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Emergency Management Guide for Nursing Homes

By Dean Cooper,2014-04-26 10:54
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Emergency Management Guide for Nursing Homes

    Foreword

     The Florida Health Care Association is committed to bringing long term care emergency management planning to the forefront of our profession by aiding nursing homes in the development of effective emergency management plans which are comprehensive and aligned with state and local governments. FHCA’s Education and Development Foundation has partnered with the John A. Hartford Foundation, the University of South Florida, the Florida Department of Health and the American Health Care Association in the development of tools to support the emergency response system nationally, at the state and local levels, and at the nursing home.

     The design components have been aligned with the comprehensive emergency management requirements of the federal Department of Homeland Security, the Centers for Medicare and Medicaid Services, the Center for Disease Control and the Florida Agency for Health Care Administration. The intent is for nursing homes’ emergency management plans to describe who will do what, when, and with what resources before, during, and after an emergency.

     This guide provides nursing home administrators, corporate representatives, owners, and key emergency management staff with information on a national concept for developing risk-based, all-hazard plans.

     This guide provides an established format for developing a basic plan, offers direction for developing standard operating procedures for use during an emergency, and addresses specific hazards which may threaten a nursing home.

     FHCA welcomes recommendations on how this guide may be improved to better serve the nursing home community and the residents they protect and serve. Comments should be directed to: FHCA, Attn: Emergency Management Guide.

William J. Phelan LuMarie Polivka-West

    President & CEO, Florida Health Care Association FHCA Education & Development Foundation

     Principal Investigator

    John A. Hartford Foundation Grant

    Emergency Management Guide for Nursing Homes About this Document

    About this Document

    Purpose

    This guide is meant to assist nursing home administrators, corporate representatives, owners, and staff in their efforts to develop and maintain a practical all-hazard emergency operations plan. This guide is a collection of ideas and advice, not a sample emergency operations plan. Each nursing home’s emergency operations plan must indicate what that nursing home will do to

    protect itself from its hazards with the resources it has or can obtain.

Applicability/Scope

    This guide is intended primarily for use by nursing home staff responsible for emergency operations plan development and maintenance. It creates no requirements for any nursing home, and its recommendations may be used, adapted, or disregarded, based on a particular facility’s own policies and state law.

Supersession

    This guide is new. It replaces the 2005 Florida Health Care Association American Health Care

    Association Disaster Planning Guide.

Authorities

    This guide is issued by the Florida Health Care Association in partnership with the University of South Florida and the Florida Department of Health’s Office of Emergency Operations. Funding

    for the guide’s development came through the John A. Hartford Foundation and the FHCA. The

    planning format is based on the Federal Emergency Management Agency in their Guide for All-Hazards Emergency Operations Planning to be used by jurisdictions at the state and local level. Further, the components set forth in this guide satisfy the basic emergency management requirements of 400, Part II, Florida Statutes, s. 59A-4.126, Florida Administrative Code, as well as the new national recommendations of the Centers for Medicare and Medicaid Services. Nursing homes may use this guide to supplement guidance they receive from their states.

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    Emergency Management Guide for Nursing Homes About this Document

    Overview of Contents

    Part I of the guide explains what a comprehensive emergency management plan is and details the recommended organization of an all-hazard basic plan. It describes plan components and employs sample statements to clarify meaning.

    Part II of the guide provides highly specialized tips and procedures developed by providers through lessons learned and is organized in an appendix format. These appendices are intended to help with the creation of policies and procedures.

    Part III of the guide highlights and describes incident-specific hazards. The incident-specific hazard appendices extend beyond the all-hazards tone of the basic plan explained in Part I and address special response procedures, notifications, protective actions, and other needs which may be generated by a specific hazard. The incident-specific hazard appendices supplement a facility’s basic plan and standard operating procedures.

    Part IV of the guide introduces the Nursing Home Incident Command System. The Incident Command System concentrates direction and control actions on field operations for staff who are responding to the scene of an emergency. This part of the guide demonstrates why and how the Incident Command System may be adopted for use by nursing homes in the creation of their emergency plan.

    Part V of the guide offers a description of and a process for creating emergency preparedness training and exercises that are based on the specific standards given by the National Incident Management System.

    Part VI of the guide is a compilation the federal regulations and interpretive guidelines which are used to conduct inspections of nursing homes to determine compliance with 42CFR 483, Subpart B Requirements for Long Term Care Facilities.

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    Emergency Management Guide for Nursing Homes About this Document

    Creation/Revision Process

    The guide has to reflect the 2004-2005 hurricane seasons and the lessons learned in order to be relevant. The effected Gulf Coast states convened a 2006 summit where nursing home providers connected with each other to “blow up” the experience and examine the actions that were effective and the ones that were not. Nursing homes across the region committed to a more connected relationship with local and state emergency managers and to share best practices and this guide reflects that intent. In 2006, the grant, Hurricane and Disaster Preparedness for Long-

    Term Care Facilities, was awarded to the Florida Health Care Education and Development

    Foundation by the John A. Hartford Foundation to develop emergency preparedness tools, such as the Comprehensive Emergency Management Software Application for Nursing Homes, the

    National Criteria for Evacuation Decision-Making in Nursing Homes, and this guide, the

    Emergency Management Guide for Nursing Homes.

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    Emergency Management Guide for Nursing Homes

    Contents

Part I The Basic Plan

    Defining a Comprehensive Emergency Management Plan ...........................................................1

    Outline ....................................................................................................................................4 Administration ............................................................................................................................5 Executive Summary ................................................................................................................5 Plan Review and Maintenance .................................................................................................5

    Authorities and References ......................................................................................................6 Introduction ................................................................................................................................8 Profile .....................................................................................................................................8 Purpose ...................................................................................................................................9 Scope ......................................................................................................................................9 Situation.................................................................................................................................... 10 Risk Assessment ................................................................................................................... 10 Zones and Local Points of Interest ......................................................................................... 12

    Vulnerability Assessment for Residents................................................................................. 13

    Planning Assumptions ........................................................................................................... 18 Concept of Operations ............................................................................................................... 19 Alert, Notification, and Activation ........................................................................................ 19

    Command and Coordination ...................................................................................................... 25 Command Structure .............................................................................................................. 25 Communication ..................................................................................................................... 32 Roles/Responsibilities ........................................................................................................... 37 Evacuation ............................................................................................................................ 38 Sheltering in Place ................................................................................................................ 45 Host Receiving Site ............................................................................................................... 53 Training and Exercises .......................................................................................................... 55 Recovery ............................................................................................................................... 56

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    Emergency Management Guide for Nursing Homes

    Part II Appendices

    Introduction to the Appendices .................................................................................................. 58

    Appendix A: Emergency Staffing ............................................................................................. 60

    Appendix B: Emergency Communication Needs ...................................................................... 62 Appendix C: Resident Care Services by Vulnerability Assessment ........................................... 66 Appendix D: Vendor Support Communication Chart ................................................................ 73 Appendix E: Routine Mail Processing ...................................................................................... 75 Appendix F: Life Safety and Environmental Evaluation ........................................................... 76 Appendix G: Incident Command Post Sample Planning Meeting Agenda................................. 82 Appendix H: All Hazards Staff Response to Emergency........................................................... 83 Appendix I: A Staged Implementation of a Resident Identification System .............................. 84 Appendix J: Insured’s Guide to Hurricane and other Catastrophic Claims ................................ 85

    Appendix K: Resident Survival Kits ......................................................................................... 91

    Appendix L: Staff Survival Kits ............................................................................................... 92

    Appendix M: Pet Policies ......................................................................................................... 93

    Appendix N: Employee Staffing Letter and Form ..................................................................... 95 Appendix O: Re-entry to Area Letters or Vehicle Display Passes ............................................. 97 Appendix P: Generators and Utilities ....................................................................................... 99

    Appendix Q: Sample Letter to Families, Guardians, or Responsible Parties ............................ 103 Appendix R: Website References ........................................................................................... 104

    Appendix S: Glossary of Common Terms and Acronyms ....................................................... 106 Appendix T: Business Continuity ............................................................................................ 116

    Appendix U: Supplies, Quantities ........................................................................................... 119

    Appendix V: Timeline for Disaster Preparedness Activities.................................................... 120 Appendix W: Housekeeping Tips ........................................................................................... 121 Appendix X: Dietary Department Tips ................................................................................... 122 Appendix Y: Nursing Department Tips .................................................................................. 124 Appendix Z: Guidance for the Safe Transportation of Oxygen ............................................... 126 Appendix AA: Emergency Resident Handling ........................................................................ 127 Appendix BB: National Criteria for Evacuation Decision-Making in Nursing Homes ............. 130

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    Emergency Management Guide for Nursing Homes Part III Incident-Specific Hazards

    Incident-specific Hazards ........................................................................................................ 152 Biological Event...................................................................................................................... 153 Bomb Threat ........................................................................................................................... 159 Earthquake .............................................................................................................................. 161 Extended Power Outages ......................................................................................................... 165 Extreme Temperatures ............................................................................................................ 167 Fire ......................................................................................................................................... 169 Wildfires ................................................................................................................................. 173 Floods ..................................................................................................................................... 175 Hazardous Materials................................................................................................................ 178 Severe Weather (Tornados) ..................................................................................................... 185 Tropical Cyclones (Hurricanes) ............................................................................................... 187 Winter Storms ......................................................................................................................... 191

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    Part IV The Nursing Home Incident Command System

    The Nursing Home Incident Command System ....................................................................... 194

    A Nursing Home’s Introduction to the Incident Command System ...................................... 195

    Job Action Sheets ................................................................................................................ 202

    Incident Command ...................................................................................................... 203 Liaison Officer ............................................................................................................. 205

    Public Information Officer ............................................................................................ 207 Safety Officer ............................................................................................................... 209

    Operations ................................................................................................................... 210

    Resident Services Branch Director ............................................................................... 212 Nursing Services Unit Leader ...................................................................................... 214 Transfer and Discharge Unit Leader ............................................................................ 215 Psychosocial Unit Leader ............................................................................................ 216 Social Services Manager .............................................................................................. 218 Rehabilitative Manager ................................................................................................ 219 Activities Manager ...................................................................................................... 220 Infrastructure Branch Director ..................................................................................... 221 Dietary Services Unit Leader ....................................................................................... 223 Environmental Services Unit Leader ............................................................................ 224 Maintenance Unit Leader ............................................................................................. 225 Security Unit Leader .................................................................................................... 227 Planning ...................................................................................................................... 229

    Situation Unit Leader ................................................................................................... 230 Documentation Unit Leader ......................................................................................... 231 Logistics ...................................................................................................................... 232

    Service Branch Director............................................................................................... 234 Communication Hardware Unit Leader ........................................................................ 236 IT/IS Unit Leader ........................................................................................................ 237 Support Branch Director .............................................................................................. 238 Staffing/Scheduling Unit Leader .................................................................................. 240 Facility Supply Unit Leader ......................................................................................... 242 Central Supply Unit Leader ......................................................................................... 244 Dependent Care Unit Leader ........................................................................................ 246 Transportation Unit Leader .......................................................................................... 248 Finance/Administration ............................................................................................... 249 Business Continuity Unit Leader ................................................................................. 251 Procurement Unit Leader ............................................................................................. 253 Cost Unit Leader ......................................................................................................... 255 Employee Time Unit Leader ........................................................................................ 256 Compensation/Claims Unit Leader .............................................................................. 257

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    Part V Training and Exercises

    Training and Exercises ............................................................................................................ 258

Part VI Federal Regulations

    Federal Regulations ................................................................................................................. 284

    Table of Sample Statements

    Sample Statement 1 Authorities and References ..........................................................................7 Sample Statement 2 Alerting Staff ............................................................................................ 20

    Sample Statement 3 Alerting Family Members .......................................................................... 23 Sample Statement 4 Emergency Coordination ........................................................................... 29 Sample Statement 5 Public Health Integration ........................................................................... 31 Sample Statement 6 Emergency Tracking System ..................................................................... 31 Sample Statement 7 Equipping Supplies for Sheltering in Place ................................................ 50 Sample Statement 8 Sheltering Staff Dependents ...................................................................... 52 Sample Statement 9 Notifying and Tracking ............................................................................. 54

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    Emergency Management Guide for Nursing Homes

    Part I

    The Basic Plan

     This part of the guide defines the four components of a comprehensive emergency

    management plan. It also outlines an organizational structure recommended by the Federal

    Emergency Management Agency. Also described are the plan components supported by sample

    statements.

    In addition to a basic plan, nursing homes will include other items such as procedures,

    checklists, maps, mutual aid agreements, vendor contracts, and hazard-specific appendices to

    support their plan.

    Florida Health Care Association 1

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