EMERGENCY MANAGEMENT
FOR COLORADO NURSING HOMES
AND ASSISTED LIVING RESIDENCES
BE SAFE, BE PREPARED
Updating The CDPHE Long Term Care
Emergency Operations Plan
After Florida was struck by devastating Hurricane Andrew in 1992: after the terrorist attack on the World Trade
Center on 9/11; and after the wide-spread destruction and confusion of Hurricane Katrina in 2005, many states and
health care associations have used the lessons they learned to contribute to the development of long term care
emergency operations plans specific to long term care. As Director of Communications for the Florida Health Care
Association, I was assigned to be staff liaison to a new Emergency Preparedness Committee after Hurricane
Andrew. I was honored to collaborate and have a hand in writing the first Emergency Operations Plan (EOP) for
nursing homes and assisted living residences. Emergency Operations Plans specific to long term care have been
refined, revised and re-written over the past decade; there is already a wealth of valuable resources for long term
care facilities to utilize. My mission was to build a more user-friendly, less time consuming emergency operations
toolkit for the Colorado Department of Public Health and Environment, to be used by both nursing homes and
assisted living residences. I have taken some of the best ideas developed by other associations, including some of
my own designs and templates, and integrated these plans into this EOP Toolkit. I have credited all sources that
have been adapted into this project. The wheel (emergency planning) has already been invented. Now we must
build and fine tune the engine (EOP) around our own community’s preparedness needs. It has been a pleasure for
me to utilize my experience and knowledge to benefit our most vulnerable populations, the frail elderly and disabled
of all ages, as well as their dedicated caregivers.
David S. Skipper, MA, PREPARE Specialist
Vice President of Public Relations and Emergency Management
Colorado Health Care Association & Center for Assisted Livin g
Acknowledgements
This revision of previous Colorado Department of Public Health and Environment emergency operations plans for
nursing homes and assisted living residences was researched, written, compiled and re-designed by David Skipper,
M.A., Vice President of Public Relations and Emergency Management of Colorado Health Care Association and
Center for Assisted Living and certified PREPARE Specialist. This revised toolkit was made possible by a grant
from the U.S. Department of Health and Human Services.
Appreciation is also extended to the Colorado Department of Public Health and Environment, Jefferson County,
Mesa County, The Center for Integrated Disaster Preparedness, Department of Emergency Medicine University of
Colorado Denver School of Medicine, Stan Szpytek, LSC and Emergency Management Consultant, Candi Foraker,
Hildebrand Care Center, Chad Wagner, E.Dene Moore Care Center, Ray Diffenbaugh, Azura of Lakewood, Mike
Testa of RTW, Inc., Courtney LaCava, CHCA Intern, the Florida Health Care Association, the California
Association of Health Facilities, Kaiser Permanente, the University of Montana, Kansas Association of Health
Facilities
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Table of Contents
I. Historical Perspectives: Why Do I Need To Prepare?
II. Long Term Care Basic Emergency Operations Plan (EOP)
Purpose
Scope
Situation and Planning Assumptions
1. Situation Overview
2. Planning Assumptions
3. Hazard Vulnerability Analysis
4. Building Resilient Community Partnerships
5. Colorado All Hazards and Area Emergency Managers
6. Hazard Vulnerability Analysis Tool
7. Emergency Operations Plan Checklist
III. Memorandum of Understanding (MOU)
Writing Guide for A Memorandum of Understanding (MOU)
Basic Memorandum of Understanding Sample
IV. Concept of Operations: The Basics
National Incident Management Systems for Long Term Care Facilities
Incident Command for Long Term Care
1. The Functions of ICS
2. ICS Job Action Sheets
3. ICS Job Responsibilities and Authorities Chart
5. Command Responsibilities Chart
4. ICS/Long Term Care Cross Reference Chart
5. ICS Incident Command Chart
V. Continuity of Operations
Policy
Continuity of Operations Goals and Planning Elements
Response to Internal Emergencies
Response to External Emergencies
Shelter-in-Place
Evacuation, Mass Casualty and Transportation
Resident Evacuation and Shelter-in-Place Policy
Resident Evacuation Information Form
Transportation Log for Evacuated Residents
Transportation Log for Discharged Residents
Resident/Guest Emergency Go-Kit Checklist
Facility Evacuation Checklist
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Infection Control Practices for Resident Management
Resident Placement
Evidence Collection
Mass Prophylaxis
Point of Dispensing Sites (PODS)
VI. Facility Plan Development and Maintenance
Surveyors and Life Safety Code Inspections
VII. Authorities and Legal References
State Regulations
Federal Regulations
OSHA Regulations
Life Safety Code Regulations
Legal References
Guidelines, Development and Strategy Documents
VIII. Hazard Specific Standard Operating Guidelines
Active Shooter/Suspicious Person(s)/Hostage Situation
Animal Care and Pet Safety During An Emergency
Avalanche
Bomb Threat/Suspicious Mail
Chemical, Biological, Radiological, Nuclear, Explosive (CBRNE)
Civil Disturbance
Drought
Earthquake
Electrical and Other Power Outages
Emergency Generators
Emergency Notification of Administrator
Epidemic and Pandemic
Explosions
Fire
Flood and Dam Failure
Heat and Humidity
Lockdown
Sample Resident Services Department Checklist
Missing Resident/Guest
Murder/Suicide
Psychological First Aid
Severe Weather and Tornados
Shelter-in-Place
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VIII. Hazard Specific Standard Operating Guidelines
Social Media and Emergency Management
Staff Responsibilities
Staff Shortage
Subsidence (not included)
Surge Capacity
Influx Surge Template for Long Term Care
Influx Surge Equipment Storage Checklist
Influx/Surge Supply Vendor Checklist
Influx of Residents Log
Surge Planning Worksheet
Terrorism
Terrorism Vulnerability Self-Assessment Checklist
Tornados, Thunderstorms and Winter Storms
Wildfire (removed for revision)
Workplace Violence
IX. ICS Incident Action Planning Forms
X.
Acronyms and Glossary of Terms
XI.
Facility Operations Plan Template
XII. Drills and Exercises
XII. Other Valuable Resources
Healthcare Coalition Directory for Collaborative Planning, Integrative Response
Center for Integrated Preparedness Reference Tool
Adapting Standards of Care Under Extreme Conditions
Assessing the Impact of Hurricane Katrina
National Criteria for Evacuation Decision-Making in Nursing Homes.
Long Term Care Hazard Surveillance Forms
Colorado All Hazards Map
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SECTION | 1
Why Do Long Term Care Communities Need To Prepare?
________________________________________________________________________________________________________
The Waldo Canyon Fire in Colorado Springs in June, 2012, was the most devastating wildfire in
Colorado history evacuating more than 32,000 individuals including two nursing homes. Over
130 EF3-EF4 tornados devastated states from the border of western Kansas all the way east to
Kentucky and north to Indiana during February and March, 2012. In Colorado, we have felt the
costly effects of floods, wild fires, severe winter storms, tornados, rockslides, avalanches, and
even earthquakes. A catastrophic EF5 multiple vortex tornado, struck Joplin, MO in the late
afternoon of Sunday, May 22, 2011. It was part of a larger late-May tornado outbreak sequence
and reached a maximum width of in excess of 1 mile (1.6km) during its devastating path through
the southern part of the city. A Colorado nursing home withstood the fury of a major tornado in
2007. From natural disasters like these to the terrorist attacks on 9-11, our Nation has
experienced its’ fair share of emergencies. Since then, we have learned from these events and
moved toward a more cohesive and comprehensive public policy strategy to prepare for
whatever comes next.
Additionally, the phenomenon known as the “greying of America” has resulted in an increased
need for long term care communities and has produced areas of population density. This,
combined with the catastrophic effects of recent disasters, has alerted us to the need for effective
emergency operations plans for nursing homes and assisted living residences. This need is
further elaborated in federal and state regulations.
This emergency management and planning toolkit is made available to assist long term care
providers, with the resources to effectively develop, maintain and implement the required federal
and state hazard vulnerability analysis, emergency operations plans and guidelines for your
nursing home or assisted living residence.
As a long term care provider, your primary mission is
to give quality care and life to our most vulnerable
population, the frail, elderly, and disabled in Colorado.
Long term care is the most heavily regulated business
in the country, second only to the nuclear industry, in
the United States. Valuable time caring for your
residents can be consumed by complying with a myriad
of complex rules and regulations, which require ongoing documentation, accountability, and compliance.
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The original toolkits provided by the Colorado Department of Public Health and Environment
(CDPHE) were based on then-current and specific national emergency preparedness and
management procedures, language and templates.
___________________________________________
Our goal is to insure that all communities, police
units, fire departments, government agencies, and
military branches speak and understand the
language and procedures ofeffective emergency
management.
___________________________________________
Your community should be prepared for any
potential emergency or disaster, as determined by
your geographic region and hazard vulnerability
analysis.
Many long term care providers reported that the CDPHE Toolkits, while educational and
informative, were not user-friendly. The Hazard Vulnerability Analysis process was complex.
Developing and implementing an Emergency Operations Plan (EOP) was very time consuming.
Communities were challenged by the complexity of identifying and developing Job Action
Sheets. The sheer volume of the required documentation was intimidating.
You will encounter many acronymns and terms. APPENDIX A of this guide includes
websites for downloading comprehensive lists.
The original CDPHE toolkits were also designed separately: one for nursing homes and one for
assisted living residences. This new toolkit combines both into one Long Term Care Emergency
Operations Planning Resource Guide and Templates, with specific sections and appendicies
applicable to nursing homes and/or assisted living residences. For the purposes of this toolkit, all
nursing homes and assisted living residences will be referred to as long term care facilities,
unless resources are facility specific in nature.
This emergency preparedness toolkit provides you
with a template to build out your facility
emergency operations plan (EOP) using the
simplified hazard analysis tool as well as standard
operating guidelines for all potential hazards,
disasters and emergencies. Additional resources
and links can be found under additional resources.
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To complete your toolkit please review each section of this document. This toolkit is also
designed to use each section and standard operating guidelines as a training resource for your
staff and residents. Use the Long Term Care Emergency Operations Plan Template as an outline
to build out your plan using the appropriate documents identified in this guide.
If you have questions regarding this information please contact:
Colorado Department of Public Health and Environment
Health Facilities and Emergency Medical Services Division
4300 Cherry Creek Drive South
Denver CO 80246-1530
303.692.2800
health.facilities@state.co.us
Icons used througthout this toolkit indicates:
further web resources
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hint, tip or best practice