NAME OF NURSING HOME
ADULT CONGRAGATE LIVING FACILITY
EMERGENCY OPERATIONS PLAN
I. PURPOSE STATEMENT:
The purpose of this plan is to describe the actions to be taken by the
facility operator and facility staff in the event of an emergency or disaster
that occurs at or otherwise threatens the lives or safety of the occupants.
The key to effective emergency planning is flexibility, which is attained by
contingency planning (i.e., consideration of all likely possibilities and
development of options for action, which are effective under each
possibility). The plan must compare disaster types and magnitudes with
the potentially available resources in each given case, and present options
for action.
II. SITUATION:
The situation is made up of the physical location and characteristics of the
facility and the people associated with it. Include the location, the
neighborhood infrastructure, the number and type of Clients, the facility
staffing, the operational practices, and the natural and man-made hazards
that are present.
A. Facility Description:
1. Number of buildings and floors, year and type of construction, well
or city water, sewer or septic tank. Indicate location of smoke
alarm/sprinkler system installed, and whether it is independent of
public power.
2. Give the elevation of the lowest floor living space, geographical
location, and closest major street intersections.
3. Indicate whether the facility is located in a Flood Hazard Area or
other designated evacuation area.
4. Attach as Tab A a floor plan of facility showing office, Client, staff,
and utility spaces, locations of hazardous materials storage, and
emergency exits. Include also a sketch map of the property with
names of adjacent streets.
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5. Show that the facility has an auxiliary emergency power
generator(s). Show whether the generator has the capacity to
supply all the electric power to run the entire facility and all
powered equipment. Indicate whether the generator is above the
projected flood level. Show the location of a simple attachment
point to which external generators could be connected if needed.
Indicate whether the air conditioning and other critical utilities are
above the flood level.
B. Operational Considerations:
In an emergency, the facility may be without telephone, electric power,
or public water and sewer service. Utility outages may last for several
days. The facility must be able to exist on its own for at least 48 hours,
without outside assistance. Plans must provide for alternative sources
of water, lighting, temperature control for medicines, waste disposal,
etc.
1. Clients. Attach as Tab B a current roster of Clients. Specify room
location and ambulatory condition. Indicate the Clients’ emergency
evacuation and shelter status as Category I, Admit or Shelter; or
Category II in accordance with Tab L. Include next of kin.
Indicate whether Clients have relatives or other persons who have
agreed to recover or transport them, whenever called in an
emergency. Staff.
2. Attach as Tab C a list of live-in and non live-in, full and part time
staff. Include name, address, and telephone/pager numbers of all
personnel. Indicate where the official copy of the list will be
posted.
3. Identify transport capabilities, including facility owned and
operated, routinely available on the premises, and non-owned
resources contracted to provide transportation in an emergency.
In the Concept of Operations section of the Plan, include the
means of transporting all Clients and support staff from the
facility to a safe destination outside of the risk area. If staff-owned
vehicles are to be used, attach as Tab D a statement of agreement
to this effect from each staff member involved.
4. Show how many days’ worth of non-perishable meals is always
kept on hand for Clients and staff. Include special diet
requirements.
5. Identify medications stored at the facility, and note any special
temperature or security requirements.
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6. Indicate staff members whose personal or family emergency
preparedness plans include evacuating with the nursing home.
7. Indicate whether the facility has and uses a ”weather alert radio”,
or relies on local radio and television news and weather predictions
and announcements.
8. Indicate whether the facility has lightning rods or other lightning
protection devices installed.
C. Hazards Analysis:
It is vital to review the various types of disasters that are most likely to
affect the facility. For example, a facility near a river or creek prone to
flooding will give primary emphasis to flooding incidents, while another
facility may plan primarily for tornadoes and winter storms.
Indicate those hazards to which the facility may be subject:
1. Fire, both internal and external
2. Severe thunderstorms and lightning
3. Tornadoes
4. Flooding
5. Hazardous substances, including both fixed facilities and
transportation
6. Winter storms
7. Bomb threats
8. Terrorist incidents
9. Earthquakes
10. Civil disturbances
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D. Assumptions:
Assumptions are accepted as facts. As such, they will govern this plan.
The following are considered to be generally necessary assumptions.
The facility may have to do some work to make good on them.
1. Facility operators are responsible for their Clients at all times in all
emergencies and evacuations, government-ordered or otherwise.
2. The facility operator will continually update this plan to insure that
it reflects current operating circumstances, Client characteristics,
relevant hazards, and facility emergency resources.
3. Facility staff will perform as described in this plan.
4. Facilities shall develop mutual aid or other agreements as
appropriate for care of evacuated Clients.
5. In an emergency situation, hospitals may be able to admit only
those who need life-saving treatment.
6. In an emergency situation, usual utilities and services could be
unavailable for 48 hours or more.
7. The time required to obtain a response from emergency services
will increase in proportion to the severity, magnitude, and nature of
the emergency.
8. Local radio and TV stations will broadcast watches and warnings,
and emergency public information provided to them by government
authorities.
9. The projected or actual presence of several inches of floodwater in a
facility is not necessarily a threat to life and does not in itself
mandate that the facility be evacuated.
10. When the facility is evacuated to a host shelter location outside the
immediate area, the appropriate facility staff and staff families will
accompany residents to the host location.
11. Evacuation of the facility may require special prearranged
transportation agreements between the facility and contractors.
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III CONCEPT OF OPERATIONS:
This portion of the plan is used to describe what will be done and how it
will be done in the event that an emergency occurs.
A. Preservation of life and safety is dependent upon timely and full
accomplishment of protective measures undertaken before, during, and
after an emergency,
1. In preparation for the hazards facing the facility,
precautionary actions are prudently required, They include,
but are not limited to:
a. Develop and maintain an emergency operations plan.
Update it annually or more frequently as
circumstances change. Insure that all staff personnel
are trained and tested in its use. Conduct fire drills at
least once per shift per quarter and conduct separate
tornado or hazardous materials in-place shelter
exercises and hurricane or flooding evacuation
exercises at least once each year. Send advance notice
of annual practice exercises to the St. Louis County
Office of Emergency Management. The St. Louis
County OEM may be holding an exercise that would
provide a scenario for the facility exercise.
b. Outfit the facility with sufficient emergency
equipment and supplies to provide for at least 48
hours survival without outside assistance. List the
equipment and supplies to be stocked, such as
emergency lighting, water storage containers, canned
food, can openers, cooking and meal service supplies,
sanitary supplies, first aid and medical treatment
supplies, debris clearance and repair tools and
supplies, etc.
c. Since evacuation may be necessary, arrangements have been made to
relocate facility Clients and staff to (name of host shelter facility(s) and
location(s). Describe how facility staff will coordinate operations with
staff at the host location, if applicable. See Tab E for signed
agreements with host shelter facility(s). Find a host shelter facility(s)
within the St. Louis County or surrounding Counties to take care of
evacuations due to a fire at the facility or in the aftermath of a
tornado, etc.(localized incidents). Evacuations caused by the threat of
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a catastrophic emergency, such as an earthquake, will require
relocation to a host shelter facility(s) outside of the risk area.
d. The administrator will compile a list of evacuation host
facilities for two types of events; local emergencies, and
catastrophic emergencies. A local emergency is an
emergency such as a hazardous materials incident, a
fire in the facility, or localized flooding, in which the
nursing home’s clients can be moved within St. Louis
County or to an adjoining County. A catastrophic
emergency is an emergency such as an earthquake or a
disaster that is so wide spread that the entire area must
be evacuated outside the probable danger, or risk area.
(1) Local Emergencies: Look for facilities in which
clients can be kept for a short period and in which
their condition can be maintained at as high a level
as possible according to the following priority:
(a) Nursing homes owned by the same company: An
inter-nursing home agreement must be signed
with a corporate representative and the
administrator of the accepting host home, and
must be updated annually or when changes
occur. Copies should be sent to the St. Louis
County OEM.
(b) Other nursing homes: An inter-nursing home
agreement must be signed with the
administrator of the accepting host home, and
must be updated annually or when changes
occur. Copies should be sent to the St. Louis
County OEM.
(c) Other types of congregate care facilities: An
agreement must be signed with the
administrator of the facility, and must be
updated annually or when changes occur.
Copies should be sent to the St. Louis County
OEM.
(d) Hotels, motels, and apartment buildings: An
agreement must be signed with the owner. The
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agreement must specify the conditions under
which the nursing home can move its clients in,
and must specify what will happen to any
current lodgers when that happens. The
agreement must be updated annually or when
changes occur. Copies should be sent to the St.
Louis County OEM.
(e) Schools, churches, and other institutions:
Facilities can be used for evacuees only in cases
in which they are not already committed to being
an emergency public shelter. An agreement must
be signed with the person responsible for the
facility, and must be updated annually or when
changes occur. A copy of the agreement should
be sent to the St. Louis County OEM.
(f) Public shelter: The public shelter is a last resort
shelter. Conditions will be poor, and the health
of clients may be endangered by the conditions.
The nursing home administrator will report his
failure to find other shelter to the St. Louis
County OEM and will provide the OEM a
complete listing of the clients, and the staff, staff
families, equipment, and supplies that will
accompany the clients. The nursing home
administrator will continue to look for other
accommodations, and will report his or her
success or failure to the St. Louis County OEM
annually.
(2) Catastrophic Emergencies:
St. Louis County is
subject to catastrophic emergencies, such as
earthquakes or power outages that could require the
evacuation of the large areas St. Louis County.
e. Evacuation includes transportation and enroute
support. Describe and document specific
arrangements made for transporting Clients and staff
to host facilities. See Tab F for signed transport
agreements.
2. When warning is received that a specific hazardous event is
expected, staff briefings are to be held, updated information
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obtained, external support services put on alert, and clients
and their support requirements prepared. Clients have to be
checked to make sure that their Emergency Categories are
up-to-date. All employees will be alerted to the higher levels
of preparedness as threatening weather or other potential
hazards develop, and will review their functions and
responsibilities for the hazard that is approaching.
3. The facility alert system will be activated. The following
groups shall be put on the notification list:
a. Internal Alert and Notification, including both on-duty
and off-duty personnel.
b. External notification of evacuation host shelter sites,
including hospitals.
c. Families of Clients.
d. External support services, including vendors, contractors,
etc.
e. Other organizations and individuals as appropriate.
4. During an unexpected event such as a tornado, plans and
procedures must be specific to protect and monitor Client condition
throughout the emergency to the extent possible.
5. After the event has ended, recovery of public and on-site utilities
and restoration of routine client services will be the first priority.
The recovery period may be lengthy and require a large measure of
self-reliance.
B. Establish a command post (CP) at a predesignated location in the
facility suitable for the hazard, as severe weather or other hazards
approach. Account for the location of all staff and Clients and
establish condition status according to preset procedures.
C. In the event of a fast moving emergency, such as a tornado, a flash
flood, or a hazardous materials incident, it may not be advisable to
evacuate the facility. In that case, Shelter In-Place will be used. Since
hazardous materials incidents, tornadoes, and other, like events can
occur at any time of the day or night, the facility personnel shall be
trained in the actions needed for in-place sheltering. The following
considerations will apply:
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1. Shelter-In-Place, General:
a. Make sure all Clients and staff are inside. Monitor Clients’
condition. Assign at least one person per wing to insure that
it is done.
b. Make sure all doors and windows are closed. Assign at least
one person per wing to insure it is done.
c.
Close all air intake vents and units in bathrooms, kitchen,
laundry, and other rooms (hazardous materials units). Turn
off heating, cooling, and ventilation systems that take in
outside air, both central and individual room units. Units
that only recirculate inside air may have to be kept running
during very cold or very hot weather to avoid harm to clients
d. Cover and protect food, water, and medications from airborne
contamination and from contact with waste materials,
including infectious waste.
e. Maintain contact with fire authorities regarding the hazard
and internal conditions. Remain inside until notification of
an “All Clear”.
f. Obtain advice from public health authorities regarding the
need for decontamination, and the means for doing it.
g. Evaluate all Clients, particularly those with respiratory
problems, and provide oxygen or suitable assistance.
2. Shelter In Place - Tornado:
a. Move Clients and staff to designated tornado shelter areas, or to
small interior rooms and hallways, away from windows.
Mattresses and blankets may be used to reduce injury from
flying debris.
b. Remain in protective posture until the Tornado Warning has
expired.
c. Assess injuries and damages suffered by Clients, the facility,
and utilities as soon as the tornado danger has passed. Compile
injury and damage reports at the command post.
D. Evacuation:
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1. Review and update Client Emergency Categories to ensure they are
correct. Give notice of the impending evacuation to local next of kin
who have previously stated that they would recover the Client and
assume responsibility for their care in the event of an evacuation.
2. Review evacuation checklist, if applicable (see Tab O).
3. Summon Transport equipment and issue instructions to drivers.
Assign any needed attendants, and load Clients. Check with
support organizations for assistance in loading Clients, equipment,
and supplies.
4. Describe arrangements for dispatching Client medical records with
evacuated Clients. Send special foods and medications, in original
containers, and other required support materials along with
Clients. Specify in a checklist as Tab G what equipment and
supplies are to accompany Clients. Roads will be congested and
traffic may move very slowly. Describe how clients will be fed
and/or medicated enroute, should that become necessary.
5. Advise host shelter sites of estimated time of departure and arrival.
6. Advise the St. Louis County Office of Emergency Management of
departure and destination in order to facilitate locator activities.
E. Return To The Facility:
1. Contact the St. Louis County Office of Emergency Management to
see if an “All Clear” has been issued for re-entry into the area, and
all utilities have been restored.
2. Pre-determined staff personnel will be sent to the facility site to
determine whether it is possible to return, and will prepare for the
return.
IV. ORGANIZATION AND RESPONSIBILITIES:
A. Organization And Staffing:
1. Attached as Tab H is an organization and staffing chart. It
depicts functional responsibilities, organizational structure,
and job titles, along with telephone numbers of staff
personnel. Date the chart and keep it current.
2. Responsibilities of staff for implementation of the actions
outlined in “III Concept Of Operations” are as follows:
Someone, by job title, must have primary responsibility for
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every action covered in the “Concept Of Operations”. Others
may be given assistance roles. Some samples of
responsibilities are provided as follows. Other positions, if
applicable, should be added.
a. Administrator:
(1)
Brief all staff on their responsibilities in an
emergency and maintain records of their briefings.
(2)
Implement the plan and supervise its execution.
(3)
Contract with and notify supporting agencies,
evacuation hosts, and transport, food, and other
service and material suppliers.
(4)
Notify the public officials of evacuation decisions,
destinations, and arrival, as facility official
spokesperson.
b. Charge Nurse:
(1) Develop and maintain client and staff status
reports.
(2) Prepare Clients for the hazard concerned,
whether in-place shelter or evacuation.
(3) Supervise loading of clients, support staff, and
any accompanying staff families into evacuation
vehicles. Prepare vehicle manifests, and
supervise provision of care enroute.
(4) Coordinate with dietary staff.
c. Food Service Supervisor:
(1) Arrange to have on hand foods that do not
require refrigeration or cooking, for use in
evacuation or in-place sheltering situations.
(2) Supervise the packing for transport of foods,
water, and service supplies for use at host
locations.
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(3) Provide ice and containers to preserve
perishable foods and medicines in an
evacuation.
d. Maintenance Person:
(1) Develop procedures and provide for their
implementation to secure the facility. Procure
and keep on hand the needed supplies and
equipment.
(2) Secure utilities, tie down propane tanks, remove
hazardous materials from the threat of
floodwater, and secure anything that might be
blown away in a high wind.
(3) Close off all outside ventilation sources.
V. ADMINISTRATION AND LOGISTICS
A. Tab A:
Facility floor plan and sketch map of area.
B. Tab B: Client roster with room location and ambulatory
condition. Include designation as Category I or II as appropriate.
Include names of next of kin. Indicate clients who have relatives or
other persons who have agreed to recover them, when called, in an
emergency.
C. Tab C: Staff roster, including live-in and non live-in, full and
part time. Include name, address, and telephone number.
D. Tab D:
Transport agreements with staff members.
E. Tab E: Agreements with evacuation host shelter facilities, dated
and renewed annually.
F. Tab F: Agreements with evacuation transport services, dated and
renewed annually. Include types of vehicles and indicate which
Clients, staff, equipment and supplies will go into each vehicle.
G. Tab G: Checklist of items to accompany clients, including
medications and special foods. Include loading plan to indicate
what goes in each vehicle.
H. Tab H: Organization and staffing chart, with responsibilities, job
titles, and phone numbers of staff personnel.
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I. Tab I:
Telephone numbers of the emergency point of contact at
the parent headquarters, if any, of this facility.
J. Tab J:
List of emergency telephone numbers, such as law
enforcement, fire, EMS, public works, utilities, fuels, evacuation
host facility point of contact, St. Louis County Office Of Emergency
Management, Red Cross, etc.
K. Tab K: List of 24-hour telephone numbers for nursing supplies,
dietary supplies, and pharmacy supplies.
L. Tab L: Resident Census and Conditions to be used for Disaster
Evacuation Planning form. Explanation of Categories I and II.
M. Tab M:
Maps with evacuation routes highlighted.
N. Tab N: Transfer form authorizing admission of nursing facility
Category I Hospital Admit (HA), Clients into a hospital in time of
emergency.
O. Tab O:
Hurricane evacuation checklist.
VI. PLAN DEVELOPMENT AND MAINTENANCE
A. Development and maintenance of this plan in coordination with the St.
Louis County Office of Emergency Management is the responsibility of
the facility administrator.
B. The supervisor of each functional area (e.g. administration, dietary,
nursing, maintenance) is responsible for timely contributions to this
plan and is to develop any Standard Operating Procedures needed in
his or her functional area to insure the effectiveness of this plan.
C. The plan will be reviewed for possible shortcomings by the facility
manager and supervisory personnel following every emergency and
every emergency exercise. This will take place at least annually.
D. All changes that affect external organizations will be coordinated with
them, to mutual satisfaction.
E. This plan and any revisions and changes shall be submitted to the St.
Louis County Office of Emergency Management upon promulgation. A
receipt will be used to verify delivery. The St. Louis County Office Of
Emergency Management shall review the plan or any changes.
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VII. AUTHENTICATION
This Emergency Operations Plan provides the operational procedures that
this facility will follow during emergency events. This plan supersedes
any previous emergency operations plans promulgated for this purpose.
_________________________
__________________________
Facility Name
Effective Date
________________________________
Facility Administrator’s Signature
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TAB L
NURSING HOME RESIDENT CENSUS AND
CONDITIONS TO BE USED FOR DISASTER
EVACUATION PLANNING
NAME OF FACILITY:
________________________________________________________________________ADDRESS:
PHONE #
________________________________________________________________________
FACILITY MEDICARE #
MEDICAID #
________________________________________________________________________
TOTAL RESIDENT CENSUS:
________________________________________________________________________
Please categorize your residents according to the criteria listed
below:
Clients with special need(s)
who are acutely ill.
 Intravenous therapies
 Tracheotomy/respiratory
care
 Stage III and IV
decubitus
 Kidney dialysis
 Other__________________
_______________________
_______________________
_______________________
_______________________
_______________________
_______________________
Total #
Clients with special need(s),
whose condition will
probably deteriorate during
an evacuation.


Intravenous therapies
Tracheotomy/respiratory
care
 Stage III and IV
decubitus
 Kidney dialysis
 Other__________________
_______________________
_______________________
_______________________
Total #
____________________________________
Signature of Person Completing Form
_______________________
Date
____________________________________
Title
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Category II: Clients with
limited needs.
 Bladder/bowel
incontinence
 Chairbound
 Tube feeding
 Indwelling catheter
 Contractures
 Injections
 Other__________________
_______________________
_______________________
_______________________
_______________________
_______________________
Total #
TAB N
TRANSFER FORM
In the event of an emergency which necessitates the evacuation of
___________________________________________(name of nursing facility)
I,__________________________________(name of Resident/Patient’s Physician),
hereby authorize the Medical Director or his designee at the receiving/host
hospital the right to order the continuation of care for
___________________________________________________________________
(name of patient),
provided the host hospital has the physical and staffing capability to admit
the evacuated nursing home patient.
______________________________
Resident/Patient’s Physician
_____________________
Date
______________________________
Medical Director of Nursing Facility
______________________
Date
______________________________
Resident/Patient or Legal Representative
or Responsible Party
______________________
Date
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TAB O
EVACUATION CHECKLIST
TAKE THE FOLLOWING ACTIONS IN SEQUENCE
Contact vendors with whom you have contracted to provide assistance in
emergencies:

Transportation provider.

Labor provider for loading and unloading.

Medical suppliers.

Water suppliers.

Food suppliers.

Evacuation host shelter sites.
Review and update Client Category on all Clients in accordance with Tab
L, resident census and conditions. Check Category I Hospital Admit and
Shelter status.
Update and issue ID bracelets.
WHEN PRECAUTIONARY EVACUATION IS IMMINENT

Order emergency medical supplies.

Order emergency water supply.

Order emergency food supply.

Contact transportation providers and confirm arrangements.

Contact labor providers and confirm arrangements.
THINGS YOU WILL NEED FOR EVACUATION

Ramp to load residents on buses.

Medicine carts.

MAR (whole chart if possible).
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
Clothing with Clients’ name on their bag.

Water supply for trip.

Crash cart.

Emergency drug kit.

Bingo and/or other games.

Communications devices: cell phones, walkie-talkie, weather radio, CB
(bring all you have.

Cigarettes.

Air mattresses or other bedding.

Facility checkbook.

Cash, including quarters for vending machines, laundry machines, etc.

Important papers: insurance policies, titles to land and vehicles, etc.

Computer backup tape.

List of important phone numbers/rolodex.

Emergency prep box: baggies, yarn, batteries, flashlights, duct tape,
string, wire, knife, hammer and nails, pliers, screwdrivers, fix-a-flat,
etc.

Non perishable food items.

Dietary workers.

Disposable plates and utensils.

Diet cards.

Additional items as needed.
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