2. The behavior of children may signal abuse or neglect long before any change in physical appearance. Some of the signs may include: Nervousness around adults Aggression toward adults or other children Inability to stay awake or to concentrate for extended periods Sudden, dramatic changes in personality or activities Unnatural interest in sex Frequent or unexplained bruises or injuries Low self-esteem Poor hygiene

3. Child abuse and neglect occur in all segments of our society, but the risk factors are greater in families where parents: Appear uninterested in the care or safety of their children Seem to be having economic, housing or personal problems Are isolated from their family or community Have difficulty controlling anger or stress Are dealing with physical or mental health issues Abuse alcohol or drugs

4. If you suspect abuse or neglect may be occurring, report it. To find out how, call information or contact your department of social services listed under government agencies in the phone book. If you think a child is in immediate danger, call the police. Childhelp USA National Child Abuse Hotline 15757 N. 78th St. Scottsdale, AZ 85260 (800) 4-A-CHILD The hotline offers crisis intervention, information, literature and referrals. APSAC 407 S. Dearborn St., Suite 1300 Chicago, IL 60605 (312) 554-0166 A multidisciplinary membership society promoting support among professionals who work with victims of child abuse.

5. Physical Abuse A non-accidental act which results in physical pain or injury, it includes physical coercion and physical restraint. Abusive Physical Behavior Includes hitting, slapping, burning, pushing, punching, pinching, biting, arm twisting, cutting, hair pulling, forced confinement in room, chair or bed. Signs of physical abuse Abrasions, Bruises, Burn blisters, Contusions, Rashes, Swelling, Lacerations Lack of awareness, Weight loss, Agitation, Broken bones. Etc. Sexual Abuse Non-consensual sexual contact, language or exploitative behavior. Abusive Sexual behaviors Includes rape, indecent assault, sexual harassment, sexual interference. Signs of sexual abuse - Unexplained sexually transmitted disease or infections - Bruising in genital areas or inner thighs - Bleeding from the genital area - Difficulty in walking or sitting not associated with a medical condition - Fear - Agitation - Disturbed sleep - Withdrawal

6. Financial abuse The illegal, improper use and/or mismanagement of a person's money, property or resources. Abusive financial behavior Fraud, Stealing, Forgery, Embezzlement, Reluctance to pay for accounts or debts, Forced changes to a Will, etc. Signs of Financial abuse Loss of jewelry or personal belongings, Expression of fear and anxiety when discussing finances, Unexplained amounts of money missing from bank accounts, Unpaid accounts, Loss of trust, Confusion over ownership of assets, property etc. Psychological/ Emotional Abuse Psychological abuse is language or actions designed to intimidate another person and is usually characterized by a pattern of behavior repeated over time, intended to maintain a 'hold of fear' over the older person. Abusive psychological/emotional behavior Humiliation, Blaming, Name calling, Insults, Silence, Shouting, Coercing, Intimidation, Withdrawal of affection, etc. Signs of psychological abuse Fearfulness, Hopelessness, Withdrawal, Low self esteem, Confusion, Sleep deprivation, Anger, Depression, Anxiety, etc.

7. Social abuse Restricting or stopping social contact with others and stopping or restricting activities. Abusive social behavior Includes being discouraged or stopped from seeing other people. Signs of social abuse Loss of interaction with others, Sadness and grief of people not visiting, Worried or anxious after a particular visit, Appears shamed, Low self esteem, Withdrawn, etc. Neglect Neglect is the failure of a care giver in a relationship of trust to provide necessities or blocking the provision of basic needs being provided. Neglect can be deliberate or unintended. Abusive neglectful behavior - Not providing adequate clothing, and personal items - Unwillingness to allow adequate medical, dental care or personal care - Inappropriate use of medication - Refusal to permit other people to provide adequate care Signs of neglectful behavior - Poor hygiene or personal care - Absence of health aids (dentures, hearing aids, glasses) - Unkempt appearance, inappropriate, or lack of, clothing - Weight loss - Lack of personal items (photos, ornaments)

8. Rights of Older Persons International Federation of Ageing In December 1991, the United Nations adopted a set of United Nations Principles for Older Persons, recommending that all member governments incorporate them into their programs for older people. Independence Participation Care Self – fulfillment Dignity As the number and percentage of individuals 65 and over has increased in this country, so has the incidence of elder abuse. Unfortunately, the prevalence and nature of this growing problem has generally remained hidden from public view. It is imperative that healthcare professionals become more aware of the scope and many issues surrounding this sensitive topic.

9. Reporting an abusive situation Care staff should report a situation of abuse to their supervisor in any of the previous circumstances Initial response to an abusive situation All staff, once they are aware of an abusive situation, will need to take steps to respond to it. Urgent / Emergency Non-urgent Listen to the older person Reaffirm they have rights Help is available Report Elder Abuse IDOA hotline at 800-252-8966 or 800-279-0400

10. Cultural Competence What is Cultural Competence? A set of congruent behaviors, attitudes and policies that come together as a system, agency or among professionals and enable that system, agency or those professionals to work effectively in cross-cultural situations. Culture shapes individuals' experiences, perceptions, decisions and how they relate to others. It influences the way patients respond to medical services and preventive interventions and impacts the way physicians deliver those services. In a society as culturally diverse as the United States, physicians and others in healthcare delivery need to increase their awareness of and sensitivity toward diverse patient populations and work to understand culturally influenced health behaviors. AREAS OF DISSONANCE 1. Historical Distrust Past injustices may cause minority patients to distrust their providers. Taking time to establish a rapport and explain why the forms are needed and who sees the forms may alleviate these fears. 2. Interpretations of Disability Physicians feel that treatment should include intervention and that biological anomalies should be corrected. However, some cultures believe that the "disability" is spiritual rather than physical or that the "disability" itself is a blessing or reward for ancestral tribulations. It's not just political correctness. It's good medicine. Culture influences the way patients respond to medical services and preventive interventions.

11. Cultural Competence It's not just political correctness. It's good medicine. Culture influences the way patients respond to medical services and preventive interventions. 3. Concepts of Family Structure and Family Identity Patient decision-making may include members of the extended family and the community. Providers should consider familial influence on treatment decisions. 4. Incompatibility of Explanatory Models If patients' and providers' ideas differ about the structure and function of the body, for example, causes of diseases being bacteria, virus or the environment versus the "evil eye," "loss of soul" or "curses," it will be difficult to get patients to comply with treatment. 5. Disease Without Illness Physicians are well indoctrinated about the dangers of "invisible" diseases like hypertension, high cholesterol and HIV infection, but people in other cultures are not as willing to intervene when there are no symptoms.

12. Cultural Competence How do I become culturally competent? L isten with sympathy and understanding to the patient's perception of the problem. E xplain your perceptions of the problem and your strategy for treatment. A cknowledge and discuss the differences and similarities between these perceptions. R ecommend treatment while remembering the patient's cultural parameters. N egotiate agreement. It is important to understand the patient's explanatory model so that medical treatment fits in their cultural framework. 6. Illness without Disease Physicians need to be aware of common folk illnesses that may affect members of a cultural community. "Some may see a medical doctor for relief of symptoms while also going to a folk doctor or traditional healer to be rid of the cause of the illness." In addition, although a few practices may be harmful (or misinterpreted as abuse), most folk medical beliefs and practices are not harmful and do not interfere with biomedical therapy. Providers should not try to change patients' benign beliefs but should educate them on the importance of biomedicine as complementary. A combination of the two forms of therapy may increase patient compliance because this is within the ethno cultural ideals of the patient. 7. Misunderstandings of terminology, language or body language Monolingual providers who encounter patients who do not speak their language cite this as a barrier to healthcare. Body language can be misinterpreted between cultures. It's not just political correctness. It's good medicine. Culture influences the way patients respond to medical services and preventive interventions.

13. Advanced Healthcare Directive What is an advance directive? It tells your doctor what kind of care you would like to have if you become unable to make medical decisions (if you are in a coma, for example). If you are admitted to the hospital, the hospital staff will probably talk to you about advance directives. A good advance directive describes the kind of treatment you would want depending on how sick you are. How can I write an advance directive? You can write an advance directive in several ways:  Use a form provided by your doctor.  Write your wishes down by yourself.  Call your state senator or state representative to get a form.  Call a lawyer.  Use a computer software package for legal documents. Advance directives and living wills do not have to be complicated legal documents. They can be short, simple statements about what you want done or not done if you can't speak for yourself. Remember, anything you write by yourself or with a computer software package should follow your state laws. You may also want to have what you have written reviewed by your doctor or a lawyer to make sure your directives are understood exactly as you intended. When you are satisfied with your directives, the orders should be notarized if possible, and copies should be given to your family and your doctor.

14. Advanced Healthcare Directive Why are advance directives important to medical care? It allows an individual to participate indirectly in future medical care decisions even if they become unable to make informed decisions. Instructive directives may extend individual autonomy and help ensure that future care is consistent with previous desires. The living will was created to help prevent unwanted and ultimately futile invasive medical care at the end-of-life. When should I refer to a patient's advance directive? It is best to ask a patient early on in his care if he has a living will, or other form of advance directives. Not only does this information get included in the patient's chart, but by raising the issue, the patient has an opportunity to clarify his wishes with the care providers and his family. However, advance directives take effect only in situations where a patient is unable to participate directly in medical decision making. Are advance directives legally binding? Advance directives are recognized in one form or another by legislative action in all 50 states (in Washington, see RCW 11.94). If the directive is constructed according to the outlines provided by pertinent state legislation, they can be considered legally binding. In questionable cases, the medical center's attorney or ethics advisory committee can provide guidance on how to proceed.

15. The Patient's Bill of Rights Patient rights were developed with the expectation that hospitals and healthcare institutions would support these rights in the interest of delivering effective patient care. According to the American Hospital Association, a patient's rights can be exercised on his or her behalf by a designated surrogate or proxy decision- maker if the patient lacks decision-making capacity, is legally incompetent, or is a minor. EACH PATIENT HAS A RIGHT, AT A MINIMUM TO THE FOLLOWING: 1. To be informed of these rights and facility’s rules and regulations; 2. To be informed of services available in the facility, of the names and professional status of personnel providing and/or responsible for his/her care; 3. To be assured of medical care and to be informed of his/her current medical condition, unless medically contraindicated; 4. To participate in the planning of his/her care and treatment; to have the right to refuse medication and treatment; to be informed of available treatment options, including the option of no treatment, and possible benefits and risks of each option;

16. The Patient's Bill of Rights 5. To express grievances to the staff and governing authority and to recommend changes in policies and services; 6. To consent to or decline to participate in proposed research studies or human experimentation; 7. To be free from; mental and physical abuse, exploitation, and chemical, physical or other types of restraints unless they are authorized by a physician for a limited period of time to protect the patient or others from injury. Drugs or other medications shall not be used for discipline of patients or for the convenience of facility personnel; 8. To be assured confidential treatment of his or her medical/health record, and to approve or refuse the release of the record to any individual outside the facility, except as required law or third-party payment contract; 9. To be treated with consideration, respect and full recognition of his/her dignity, individuality, and right to privacy; 10. To be free from being asked to perform any work for the facility, unless the work is part of patient treatment and is performed voluntarily by the patient. Such work shall be in accordance with Local, State, and Federal regulations;

17. The Patient's Bill of Rights 11. To join with other patients or individuals to work for improvements in patient care; 12. To be assured of exercising civil and religious liberties, including the right to impendent personal decisions; 13. To not be the subject of discrimination because of age, race, religion, sex, sexual preference, nationality, handicap, diagnosis, ability to pay, or source of payment; and 14. To not be deprived of any constitutional, civil and/or legal rights solely because of receiving service from the facility; Patients may call NJ Department of Health Hotline at 800-792-9770, or by mail: NJ State Department of Health, Healthcare Systems Analysis, Inspections Compliance & Enforcement, P.O. Box 360, Trenton, NJ 08625 This list of Patient Rights is an abbreviated summary of the current NJ Law and Regulations governing the rights of patients.

18. U.S. Department of Health and Human Services Health Insurance Portability and Accountability Act (HIPAA) HIPAA is a way that you and your family can have a continuity of health insurance even through job changes and perhaps even unemployment. Just as employees are portable, so should be health insurance, thanks to HIPAA. A few decades ago, people stayed in one or two jobs throughout a whole career. In those days people had no need for HIPAA, because their jobs were stable. But today, in a time when jobs and even careers are constantly changing, HIPAA can make a big difference in your personal welfare, or even the welfare of your family. HIPAA makes it easier for individuals and small businesses to get and keep health insurance. To reduce the cost of health insurance, HIPAA also includes an administrative simplification section to encourage electronic transactions. Due to the electronic transactions, HIPAA also has a host of new regulations to assure the security and privacy of electronically stored medical data. The regulations set standards for electronic transactions, the privacy of all medical records and all identifiable health information and the security of electronically stored information.

19. U.S. Department of Health and Human Services HIPAA is not a guarantee that you will have health insurance, or that you will keep health insurance after a job change. But HIPAA provisions may help you keep insurance during transitions, and they may help you get other insurance if you lose the insurance coverage that was provided by a previous employer. What is the Privacy Rule in HIPAA? The Privacy Rule regulates who can see an individual’s Protected Health Information (PHI). Under HIPAA, anyone can choose to allow or not allow others to collect and/or use their PHI. Why is this Privacy Rule of benefit to individuals? Insurance companies and some physicians have sold the health information they had for profit. Pharmaceuticals can utilize such health information to rationalize benefits from medicines. A person who may be likely to getting AIDS.

20. U.S. Department of Health and Human Services What is Protected Health Information (PHI)? PHI stands for any identifiable health information that could be used against a person. For example, one’s heart rate and blood pressure, demographics, (not height or weight). Individually Identifiable Health Information is information that could be used against a person, including demographic information collected from an individual, and: Physicians have always been bound to protect information revealed by patients or discovered during the course of medical treatment. Researchers also have an obligation to keep this informational confidential! 1. Is created or received by a healthcare provider, health plan, employer, or healthcare clearinghouse; and 2. Relates to the past, present, or future physical or mental health or condition of an individual; the provision of healthcare to an individual; or the past, present, or future payment for the provision of healthcare to an individual; and a. That identifies the individual; or b. With respect to which there is a reasonable basis to believe the information can be used to identify the individual.

21. Be Safe! Tony Soares, Safety Director Compensation Solutions, Inc. tsoares@compsolutionsinc.com Tel: 1-888-201-5680 Ext. 192

25. BENEFITS – Reducing fear, anxiety and minimizing the impact of disasters. BEFORE – Know the risks and danger signs, purchase appropriate insurance (keep copy of it & vital documents elsewhere), develop a plan, assemble a disaster kit (Blankets, First Aid Kit, Battery operated radio, Fresh batteries, Whistle, sanitation, and 3-Day supply of Food and Water). Develop safety skills (First Aid, CPR, Fire Extinguisher). Develop an emergency communication plan (Ask an out-of-state relative or friend to serve as the "family contact" After a disaster). Have a plan for getting back together. DURING – Plan into action / Follow written procedures, Follow guidance of officials. EVACUATION: Full tank of gas, $$$, e-Kit in car, Gather family (Who to contact), Notify others of plan. Know evacuation routes. SHELTER IN PLACE: Lock doors & windows. Shut-off gas? Leave freezer & refrigerator plugged in? AFTER – Repair property, Take steps to prevent future loss. National Next Of Kin Registry… http://nokr.org/nok/restricted/home.htm http://www.ready.gov/index.html http://www.fema.gov/hazards/ http://www.weather.gov/nwr NOAA Weather Radio (MHz): 162.4 162.5 http://www.fema.gov/areyouready/assemble_disaster_supplies_kit.shtm Are you READY? to prepare

26. Preparation The facility is equipped with an automatic emergency electrical system (back-up generator). In the event of a power failure, the system will automatically start and provide electricity to all necessary support systems. During a power failure If the back-up generator does not automatically start, the nurse manager, or designee, shall start the system manually. Ensure that critical medical/electrical equipment is on emergency power (RED outlets). Notify the power company immediately. Any case not already in progress will be delayed or canceled until NORMAL power is restored. You must complete any case that is already in progress, as expeditiously as possible, and no further case started. Cases will only be re-started when it is certain that NORMAL power has been returned and the Medical director, or designee, has given the approval to resume operations. Power Failure

27. Fires Each Year: 4,000 Americans die and more than 25,000 are injured in fires (most of which could be prevented). 500,000 residential fires. Direct property loss over $ 9 billion. Speed: A fire can double in size every 30 seconds. A wastebasket fire can consume a room in less than five minutes, and an entire house in less than 15 minutes. Danger: Heat and smoke can be more dangerous than the flames. Asphyxiation is the leading cause of fire deaths, exceeding burns by a three-to-one ratio. Smoke Alarms: It decreases your chances of dying in a fire by half. Place them in every level of your residence, in bedrooms (on the ceiling or on the walls – 4 to 12 inches from ceiling), at the top of stairways and near the kitchen. Test and clean them once/Mo. Replace batteries once/Yr. Replace them once/10 yrs. Prevent: Clean out storage areas. Never use flammables indoors. Store flammable liquids in approved containers. Keep heat sources away from flammables & combustibles. Screened fireplace. Heating units inspected yearly by a certified specialist. Have electrical wiring inspected by an electrician. Sleep with door closed. Install fire extinguishers. Ask FD to inspect your house. Escaping: Review escape routes with family. Practice escaping from each room. Keep halls, stairwells and doorways CLEAR to facilitate evacuation. 1906 – San Francisco, CA: 500 city blocks, from 500 to 3,000 deaths

28. If You Discover A Fire Or Smoke: Warn others - Fire Alarm. If You Hear A Fire Alarm: Immediately leave the building using the nearest safe exit. Leave The Building Immediately: Do not stop for personal belongings Crawl low in smoke  Use wet cloth to cover your nose and mouth  Don’t use elevators  If you catch fire, DON’T RUN! – Stop, Drop and Roll  Don’t open a hot door (feel it with the back of your hand) - Close doors as you go. Call Fire Department: (9-1-1) from a safe location and give ALL relevant information. If fire is small and controllable, you have received fire extinguisher training; You may (voluntarily) try to stop the fire (if it is not blocking your exit route). Remember “PASS”. Stop the source of the fire by using a fire extinguisher, water (do NOT use water on grease or oil), salt, or by covering the container. Once out, assemble in a pre-determined area. Fires

29. Floods Before: Buy Flood Insurance (take photos or videos of all of your important possessions. If your home is damaged in a flood, these documents will help you file a full flood insurance claim. Store important documents and irreplaceable personal objects (such as photographs) where they won't get damaged. If major flooding is expected, consider putting them in a storage facility. Buy and install sump pumps with back-up power. Have a licensed electrician raise electric components (switches, sockets, circuit breakers and wiring) at least 12" above your home's projected flood elevation. For drains, toilets, and other sewer connections, install backflow valves or plugs to prevent floodwaters from entering. Anchor fuel tanks. An unanchored tank in your basement can be torn free by flood waters, and the broken supply line can contaminate your basement. An unanchored tank outside can be swept downstream, where it can damage other houses. If your washer and dryer are in the basement, elevate them on masonry or pressure-treated lumber at least 12" above the projected flood elevation. Place the furnace and water heater on masonry blocks or concrete at least 12" above the projected flood elevation. 1889 – Johnstown, PA: 2,200 deaths 1931 – China: 3,700,000 deaths 1887 – China: 900,000 deaths

30. During: When a flood warning has been announced. Fill bathtubs, sinks, and jugs with clean water in case water becomes contaminated. Listen to a battery-operated radio for the latest storm information. Turn off all utilities at the main power switch and close the main gas valve. If told to evacuate your home, do so immediately. If the waters start to rise inside your house before you have evacuated, retreat to the second floor, the attic, and if necessary, the roof. Floodwaters may carry raw sewage, chemical waste and other disease-spreading substances. If you've come in contact with floodwaters, wash your hands with soap and disinfected water. Avoid walking in floodwaters. Six inches of moving water can knock you off your feet. Don't drive through a flooded area. If you come upon a flooded road, turn around and go another way. A car can be carried away by just 2 feet of flood water. Electric current passes easily through water, so stay away from downed power lines and electrical wires. Look out for animals -- especially snakes. Animals lose their homes in floods, too. Floods

31. After The Flood: Call the agent who handles your flood insurance to file a claim. Check for structural damage before re-entering your home. Don't go in if there is a chance of the building collapsing. Upon re-entering your property, do not use matches, cigarette lighters or other open flames since gas may be trapped inside. If you smell gas or hear hissing, open a window, leave quickly, and call the gas company from a neighbor's home. Keep power off until an electrician has inspected your system for safety. Check for sewage and water line damage. If you suspect damage, avoid using the toilets and the tap and call a plumber. Throw away any food -- including canned goods -- that has come in contact with floodwaters. Until authorities declare your water supply to be safe, boil water for drinking and food preparation. To make filing your claim easier, take photos of any water in the house and save damaged personal property. An insurance adjuster will need to see what's been damaged in order to process your claim. Salvage water-damaged books, heirlooms and photographs with restoration tips from: http://www.fema.gov/hazards/floods/coping.shtm Floods

32. Landslides and Debris Flow (Mudslide) It strikes without warning. The force of rocks, soil, or other debris moving down a slope can devastate anything in its path. Before… Get a ground assessment of your property. Plant ground cover on slopes and build retaining walls. Build channels or deflection walls to direct the flow around buildings. Warning Signs… Doors or windows stick or jam for the first time. New cracks appear in plaster, tile, brick, or foundations. Outside walls, walks, or stairs begin pulling away from the building. Cracks appear on the ground or on paved areas such as streets or driveways. Underground utility lines break. Bulging ground appears at the base of a slope. Water breaks through the ground surface Fences, retaining walls, utility poles, or trees tilt or move. You hear a faint rumbling sound that increases in volume as the landslide nears. 1970 – Peru: 18,000 deaths

33. During… If indoors: Stay inside, take cover under a desk, table, or other piece of sturdy furniture. If outdoors: Try and get out of the path of the landslide or mudflow. Run to the nearest high ground in a direction away from the path. If rocks and other debris are approaching, run for the nearest shelter such as a group of trees or a building. If escape is not possible, curl into a tight ball and protect your head. Plant ground take on slopes and build retaining walls. After… Stay away from the slide area. There may be danger of additional slides. Check for injured and trapped persons near the slide area. Give first aid if trained. Listen to a battery-operated radio or television for the latest emergency information. Flooding may occur after a mudflow or a landslide. Check the building foundation, chimney, and surrounding land for damage. Sinkholes… A sinkhole occurs when groundwater dissolves a vulnerable land surface such as limestone, causing the land surface to collapse from a lack of support. Landslides and Debris Flow (Mudslide)

34. Winter Storms They are accompanied by strong winds creating blizzard conditions with blinding wind-driven snow, severe drifting, and dangerous wind chill. Strong winds can knock down trees, utility poles, and power lines. Storms near the coast can cause coastal flooding and beach erosion as well as sink ships at sea. Before… Be familiar with winter storm warning messages. Service snow removal equipment and have rock salt on hand to melt ice on walkways and kitty litter to generate temporary traction. Make sure you have sufficient heating fuel; regular fuel sources may be cut off. Winterize your home: Insulate walls and attic. Caulk and weather-strip doors and windows. Install storm windows or cover windows with plastic from the inside. Have safe emergency heating equipment available. Fireplace with ample supply of wood. Small, well-vented, wood, coal, or camp stove with fuel. Portable space heaters. Install and check smoke detectors. Keep pipes from freezing. Have disaster supplies on hand, in case the power goes out. 1993 – E. Coast USA: 500 deaths

35. During… If indoors: Stay indoors and dress warmly. Conserve fuel (lower the thermostat and close off unused rooms). Food provides the body with energy for producing its own heat. If outdoors: Dress warmly (wear loose-fitting, layered, light-weight clothing). Outer garments should be tightly woven and water repellant. Mittens are warmer than gloves because fingers generate warmth when they touch each other. Stretch before you go out. If you go out to shovel snow, do a few stretching exercises to warm up your body. Also take frequent breaks. Cover your mouth. Protect your lungs from extremely cold air by covering your mouth when outdoors. Try not to speak unless absolutely necessary. Avoid overexertion. Cold weather puts an added strain on the heart. Be aware of symptoms of dehydration. Watch for signs of frostbite and hypothermia. Keep dry. Change wet clothing frequently to prevent a loss of body heat. Help your neighbors who may require special assistance. If no shelter: Prepare a wind-break, or snow cave for protection from the wind. Build a fire for heat and to attract attention. Place rocks around the fire to absorb and reflect heat. Do not eat snow: It will lower your body temperature. Melt it first. Winter Storms

36. During… In a car: Stay in your car. Disorientation occurs quickly in wind-driven snow and cold. Run the motor about ten minutes each hour for heat. Open the window a little for fresh air to avoid carbon monoxide poisoning. Make sure the exhaust pipe is not blocked. Make yourself visible to rescuers (turn on the dome light at night when running engine, tie a colored cloth (preferably red) to your antenna or door, raise the hood indicating trouble after snow stops falling). Exercise from time to time by vigorously moving arms, legs, fingers, and toes to keep blood circulating and to keep warm. Frostbite: It can permanently damage its victims. A loss of feeling and a white or pale appearance in fingers, toes, or nose and ear lobes are symptoms of frostbite. Hypothermia: When the body temperature drops to less than 95 °F. Symptoms: uncontrollable shivering, slow speech, memory lapses, frequent stumbling, drowsiness, and exhaustion. Help: begin warming the person slowly and seek immediate medical assistance. Warm the person's trunk first. Use your own body heat to help. Arms and legs should be warmed last because stimulation of the limbs can drive cold blood toward the heart and lead to heart failure. Put person in dry clothing and wrap their entire body in a blanket. Never give a frostbite or hypothermia victim something with caffeine in it (like coffee or tea) or alcohol. Winter Storms

37. Thunderstorms & Lightning Precautions… Get inside a home, building or car (not convertible). Rubber-sole shoes and rubber tires provide NO protection from lightning. You are protected if you are not touching metal. Secure outdoor objects. Shutter windows and unplug appliances. Avoid showering – Plumbing fixtures can conduct electricity. Use a corded telephone only for emergencies – Cellular phones are safe. 30/30 RULE: Go indoors (if you hear no thunder within 30 secs from lightning). Stay indoor for 30 min (after the thunderstorm appears to have passed). Lightning often strikes as far as 10 miles away from any rainfall. It can travel sideways and strike under blue skies. If you are… In a forest – Seek shelter in a low area under a thick growth of small trees. In an open area – Go to a low place (ravine or valley). Be alert for flash floods. On open water – Get to land and find shelter immediately. Anywhere you feel your hair stand on end – Squat low to the ground on the balls of your feet. Place your hands over your ears and your head between your knees. DO NOT lie flat on the ground. Lightning: Avg. 67 deaths per year in USA

38. Earthquakes An earthquake is a sudden movement of the earth, caused by the abrupt release of strain that has accumulated over a long time. For hundreds of millions of years, the forces of plate tectonics have shaped the earth, as the huge plates that form the earth’s surface slowly move over, under, and past each other. Sometimes, the movement is gradual. At other times, the plates are locked together, unable to release the accumulating energy. When the accumulated energy grows strong enough, the plates break free. Before: Repair defective electrical wiring, leaky gas lines, and inflexible utility connections. Get appropriate professional help. Do not work with gas or electrical lines yourself. Bolt down and secure to the wall studs your water heater, refrigerator, furnace, and gas appliances. Install an automatic gas shut-off valve that is triggered by strong vibrations. Place large or heavy objects on lower shelves. Fasten shelves, mirrors, and large picture frames to walls. Brace high and top-heavy objects. Store glass, china, and other breakables on low shelves or in cabinets that fasten shut. Anchor overhead lighting fixtures. Be sure the residence is firmly anchored to its foundation. Install flexible pipe fittings to avoid gas or water leaks. Locate safe spots in each room, under a sturdy table or against an inside wall. Hold earthquake drills with your family members: Drop, cover, and hold on! 1906 – San Francisco, CA: 500 deaths 1556 – China: 830,000 deaths

39. During: Minimize your movements during an earthquake to a few steps to a nearby safe place. Stay indoors until the shaking has stopped and you are sure exiting is safe. Indoors: Take cover under a sturdy desk, table, or bench or against an inside wall, and hold on. If there isn’t a table or desk near you, cover your face and head with your arms and crouch in an inside corner of the building. Stay away from glass, windows, outside doors and walls, and anything that could fall, such as lighting fixtures or furniture. Stay in bed - if you are there when the earthquake strikes - hold on and protect your head with a pillow, unless you are under a heavy light fixture that could fall. In that case, move to the nearest safe place. Use a doorway for shelter only if it is in close proximity to you and if you know it is a strongly supported, load-bearing doorway. Stay inside until shaking stops and it is safe to go outside. Most injuries during occur when people are hit by falling objects when entering into or exiting from buildings. Be aware that the electricity may go out or the sprinkler systems or fire alarms may turn on. DO NOT use the elevators. Earthquakes

40. Outdoors: Stay there. Move away from buildings, streetlights, and utility wires. In a moving vehicle: Stop as quickly as safety permits and stay in the vehicle. Avoid stopping near or under buildings, trees, overpasses, and utility wires. Proceed cautiously once the earthquake has stopped, watching for road and bridge damage. Trapped under debris: Do not light a match.· Do not move about or kick up dust. Cover your mouth with a handkerchief or clothing. Tap on a pipe or wall so rescuers can locate you. Use a whistle if one is available. Shout only as a last resort - shouting can cause you to inhale dangerous amounts of dust. After: Be prepared for aftershocks. These secondary shockwaves are usually less violent, but can be strong enough to do additional damage to weakened structures. Open cabinets cautiously. Beware of objects that can fall off shelves. Stay away from damaged areas unless your assistance has been specifically requested. Be aware of possible tsunamis if you live in coastal areas. These are also known as seismic sea waves (mistakenly called “tidal waves”). When local authorities issue a tsunami warning, assume that a series of dangerous waves is on the way. Stay away from the beach. Earthquakes

41. Tornados / Hurricanes Signs: Dark (often greenish sky), large hail, dark low-lying cloud (particularly if rotating), loud roar (similar to a freight train). If A Tornado / Hurricane Warning Is Issued… SECURE FILES, and lock up confidential documents. TURN OFF ELECTRICAL EQUIPMENT – And all other utilities (propane). SECURE HAZARDOUS MATERIALS PROTECT EQUIPMENT, in order to minimize damage. SECURE MATERIALS, which must be left outside. PROTECT WINDOWS – Permanent storm shutters or board up windows with 5/8” marine plywood (cut to fit and ready to install). SECURE ROOFS – Install straps or additional clips to securely fasten the roof to the main structure. 1900 – Gavelston, TX: Hurricane results in 6,000 to 12,000 deaths

42. Hurricanes Atlantic Hurricane Season: June to November, peaking from August to October. Beware: Widespread torrential rains (deadly floods), landslides, storm surges (a dome of water pushed onshore that can reach 25 feet high and be 50-100 miles wide, and storm tides (that can reach 20 feet high). CAT 1: 74-95 mph winds, storm surge from 4 to 5 feet, minimal damage. CAT 2: 96-110 mph winds, storm surge from 6 to 8 feet, moderate damage. CAT 3: 111-130 mph winds, storm surge from 9 to 12 feet, extensive damage. CAT 4: 131-155 mph winds, storm surge from 13 to 18 feet, extreme damage. CAT 5: More than 155 mph winds, storm surge greater than 18 feet, catastrophic damage. Number of Category 4 and 5 Hurricanes Has Doubled Over the Past 35 Years to 10 per year

43. Tornados Spawned From Powerful Thunderstorms: Rotating, funnel-shaped cloud that extends from a thunderstorm to the ground with whirling winds that can reach 300 mph causing fatalities and devastating neighborhoods in seconds. Facts… They generally occur near the trailing edge of the thunderstorm They may strike quickly, with little or no warning The average forward speed is 30 mph, varying from stationary to 70 mph. Waterspouts are tornadoes that form over water Peak tornado season is March through May They are more likely to occur between 3 p.m. and 9 p.m. 1925 – IN, IL, MO: Tornado results in 695 deaths,

44. Tornados / Hurricanes During The Tornado / Hurricane… If You Are Inside: Stay indoors, away from windows and glass doors. Go to lowest floor (winds are stronger at higher elevations. Get under a heavy desk, table or proceed to the corner of the room and lie flat and put your arms over your head. If possible cover your body with a blanket or rug. If You Are On The Road: Take shelter in a nearby steel-framed or concrete building, if possible. If no building is available, park your car and seek shelter away from the car in a nearby ditch or ravine. Protect your body and head with anything available (from flying debris). Don't go into a grove of trees or under a vehicle. Tornados: Avg. 800 deaths per year in USA (1,500 injuries)

45. After The Tornado / Hurricane… DON'T RE-ENTER THE BUILDING, until instructed. STAY AWAY FROM DOWNED ELECTRICAL WIRES AND UTILITY SERVICES. LISTEN TO THE RADIO FOR WEATHER UPDATES. DON'T USE THE TELEPHONE, unless necessary to report an injury or fire. WHEN RE-ENTERING BUILDING, be alert to gas and water leaks, broken electrical wiring and ruptured sewer lines. Do not use a match or candle to check for leaking gas pipes - check for leaks on a gas line. Tornados / Hurricanes

46. Volcano Eruptions: Quite or explosive. There may be lava flows, flattened landscapes, poisonous, and flying rock and ash. It can be followed by earthquakes, mudflows, flash floods, rock falls and landslides, acid rain, fire and (under special conditions) tsunamis. EVACUATE – Avoid flying debris, hot gases, lateral blast, and lava flow. BE AWARE OF MUDFLOWS – It can move faster than you can run. AVOID – River valleys and low-lying areas. ASH: Pulverized rock that can be abrasive, acidic, etc. If wet, it’s weight can collapse roofs. Wear long sleeve shirts and long pants. Use goggles and wear eyeglasses instead of contact lenses. Use a dust mask or dump cloth to help with breathing. Stay away from downwind from the volcano. Stay indoors until the ash has settled (unless danger of roof collapsing). Seal room/house to prevent ash from getting inside. Avoid running car or truck engines (ash can damage moving parts and stall vehicles) 1815 – Indonesia: 92,000 deaths,

47. Tsunamis Cause: the most prevalent is earthquakes. In addition, landslides, volcanic eruptions, explosions, and even the impact of cosmic bodies, such as meteorites, can generate tsunamis. Strengths: It can move at speeds of hundreds of mph in open ocean and smash into land with waves as high as 100 feet or more. Beware: If noticeable recession in water away from the shoreline, move inland or higher ground immediately. After A Tsunami: Stay away from flooded and damaged areas until officially safe, beware of debris in the water. 2004 – South East Asia: 300,000 deaths,

48. Terrorism Acts of terrorism include: assassinations; kidnappings; hijackings; bomb scares and bombings; cyber attacks (computer-based); and the use of chemical, biological, nuclear and radiological weapons. High-risk targets: military and civilian government facilities, international airports, large cities, and high-profile landmarks. Terrorists might also target large public gatherings, water and food supplies, utilities, and corporate centers. Further, terrorists are capable of spreading fear by sending explosives or chemical and biological agents through the mail. Guidelines: Be aware of your surroundings. Move or leave if you feel uncomfortable or if something does not seem right. Take precautions when traveling. Be aware of conspicuous or unusual behavior. Do not accept packages from strangers. Don’t leave luggage unattended. Promptly report unusual behavior, suspicious or unattended packages/devices to the police or security personnel. Learn where emergency exits are located in buildings you frequent. Plan how to get out in the event of an emergency. Be prepared to do without services you normally depend on: electricity, telephone, natural gas, gasoline pumps, cash registers, ATMs, and Internet transactions.

49. Explosions Terrorists have the information readily available to them in books and other information sources on how to make explosive devices. The materials needed can be found in many places, such as hardware, and auto supply stores. Explosive devices are highly portable using vehicles and humans as a means of transport. They are easily detonated from remote locations or by suicide bombers. Parcels that should make you suspicious… Are unexpected or from someone unfamiliar to you. Have no return address, or have on that can’t be verified as legitimate. Are marked with endorsements such as “Personal,” “Confidential,” or “Do not X-ray.” Have protruding wires or aluminum foil, strange odors, or stains. Show a city or state in the postmark that doesn’t match the return address. Are of unusual weight given their size, or are lopsided or oddly shaped. Are marked with threatening language. Have inappropriate or unusual labeling. Have excessive postage or packaging material, such as masking tape and string. Have misspellings of common words. Are addressed to someone no longer with your organization or are otherwise outdated. Have incorrect titles or titles without a name. Are not addressed to a specific person.

50. During: Get under a sturdy table or desk if things are falling around you. When they stop falling, leave quickly, watching for obviously weakened floors and stairways. As you exit from the building, be especially watchful of falling debris. Leave the building as quickly as possible. Do not stop to retrieve personal possessions or make phone calls. Do not use elevators. IF YOU ARE TRAPPED IN DEBRIS… use a flashlight to signal your location Avoid unnecessary movement, so that you don’t kick up dust. Cover your nose and mouth with cotton material on hand. Tap on a pipe or wall so that rescuers can hear where you are SHOUT ONLY AS A LAST RESORT Shouting can cause you to inhale dangerous amounts of dust. ONCE YOU ARE OUT: Do not stand in front of windows, glass doors, or other potentially hazardous areas. Move away from sidewalks or streets to be used by emergency officials or others still exiting the building. Explosions

51. Chemical Threat Chemical agents are poisonous vapors, aerosols, liquids, and solids that have toxic effects on people, animals, or plants (Sarin, Mustard Gas, Cyanide Gas, Phosgene, etc.). They can be released by bombs or sprayed from aircraft, boats, and vehicles. They can have an immediate effect (a few seconds to a few minutes) or a delayed effect (2 to 48 hours). A chemical attack could come without warning. Signs of a chemical release include people having difficulty breathing; experiencing eye irritation; losing coordination; becoming nauseated; or having a burning sensation in the nose, throat, and lungs. Also, the presence of many dead insects or birds may indicate a chemical agent release. Watch For Signs: People having difficulty breathing; experiencing eye irritation; losing coordination; becoming nauseated; or having a burning sensation in the nose, throat, and lungs. Also, the presence of many dead insects or birds may indicate a chemical agent release. ESCAPE THE AREA (where is the chemical coming from?), Leave the building or shelter-in-place? IF SHELTER-IN-PLACE, Internal room (preferably with no windows and on the highest floor). Seal room with duct tape and plastic sheeting (pre-cut it). Listen to radio for instructions from authorities.

52. Decontamination Guidelines… Use extreme caution when helping others who have been exposed to chemical agents. Remove all clothing and other items in contact with the body. 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. Gently wash face and hair with soap and water before thoroughly rinsing with water. 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. MEDICAL ATTENTION: Proceed to a medical facility for screening and professional treatment. Chemical Threat

53. 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 (Anthrax, Botulism, Plague, Smallpox, Ebola, Ricin, etc.). Delivery methods include: Aerosols (dispersed into the air), Insects and Animals, Food and Water, and by Person-to-person contamination. Before: Ensure all required or suggested immunizations are up to date. Children and older adults are particularly vulnerable to biological agents. A High Efficiency Particulate Air (HEPA) filter removes particles in the 0.3 to 10 micron range and will filter out most biological agents that may enter your house. During: If you become aware of an unusual and suspicious substance nearby: Move away quickly. Wash with soap and water. Contact authorities. Listen to the media for official instructions. Seek medical attention if you become sick. If you are exposed to a biological agent:: Remove/bag your clothes and personal items (contaminated). Wash yourself with soap and water and put on clean clothes. Seek medical assistance. You may be quarantined. 2006 "The H5N1 virus could kill Up to one billion people around the whole world in six months.... We are half a step away from a worldwide pandemic catastrophe." Dmitry K. Lvov, Director, D.I. Ivanovsky Institute of Virology, Russian Academy of Medical Sciences 1918 – H5N1 killed 50 million people. (world population: 1.8 billion) - http://www.survivetheflu.com/ 1347 – Bubonic Plague killed 25 million people just in Europe. (world population: 440 million)

54. Radiological Accident It can occur wherever radioactive materials are used, stored or transported. In addition to nuclear power plants, hospitals, universities, research laboratories, industries, major highways, railroads or shipping yards. Radioactive materials are composed of atoms that are unstable. An unstable atom gives off its excess energy until it becomes stable. The energy emitted is radiation. People receive some radiation exposure each day from the sun, radioactive elements in the soil and rocks, household appliances like television sets and microwave ovens, and medical and dental x-rays. Radiation cannot be detected by sight, smell, or any other sense. There are three factors that minimize radiation exposure to your body: Shielding: The thicker and harder material between yourself and the radioactive material, the less exposed you are (thick walls, concrete, bricks, books and earth). Fall-out shelter or Basement will protect you from the immediate effects of the blast and the pressure wave. Distance: The further away you are from the radiation source, the lower your exposure. Time: Minimizing the time spent exposed will also reduce your risk.

55. Before: Be prepared to evacuate or shelter in your home. Develop an emergency communication plan. have a plan for getting back together. Ask an out-of-state relative or friend to serve as the "family contact." After a disaster. During: Go to a basement or other underground area, if possible. Seal room with duct tape and plastic sheeting (pre-cut it). Listen to radio for instructions from authorities. DECONTAMINATE YOURSELF, by washing with soap and water and getting rid of all contaminated clothing (Put items worn outdoors in a plastic bag and seal it). After: When the immediate danger has passed, avoid using foods from your garden or milk from your cows or goats until these can be inspected by a local emergency official. Contamination could affect areas as far as 50 miles from accident site. Stay inside until authorities say it is safe. Note: A nuclear power plant accident would not cause the same widespread destruction as a nuclear weapon. Although radioactive materials could be released in a cloud or plume, no fallout is produced to endanger people. Radiological Accident

56. Radiological Dispersion Device 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 with radioactive material. It is designed to scatter dangerous and sub-lethal amounts of radioactive material over a general area. They require limited technical knowledge to build and deploy compared to a nuclear device. Radioactive materials in RDDs are widely used in medicine, agriculture, industry, and research, easier to obtain than weapons grade uranium or plutonium. Purpose: To cause psychological fear and economic disruption. the number of deaths and injuries from an RDD might not be substantially greater than from a conventional bomb explosion. Affected Area: 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.

57. Nuclear Blast 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. Hazards: Size of the device: A more powerful bomb will produce more distant effects. Height above the ground the device was detonated: 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.

58. Radioactive Fallout: Any nuclear blast results in some 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 up-draft of air that forms the familiar mushroom 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. Radioactive fallout poses the greatest threat to people during the first two weeks, by which time it has declined to about 1 percent of its initial radiation level. Electro Magnetic Pulse (EMP): A nuclear weapon detonated in or above the earth’s atmosphere can create an electro magnetic pulse (EMP), a high-density electrical field. 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. Nuclear Blast

59. Before: Make a list of potential shelters near your home, workplace, and school. During periods of increased threat increase your disaster supplies to be adequate for up to two weeks. During: Take cover, below ground if possible, and stay there until instructed to do otherwise. 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. Take shelter as soon as you can, even if you are many miles from ground zero where the attack occurred - radioactive fallout can be carried by the winds for hundreds of miles. After: Decay rates of the radioactive fallout are the same for any size nuclear device. However, the amount of fallout will vary based on the size of the device and its proximity to the ground. It might be necessary for those in the areas with highest radiation levels to shelter for up to a month. People in most of the areas that would be affected could be allowed to come out of shelter within a few days and, if necessary, evacuate to unaffected areas. Nuclear Blast

60. Recovering from Disaster Health: Exhaustion, Drink plenty of water, eat well, wash hands often. Safety: Watch for gas leak, broken glass, electrical hazards and slippery floors. Emotional Stress: IF: difficulty sleeping, communicating, concentrating; frustration, depression, guilty, fear, headaches, tunnel vision, muffled hearing, etc. DO: seek help from professional counselors and religious institutions, talk to others about your feeling, maintain a normal routine, spend time with family and friend, promote your own physical health. Help Others: Volunteer! Helping others deal with their problems will improve you emotionally, psychologically and physically. Get Ready! Accepting the fact that disasters do happen. Opportunity to identify and collect resources needed during and after a disaster. When people feel prepared, they cope better and so do children.

61. Workplace Violence 1.7 million cases reported annually. Homicide is now second only to motor vehicles as a cause of work-related deaths. Over 5,000+ homicides at work over the past five years. (See high risk jobs) Corporate America spends about U$ 6.5 billion per year in the aftermath of workplace violence. Homicides and suicides continue to be one of the leading causes of occupational fatalities. UNDER REACTION TO VIOLENCE – “Violence is random and unpredictable” Warning Signs: Substance abuse, Severe Stress, Violent history, Decreased productivity, Social isolation and poor peer relationships, Poor personal hygiene, Drastic changes in personality. STAGE 1: Objectifying and dehumanizing others, Challenging authority, Regularly becoming augmentative, Alienating customers or clients, Originating and spreading lies about others, Swearing excessively (using sexually explicit language), Abusing others verbally, sexually harassing others. STAGE 2: Arguing frequently and intensely, Blatantly disregarding organizational policies and procedures, Setting traps for others, Stealing from the company or from co-workers, Making verbal threats, Conveying unwanted sexual or violent intensions (by letter, voice mail or e-mail), Blaming others for problems or difficulties. STAGE 3: Getting involved in physical confrontations, Displaying weapons (guns, knives, pepper spray, etc.), Attempting to or committing assault, sexual assault, homicide, arson or suicide.

62. Employers: Boost security with guards, locks, cameras, silent alarms, etc. Restrict entry with coded cards, name tags, and sign-in procedures Improve lighting, especially in hallways and parking areas Screen potential employees for violent criminal histories Ban weapons, harassment, assaults, and threats on the premises Prevent former employees from returning to the workplace Set up an employee hotline to report threats or bizarre behaviors Respond quick and firmly to workplace fights and threats Train employees to resolve conflicts peacefully Offer counseling to employees in distress Employees: Follow your company’s security procedures Take extra care in stairways or elevators (if attacked on an elevator, punch all floor buttons and yell for help when the door opens) Avoid working late (have someone walk with you to your car, park in well-lit areas, check your car before unlocking it) Workplace Violence

63. Violent Acts – Dangerous Intruder Employees: PERSONAL THREATS, HARASSING PHONE CALLS, FIGHTING, ROBBERY, MURDER… YOUR GOAL = Prevent anyone from being injured or killed. Calmness is contagious. COOPERATE: Assailant will not harm anyone as long as he/she perceives that his/her objectives are being met. Remain calm and courteous (show respect for the person). SHOOTING: Do NOT run! He/she believes you will call the police and jeopardize his/her objectives. BE A GOOD WITNESS: Remember, write notes immediately. Who does he/she look like? Traits: General built, Skin color, Eye color, Hair color/style, Mustache color/style, Glasses color/style, Clothes, Smell, Shoes, Speech type. Vehicle: Make, color, 2/4door, hatchback, truck, wheels, plate number. CALL 9-1-1 and provide name of company, site's address and telephone number.

64. Civil Unrests Employees: ALL EMPLOYEES MUST USE ONE ENTRANCE: Designated by the Facility Coordinator. EACH EMPLOYEE MUST DISPLAY A VALID PHOTO ID: To gain access to the facility. ALL VISITORS MUST BE CLEARED: 24 hours prior to their arrival. The employee who the visitor is seeing will be responsible for obtaining the appropriate clearances. ANY INDIVIDUAL WHO RECEIVES A THREAT: Or harassing behavior from demonstrators must immediately report it to the Facility Coordinator, through their supervisor. EMPLOYEES SHOULD NOT ENGAGE IN DISPUTES WITH DEMONSTRATORS: The Facility Coordinator shall arrange protected parking lots, which will allow personnel to park and enter the building without walking through demonstrators. ALL EXTERIOR DOORS MUST BE KEPT CLOSED: Exiting should be through the designated entrance point of the facility.

65. Riots Employees: CALL 9-1-1 NOTIFY YOUR SUPERVISOR. IF RIOTING IS OUTSIDE THE FACILITY: lock entrances and stay indoors until Facility Coordinator or Police gives an all clear. IF LOOTING AND RIOTING IS OCCURRING WITHIN THE BUILDING: the supervisors or Facility Coordinator shall evacuate personnel to an outside secure area, away from the building.

66. Bomb Threats Employees: DOCUMENT ALL THE INFORMATION THE CALLER GAVE: As precisely as possible. NOTIFY THE FACILITY COORDINATOR: Manager or Supervisor. EVACUATE: Once informed to do so. NOTIFY SUPERVISORS OF UNUSUAL PACKAGES: Objects that do not belong in the work area. NOTIFY SUPERVISORS OF ANY INDIVIDUALS: Vehicles in the area of the building, which appear to be suspicious in nature. IF AN EXPLOSION OCCURS: Follow the fire emergency procedure.

67. Communication With The Media Employer: DESIGNATE A MEDIA EMERGENCY SPOKESPERSON. No one should speak with the media other than the designated individual. INITIALLY, THE MEDIA REPRESENTATIVE MUST DECLINE PROVIDING SPECIFIC COMMENTS TO THE PRESS UNTIL THE SITUATION HAS BEEN VERIFIED WITH ACCURATE INFORMATION. It is preferable to decline comments to the press until the situation is controlled. If no comments are provided, the media will still provide a news story. Providing information is a delicate issue and providing some type of information is less damaging than providing NO information. THE DESIGNATED EMERGENCY SPOKESPERSON SHOULD BE TRAINED TO: Release only information that is verified. To respond honestly and briefly to media questions. To provide information as quickly possible to meet press deadlines.

68. Significant Legal Liabilities! Failure to anticipate potential issues, such as equipment malfunction, medical malpractice, injury to personnel or patient, inadvertent release or loss of patients’ healthcare information, theft of tools/equipment/supplies, theft of cash or drugs, theft or unauthorized access to patient records, etc. What is Risk management? It is a detailed process used to identify and assess risk, identify and accept mitigation for risk. It incorporates understanding the potential for risk, as well as the consequence. The goal of risk management is not to eliminate risk, but balance it responsibly. The Benefits of Risk Management  Reduction in Material and Property Damage.  Effective Mission Accomplishment.  Reduction in Serious Injuries and Fatalities. Healthcare and Risk Management

69. Hazard - A condition with the potential or causing injury, damage, or mission degradation. Risk - An expression of possible loss in terms of severity and probability. Risk Assessment - Using sound concepts to detect hazards and estimate the risk they pose. Operational Risk Management: The process of dealing with risk associated with healthcare operations, which includes:  Risk assessment  Risk decision-making  Implementation of risk controls Risk Management Process 1. Identify Hazards 2. Assess Hazards 3. Make Risk Decisions 4. Implement Controls 5. Supervise Healthcare and Risk Management

70. 1.Identify Hazards a.List Hazards b.List Possible Causes of Hazards Risk decision-making 2.Assess Hazards a.Prioritize Identified Hazards  Severity of Possible Loss  Probability of Possible Loss b.Use available Tools  Risk Assessment Matrix 3.Make Risk Decisions a.Consider Risk Control Options  Start with Most Serious Risk First  Refer to preliminary Hazard Analysis Causes b.Does Benefit Outweigh Risk c.Communicate with Higher Authority if Required 4.Implement Controls a.Administrative Controls b.Engineering Controls c.Personal Protective Equipment 5.Supervise a.Monitor for Effectiveness of Controls Engineering Controls b.Watch for Changes Healthcare and Risk Management

71. Operational Risk Management: Levels of Application:  Hasty- On the Run Consideration  Deliberate- Application of the Complete 5-Step Process  In-Depth- Complete 5-Step Process with detailed analysis Risk Management Rules 1.Integrate into planning 2.Accept NO unnecessary risks 3.Make Risk Decisions at the proper level 4.Accept Risk IF benefits outweigh the cost Summary  Risk Management is a systematic way of thinking  The Risk Management Process increases awareness of hazards and risks involved in an operation Healthcare and Risk Management

72. Be Safe! Tony Soares, Safety Director Compensation Solutions, Inc. tsoares@compsolutionsinc.com Tel: 1-888-201-5680 Ext. 192

74. Fire Facts US has one of the highest fire death rates in the world. 2004 U.S.fire departments responded to an estimated 1,550,500 fires. Resulting in: 3,900 civilian fire fatalities 17,785 civilian fire injuries $9,794,000,000 in direct property loss There was a civilian fire death every 135 min and a civilian fire injury every 30 min Home fires caused 3,190, or 82%, of the civilian fire deaths Fires accounted for seven percent of the 22,616,500 total calls. Fire is the third leading cause of accidental death in the home

75. Evacuation - Recognize a Fire Condition Do you see or smell smoke? Does equipment or electrical cords feel hot to the touch? Do you see flames? Fire Fighting Dangers Flame Heat Smoke Toxic vapors Suffocation Explosions 1/4

76. Evacuation - Activate the Fire Alarm Pull the lever of the nearest Fire Alarm Pull station to start the evacuation of the building. 2/4

77. Evacuation - Leave the building Help the ones in need. 3/4

78. Evacuation - Dial 9-1-1 Call 9-1-1 to make sure help is on the way Be specific with information 4/4

79. What is Fire? It is the active principle of burning, characterized by the heat and light of combustion Fire is a vital part of our lives: Heating Cooking Fire is a “living” thing that feeds itself once created: Needs Fuel Needs Oxygen If you had to fight a fire that involves flammable liquids (like gasoline), what fire Extinguishers would you use? Water Carbon Dioxide K Fire Extinguisher ABC Fire Extinguisher ABCD Fire Extinguisher

80. How Does a Fire Work? Three components Oxygen Heat Fuel All three components are needed to start a fire Fire extinguishers remove one or more of the components

81. Types of Fires Class A - Wood, paper,cloth, trash Water (heat out) Class B - Flammable liquids, oil, paint, gas, grease Carbon Dioxide (oxygen out) Class C – Electrical (motors, computers, etc.) Carbon Dioxide, Halotron I, FE-36 Class D - Combustible metals like beryllium, magnesium, etc. Potassium and sodium Class K - Kitchen fires Low PH Wet Chemical Agent with fine mist discharge that helps prevent grease splash and fire re-flash

82. Pressurized Water Extinguishers Rated ONLY for Class A fires It will stop a fire that involves wood, paper or trash If used on electrical equipment, it will cause an electrical shock - water & electricity don’t mix (electrical chock injuries can be worse than fire injuries) If used on a fire that involves metals (beryllium, magnesium, Titanium, etc.), it will increase the fire If used in a kitchen fire, it will spread the grease

83. ABC (Multi-purpose) Are best all-around choice Help prevent re-ignition Make a mess Class BC contains sodium bicarbonate Class ABC contains ammonium phosphate

84. Carbon Dioxide (CO 2 ) Extinguishers Are Class BC-rated Are not effective on Class A fires (does not displace enough O2 to putout fire) Should NOT be used on Class D—metal fires Do not leave any residue Are a good choice for computers or electronics (non-conductive) Must be used 3 to 8 feet from the fire (No pressure gauge)

85. Metal/Sand Extinguishers Class D rated Powdered copper Sodium chloride Forms an airtight crust over the fire

86. Halon Extinguishers Are Class BC-rated (Gas interrupts fire’s chemical reaction) Protect valuable electrical equipment Leaves no residue Is non-conducting Have a range of 4 to 6 feet Halon production is now banned – Environmental Hazard (destroys ozone)

87. Halotron I Extinguishers Replaces Halon 1211 Discharges as a liquid Leaves no residue Is non-conducting Is ideal for computers and electronics Is Class BC-rated Halotron I is an ozone-friendlier than Halon Halotron I production is slated to cease in 2015

88. Halon 1211 replacement Less toxic No ozone depletion Class BC-rated The FE-36 agent is less toxic than both Halon 1211 and Halotron I. In addition, FE-36 has zero ozone-depleting potential; FE-36 is not scheduled for phase-out FE-36 TM Extinguishers

89. Water Mist Extinguishers Class AC-rated Safety from electrical shock Less scattering of burning materials Hospital environments and clean rooms Unlike an ordinary water extinguisher, the misting nozzle provides safety from electric shock and reduces scattering of burning materials. This is one of the best choices for protection of hospital environments, books, documents and clean room facilities. In non-magnetic versions, water mist extinguishers are the preferred choice for MRI or NMR facilities or for deployment on mine sweepers.

90. Fire Extinguisher Operation P = Pull the pin A = Aim the nozzle at the base of the fire S = Squeeze the handle S = Sweep from side to side Remember PASS The PASS Method will work on all types of extinguishers

91. Pull the pin This will allow you to squeeze the handle in order to discharge the extinguisher P.A.S.S. Method

92. Aim at the base of the fire Aiming at the middle will do no good, the agent will just go through the flames P.A.S.S. Method

93. Squeeze the handle This will release the pressurized extinguishing agent P.A.S.S. Method

94. Sweep side to side Spray it at the base of the fire Cover the entire area that is on fire Continue until fire is extinguished Keep an eye on the area for re-lighting P.A.S.S. Method

95. Safety Precautions when fighting a fire Stay upwind of the fire Aim low

96. NEVER allow the fire to get between you and a route to escape Safety Precautions when fighting a fire

97. NEVER go into a unknown area to fight a fire Safety Precautions when fighting a fire

98. Alarm has been pulled Fire Dept. has been called Fire is small and contained You can avoid the smoke Exit is clear Extinguisher is nearby You have been trained to use the extinguisher Fight-or-Flight Decision Use it if you feel comfortable (voluntary basis) and have been trained. Remember you are NOT a trained fire fighter. You should NEVER put your life in danger.

99. Fire Evacuation Procedure Stop work immediately when alarm sounds End all calls Do not take personal items with you Move quickly to nearest exit without running Do not use elevators Meet at you assigned Assembly Area and await further instructions Return to work only after an “All Clear” is given

100. Make sure your extinguisher can be used in an emergency It is mounted on the wall It is not blocked Pressure is acceptable Monthly inspected Pin and seal intact No dents or damage Fire Extinguisher Inspections

101. Locations and Signs Readily accessible 75 feet—Class A 50 feet—Class B 50–75 feet—Class C 75 feet—Class D Highly visible sign

102. Fire Prevention Principles Keep unnecessary heat sources out of the workplace: Candles Matches Lit Cigarettes Smoke only in designated areas Eliminate the use of extension cords Use heaters with automatic temperature control limit switches Store flammable materials in an approved cabinet Make sure all electronics carry UL approval ratings Power down all electrical equipment at the end of the day Keep equipment clean to prevent residue build-up (mainly driers) Keep exits clear on both sides of the door (know where all exits are located) Do not block fire extinguishers or other fire protection devices Report smoke or flames immediately Empty trash receptacles daily Good Housekeeping – # 1 fire prevention tip (clean, neat & organized)

103. Use Hot Work Permits when welding or performing other operations that generate sparks Do not pour flammable solvents in your waste baskets Check electrical cords and tools for damages Use ONLY approved safety containers for storing flammables (flame arrestor) When pouring flammable from one container to another, remember bonding and grounding to reduce the potential for explosion due to static electricity Soiled, oily rags (spontaneous combustion if not stored appropriately) use Safety Waste Cans (metal cans with metal lids) Keep aisles and passageways clear Do not attempt to fight a fire unless you are properly trained Follow all rules regarding fire protection and emergency evacuation Fire Prevention Principles

104. Be Safe! Tony Soares, Safety Director Compensation Solutions, Inc. tsoares@compsolutionsinc.com Tel: 1-888-201-5680 Ext. 192