“Death Toll in Kentucky Floods Rises to 28 as Area Braces for More Rain.” This headline from late July is all too common. Crises—natural disasters, active shooter situations, the pandemic, power grid issues, and more—are increasingly becoming the norm. While long term care facilities must have disaster preparedness plans, it’s time to revisit these and make them flexible enough to address whatever situation comes your way.
All-Hazards Assessment
“We have seen an increase in disasters—shootings, workplace violence, hurricanes, tornados, and more—in recent years. We need to think about potential hazards in our area,” said Betty Frandsen, MHA, RN, FACDONA, president of Med-Net Academy in Princeton, N.J. David Smith, MD, CMD, president of Geriatric Consultants in Brownwood, Tx., added, “The pandemic has sucked the majority of the oxygen from the room. We need to get back to addressing other issues related to emergency preparedness. This means looking at the full scope of assessments and where our highest risks are.”
According to Stan Szpytek, president of Fire and Life Safety, Inc. in Mesa, Az., “The key to planning for crises of all shapes and sizes in any type of facility is a hazard vulnerability assessment. Once you identify risks, you can focus on how you will address them,” he said. There are several such tools, including one from AHCA/NCAL (https://www.ahcancal.org/News-and-Communications/Blog/Pages/Access-AHCA NCAL’s-Hazard-Vulnerability-Assessment-Tool.aspx). This one was built on a foundation of established risk probability and assessments and designed specifically for the nursing home and assisted living environment.
However, Szpytek stressed that while it is practical to address viable risks based on geocentric factors and past experiences, the emergency preparedness plan needs to be flexible enough to handle the unpredictable and unexpected. He said, “Prior to the COVID-19 pandemic, most people didn’t see this as a viable possibility.” He referred to one list that includes 80 possible disasters or crises, including a zombie apocalypse. “This may be tongue in cheek, but it just shows that we need to be active and forward thinking. There is always an unknown factor that we need to prepare for,” Szpytek said.
Expecting the unexpected is good advice for a hazardous situation. For instance, he recalled a situation where there was a fire in a facility. “The fire was reported, and the police responded; but they quickly determined that it could have been intentionally set. When they got up to the stairwell, they were greeted by a resident with a gun who started firing on first responders. It was a routine call until it wasn’t.”
Frameworks Need Flexibility
Szpytek stressed, “The key to incident management is flexibility. You need to have a framework, but it needs to be flexible enough to pivot quickly with changing circumstances.” Typically, he said, “You have some warning, but not always. Wildfires, for example, move quickly; and you may have just minutes to evacuate.” In a true disaster, it is important to realize that you may be on your own and will have to make decisions very quickly with limited information.
“Training, drills, and exercises can increase leaders’ ability to be flexible and take decisive action. At the same time, regular tabletop exercises can help develop a culture of preparedness,” said Szpytek. While someone needs to have the role of incident commander, all staff need to be involved. He noted, “Most facilities now have emergent infection diseases at the top of their list of potential emergencies, so people on the care side of the equation need to be involved with emergency management.” However, when they are involved in training, drills, and other aspects of emergency preparedness, any staff member can potentially make a significant difference and even save lives in a disaster.
Don’t let optimistic bias overwhelm or interfere with your decision-making, Szpytek said. “Just because something never happened before doesn’t mean it can’t happen. Just because you’ve never had a fire in your facility, pull the fire alarm when you smell or see smoke. Don’t waste time tracking down maintenance staff.” This means creating a culture where staff feel confident responding to an emergency and know that they will never be punished for erring on the side of caution.
Frandsen agreed, noting, “You can’t just sit back and think that something won’t happen here.” She explained, “A few years ago when I was an administrator, our facility was near a civic center where a gunman charged in and shot some people; but no one thought to tell us. We found out because someone saw the S.W.A.T. team in our parking lot. Until that point, we had an open door policy; but we now realized we had to rethink it.” When new or revised policies are created and instituted, it is essential to train every staff member and make sure they understand their roles.
The Promising Prospect of Partnerships
“You’ve got to have relationships developed in advance. But these can’t just involve paper compliance. You need to have real relationships that go 2-3 deep because everyone will need services at the same times. You need to have alternative sources for things like transportation and food service in a crisis,” Szpytek said.
He stressed, “In my opinion, 70% of emergency planning is clerical in nature. Keep everything up-to-date and documented. Get your ducks in a row with vendors and other partners. Focus on contracts, letters of agreement, pricing frameworks, etc.” Smith suggested, “I have recommended to hospitals and facilities that they put all emergency planning information, alternate sources for water/power, and a complete and updated list of contacts on a computer that’s never connected to the Internet so it can’t be corrupted accidentally or intentionally.”
Don’t forget to plan for recovery and restoration. You need relationships with these types of organizations so you’re not scrambling later and end up working with companies who take advantage of your desperation and urgency. Recovery/restoration people can help identify issues you need to be prepared for. For instance, as Frandsen noted, a flood isn’t over after the water is removed. You have to worry about bacteria and mold. When there’s a wildfire, the local watershed might be affected, making water unsafe to drink.
At least one drill every year needs to be full-scale and communitywide, involving other facilities and stakeholders in the area. This will strengthen partnerships and relationships, as well as identify any gaps in communication or resource access. For instance, Smith said, “During the recent hurricane in Houston, all four lanes going out of the city were gridlock, while all lanes coming into the city were wide open.” A full-scale drill, combined with a good relationship with state and local agencies and leaders, could identify and address such issues to prevent them from reoccurring in the future.
Read more: A Staffing Shortage Is an Emergency
Joanne Kaldy is a freelance writer and communications consultant based in New Orleans.
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