responsibility for the personnel, equipment, medical supplies and pharmaceuticals from the donor facility during the time the personnel, equipment, supplies, and pharmaceuticals are at the recipient facility. The recipient facility will reimburse the donor facility, to the extent permitted by federal law, for all of the donor facility’s costs determined by the donor facility’s regular rate. Costs include all use, breakage, damage, replacement, and return costs of borrowed materials, for personnel injuries that result in disability, loss of salary, and reasonable expenses, and for reasonable costs of defending any liability claims, except where the donor facility has not provided preventive maintenance or proper repair of loaned equipment which resulted in patient injury. Reimbursement will be made within 90 days following receipt of the invoice.

5.2 The recipient facility assumes the legal and financial responsibility for transferred patients upon arrival into the accepting facility. Upon admission the recipient facility is responsible for liability claims originating from the time the patient is admitted to the recipient facility until discharge. Reimbursement for care should be negotiated with each facility’s insurer under the conditions for admissions without pre-certification requirements in the event of emergencies.

The goal is to have all parties maintain liability of their own employees:

Each party to this Agreement shall defend, indemnify and hold harmless all other parties to this Agreement from and against any and all liability, loss, expense, attorneys fees, or claims for injury or damages arising out of the performance of this Agreement, but only in proportion to


and to the extent such liability, loss, expense, attorneys' fees, or claims for injury or damages are caused by or result from the negligent or intentional acts or omissions of the party, its officers, agents, or employees.

5.3 Hold Harmless Condition: The recipient facility should hold harmless the donor facility for acts of negligence or omissions, on the part of the donor hospital, in their good faith response for assistance during a disaster. The donor hospital, however, is responsible for appropriate credentialing of personnel and for the safety and integrity of the equipment and supplies provided for use at the recipient facility.

5.4 Liability, malpractice and disability claims, attorneys’ fees, and other incurred costs are the responsibility of the recipient hospital. An extension of liability coverage will be provided by the recipient facility, to the extent permitted by federal law, insofar as the donated personnel are operating within their scope of practice.

6. Indemnity Clause:

6.1.1 Sending facility, including all employees and agents, shall not be liable to receiving facility against all claims, demands, liabilities, judgments, awards, fines, liens, labor disputes, losses, damages, expenses, charges or costs of any kind or character, including attorney’s fees and court costs (hereinafter collectively referred to as ‘Claims’) related directly to this MOA and arising either directly or indirectly from any act, error or omission or negligence of Recipient facility or its contractors, licensees, agents, servants, or employees, including without limitation Claims caused by the concurrent negligent act, error or omission, whether active or passive of sending facility.

6.1.2 Recipient facility, also, including all employees and agents, shall not be liable to sending facility against all claims, demands, liabilities, judgments, awards, fines, liens, labor disputes, losses, damages, expenses, charges or costs of any kind or character, including attorney’s fees and court costs (hereinafter collectively referred to as ‘Claims’) related directly to this MOA and arising either directly or indirectly from any act, error or omission or negligence of Sending facility or its contractors, licensees, agents, servants, or employees, including without limitation Claims caused by the concurrent negligent act, error or omission, whether active or passive of recipient facility.

6.1.3 Both Sending and Recipient facilities shall have obligation however, to defend or indemnify accused facility from a Claim if it determined by a court of competent jurisdiction that such claim was caused by sole negligence or willful misconduct of accused facility.

7. Conformance with Rules and Regulations Permits and Licenses:

7.1.1. All parties shall be in conformity with all applicable Federal, State, County, and local laws, rules, and regulations, current and hereinafter enacted, including facility and professional licensing and/or certification laws and keep in effect any and all


licenses, permits, notices and certifications as are required. All parties shall further comply with all laws applicable to wages and hours of employment, occupational safety, and to fire safety, health and sanitation.

7.1.2. All undersigned parties certify that they possess and shall continue to maintain or shall cause to be obtained and maintained, at no cost to other parties, all approvals, permissions, permits, licenses, and other forms of documentation required for it and its employees to comply with all existing foreign or domestic statutes, ordinances, and regulations, or other laws, that may be applicable to performance of services hereunder.

Term of the Agreement

The term of this agreement shall be effective April 1, 2009 with no end date. This agreement shall be reviewed every three (3) years under the terms and conditions then in effect, this agreement shall be renewed automatically, unless either party gives the other party written notice of intention, not to renew, no less than thirty (30) days prior to the expiration date of the then current term.

Effective Date, Future Amendment and Construction

Development of operational procedures, forms and other tools to operationalize this MOA shall be conducted by the SNF Disaster Preparedness Area Coordinators and participants through the “Skilled Nursing Facility Disaster Preparedness Task Force”. Updates to those procedures, forms, or tools do not require revision of this MOA.

This Memorandum of Agreement is in no way meant to affect any of the participants’ rights, privileges, titles, claims, or defenses provided under federal or state law or common law.

This MOA may not be assigned and shall be governed under California law and may be amended upon written consent of the participants. This MOA contains the entire agreement of the subject matter contained herein and shall give rights to no other parties except where expressly stated. In the event a court of competent jurisdiction deems one or more provisions invalid, the remaining provisions shall remain in full force and effect. Waiver of any breach shall not operate to be a waiver of any other or subsequent breach. The participants shall maintain the confidentiality of patient and other records as required by law.


IN WITNESS AND AGREEMENT WHEREOF, we have set our hands and seals that date below written.

________________________________________________________ ______________

Facility Date

Signature Title

Printed Name

____________________________________________________ _________________

Facility Date

Signature Title

Printed Name

Retrieved http://docplayer.net/9309701-San-diego-county-area-skilled-nursing-and-or-long-term-care-facilities-emergency-mutual-aid-memorandum-of-agreement.html


3. Activating Community Alternate Care Sites

When disaster strikes a LTC facility, experts agree that deciding to Shelter-in-Place (SIP) is the best location in which to provide consistent healthcare to residents. However, there are events when a SIP strategy is not feasible if the facility is unsafe, and/or the residents are without heat or air conditioning for an extended period. Such emergencies may require evacuation. Primary decisions that need to be made once an order for evacuation is given.

A. How the residents will leave the facility considering: • Acuity level • Access to various forms of transportation • Who will assist residents while in transit

B. Where the residents will go: • Relationships with LTC facilities, hospitals, schools, churches • Distance between evacuating and receiving facility

C. What support is available to assist: • County Emergency Manager • Local Health Department • Regional Healthcare Coalition • Local first responders (fire, police, EMS) • Professional Volunteers

D. What accompanies the residents: • Personal belongings • Medical equipment/supplies • Ambulatory aids/walker/wheelchairs • Dietary and Laundry Supplies • Records and Charts

E. How facility will contact family members/resident representatives • Emergency contact list • Designated phone lines

The final decision to evacuate or to shelter-in-place is the responsibility of one person, or her/his alternate. In accordance with the National Criteria for Evacuation Decision-Making in Nursing Homes, created by the FL Health Care Association, the decision to evacuate will be based on:

a. “Internal factors -- resident acuity, risk, physical structure, transportation, destination, staff, and supplies.

b. External factors -- the nature of the emergency event, time, scope, and location of the facility.”

Once the decision has been made to evacuate, the Incident Commander will decide the order in which residents will be evacuated.


______________________________________ (facility name) acknowledges the need to plan for facility evacuation well in advance of a crisis or disaster situation requiring partial or complete evacuation. ______________________________________ (facility name) understands that if a community-wide and regional disaster is occurring, the facility has to be prepared to be self-sufficient, as response times of Emergency Medical Services and other transportation providers may be delayed.

4. Evacuation Routes and Directions to Alternate Facilities

In the event of an evacuation of __________________________________________ (facility name), it is essential to know designated evacuation routes, as well as alternate routes in accordance with the County’s Emergency Management Plan. __________________________________________ (facility name) has pre-determined the primary evacuation routes and alternate evacuation routes in advance of a crisis or disaster scenario. The following is completed and updated annually or when significant changes in regional evacuation planning occur:

Evacuation to the North: Primary Route– Alternate Route–

Evacuation to the South: Primary Route– Alternate Route–

Evacuation to the East: Primary Route– Alternate Route–

Evacuation to the West: Primary Route– Alternate Route–

Facility should insert evacuation routes and directions to alternate facilities. Alternate Facility Name (50 miles away): _______________________________________

Alternate Facility Address: ____________________________________________________ Alternate Facility Cross Streets: _________________________________________________ Evacuation Route/Directions: __________________________________________________ __________________________________________________________________________ Travel Time: ________________________________________________________________


Map:

Alternate Facility Name: ______________________________________________________ Alternate Facility Address: ____________________________________________________ Evacuation Route/Directions: __________________________________________________ __________________________________________________________________________ Alternate Facility Cross Streets: _________________________________________________ Travel Time: ________________________________________________________________ Map:

Alternate Facility Name: ______________________________________________________ Alternate Facility Address: ____________________________________________________ Evacuation Route/Directions: __________________________________________________ __________________________________________________________________________ Alternate Facility Cross Streets: _________________________________________________ Travel Time: ________________________________________________________________


Map:

Alternate Facility Name: ______________________________________________________ Alternate Facility Address: ____________________________________________________ Evacuation Route/Directions: __________________________________________________ __________________________________________________________________________ Alternate Facility Cross Streets: _________________________________________________ Travel Time: ________________________________________________________________ Map:


5. Implementing Facility Transportation Arrangements

When possible, evacuation procedures should be completed before the onset of an expected emergency. Administration must determine how long it will take to complete a full-scale facility evacuation. The amount of time it takes to evacuate, then travel to the sheltering facility should be multiplied times three to account for evacuation traffic, as well as other factors (FL Health Care Association Recommendations).

1. Sample Transfer Agreement

This agreement is made and entered into by and between YOUR FACILITY NAME, CITY, STATE, a nonprofit corporation (hereinafter called “YOUR FACILITY”) and RECEIVING FACILITY NAME, CITY, STATE, a nonprofit corporation, (hereinafter called “RECEIVING FACILITY”):

WHEREAS, both YOUR FACILITY and RECEIVING FACILITY desire, by both

means of this Agreement, to assist physicians and the parties hereto in the treatment of trauma patients (e.g., burn, traumatic brain injuries, spinal cord injuries, pediatrics); and whereas the parties specifically wish to facilitate: (a) the timely transfer of patients and information necessary or useful in the care and treatment of trauma patients transferred, (b) the continuity of the care and treatment appropriate to the needs of trauma patients, and (c) the utilization of knowledge and other resources of both facilities in a coordinated and cooperative manner to improve the professional health care of trauma patients.

IT IS, THEREFORE, AGREED by and between the parties as follows:

12. PATIENT TRANSFER: The need for transfer of a patient from YOUR FACILITY to RECEIVING FACILITY shall be determined and recommended by the patient’s attending physician in such physician’s own medical judgment. When a transfer is recommended as medically appropriate, a trauma patient at YOUR FACILITY shall be transferred and admitted to RECEIVING FACILITY as promptly as possible under the circumstances, provided that beds and other appropriate resources are available. Acceptance of the patient by RECEIVING FACILITY will be made pursuant to admission policies and procedures of RECEIVING FACILITY.

13. YOUR FACILITY agrees that it shall:

a. Notify RECEIVING FACILITY as far in advance as possible of transfer

of a trauma patient. b. Transfer to RECEIVING FACILITY the personal effects, including money

and valuables and information relating to same.


c. Make every effort within its resources to stabilize the patient to avoid all immediate threats to life and limbs. If stabilization is not possible, YOUR FACILITY shall either establish that the transfer is the result of an informed written request of the patient or his or her surrogate or shall have obtained a written certification from a physician or other qualified medical person in consultation with a physician that the medical benefits expected from the transfer outweigh the increased risk of transfer.

d. Affect the transfer to RECEIVING FACILITY through qualified personnel and appropriate transportation equipment, including the use of necessary and medically appropriate life support measures.

14. YOUR FACILITY agrees to transmit with each patient at the time of transfer, or in

the case of emergency, as promptly as possible thereafter, pertinent medical information and records necessary to continue the patient’s treatment and to provide identifying and other information.

15. RECEIVING FACILITY agrees to state where the patient is to be delivered

and agrees to provide information about the type of resources it has available. 16. Bills incurred with respect to services performed by either party to the Agreement

shall be collected by the party rendering such services directly from the patient, third party, and neither party shall have any liability to the other for such charges.

17. This agreement shall be effective from the date of execution and shall continue

in effect indefinitely. Either party may terminate this agreement on thirty (30) days notice in writing to the other party. If either party shall have its license to operate revoked by the state, this Agreement shall terminate on the date such revocation becomes effective.

18. Each party to the Agreement shall be responsible for its own acts and omissions

and those of their employees and contractors and shall not be responsible for the acts and omissions of the other institutions.

19. Nothing in this Agreement shall be construed as limiting the right of either to

affiliate or contract with any hospital or nursing home on either a limited or general basis while this agreement is in effect.

20. Neither party shall use the name of the other in any promotional or advertising

material unless review and written approval of the intended use shall first be obtained from the party whose name is to be used.

21. This agreement shall be governed by the laws of the State of INSERT STATE.

Both parties agree to comply with the Emergency Medical Treatment and Active Labor Act of 1986, and the Health Insurance Portability and Accountability Act of


1996 and the rules now and hereafter promulgated thereunder.

22. This Agreement may be modified or amended from time to time by mutual agreement of the parties, and any such modification or amendment shall be attached to and become part of the Agreement.

YOUR FACILITY RECEIVING FACILITY SIGNED BY: SIGNED BY:

DATE: DATE: Retrieved from: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/Downloads/Facility-Transfer-Agreement-Example.pdf


6. Evacuation Operations

Evacuations may be planned if there is advance warning or they may occur due to a catastrophic emergency situation. If time permits, evacuations will be coordinated to occur in two phases. Phase I will transport the highest acuity residents traveling via ambulance. These residents will be transferred first if at all possible. Phase II will transport all other residents who can travel via buses and cars. Note: The order designated may change depending upon the type/level of disaster, residents’ medical conditions and transportation utilized. For example, when loading a bus, load the most robust residents first, to the back of the bus, and the frailest residents to the front, so that the most at risk persons can be unloaded first. When loading into individual vehicles – load residents with extreme medical conditions first in order to maximize staff resources, energy and strength.

Evacuation terms:

Horizontal Evacuation: Moving residents, staff, and visitors to a safe area on the same floor (compartmentalizing through the use of rated doors and rated assemblies—smoke partitions, fire walls, etc.) into an adjacent smoke/fire compartment (Partial Evacuation) Vertical Evacuation: Moving residents, staff, and visitors to upper or lower floors, depending on the nature of the incident, and into a safe area/area of refuge within the facility (Partial Evacuation) Staging Area: Last place to move residents before leaving the building. Residents may be sent to a staging area based on acuity level Complete/Outside Evacuation: Moving residents, staff, and visitors to a pre-designated area outside Relocation: Moving residents to an off-campus alternate facility/receiving facility Shut Down: Turning off all electricity, gas, etc. to the facility

7. Staff Assignments for Evacuation Procedures

A. Only the Administrator or his/her designee can declare an Evacuation. If the Administrator is not on the premises during an emergency and cannot be reached, the succession of command will be followed.

B. Contact ownership, Corporate Contact, Division of Health Service Regulation, Emergency Management Office, Medical Director, and Kentucky Long Term Care Ombudsman.

C. Coordinate evacuation efforts with County Emergency Manager, who will activate its Incident Command System.

D. Meet with the management team to finalize plans for the Evacuation. Activate Recall Roster. E. Notify all staff and residents of the need to evacuate and the steps that will be taken. F. Send completed Resident Evacuation Tracking Log to County Emergency Manager and

report evacuation information to other agencies as required.


G. Contact families and resident representatives to notify about evacuation. Ensure everyone is aware of emergency numbers, including alternate care facility numbers.

H. Prepare “Emergency Go Box” for travel. I. Notify medical supplies, food, water, and medications vendors. J. Medical Records Department prepare resident medical records for transport, with a

mechanism for safeguarding, once the residents reach the alternate care facilities. K. Incident Commander and/or Administrator will track the emergency’s progress and report to

management staff, who will disseminate information to respective employees, or a facility wide meeting should be held.

L. Designate a staff member to monitor and complete the Resident Evacuation Tracking Log. Ensure all disaster supplies are packed and loaded for transport, including mattresses, air mattresses, cots, pillows, food, water, medical supplies, etc. Designate an individual to oversee this aspect of the Evacuation and an individual(s) to travel with the all the supplies for safeguarding.

M. Pack adaptive equipment, special-need items, and preventative devices for falls and skin break down. Pack blender/food processor for residents with special diets. Include process for requesting additional needed provisions for delivery to the resident.

N. Pack and secure medications, depending on the circumstances of the evacuation. If residents are traveling a short distance primarily together, transporting the medication carts is the best option. Residents traveling to separate destinations will transport medications with them in a secure manner accompanied by a staff member or EMT if traveling via ambulance. If residents are traveling a long distance outside the geographical area, critical medications for diabetes, cardiac conditions, psychiatric disorders, etc. should be carried in the residents’ emergency “go bags.” During a state-mandated evacuation, travel may be delayed, and medication carts might be transported separately experiencing delays.

O. Emergency medication boxes should accompany all transfer vehicles with narcotics under double lock. A licensed nurse will be designated for each vehicle to ensure medications are safeguarded, whether medications are secure in the medication carts or in the resident emergency “go bags.” If residents needing critical medications are deemed unsafe to carry their own medications, then a licensed nurse will do so.

P. Provide separate coolers for temperature-controlled medications. Q. Pack coolers of ice and drinks if traveling long distances. R. Only volunteers trained to the needs of the chronic, cognitively impaired, and frail

population, as well as knowledgeable of methods to minimize transfer trauma, can assist with transporting residents.

S. Group the residents according to unit, acuity, or whatever works best and assign staff members accordingly. Pack Resident Emergency “Go Bags” with Emergency Packets, Identification Bracelets, and Medical Records. Ensure each vehicle has a supply of emergency supplies.

T. Comfort and reassure residents throughout the process by encouraging evacuees to talk about expectations, anger, and/or disappointment; working to develop a level of trust; presenting an


optimistic, favorable attitude about the relocation; anticipating that anxiety will occur; being agreeable and not arguing with residents; encouraging rather than giving orders; understanding that residents’ behavior should not be taken personally; Using praise liberally; Including residents in assessing problems; encouraging staff to introduce themselves to residents and encouraging family participation.

U. The highest acuity residents traveling via ambulance should be transferred first, if at all possible, as Phase I of the evacuation. Medical Records will be sent with each of the Phase I residents.

V. Designate a staff member to coordinate the Phase I Evacuation. W. Residents who can travel by bus or car will be evacuated in Phase II. Phase II residents will

be moved to a staging area prior to evacuation. Staff members will be designated to each of the vehicles to assist residents during the transport.

X. Secure the facility and turn off and unplug all electronics and computers. Y. Designate a staff member to stay behind, if deemed safe, to safeguard the facility. Z. Activate shut-down procedures for non-essential utilities. AA. Accompany residents to receiving facility and unload. Should a resident become ill, or

die, during transport, the Incident Commander at the sending facility will be contacted and s/he will determine the appropriate action and transportation destination, establish contact with the Administrator of the receiving facility, notify other officials and initiate the required documentation.

BB. Establish a “Nursing Office” at the receiving facility. Establish daily communications with staff members, residents, and resident families/resident representatives.

CC. Establish procedure at receiving facility for residents to report loss of personal effects during evacuation process to FEMA or other appropriate agency.

DD. Monitor the situation with local authorities to determine a plan for re-entry into the facility.

8. Staff Assignments by Position

1. Administrator/Incident Commander a. Meet with management team to activate Incident Command System (ICS) and finalize

instructions for evacuation. b. Contact ownership, Corporate Contact, Division of Health Service Regulation,

Emergency Management Office, Medical Director, and Ombudsman to notify them of decision to evacuate.

c. Notify staff members of decision to evacuate. d. Establish communications with the Administrator of the receiving facility. e. Notify alternate care facilities of pending arrival. f. Designate Phase I and Phase II Coordinators in conjunction with Director of Nursing. g. Designate a staff member to monitor and complete the Resident Evacuation Tracking Log

at end of this Evacuation Section.


h. Contact vendors that may be needed for post-disaster restoration and make arrangements for services.

i. Secure the facility and ensure all electronics and computers have been turned off and unplugged.

j. Activate shut-down procedures for non-essential utilities. k. Ensure Emergency Go-Box is complete. l. Accompany residents to receiving facility and unload. m. Establish daily communications with staff members, residents, and resident

families/responsible parties. n. Remain calm to not upset the residents. o. Initiate recovery and re-entry efforts when deemed safe.

2. Director of Nursing a. Designate groups of residents to be transported based on acuity and determine staffing

needs. b. Complete Resident Acuity Sheet for Evacuation to determine transportation needs. c. Prepare list of residents and where they are evacuating to, so nursing staff can prepare

Emergency “Go Bags” to include clothing, supplies, medications, etc. d. Ensure complete data backup. e. Designate Phase I Coordinator in conjunction with Incident Commander. f. Designate Phase II Coordinator in conjunction with Incident Commander. g. Assist in coordinating transfer of all residents to hospital(s). h. Notify pharmacy of pending evacuation and alert for need to provide back-up

medications. i. Remain calm to not upset the residents. j. Supervise resident evacuation from the building and the flow of residents. Ensure

residents have Emergency Packets, Go Bags and Identification Bands. k. Accompany residents to receiving facility and establish a Nursing Office, to be manned

by the Director of Nursing and other Administrative Nurses. l. Communicate to staff members throughout the process and thank them for their efforts.

3. Nursing Staff a. Ensure all physician orders have been obtained for residents. b. Prepare medications for residents going to hospitals—ensure a week’s worth of

medications, if possible. c. Prepare medications for residents going home with families/resident representatives—

ensure a week’s worth of medications, if possible. d. Prepare equipment, medical supplies, first aid supplies, treatment carts, crash cart,

emergency medication boxes, oxygen, and medication carts for transport. e. Ensure residents are properly prepared for evacuation. f. Assist in resident transfers. g. Designate staff members to accompany each resident group. h. Remain calm to not upset the residents.


a. Transfer all residents from beds to wheelchairs, Geri-chairs, etc., if possible b. Prepare residents in designated groups according to acuity for transport to alternate care

facilities. Ensure the residents:


i. Are properly attired for the weather with shoes, coats, hats, etc. ii. Are wearing ID bands. iii. Have Emergency Packets with face sheet, identification, DNR orders, insurance

information, etc. iv. Have Emergency “Go Bags” with personal clothing, gowns/pajamas, shoes,

slippers, socks, underclothes for three to four days. v. Have incontinence supplies, personal grooming items, and other medical supplies. vi. Have dental supplies, dentures, hearing aids, eyeglasses, etc. vii. Have pillows, blankets, bed linens, (mattress may be transported as well). viii.Ensure all adaptive aids, such as hearing aids and dentures, are packed and

properly labeled. e. Remain calm not to upset the residents.

5. Medical Records a. Protect and gather resident records for transport. Send each record with the Phase I

resident to his/her receiving location. b. Send resident records for Phase II residents to the receiving facility. c. Ensure resident records are safeguarded at the receiving facility. d. Ensure complete data backup. e. Remain calm to not upset the residents.

6. Office Staff

a. Protect and gather vital employee and facility records for transport if necessary. b. Ensure complete data backup prior to the disaster’s onset. c. Ensure all computers and computers have been turned off and unplugged. d. Set up process to maintain time sheets for staff working at the alternate care sites. e. As directed by Incident Commander, continue to notify families/resident representatives

of plan to evacuate. f. Document all emergency actions taken and notifications. g. Ensure telephone/emergency phone coverage for the facility. h. As directed by Incident Commander, continue to notify staff members to report to the

facility as soon as possible. i. Remain calm to not upset the residents.

7. Social Services/Activities a. Notify families/resident representatives who have requested their loved ones be

discharged to their care. Make a list and forward to the nursing department, so discharge orders can be obtained from attending physicians.

b. Remain calm to not upset the residents. c. Work closely with nursing staff to meet the needs of the residents.

8. Maintenance

a. Work with responding emergency agencies on items such as utility controls and elevator operations. Support responding emergency agencies with building security and traffic control.

b. Make final rounds of the facility and grounds. c. Make emergency repairs of the facility. d. Secure windows and other building openings. e. Close windows, pull shades and close drapes.


f. Check equipment for functionality. g. Secure the facility and turn off and unplug all electronic devices and computers. h. Activate shut-down procedures. i. Secure all potential flying debris (above, below, around, and in the facility). j. Gather supplies, such as radios, flashlights, batteries, etc. for transport. k. Remain calm to not upset the residents.

9. Food Services a. Set refrigerators and freezers to lowest setting prior to exiting the facility. b. Unplug non-essential equipment. c. Gather emergency food, water, cooking utensils, and food disposal supplies for transport.

Assign staff member to accompany food items during transportation to the alternate facility.

d. Protect and gather vital resident and department records for transport. e. Notify vendors to deliver supplies, including ice and water to alternate care facility. f. Determine the number of residents, visitors, volunteers, employees, and their family

members for whom food service will be provided. g. Prepare to assist in resident evacuation and report to the alternate care facility. h. Remain calm to not upset the residents.

10. Housekeeping/Laundry a. Protect and gather an adequate supply of linens to be transported to the evacuation site. b. Unplug all equipment. c. Notify vendors to deliver supplies to the alternate care facility, if necessary. d. Determine the number of residents, visitors, volunteers, employees, and their family

members who will need supplies and linens. e. Gather supplies such as linens, blankets, trashcan liners, mops, rags, buckets, trash cans,

cleaning supplies, toilet paper, etc. f. Prepare to assist in resident evacuation and report to the alternate care facility. g. Remain calm to not upset the residents.

11. Transportation a. Check fuel, oil, and water levels for each vehicle. b. Prepare maps with evacuation routes and alternate routes. c. Remain calm to not upset the residents.

12. Medical Director a. Will assist facility with transfer decisions. b. Provides emergency orders if attending physician cannot be reached.

9. Resident Emergency Go-bags

Those caring for residents at an alternate site can best provide care and support for displaced residents when personal belongings accompany the resident during the transportation phase. Resident Go-bags should contain the following essential items in quantities to last 3-4 days:

• personal clothing


• gowns/pajamas • shoes • slippers • socks • underclothes • toiletries • glasses • dentures

10. Resident Emergency Packets

______________________________________ (facility name) should maintain an Emergency Packet for each resident that will be located ___________________________________. The packet should be placed in a plastic bag labeled with the resident’s name. This Emergency Packet will be sent with the resident to the receiving facility during an evacuation. The medical record will be sent with the resident as well, but the emergency packet contains a duplicate copy in case the original medical record is lost, misplaced, or destroyed. Staff working third shift may be called upon to prepare and update Resident Emergency Packets. The emergency information packet should include:

a. Identification bracelet/s (see Resident Identification Bracelet section for more

information)

b. Vests to hold clipboard, medications, etc. c. Face Sheet/Data Sheet

• Contact information of family/resident representative • Social Security Number • Medicare/Medicaid/other insurance provider numbers • Date of birth, etc. • Allergies • Diagnoses/Medical Conditions

d. Photograph e. Current medications f. Resuscitation instructions with copy of DNR, if applicable g. Power of Attorney and/or advance directives h. Diet and special provisions, such as thickened liquids only i. Written process for requesting urgent and non-urgent additional supplies/equipment/etc.

to be delivered to the receiving facility with emergency contact numbers This emergency information should be updated monthly during resident care planning to ensure accurate information. Other triggers for an update may include: j. Significant change in resident’s condition k. Hospitalization l. Knowledge of changes in the family such as a death, illness, or relocation


______________________________________ (facility name) should address with the resident, family and/or resident representative upon admission, and at a minimum annually, arrangements that would be made in the event of a planned evacuation, in which there is time for family assistance.

These arrangements should be documented and maintained in the resident’s medical records. Facilities located in areas prone to ________should update prior to or during _______peak season.

11. Resident Evacuation Wristbands

During an evacuation, each resident should wear a (color/description) _________________ identification wristband on the (right/left) ________ wrist that includes the following information:

a. Resident’s full name/Date of Birth b. No known allergies (NKA) – or list food/medication allergies (in red) c. Critical diagnosis (Diabetic, Epileptic, Psychiatric Diagnosis, etc.) d. Facility name and contact number e. On back or inside of band add name of physician and name of resident representative

with contact numbers for each f. Note “Do Not Resuscitate (DNR), if applicable

A (color/description) ______________________________ critical medical information band should be worn on the (left/right) _______ wrist and be utilized for each resident with special needs. The critical medical information band will include the following information:

a. Resident’s full name b. Facility name and contact number c. Note if resident is either insulin-dependent—diabetes mellitus (DDM)—or non-insulin

dependent—diabetes mellitus (NIDDM)—if diabetic d. Note if resident is using a thickener product or mechanically altered diet (e.g., puree,

mechanical, soft, etc.) e. Include other special needs (at risk for wandering, at risk for falls, at risk for skin

breakdown, etc.)

________________________ (staff member) should be designated to assure that identification wristbands are generated for all residents. Identification wristbands should be reviewed during plan of care meetings to confirm accuracy.

12. Emergency Transfer Techniques

When resident is found face down on the floor

Hip Roll • Place a blanket (folded lengthwise in half) next to the resident and kneel on it


• Grasp resident at shoulder and hip, roll toward you onto blanket • Grasp corners of blanket and pull resident from room, headfirst

Ankle Roll

• Place blanket (folded lengthwise in half) next to resident • Position yourself at resident’s feet • Cross ankle furthest from the blanket over other ankle • Using both hands, press down on top ankle and lift the bottom foot. With a twisting

motion, roll resident over on blanket • Grasp corners of blanket and pull patient from room, head first

Removal of resident from a bed

Removal of someone from a bed takes practice. Find the one carry that you can handle best. If you can practice often enough, the resident’s weight and height will not be important factors. Emergency carries for one person

Pack Strap Carry • Face the head of the bed • Grasp resident’s nearest wrist with your nearest hand, palm down. Raise resident’s arm • Grasp resident’s other wrist by slipping your free hand under the arm • Pull resident to a sitting position by stepping backward • In a continuous operation:

o Lift resident’s arm over your shoulders as you turn toward the foot of the bed o Cross resident’s arm over your chest pulling down firmly. (Caution: bring your

shoulder tight up into resident’s armpit.) o Turn toward the head of the bed and your forward momentum will roll resident on to

your back. o Carry the resident from the room in a stooped position

Hip Carry

• Face Resident • Grasp Resident’s farthest wrist, palm down with head closest to head of bed • In a continuous operation:

o Turn toward head of bed o Place resident’s arm over your head and around your neck o Sit on bed, slip free hand around resident’s back and grasp resident at armpit o Secure upper half of resident’s body firmly against you o Grasp resident around knees with free hand o Pull resident onto your back. Stand and walk in a slightly stooped position.

Pass through doorways sideways, being careful not to strike resident’s head against the wall or door jam


Emergency removal of resident from bed when working alone

Cradle Drop • Place blanket parallel to bed • Slip your arms under body and pull resident toward edge of bed • Drop to knee nearest to head • Pull lower half of body from bed so that your extended knee supports resident’s hips • Use both arms to lower upper body of the resident to the floor • Let legs slide gently to blanket. Grasp corners of blanket and pull resident from room

head first Emergency Carries for Two or More Persons

Wing Carry • Person at resident’s head gives command • First person raises resident to a sitting position by placing one hand under resident’s neck

and grasping far shoulder. With other hand, grasp upper biceps • Simultaneously: Second person swings resident’s legs off of the bed • Both rescuers: • Sit on bed next to resident • Place resident’s arms around her/his own neck • Reach arms around resident’s waist, grasping each other’s arms behind resident • Reach under resident’s knees grasping wrists or using a finger-locking grasp • Stand and walk close to resident. Hips support weight

Extremity Carry • Raise resident to sitting position by placing one hand under resident’s neck and grasping

far shoulder. With the other hand, grasp under biceps • Slip your arms under the resident’s arms and lock them across her/his chest • Second person grasps resident’s ankles. Separate legs and back between them, grasping

resident at the knees • Remove resident from room, feet first

Three Person Carry • First person – one hand under resident’s shoulders – other above waist • Second person – one hand above and one below hips • Third person – one hand above knees, one above ankles • Move resident to edge of bed, assume somewhat semi-kneeling position, lift and roll

resident high on your chest • Remove resident from room feet first

Four Person Carry • Procedure is basically the same in above three-person lift; only in this case after lifting

resident from bed, the resident is lowered to the floor on top of a blanket already spread by the fourth person. Fourth person assists in lowering resident to blanket. Person lifting at the knees and ankles then positions her/himself on same side as fourth person


• One person at each side of resident’s shoulders and knees • Head person grips blanket above shoulders and opposite elbows • Fourth person grips blanket 6 inches above and below the knees • All rescuers roll blanket tightly to resident • Lift and carry resident with arms extended. When going down stairs, resident is feet first

*All carrying procedures should be routinely reviewed and practiced.© 2005 All rights reserved by Florida Health Care Association


13. Facility Go Box

______________________________________ (facility name) should establish an Emergency “Go Box” and place it in secure locations throughout the facility, so that the Administrator and/or Incident Commander can grab it in an emergency situation. The “go-box” should contain at least the following items:

Emergency Go Box Items for Facility

Boxes are located: ________________________________________________________

ü Item

Cell phone & phone charger Two-way radios & batteries Flashlights & batteries First Aid Kits Cash/credit cards Additional keys for the facility Emergency key contacts list List of employees with information for payroll purposes List of employees contact/emergency numbers (see communication section) Copies of facility floor plans (enlarged) Badges for visitors/Pens/Pads/Blank Avery labels/ Colored Sharpe Markers Incident Command Structure (ICS) Facility Action Cards N95 Masks/Latex gloves Working gloves/duct tape Colored t-shirts or reflective vests/incident commander vest Restraints (for emergency purposes only)

14. Decision to move residents or discharge residents

A. Residents will respond to disruptions in unanticipated ways. For some residents, relocating to a receiving facility may seem like an adventure. For others, displacement from the familiar may increase their confusion and potentially add to their stress.

B. Administrators must determine the best option for each resident. Family members and/or resident representatives may decide to house their loved one rather than have her/him transported to another facility.


C. Facilities must have procedures in place to assist staff make quick decisions whether to move or discharge residents when evacuating the facility.

D. Communicating with family members/resident representatives as soon as a decision to evacuate has been made will ease the transition for staff, residents and family members/ resident representatives. The following communication wording may be appropriate to share when an evacuation is pending:

“Our primary concern is resident safety and comfort. Therefore, we plan to remain in our facility should an emergency occur. However, if the building is damaged or we cannot remain on our grounds for other reasons, we have made arrangements for residents and staff to relocate to another location. Family members and resident representatives will be contacted if evacuation is necessary. If possible, staff can assist in coordinating arrangements for residents who want to stay with family members/resident representatives during an evacuation rather than move to another long-term-care facility.”

15. Resident Tracking

During a disaster/emergency situation a list of all residents and their locations will be developed and updated by: (name/position) and kept at: (location).

A staff member should be designated to monitor and complete the Resident Evacuation Tracking Log.

Admission and Discharge Protocols

In the event that the facility needs to discharge residents or accommodate displaced residents, or discharges from hospitals (name/position) will be responsible for reviewing a roster of current residents and developing a list of those who are appropriate for discharge. Developing criteria for tracking


16. Resident Evacuation Checklist

Name of Resident __________________________________________________________________________

Social Security # _______________________________________ Room# _________________________

Discharged to: _____________________________________________________________________________

(Facility name or family/resident representative)

Name(s) of Physician(s) notified: Family/Resident Representative Notified:

1. ____________________________________________ Name __________________________________

2. ____________________________________________ Relationship ____________________________

3. ____________________________________________ Name __________________________________

4. ____________________________________________ Relationship ____________________________

Kentucky Long Term Care Ombudsman notified: Name: _______________________

Medical Records Sent: �Yes � No Transfer Mode: ____________________________________

Personal Belongings Sent with Resident:

List Belongings: w/resident w/family/RR

_________________________________________________________ � �

_________________________________________________________ � �

_________________________________________________________ � �

_________________________________________________________ � �

Medical Equipment Sent with Resident:

Equipment labeled __________________________________________________________________________

Medication and Supplies Sent with Resident:

Diet Regimens:

Additional Comments

Signature of Person Completing Discharge Process Print Name of Person Completing Discharge Process __________________________________________ __________________________________________ Date:________________________ Time: ________________(AM/PM) (EST/CST/MT/PT)


17. Tracking Residents off-site at time of Emergency

Residents could be off-site during an emergency or disaster attending an activity or visiting family. A facility’s emergency preparedness plan should include a procedure to account for and contact residents and accompanying staff when off-site. In the following space, describe the procedure and facility plans to contact residents off-site during an emergency.

18. Staff Tracking

It is essential to have a written list of all your staff member in case cell phones/electronic devices are damaged, lost or can’t be charged. During an emergency situation texts may get through when phone calls will not.

a. Make sure all employees have their supervisor’s emergency contact number.

b. Create a list of staff phone numbers/alternate numbers and email addresses.

c. Update contact information at least annually during performance evaluation.

d. Print a hard copy of the list to use in case of utility outage.

19. Pharmaceutical and Medical Device Tracking

a. Pack and secure medications, depending on the circumstances of the evacuation. b. If residents are traveling a short distance primarily together, transporting the

medication carts is the best option. c. Residents traveling to separate destinations will transport medications with them in a

secure manner accompanied by a staff member or EMT if traveling via ambulance. d. If residents are traveling a long distance outside the geographical area, critical

medications for diabetes, cardiac conditions, psychiatric disorders, etc. should be carried in the residents’ emergency “go bags.”

e. During a state-mandated evacuation, travel may be delayed, and medication carts might be transported separately experiencing delays.

f. Emergency medication boxes should accompany all transfer vehicles with narcotics under double lock.


g. A licensed nurse will be designated for each vehicle to ensure medications are safeguarded, whether medications are secure in the medication carts or in the resident emergency “go bags.”

h. If residents needing critical medications are deemed unsafe to carry their own medications, then a licensed nurse will do so.

i. Provide separate coolers for temperature-controlled medications. j. Dedicate a staff member to track pharmaceuticals.

20. Transportation Assessment Tool

The following tool provides instructions for facilities to use in the event an evacuation is required. The tool may also be helpful as a training tool when participating in a facility-based or community-based exercise.

Kentucky LTC Facilities Evacuation Transportation Assessment Tool – 8/14; Emergency Preparedness for Aging Training Grant, 2014-2015, #PO2 728 1400005808 1; Adopted from “Fire Emergency Management for Healthcare Facilities” by Russell Phillips Associates, LLC For more information, contact Betty Shiels, [email protected], 502-852-8003 or Diana Jester, [email protected], 502-852-3487. Website: www.kyepltc.com

303

KENTUCKY

LTC FACILITIES EVACUATION TRANSPORTATION

ASSESSMENT TOOL


304

1. INSTRUCTIONS

Dear Nursing Facility Administrator:

The attached tool will assist in determining the necessary transportation resources to evacuate your nursing facility residents in a disaster.

This tool will determine emergency evacuation transport needs for nursing facilities, with information broken down by resident population.

This process will provide Fire, EMS and Emergency Management with a strong knowledge of the resources needed to evacuate single or multiple nursing facilities simultaneously and will help improve the pre-planning work currently underway in your community.

Due Date: ONGOING (attempt to incorporate at the end of fire drills)

Scope: We expect this tool to take approximately 30 minutes – 1 hour to complete.

Objectives:

▪ Identify the number of residents who need transport due to evacuation and those that can be discharged. ▪ Evaluate transportation needs based on resident acuity and mobility.

Instructions (for Administrator) – READ DIRECTIONS BEFORE COMPLETING:

1. Provide the Nurse / Physician Decision-Making Guide (Pages 3-4) to all clinical departments along with Pages 5-7. Instruct the Unit Coordinators to complete the Clinical Area Totals for Evacuation Planning on Pages 5-6 and return it to you.

2. Administrator/DON: Prepare a checklist of all department/units that should be submitting in the Clinical Area Totals for Evacuation Planning form and verify all have responded before completing #3 below.

3. Administrator/DON: Collect all forms, combine all numbers, and enter them onto the “Facility Totals” document (Page 7-9).

4. Resident/Medical Records/Staff/Equipment Tracking Sheet (pages 10-11) should be copied double-sided. Multiple copies of this form will be needed.

DISCLAIMER: This is not customized to the State of Kentucky or specific paramedic protocols in KY and should be used as a baseline tool to determine

transportation needs for planning and during a disaster.


305

Resident Transportation Decision-Making Guide Based on Clinical Criteria

Transportation Levels by Clinical Categories:

a. Residents requiring Critical Care Transportation (RN-staffed) Count of residents requiring Critical care transport=

□ Need any medications administered via Physician orders by any means in any dosage prescribed□ Neurosurgical ventricular drains□ Invasive hemodynamic monitoring which cannot be temporarily or permanently discontinued (i.e. intra-arterial catheter if noninvasive

blood pressure have not been reliable for Residents, they are hemodynamically unstable, and they have a continuing chance of survival.)

b. Residents requiring ALS transport (Paramedic) Count of Residents requiring ALS transport= □ IVs with medication running that are within paramedic protocols□ IV pump(s) operating (can be provided by the transport crew)□ IV with clear fluids (no medications)□ Need limited medications administered via Physician orders by limited means in limited dosage prescribed□ Cardiac monitoring/pacing (only external pacing can be provided by the transport crew) / intra-aortic counter pulsation device / LVAD□ Ventilator dependent (vent can be provided by the transport crew or home vent)□ Prone or supine on stretcher required.

c. Residents requiring BLS transport (EMT) Count of Residents requiring BLS transport= □ O2 therapy via nasal cannula or mask (can be provided by the transport crew)□ Saline lock and Heparin lock□ Visual monitoring / Vitals (BP/P/Resp)□ Prone or supine on stretcher required or unable to sustain□ If Behavioral Health, provide information regarding danger to self or others.

d. Residents requiring Chair Car/Wheelchair Accessible Bus(Medically knowledgeable person to ride on the transport) Count requiring Chair Car/ Wheelchair Accessible Bus transport=

□ No medical care or monitoring needed, unless they have their own trained caregiver rendering the care.□ Not prone or supine, no stretcher needed.□ No O2 needed, unless resident has own prescribed portable O2 unit safely secured en route.□ If Behavioral Health, provide information regarding danger to self or others.

NOTE: Some wheelchair van companies provide a standard wheelchair, if needed, for the duration of the trip. Buses do not provide wheelchairs. Some electric wheelchairs cannot be secured in wheelchair vans due to size or design. These are NOT to be transported with the resident.


306

e. Residents requiring Normal Means of Transport (typically a bus – resident must be limited assist transfer or no assist required – Medically knowledgeable person to ride on the transport) Count requiring Chair Car/ Wheelchair Accessible Bus transport=

□ No medical care or monitoring needed, unless they have their own trained caregiver rendering the care. □ No O2 needed, unless resident has own prescribed portable O2 unit that can be safely secured en route. □ Not prone, supine, or in need of a wheelchair (can ambulate well enough to climb bus steps) □ If Behavioral Health, provide information regarding danger to self or others. □ Limited assist transfers or no assist required.

NOTE: A person with a folding wheelchair, who can ambulate enough to get in and out of a car, could go by car if there was room to bring/pack the wheelchair.

f. Residents requiring bariatric ambulance or transport. (A good base is to start at >350lbs.)

Count requiring Chair Car/ Wheelchair Accessible Bus transport=


307

Clinical Area Totals for Evacuation Transportation Planning

To be completed and sent internally to the Administrator/DON

Clinical Area Name: (wings, units,

etc.) Individual Completing Form/Title:

Time(AM/PM) (ET/CT/MT/PT) and Date Completed: Total Beds: #

# of Total Residents:

(Should match TOTAL box below in 1.a.)

Using the data collected from clinical areas, provide the total number of residents requiring each level of transportation for

evacuation. (Note: Normal form of transportation is for Limited Assist Transfer residents.)

1. a. TRANSPORTATION LEVELS

Critical Care Transport ALS Transport BLS Transport Wheelchair Accessible

Bus

Normal (bus, van, car,

etc.

TOTAL

# # # # # #

1. b. SUPPLEMENTAL INFORMATION

#Requiring Continuous O2 # of Ventilators #with special medical equipment

(can’t be discontinued)

# of Dementia or Psych Secured

# # # #

NOTE: Information in #2 and #3 below is supplemental and the # of residents below SHOULD already be included in the TOTAL in #1.


308

2. DISCHARGE TO HOSPITALS


Bus


etc.

TOTAL

# # # # # #

Clinical Area Totals for Evacuation Transportation Planning

3. BARIATRIC RESIDENTS Please provide additional information for each area below for the specific transportation needs of Bariatric Residents. Note: BLS Transport is categorized

as >350 lbs., while buses are categorized as <500 lbs.

Critical Care Transport ALS Transport BLS Transport Wheelchair Accessible Bus TOTAL BARIATRIC

350-500 lbs. >500 lbs. 350-500 lbs. >500 lbs. 350-500 lbs. >500 lbs. 350-500 lbs. >500 lbs. 350-500 lbs. >500

lbs.

# # # # # # # # # #

4. DISCHARGE TO HOME Please provide additional information for each area below for the specific transportation needs of residents Discharged to Home.

Wheelchair Accessible Bus Normal (bus, van, car, etc.) TOTAL DISCHARGE TO HOME

# # #

4. Resident information or special notes you would like to include about your wing/unit.


309

Facility Totals for Evacuation Transportation Planning

To be completed and sent internally to the Administrator/DON and used to support EMS & Fire (see page 1)

Facility Name and City:

Individual Completing Form/Title:

E- mail Address: Time(AM/PM)(ET/CT/MT/PT) and Date Completed: Total Beds: #

2. # of Total Residents: # (Should match TOTAL box below in 1.a.)

Using the data collected from clinical areas, provide the total number of residents requiring each level of transportation for

evacuation. (Note: Normal form of transportation is for Limited Assist Transfer residents.)

1. a. TRANSPORTATION LEVELS


Bus


etc.

TOTAL

# # # # # #

1. b. SUPPLEMENTAL INFORMATION

#Requiring Continuous O2 # of Ventilators #with special medical equipment

(can’t be discontinued)

# of Dementia or Psych Secured

# # # # NOTE: Information in #2 and #3 below is supplemental and the # of residents below SHOULD already be included in the TOTAL in #1.

2. DISCHARGE TO HOSPITALS Critical Care Transport ALS Transport BLS Transport Wheelchair Accessible

Bus


etc.

TOTAL

# # # # # #


310


3. BARIATRIC RESIDENTS Please provide additional information for each area below for the specific transportation needs of Bariatric Residents. Note: BLS Transport is categorized as >350

lbs., while buses are categorized as <500 lbs.

Critical Care Transport ALS Transport BLS Transport Wheelchair Accessible Bus TOTAL BARIATRIC

350-500 lbs. >500 lbs. 350-500 lbs. >500 lbs. 350-500 lbs. >500 lbs. 350-500 lbs. >500 lbs. 350-500 lbs. >500 lbs.

# # # # # # # # # #

4. DISCHARGE TO HOME

Please provide additional information for each area below for the specific transportation needs of residents Discharged to Home.

Wheelchair Accessible Bus Normal (bus, van, car, etc.) TOTAL DISCHARGE TO HOME

# # #

5. ASSISTED LIVING Total Additional residents on-site for Assisted Living

Wheelchair Accessible Bus Normal (bus, van, car, etc.) TOTAL ASSISTED LIVING

# # #

6. SENIOR INDEPENDENT LIVING Total Additional residents on-site for Senior Independent Living

Wheelchair Accessible Bus Normal (bus, van, car, etc.) TOTAL SENIOR INDEPENDENT LIVING

# # #


311


7. ADULT DAY HEALTHCARE Total Additional residents on-site for Adult Day Healthcare

Wheelchair Accessible Bus Normal (bus, van, car, etc.) TOTAL ADULT DAY HEALTHCARE

# # #

8. Please provide us with the breakdown of nursing facility residents, assisted living residents, residential care/adult home residents and senior independent residents to clarify the primary box in #1 on previous page (if multiple levels of care were entered in that box).

9. Resident information or special notes you would like to include about your facility.

Kentucky LTC Facilities Evacuation Transportation Assessment Tool – 8/14; Emergency Preparedness for Aging Training Grant, 2014-2015, #PO2 728 1400005808 1; Adopted from “Fire Emergency Management for Healthcare Facilities” by Russell Phillips Associates, LLC For more information, contact Betty Shiels, [email protected], 502-852-8003 or Diana Jester, [email protected], 502-852-3487. 313

ATTACHMENT C - KY LTC SURGE RESIDENT TRACKING SHEET - Page 1 of 2

**Each Receiving Facility will need its own Tracking Sheet**

Resident Transported FROM (Sending Facility): Print YOUR Name/Phone#/Fax#:

Resident Transported TO (Receiving Facility): Contact Person @ Receiving Facility: Phone:

Date & Departure Time from Facility (AM/PM): Date & Time Arrived at Stop-Over Facility (AM/PM): Phone:

Date & Time Left Stop-Over (AM/PM): Date & Time Arrived at Receiving Facility (AM/PM)

Staff sent with Resident(s):

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Resident Name (Last, First) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 □KEEP One Copy □ FAX or SEND a copy to Receiving Facility □GIVE a copy to Transporters Receiving Facility: Have you communicated back that you received the residents? □YES □ NO (If NO, please do so)

Receiving Facility: Print Name & Key Contact and Phone #:


ATTACHMENT C - KY LTC SURGE RESIDENT TRACKING SHEET - Page 2 of 2

**Each Receiving Facility will need its own Tracking Sheet**

Resident Transported FROM (Sending Facility): Print YOUR Name/Phone#/Fax#:

Resident Transported TO (Receiving Facility): Contact Person @ Receiving Facility: Phone:

Date & Departure Time from Facility (AM/PM): Date & Time Arrived at Stop-Over Facility (AM/PM): Phone:

Date & Time Left Stop-Over (AM/PM): Date & Time Arrived at Receiving Facility (AM/PM)

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Resident Name (Last, First) Y N Y N Y N Y N Staff Name (Last, First) Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N Y N □KEEP One Copy □ FAX or SEND a copy to Receiving Facility □GIVE a copy to Transporters ing Facility: Have you communicated back that you received the residents? □YES □ NO (If NO, please do so)

Receiving Facility: Print Name & Key Contact and Phone #:


D. Hosting Evacuees From One LTC to Another Surge capacity involves assessing a facility’s ability to increase hosting capacity to facilitate rapid transfers and/or discharges during an emergency. When considering assistance to other facilities, identify areas where staff may shelter residents from other LTC communities, or hospitals. There are three categories of medical surge. The attached tool includes necessary steps to welcome residents, and potentially staff, from other facilities who require immediate assistance due to an emergency at their home facility: 1. Conventional Surge Capacity

a. Increase in census consistent with daily use of the hosting/receiving facility b. Available beds filled and staffed by hosting/receiving facility

2. Contingency Surge Capacity a. Increase in census not consistent with daily use of the receiving facility b. Additional bed capacity is available by consolidating bed space, room conversions from

single to double. 3. Crisis Surge Capacity

a. Increase in census requiring space, staff, supplies and a change in the usual standards of care for the hosting/receiving facility

b. Additional bed capacity may include cots, unconventional beds set up in designated areas of the facility not typically used as sleeping quarters.

The above abbreviated descriptions were adapted from an article by John Hick, MD, and his colleagues in the Journal of Disaster Medicine and Public Health Preparedness, (June 2009).


1. 1135 Waiver

When the President declares a disaster or emergency under the Stafford Act or National Emergencies Act and the HHS Secretary declares a public health emergency under Section 319 of the Public Health Service Act, the Secretary is authorized to take certain actions in addition to her regular authorities. For example, under section 1135 of the Social Security Act, she may temporarily waive or modify certain Medicare, Medicaid, and Children’s Health Insurance Program (CHIP) requirements to ensure that sufficient health care items and services are available to meet the needs of individuals enrolled in Social Security Act programs in the emergency area and time periods and that providers who provide such services in good faith can be reimbursed and exempted from sanctions (absent any determination of fraud or abuse). Examples of these 1135 waivers or modifications include:

• Conditions of participation or other certification requirements • Program participation and similar requirements • Preapproval requirements • Requirements that physicians and other health care professionals be licensed in the

State in which they are providing services, so long as they have equivalent licensing in another State (this waiver is for purposes of Medicare, Medicaid, and CHIP reimbursement only – state law governs whether a non-Federal provider is authorized to provide services in the state without state licensure)

• Emergency Medical Treatment and Labor Act (EMTALA) sanctions for redirection of an individual to receive a medical screening examination in an alternative location pursuant to a state emergency preparedness plan (or in the case of a public health emergency involving pandemic infectious disease, a state pandemic preparedness plan) or transfer of an individual who has not been stabilized if the transfer is necessitated by the circumstances of the declared emergency. A waiver of EMTALA requirements is effective only if actions under the waiver do not discriminate on the basis of a patient’s source of payment or ability to pay.

• Stark self-referral sanctions • Performance deadlines and timetables may be adjusted (but not waived). • Limitations on payment to permit Medicare enrollees to use out of network

providers in an emergency situation

These waivers under section 1135 of the Social Security Act typically end no later than the termination of the emergency period, or 60 days from the date the waiver or modification is first published unless the Secretary of HHS extends the waiver by notice for additional periods of up to 60 days, up to the end of the emergency period. Waivers for EMTALA (for public health emergencies that do not involve a pandemic disease) and HIPAA requirements are limited to a 72-hour period beginning upon implementation of a hospital disaster protocol. Waiver of EMTALA requirements for emergencies that involve a pandemic disease last until the termination of the pandemic-related public health emergency. The 1135 waiver authority applies only to Federal requirements and does not apply to State requirements for licensure or conditions of participation. In addition to the 1135 waiver authority, Section 1812(f) of the Social Security Act


(the Act) authorizes the Secretary to provide for SNF coverage in the absence of a qualifying hospital stay, as long as this action does not increase overall program payments and does not alter the SNF benefit’s “acute care nature” (that is, its orientation toward relatively short-term and intensive care). Under this authority, CMS can issue a temporary waiver of the SNF benefit’s qualifying hospital stay requirement for those beneficiaries who are evacuated or transferred as a result of the emergency situation. In this way, beneficiaries who may have been discharged from a hospital early to make room for more seriously ill patients will be eligible for Medicare Part A SNF benefits. In addition, beneficiaries who had not been in a hospital or SNF prior to being evacuated, but who need skilled nursing care as a result of the emergency, will be eligible for Medicare Part A SNF coverage without having to meet the 3-day qualifying hospital stay requirement. Trigger Points In determining whether to invoke an 1135 Waiver (once the conditions precedent to the authority’s exercise have been met), the Assistant Secretary for Preparedness and Response (ASPR) convenes a meeting of relevant OPDIVS to determine the need and scope for such modifications. Information considered includes requests from Governor’s offices, feedback from individual healthcare providers and associations, requests to regional or field offices for assistance, and information obtained from the Secretary’s Operation Center. The intent is to determine whether the waivers or modifications allowed under the 1135 Waiver Authority will assist healthcare providers in dealing with the response to a disaster.

While hurricanes and other disasters represent a date-certain impact and generally known duration, public health emergencies around diseases or viruses may be considered a more diffuse and dispersed event. In evaluating trigger points for implementation of an 1135 waiver, it is important to recognize that a state or geographic region may have limited activity as a whole, while a particular city or community may be experiencing a severe outbreak. This geographic variation makes quantifiable trigger points difficult to define.

One of the best indicators for the need and geographic scope of an 1135 Waiver is healthcare provider and provider association contacts with CMS Regional Offices. As the waivers and modifications allowed under the 1135 waiver authority deal most often with Medicare Conditions of Participation (and EMTALA), most providers and associations will turn first to the CMS Regional Office for relief. Since one of the purposes of the 1135 Waiver is to provide waivers and modifications to assist providers furnishing services to Medicare, Medicaid and CHIP beneficiaries, it seems apparent that any trigger should be set up primarily to track providers’ needs.

A tracking mechanism could be utilized and reported weekly to CMS Central Office indicating the number and nature of inquiries for flexibilities. For example, CMS Regional Offices can collect information on:


• Requests by hospitals to provide screening/triage of patients at a location offsite

from the hospital’s campus; • Hospitals housing patients in units not otherwise appropriate under the Medicare

Conditions of Participation or for a duration that exceeds regulatory requirements; • Hospitals or nursing homes requesting increases in their certified bed capacity.

These requests could be grouped by state and city, to allow for more accurate reporting of the impact of a public health emergency. The benefit of a reporting system to the CMS Regional Offices is that information and assistance may be provided on flexibilities available to providers, even without an 1135 waiver, that could assist in their emergency response. This information, in addition to the usual channels of input identified above, should allow ASPR, CMS and the relevant OPDIVs to have the information necessary to recommend whether the Secretary should invoke the 1135 Waiver Authority.

Implementation of 1135 Waiver Authority

Once an 1135 Waiver is authorized, in past emergencies, health care providers have submitted requests to operate under that authority to the State Survey Agency or CMS Regional Office. The requests generally have included a justification for the waiver and expected duration of the modification requested. Providers and suppliers have been asked to keep careful records of beneficiaries to whom they provide services, in order to ensure that proper payment may be made. The State Survey Agency and CMS Regional Office has reviewed the provider’s request and make appropriate decisions, usually on a case-by-case basis. CMS has approved specific waivers and modifications only to the extent that the provider in question has been affected by the disaster or emergency. . Providers are expected to come into compliance with any waived requirements prior to the end of the emergency period.

Federally certified/approved providers must operate under normal rules and regulations, unless they have sought and have been granted modifications under the Waiver authority from specific requirements.

Blanket Waiver Modifications CMS has, in past disasters, implemented specific waivers or modifications under the 1135 authority on a “blanket” basis, when a determination has been made that all similarly situated providers in the emergency area needed such a waiver or modification. Examples include hospitals that have initiated their disaster plans and are operating under the Emergency Medical Treatment and Labor Act (EMTALA) waiver, the 25-bed limit and 96-hour annual average per patient length of stay requirement for Critical Access Hospitals, and requests for increases in the number of certified beds for providers. While blanket authority for these modifications may be allowed, the provider should still notify the State Survey Agency and CMS Regional Office if operating under these modifications to ensure proper payment. Similarly, most reporting requirements (such as nursing homes providing Minimum Data Set updates on residents) are suspended for all providers in the impacted areas in accordance with the Waiver authority.


The decision to implement a “blanket” waiver or modification of a particular Medicare, Medicaid or CHIP requirement is based on the need and frequency of requests for specific waivers or modifications in response to the disaster or emergency. Using the Waiver Tracking form (example attached), CMS Regional Offices can quickly determine when blanket authority provides greater efficacy and efficiency in responding to the disaster. Factors considered include the scope and severity of the emergency, the expected duration, feedback from the state survey agency and state and federal emergency response officials (who often have personnel able to provide first-hand information), as well as supporting data gathered by state provider associations. Retrieved from: https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/1135-Waivers.html


2. Kentucky Long Term Care Medical Surge Receiving Plan Template This template was developed to assist LTC Facilities in their efforts to determine their Surge Capacity to “host” residents from other LTC facilities during a disaster. This Receiving Plan Template accompanies the Kentucky Long Term Care (LTC) Surge Operating Guidelines and together are intended to provide guidance to LTC facilities on the receiving end of a health care facility evacuation, as well as, policymakers, and first responders. This Template enables LTC facilities to rapidly expand their conventional capacity and types of service capabilities to care for an increase in evacuated patients/residents due to emergency, disaster, exercise or planned events.

(see following pages)


KENTUCKY LONG TERM CARE

MEDICAL SURGE RECEIVING PLAN TEMPLATE

For more information

Betty Shiels, [email protected] ,502/ 852-8003 or Diana Jester, [email protected], 502/ 852-3487

Developed through KCHFS/KDPH 2013-2014 Emergency Preparedness for Aging Training Grant # PON2 728 1200002645-3.


TABLE OF CONTENTS

Overview ........................................................................................................... 3 Section I Surge Capacity Assessment ............................................................ 4 Section II Preparation for Surge Request ........................................................ 6 Section III Activation of Surge Receiving Plan ................................................ 7

Attachment A: Surge Capacity Planning Forms .............................................. 11 Attachment B: Surge Equipment Needs .......................................................... 16 Attachment C: Resident Tracking Sheets ........................................................ 17 Attachment D: Vendors / Agreements ............................................................. 19 Attachment E: Kentucky LTC Surge Receiving OIG Notification Form ........... 22

Developed with partial funding from KCHF/KDPH 2013-2014 Emergency Preparedness for Aging Training Grant # PON2 728 1200002645 3. Adapted from the Influx of Residents/Surge Guidelines for Nursing Homes (Best Practice Guide) created for Long Term Care in Kentucky in March 2012 by Russell Phillips & Associates. The Initial Guide was developed by Russell Phillips & Associates, LLC as a tool for the Massachusetts Department of Public Health and the Connecticut Department of Public Health. Additionally, the project workgroup consisted of various partners including the Massachusetts Senior Care Association, the LeadingAge Connecticut, and various long term care facilities in Connecticut and Massachusetts. (www.phillipsllc.com / 585-223-1130).


OVERVIEW This Receiving Plan Template accompanies the Kentucky Long Term Care (LTC) Surge Operating Guidelines and together are intended to provide guidance to LTC facilities on the receiving end of a health care facility evacuation, as well as, policymakers, and first responders. This Template enables LTC facilities to rapidly expand their conventional capacity and types of service capabilities to care for an increase in evacuated patients/residents due to emergency, disaster, exercise or planned events. Surge may be required for immediate hosting of persons due to

• An isolated single facility evacuation • A regional event resulting in multiple facility evacuations • Events affecting infrastructure and transportation routes where extended travel is

unsafe due to road conditions and/or weather conditions • Events limiting access to transportation resources, for example, roads are clear

but ambulances and buses are unavailable The Receiving Plan Template enables the facility to plan for short-term (3-4 days) placement of persons evacuated from LTC and other health care facilities who are not residents of the receiving LTC facility but have been impacted by a disaster. LTC facility capacity assessment tools are provided to assist decision-making regarding the type of surge the LTC facility is willing to offer; to outline steps the facility can take to notify the OIG of housing evacuees; to complete a surge agreement with the sending facility; to enable implementation of the surge plan for three levels of medical surge:

• By filling available open beds • By doubling and tripling rooms to expand capacity • By adding beds or cots to non-sleeping areas

There are three categories of medical surge capacity. The following definitions are adapted from an article by John Hick, MD, and his colleagues in the Journal of Disaster Medicine and Public Health Preparedness, (June 2009).

Conventional Surge Capacity refers to an increase in census that would require space, staff and supplies that are consistent with daily use in the facility during an emergency event. Available beds would be filled and staffed. Evacuees would not be admitted so they would not be called residents. Same for other categories.

Contingency Surge Capacity refers to an increase in census that would require space, staff and supplies that are not consistent with daily use in the facility during an emergency, when the facility opens up available beds, consolidates filled bed space by converting single to double rooms and/or doubles to triples if space is sufficient. Such a surge would have a minimal impact on usual resident care practices. Assessment would include the number and acuity levels of additional persons that could be accepted.

Crisis Surge Capacity refers to an increase in census that would require space, staff and supplies plus a change in usual standards of care that are not consistent with daily use in the facility during an emergency. Crisis capacity could involve the use of cots or unconventional beds in planned areas and trigger crisis standards of care. Crisis surge would provide sufficiency of care during a catastrophic disaster.


Other definitions regarding medical surge capacity can be found in the Public Health Emergency Medical Surge Capacity and Capability Handbook (MSCC) Glossary http://www.phe.gov/Preparedness/planning/mscc/handbook/Pages/appendixd.aspx

SECTION 1: SURGE SPACE/CAPACITY ASSESSMENT Surge Capacity Planning Worksheets, see Attachment A, are included to assist facilities in identifying designated areas for hosting evacuees, the type of surge the receiving facility is willing to provide, and the process involved reaching a surge agreement with the sending facility. Excel format is available at www.kyepltc.com It is recommended that the facility complete a complete assessment of available beds and available space to be prepared for a request to receive evacuees from an evacuating LTC facility prior to a disaster, and filed in the facility emergency plan. In order to establish the space assessment, maintain Life Safety regulations (included on each worksheet) for bed/cot placements and apply them by:

A. Identifying available beds that could be used for short term (3 to 4 days) evacuee hosting using facility floor plans.

B. Identifying available licensed beds by gender, level of care and payer source, excluding beds being held for confirmed admission

C. Reviewing facility floor plans to determine which resident rooms could be expanded from singles to doubles and doubles to triples

D. Identifying non-sleeping spaces that could be used for surge and apply the same life safety regulations

E. Determining limitations to levels of care that the facility is able to receive F. Summarizing the results from all worksheets on the Surge Sheltering

Report, Attachment A. This becomes the basis for completing the KY LTC SURGE RECIVING OIG Notification Form, Attachment E. The floor plan/s can be attached to the Surge Sheltering Report, in Attachment A, and the KY LTC SURGE RECEIVING OIG Notification Form to notify the OIG during a surge and to document what you did and why.)

We have included a sample floor plan and life safety regulations to illustrate how a facility may identify available non-sleeping space as well as maintain life safety regulations. They are presented on the following page.


• Ensure all surge bed arrangements will be free of impeding egress or reduce life safety

• Maintain three (3) feet between beds. Adjust as necessary if using cots • Maintain four (4) foot egress paths to the exit access corridor • Maintain 1.5 – 2 feet between the perimeter wall and the side of a bed/cot. For

resident rooms, typically, depending on room configuration, a room with a depth of 13’ can be a double/semi-private room. A room with a depth of 19’ can be a triple. That model is dependent on bathroom configurations and other unique room configurations.

• Consider gender, level of care and payor source • Identify all outlets which are supported by the generator for emergency power • Plan for increased supervision for those residents identified in need • Place privacy dividers between beds, cots or mattresses • Use dividers in all situations, or at minimum, when providing care • Provide night lighting in each surge area • Provide call devices for each resident • Provide storage areas for resident belongings and personal needs equipment.

Key personal belongings such as eye glasses, hearing aids, prosthesis, dentures, etc. should be located proximal to the resident. Other items such as clothing, shoes, etc. may be stored in a separate location.

• Establish one or more provisional work station(s) located within or near surge areas.

• Provide constant (24/7) clinical staffing in surge areas located outside of normal resident care areas.

Plans for establishing a surge response plan may be reviewed with the county Emergency Manager (EM), Local Health Department (LHD), local Fire Department (FD), and/or Emergency Medical Services (EMS).


SECTION 2: PREPARATION FOR SURGE REQUEST

Individual LTC facilities are encouraged to establish a protocol for determining ability to accept evacuees from LTC or other healthcare facilities, and should consider census, staffing, supplies and equipment available, and level/type of care that the facility can and cannot provide in a medical surge situation. It is recommended that surge capacity be reviewed on a regularly scheduled basis, because emergencies are unpredictable. In addition, a procedure should be established that enables designated staff from all shifts to help decide to what extent a request can be met for hosting medical surge evacuees. To establish a Surge Agreement with the sending facility, the following items should be reviewed with the potential sending facility that enables the receiving facility to match the space available with the request for surge. The needed information includes:

• Number of proposed evacuees § Estimated time of arrival § Sending facility name, address and contact phone number(s) and contact

name, § Gender breakdown of evacuees § Type/s of beds needed § Space available for additional beds if rooms are consolidated § Number of beds, cots, etc. to be sent by evacuating facility § Number of arriving evacuees requiring wandering precautions § Evacuee medical equipment needs (do not accept residents on life support if

you do not have an emergency generator) § Number of evacuees requiring specialized medical needs (isolation, dietary,

infection control) § Quantity and type of medical equipment arriving with evacuees § Quantity and type (clinical or not) of staff arriving with evacuees § Will medications accompany evacuees § Will charts accompany evacuees § Reimbursement terms and agreement for the days sheltered

The decision to accept a medical surge should be followed by a written confirmation such as a Memorandum of Understanding that outlines expectations and limitations between sending and receiving facilities. The confirmation should be hand delivered, e-mailed or faxed to both facilities within 24 hours, or as soon as conditions allow. Kentucky Long Term Care Surge Receiving OIG Notification Form along with the Surge Capacity Planning Forms can then be sent to the OIG by e-mail.


SECTION 3: ACTIVATION OF SURGE RECEIVING PLAN Incident Command • Activate facility Incident Command System and establish an Internal Command

Center. • Designate a phone number/phone line to the Command Center • Designate a dedicated phone number for incoming calls • Designate a dedicated FAX number for the Command Center Staffing • Determine the need to call in additional staffing. • Determine the quantity/type of staff (RN, LPN, CNA, other) that may be provided by

the Sending Facility. Clarify with Sending Facility Staff roles and expectations regarding clinical care and division of labor. Additional ancillary staff (food service, housekeeping, maintenance, etc. will probably be needed throughout the situation.

• Maintain staff-to-resident ratios necessary to meet resident and evacuee needs throughout the duration of the situation and according to the LTC emergency plan.

• Integrate Sending Facility Staff into care planning • Keep Financial Officer informed of staffing issues Supplies • Conduct a baseline inventory of all supplies with specific focus on:

§ Food Service – types and quantity of food and beverage § Nursing – types and quantity of medical equipment (pumps, oxygen

cylinders/concentrators, oxygen tubing/cannulas/masks, etc.) and medications ( which ones/how many)

§ Housekeeping / Laundry – quantity of linens § Maintenance – types and quantities of beds, mattresses, privacy dividers, etc.

Reference Attachment B Surge – Equipment • Assess the type and quantity of equipment / supplies that will be arriving from the

evacuating facility if possible. • Contact vendors to request additional supplies as soon as a shortage projected given

number of anticipated evacuees. Reference Attachment C –Vendors / Agreements. Triage • Triage: the process of deciding which patients should be treated first based on how

sick or seriously injured they are • Establish a triage area. Consider a location that is proximal to the facility main

entrance, spacious enough to accommodate a number of evacuees; secure enough to limit elopement; and, accessible to toileting facilities.

• Designate an individual to oversee the set-up and operations of the triage area. Ensure adequate staffing and supplies at the triage location. Consider the following:

§ Staffing o Nursing / Evacuee Care (triage, managing care) o Social Work o Food Service (food and beverage) o Administrative (tracking and documentation)

§ Supplies Attachment B –Equipment Needs o Chairs / wheelchairs o Pens, paper, nametags, charting materials


o Food and beverage o Medications (which ones/how many) o Portable oxygen (cylinders, tubing, cannulas, etc.) o Blood pressure cuffs and stethoscopes o Waterless hand washing solution o Infection Control Universal precautions as outlines in the LTC Emergency

Plan • Document the arrival of all evacuees as they enter the triage area. Utilize the

Resident Tracking Sheet (See Attachment C) • If arriving evacuees do not have a completed Resident Tracking Sheet (See

Attachment C) have sending staff collect, document and complete a sheet for each group of evacuees transported to your facility.

• Establish an interim plan of care and detailed supervision needed for each evacuee as appropriate in cooperation with sending staff.

• Establish a new chart to separate and document care from Sending Facility to Receiving Facility.

Food and Nutrition • Modify planned menus as necessary to accommodate the additional evacuee • Maintain food supplies and provide meals for evacuees and additional staff as

outlined in LTC Emergency Plan.

External Communication • Notify State and local authorities, as required by regulations and as outlined in the

emergency plan to implement the facility’s receiving surge plan. • Coordinate with Sending Facility to provide initial contact information and regular

updates to evacuees’ family members/ guardian/s and attending physician/s for medical surge evacuees.

• Provide media information and updates. Media and Families-Include Sending Facility Staff • Designate an individual to prepare and provide statements to the families. Coordinate

statements with the evacuating facility and the emergency agencies. • Sending Facility Staff notify the families/responsible parties of evacuees as soon as

possible. There should be a list of responsible party/parties in evacuee’s chart: (Durable) Power-of-Attorney Agent; Health Care Surrogate; Guardian). This is only for 3-4 days.

• Establish separate staging locations (internal or external) for media and family members, keeping in mind the preference to distance media from families and evacuees.

Evacuee Tracking • Receiving Facility Disaster Chart establishes evacuee tracking from arrival through

return to Sending Facility. All patient care will be documented on the Disaster Chart using a receiving facility charting process.

• Notify the Sending Facility of the total number of evacuees received along with the specific name of each evacuee received. If the Sending Facility has designated a fax line or email address, fax or email a completed copy of the Resident Tracking Sheet (See Attachment C).

• Determine ways to communicate with a contact at the Sending Facility in the event that the facility is closed following evacuation.


Arriving/Sending Facility Staff & Staff Credentialing • Confirm arriving staff from the Sending Facility have Identification badges provided by

the Sending Facility. • Log-in/Sign-in Sending Facility Staff as they arrive and identify the evacuees who are

to receive their care while at the Receiving Facility. • Provide Receiving Facility temporary identification. • Designate where and to whom arriving staff/Sending Facility Staff are to report. • Special Disaster care provider “privileges” may be granted upon presentation of a

valid government issued photo ID (e.g., driver’s license or passport) and any of the following: § A current picture ID or other ID card from a Hospital or Nursing Home. § A current license certification or registration to practice and a valid picture ID

issued by a state, federal or regulatory agency. A primary source of verification must be given where applicable.

§ Identification indicating that the individual is a member of a Disaster Medical Assistance Team (DMAT) or Medical Reserve Corps (MRC).

§ Identification indicating that the individual has been granted authority to render care in emergency circumstances; such authority having been granted by a federal, state or municipal entity.

§ Verification by current organizational staff member(s) with personal knowledge of the practitioner’s identity.

Finance • Activate Incident Command System (ICS) Financial Officer to track surge agreement

and surge expenses, including staff time, beginning as soon as surge agreement is reached with the evacuating facility.

• Monitor all costs and resources utilized throughout the duration of the event, especially documenting disaster related costs that exceed normal operating costs. Maintain receipts for purchases directly related to the situation.

Evacuee Placement • Prior to an emergency, identify the level/type of care that the Receiving Facility can

provide and cannot provide • Verify the quantity, type and location of open beds throughout the facility. • Ensure available rooms/beds are prepped for use. • When feasible, utilize open beds that are proximal to each other to avoid scattering

evacuees throughout the facility

Continuing Care • Monitor evacuees for medical, nursing, behavioral and psychological needs. Monitor

the impact of the influx on existing residents. • When behavioral health care is needed, contact KY Community Crisis Response

Board (KCCRB). • Provide additional nursing and medically related social services support as necessary. • Incorporate surge evacuees into facility resident activities, as appropriate. • Nursing staff or designated medical care managers will communicate with attending

physicians, as necessary. • Coordinate transportation for clinical services such as dialysis, medical appointments,

etc. • Provide consistent services and support to residents facility wide.


Medications and Medical Records • Develop and designate specific storage locations for surge evacuee medications and

medical records. Maintain normal controlled substance security standards. • Inventory and account for all medications.

o If Receiving Facility is providing medications, establish one system for dispensing.

o If medications for surge evacuees are provided by the Sending Facility Staff, establish a system that is agreeable to staff from both sending and receiving facilities.

o A complete medication record will be included in the Disaster Chart and reviewed by the Sending Facility Staff and the Incident Command System (ICS) Financial Officer.

Continuing Care • Toileting: monitor evacuee toilet needs and provide staff to accompany to toilet

facilities. Activate disaster plan for red bags on hand and other options if toilets fail. Plan ahead for provision of bedside toilets.

• Bathing: develop a bathing schedule based on the available bathing facilities. • Infection Prevention and Control: maintain infection control standards. Provide an

appropriate level of isolation/containment as needed. Calculate use and needs for current facility plus maximum number of surge evacuees.

• Psychological Needs: monitor resident and evacuee psychological status. Provide additional social services/KCCRB support.

• Activities: provide resident and evacuee activities as available space allows. • Clinical Services: coordinate clinical services such as dialysis, medical appointments,

etc. and any transportation as needed in collaboration with Sending Facility Staff. • Communicate with attending physicians as necessary, in collaboration with Sending

Facility Staff, and Medical Director if necessary. • Establish a process for constant monitoring of surge areas for care needs, safety and

updates to the Sending Facility. Notifying the OIG Notification may be made to the OIG using a completed KY LTC Surge Receiving OIG Notification Form, Attachment E, Surge Summary Report, included in Attachment A, and any accompanying floor plans if contingency or crisis surge are implemented. This will notify the OIG that a facility has received evacuees, the number and type and identify the facility readiness to do so as well as provide exhibits for justification of decisions made. Reimbursement between Sending Facility and Receiving Facility Reimbursement agreements during a surge are agreements between both facilities based on agreed upon rates established prior to implementation of the surge agreement in conjunction with payer source reimbursement rates.


ATTACHMENT E -- Kentucky LTC Surge Receiving OIG Notification RECEIVING FACILITY IDENTIFICATION:

FACILITY NAME: _______________________________________ Address: ______________________________________________


Facility Licensure # ___________ Facility Certification #: _____________

SENDING FACILITY IDENTIFICATION

FACILITY NAME: _______________________________________ Address: ______________________________________________


Facility Licensure # ___________ Facility Certification #: _____________

NATURE OF THE EVENT: ______________________________________________________________________________________

Surge Type Request:

SECTION A1

CONVENTIONAL SURGE BED AVAILABILITY

Y N CONVENTIONAL SURGE AUTHORIZATION BEDS REQUESTED

H-1: Bed A-1: Conventional Surge: Open Beds for Surge (Number and Type)

SNF: __________ NF: __________ NH: __________ ICF:__________

ALZ: __________ PC: __________ ICF/MR: __________

GENDER: PAYOR SOURCE: F _____ MEDICARE:_________ M ____ MEDICAID:_________ PRIVATE PAY:______

Comments:____________________________________________________________________________________

SECTION A2

CONTINGENCY SURGE PROPOSED BED EXPANSION

Y N CONTINGENCY SURGE AUTHORIZATION BEDS REQUESTED

H-1: Bed A2: Proposed Additional Beds for Rooms Doubled and Tripled (Number of proposed evacuees by Type )

SNF: __________ NF: __________ NH: __________ ICF:__________

ALZ: __________ PC: __________ ICF/MR: __________


Comments: ___________________________________________________________________________________

SECTION A3

CRISIS SURGE PROPOSED BED EXPANSION

Y N CRISIS SURGE AUTHORIZATION BEDS REQUESTED

H-1: Bed A-3: Proposed Additional Beds in Non-Sleeping Areas (Number of proposed evacuees by Type) SNF: __________ NF: __________ NH: __________ ICF:__________

ALZ: __________ PC: __________ ICF/MR: __________


Comments: ___________________________________________________________________________________

SECTION A1-3

PROPOSED BED EXPANSION (Total of A1+A2+A3= )

COMMENTS

Completed forms should be faxed, e-mailed or verbally transmitted to: Kentucky Office of Inspector General, Kentucky Long-Term Care Ombudsman Program, and/or other: __________________________ Developed through KCHFS/KDPH 2013-2014 Emergency Preparedness for Aging Training Grant # PON2 728 1200002645-3. For more information, contact Diana Jester, University of Louisville, [email protected], 502-852-3487 or Betty Shiels, PhD-ABD, University of Louisville, 502-852-8003 ; [email protected] 1 of 3


ATTACHMENT E -- Kentucky LTC Surge Receiving OIG Notification Receiving Facility Identification: FACILITY NAME: ____________________________________________________ Sending Facility Identification: FACILITY NAME: ____________________________________________________ Date: _______/____________/_________ Time: ________________ AM/PM

Section B IMMEDIATE NEEDS Y N COMMENTS B-1: Does your facility have any immediate needs, i.e., staffing? B-2: Are there any immediate health and medical needs? � Minor Injuries � Serious Injuries � Life Threatening Injuries

� Fatalities � Behavioral Health � Crisis Standards of Care

B-3: Is your facility accessible by normal routes? SECTION C RESOURCES Y N COMMENTS

Y N COMMENTS

C-1: Does your facility have adequate refrigeration for the additional medications?

C-2: Is there adequate number of medications, clinical supplies, i.e., O2, sharps containers, biohazard bags, etc. for the additional evacuee volume (3-5 days)?

C-3: Is there adequate number of facility supplies, i.e., cleaning supplies, trash bags, etc. for the additional evacuee volume? (3-5 days)?

C-4: Is sending facility bringing bed linens? C-5: Is sending facility bringing special medical equipment, i.e. tube feeding, O2, etc.?

C-6: Is sending facility bringing incontinence care supplies? SECTION D COMMUNICATIONS Y N LIST CONTACT INFORMATION D-1: Are landline telephones available? D-2: Are cell phones available? – Is Texting Available? D-3: Can you access the internet? D-4: Are email services available? SECTION E SECURITY Y N COMMENTS

E-1: Do you have security in place? E-2: Is your facility currently on lockdown? E-3: Is there a security risk from outside people or patients/clients? E-4: Can all outside access sites (doors/windows) be locked? E-5: Does your facility need security assistance? SECTION F STRUCTURAL ASSESSMENT/HVAC Y N COMMENTS F-1: Is the heating and air (HVAC) system operational? If no, is there adequate ventilation?

SECTION G ELECTRICAL POWER Y N COMMENTS G-1: Is your facility currently using commercial electrical power? G-2: Is the generator currently being used? G-3: Can the generator run 100% of the facility? If no, what does the generator supply power to?

Completed forms should be faxed, e-mailed or verbally transmitted to: Kentucky Office of Inspector General, Kentucky Long-Term Care Ombudsman Program, and/or other: __________________________ Developed through KCHFS/KDPH 2013-2014 Emergency Preparedness for Aging Training Grant # PON2 728 1200002645-3. For more information, contact Diana Jester, University of Louisville, [email protected], at 502-852-3487 or Betty Shiels, PhD-ABD, University of Louisville, 502-852-8003; [email protected]; 8/14 2 of 3


ATTACHMENT E -- Kentucky LTC Surge Receiving OIG Notification Receiving Facility Identification: FACILITY NAME: ____________________________________________________ Sending Facility Identification: FACILITY NAME: ____________________________________________________ Date: _______/____________/_________ Time: ________________ AM/PM

SECTION G Electrical Power (continued) Y N COMMENTS

Y N COMMENTS

Y N COMMENTS G-4: How many days can your generator currently run based upon current fuel supply?

G-5: What type of fuel does the generator use? Diesel _____Gasoline _____Natural Gas _____Propane

SECTION H WATER AND SEWER Y N COMMENTS H-1: Are hot and cold running water available? H-2: Is there an adequate water supply onsite for the additional evacuee volume of at least 1 to 2 gal/day/person for 3-5 days?

H-3: Are ice supplies available from an approved source? H-4: Are there an adequate # of hand washing stations? H-5: Is the sewage system adequate for the additional evacuee volume?

SECTION I FOOD SERVICE Y N COMMENTS I-1: Is there a safe food source for staff /residents/visitors? I-2: Can foods be held at proper temperatures (<41°F - >145°F) I-3: Is there an adequate supply of food onsite for the additional evacuee volume for 3-5 days?

I-4: Is there an adequate supply of special diet items (thickening mix, tube feeding, etc.) for the additional evacuee’s (3 to 5 days)?

SECTION J LIFE SAFETY Y N COMMENTS J-1: Is fire alarm system operational? J-2: Is sprinkler system operational? J-3: Is fire watch in effect?

J-4: Has a revised emergency plan been formulated for: a. Fire b. Evacuation


Name: ____________________________________________________ Job Title: _____________________________________

Phone: (_______) _______-_________ Mobile Phone: (_______) _______-_________ Alt Phone: (_______) _______-__________

Fax: (_______) _______-_________ Email:_______________________________________________________________________

Completed forms should be faxed, e-mailed or verbally transmitted to: Kentucky Office of Inspector General, Kentucky Long-Term Care Ombudsman Program, and/or other: __________________________ Developed through KCHFS/KDPH 2013-2014 Emergency Preparedness for Aging Training Grant # PON2 728 1200002645-3. For more information, contact Diana Jester, University of Louisville, [email protected], at 502-852-3487 or Betty Shiels, PhD-ABD, University of Louisville, 502-852-8003; [email protected] ; . 8/14 . 3 of 3


Appendix A

Excel Spreadsheet to calculate and plan for Surge Capacity in the facility.

Excel Spreadsheet Tabs: Attachment A – Contingency Surge Capacity Planning Expand Single to Doubles Expand Doubles to Triples Attachment A – Crisis Surge Capacity Planning Non-Sleeping Areas Attachment A – Surge Sheltering Report Summary Sheet Attachment B Equipment Needs Attachment C KY LTC Surge Resident Tracking Sheet – Page 1 KY LTC Surge Resident Tracking Sheet – Page 2


XI. Training and Testing/Exercises

CMS Rule: “Develop and maintain training and testing programs, including initial training in policies and procedures and demonstrate knowledge of emergency procedures and provide training at least annually. Also annually participate in: A full-scale exercise that is community- or facility-based; An additional exercise of the facility’s choice.”

Annual review and testing of plan elements is required to ensure that an All-Hazards Approach

to Emergency Preparedness can be carried out if and when a long-term care facility is faced with

a community disaster or emergency situation within the facility.

The training and testing program is based on the:

• Risk assessment (community-based and facility-based)

• Community Emergency Plan

• Facility Emergency Plan

• Facility Communications Plan

• Facility Policies and Procedures

A. Staff Training

The training and testing programs must include:

Training program must include:

• Initial training to new employees and existing staff, individuals providing services under

arrangement (contract dieticians/therapists, etc.), volunteer (consistent with expected

role/s)

• Refresher training annually

• Documentation of training

• Demonstrate staff knowledge of emergency procedures

B. Fire Drills

Fire drills required by the Life Safety Codes are posted by the Centers for Medicare and

Medicaid on their website which includes provider compliance with National Fire Protection

Association (NFPA) 101 Life Safety Code (LSC) requirements and includes links to applicable

laws, regulations, and compliance information. LSC Laws, Regulations, and Compliance

Information available at: https://www.ssa.gov/OP_Home/ssact/title18/1819.htm

C. Exercises

Full-scale community or functional exercise at least once per year OR individual facility-based

(if community-based isn’t accessible)


i. Community-Wide Exercises

Kentucky’s 15 Health Care Coalition Regions organize and prepare annual community-wide

exercises with community healthcare partners. These exercises engage healthcare providers

in a community response to a crisis by partnering first response emergency responders (fire,

police, EMS) with hospitals, shelters, LTC facilities and other agencies that will be impacted

by the crisis. A full-scale exercise is scheduled months in advance and coordinated through

the regional HCC with County Emergency Managers and State Regional Coordinators

sharing expertise and support. Each full-scale exercise includes multiple partners, takes

place in a particular area and responds to a named emergency (i.e. tornado touching down in

a particular area in Kentucky). Regional Health Care Coalitions may request that LTC

Facilities report 1) facility status, 2) resource requests and, 3) bed availability via the on on-

line situational awareness software program WebEOC available at

https://webeoc.chfs.ky.gov/eoc7/, or by scanning and email the KY LTC Facility Disaster

Assessment Form to [email protected]

One additional exercise may include:

o Second full-scale exercise, community or

o Facility-based (internal) exercise

o Tabletop exercise includes group discussion led by facilitator, using narrated,

clinically-relevant scenario, set of problem statements, directed messages, or

prepared questions designed to challenge the emergency plan

ii. Internal Exercises

Internal Exercises are facility-based in scope, using the same methods used in a community-wide

or functional exercise.

iii. Table Top Exercises

Tabletop exercises and table-based activities typically held in an informal setting and presented

by the Facilitator. There is no hands-on practice or field work. This type of exercise is intended

to generate discussion of various issues regarding a hypothetical, simulated emergency.

Tabletop exercised can be used to:

• enhance general awareness

• validate plans and procedures

• rehearse concepts

• assess the types of systems needed to guide the:

o prevention of

o protection from

o mitigation of

o response to, and

o recovery from a defined incident.


Delivered in a low-stress environment, the tabletop exercise offers participants the opportunity to

explore different ideas in the context of a real-world scenario. All participants should be

encouraged to the discussion and be reminded they are making decisions in a “no-fault”

environment.

Effective facilitation is critical to keeping participants focused on exercise objectives. The

Facilitator may ask about the decisions made, including how a decision was reached or what

implications a decision might have. The exercise ends either when all actions have been

discussed or when the time limit is reached. Participant learning is reinforced and feedback is

provided through a hot was (review) at the conclusion of the exercise.

The following link provides a tabletop scenario for use by LTC facilities.

Link below to access a tornado tabletop exercise:

http://ghca.info/ghca-content/uploads/2014/09/TORNADO-TABLETOP-EXERCISE_final.pdf

iv. Functional Exercises

A functional exercise (FA) examines or validates the coordination, command and control among

various multi-agency coordination centers which may include emergency management, field

office, local health department, etc. A Functional Exercise does not involve “boots on the

ground.” An example would be a test and evaluation of the centralized emergency operations

capability and timely response of one or more departments under a stress environment. A

functional exercise could be centered in the Incident Command Center (ICC), and the use of

outside activity (building on fire) and response could be simulated.

D. Real World Event Emergency

If an actual emergency occurs in the LTC County, and the Community-Based or Facility-

Based Emergency Plan is implemented, the facility is not required to conduct a full-scale

community-based exercise for one (1) year following the onset of the emergency event.

E. After Action Report/Improvement Plan (AAR/IP)

When a facility participates in any type of exercise (internal or external) or a real world event,

the facility must complete an After Action Report/Improvement Plan. This tool is for health care

providers to use to document their performance during emergency planning exercises and real

emergency events to make recommendations for improvements for future performance. After

documenting what actions/activities/responses went well, there is the opportunity to record

actions/activities/responses that have room for improvement in emergency planning, staff

training, etc. The risk management/safety committee should be involved in the discussion of the

areas that need improvement as well as the timeline for completion.

An example of an AAR/IP is provided.


Sample comments have been added to the form as an example of how the form can be

completed.

The AAR/IP is typically completed after the exercise is finished and all participants provide

input. The Safety Committee and/or Incident Command staff complete the report. A copy is

filed for survey purposes.

For Official Use Only] Kentucky Emergency Preparedness for Aging & LTC

After Action Report/Improvement Plan – Region 2 Total Eclipse Exercise

AAR/IP)


Region 2 Exercise – Total Eclipse

Date: March 1, 2017

AFTER ACTION REPORT/IMPROVEMENT PLAN

Date: March 3, 2017

LTC Facility Name: ______XYZ Nursing and Rehab_________________________________

County____Lyon_________________________ City________Eddyville____________



AAR/IP)


EXECUTIVE SUMMARY The purpose of this report is to analyze results, identify strengths to be maintained and built

upon, identify potential areas for further improvement, and support development of corrective

actions. The Total Eclipse Function Exercise (FE) was designed to test and evaluate Region 2

HCC and member agencies to coordinate emergency operation and support during a weather and

eclipse event. The Functional Exercise (FE) will be conducted in HCC Region 2 (Caldwell,

Christian, Crittenden, Hopkins, Livingston, Lyon, Muhlenberg, Todd, and Trigg Counties of

Kentucky) on March 1, in response to a simulated severe weather and eclipse. The Total Eclipse

is scheduled for 9:00 to 12:00 (CT).

On March 1, 2017, LTC facilities in KY Region 2 HCC will be asked to participate in:

Information Sharing

• Reporting bed availability

• Communicating status of the facility

Medical Surge

• Reporting bed availability

Resource Requests

• Requesting assistance (if needed) due to any damage from severe weather

This report reflects the __XYZ Nursing and Rehab_______________________(Facility

Name) participation in the Region 2 Total Eclipse Exercise on March 1, 2017.

Major Strengths identified by __XYZ Nursing and Rehab (Facility Name) The major strengths identified during this Real World Event are as follows:

• All staff responded to tornado warning per the emergency plan.

• [Additional major strength]

• [Additional major strength]

Primary Areas for Improvement



AAR/IP)


Throughout the Region 2 Total Eclipse Exercise, several opportunities for improvement in ___XYZ Nursing and Rehab’s (facility name) ability to respond to the incident were identified. The primary

areas for improvement, including recommendations, are as follows:

Appendix A: Improvement Plan [KY HPP Region 2]

• It took over 15 minutes for all staff, residents and visitors to be notified of the tornado

warning.

• [Additional key recommendation]

• [Additional key recommendation]

SECTION 1: EXERCISE OVERVIEW Exercise Details

Exercise Name Total Eclipse Functional Exercise

Type of Exercise Functional

Exercise Start Date March 1, 2017

Exercise End Date March 1, 2017

Duration 3 Hours

Location Kentucky Region 2 HCC

Sponsor Kentucky Emergency Preparedness for Aging and LTC Program Program KY Hospital Preparedness Program; KY Department for Public Health, Preparedness Branch

(KDPH)

Capabilities Emergency Operations Coordination

Information Sharing



AAR/IP)


Medical Surge

Resource Requests

Scenario Type Severe weather during a large scale public event (Total Eclipse)

SECTION 4: CONCLUSION

[This section is a conclusion for the entire document. It provides an overall summary to the report. It

should include the demonstrated capabilities, lessons learned, major recommendations, and a summary of

what steps should be taken to ensure that the concluding results will help to further refine plans, policies,

procedures, and training for this type of incident.

Subheadings are not necessary and the level of detail in this section does not need to be as comprehensive

as that in the Executive Summary.]

THE ADMINISTRATOR OF THE XYZ NURSING AND REHAB FACILITY RECEIVED THE MESSAGE

ABOUT THE TORNADO WARNING AT APPROXIMATELY 9:00 AM. SHE INFORMED OTHER KEY STAFF

MEMBERS TO NOTIFY ALL STAFF, RESIDENTS AND VISITORS. UNFORTUNATELY, IT TOOK OVER 15

MINUTES FOR EVERYONE TO BE NOTIFIED. ONCE STAFF RECEIVED THE WARNING, THEY TOOK

APPROPRIATE ACTIONS TO PROTECT RESIDENTS AND VISITORS AND FOLLOWED THE EMERGENCY

PLAN. STAFF KEPT THE RESIDENTS CALM. ALL STAFF, RESIDENTS AND VISITORS REMAINED IN

THEIR SAFE LOCATIONS UNTIL THE “ALL CLEAR” WAS GIVEN.

THERE WILL BE A MEETING OF THE SAFETY COMMITTEE TO REVIEW THE PROCEDURES TO NOTIFY

STAFF, RESIDENTS AND VISITORS ABOUT TORNADO WATCHES/WARNINGS. THE POLICY MAY BE

REWRITTEN. AFTER THE POLICY HAS BEEN REVIEWED, THERE WILL BE AN IN-SERVICE TRAINING OF

ALL STAFF ON THE CORRECT PROCEDURES. AFTER THE IN-SERVICE, THERE WILL BE A NO-NOTICE

TORNADO DRILL. AFTER THE DRILL, THE SAFETY COMMITTEE WILL MEET TO DISCUSS HOW THE

NOTIFICATION PROCESS WAS FOLLOWED.



AAR/IP)


APPENDIX A: IMPROVEMENT PLAN This IP has been developed specifically for _______________________ (Facility Name) as a result of Total Eclipse Exercise conducted on March 1, 2017. These recommendations draw on both the After Action Report and the After Action Conference. [The IP should include the key recommendations and corrective actions identified in Chapter 3: Analysis of Capabilities, the After Action Conference, and the EEGs. The IP has been formatted to align with the Corrective Action Program System.]

Capability Observation Title Recommendation Corrective Action Description

Primary Responsible

Dept.

Responsible

Staff

Start Date Completion

Date

[Example:

Capability 1: Information Sharing

Example:

Observation 1: Staff notification

Example:

1.1 Who is assigned to receive the initial notification?

Who is assigned to begin the process of notification?

Example:

1.1.1 Review policy

Examples:

Administration

Examples:

Administrator

March 1, 2017

Sep 1, 2018

1.1.2 Update emergency plan

Planning

Chair,

Life Safety Comm.

Sep 2, 2018

Oct 2, 2018



AAR/IP)


1.2 Insert Recommendation 2

1.2.1 In-service training of notification procedures

Training

DON

1.2.2 Insert Corrective Action 2

Nursing

DON

2. Observation 1: Resource Inventory not assessed for potential shelter-in-place

2.1: Who is assigned to assess inventory for facility?

2.1.1

Rewrite policy to include this duty

Planning

Chair,

Life Safety Comm

2.1.2 Insert 2. Observation 2Action 2

Examples:

Administration



AAR/IP)


PARTICIPANT FEEDBACK FORM

Exercise Name: Total Eclipse Exercise Date: March 1, 2017

Participant Name: Amy Title: Administrator

LTC Facility: XYZ Nursing and Rehab

PART I: RECOMMENDATIONS AND CORRECTIVE ACTIONS 1. Based on the exercise today and the tasks identified, list the top 3 strengths and/or areas that need improvement.

____________________________________________________________________ Administrator received notification of tornado warning in a timely manner. ________ Staff knew procedures to keep staff, residents and visitors safe. __________________ All staff, residents and visitors stayed in safe locations until “All Clear” was given. __

2. Identify the corrective actions that should be taken to address the issues identified above. For each corrective action, indicate if it is a high, medium, or low priority.

Safety committee will meet to discuss notification process as it took 15 minutes for everyone to receive the notification. The procedures will be rewritten if necessary. An in-service for all staff will be held to review the notification procedures. A no-notice drill will be held within one month of the in-service. The Safety committee will meet again to review the notification process during the drill. ______________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________

3. Describe the corrective actions that relate to your area of responsibility. Who should be assigned responsibility for each corrective action?

Administrator, Safety Committee _________________________________________ ____________________________________________________________________ ____________________________________________________________________ ____________________________________________________________________



AAR/IP)


4. List the applicable equipment, training, policies, plans, and procedures that should be reviewed, revised, or

developed. Indicate the priority level for each.

Review notification procedure - HIGH _____________________________________ Rewrite notification procedure if necessary - HIGH ___________________________ In-service training for all staff - HIGH _____________________________________ No-notice drill to test notification procedures – HIGH All these are HIGH due to the frequency of tornadic activity in our area. __________



AAR/IP)


PART II – PARTICIPANT FEEDBACK Please provide any recommendations on how this exercise or future exercises could be improved or enhanced. _______________________________________________________________________ Example: At the next exercise or drill, “damage” the facility so that vertical evacuation can be practiced. _______________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________

KY LTC Emergency Preparedness Manual-University of Louisville KY Emergency Preparedness for Aging & LTC 349

XII. Employee Emergency Preparedness

A Prepared Staff = A Prepared Facility Administrators know that the quality of care provided to residents and the successful daily operations of a long-term-care facility is dependent primarily on the presence of a healthy, committed, and trained workforce. During an emergency, when residents and staff become stressed, it can be challenging for staff to focus completely on work tasks because of their concern about the welfare of their own families and loved ones. Often, staff members have responsibility for multiple family members that might include children, grandchildren, parents or spouses.

A. Implementing Emergency Planning Policies: Staff When administrators develop an emergency preparedness plan for the facility, it is most effective when it also includes an emergency plan for employees. ______________ (facility name) should ensure that the information for all staff members be updated at least annually, preferably during the employee’s annual review. This information will include:

• telephone numbers • emergency numbers • an updated list of dependents • plans for dependents during an emergency situation.

Each facility should develop a policy that states under what conditions, if any, employees’ immediate family members and pets will be permitted to shelter at the facility during an emergency. This policy should be communicated to all staff prior to an emergency situation so staff members can make plans. If evacuation is necessary, the facility will need staff to provide care and services at the receiving facility. Discussions will occur with the receiving facility administration in advance to determine if family members of the sending facility’s staff would be allowed to shelter at the receiving facility. Employees reporting to work or remaining at work during an emergency will need essential items from home in order to remain focused on caring for residents. The following list includes the basics needed for each staff member and, if policy permits, family members sheltering at the facility or relocating to an evacuation site:

• Sleeping bag/air mattress • At least 3 changes of clothing • Toiletries, prescription medications • Flashlights and extra batteries • Special items for infants, children, adult dependents and/or pets

September is recognized as National Preparedness Month (NPM), which serves as a reminder to take action to prepare for the types of emergencies that could affect everyone where they live, work and visit. Using the NPM materials at www.ready.gov/september on bulletin boards and in employee communications can remind staff to update their personal/family emergency plans.


B. Employee Personal Readiness

Employees should complete this form to assist in preparing the facility’s emergency preparedness plans, and help employees formulate their own personal plans.

1. Employee Emergency Preparedness Information Name

Home Phone Number

Mobile Number What is the best number to reach you?

Home □ Mobile □

Address City State Zip Position Name of Relative to

contact in an emergency Relative’s Phone Number

If you evacuate, where do you plan to go? (Place, Name) Phone Number

Address City State Zip Will you report to work if called in during an emergency? c Yes c No Will you need assistance preparing personal property for an emergency situation? c Yes c No If yes, please explain: Do you have family members requiring special arrangements? c Yes c No How many? _____ If permitted to do so by the administrator, do you plan to bring family members when reporting to work? c Yes c No How many? Do you have special needs? c Yes c No Please explain:


Will you accompany evacuating residents, if necessary? c Yes c No If the administrator permits, do you plan to bring family members with you to evacuation site? Pets? c Yes c No If yes, please list Do you have special needs? c Yes c No If yes, please explain: Can you assist with resident care or other duties? c Yes c No Can we assist you with your personal emergency preparation? c Yes c No If yes, how? Signature Date


B. Employee Personal Readiness – Children: Fill out one form for each child. Keep a copy of the forms in your disaster supply kit and personnel file. Update your forms at least once a year with current photo.

2. Infant/Child/Dependents Emergency Preparedness Information

Child’s Name Age: Cell Phone Number (if has one) Address of School or Daycare City State Zip Grade Level Phone Number of school or

daycare. Relative or Friend’s Phone Number who could pick up your child if necessary.

If your child’s school/daycare evacuates, where will they go? Phone Number Address of Evacuation Location City State Zip Does your child have special needs? c Yes c No If yes, please explain. Please provide any other pertinent information (relating to disaster situations): Signature Date


B. Employee Personal Readiness – Adult Dependents: Fill out one form for each adult. Keep a copy of the forms in your disaster supply kit and personnel file. Update your forms at least once a year with current photo.

3. Adult Dependent Emergency Preparedness Information

Adult’s Name Age: Cell Phone Number (if s/he has one)

Is your dependent at your home while you work? ___ Y ___N If no, where is your dependent?

Street address of your dependent while you are at work: Phone Number City State Zip Neighbor or relative who could house your adult dependent in an emergency:

Neighbor/Relative’s phone number:

Does your adult dependent have special needs? c Yes c No If yes, please explain, including medications. Please provide any other pertinent information (relating to disaster situations): Signature Date


C. Employee Communication Plan During a disaster/emergency situation, it is important to be able to communicate with family, friends and others. Most people have all their contact information on their cell phones or other electronic devices. It is important to have a written list of all your contacts in case your cell phone/electronic devices are damaged, lost or can’t be charged. Teach your family to text “I’m OK” in emergencies as sometimes texting works when phone calls will not. ** Make sure you have an emergency contact number for your supervisor. Out-of-Area Contact: In the event that you and members of your family are separated, it is good to have one contact that lives out of the immediate area. Their phone systems may work while the local phone systems may be damaged and inoperable. Teach family members to text or call this out-of-area contact and to report their location. The out-of-area contact will be able to collect information on all family members and report back. Name: ______________________________________________________________________________________

Address: ____________________________________________________________________________________

Phone Number: ________________________________ Email: _______________________________________

Name: _____________________________________________________________________________________

Address: ____________________________________________________________________________________


Name: _____________________________________________________________________________________

Address: ____________________________________________________________________________________


Name: _____________________________________________________________________________________

Address: ____________________________________________________________________________________


Name: _____________________________________________________________________________________

Address: ____________________________________________________________________________________


Name: _____________________________________________________________________________________

Address: ____________________________________________________________________________________


Name: _____________________________________________________________________________________

Address: ____________________________________________________________________________________



D. Family Disaster Plan: Helping Staff Prepare at Work/Home

Disasters, of any type, can strike quickly and without warning. It can force you to evacuate or stay in your home. Consider what you would do if your utilities and communications systems were cut off. Local officials and relief workers will be on the scene, but will be unable to reach everyone right away. In the case of a terrorism event, your best option may be to stay in and close up your home or building. Families do and will cope with disaster by advance preparation and by working together as a team. Follow the steps outlined to create your personal family disaster plan. Reassure your family that, if you are not together when disaster strikes, that you will contact them when able and give them your location, either at work or at the evacuation location. Knowing what to do is your best protection and YOUR responsibility. If at work:

§ Report to the site directed by your supervisor. It may be the facility or their evacuation location.

§ Identify a meeting place for your family if your home is unsafe to enter after the disaster. § If your phone is working, resist the temptation to call home, school, or other family

and/or friends. Non-essential calls may make an emergency call impossible. Phone systems can handle only a specified number of calls. Teach all family members to text “I’m OK” instead of calling.

If at home: § Provide safe shelter (at home, other agreed-upon location, Red Cross shelter). § Verbalize an agreed-upon contact person (out of area). § Develop a plan for future communication with one another. § Check and secure your personal car emergency kit in the trunk of your car.

Emergency Supplies Keep enough supplies in your home to meet your family’s needs for at least three days. Assemble a disaster kit with items you may need in an evacuation. Store these items in sturdy, easy to carry containers that you can “pick up and go” with. Use the attached worksheet to spread out the purchase of your emergency supplies. You probably already have a great many items in your home. Include:

A 3-day supply of water (one gallon per day per family member) and food that will not spoil § One to three changes of clothing and sturdy, closed-toe footwear per person, one

blanket/sleeping bag per person § A first aid kit that includes your family’s prescription medications § Emergency tools including a battery-powered radio, flashlight and plenty of extra

batteries § An extra set of car keys and a credit card and/or cash § Sanitation supplies (heavy plastic bags, toilet paper, baby wipes) § Special items for infant, children, elderly or disabled family members § An extra pair of glasses

Keep important family documents in a waterproof container. Keep a smaller kit in the trunk of your car.


Utilities Locate the main electric fuse box, water service main, and natural gas main. Learn how and when to turn these utilities off. Teach all responsible family members. Keep necessary tools near gas and water shut-off valves. Remember, turn off the utilities only if you suspect the lines are damaged or if you are instructed to do so.

Neighbors Helping Neighbors If there are is a Neighborhood Watch or another community group in your neighborhood, you could work together after a disaster until help arrives. If you are a member of a neighborhood organization, such as home association or crime watch group, introduce disaster preparedness as a new activity. Know your neighbors’ special skills (e.g., medical, technical) and consider how you could help neighbors who have special needs, such as disabled and elderly persons. Make plans for child care in case parents cannot get home. Home Hazard Hunt During a disaster, ordinary objects in your home can cause injury or damage. Anything that can move, fall, break, or cause a fire is a home hazard. For example, a hot water heater or bookshelf can fall. Inspect your home at least once a year and fix potential hazards. Contact your local fire department to learn about home fire hazards. If Disaster Strikes If disaster strikes: remain calm and be patient. Put your plan into action. Check for injuries: Give first aid and get help for seriously injured people. Listen to your battery-powered radio for news and instructions: Evacuate, if advised to do so. Wear protective clothing and sturdy, closed-toe shoes. Evacuation Evacuate immediately if told to do so:

• Listen to your battery-powered radio and follow the instructions of local emergency officials

• Wear protective clothing and sturdy, closed-toe shoes • Take your Disaster Supplies Kit • Lock your home § Use travel routes specified by local authorities—do not use shortcuts because certain

areas may be impassable or dangerous If you have time:

• Shut off water, gas, and electricity before leaving, if instructed to do so • Post a note telling others when you left and where you are going § Make arrangements for your pets


E. Pets Preparedness Plan Residents with pets should specify arrangements for their pets in the event the building is evacuated. The following is a template for a Pet Preparation Form.

PET PREPARATION FORM

I, have made the following arrangements for my pet in the event there is a disaster/emergency. I am aware of the fact that some temporary shelters do not allow pets to be housed. Therefore I have made the following arrangements: Type of Pet: Age of Pet: Name of Pet: Name of Kennel/Relative/Friend taking responsibility for my pet: Address: Telephone Number: Pet’s special Needs:

Planning for pets in an emergency A few simple steps to ensure the pet’s safety can go a long way when disaster strikes.

• Identify residents that have a pet and how those animals will be cared for in an emergency.

• Plan for any pets that are kept on the facility premises (i.e., birds). • Consider placing stickers on the main entrances of the facility to alert rescue workers to

the number and types of pets inside and update the information on the stickers every six months.

Evacuating with a pet Keep in mind that the place the resident will relocate to during an emergency may not take pets or be able to care for them (such as a hospital, nursing home, or public shelter). As a reminder, service animals are always allowed. In planning for an emergency evacuation:

• Arrange for the resident’s family or friends to shelter the pet. Check with local veterinarians, boarding kennels, or grooming facilities to see if they can offer to shelter pets during an emergency. These arrangements should be made prior to an emergency.

• When conducting evacuation drills, practice evacuating the pets to familiarize the animal with the process and increase their comfort level.

• Identify staff that will assist the resident with her/his pet if needed or will be responsible for any pets the facility keeps on the premises.


• Identify which rooms the pets are located in (know the animals hiding places) so they can be easily found during an emergency.

• Keep in mind a stressed pets may behave differently than normal and their aggression level may increase. Use a muzzle to prevent bites. Also be advised that panicked animals may try to flee.

• Small animals can be transported using a covered carrier, cage, or secure box. To minimize stress, keep the carrier covered and attempt to minimize severe changes in temperature and noise. Animals too large for carriers should be controlled on a sturdy leash and may need to be muzzled.

• Know where the pet’s collar/harness, leash, muzzle, etc., are stored. Consider other essential items to take along if available and time permits such as:

o Current color photograph of the resident and pet/service animal together (in case the resident is separated).

o Copies of medical records that indicate dates of vaccinations and a list of medications the pet/service animal takes and why.

o Physical description of the pet/service animal, including species, breed, age, sex, color, distinguishing traits, and any other vital information about characteristics and behavior.

o Proof of identification and ownership. o Collapsible cage or carrier. o Comfort toys or bedding

Pet Identification

• Pets and service animals must have proper identification. Dogs and cats should wear a collar or harness, rabies tag, and identification tag at all times. Identification tags should include a name, address, and phone number.

• Talk to a veterinarian about micro-chipping the pet. A properly registered microchip enables positive identification if the resident and pet/service animal are separated.

Emergency Contacts Create a list of contacts for those residents with a pet or service animal as appropriate. This should be done before an emergency occurs. Consider local and out-of-area resources. Keep a copy of this list in a readily accessible location (near the phone). Contact information includes: Name and Telephone Number Local Veterinarian: ________________________________________________________ Alternate Veterinarian: _____________________________________________________ Emergency Pet Contact: ____________________________________________________ (Family or Friend) Local Boarding Facility: ____________________________________________________ Local Animal Shelter: ______________________________________________________ Humane Society: __________________________________________________________


F. When Staff Return Home After a Disaster: Home Evaluation • Natural gas. If you smell gas or hear a hissing or blowing sound, open a window and leave

immediately. Turn off the main gas valve from the outside, if you can. Call the gas company from a neighbor’s residence. If you shut off the gas supply at the main valve, you will need a professional to turn it back on. Do not smoke or use oil, gas lanterns, candles, or torches for lighting inside a damaged home until you are sure there is no leaking gas or other flammable materials present.

• Sparks, broken or frayed wires. Check the electrical system unless you are wet, standing in water, or unsure of your safety. Turn off the electricity at the main fuse box or circuit breaker. If the situation is unsafe, leave the building and call for help. Do not turn on the lights until you are sure they’re safe to use. Have an electrician inspect wiring.

• Roof, foundation, and chimney cracks. Evacuate premises. Call a professional. • Appliances. If appliances are wet, turn off the electricity at the main fuse box or circuit

breaker. Then, unplug appliances and let them dry out. Have appliances checked by a professional before using them again. Also, have the electrical system checked by an electrician before turning the power back on.

• Water and sewage systems. If pipes are damaged, turn off the main water valve. Check with local authorities before using any water; the water could be contaminated. Pump out wells and have the water tested by authorities before drinking. Do not flush toilets until you know that sewage lines are intact.

• Food and other supplies. Throw out all food and other supplies that you suspect may have become contaminated or come in contact with floodwater. If your basement has flooded, pump it out gradually (about one third of the water per day) to avoid damage. The walls may collapse and the floor may buckle if the basement is pumped out while the surrounding ground is still waterlogged.

• Open cabinets. Be alert for objects that may fall or any animals (rats, snakes, etc.) that may have been trapped.

• Clean up household chemical spills. Disinfect items contaminated by raw sewage, bacteria, or chemicals. Also clean salvageable items.

• Call your insurance agent.

Pets: Protect your pets. Leash your pets or keep them in a fenced yard when they go outside to minimize contact with other animals that might be loose. The behavior of your pets may change after an emergency. Normally quiet and friendly pets may become aggressive or defensive. Watch animals closely.

Wild Animals: Wild animals can be forced from their natural habitats by flooding, and many pets and livestock may also be displaced. If bitten, seek immediate medical attention and contact your local health department. Rats may be a problem after a flood. Secure all food supplies, throw out any food animals might have touched, and seal possible rodent entrances.

Insects: An increase in mosquitoes or other insects can be expected after flooding. To reduce exposure to insects, wear protective clothing such as long sleeves and pants with legs tucked


into boots. Protect exposed skin and clothing with insect repellent and follow the instructions on the label. Mosquitoes can be avoided by remaining indoors when they are most active, generally dusk and dawn.

Information from: http://health.state.tn.us/localdepartments.htm


G. Getting Kids Involved In Emergency Preparedness Activities

FEMA https://www.ready.gov/kids/know-the-facts Sesame Street video (3:23) https://www.youtube.com/watch?v=FpjaUvk-Ecg Sesame Street video (16:22) https://www.youtube.com/watch?v=0CkuFDkUVWU National Weather Service http://www.nws.noaa.gov/om/reachout/kidspage.shtml Disaster Master https://www.ready.gov/kids/games/data/dm-english/index.html Disaster Hero http://www.tularecounty.ca.gov/oes/index.cfm/preparedness/for-kids-only/disaster-hero/ Flat Stanley https://www.ready.gov/flatstanley Kids Get A Plan http://kidsgetaplan.com/

Youth Emergency Preparedness Curriculum-Ready Kids https://www.fema.gov/media-library/assets/documents/34411 Ready..Set..Prepared http://www.utah.gov/beready/family/documents/ReadySetPrepare02.pdf


XIII. Mental Health Planning A. Psychological First Aid for Staff and Residents Staff members are a long-term-care facility’s most valuable asset. Dealing with an emergency can result in a high level of mental and emotional stress for staff. Staff working additional hours may be resistant to taking a break or acknowledging the high level of exhaustion that accompanies stressful situations. As part of Emergency Preparedness Planning, it could be helpful for facilities to develop a system by which staff members can identify co-workers who may need a break. A procedure that helps staff members communicate and deal with stress brought on by fatigue, loss, or other disaster-related issues can help ensure that staff members maintain the ability to meet the needs of residents and ensure a healthy workforce following an emergency. Disaster Events

• Everyone who sees or experiences a disaster is affected by it in some way. • It is normal to feel anxious about one’s own safety and that of family and close friends. • Profound sadness, grief, and anger are normal reactions to an abnormal event. • Acknowledging feelings helps recovery. • Focusing on strengths and abilities helps with the healing process. • Accepting help from community programs and resources is healthy. • Everyone has different needs and different ways of coping. • It is common to want to strike back at people who have caused pain. • Children and older adults are of special concern in the aftermath of disasters. Even

individuals who experience a disaster “second hand” through exposure to extensive media coverage can be affected.

• Local faith-based organizations, voluntary agencies, or professional counselors are available for counseling.

• FEMA and state and local governments may provide crisis-counseling assistance in affected areas.

Signs of Disaster Related Stress Individuals with the following signs, might benefit from crisis counseling or stress management assistance:

• Difficulty communicating thoughts. • Difficulty sleeping. • Difficulty maintaining balance. • Low threshold of frustration. • Increased use of drugs/alcohol. • Limited attention span. • Poor work performance. • Headaches/stomach problems. • Tunnel vision/muffled hearing. • Colds or flu-like symptoms. • Disorientation or confusion. • Difficulty concentrating. • Reluctance to leave home. • Depression, sadness. • Feelings of hopelessness.


• Mood-swings and bouts of crying. • Overwhelming guilt and self-doubt. • Fear of crowds, strangers, or being alone.

Easing Disaster-Related Stress

• Talk about feelings with a trusted friend or relative - anger, sorrow, and other emotions – even though it may be difficult.

• Seek help from professional counselors who deal with post-disaster stress. • Let go of responsibility for the disastrous event and any frustration or guilt resulting from

not helping directly in the rescue work if doing so is not possible, or to do so would increase stress.

• Take steps to promote physical and emotional healing by healthy eating, rest, exercise, relaxation, and meditation.

• Maintain a normal family and daily routine; limit demanding responsibilities. • Spend time with family and friends. • Participate in memorials. • Use existing support groups of family, friends, and religious institutions. • Prepare for future events by restocking disaster supplies kits and updating the family

disaster plan.

B. Kentucky Community Crisis Response Board (KCCRB) Psychological First Aid

The Kentucky Community Crisis Response Board (KCCRB), created under KRS Chapter 36 and Chapter 42, ensures an organized, rapid and effective response in the aftermath of crisis and disaster. KCCRB is recognized as the lead disaster behavioral health agency by the Kentucky Department for Behavioral Health, Developmental and Intellectual Disabilities (DBHDID - state mental health authority), Kentucky Division of Emergency Management (KyEM) and the American Red Cross (ARC). KCCRB has the primary responsibility to provide disaster behavioral health services for the Commonwealth.

According to KCCRB, providing "Psychological First Aid" includes the following:

• addressing of immediate physical needs • comforting and consoling affected individuals • providing concrete information about where to turn for help • listening to and validating feelings • linking individuals to support systems • normalizing stress reactions to trauma and sudden loss • reinforcing positive coping skills

A team of skilled first responders from KCCRB help: • Coordinate state disaster behavioral and mental health services • Administer FEMA Crisis Counseling grants (when necessary) following a Presidential

Declaration • Collaborate with local and regional mental health professionals to provide needed

services


• Credential and maintains a statewide network of trained professional volunteer responders

• Deploy rapid response teams to crisis and disaster sites. KCCRB services are available 24 hours-a-day at (888) 522-7228 https://kccrb.ky.gov/Pages/index.aspx C. Additional Mental Health Resources Disaster Distress Hotline Sponsored by Substance Abuse & Mental Health Services Administration (SAMHSA) The Disaster Distress Helpline is a national hotline dedicated to providing year-round immediate crisis counseling for people who are experiencing emotional distress related to any natural or human-caused disaster. This toll-free, multilingual, and confidential crisis support service is available to all residents in the United States and its territories. Stress, anxiety, and other depression-like symptoms are common reactions after a disaster. Call 1-800-985-5990 or text TalkWithUs to 66746 to connect with a trained crisis counselor. Counseling Services The Disaster Distress Helpline puts people in need of counseling on the path to recovery. Staff members provide counseling and support before, during, and after disasters and refer people to local disaster-related resources for follow-up care and support. Since its launch in February 2012, the Disaster Distress Helpline has provided support in response to disasters such as Hurricane Sandy, the Boston Marathon bombing, and the Ebola outbreak. The Disaster Distress Helpline is staffed by trained counselors from a network of crisis call centers located across the United States. These counselors provide:

• Crisis counseling for people in emotional distress related to any natural or human-caused disaster

• Information on how to recognize distress and its effects on individuals and families • Tips for healthy coping • Referrals to local crisis call centers for additional follow-up care and support

Crisis counselors on the Disaster Distress Helpline listen with patience and without judgment. No identifying information is required when calling or texting the Disaster Distress Helpline. The counselor may ask for some basic information at the end of the call, but these questions are optional and are intended to help SAMHSA keep track of the types of calls it receives. The impact of crises may affect people in different ways. Learn how to recognize the warning signs and risk factors for emotional distress related to natural and human-caused disasters. The Disaster Distress Helpline is open to everyone. This includes survivors of disasters; loved ones of victims; first responders; rescue, recovery, and relief workers; clergy; and parents and caregivers. Callers may contact the Disaster Distress Helpline for themselves or on behalf of someone else. Call or Text Call 1-800-985-5990 or text TalkWithUs to 66746 to connect with a trained crisis counselor. The Disaster Distress Helpline’s number 1-800-846-8517 is available to all hard of hearing and deaf people. SAMHSA also has an interpretation service that connects callers with counselors in more than 150 languages. Call 1-800-985-5990 and press 2. Deaf/Hard of Hearing:

• Text TalkWithUs to 66746


• Use the preferred relay service to call the Disaster Distress Helpline at 1-800-985-5990

Spanish Speakers: • Call 1-800-985-5990 and press "2" • From the U.S., text Hablanos to 66746

Texting is subscription based and only involves a few steps: 1. Enroll in the service by texting TalkWithUs or Hablanos exactly as written. It’s important

to do this before sending the first text message because otherwise the enrollment may fail, and callers may not be able to speak with a counselor, or may accidentally subscribe to another service.

2. For texting support in Spanish: People in the United States should text Hablanos to 66746.

3. Look for confirmation that your subscription was successful. A Success! message will be sent.

4. To unsubscribe, text Stop or Unsubscribe to 66746 at any time. For help, text Help to 66746.

5. Standard text and data message rates will apply when texting from mobile phones. SAMHSA will not sell phone numbers to other parties.


D. Tips for Retaining and Caring for Staff after a Disaster September 19, 2016

When disasters strike, the ripple effects are significant. Survivors may be injured or displaced, or may have loved ones in similar situations. The emotional, physical, and financial tolls can be jarring, and no one in the community is immune. Healthcare providers and staff who maintain facility operations are no exception, and yet they are a critical component of the response phase and expected to care not only for their own loved ones, but community members and the facility, too. Leadership plays a vital role in ensuring staff feel cared for and safe.1 Remind your team that their jobs are important and secure. Provide regular and clear communication regarding how leadership is working to continue and restore operations. This tip sheet assumes that a facility is operational after an event and that certain pre-planning and continuity of operations considerations are already in place. Here we share general promising practices—categorized by immediate and short-term needs—for facility executives to consider when trying to retain and care for staff after a disaster. Immediate Needs It will be easier to encourage employees to return to work if they know that certain immediate needs will be met. First, try to help your employees (and their loved ones if applicable) receive access to any medical care necessary to address injuries incurred as a result of the incident. Next, try to be as flexible as possible with scheduling just after an event. Consider providing a “concierge service”—the ability for staff to meet with one person in one convenient place who can help employees meet the following immediate needs: • Shelter • Transportation • Food, water, hygiene • Care for loved ones • Behavioral health care • Funding • Communication/ charging stations • Flexible schedules

Shelter. If staff have lost their homes or their residences areuninhabitable, consider providing them with shelter within or close to the facility. Nearby schools, hotels, houses of worship, and other local stakeholders may be willing to donate space and/or materials. Make sure employees have access to a current list of local shelters as soon as it is available.2 After Hurricane Sandy, one health system (comprised of 16 hospitals) placed 62 employees’ families into temporary housing.3 Transportation. It may be difficult for displaced staff to get to and from work after a significant flood or other disaster. Consider partnering with churches or schools to use buses and drivers to transport employees to and from work. In South Carolina, fire personnel used boats to transport staff through floodwaters to the hospital.4 Consider setting up a regular shuttle service or volunteer carpool service. After storms, gas can be in short supply. Facilities in Florida have had a tanker come to the hospital, allowing staff to fill their tanks. Food, water, and personal hygiene. In the immediate aftermath of a disaster, it may be challenging for staff and their loved ones to access food and water. Work with your facility’s cafeteria to ensure food and water is available for staff (and for their loved ones being cared for). Try to ensure staff has access to showers/wipes, antibacterial gels, and other toiletries as available and requested. If their loved ones are staying elsewhere, consider providing employees


with potable water, food, and other items to take to them. Some facilities have coordinated the delivery of groceries so that staff had a box of food and drink when they left work. Try to promote the consumption of healthy foods and beverages. Child (or older adult) “daycare.” Healthcare providers will be more likely to report to work if they know their loved ones are cared for and safe. Consider providing on-site child care (and on-site care for older adults, if possible) for all shifts. If practical, work with the local school system to set up temporary transportation to and from local schools to minimize disruption in children’s routines. Pet care. Recent experience has shown that survivors may be reluctant to evacuate their homes because they do not want to leave their pets behind.5 Employees may volunteer to “foster” their colleagues’ pets in the short term (or make sure the pets have been let out and have an adequate supply of food and water). If practical, identify nearby shelters that accept pets and share this information with your team. Behavioral health care. Some of your employees may have literally “lost everything.” On-site disaster behavior health professionals (e.g., an available member of your facility’s employee assistance program [EAP] who is certified in Psychological First Aid6) can help staff get through the initial shock of the event, and provide them with additional resources and services as necessary. Leaders trained in “Building Workforce Resilience through the Practice of Psychological First Aid”7 can also help leaders guide their teams through stressful disaster response operations. Ensure staff have the time and a safe place to grieve/share stories. Consider scheduling optional meetings where staff can share challenges they are encountering. Provide a designated email address and/or collection box at each facility labeled “Staff Concerns/Questions” to allow those who wish to remain anonymous to share information.8

Consider setting up a 24/7 hotline or offer links to professional mental health sources.9 Funding. Consider working with your Board of Trustees and other community leaders to commit funding or raise money that can be used to provide assistance to employees and their families. The Board of Trustees from a hospital system in New Jersey committed $1 million to team members affected by Hurricane Sandy.10 The same group distributed $350 gift cards to “severely impacted team members” to assist with the purchase of necessities. A hospital association in Mississippi established a fund for hospital employee families after a tornado devastated the facility and community.11 Communication. Consider using social media to keep employees apprised of any service updates throughout the response and recovery phases. Tools such as Facebook and Twitter can be used to announce upcoming events (e.g., staff meetings, fundraising events). One hospital system used Facebook to provide staff and community members with service updates after a tornado devastated the facility.12 Residents, the media, and some practitioners used Twitter to share news related to Superstorm Sandy specific to the evacuation of Langone Medical Center. Charging stations. Make sure staff (and their loved ones, as necessary and practical) are able to charge their mobile devices. This can help them stay in touch with their loved ones, colleagues, and contractors. Flexible scheduling. There will be staff who cannot make it home, and staff who cannot make it in. In Florida, some facilities stagger work times, allowing employees to meet with contractors and repair teams. Short-Term Needs Once employees have been able to adjust to their “new normal” and gain a better understanding of the recovery process that lies ahead, healthcare facilities can continue making it easier for team members to report for duty. In addition to maintaining care that was provided in the immediate aftermath, facility executives may consider providing the following:


After his staff and facility experienced a tornado, a hospital Chief Executive Officer noted, “Take time to laugh and cry with each other. Healthcare workers always stand ready to help our community in a time of need and sometimes that is at our own expense.”1

Disaster service liaison • Clothing/Laundry • Behavioral health care • Care for loved ones • Nourishment • Transportation • Home improvement • Paychecks/ leave • Volunteers

On-site post-disaster services liaison(s). Consider staging someone on site (e.g., from FEMA or the American Red Cross) who can help your staff document their personal loss and create a recovery plan. If closure of the facility is imminent and employees are facing temporary unemployment, you may wish to convene meetings where employees can learn more about Disaster Unemployment Assistance through the Department of Labor13 and loans available through the Small Business Association.14 Clothing and laundry services. Staff who evacuated their homes may not have access to clothes other than what they were wearing at the time the disaster hit. Encourage employees to help one another—in one state, employees brought snacks and toiletry items in for those who were stranded and unable to go home for supplies.15 Consider relaxing the dress code to help staff deal with laundry challenges. Work with the on-site or subcontracted laundry service provider to collect, track, and launder staff items. Maintaining morale can help you retain and demonstrate your commitment to the health of employees. Encourage your team to seek help from the EAP or other behavioral health professional if they need to.16 Consider appointing an employee whose primary duty is to focus on staff wellness and morale. This helps demonstrate your commitment to your team, and can be integrated into the culture of the organization as it moves forward. Find meaningful/genuine ways to acknowledge the work of your employees (e.g., thank you notes, other forms of recognition, and deliveries of coffee and healthy snacks). Encourage and help staff and their loved ones to get back to routine activities as soon as practical.17 Find ways to create “fun” for the employees and ways for them to appropriately “let off steam” and continue to build a team environment to know they are supported. Home improvement help and materials. Some staff may have sustained damage to their homes, but can still live in them. Many hospitals in Florida keep a supply of tarps on hand and distribute them to employees after hurricanes. Others even establish a response team from plant operations or facilities management to help “shore up” employees’ homes. Some colleagues and/or team of first responders may be able to help others “dig out” or clean up once the threat has dissipated. Paychecks and donating leave. Some employees may live “paycheck to paycheck” and others may have relatively low personal leave balances. Rebuilding after a disaster is costly and takes time. Consider paying staff as soon as possible and encouraging colleagues to donate vacation time. Shortly after Hurricane Sandy, employees who were scheduled to work received a full paycheck, even if they were not able to make it in.18 Also after Hurricane Sandy, staff contributed more than 1,000 vacation hours to their colleagues.19 Some facilities in Florida have worked with credit unions to establish “ATMs,” allowing employees access to cash. Consider pay incentives for extra work performed by those able to report for duty. Use other professionals and volunteers. Network with healthcare facilities not affected by the event to borrow staff, with a “no-hire pledge” in place. Identify nurses and other practitioners


whose place of employment was damaged, and bring them on to assist with certain tasks (e.g., administrative); their knowledge of clinical language and facility processes will help. Volunteers can free up your staff to perform their regular jobs by serving as runners, performing administrative duties, and even making or delivering sandwiches. Train temporary employees and use downtime procedures for untrained staff. The aftermath of a disaster can be traumatic. People may want to return to work, but may be hampered by injury, caring for loved ones, or unable to access transportation. These tips can help healthcare facility executives provide support for those who care so much for others, ensuring the continuity of a healthy, safe workforce and a resilient community at large.

1 http://www.pnl.gov/main/publications/external/technical_reports/PNNL-18405.pdf 2 http://www.redcross.org/get-help/disaster-relief-and-recovery/find-an-open-shelter 3 https://www.northwell.edu/about/news/north-shore-lij-raises-23-m-employees-devastated-hurricane-sandy 4 http://www.modernhealthcare.com/article/20151009/NEWS/151009909 5 https://www.avma.org/KB/Resources/Reference/disaster/Pages/PETS-Act-FAQ.aspx 6 http://www.nctsn.org/content/psychological-first-aid 7 https://live.blueskybroadcast.com/bsb/client/CL_DEFAULT.asp?Client=354947&PCAT=7365&CAT=9399 8 http://www.omh.ny.gov/omhweb/disaster_resources/pfa/Healthcare.pdf 9 http://www.omh.ny.gov/omhweb/disaster_resources/pfa/Healthcare.pdf 10 https://www.meridianhealth.com/media/press-releases/2012/meridian-health-announces-financial-support-for-super- storm-sandy.aspx; https://www.meridianhealth.com/media/press-releases/2012/meridian-health-announces-financial- support-for-super-storm-sandy.aspx 11 http://www.winstonmedical.org/about-us/tornado/ 12 https://www.facebook.com/winstonmedicalcenter/?fref=ts 13 https://www.benefits.gov/benefits/benefit-details/597; https://www.fema.gov/media-library/assets/documents/24418 14 https://www.sba.gov/loans-grants/see-what-sba-offers/sba-loan-programs/disaster-loans 15 https://www.scha.org/news/sc-hospitals-rise-above-the-flood 16 http://www.omh.ny.gov/omhweb/disaster_resources/pfa/Healthcare.pdf 17 http://www.omh.ny.gov/omhweb/disaster_resources/pfa/Healthcare.pdf 18 https://www.meridianhealth.com/media/press-releases/2012/meridian-health-announces-financial-support-for-super-storm-sandy.aspx 19 https://www.northwell.edu/about/news/north-shore-lij-raises-23-m-employees-devastated-hurricane-sandy Retrieved from: https://asprtracie.hhs.gov/.../tips-for-retaining-and-caring-for-staff-after-disaster.pdf


RESOURCES FOR MAKING YOUR PLAN COMPREHENSIVE (This Resource List updated and revised February 2017)

KENTUCKY LTC EMERGENCY PREPAREDNESS MANUAL Website: www.kyepltc.com AGREEMENTS/MUTUAL AID

Inter-facility Transfer Agreement, Washington Health Care Association – Miscellaneous http://www.whca.org/benefits/document-library/

Sample Mutual Aid Transfer Agreement: Wisconsin Department of Health Services https://www.dhs.wisconsin.gov/ems/wi-interfacilitytransportguidelines-2006.pdf

Sample Mutual Aid Transfer Agreement: Alabama Nursing Home Association http://anha.org/uploads/web/MutualAidAgreement.pdf

CHEMICAL

CDC Emergency Preparedness: Chemical Emergencies http://emergency.cdc.gov/chemical/

Kentucky CSEPP: Chemical Stockpile Emergency Preparedness Program http://csepp.ky.gov/

COMMUNICATION Writing a Crisis Communication Plan http://www.ready.gov/business/implementation/crisis Risk Communication Materials http://chfs.ky.gov/dph/epi/preparedness/materials.htm Bridging Statements for Media Interviews

Centers for Disease Control and Prevention Communication

Emergency Preparedness and Response - Resourceful CDC emergency Web site

http://emergency.cdc.gov/cerc/

77 Questions Commonly Asked by Journalists During a Crisis

Emergency Public Information Pocket Guide - Oak Ridge Institute for Science and Education (ORISE)

Mobile Joint Information Center Guide for Needs Assessment/Components for Field Response Communication Activities

Questions for Reporters

CONTACTS: STATE

KY CSEPP: Chemical Stockpile Emergency Preparedness Program County Contact: http://csepp.ky.gov/Pages/CSEPP-Counties.aspx

Kentucky Department for Public Health – Emergency Preparedness http://chfs.ky.gov/dph/epi/preparedness/

Kentucky Department of Military Affairs http://dma.ky.gov/Pages/index.aspx


Kentucky Division of Emergency Management –Regional Response Offices http://kyem.ky.gov/Who%20We%20Are/Pages/AreaOffices.aspx Kentucky Office of Homeland Security http://homelandsecurity.ky.gov/Pages/default.aspx Kentucky Office of Inspector General – Central & Regional Offices http://chfs.ky.gov/os/oig/oigcontacts.htm Kentucky Office of the State Long Term Care Ombudsman http://chfs.ky.gov/dail/kltcop.htm CONTACTS: FEDERAL

Centers for Medicare & Medicaid Services Regional Offices https://www.cms.gov/About-CMS/Agency-Information/RegionalOffices/index.html?redirect=/regionaloffices/

Centers for Medicare & Medicaid Services/Regional Offices- Regulations & Guidance

https://www.cms.gov/Regulations-and-Guidance/Regulations-and-Guidance.html

https://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/HealthCareProviderGuidance.html

Department of Homeland Security

http://www.dhs.gov/xutil/contactus.shtm

FEMA - State Offices and Agencies of Emergency Management/Regional Contact Information http://www.fema.gov/regional-contact-information

DEMENTIA Disaster Preparedness

http://www.alz.org/national/documents/topicsheet_disasterprep.pdf http://www.alz.org/care/alzheimers-dementia-disaster-preparedness.asp

Planning for a Pandemic/Epidemic or Disaster: Caring for Persons with Cognitive Impairment

http://www.ahcancal.org/facility_operations/disaster_planning/Documents/pandemic_dementia_care.pdf

EVACUATION

National Criteria for Evacuation Decision-Making in Nursing Homes http://www.ahcancal.org/facility_operations/disaster_planning/Documents/NationalCriteriaEvacuationDecisionMaking.pdf

HIPAA • Bulletin: HIPAA Privacy in Emergency Situations

https://www.hhs.gov/sites/default/files/emergencysituations.pdf • Can healthcare information be shared in a severe disaster?

https://www.hhs.gov/hipaa/for-professionals/faq/1068/is-hipaa-suspended-during-a-national-or-public-health-emergency/index.html

• Health Information Privacy – Is HIPAA Privacy Rule Suspended during a National or

Public Health Emergency?


https://www.hhs.gov/hipaa/for-professionals/faq/1068/is-hipaa-suspended-during-a-national-or-public-health-emergency/index.html

• Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule: A Guide for

Law Enforcement https://www.hhs.gov/sites/default/files/ocr/privacy/hipaa/understanding/special/emergency/final_

hipaa_guide_law_enforcement.pdf • HIPAA Privacy Rule: Disclosures for Emergency Preparedness – A Decision Tool

https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/decision-tool-overview/index.html

• Hurricane Katrina Bulletin: HIPAA Privacy and Disclosures in Emergency Situations https://www.hhs.gov/sites/default/files/katrinanhipaa.pdf • When does the Privacy Rule allow covered entities to disclose PHI to law enforcement

officials? https://www.hhs.gov/hipaa/for-professionals/faq/505/what-does-the-privacy-rule-allow-covered-

entities-to-disclose-to-law-enforcement-officials/index.html • HIPAA Policy Brief

https://www.phe.gov/about/OPP/dhsp/Pages/hipaa-policybrief.aspx

For more information on HIPAA and Public Health: http://www.hhs.gov/ocr/privacy/hipaa/understanding/special/publichealth/index.html For more information on HIPAA and Emergency Preparedness and Response: http://www.hhs.gov/ocr/privacy/hipaa/understanding/special/emergency/index.html General information on understanding the HIPAA Privacy Rule may be found at: http://www.hhs.gov/ocr/privacy/hipaa/understanding/index.html TRACIE resources: https://asprtracie.hhs.gov/documents/aspr-tracie-hipaa-emergency-fact-sheet.pdf Department of Health and Human Services Healthcare Emergency Preparation Gateway (ASPR Tracie). August 31, 2016

FACILITY OPERATIONS: CARBON MONOXIDE Clinical Guidance for Carbon Monoxide (CO) Poisoning After a Disaster http://emergency.cdc.gov/disasters/co_guidance.asp

FACILITY OPERATIONS: GENERATORS Emergency Generator Critical Facility Site Survey http://www.vdh.virginia.gov/OLC/emergencypreparedness/ Emergency Power Facility Assessment Tool (EPFAT) http://epfat.swf.usace.army.mil/

Safe Use of Electricity


http://www.safeelectricity.org/information-center/library-of-articles/english-articles 5 Tips to Keep Emergency Generators Performing in LTC Facilities

http://www.ltlmagazine.com/blogs/stan-szpytek/5-tips-keep-emergency-generators-performing-ltc-facilities

JOB ACTION SHEETS

Florida Health Care Association Nursing Home Incident Command System JOB ACTION SHEETS http://www.fhca.org/emerprep/actionsheet.pdf

KY ALL HAZARDS PLAN http://kyem.ky.gov/programs/Pages/State-ESP-and-EOP.aspx

MENTAL HEALTH/PSYCHOLOGICAL FIRST AID American Health Care Association Psychological First Aid: Field Operations Guide for Nursing Homes http://www.ahcancal.org/facility_operations/disaster_planning/Documents/PsychologicalFirstAid.pdf

Kentucky Community Crisis Response Board KCCRB Online Resource Library including After a Disaster –Senior Special Concerns http://kccrb.ky.gov/resources/ Substance Abuse and Mental Health Services Administration

http://www.samhsa.gov/

Kentucky Cabinet for Health and Human Services, Department for Mental Health, Developmental and Intellectual Disabilities Provider Directory -- http://dbhdid.ky.gov/ProviderDirectory/ProviderDirectory.aspx

ORGANIZATIONAL CHARTS

FHCA NH Incident Command Center: Organizational Chart – Blank & Florida’s http://www.fhca.org/emerprep/orgchartblank.pdf CAHF NH Incident Command Center: Organizational Chart-Complete http://www.cahfdownload.com/cahf/dpp/NHICS/NHICS_Attachment_A_IMT.pdf

PANDEMIC FLU CDC Long Term Care & Other Residential Facilities Pandemic Influenza Planning Check list: http://www.flu.gov/planning-preparedness/hospital/longtermcare.pdf http://www.cdc.gov/oid/index.htmlhealorg/ResI/InfoSeries/Pages/EmergencyPre.hllawyers.org/o Ebola http://www.cdc.gov/vhf/ebola/ Enterovirus http://www.cdc.gov/non-polio-enterovirus/about/overview.html H1N1 Influenza

http://www.cdc.gov/h1n1flu/guidance


Influenza (Flu) http://www.cdc.gov/flu/ www.Flu.gov

Kentucky

http://chfs.ky.gov/dph/epi/preparedness/panflu

Pandemic Influenza Information for Health Professionals

http://www.cdc.gov/flu/professionals/

Pan-Flu Preparedness: Key Legal Issues For Healthcare Providers https://www.healthlawyers.org/Search/test-search/Pages/results.aspx?k=pan%20flu%20preparedness Zika virus http://www.cdc.gov/zika/

SURGE ASSESSMENT

California Department for Public Health Standards and Guidelines for Healthcare Surge During Emergencies – Vol. V: Long-Term Care Health Facilities http://www.bepreparedcalifornia.ca.gov/CDPHPrograms/PublicHealthPrograms/EmergencyPreparednessOffice/EPOProgramsandServices/Surge/SurgeStandardsandGuidelines/Documents/CDPH_VolV_LTC_PublicComment_020810.pdf Contra Costa County Medical Surge Capacity Plan 1/29/2007. www.cchealth.org/groups/ems/pdf/medical_surge_capacity_plan_jan07.pdf (Accessed 3/6/14).

Surge Capacity in Disaster Medicine Hick, J.L., Barbera, J.A., & Kelen, G. D. 2009. Concepts in Disaster medicine: Refining Surge Capacity; Conventional, Contingency, and Crisis Capacity. American Medical Association. http://www.ncbi.nlm.nih.gov/pubmed/19349869

TRAINING AND EDUCATION NIMS Resource Center http://training.fema.gov/emiweb/is/icsresource/trainingmaterials.htm NIMS Training Courses – https://training.fema.gov/nims/ FEMA Comprehensive Emergency Preparedness Guide http://www.fema.gov/media-library-data/20130726-1828-25045 0014/cpg_101_comprehensive_preparedness_guide_developing_and_maintaining_emergency_operations_plans_2010.pdf

Community Emergency Response Teams http://www.fema.gov/community-emergency-response-teams

WEATHER EMERGENCY RESOURCES NOAA Weather Radio All Hazards http://www.nws.noaa.gov/nwr/index.php NWR Station Listing for Kentucky - Broadcast Frequencies

http://www.nws.noaa.gov/nwr/Maps/PHP/KY.php#Station


County by County Coverage:

http://www.nws.noaa.gov/nwr/Maps/PHP/KY.php#County

ADDITIONAL RESOURCES/LINKS Agency for Healthcare Research and Quality (AHRQ) Tool for hospitals, home care and planners: http://archive.ahrq.gov/prep/homehealth/

Data Sources for At-Risk Populations: http://archive.ahrq.gov/prep/atrisk/

America Health Care Association – Disaster Preparedness All Hazards Planning Resources and Links

http://www.ahcancal.org/facility_operations/disaster_planning/Pages/default.aspx Lessons Learned/ Best Practices

Caring for Vulnerable Elders During a Disaster: National Findings of the 2007 Nursing Home Hurricane Summit http://www.ahcancal.org/facility_operations/disaster_planning/Documents/Hurricane_Summit_May2007.pdf

Centers for Disease Control and Prevention Preparedness Resources for Long-Term, Acute, and Chronic-Care Facilities

http://www.cdc.gov/phpr/healthcare/planning2.htm Strategic National Stockpile http://www.cdc.gov/phpr/stockpile/stockpile.htm

Centers for Medicare & Medicaid Services

Survey & Certification: Emergency Preparedness Checklist Recommended Tool for Effective Health Care Facility Planning (Rev. Dec 2013)

http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertEmergPrep/Downloads/SandC_EPChecklist_Provider.pdf

Fire Code Requirements for Nursing Facilities

http://www.nfpa.org/codes-and-standards

Florida Health Care Association

A Nursing Home's Introduction to the Incident Command System http://www.fhca.org/emerprep/command.php

Kentucky Associations Kentucky Association for Health Care Facilities www.kahcf.org LeadingAge Kentucky

http://leadingageky.org/ Kentucky Hospital Association www.kyha.com


Kentucky Local Health Departments http://chfs.ky.gov/NR/rdonlyres/F37BDF08-7C60-4E61-B001-29B8D2A68FE6/0/AlphaLHDlisting11111.pdf

USA Model Long Term Care Plans Florida Health Care Association http://www.fhca.org/emerprep/ Mississippi State Department of Health http://msdh.ms.gov/msdhsite/_static/44,0,122.html Pacific Northwest Article https://www.pnwpga.com/2015/who-cares-about-long-term-care-in-2016/ Virginia Department of Health http://www.vdh.virginia.gov/oep/planning Washington State Long Term Care https://www.dshs.wa.gov/altsa/long-term-care-services-information

Wisconsin Department of Health Services http://www.dhs.wisconsin.gov/rl_dsl/emergency-preparedness/emerg-prep-hva.htm


ACRONYMS/GLOSSARIES Accountability—Effective accountability during incident operations is required at all levels within the facility. The following guidelines are adhered to:

Check-In (all employees and responders must report in to receive an assignment in accordance with the procedures established by the incident commander), Incident Action Plan (response operations must be directed and coordinated as outlined in the IAP, Unity of Command (each individual involved in incident operations will be assigned to only one supervisor), Span of Control (Supervisors must be able to adequately supervise and control their subordinates, as well as communicate with and manage all resources under their supervision), Resource Tracking (Supervisors must record and report resource status changes as they occur).

Active Shooter – An individual actively engaged in killing or attempting to kill people in a confined and populated area, typically through the use of fire arms. Alternate Communication Methods: Include cellular phones, satellite phones, internet, two-way radios, CB, HAM radios. Alternate Facility Relocation Site—A facility that can be utilized in case of a complete evacuation of the primary facility that meets basic requirements for the safety and security of the residents and staff members. It is suggested that the facility establish at least two alternate sites, one in the same vicinity and one at least 50 miles away. Area of Refuge— Designated rooms within the facility where residents and staff take shelter during a disaster. The Area of Refuge is selected based on the nature of the emergency, resident acuity level and staff support. Blizzard Warning—Blizzard event is anticipated within 24-36 hours. Blizzard Watch—Sustained wind or gusts of 35 mph accompanied by snow or snow drifts make conditions favorable for a blizzard event. Visibility of less than ¼ mile for a period of three – four hours is possible. Boil Water Advisory-- A precautionary measure issued to ensure the safety of the water supply until water quality tests confirm the water is safe to drink. Chain of Command—Every person participating in the incident has a designated supervisor. There is a clear line of authority within the incident command organization, and all lower levels connect to higher levels, eventually leading back to the Incident Commander. The Chain of Command follows an established organizational structure that adds layers of command as needed. The basic outline of command layers are command, sections, branches, divisions/groups, units, resources. Cold (Severe)—When facility temperature drops to 65 degrees Fahrenheit and remains so for 4 hours. Codes (emergency) used by KY Hospital Association and recommended for use in Long-Term-Care:

§ Code Silver: Active Shooter/Person with a Weapon/Hostage Situation § Code Black: Bomb/Bomb Threat (including Suspicious Packages) § Plain Speech/Text: Earthquake § Plain Speech/Text: Epidemic/Pandemic Episode § Code Red: Fire Emergency § Plain Speech/Text: Fire Watch


§ Plain Speech/Text Flood/Flash Flood § Code Orange: Hazardous Material/ Spill/Release § Plain Speech/ Text Karst/Sinkholes/Caves § Plain Speech/ Text Landslide § Code Blue: Medical Emergency § Plain Speech/Text Missing Resident § Code Orange: Nuclear Power: Hazardous Material/Spill/Release § Plain Speech/Text Severe Heat/Severe Cold § Plain Speech/Text Snow Emergency Plan § Plain Speech/Text: Terrorist Attack § Plain Speech/Text Tornado Watch § Plain Speech/Text Tornado Warning § Plain Speech/Text: Utility Outage § Plain Speech/ Text Wildland/Forest Fire § Plain Speech/Text: Workplace Violence/Threat of Violence

Communications and Information Management—NIMS requires incident management organizations to ensure that effective interoperable communications and information management processes, procedures, and systems exist to support a wide variety of incident management activities across agencies and regions. Continuity of Operations Planning (COOP)—Ensures that the facility can sustain vital operations, including administrative and business components, immediately following a crisis or disaster situation. Critical Medical Information Wristband—Orange wristband for residents with special needs. Band is worn on the same wrist as the Resident Evacuation Identification Wristband and includes resident’s full name, facility name and contact number, and an indication if the resident is diabetic. Note should specify if resident is insulin dependent—diabetes mellitus (ddm)—or non insulin dependent—diabetes mellitus (niddm). If diabetic, note indicates if resident is using a thickener product or mechanically altered diet, or other special needs. Disaster Assessment Form—See Kentucky Long Term Care Facility Disaster Assessment Form Disaster Menu—Emergency menu that can be developed using minimal resources of food, water, and utilities. Disaster Preparedness Assessment—To be conducted on an annual basis to determine the readiness of the physical plant and associated supplies/provisions within the facility to manage a crisis or disaster situation. Drills—Activities that test, develop, or maintain skills in a single emergency response procedure. Focus is limited. Personnel and equipment do not deploy. Emergency Go Boxes—Contain cell phone/charger, cash/credit cards/additional keys, emergency key contacts list, list of employee payroll and contact information, and badges for visitors. Can be placed in secure locations throughout the facility, so that the Administrator and/or Incident Commander can grab them in an emergency. Emergency Management Codes—Used by Kentucky Hospital Association and recommended for long term care facilities to notify employees of crises or disaster situations that may impact the facility. Evacuation (Types)


Complete/Outside Evacuation—Moving residents, staff, and visitors to a pre-designated area outside of the building.

Horizontal Evacuation—Moving residents, staff, and visitors to a safe area on the same floor (compartmentalizing through the use of rated doors and rated assemblies—smoke partitions, fire walls, etc.) into an adjacent smoke/fire compartment (Partial Evacuation).

Phase I Evacuation—Transport of the highest acuity residents traveling via ambulance. These residents will be transferring to hospitals and will be transported first, if possible. Phase II Evacuation—Transport of all other residents who can travel via buses and cars.

Relocation—Moving residents to an off-campus alternate facility (may be referred to as Receiving Facility).

Vertical Evacuation—Moving residents, staff, and visitors to upper floors in the event of rising flood waters. (Partial Evacuation).

Facility Action Cards—Brief job descriptions to be utilized as “cheat sheets” for the designated ICS positions. Finance/Administration—One of the five ICS management functions; the facility’s Finance Leader is tasked with tracking incident related costs, personnel records, requisitions, and administrating procurement contracts required by Logistics. These include: contract negotiation and monitoring, timekeeping, cost analysis, compensation for injury or damage to property. Fire Watch—A process in which staff continuously monitor a facility for potential fire risk when the alarm, smoke detectors, sprinkler/power systems are not operational. System shutdown could occur during construction, electrical storms, or any unplanned incident/event that disrupts the fire alarm system. Flash Flood—Occurs when excessive water fills dry creeks, basins, and/or overflows rivers and shallow waterways in a short period of time, often without warning, following heavy rain, tornado, snow/ice melt. Flash Flood Warning—Issued by the National Weather Service when flooding is occurring or imminent. Flash Flood Watch—Issued by the National Weather Service when conditions are favorable for excessive rain or snow melt in flood prone areas. Flood Warning—Flooding is already occurring or will occur soon. Take precautions at once. Be prepared to go to higher ground. If advised, evacuate immediately. Flood Watch—Flooding is possible. Stay tuned to National Oceanic and Atmospheric Administration (NOAA) radio. Be prepared to evacuate. Tune to local radio/television stations for additional information. FLOP—Acronym for the four major management functions that report to the Incident Commander in ICS organizational structure: Finance/Administration, Logistics, Operations, and Planning.

Freezing Rain Advisory—an accumulation of freezing rain of below ½” (warning criteria) is anticipated within 12-36 hours. Functional Exercise—A functional exercise (FA) examines or validates the coordination, command and control among various multi-agency coordination centers which may include emergency management, field office, local health department, etc. A Functional Exercise does not involve “boots on the ground.” An example would be a test and evaluation of the centralized emergency operations capability and timely


response of one or more departments under a stress environment. A functional exercise could be centered in the Incident Command Center (ICC), and the use of outside activity (building on fire) and response could be simulated. Full Scale Exercise— A Full Scale Exercise (FSE) is a multi-agency, multi-jurisdictional, multi-discipline exercise involving functional and “boots on the ground” response (e.g. firefighters, decontaminating mock victims, etc.) to an imagined disaster scenario. Health Alert Network (HAN)--sends messages prior to and/or during emergencies. The system is administered by the Kentucky Department for Public Health (KDPH) at the state level and the Local Health Departments at the county level. Hazardous Materials—Substances that are flammable or combustible, explosive, toxic, noxious, corrosive, oxidizable, an irritant, or radioactive. Hazard Vulnerability Analysis (HVA)—An evaluative process that helps facility administrators determine what events or incidents may negatively impact the operations. While it is impossible to forecast every potential threat, the HVA identifies as many potential threats as possible in order to adequately anticipate and prepare to manage a crisis or disaster situation. Healthcare Planning Coalitions (HPC/HPP)—Established by the Kentucky Department for Public Health and based on a national model, Kentucky’s 13 regional coalitions meet at least bi-monthly to discuss risks related to potential emergencies/disasters in their regions, become educated about current healthcare issues, participate in training/ exercises and purchase emergency supplies and equipment based on identified needs. Members include healthcare providers (hospital, clinic, long-term care), EMS, health department staff, fire, and other emergency responders. Heat (Severe)—When facility temperature reaches 85 degrees Fahrenheit and remains so for 4 hours. Hurricane Landfall—The periods of time in which hurricane winds, rains, and storm tide present a danger to the general population as the storm approaches land and passes through the area. Hurricane Warning—A hurricane is expected to hit land within 24 hours. Hurricane conditions are imminent, bringing: sustained winds of 74 miles per hour or higher, torrential rain fall which will cause flooding, storm surge, rising tidal sea levels of more than 10 feet above normal. Hurricane Watch—A hurricane is possible within 36 hours. Stay tuned for additional advisories. Tune to local radio and television stations for additional information. Ice Storm Warning—Storm with the potential of bringing ½” or more of ice within 12-36 hours and covering at least 50% of zone or population concentration area. Incident—An incident is an occurrence, either caused by humans or natural phenomena, that requires response actions to prevent or minimize loss of life or damage to property and/or the environment. Incident Action Plan (IAP)—For a specific event or incident, response is coordinated and managed through one plan of action led by the Incident Commander. Incident Command—One of the five management functions that make up the foundation upon which the ICS organization develops. These functions apply whether handling a routine emergency, organizing for a major non-emergency event, or managing a response to a major disaster.

Incident Commander—The most qualified staff member (in regard to the Incident Command System) on duty at the time of the incident (or simulation) will assume the Incident Commander position. The Incident Commander designates the other four Incident Command positions (Operations, Planning, Logistics, Finance/Administration) and creates the overall incident objectives and responses.


Incident Command Center—An designated area, within or outside of the facility, where the Incident Commander, management team, as well as other staff members convene to review the situation and strategize the course of action. Incident Command System (ICS)—A component of the federal National Incident Management System (NIMS), ICS has become the standard for incident management across the United States. The management system provides procedures for controlling personnel, facilities, equipment, and communications and is designed to be used from the time an incident occurs until the requirement for management and operations no longer exists. Incident Management Sheet—Documents incidents and pertinent details surrounding the emergency situation, including employees who assume ICS functions during the incident. Karst Landscape – a landscape, common in Kentucky, that consists of porous rock (generally limestone) that allows water to move rapidly across the surface and breakdown the rock. Caves, dry streams and sinkholes are indicators of a karst landscape. Kentucky Community Crisis Response Board (KCCRB)--is the lead disaster behavioral health agency in Kentucky providing direct, contracted and volunteer crisis behavioral health services during and following a disaster. Kentucky Emergency Operations Center—Center of emergency services for state, under which emergency-based information, direction and programming are organized and communicated via various mass-communication mediums. Kentucky Emergency Management (KYEM) – A division of the Department of Military Affairs that coordinates a system of mitigation, preparedness, response and recovery to protect the lives, environment and property of Kentuckians. KYEM operations include emergency management within the five areas of finance, grants, information and training, planning, policy and procedure. Kentucky Long Term Care Facility Disaster Assessment Form-- Tool for long-term-care facilities to communicate status of facility during an emergency. Liaison Officer—A member of the Command Staff designated by the Incident Commander, who serves as the primary contact for supporting agencies assisting at an incident. Logistics—One of the five ICS management functions, the facility’s Logistics Leader is tasked with providing all resources, services, and support required by the incident, including: ordering, obtaining, and maintaining essential personnel, equipment, and supplies; providing communication planning and resources; setting up food services; setting up and maintaining incident facilities; providing transportation; providing medical services to incident personnel. Morgue Log Sheet—Documents the temporary storage of human remains during an emergency. National Incident Management System (NIMS)—Developed by Department of Homeland Security to manage emergency crisis and disaster situations in an organized and efficient manner. NIMS is used by federal, state, tribal and local governments. Nuclear Power Plant Emergency

Notification of Unusual Event—A minor problem has occurred at the nuclear plant. No radiation leak is expected. No action at the facility is necessary. Alert—A minor problem has occurred at the nuclear facility, and small amounts of radiation could leak inside the plant. This will not affect the facility and no action is required.


Site Area Emergency—Area sirens may be sounded. Listen to local radio/ television for safety information. General Emergency—Radiation could leak outside the plant and off the plant site. The sirens will sound. Tune to local radio or television station for reports. Be prepared to follow instructions promptly.

Official Spokesperson—An individual, often the Incident Commander, designated to educate and update staff members, residents, family members, and other applicable members/organizations within the community on issues pertaining to the facility’s all hazards emergency management program. Operation Period—Incident Action Plans include the measurable strategic operations to be achieved and are prepared around a time frame called an Operational Period. Operations—One of the five ICS management functions, the facility’s Operations Leader is tasked with directing all actions to meet the incident objectives and may work directly with emergency responders (fire, police, EMS, etc.)

Planning—One of the five ICS management functions, the facility’s Planning Leader is tasked with the collection and display of incident information, primarily consisting of the status of all resources and overall status of the incident, including: collecting, evaluating, and displaying intelligence and information about the incident; preparing and documenting incident action plans; conducting long-range and/or contingency planning; developing plans for demobilization; maintaining incident documentation; tracking resources assigned to the incident. Preparedness—The range of deliberate, critical tasks and activities necessary to build, sustain, and improve the operational capability to prevent, protect against, respond to, and recover from domestic incidents. Preparedness involves efforts at all levels of government and between government and private sector and nongovernmental organizations to identify threats, determine vulnerabilities, and identify required resources. Within the NIMS, preparedness is operationally focused on establishing guidelines, protocols, and standards for planning, training and exercises, personnel qualification and certification, and equipment certification. Probability—The likelihood of an event occurring near or in a facility based on the HVA. Issues to consider in determining probability are: known risk, historical data, manufacturer/vendor statistics. Public Information Officer—Designated by the Incident Commander and serves as the conduit for information to internal and external stakeholders, including the media or other organizations seeking information directly from the incident or event. R.A.C.E.—Acronym used to respond to fire emergency; Rescue (Rescue /Evacuate persons in immediate danger). Alarm (Pull nearest “pull station.” Announce “CODE RED” and fire location over loud speaker. Repeat the announcement). Confine (Confine the fire by closing doors to isolate the fire and smoke). Extinguish (Attempt to extinguish the fire only if the first three parts of the R.A.C.E. Procedure have been completed and the fire appears to be manageable). Radiation (minimize exposure) by:

Distance—The more distance between people and the source of the radiation, the better. This could include evacuation or remaining indoors. Shielding—The more heavy, dense material between people and the source of the radiation, the better. Time—Most radioactivity loses its strength fairly quickly.

Radiological Dispersion Device (RDD)—Combines a conventional explosive device (such as a bomb) with radioactive material; designed to scatter dangerous/ sub-lethal amounts of radioactive material over general area.


Recall Roster—List of facility employees including emergency contact numbers that can be implemented during an emergency. Resident Acuity Sheet—Documents resident census by acuity level when preparing for facility evacuation. Resident Emergency “To Go” Bag-- Contains personal clothing, gowns/pajamas, shoes, slippers, socks, underclothes, toiletries, glasses, dentures, etc. for three to four days. Resident Evacuation Identification Wristband—Clear/white identification wristband that includes resident’s full name, no known allergies (NKA) or list of food/medication allergies (in red), critical diagnosis, facility name and contact number, name of physician, name of responsible parties with contact numbers for each, and DNR, if applicable. Resident Information Packet—Plastic packet sent with resident to receiving facility during evacuation. Contains resident’s identification bracelet, face sheet/data sheet with contact information of responsible party/family, Social Security Number, Medicare/Medicaid/other insurance provider numbers, photograph, date of birth, allergies, diagnoses/medical conditions, current medications, resuscitation instructions with copy of DNR, Power of Attorney or advance directives, diet and special provisions, transfer methods. Resident Needs—Using a Person-Centered approach to care, which includes identifying resident preferences in regard to healthcare, dining options, roommate selection, choice in representatives and goal setting. Resident Representative—Individual chosen by a resident to attend personal care plan meetings and represent her/his wishes in regards to care, personal preferences, and goals. Resident Representative has access to information and participates in healthcare discussions. May serve as, POA, legal guardian, and healthcare surrogate, as designated by the resident. Resident Tracking Log—Form completed when residents evacuate their home facility. It includes the resident’s name, gender, time of departure, mode of transportation and provider, destination, which family members were notified (name, date and time) and which, if any equipment accompanied the resident. The medical chart and medication sheet are also listed on the tracking log. Resource Management—Efficient incident management requires a system for identifying available resources at all jurisdictional levels to enable timely and unimpeded access to resources needed to prepare for, respond to, or recover from an incident. Resource management under the NIMS includes mutual-aid agreements; the use of special federal, state, local, and tribal teams; and resource mobilization protocols. Risk—Component of the HVA and includes potential impact that any given hazard may have on the facility. Issues to consider are: threat to life and/or health, disruption of services, damage/failure possibilities, loss of community trust, financial impact, legal issues. Safety Officer— Staff person designated by the Incident Commander who monitors safety conditions and develops measures for assuring the safety of all assigned personnel. Saffir/Simpson Scale—Used by the National Hurricane Center to give public officials a continuing assessment of the potential for wind and storm surge damage. Shelter-in-Place—Suitable spaces in facility that are structurally sound and away from potential exposure areas for residents, staff, volunteers, vendors and visitors to seek shelter during an emergency situation. SHOC—State Health Operations Center (SHOC) provides command and control for all public health and medical response and recovery functions, Emergency Support Function (ESF) 8, in a statewide or local emergency or disaster.


Shut Down—Turning off all electricity, gas, etc. to the facility in case of disaster. Simulation—In a simulation, personnel demonstrate at least a portion of the actual response activities that they would execute in an emergency. Drills and simulations give participants the opportunity to practice and demonstrate how they would respond to and manage a crisis. The primary difference between a drill and a simulation is that during a drill, equipment and personnel do not actually deploy. Single Command—Command function in which the Incident Commander will have complete responsibility for incident management. A Single Command may be simple, involving an Incident Commander and single resources, or it may be a complex organizational structure with an Incident Management Team.

Span of Control—Span-of-control is the most fundamentally important management principle of ICS. It applies to the management of individual responsibilities and response resources. The objective is to limit the number of responsibilities being handled by, and the number of resources reporting directly to, an individual. ICS considers that any single person’s span of control should be between three and seven individuals, with five being ideal. In other words, one manager should have no more than seven people working under her/him at any given time. Staging Area – Last place to move residents before leaving the building. Residents may be sent to a staging area based on acuity level. Surge Capacity Assessment—Tool used to determine how many additional individuals a receiving facility can safely Shelter-in-Place if a neighboring facility needs to evacuate residents due to an emergency situation.

Tabletop Exercise— A tabletop exercise is a simulated emergency situation. It is a facilitated activity conducted in a conference room setting involving the discussion of a scenario by participants or a response team or teams. It is intended to evaluate plans and procedures then resolve questions of coordination and assignment of responsibility. Tabletop exercises are not concerned with time pressures, stress, or actual simulations of specific events. Take Cover Procedure—Any situation where the safety and well-being of the residents and staff members of the facility are at risk due to an event that occurs outside of the facility. The Administrator and/or Incident Commander is responsible for directing residents, staff, volunteers, vendors and visitors to Take Cover inside the facility in a designated area. Threats—Include fire/explosion, flood, bomb threat, tornado, hurricane, severe weather, power failure, utility disruption, workplace violence, security threat, missing resident, internal hazardous materials spill/leak, pandemic episode, unknown acts of terrorism.

Threats (Unique)—Threats that can potentially impact the facility 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.

Tornado Warning—A tornado has been sighted in the area or is indicated by radar. Take shelter immediately. Tornado Watch—Atmospheric conditions are right for tornadoes to potentially develop. Be ready to take shelter. Stay tuned to radio and television stations for additional information. Transfer of Command—The process of turning over responsibility from one Incident Commander to another using a five step process. Tropical Depression—Winds less than 30 miles per hour. Tropical Storm—Winds over 39 miles per hour, but less than 74 miles/hour.


Tropical Storm Watch—Issued when storm conditions are expected within 36 hours. Tropical Storm Warning—Issued when storm conditions are expected within 24 hours. Unified Command—Command function in which responding agencies and/or jurisdictions with responsibility for the incident share incident management. A Unified Command may be needed for incidents involving: multiple jurisdictions, a single jurisdiction with multiple agencies sharing responsibility, multiple jurisdictions with multi-agency involvement.

Unity of Command—Each individual participating in the operation reports to only one supervisor.

WebEOC—password protected, web-based communication system that provides an overview of the status of the healthcare providers: hospitals, health departments, and long-term-care facilities during emergency situations Wildland Fire—A fire that occurs in an area with few or widely-scattered structures. Roads, railways and powerlines may transverse the area. Wildland fire includes prescribed fire and wildfire. National and State Parklands are typical of wildlands. Wind Chill Advisory—Conditions suggest that wind chill temperatures exceeding -15 degrees F are possible during the next 24-72 hours. Wind Chill Warning-- Conditions suggest that wind chill temperatures exceeding -25 degrees F are likely during the next 24-72 hours. Wind Chill Watch—Conditions suggest that wind chill temperatures exceeding -25 degrees F are possible during the next 24-72 hours. Winter Storm Warning—Likelihood that heavy sleet, heavy snow, ice and/or blowing snow will develop within 24-72 hours. Criteria for snow: 7 inches of accumulation within 12 hours; 9 inches or more within 24 hours, that covers 50% or more of the zone or population concentration area. Criteria for ice is ½” or more covering 50% or more of the zone. Winter Storm Watch—Potential that heavy sleet, heavy snow, ice and/or blowing snow will develop within 24-72 hours. Criteria for snow: 7 inches of accumulation within 12 hours; 9 inches or more within 24 hours, that covers 50% or more of the zone or population concentration area. Criteria for ice is ½” or more covering 50% or more of the zone. Winter Weather Advisory—Greater than 80% that winter storm (snow, ice, sleet or a combination) will occur within 12-36 hours, but stay less than warning threshold. Workplace Violence—“Violent acts (including physical assaults and threats of assaults) directed toward persons at work or on duty.” (National Institute for Occupational Safety and Health (NIOSH).)

Kentucky LTC Emergency Preparedness Manual€¦ · Emergency Preparedness for Aging and LTC, Kent...

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Transcript of Kentucky LTC Emergency Preparedness Manual€¦ · Emergency Preparedness for Aging and LTC, Kent...