EMERGENCY PREPAREDNESS
Vanessa Walker, MSN, RN, PHN
Kenneth Lee, MD
DISCLOSURES
VANESSA WALKER MSN, RN, PHN
and
KENNETH LEE, MD
have no financial interest to disclose.
LEARNING OBJECTIVES
At the conclusion of this activity, the participant
will be able to:
1.
Identify challenges/barriers for persons with disability during disaster
evacuation.
2.
Describe emergency management exercises and processes to use prior
to a disaster.
3.
Identify ways to triage patients utilizing zones and categories.
4.
Name the analysis each organization must identify in writing that scores
potential disasters.
5.
Prepare your own programs emergency plan
4 P’S OF NATURAL DISASTER
•
PREVENTION
•
PEE
•
POOP
Domestic Terrorism
Boston Bombing
PERSONS WITH DISABILITY:
CHALLENGES OF EMERGENCY DISASTER
RESPONSE
PROTECTING PERSONS WITH DISABILITIES IN
DISASTER SITUATION
•
Unable to or disinclined to evacuate
•
More likely to suffer injury
•
Lose their medication/assistive device
•
Disrupted or lost care-giver support
•
At higher risk than usual for exploitation and abuse
•
More likely to be left behind
abandoned or unable to
leave home without assistance
PROTECTING PERSONS WITH DISABILITIES IN
DISASTER SITUATION
•
EVACUATION
•
Clear communication messages
•
At least two forms of means: radio, sms, phone, etc
•
Quick ID of the location of those who need assistance
•
Agency awareness
•
Local EMS service
•
fire department
PROTECTING PERSONS WITH DISABILITIES IN
DISASTER SITUATION
•
Access to Humanitarian Aid and Participation in Recovery
Planning
•
Have the right to safe, non-discriminatory and prioritized
access to humanitarian assistance.
•
Be part of the planning process
•
Involve a person with
disability in planning
process
PROTECTING PERSONS WITH DISABILITIES IN
DISASTER SITUATION
•
SHELTERS
•
Lack of physical access to the facilities
•
Lack of accessible communication and communication in alternative languages and
formats
•
Blocked or nonexistent disabled parking
•
Blocked accessible paths by parked law enforcement vehicles
•
Lack of access to the facilities with Service Dogs.
•
Lack of accessible bathrooms
•
Lack of accessible sleeping equipment
•
Lack of access to food and healthcare needs
•
Lack of or loss of contact with the rest of the family
•
Lack of facilities for Power for people who need
to recharge power devices
PROTECTING PERSONS WITH DISABILITIES IN
DISASTER SITUATION
•
HOUSING AND RECONSTRUCTION
•
Temporary/permanent housing
•
Physical accessibility, location, consider
caregiver space, equipment/supplies
•
Planning
•
Planning appropriately will prevent
PROTECTING PERSONS WITH DISABILITIES IN
DISASTER SITUATION
•
PROTECTION FROM EXPLOITATION AND ABUSE
•
Higher risk
•
Especially women and children
•
Need high level of vigilance
•
PLANNING
•
Resource allocation
PROTECTING PERSONS WITH DISABILITIES IN
DISASTER SITUATION
•
HEALTHCARE AND SOCIAL SERVICES
•
Remember, they have baseline medical condition
•
Trying to get the necessary special resources may be
difficult
•
Additional injuries
•
Basic humanitarian aid (may forget
about this due to concentrating on
their disability)
PROTECTING PERSONS WITH DISABILITIES IN
DISASTER SITUATION
•
PSYCHOSOCIAL SUPPORT
•
At higher/increased psychosocial stress and anxiety
•
Newly injured may have difficulty adjusting to another
catastrophy
•
RETURN TO WORK
•
LEGAL CAPACITY
AND PROTECTION
•
Rights protected
•
POA
GENERAL THEME
•
• notification;
• evacuation;
• emergency transportation;
• sheltering;
• access to medications, refrigeration, and
back-up power;
• access to their mobility devices or service
animals while in transit or at shelters; and
• access to information.
Vanessa Walker, MSN, RN, PHN
SCI HOME CARE
EMERGENCY MANAGEMENT
SCI Home Care Emergency
Management Plan
•
The Joint Commission
•
Integrated Plan
•
Test Phases /Exercises
•
Adjustment to Plan
•
Leadership Role
NOTE
: One single emergency can
adversely impact patient safety and
the organization’s ability to provide
care, treatment or services.
HAZARD VULNERABILITY ANALYSIS
Basis of evaluation: Probability of occurrence, risk to organization, and current status of preparedness.
Scoring: 0 = Not applicable, 1 = Low risk2 = Moderate risk, 3 = High risk
Comment: Score>2 requires inclusion in policy. All other hazards have been assessed as 1 or 0 for Network level
response and do not require inclusion in the policy.
Type of event Probability Human Impact Property Impact Operational Impact Rank
Likelihood this will occur within one year
Possibility of Death or Injury
Physical Losses and Damages Interruption of Services Score>2 requires inclusion in policy Earthquake 3 2 3 3 11 Power Failure 2 0 1 3 6 Fire 1 1 2 2 6 Flash Flooding 1 1 1 2 5 High Winds 1 1 1 2 5 Terrorist Act 1 1 1 2 5 Biological Exposure (Terrorist Attack) 1 2 0 2 5 Civil Unrest 1 1 1 2 5
DISASTER SIMILARITIES
Evidence shows that most emergencies
are alike and require similar preparation
for example, disasters cause:
•
Injury
•
Destruction of property
Mitigation
Preparedness
Response
Recovery
FOUR PHASES OF EMERGENCY
MANAGEMENT
FOUR PHASES OF EMERGENCY MANAGEMENT
•
Mitigation
-actions taken
before and after
a disaster (identifying
vulnerable patients, developed categories and zones).
•
Preparedness
-actions taken
before
an actual disaster (utilize
the cascade call list, disaster drill, table top exercise, educate
patients and staff, review the emergency supply list, assign
duties to staff).
•
Response
- actions/activities taken
during
an actual disaster
(call staff into office-cascade call list, assign duties, curtail visits,
staff call patients-disaster drill-assist patients with emergency
plan, shelter placements, call oxygen vendors, assist with
FOUR PHASES OF EMERGENCY MANAGEMENT
•
Recovery
-actions/activities
after
a disaster to return back to
normal (resume visits, replenish Veteran with medication and
supplies, assist with improved living quarters, etc.).
When you mitigate and prepare well,
response and recovery are easier.
• Quadriplegia,
total-maximum
assistance in
activities of daily living
(ADLs), bedbound,
oxygen, ventilator, enteral
feeding pump
dependent
CATEGORY 3 =
Highest Risk
• Quadriplegia/Paraplegia
requires
moderate/
sporadic assistance with
ADLs/motorized
wheelchair bound
CATEGORY 2 =
Moderate Risk
• Paraplegia, lives alone,
independent or
minimal assistance
with
ADLs, manual wheelchair,
walker, cane, (CNH, ALF,
Group care homes-have
emergency plans)
CATEGORY 1
= Lowest Risk
CATEGORIES
OF
RISK
1-North West
-N 10/60 FWY, W 605 FWY
2-North East
-N 60 FWY, E 605 FWY
3-South West-
S 10/60 FWY, W 605 FWY
4-South East
-S 60 FWY, E 605 FWY
EMERGENCY
TRIAGE
LOCATIONS
Veteran
Treatment
Care Plan
Emergency
Management
Binder
SCI Home
Care Share
Drive
Map located
in SCI Home
Care Nurse /
Social Worker
Office
HOME CARE DISASTER DRILL
DATE:______________ DISASTER TYPE: _________________________________________________________________________ 1. Was Veteran/caregiver at home: ?_____________________________________________________________________________ 2. Who did you speak with about the disaster drill? ________________________________________________________________ 3. What do you know about this type of disaster? __________________________________________________________________ 4. How would you respond to this type of disaster? ________________________________________________________________ 5. What are the limitations of the Veteran i.e., cant’ walk, wheelchair bound, bed bound, total patient care, etc .?_____________ 6. Do you have a Life Alert, emergency exit plan that provides a ramp for wheelchair access along with a manual wheelchair?__ 7. Does the Veteran have equipment such as oxygen, ventilator, feeding pump, etc. which could be affected by the disaster?_ 8. Do you have access to a battery operated radio, flashlight, cell phone, candles, matches, batteries, can opener? ____________ 9. Do you have a fire extinguisher and smoke alarms in your residence? _______________________________________________ 10. Do you have an emergency kit, if so contents includes (gauze, band aids, tape, cotton balls, CTA, rubbing alcohol, scissors)? 11. Do you have identifying family or friends in and out of town who may be of support in the event of a disaster?____________ 12. Do you have a week supply of water, food and medication on hand if an emergency were to arise? ______________________ Education provided to the Veteran/caregiver in response to answers provided: Call your local fire department or Red Cross. Call the utility companies and vendor for equipment issues such as oxygen, ventilator etc. Tune into your local TV/ radio for public
announcements. Contact the SCI program to discuss any issues you may have. Keep cash on hand in case of an emergency. Education provided specific to the emergency:____________________________________________________________________ Verbalization of understanding of instructions provided: Good , Fair, Poor
Comments or education provided by the SCI Home Care Staff addressed based on the responses: __________________________:
______ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ ________ _______ _ ________ ________ ________ ________ ________ ____ _____________ ________ ________ ________ ________ ________ _______ ________ ________ ________ ________ ________ ________ ________ ________ _ _______ ________ ________ ________ ________ ______
TABLETOP EXERCISE
Key personnel discuss
emergency management plan
written and verbal scenario
Rehearsal to coordinate:
•
Communication
•
Staff responsibilities
•
Veteran care activities
•
Medication / Supplies
•
Resources / Equipment
Goal:
•
Protect life
EVALUATION OF DRILLS/CASCADE CALL –
PLAN, DO, STUDY, ACT MODEL
1.
DISASTER DRILL
- Analyze patient and staff knowledge
deficits-consistency in staff education, (action)- educate
patients via pamphlets, emergency supply check list,
developed templates for staff-earthquake, power failure, fire,
staff participate in drills biannually along with actual disaster
occurrence(s)
2.
CASCADE CALL LIST
-
Evaluate the timeliness of staff
getting back to the coordinator, staff participation,
(action)-staff read annually the emergency disaster policy,
participate in cascade calls biannually along with actual
disaster occurrence(s)
EARTHQUAKE EDUCATION TEMPLATE
•
If you are inside,
stay inside:
•
If you are ambulatory, find cover under a desk, table or other solid piece of
furniture, get under it. Hold on to it and protect your face and head with your
arms.
•
If you are not able to get under something, sit down on the floor against
•
the wall and cover your head with your arms.
•
If you are wheelchair bound
, brace your chair against the wall, lock your
wheels and cover your head with your arms
•
If you are bedbound,
stay there. Pull the covers up and protect your head
with a pillow.
•
If you are outside
, stay outside:
•
POWER FAILURE EDUCATION TEMPLATE
•
If you are in a vehicle, stay inside the vehicle, pull over, stay away from buildings etc. until
the shaking stops.
•
After the shaking stops, wait a few minutes before moving, there may be aftershocks.
•
If you are trapped, make noise and shine a flashlight if available.
•
To help prepare your food, keep one or more coolers and ice in your home. Throw away
unsafe food.
•
Turn off and unplug all unnecessary electrical equipment, appliances and sensitive
electronics.
•
Leave one light on so you will know when the power comes back on.
•
Eliminate unnecessary travel especially by car. Traffic lights will be out and roads will be
congested.
•
If you are on emergency life support equipment such as ventilator or oxygen that
require electricity, use your portable oxygen tank.
FIRE EDUCATION TEMPLATE
•
Turn off oxygen equipment immediately if there is a fire.
•
Use your fire extinguisher if it safe to do so.
•
If you are able to get out right away:
Stay calm, follow your exit plan. Feel the doors with your hand. If they feel warm
or if smoke is seeping in, don't open the door. Use another way out.
•
Report the fire to the fire department. Tell them what room you are in your residence.
•
If you are caught in smoke, stay low and crawl to the door.
•
Keep the doors closed if you can't get out:
Stuff cloth around the doors and cover vents to keep smoke out.
•
Phone the fire department. Tell them what room you are in your residence.
•
Signal for help, open windows only if no smoke can come in.
•
Stop, drop and roll if your clothes catch fire: Roll on the floor until the flames go out. Cover your face with your
•
hands.
•
If you can not roll, smother the flames with a blanket, towel or coat.
•
Fire safety prevention:
•
Turn the stove off when you leave the cooking area.
•
Keep space heaters at least 3 feet away from any obstacles.
•
Never smoke when you are tired or taking medication which may cause drowsiness.
•
I f on oxygen, display a no smoking sign in your outside window/door or entrance to your door if you stay in a
room.
EMERGENCY SUPPLY CHECK LIST
Yes No NA SAFETY / SURVIVAL ITEMS:
Battery-powered radio Cell phone and charger Flashlights
Batteries Can opener
Fire extinguisher (necessity) Smoke alarm (necessity) Candles
Matches Whistle
First aid kit (gauze, band aids, tape, cotton balls, cotton tip, applicators, rubbing alcohol, antibiotic ointment, scissors) Cash and credit cards
Copies of documents (medical cards, passport, bank account numbers, birth and marriage certificates, insurance policies) Eye glasses, hearing aids
Clothing, shoes
LIVING SUPPLIES:
Water (1 week supply)
Food (canned, packaged) (1 week supply) Bowel care supplies
Dressing supplies Catheter supplies
Medications (List) (1 week supply)
Insulin, syringes (glucometer supplies if indicated) (1 week supply) Walker, Cane
Motorized wheelchair (need manual wheelchair backup) Manual wheelchair
Oxygen concentrator, (Tanks) (Notify Electric Company) Ventilator, Suction machine (Notify Electric Company) CPAP, BIPAP (Notify Electric Company)
Nebulizer (Notify Electric Company)
Enteral feeding pump (Notify Electric Company) Blood pressure machine
Life Alert
OTHER:
Emergency Exit Plan in place
List of local contacts: Name, address, telephone number List of out of town contacts: Name, address, telephone number Local Shelter: Name, address, telephone number
ACCESS TO MANUAL WHEELCHAIR BACKUP FOR
EVACUATION
FISCAL YEAR UNIQUE VETERANS SERVED NUMBER OF MANUAL WHEELCHAIRS NEEDED
2012 20 4 (20%)
2013 36 6 (17%)
TOTAL
56 10 (18%)
ACCESS TO MANUAL WHEELCHAIR BACKUP FOR EMERGENCY EVACUATION
Findings:
A total of 56 Veterans were served in FY 2012 and 2013.
Of the 56 Veterans a total of 10 (18%)of the Veterans did not possess manual wheelchairs as a backup.
Interventions:
Recommendation to the SCI Primary Care Provider (PCP) to order manual wheelchairs.
Outcome
: A total of 10 (18%) of Veterans with motorized wheelchairs required manual wheelchairs.
After the PCP ordered the manual wheelchair the results increased from 46 (82%) to 56 (100%)
MANUAL WHEELCHAIR BACKUP OUTCOMES
0%
20%
40%
60%
80%
100%
Veterans with back-up wheelchairs
Before
After
Compliance rate
ACCESS TO FIRE EXTINGUISHERS
FISCAL YEAR UNIQUE VETERANS SERVED FIRE XTINGUISHERS NEEDED
2012 20 8 (40%)
2013 36 8 (22%)
TOTAL 56 16 (29%)
ACCESS TO FIRE EXTINGUISHERS FOR EMERGENCY EVACUATION
Findings:
A total of 56 Veterans were served in FY 2012 and 2013.
Of the 56 Veterans, (16)29% of the Veterans required fire extinguishers. Of the (16) 29% only (13) 23% purchased the
fire extinguishers as they were instructed by the SCI Home Care Nurse, Social Worker during the visit, disaster drill
along with instructions provided to the Veteran in the emergency supply list.
Interventions:
Instructed the Veterans to purchase fire extinguishers for emergency preparedness i.e. prevent fires.
Outcome:
Only 13 (23%) of the 16 (29%)Veterans requiring fire extinguishers were compliant with purchasing the
fire extinguishers. A total of 53 (95%) of the 56(100%) Veterans were compliant with securing the fire extinguishers
after instructed to purchase them.
SECURING FIRE EXTINGUISHER
AFTER INSTRUCTION
Compliant
95%
Non-Compliant
5%
VA LONG BEACH SPINAL CORD INJURY HOME CARE
EMERGENCY MANAGEMENT INFORMATION CARD
Name ___________________________________________ Last Four _____________________ DOB _____________ Primary Care Provider ______________________________ Telephone No. __________________________________ Emergency Contact No. ____________________________________________________________________________ //////////////////////////////////////////////////////FOLD/////////////////////////////////////////////////////////////////// // SCI Type ___________________ Other Diagnosis _______________________________________________________ Bladder Management __________________ Bowel Management__________________________________________ Decubitus Ulcer _______________________ Oxygen /Vendor No. _________________________________________ Enteral Feeding _______________________ Autonomic Dysreflexia _______________________________________ DNR _______________________ Other _______________________________________________________________
//////////////////////////////////////////////////////BACK/////////////////////////////////////////////////////////////////// / MEDICATION LIST
ALLERGIES_______________________________________________________________________________________
•
Only education provided
•
Cited by CARF
WISCONSIN TORNADO 2013
MILWAUKEE
EMERGENCY
MILWAUKEE EMERGENCY
PREPAREDNESS
MILWAUKEE EMERGENCY
PREPAREDNESS
VA Spinal Cord Injury/Disorder Services
Emergency Preparedness
Go Bag
For Individuals with Spinal Cord Injury and Disorders (SCI/D)
A Go Bag is a small supply of items you would have access to at all times in case there is an
emergency or natural disaster. An emergency can be an event that takes place over a period of several hours to a day or more. Be prepared by relying on your own resources.
Items to pack:
Cell phone (include phone/vehicle charger)
Contact information (include physician, family, friends, personal support network)
Instructions on your injury and personal care
Bottled water
Medications (3 or more days of meds and a list with times taken and reason for use)
Food(e.g.: energy bars, etc.)
Small flashlight Hand sanitizer Catheters Suppositories Lubricants Gloves Emergency Blanket Whistle
Add additional items to meet your individual needs
MILWAUKEE EMERGENCY
PREPAREDNESS
Milwaukee VA Medical Center Spinal Cord Injury/Disorder Center
HomeEmergency Plan
Please fill out and provide to your local Emergency Management Services. (ie: police, fire department, power company-if appropriate, neighbors, etc)
Name
Address where the Veteran reside: Contact Numbers:
Home: Cell:
Emergency Contact Information:
Name: Association: Home Phone: Cell Phone:
Medical condition and any special needs that you want them to be aware of:
Milwaukee VA Medical Center 414-384-2000
