WeCare Nursing Home, Inc.: Disaster planning

Saturday, March 24, 2012

Disaster planning

Disaster Planning Document

Purpose:

To provide procedures/guidelines for responses to both internal and external disaster situations that may affect nursing home staff, residents and visitors.
To identify responsibilities of individuals and departments in the event of a disaster situation.
To identify standard operating guidelines for emergency activities and responses.

Situations and Assumptions:

Several types of hazards pose a threat to the facility, including:

General Considerations

Lines of Authority
Nursing Home Administrator
Director of Nursing
Charge Nurse
Department Supervisors
Communications

A command center will be set up per emergency response team.

A calling tree has been established and will be updated at least quarterly by department heads. Each department is responsible to call people in their own department.

Definitions Used In This Plan:

Partial Evacuation: Residents are not required to leave the premises. They may be brought to hallways in the event of a severe weather situation. In the event of a controlled/contained fire, residents may only be evacuated to beyond the fire doors to a wing.

Total Evacuation: Residents are taken from the building to area shelters or hospitals.

Internal Disaster: Fire, explosion, flooding, bomb threat, etc. which threatens the safety of persons within the facility and necessitates setting the evacuation plan in order.

External Disaster: Tornado, flood, disbursement of dangerous airborne particles or poisonous gases which threaten the safety of persons within the facility and necessitates setting the evacuation plan in order.

Triage: The screening and classification of sick or injured persons during a disaster to determine priority needs for efficient use of medical manpower, equipment, and facilities and to determine the priority of treatment.

FIRE/DISASTER PLAN

Due to the overwhelming danger to our residents in the event of a fire, it is extremely important that each employee know his/her duty at the time the fire alarm sounds.

Staff should be so familiar with this procedure that it becomes second nature - an instinctive reaction results when the fire alarm sounds. Keep in mind, it is our responsibility to provide for the safety of the residents.

The most important concern in this situation is panic. In order to prevent this, know your responsibility in an emergency. As all personnel must remain calm, NEVER SHOUT FIRE.

RESPONSIBILITIES

Person discovering the fire:

Remove residents in immediate room to safety, being sure to move all their oxygen tanks with them, closing the window and door behind you. Pull a corner of the privacy curtain out the door to signify this.
Sound the alarm by pulling the closest alarm station. (Location of fire alarms noted on floor plan.)
Report location of fire to charge nurse.

Charge Nurse (floor RN, or most senior LPN):

Call 9-1-1 – inform fire department where to enter building.
Notify reporting staff of location of fire.
Remain at desk.

Area Fire Supervisor (second nurse):

Direct rescue activities at the scene utilizing reporting staff.
Keep area clear and residents confined until the fire department arrives.
Account for all residents and staff evacuated into assembly area (normally the dining rooms).

CNA Staff:

CNA assigned to groups 1,3,5 stay in your wing to assist residents with needed cares.
CNA assigned to groups 2,4,6 report to area supervisor to assist with evacuation. Begin with rooms adjacent to the fire area and evacuate residents into the corridor.
- When the room is completely evacuated, including oxygen tanks, close the door pulling a corner of the curtain out of the door to signify this. If the rooms have adjoining bathrooms, go through these, closing the doors behind you.

Other Departments:

All but one person from each department report to nurses station to be assigned to assist with evacuation. Take the residents that have been evacuated into the corridor to an assembly area furthest from the fire, but with access to an outside exit.
Any residents that can be evacuated from the fire area by means of interior hallways to the assembly area, should be. Any residents that need to be evacuated through exterior exits should be brought to the assembly area as quickly as possible.

11-7 Shift

Charge Nurse:

Call 9-1-1 -- ask them to dispatch additional paramedics to aid in evacuation of residents.
Place a notice on window of west door facing outward with location of fire (which wing) specified.

All personnel:

Begin evacuation process as above.

Total Evacuation

In the event of a total evacuation, residents will be moved by ambulance, van, private cars and buses to a temporary location designated by the American Red Cross. Residents should be dressed appropriately for weather conditions.

Kitchen and toilet facilities will be available at the designated location and arrangements for cots have been make through the Community Disaster Plan.

Residents will be cared for at designated locations until the Care Center can be reoccupied or until residents can be transferred to other facilities in the area.

Kitchen employees shall move all undamaged food to the designated location.
Third nurse or DON shall evacuate the medication and treatment carts and the narcotic boxes.
The medical records staff shall evacuate the residents charts.
A designated person shall evacuate all undamaged incontinence products.
The evacuation route is determined by the location of the fire.

When total evacuation has been completed, it is the responsibility of the DON or charge nurse to account for the presence of all residents and staff. He/she must take a resident roster from medical records before leaving building to use in accounting for residents.

The department manager or person in charge of each department is responsible for accounting for all staff on duty and reporting such to the Director of Nursing or charge nurse.

In dietary department, if no department manager is present, it is the responsibility of the cook in charge (AM or PM).
In housekeeping department, it is the responsibility of the most senior housekeeper.
In laundry department, it is the responsibility of the late laundry person.
In activities, it is the responsibility of the department manager during the day, and the sole PM activity aide in the evening.
In social services, it is the social worker.
In nursing, the Director of Nursing or charge nurse is responsible to account for all CNAs and nurses, medical records person and transportation aid.

Employees are expected to report to work at the temporary location as usual.

Fire Drill Procedure

Purpose: For staff to practice the procedures to be used in the event of a fire within the facility.

Policy: Fire drills will be conducted by the maintenance department at a minimum of quarterly on each shift for the purpose of keeping staff proficient in the actions necessary to insure the safety of the residents.

Procedure:

A maintenance person will place a flashing red bulb simulating a fire somewhere in the facility. He will remain in the area to observe the response of staff.
The person finding the fire will immediately remove any resident from the room involved. Close the window and door, pulling a corner of the privacy curtain out the door to signify that the room has been evacuated.
- Then sound the alarm by pulling the closest alarm station. Report the exact location of the simulated fire (the red bulb) to the charge nurse. Return to the area to continue evacuating the adjacent rooms.
- If the resident is in bed, do not evacuate. If the resident is up in a chair, move him/her to the other side of the fire door.
Charge nurse (floor RN or most senior LPN) must come to the nurses' station immediately upon hearing the alarm. He/she will simulate calling 911 to report the fire. Remain at the desk to direct reporting staff to the area of the fire.
The second nurse serves as the fire area supervisor. He/she will direct the rescue activities of reporting staff, keep passageways clear until fire department arrives, account for all residents evacuated to assembly area.
The CNA staff assigned to groups 1,3, and 5 will stay in the assigned wing to assist with residents' needs.
The CNA staff assigned to groups 2,4, and 6 and any additional CNAs will report to the fire area supervisor to assist with evacuation. Begin with rooms adjacent to the fire area and evacuate residents into the corridor behind the fire doors.
- When the room is evacuated, close the window, bathroom door and room door, pulling a corner of the privacy curtain out the door to signify an empty room. Reassure residents it is only a drill.
Other department staff will report to the nurses' station, leaving one department member in the department. This staff is to take residents evacuated to the corridor to the assembly area furthest from the fire.
- Kitchen staff are to turn off the stove before leaving the kitchen to report to the station.

When the drill is complete, the following must be done:

Maintenance: Go with charge nurse to silence alarm and complete a report.
Charge Nurse: Reset air handling at the nurses station, then go with maintenance person (if available) to silence alarm.
CNAs and those reporting from other departments: Return evacuated residents to their rooms.
Kitchen Staff: Turn on the stove.
All staff participating in the drill will sign an attendance sheet.

TORNADO PROCEDURE

TORNADO WATCH: A tornado watch is declared when the conditions are right for a tornado to develop.

The charge nurse will monitor the weather by listening to radio/TV or scanner. The nurse should indicate to staff when a watch has been issued.

All Staff: (See specific department if listed)

Clear hall of non-essential items.
Close windows/drapes and clear sills.
Turn on more lights as sky darkens unless it increases heat uncomfortably. Clear desks of non-essential items, secure office records.
Ask residents to return to their wing.
Continue with normal activities.

Maintenance:

Secure outside furniture, collect loose objects from grounds/patios.
Advise residents of weather conditions. Ask them to return to their wings.

Nursing Staff:

Close windows and drapes and turn on lights. Verify working order of battery radios and flashlights. Evaluate availability and condition of spare wheelchairs. Have small tanks of oxygen available for residents.
Account for residents using the Medex. Tape directory to desk, record residents not on the floor. Therapies, beautician/barber, and activities should call the nurses' station to identify any residents that may be in their care.
Notify Director of Nursing/Charge Nurse of any missing residents.
Nurse in charge will determine when to begin evacuation. If severe weather is approaching our area, you do not have to wait for the official warning. Announce over the intercom that evacuation is beginning. All staff will begin severe weather procedures at once.

SEVERE THUNDERSTORM / TORNADO WARNING

TORNADO WARNING: A tornado warning is declared when the actual funnel cloud has been spotted.

Receptionist/Charge Nurse:

Announce: "Attention all staff, we are now in a severe weather/ tornado warning, begin severe weather procedures at once."
If phone does not work, send runners to all areas.

Receptionist:

Repeat announcement.
Stay at the desk as long as is safe to supervise the front door.
Send people to the assembly area and close fire doors in the area.

All Staff:

See also specific department, if listed. If on the nursing floor, help move residents to assembly area. Reassure and comfort residents.
Advise visitors and residents not to leave the building.

Nursing Staff:

Move residents to assembly area. Reassure and make residents comfortable.
When a room is completely evacuated, close the room door, pulling a corner of the curtain out of the door to signify that there is no one in the room.
If a resident refuses to move, move all other residents and then try to persuade. If the resident continues to refuse to move, notify the nurse to assess if situation is life threatening; if so, move resident.
Account for all residents.
Nurses: Take Medex, policy and procedure book, radio and flashlight with you. After office hours, the charge nurse should make notification calls of warning.
If severe weather occurs late at night and there is no time to evacuate, cover residents with their blankets, push beds away from windows and pull privacy curtains. Window drapes should already be closed.
- If time allows, line side of beds towards window with pillows, etc. Begin in the area where the storm is approaching.

EMERGENCY PROCEDURES DURING DISCONTINUATION OF WATER SUPPLY

Purpose: To ensure that there will be adequate water supply on hand to supply residents with water for personal and hygienic needs.

Procedure: If water supply is suddenly disrupted for any reason, the following steps will be taken by staff on duty during the time of the discontinuation of water supply.

Notify the Administrator or Administrator’s designee and the Maintenance personnel.
All attempts will be made to determine the cause for water disruption and the probable length of shutdown.
Dietary department will give out juices and other fluids that are on hand for consumption by residents.
Disposable dishes and utensils may be used during emergencies.
If necessary, water will be brought in and dispensed as needed. This will be initiated through emergency government.
If it becomes apparent that a water shortage will last for an undetermined length of time, the Administrator will order emergency measures taken to ensure proper care for ill residents and for those whose treatment has been disrupted by lack of water supply.
- Arrangements may need to be made to transfer those residents to hospitals or other long term care facilities for care.

WATER SUPPLY

The facility will be supplied with potable drinking water in the event of a disaster.

Small quantities of water may be purchased from local stores.

Larger quantities will be provided by local government sources or large water hauling suppliers.

BOMB THREAT TELEPHONE PROCEDURES

Purpose: To provide a consistent procedure for handling bomb threat situations.

Policy: The following plan for handling bomb threat situations in nursing homes was discussed and approved by a representative group of health care and law enforcement officials in the areas where bomb threats have been received.

In the past, the majority of bomb threats turned out to be hoaxes. However, the current trend nationally is that more threats are materializing. It is practically impossible upon receipt of a bomb threat to determine whether it is real or a hoax.

Procedure: Whenever the Administrator or other personnel receive threats or warnings about bombs in the building, they are responsible for immediately notifying:

the Police Department (Phone 9-1-1)
the Administrator.

The Administrator (or person of decision making responsibility in his/her absence) is responsible for making the decision regarding evacuation. This decision needs to be made promptly. Evacuation needs to be orderly so that no panic results.

In some situations, it may be desirable to obtain the advice of legal law enforcement authorities.

Keys will be available so that searchers can inspect all rooms. Employee coatroom areas will be searched.

The Administrator or designee will remain with the Search Commander during the entire search to provide assistance and counsel during the search.

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.

All personnel who might receive a bomb threat call should have readily available the names and telephone numbers of the police department and other emergency personnel.

Telephone Procedures: All personnel who normally receive telephone calls from the general public shall be instructed in the following procedures:

Keep the caller on the line as long as possible.
Ask the caller to repeat the message.
Record every word spoken by the person making the call.
Record time call was received and terminated.
Ask the caller his name.
See following table for recording information.
If the caller does not indicate the location of the bomb or possible detonation time, the person receiving the call should ask the caller to provide this information.
It may be advisable to inform the caller that the building is occupied and the detonation of a bomb could result in death or serious injury to many innocent people.

BOMB THREAT – TELEPHONE PROCEDURE

PROCEDURE: Listen - Do Not Interrupt Caller Except to Ask:
When will it go off?			Certain House
Where is it planted?			Time Remaining
What does it look like?			Area
Did caller seem familiar with building by the description of bomb location?
Your Name			Time of Call		Date
CALLER’S IDENTITY:	Male		Female		Approximate Age
VOICE CHARACTERISTICS		Loud		Soft
High Pitch	Deep		Fast		Excellent
Raspy	Pleasant		Slow		Good
Intoxicated	Distinct		Stutter		Fair
Nasal	Foul		Slurred		Poor
Other
ORIGIN OF CALL:	Local		Long Distance		Booth
Internal (from within the building)
ACCENT:	Local		Not Local		Foreign
Regional	Race		Calm		Angry
Rational	Irrational		Coherent		Incoherent
Emotional	Laughing		Deliberate		Righteous
Other
BACKGROUND NOISES:			Quiet		Voices
Music	Animals		Mixed		Party
Airplanes	Bedlam		Office Machines		Factory Machines
Street Traffic	Other

PROCEDURE FOR EVACUATION IN CASE OF A RADIOLOGICAL ACCIDENT

Purpose: To outline an emergency plan to be followed in the case of a radiological accident.

Policy: The following is the procedure to be followed in the case of a radiological accident.

In the case of an accident at a nuclear power plant, the office of emergency government will use the following alert systems:

County siren system
County scanner system

The facility will receive a phone call from the county public health Emergency Broadcast System on the radio and television.

Upon notification, facility staff should immediately call the Administrator and Director of Nursing to inform them of the exact notification. All in-town facility staff members should immediately report to the facility to assist with the evacuation of residents and facility records.

All residents and staff will be evacuated by transportation provided by emergency government. Concentrate on preparing all residents for evacuation. Do not take clothing, food or water. They will be provided at the evacuation site.

The following residents will be transferred to hospitals by ambulance or medi-van:

Oxygen dependent residents
Tracheostomy residents
Tube fed residents
Severe wounds and decubiti
Severe pain control i.e., terminal cancer
Severe obesity (Hoyer lift assist required)

All staff outside the facility should report to assist in resident evacuation as soon as possible. Staff will be needed to care for residents at the shelter areas.

One staff member will accompany each vehicle going to the hospital and to each shelter area to calm residents and reassure them. Resident medical chart will be transferred to the hospital and/or shelter.

Nurse will make certain that the chart accompanies the resident to the hospital or shelter.

The Administrator and supervisory staff will contact other nursing facilities and residents' families to relocate residents in proper environments to ensure appropriate care.

If return to the facility is not possible, the Administrative staff will seek supplemental staff to assist in the care of residents until return or relocation is completed.

CHEMICAL SPILLS

Purpose: To inform staff of action to be taken in the event of an outdoor chemical spill.

Policy: The following action will be taken in the event of an outdoor chemical spill.

Shut down outside intake ventilation.
Close all doors to the outside and close and lock all windows.
Maintenance staff should set all 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.
Turn off all heating systems.
Turn off all 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 in the building.
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.
If an explosion is possible outdoors, close drapes, curtains or shades over windows. Stay away form external windows to prevent injury from flying glass.
Tune into the Emergency Broadcasting System on the radio or television for further information and guidance.

Law enforcement agencies will make a determination regarding possible evacuation of residents.

POWER OUTAGE

Procedure: In the event of a power outage, the following are powered on the emergency generator:

Heating systems
Air handlers
All red outlets
Air conditioning unit, if needed.
Hallway and stairwell emergency lights
Fire alarm system
Telephone panel

For lengthy power outages, contact emergency government to see if arrangement can be made for auxiliary generators.

USE OF PERSONAL ELECTRICAL APPLIANCES

Purpose: To provide a safe environment for all residents, staff and visitors.

Policy: All electrical appliances brought into the facility for resident use must be inspected by the Maintenance Department prior to use.

Maintenance staff inspects appliances in accordance with NFPA standards. A log is kept in the Maintenance office of all inspections.

The following electrical appliances may not be brought in for resident use:

electric blankets
coffee pots
irons
toasters
microwave ovens
heating pads
hot plates
electric space heaters

The following appliances may be brought in for resident use:

radios
tape recorders
CD players
electric razors
fans
mini Christmas lights
VCRs
electric calculators
electric clocks
TV sets
hair dryers
air conditioners

Allowing the use of a refrigerator in a resident’s room is determined on an individual basis.

INTERNAL DISASTER PLAN

Procedure: An internal disaster is one that occurs within the building and which causes a disruption of services or destruction in some form. An internal disaster may be minor to extremely serious.

The Administrator and Maintenance Supervisor shall be notified in the event of disasters and for all fires regardless of the size. The following disasters are listed with type of action to be taken in the event of an internal disaster.

FIRE: In the event of a fire, procedures in the fire plan shall be followed.

BOMB THREAT: In the event of a bomb threat, procedures in the bomb threat procedures portion of this disaster plan shall be followed.

LOSS OF TELEPHONE SERVICES: In the event that telephone service is lost at the facility due to outside causes, the telephone company must be notified immediately. There is a cellular phone in the med. room that may be used if the phone system does not work.

If the cellular phone does not work, the nurse should designate a staff person to go to the nearest operating local telephone to report the telephone outage. The number to call for service is xxx-xxxx.

If the telephone outage continues, a driver and a vehicle should be designated to be ready to depart in an emergency to report any disaster requiring emergency services from the Police, Fire Department or Ambulance Service.

EXPLOSION: An explosion of some form is always possible from many causes. In the event of an explosion, persons witnessing the explosion should alert other persons in danger immediately.

Explosions can be caused by short circuiting electrical systems, unsafe fuel vapors, dropping compressed gasses containers in such a way as to break off valve heads, improper use of chemicals or spilling volatile liquids, and putting too much pressure in an enclosure (tank, pipeline, bottle, etc.).

Explosions result in some form of property damage and can cause personal injuries or death. In the event of personal injuries, persons witnessing the explosion shall take immediate action to assist the injured without placing themselves in immediate danger.

The injured persons should be given first aid and treatment as necessary. When the injured have been removed from the scene and others have been removed from immediate danger, the assessment of damages must be made.

A report must also be made. The report must contain what happened, the time of the explosion, the extent of injuries, etc. It is essential to try to remember all details of the explosion. This information is vital in the event of any future legal actions.

FIRE EXTINGUISHER

How to use a fire extinguisher:

Remove fire extinguisher from holder on wall.
Hold the fire extinguisher upright.
Pull the pin on the handle of fire extinguisher.
Point the nozzle of the hose at the base of the flame.
Squeeze the lever until fire is out.

http://www.dhs.wisconsin.gov/rl_dsl/NHs/NH3distrPlng.htm

WeCare Nursing Home, Inc.

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