The possibility of public health emergencies arising in the United States concerns many people in the wake of recent hurricanes, tsunamis, acts of terrorism, and the threat of pandemic influenza. Though some people feel it is impossible to be prepared for unexpected events, the truth is that taking preparedness actions helps people deal with disasters of all sorts much more effectively when they do occur.

PURPOSE OF PLANNING:

• To lessen the severity and impact of any potential emergency.
• To identify the vulnerability of the organization to specific disasters or emergencies and the impact those emergencies may have on the operation or the demand for its services.
• To identify resources both internal and external that may be used during an emergency.
• To ensure that all employees are capable of reacting to and implementing an emergency action plan in the event of an emergency.

Definition: An emergency is defined as any event either natural or man made that significantly disrupts the environment of care; that significantly disrupts the care and services; or that results in sudden, significantly changed or increased demands for the organization’s services or resources. An emergency may be any unplanned event that can cause deaths or significant injuries to employees, customers or the public; or that can shut down the business, disrupt operations, cause physical or environmental damage, or threaten the organization’s financial standing or public image.

Risk Assessments:

Upon admission to the agency each client shall receive a risk assessment with those areas of risk incorporated into their care plan. All clients should receive a risk assessment for fire and those clients using oxygen in the home are at greater risk and therefore should receive additional resources to mitigate this risk with education and counseling. Clients using oxygen should (at a minimum) have smoke detectors in their home and optimally fire extinguishers as well.

Daily Routine Emergency Preparedness

Policy: All staff are required to plan for an emergency at the beginning of each shift or visit.
Purpose: To ensure optimal safety of each client and staff member, to promote client safety, to educate clients on safety, to avoid life threatening situations or avoidable displacements from their homes.

Procedure:

• All employees are responsible to maintain a current CPR card and professional license on file with the office.
• All employees are responsible to maintain the necessary skills required by the client. If you are unfamiliar with any part of a client’s care, you are obligated to seek out the necessary information in order to provide safe and competent care for that individual. Office personnel are available to assist with competency training and to assist you with the necessary skills and/or information needed.
• At the beginning of every shift or visit, the employee will assess all exits from the home to ensure the pathways are clear and that exits are available.
• At the beginning of every visit or shift, every employee will locate all necessary emergency equipment such as suction machines and catheters, emergency trachs, oxygen supply, emergency transport bag, emergency drugs (checking for expiration), methods of communication with EMS and equipment.
• All employees are responsible to ensure that the client has an ample supply of all necessary equipment, medication and supplies to last for at least 5 days.
• Oxygen supplies (if ordered) must be checked on each shift.
• At the beginning of every shift or visit, every employee will test all necessary equipment to ensure that all rechargeable equipment is properly charged, including back up batteries, back up ventilators, wheelchairs, etc.
• All employees will be responsible to initiate the recharging of equipment on a daily basis and as needed.
• Upon the discovery of malfunctioning equipment or batteries that will not hold a charge, all employees are responsible to inform the equipment company of malfunctions to ensure properly functioning equipment.
• It is every employee’s responsibility to ensure the client is proper informed and educated with regard to safety . Client education must be documented.
• All employees will assess client safety on an ongoing basis. This includes but is not limited to fire safety, electrical safety, fall prevention safety. Report any and all potential or real safety risks to the office if unable to resolve with the client or the family.
• Back up ventilator circuit should be already assembled and ready to use.

Fire Safety Checklist

Policy: AHHC staff implements emergency preparedness training for clients and family in case of fire.

Procedure

• Assess the home for oxygen, fire risks such as open flames, over loaded electrical circuits, clear exits, smoking materials/ashtrays
• Assess for safety devices: smoke detectors, fire extinguisher, CO2 detectors.
• Review home fire safety tips contained in the “Client Handbook”.
• Review procedures for mobility impaired persons, if applicable.
• Work with Private Duty parents on a fire escape plan.
• Identify 2 exits from client’s room(s): knowing 2 waysout of every room. One can be a window if it can be opened by one person.
• The plan should include whereto meet once outside.
• How to assist Household members with disabilities whomay need special help.
• Knowing how to get out in the dark. The lights may notwork during a fire. Determine if a flashlight would be available and itslocation.
• Determine location of fire extinguishers, ifavailable
• Encourage the family to set up Evacuation Drills in the Home (EDITH), to include practice evacuating the house, and meeting at the designated point OUTSIDE.

Emergency Action

Purpose – AHHC staff implement emergency actions for clients in crisis situations as appropriate in order to alleviate life threatening situations for clients, to stabilize client conditions, and to ensure client safety.
In the event of an emergency AHHC staff may take eight action steps:

• Assess the client carefully.
• Seek emergency help for the client by dialing the emergency telephone number, 911.
• Rescue the client if the client is in danger.
• Restore and/or maintain the client’s breathing and heartbeat (CPR).
• Control any heavy bleeding by the client.
• Treat any poisoning of the client.
• Prevent client shock.
• Continue to check the client until medical help arrives and provide appropriate support.
• Immediately following the emergency situation, the staff informs the appropriate individuals of the situation.
• The nurse informs the Nursing Supervisor and documents the event including all parties notified.

FIRE EMERGENCY PROCEDURES FOR MOBILITY-IMPAIRED PERSONS

When the Fire Alarm sounds or upon discovery of a fire, do the following:

• When you first discover a fire, determine what to do immediately. If the fire is small and you have the proper fire extinguishers, PUT IT OUT.
• Prepare the client for evacuation. If wheelchair is unavailable and client is not able to ambulate, slide client to floor on a sheet or blanket and prepare to drag the client to safety.
• Get Disaster Supply bag, ventilator (in back pack), ambu bag (if necessary), and necessary support equipment.
• Stay low and crawl to the door. Smoke fills a room from the ceiling down.
• Test the door with the back of your hand.
• If the door is hot, go to another exit.
• If the door is cool, open it slowly and go to your meeting place outside the home.
• Call for help (Dial 911).
• Do not go back in your home. You may be seriously injured.
• Report to the Fire Officer if anyone is suspected of being in the building after general evacuation; also report the location of the fire, if known.

APARTMENTS- Follow the same rules and include the following:

• Take the stairs when exiting.
• Close the door behind you and take your keys.
• Do not use the elevator. Elevators may open at a floor on fire or stop working, trapping you inside.

If You Are Trapped Inside Your Apartment

• Close the doors between you and the fire.
• Stop up cracks and vents with wet towels to keep smoke out.
• Put a wet cloth over your nose and wait at a window.
• Phone the fire department, Dial 911.
• If unable to reach a phone, signal for help with a sheet or flashlight.

Emergency Procedures in the event of a Disaster or Emergency

It is the policy of AHHC to provide continuing care services in the event of an emergency.

During severe weather conditions or during a disaster it is sometimes necessary to prioritize and make a distinction between ESSENTIAL and NONESSENTIAL staff. This distinction is found in the following policy:

Policy Regarding Essential vs. Non-Essential Personnel:

• The officers of AHHC are the only staff who can declare that a Liberal Leave Policy is in effect. When this policy is in effect, all NON-ESSENTIAL personnel are encouraged to stay at home. Supervisors are responsible for contacting and informing their staff personally when the Liberal Leave Policy is in effect. They will do this by calling subordinate staff at home before 7:00 am.
• When Liberal Leave is declared, all ESSENTIAL personnel who reside within a 15-mile radius of their assignment are expected to report to work at their normal starting time. ESSENTIAL PERSONNEL are persons in the following job categories:

General Procedure Relating to Utility Failures:

Nursing supervisors or their designees (field staff may be requested to assist with this function) are to notify the appropriate utility personnel of clients unable to leave home and who require life support (e.g.: electrical equipment) or assistive devices in order to sustain life, or to be cared for safety.

Nursing Supervisors are required to locate all employees that are scheduled to be in the affected area via phone. In the event of telephone failure, supervisors will utilize cellular phones whenever possible.

All field staff will be on standby to assist in evacuation of clients confined to home and provide necessary information to Emergency Rescue Teams. The Nursing Supervisor is responsible to follow up with the AHHC Field Staff that is responsible for the client involved. All communications are to be documented in the computer and filed in the client’s chart.

A record of the client’s name, date of occurrence, problem, and outcome is to be documented in the scheduling software program.

Suggested Preparations for Disasters

• 1 gallon water per day for each member of the household for a minimum of 3 days
• Canned food supplies for all household members for a minimum of 3 days. This should be food that does not require water, refrigeration or heating.
• Any adaptive devices you use
• Any medical supplies you need
• Any medications you use
• Flashlights and extra batteries
• Hearing aides and extra batteries
• Battery operated radio or TV
• Extra pair of glasses
• Keep car filled with at least ½ tank of gas at all times
• Extra blankets
• Extra clean clothing, socks, mittens, shoes
• Extra food for pets, animals
• Choose an alternate place to stay in the event of a long term disaster, preferably outside of the affected area.
• Extra sanitary supplies, soap, water, washcloths, towels, oral care, etc.
• Emergency number lists, medical orders, phone numbers
• Medical or health insurance information