1. Your Disaster Plan Plan Today - Survive Tomorrow Digna Cassens, MHA, RD

2. 9/2010 D.Cassens, MHA, RD Objectives At the end of this lesson the participants will be able to: – Organize a realistic plan that clearly defines leadership in the nursing centers dietary departments. – Provide the tools with which to develop a comprehensive plan to protect the residents, employees, and company in a disaster.

3. 9/2010 D.Cassens, MHA, RD Why should we prepare? Why? The decision to spend dollars and dedicate resources on disaster planning is no longer discretionary. Why? – Higher incidence of natural disasters. – More frequent manmade disasters. – Reduce risk by being prepared. – Enable fast recovery time “good luck” We can’t continue gambling on our “good luck”.

4. 9/2010 D.Cassens, MHA, RD Departments affected – Administration Business office – Nursing – Dietary – Maintenance – Housekeeping/Laundry – Social Services/Activities – Therapies

5. 9/2010 D.Cassens, MHA, RD Preparedness: Administrator responsibility Provide current information Agreements & credit lines with suppliers & purveyors to ensure uninterrupted deliveries Discharge & admissions agreements Assess facilities preparedness Communicate with administration & department heads Facilitate training Routine inspections and data reporting Assign staff Maintain all guidelines and procedures current Maintain mutual agreements file of vendors & other institutions Ensure training and education are conducted routinely & retain documentation Have knowledge of disaster & emergency management & recovery plans

6. 9/2010 D.Cassens, MHA, RD Preparedness: Nursing responsibility Maintain current inventory lists with pharmacy & medical products supplier to ensure deliveries. Three days emergency supplies available (or per individual state requirement): – Diapers – Treatment supplies – Enteral supplies & water for flushes – Medications – Water for hygiene, medication pass

7. 9/2010 D.Cassens, MHA, RD Preparedness: Dietary responsibility Maintain current inventory lists with water supplier and food purveyors to ensure deliveries. Three days emergency supplies available (or per individual state requirement). – Emergency menus & inventory list posted. – Food & supplies to serve residents & staff. – Two gallons water per resident per day (or per state or emergency management office requirement): 2 quarts per day for drinking, the remaining per day for food preparation, hygiene, sanitation. – Ensure staff training is conducted: Dietary staff Other staff: nursing, housekeeping, maintenance

8. 9/2010 D.Cassens, MHA, RD Preparedness: Housekeeping & Laundry responsibility Ensure sufficient linens & towels supplies are available to meet inventory par-levels Ensure all housekeeping and laundry staff understand their role in a disaster Protect available supplies Maintain sanitation and infection control throughout structure

9. 9/2010 D.Cassens, MHA, RD Preparedness: Maintenance responsibility Maintain testing and log for: – Generator – Utilities – Fire alarm system – Sprinkler system – Air circulating system – Elevator Emergency repairs Ensure adequate water supply available in collaboration with dietary department

10. 9/2010 D.Cassens, MHA, RD Preparedness: Social Services, Activities & Office staff responsibility Notify residents, families, physicians Maintain log of all phone calls Recall and assign staff as directed Keep current records of all residents including transfers Contract transportation companies contracted Help ready medical records, clothing, & supplies for evacuation Maintain current lists of employees & residents with emergency contact information

11. 9/2010 D.Cassens, MHA, RD Preparedness: Staff responsibility Attend drills and training offered Do not use emergency stock & notify supervisor of any shortages in materials Learn procedures for each local situation Remain watchful and alert at all times Report all problems to supervisor Agree to remain or return to work as soon as safely possible

12. 9/2010 D.Cassens, MHA, RD Your risk Assess your risk by conducting a vulnerability analysis What disasters are your locations vulnerable to? What locations are the most vulnerable? Are they prepared and ready to cope with the results of a disaster? How long will recovery efforts take?

13. 9/2010 D.Cassens, MHA, RD Your risk Fire Earthquake Flood Disruption of services Extreme weather Thunderstorm Bomb threat Explosion Windstorm Civil disturbance Elopement Hurricane Types of disasters

14. 9/2010 D.Cassens, MHA, RD Your risk Fire At risk locations: – Wooded areas – High brush areas – Hillsides – Steep canyons – Metropolitan areas – Between commercial & residential buildings

15. 9/2010 D.Cassens, MHA, RD Your risk Flood Internal: burst water pipes or main, plugged drains, burst heaters, flooded streets or neighborhood External: tsunami, hurricane, excessive rain, high tide, lakes or rivers overflow, collapsed reservoirs

16. 9/2010 D.Cassens, MHA, RD Your risk Structural Multi-story, number of floors Elevators, stairs Type of construction Age of building Access, entry, egress, exit

17. 9/2010 D.Cassens, MHA, RD Your risk Evacuation Difficulty – Physical Ambulation difficulties Impaired cognition Hearing impaired Visually impaired Injured Evacuation Difficulty – Environmental Elevators City streets Crowds Alleys Traffic

18. 9/2010 D.Cassens, MHA, RD Your risk Loss of water Loss of gas Loss of electricity Loss of transportation Loss of services & deliveries due to strike Loss of staff due to walk- out or strike Disruption of services

19. 9/2010 D.Cassens, MHA, RD Fire procedure Call out the code word Move residents & visitors to safety Close all doors & windows Activate the nearest fire alarm box Call the fire department Notify all staff Return to area with fire extinguisher

20. 9/2010 D.Cassens, MHA, RD Loss of water procedure Notify water company Know the water shut-off location Restrict the use of water Deploy potable water Release use of other water for cleaning, hygiene Turn off toilets main; line bowl with plastic bags for waste “no utilities” Implement emergency menu for “no utilities” to avoid excessive water supply use

21. 9/2010 D.Cassens, MHA, RD Water purification table AmountClear WaterCloudy Water 1 Qt1 drop3 drops 1 Gal4 drops10 drops 5 Gal¼ tsp½ tsp Let stand for 30 minutes Liquid chlorine bleach (laundry bleach) 5 ¼ % Sodium Hypochlorite solution

22. 9/2010 D.Cassens, MHA, RD Loss of gas procedure Notify gas company Know gas shut-off location If gas leak suspected notify fire department Do not use matches, candles or open flames Turn off automatic starters & pilot lights “no utilities” Use emergency menu for “no utilities”

23. 9/2010 D.Cassens, MHA, RD Loss of electricity procedure Notify the power company Know main power panel location If emergency generator does not start automatically notify Maintenance & person in charge Use flashlights (no matches or open flames)

24. 9/2010 D.Cassens, MHA, RD Earthquake procedure Protect yourself so that you can then help the residents Make initial check for injuries and damage Shut doors to damaged areas Calm the residents Move beds away from windows,close drapes & curtains Prepare for aftershocks “loss of” Follow specific “loss of” procedures as needed

25. 9/2010 D.Cassens, MHA, RD Flooding procedures Shut off all utilities Notify fire department Activate any subterranean pump Move residents to safety away from the water Causes: Broken water main Excessive rain Broken dam Causes: Broken water main Excessive rain Broken dam

26. 9/2010 D.Cassens, MHA, RD Close shades & blinds Protect residents Plan for air circulation & cooling Serve cold meals Increase hydration & include frozen items Turn off all unnecessary electric Ensure generator works Santa Ana conditions Excessive heat Wind Brown-outs Black-outs Extreme heat procedures

27. 9/2010 D.Cassens, MHA, RD Windstorm procedures Secure all outdoor furniture & equipment. Move residents inside, away from windows. Shut & secure windows & doors. Close curtains, shades. Expect and prepare for disruption of services & possible fires.

28. 9/2010 D.Cassens, MHA, RD Bomb threat procedures If a threat is called in: – Remain calm, respectful and attentive – Ask for bomb location, description, timing – Try to attract attention of other staff to call police

29. 9/2010 D.Cassens, MHA, RD Explosions procedures Shut off utilities Move residents to safest location Notify fire department Notify utility companies Administer first aid Arrange for casualties transport Inspect for damage

30. 9/2010 D.Cassens, MHA, RD Extreme weather procedures Thunderstorms – Prepare for loss of power & possible fires – Turn off all electrical appliances, TV, radio Excessive rain – Prepare for possible flooding & loss of power Tornadoes – Move residents to safe location – Secure doors, windows, draw shades & curtains

31. 9/2010 D.Cassens, MHA, RD Civil disturbance procedures Secure building locking all doors & windows. Close shades & curtains Move residents to safest, most secure locations Plan for staff not being able to arrive for next shifts if problems nearby

32. 9/2010 D.Cassens, MHA, RD Disaster kit contents sample list Emergency phone list Disaster tags Emergency treatment record Admission record Zip-lock bags for valuables Ball-point pens Note paper Battery radio/TV Spare batteries Flashlights Safety pins First aid kit Floor plan Casualty flow chart Mutual assistance agreements Heavy duty plastic bags & sturdy ties Each department must have their own disaster kit & include their own needed supplies