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Emergency/Disaster

Emergency/Disaster

The Emergency/Disaster Plan provides an orderly procedure to be implemented in an emergency to assure that the health care needs of patients continue to be met. The plan comprehensively describes its approach to a disaster. The Agency must maintain documentation of compliance with emergency preparedness. The Agency is not required to physically evacuate or transport a patient in the event of an emergency. All employees shall be oriented to the plan and their responsibilities in carrying out the plan. Possible emergency or risk factors will be identified for each patient and appropriate emergency plans discussed with the patient and/or the responsible person at the time of admission as indicated. The name and telephone number of an emergency contact will be obtained by the Agency.

The Agency has taken the following actions to develop, maintain, and implement an Emergency Preparedness and Response Plan as follows:

  1. The Agency must involve the Administrator, Director of Nursing, if applicable, and, based on the Agency’s organizational chart, other Agency leaders designated by the Administrator.
  2. The Administrator of the Agency is designated as the Agency’s disaster coordinator. In his/her absence, the Alternate Administrator is designated as the alternate disaster coordinator.
  3. The Agency has a continuity of operations business plan to address emergency financial needs, essential functions for patient services, critical personnel, and how to return to normal operations as quickly as possible.
  4. The Agency has a risk assessment to identify the potential disasters from natural and man-made causes most likely to occur in the Agency’s service area.
  5. The Agency has determined the actions and responsibilities of Agency staff in each phase of emergency planning, including mitigation, preparedness, response, and recovery. The response and recovery phases include actions and responsibilities when a warning of an emergency is not provided.
  6. The Agency has a plan to monitor disaster-related news and information including after-hours, weekends, and holidays, to receive warnings of imminent and occurring disasters.
  7. The Agency has implemented the following for the response and recovery phases of the Plan:
    • The Agency Administrator is responsible for initiating each phase of the Plan. In his/her absence the office manager is responsible.
    • The Agency has procedures for communicating with staff, patients or responsible representatives, local, state, and Federal emergency management agencies, and other entities as applicable including:
      • Emergency medical services.
      • State regulatory departments.
      • Other healthcare providers and suppliers.
      • Primary and alternate modes of communication or alert systems in the event of telephone or power failure.
  1. The patient is provided with the following:
    1. A copy of the Agency’s policy on how to handle disaster-related emergencies in the home.
    2. Patient responsibilities in the Agency’s Emergency Preparedness and Response Plan.
    3. A list of community disaster resources that can assist during a disaster-related emergency.
    4. Survival tips and plans for evacuation and sheltering in place.
  2. The patients are categorized into groups determined by the need for continuity of services, the acuity level of the patient, and the availability of someone to assume responsibility for the patient’s Emergency Response Plan if needed by the patient.
  3. The Agency has identified patients who may need evacuation assistance from local or state jurisdictions and can readily access recorded information about a patient’s triage category in the event of an emergency to coordinate and communicate as required.
  4. All employees including contractors are oriented about their responsibilities in the Agency’s Emergency Preparedness and Response Plan on hire and the plan is reviewed at least annually with an emergency drill performed.
  5. The Agency reviews its Disaster Plan as needed and after every response, but at least yearly through its Professional Advisory Committee. The Agency discusses the plan and the procedures for communicating with staff.
  6. The Agency will follow the emergency requirements during a disaster and will document in the Agency’s records attempts of staff to follow procedures in the event they are unable to comply with any of the requirements.
  7. The Agency will present its best efforts to provide care to patients in emergencies. However, if the Agency is unable to comply with situations beyond its control making it impossible to provide services, such as when roads are impassable or when a patient is relocated to a place unknown to the Agency, the Agency is not required to continue to provide care.

Our community is vulnerable to a wide range of emergencies, including natural, technological, and man-made disasters, all of which threaten the life, health, and safety of its people; damage and destroy property; disrupt services and everyday business and recreational activities; and impede economic growth and development. This vulnerability is exacerbated by the state’s growth and population, especially the growth in the elderly population, the number of seasonal vacationers, and in the number of persons of special needs. State policy for responding to disasters is to support local emergency response efforts

  1. To reduce the vulnerability of the people and the property of this state to damage, injury, and loss of life and property.
  2. To prepare for prompt and efficient rescue, care, and treatment of threatened or affected persons.
  3. To provide for the rapid and orderly rehabilitation of persons, and the restoration of services and properties.
  4. To provide for the coordination of activities relating to emergency preparedness with public and private agencies in the community.
  5. A comprehensive emergency plan is prepared, reviewed annually, and revised as necessary.

Emergencies:

  1. Any occurrence, or threat thereof which results or may result in substantial injury or harm to the population, or substantial damage to or loss of property.
  2. In the event of an emergency that disrupts the Agency’s ability to provide care, needs shall be prioritized to determine those that are the greatest. Patients will continue to receive care, if possible, with minimal disruption of schedule. Patients will be instructed in emergency measures if nursing availability is limited.
  3. If an emergency occurs, either within the Agency causing staffing limitation (such as labor disputes, staff illnesses) or within the environment (such as floods, hurricanes, fires, or other natural disasters), the Director of Nursing or designee will be responsible for reviewing patients and prioritizing them. When the demand for personnel exceeds available resources, the following factors should be considered in deciding priorities with the safety of the patient being the priority:
    • Availability of appropriate alternative coverage (family, friends, etc.) for the hours of service in question. A patient who has no other appropriate person to assist should receive a higher priority than those with appropriate alternatives.
    • Level of priority of the patient’s medical and nursing needs. Those patients whose medical and nursing needs are more acute should receive higher priority than those with less acute needs.
    • The usual number of personnel hours that the patient routinely receives from nursing services. Those patients receiving a greater number of personnel hours should receive a higher priority than those receiving less.
    • If an emergency occurs, either within the Agency causing staffing limitation (such as labor disputes, staff illnesses) or within the environment (such as floods, blizzards, hurricanes, fires, or other natural disasters), the DON or his/her designee will be responsible for reviewing patients and prioritizing them according to the following classifications:

Class I Emergency:

When the patient has a potentially life-threatening condition, requires ongoing medical treatment, or requires the assistance of a medical device to sustain life (i.e., there is a potential widespread power black-out and the patient is on a ventilator), the home environment and support system will be reviewed. When appropriate, arrangements for evacuation to an acute care facility will be made. These patients will be seen immediately. The Agency will obtain assistance from emergency personnel as necessary. (Examples:  Oxygen, Multiple Assistive Devices, Infusion)

Class II Emergency:

The patient has in-home support that may be mobilized in the event of disaster. The family is responsible for the evacuation and care of a patient. Patients with the greatest need for care will be seen as soon as possible by available staff. Patients requiring daily insulin injections, IV medications, and sterile wound care of a wound with a large amount of drainage.

Class III Emergency:

Services could be postponed 24-48 hours without adverse effects on the patient. (Examples: a new, insulin-dependent diabetic able to self-inject, a patient under cardiovascular and/or respiratory assessment, and a patient that requires sterile wound care to a wound with minimal amount or no drainage.)

Class IV Emergency:

The patient has maximum in-home support through the family structure.  The family is responsible for the care and transfer.  Services could be postponed 72-96 hours without adverse effects on the patient (Examples: a postoperative patient with no open wound, a patient who is anticipated to be discharged within the next 10-14 days, a patient who requires routine catheter changes.)

    1. In the event evacuation of the patient is required, the local authority responsible for coordinating disaster preparedness and emergency response will be contacted.  The Agency is not responsible for evacuating patients.
    2. If some patient visits cannot be made and it is not a life-threatening situation, contact will be maintained by phone if possible. If office phone service is disrupted, phones will be turned over to the answering service, if possible. A staff member will be assigned to remain in contact with the answering service to receive and send messages.

Types of Emergencies

Man-Made Emergencies: Those that are caused by acts against persons or society, including but not limited to enemy attack, sabotage, terrorism, civil unrest, and bioterrorism.

Natural Emergencies: Those that are caused by natural events, including but not limited to winter storms, hurricanes, floods, mudslides, severe wave action, droughts, and earthquakes.

Technological Emergencies: Those caused by a technological failure or accident, including but not limited to explosions, transportation accidents, radiological accidents, chemical and/or other hazardous materials incidents.

Staff Emergency Preparedness Plan

Know your Agency’s Emergency Preparedness Plan:  

    1. Know who to report to and procedures to follow.
    2. Be prepared to assume tasks/roles out of your ordinary job description.
    3. Ensure credentials are up to date and with you.
    4. Know how supplies will be procured for patients.
    5. Know the Agency’s communication procedures.

Have the automobile equipped:

    1. A full tank of gas.
    2. A shovel.
    3. Blankets.
    4. Portable battery-operated or crank flashlight.
    5. Portable battery-operated or crank radio.
    6. A list of gas stations with emergency/backup power.
    7. A cell phone charger.
    8. Booster cable.
    9. A tire repair kit.
    10. Bottled water and non-perishable high-energy foods, such as granola bars, raisins, and peanut butter.
    11. Fire extinguisher (5 lbs.; “A-B-C” type).
    12. Flares.

Have alternative communication devices available for use:

    1. Charged cell phone.
    2. Portable phone.
    3. CB Radio (handheld).
    4. Satellite phone.

Establish a family preparedness:

    1. Escape routes.
    2. Evacuation plan.
    3. Have a family communication plan.
    4. Have a point of contact that is out of town.
    5. A plan for pets.
    6. For a laptop computer have a converter that plugs into the cigarette lighter.

Damage of Written Records

    1. If written records are damaged during a disaster, the Agency must not reproduce or recreate patient records except from existing electronic records. Records reproduced from existing electric records must include:
      • The date the record was reproduced.
      • The Agency staff member who reproduced the record.
      • How the original record was damaged.
    2. The Agency is responsible for notifying the State licensing unit, by fax or email, no later than five working days after any of the following temporary changes resulting from the effects of an emergency or disaster:
      • Temporary relocating address including date of temporary relocation.
      • License number, physical address, and phone number.
      • Date the Agency plans to return to its permanent location.
    3. If the Agency is temporarily expanding its service area to assist in the emergency, the state should be notified of:
      • License number, and revised boundaries of the original service area.
      • Date of temporary expansion.
      • Date temporary expansion of the service area ends.