Download Full Building Evacuation - Massachusetts Senior Care Association

Full Building Evacuation:
Is there ever a right time to leave?
Presented by: Scott Aronson, MS
860-793-8600 / www.phillipsllc.com
Ten die as 110 Tornados Tear Through
the Midwest
Flooding forces evacuation of
240 nursing home residents
Boston Globe
Hospital Partially Evacuated
Due to Boiler Explosion
Nursing home residents
relocated after toilet explosion
Blizzard Buries Areas of New York
Loss of heat during ice storm
evacuates healthcare facility
Multiple Fatality Fire Takes the Lives of 16 Patients
Today’s Agenda
• What could force me to the sidewalk?
– Where is my Exposure?
• Outcome of July 2009 Exercises – 170
Long Term Care Facilities in MA
• To Leave or to Stay
• Overview of Statewide Emergency
Preparedness Planning Partnerships
Recent Incidents
• Ice Storm – December 2008
– Maine, New Hampshire and Massachusetts
• Flooding / Freezing – January 2009
– King and Pierce County Washington
• Flooding – Midwest
• Wildfires – California
• Tornado – Connecticut (Summer 2009)
• Loss of Central Services
– Lawrence & Memorial Hospital in August 2009
– 2 MA Nursing Homes in July 2009 and 1 in November 2009
How to Conduct an HVA
•
http://www.mpca.net/emergencymanagement/Cop
y%20of%20KP_hva.xls
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Michigan Primary Care Association –
Kaiser Tool
Multidisciplinary Team including
City/Town Emergency Manager
Review the HVA
Exterior Tour
Interior Tour
Conference Room Review
HVA Review from Town or Region
State-wide Long Term Care
Evacuation Exercises: 2009
Exercises: Lessons Learned
July 13, 14, 20, 21 and 23
• MassMAP Plan Testing
– Facility Evacuation
– Regional Resident Tracking Capabilities
• ~ 170 participating healthcare facilities
– Nursing Homes, Assisted and Rest Homes
• State Agency Participation
– DPH
– Springfield Fire / MMRS
– Central Massachusetts EMS / C-MED
• Residents Moved: ~200 mock and 1,000+ paper
Scenario
• Summer with record high heat /
thunderstorms
• LTC facility struck by lightening – took
out A/C capabilities
• Due to major regional damage from the
storm, vendor is 36-48 hours out from
repairs (parts availability/manpower)
• Temp inside facility hitting 86 degrees
• 1 resident to hospital for dehydration
Exercise Strengths
• Activation and Stand Down
– Overall, strong and consistent activation and stand
down using the Health & Homeland Alert Network
(HHAN)
• Communication
– Activation algorithms and contact information was
generally accurate
• Resident Tracking
– Tracking forms, disaster tags and communication
channels were used effectively to track residents
• Goal: Where did the resident go in comparison to the master
list
Exercise Weaknesses
• Familiarity with MassMAP tools and
forms
– Internal education on:
• Resident Emergency Evacuation Tags
• Job Action Sheets (in the Regional Coordinating
Centers)
• Resident/Medical Record & Equipment Tracking
Sheets
• Incoming Resident Log
• Role of the RCC
Exercise Weaknesses
• Quick access at RCCs to the contact
information in MassMAP and to have
enough qualified staff to support the RCC
• Incident Command System training at
member facilities
• Accurate and complete information
provided to receiving sites
Why Have an Evacuation Plan?
DPH Attestation Review
Full Building Evacuation
Evacuation From a Healthcare Facility Is
the EXCEPTION, Not the Rule
It Could Be More
Dangerous
However, “Just in Case”
All images © from their source
Evacuation Realities
• LTC evacuations are extended
incidents
• Evacuation plans are just one piece of
a comprehensive Emergency
Operations Plan
• Emergency services are a
resource…do not make them your plan
Methodology
• Establish roles and responsibilities to
manage the disaster (Incident Command
System)
• Prepare residents within units /
departments
• Move to an internal Holding Area
• Transport from the Holding Area to a stopover point, receiving facilities, or discharge
to home
Key Components of the Plan
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Activation of FBE Plan – Staff Awareness
Activation of a Labor Pool
Establishment of Internal Holding Areas
Coordination of Transportation (internal &
external)
Resident Preparation on Units
Evacuation Path of Travel
Determination of Receiving Sites
Use of Stop Over Point if applicable
Resident Tracking (internal and external)
Holding Areas
• Operations Section Chief to assign a
Holding Unit Leader
• Role is to prepare Holding Area for
residents and to:
– Track residents as they enter holding
– Track residents as they leave holding
Holding Areas
RESIDENT
ACUITY LEVEL
HOLDING AREA
LOCATION
RESIDENT PICK-UP
LOCATION
Yellow
(Mid Acuity –
transfer to other
healthcare
facilities)
Primary: BH
Recreation Room
Ambulance Pick-up
Point
Secondary: LW
Recreation Room
LW Main Lobby
Green
(Low Acuity –
Discharge to
Home)
Primary: BH
Recreation Room
Exit Door to Outside
and Pick-up at Main
Entrance
Secondary: LW
Recreation Room
LW Main Lobby
• Holding Area cleared prior to evacuation initiating
Clinical Units: Resident Preparation
• Complete top portion of the Resident
Evacuation Tracking Form
• Package chart (including Chart, MAR, Care
Plan, Treatment & Medication Kardex)
• Package with personal belongings (i.e.
glasses, dentures, hearing aids, etc.)
• Package with Medications
Pharmacy/Meds - OPTIONS
• Based on evacuation priority, provide 24 – 48
hours of meds to residents on evacuating units
– Orders should be faxed to the Pharmacy (or runners
to pick up)
– New physician orders follow the same protocol
• Med Nurse will gather meds and federally
controlled substances from unit and bring to
Holding Area
• Medication Cards will go with residents
– Put into pillowcase labeled with permanent marker
• If going to Stop Over Point, meds brought by
Med Nurse
Resident Placement
• Incident Commander/Liaison Officer to
coordinate with EMS and directly with
possible evacuation sites:
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On Campus Area
In-town
Surrounding Towns
Regional LTC Facilities
While Hospitals seem to be a good option,
they are not the best place to evacuate to
Priority of Evacuation
• Depends on the disaster
• With feedback from and in consultation with:
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Medical Director
Logistics & Safety Section Chief
Operations/Planning Section Chief
Emergency Agency Officials (Fire, Police, etc.)
• Consider:
– Ambulatory, limited or no assistance
– Non-ambulatory, low acuity
– Non-ambulatory, higher acuity/combative/nonambulatory bariatric (for non-ambulatory
bariatric: consider direct transfer to EMS
stretcher to avoid multiple transfers)
Once a Unit is Evacuated
• Once evacuation of the unit / department is
completed
– Check unit / department to ensure evacuation is
complete – TAGS
– Account for all staff
– Direct all staff to report to the Labor Pool (or they
may be leaving with residents)
– Report evacuation status to the Command Center
and the Holding Area
Nursing Home
Site Plan
Recommended Police Roadblock
Bus Staging – Hearth at Gardenside entrance
Ambulance Staging
– Hearth
at Gardenside
Ambulance
& Bus
entrance
Staging
Resident Pick-up: Discharge to
Home
Al
ps
R
oa
d
Resident Pick-up: To other
healthcare facilities
Building Evacuation
• How to Physically Evacuate a Residents
• Maintaining Care Through An
Evacuation
• Mutual Aid Evacuation and Supply Plans
Vertical Evacuation Methods
Vertical Evacuation Methods
Vertical Evacuation Methods
Smithcot
Hoyer Sling
Four Simple Steps for MedSled
1.
Securing patient to
MedSled
Lowering MedSled
with patient to floor
Pulling patient to
stairwell
Navigating stairwell
descent and evacuating
building to staging
area
2.
3.
4.
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•
Positioning of staff on
stairwell landings
Exiting building and
reusing MedSled
1
2
3
4
Specialized Equipment
Evacuation Chairs
(Stryker & Ferno)
Peabody, MA – Local Incident
Pilgrim Rehabilitation –
Peabody, MA
November 18, 2009
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10:30 AM Incident
Loss of Primary Heat & Hot Water: Shut-down of
boilers due to construction incident in parking lot
55 degrees outside during the day – dropping into
high 30’s / low 40’s in the evening
Contractor assures facility they will fix the
problem
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Communication Activities
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Building Inspector and Local Public Health
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Pilgrim Rehab activates the Region 3
Massachusetts Mutual Aid Plan (MassMAP)
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If not fixed by 2:00, occupancy permit will be pulled –
evacuation mandatory
Regional Coordinating Center (RCC) stood up at North
Hill in Needham
HHAN Activated: 15 facilities called into Pilgrim to
offer support (good or bad?)
DPH and Peabody Mayor’s Office in
communication to address timeframe for
evacuation decision and understand why
To Stay or To Go?

Why Should Pilgrim NOT Evacuate?
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70 degrees still internally
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Rooftop Heating Units providing corridor heat
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Water
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Still had water (no hot) and kitchen and laundry had back-up
hot water for their areas
Evacuation Plan
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Cranked up to heat resident rooms
Region 3 MassMAP plan activated
All patients categorized by ambulance, chair car and normal
means of transport (bus / van / shuttle)
Families communicated with
Part was expected within hours to fix the problem and
then the boiler could be reactivated quickly
To Stay or To Go?

Why Should Pilgrim Evacuate?
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Occupancy Permit Revoked – No choice
If the problem could not be fixed that day and
temperatures began to fall

Better to safely move residents when possible rather than at
2:00 AM when other facilities are not prepared to receive
Outcome
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Evacuation decision was not necessary as full
operations were achieved by 6:45 PM (ahead of
final 10:00 deadline by the Building Official)
Leadership: Needs to stay strong and advocate for
the residents / Providing clear and concise plans
will win out of initial rash decisions
Answer their questions in advance (5 W’s):
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Who: Is in charge, is going to fix your problem or evacuate you
What: Are the steps being taken to repair the facility, plan the
evacuation
When: Timeframe for the fix or when evacuation will take
place
Where: Are you going to go
Why: Should you stay or should you go – trigger points
Challenge
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On top of the noted challenges listed,
communications was key:
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Facility was flooded with support and other
calls to understand their situation:
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Other MassMAP members and area facilities
Local Public Health
State DPH
Building Commissioner
Mass Emergency Management Agency
Fire Marshal
Regional Coordinating Center (MassMAP RCC)
HHAN Administrator
Me 
Long Term Care Mutual Aid
Plan (in MA this is MassMAP)
REGION 1
REGION 2
REGIONS
3, 4, 5
Scott Aronson, MS
Russell Phillips & Associates, LLC
California / Connecticut / New York
860-793-8600
[email protected]
www.phillipsllc.com