List your emergency supplies, their amount, and their location. Such supplies include:
- water (see, for example, §19.1701(8)(A) for nursing homes);
- medications and medical supplies (including wipes, gloves, etc.);
- wheelchairs and other specific equipment used by the residents, individuals, or clients;
- garbage bags (for managing waste products in the absence of toilet water);
- flashlights and batteries;
- disposable plates and cups;
- linen and blankets; and
List the resources that your facility might have to obtain when you receive a warning of a disaster. Keep your lists updated. Nursing homes (see §19.312(c)) and ICF-MR/RC facilities (see §90.61(f)(12)) must have working flashlights.
Describe the means and process by which your facility will find, obtain, allocate, and distribute resources to meet all needs.
Consider questions such as:
- Will your facility need to hire tanker trucks to bring water?
- How will staff ensure supplies such as hygiene supplies, clothing, clean linen, oxygen, fuel, etc.?
- What procedures will ensure the selection, preservation, and availability of records essential to the effective functioning under disaster conditions and to maintain the continuity of operations: (Such records include medical, staff, financial, and construction records.)
Written, signed, and current (not more than one-year-old) agreements with vendors can help meet your needs both at your facility and, if you evacuate, at your destination site. Such agreements can address any number of needs you might have in an emergency, such as emergency supplies, laundry needs, food, nursing equipment, and emergency storage. Attach a copy of each agreement to your disaster plan.
Review and Update of the Disaster Plan
Conduct a formal audit of your entire disaster plan at least once a year. In addition to the yearly audit, evaluate and modify the plan:
- after each response to a disaster;
- after each training, drill, or exercise;
- after new hazards are identified;
- when staff or their responsibilities change;
- when emergency phone numbers change;
- after each renovation, modernization, or new construction;
- when facility (or agency) policies or procedures change; and
- after applicable regulatory changes.
Among the issues to consider are:
- Does the plan reflect lessons learned from trainings and actual events?
- Do staff members understand their respective responsibilities?
- Should there be more training?
- Does the facility need new equipment?
- Does the plan reflect changes in the physical layout of the facility?
- Does the plan reflect new facility processes?
- Does the facility face disasters that were not previously considered?
- Are the phone numbers in the disaster plan current?
- Should community agencies and organizations evaluate the plan?
Correct each problem identified in the audit.
Document each review of the disaster plan. Record each change made to the plan. Remember to brief staff on changes to the plan.
"Response" refers to the decisions that staff members implement during a disaster to address this disaster's immediate and short-term effects.
Keep a detailed log of your facility's or agency's response to a disaster. Describe what happened, at what time, the decisions made, and any deviations from the disaster plan. Such details will help you evaluate the plan after the disaster is over.
Examples of Possible Responses to a Disaster
The following applies directly to nursing homes. However, other types of facilities can have similar responses.
Administrative Staff Executive in Charge
- Establish an emergency operations center.
- Notify staff and residents of the impending disaster, its strength, and location
- Have supervisors review staffing needs.
- Have nursing staff review resident needs.
- Order special purchases as required, such as water, ice, and coolers.
- Notify the medical doctor.
- Establish hospital arrangements, if necessary.
- Oversee the notification of family members.
- Ensure that vehicles and drivers are available to evacuate residents and transport supplies.
- Check that vehicles are supplied with communication devices and destination maps.
- Make sure drivers know the evacuation routes.
- Alert the evacuation site and an alternate evacuation site.
Director of Nursing
- Help the administrator make executive decisions.
- Review and prioritize resident health care needs.
- Coordinate staffing needs based on resident needs.
- Inform staff who are on-site of the intent to evacuate.
- Tell other staff to report to the facility.
- Supervise resident removal from the building.
- Ensure that staff members check resident ID bands.
- Ensure the availability of medications and clinical supplies needed for the provision of care.
Assistant Director of Nursing
- Help the Director of Nursing notify staff of the intent to evacuate.
- Help supervise the transfer of residents to departure areas for evacuation.
- Help allocate medications and clinical supplies for evacuating residents as necessary.
Charge Nurse and Other§Nurses
- Coordinate pharmaceutical needs with the pharmacist as early as possible while delivery service is still operating.
- Supervise and direct the preparation of all residents.
- See that each resident has an adequate supply of medications.
- Prepare resident charts for evacuation.
- Check all bedrooms to ensure that residents are being properly prepared for evacuation.
- Make sure that all flashlights are in working order.
Certified Nursing§Assistants (CNAs)
- Prepare residents for evacuation.
All Nursing Staff
- Be available to accompany residents to evacuation site.
- Ensure that there is an adequate supply of food.
- When evacuation is considered, report to the administrator to discuss food supplies and needs.
- Notify all dietary staff members of the intent to evacuate.
- Help separate and pack food items for delivery to the evacuation site.
- Supervise and record the placement of utensils and food in departing vehicles.
- Assist or supervise the storage of kitchen equipment and secure the kitchen area.
- Check all rooms and equipment prior to leaving the facility.
- If there is no evacuation, carry out periodic checks to ensure a continued state of readiness in all buildings and surrounding grounds.
- Perform any emergency repairs and maintain appropriate inventories of emergency supplies.
- Document and report any building repairs needed and any supplies needed to properly secure the building during a disaster.
- Secure all loose objects around the exterior of the building.
- Ensure that an adequate amount of linen is available in resident areas.
- Make sure that adequate cleaning supplies are available.
- In the event of an evacuation, see how much clean laundry is available and report to the administrator or DON.
- Supervise the movement of clean laundry for transport to the evacuation site.
- Shut down all laundry equipment and secure the laundry area.
Recovery and Continuity
"Recovery" and "continuity" refers to the activities and programs designed to maintain or return buildings, equipment, supplies, and services to a level that, at a minimum, meets regulatory (or licensure) requirements.
Examples of these activities include the restoration of utilities, the repair of damaged walls, and the return of evacuees.
Condition of the Building and Equipment
Assess damages and identify resources needed to support the recovery and continuity of your facility.
Examples of questions to consider:
- What damage did the building(s) sustain? Does the condition of the roof, walls, floor, ceiling, windows, etc., meet the requirements?
- How much debris is there to remove?
- Does the facility have electricity?
- Is there emergency power? Does the emergency power operate as required?
- What is the temperature inside the facility?
- Does the fire alarm system operate as required?
- Does the automatic sprinkler system operate as required?
- Is the kitchen equipment operational?
- Is the sewer system operational?
- Do the phone lines work?
- Is there incoming tap water? Does this water need treating?
- Is the facility still accessible?
- Does the means of egress meet the requirements?
- What equipment needs repair or replacement?
The repair of a building can take a significant amount of time. Coordinate activities with appropriate authorities and resources. Test all new equipment.
Organizations that Can Help a Facility or Agency Prepare for a Disaster
A mitigation strategy requires teamwork and cooperation with other organizations. Have regular meetings with community emergency personnel to review your disaster plans and procedures. Seek assistance from organizations, such as:
- First responders (for example, the local fire department and emergency medical services);
- State and federal agencies; and
- Charity, volunteer, and nonprofit groups.
Involve community fire, police, and emergency management personnel in drills and exercises. Show them what your facility or agency is doing to prepare for and prevent emergencies.
Web sites have useful information. For example, the US Department of Health and Human Services has posted a checklist that home health agencies can use to prepare for an influenza pandemic. This checklist can be helpful in other types of emergencies.
The Texas Department of State Health Services has a draft of a preparedness plan for an influenza pandemic at: http://www.dshs.state.tx.us/commprep/planning/pandemic.aspx
Local Fire Departments
Local fire departments often have fire education programs for their communities. Your local fire department might be able to educate your staff about fire safety.
Contact information for some fire departments is available at: http://tfsfrp.tamu.edu/fdd/
City and County
Some cities have information on emergency preparedness. For example:
- Carrollton has information at: http://www.texasprepares.org/
- Houston has information at: http://www.houstonoem.net/go/site/1855/.
- Baytown Office of Emergency Management has posted a nursing home sample emergency plan and a nursing home checklist at:
Some counties have information on emergency preparedness. For example:
- Collin County has information on emergencies at: http://www.co.collin.tx.us/emergencies/index.jsp.
Examples of agencies that provide helpful information include the following:
- The Governor's Office of Homeland Security has useful information on disaster Preparedness at: http://www.governor.state.tx.us/homeland
- The Texas Department of Public Safety has useful information on emergency preparedness at: http://www.txdps.state.tx.us/dem/about.htm
- The Texas Department of Public Safety also has useful information on mitigation at: http://www.txdps.state.tx.us/dem/Mitigation/index.htm
- Texas Prepares.org of the Texas Department of State Health Services has useful information on emergency preparedness at: http://www.texasprepares.org/survivingdisaster.htm
- The Community Preparedness Section of Texas Department of State Health Services has several on line preparedness trainings at: http://www.dshs.state.tx.us/commprep/training/availablecourses.aspx
- The Texas Commission on Fire Protection has a resource library that provides training material. The library's Web site is: http://www.tcfp.texas.gov/library/library_services.asp
Texas.gov has useful information at: http://emergency.portal.texas.gov/en/Pages/Home.aspx
Examples of agencies that provide helpful information include the following:
- The US Department of Homeland Security's Federal Emergency Management Agency (FEMA) has useful information on how to deal with hazards at:§http://www.fema.gov/hazard/.
- FEMA has more resources for mitigation strategies at:http://www.fema.gov/government/mitigation.shtm.
- The Centers for Disease Control and Prevention has information on emergency preparedness and response at: http://www.bt.cdc.gov/.
Charities, Volunteer, and Non-Profit Groups
Examples of groups that provide assistance include the following:
The American Red Cross
The American Red Cross provides direct assistance to disaster victims in the form of shelter, food, clothing, and other services intended to alleviate the immediate needs caused by a disaster. Your local chapter might provide training on emergency preparedness. More information is available at:http://www.redcross.org/.
Amateur (or "Ham") Radio Operators
Amateur radio is a noncommercial, two-way transmission of signals over short-wave frequencies. Amateur radio can serve as a backup emergency communication system, especially because there is little or no fixed infrastructure that a disaster might destroy. Amateur radio operators can improvise and restore communications under the primitive conditions following a disaster. Some have stationed themselves at long-term care facilities to help with communication.