By John Cavanagh and Anne Malia

Change is at the center of the human experience. Nothing is permanent. Any one of us can be safe and comfortable one day and the victim of a disaster the next. Even the strongest person can find themselves a patient in a hospital or health care establishment. The measure of a society’s worth can be determined by how well their most vulnerable populations are looked after. In considering Emergency Preparedness, it is essential that we address the needs of patients during a disaster.

By federal law, a nursing home must have an emergency evacuation plan. The facility is required to “tailor its disaster plan to its geographic location and the types of residents it serves.” A nursing home is also required to review its evacuation plan, train new employees in emergency procedures and hold drills and periodic reviews with staff members. According to the National Citizens’ Coalition for Nursing Home Reform, other types of facilities may or may not be required by state law to have a comprehensive plan in place, therefore clients (and their families) should inquire about the facility’s emergency preparedness and evacuation plans. Questions should address the following topics:

• The plan: What is the facility’s emergency plan for evacuation and for “sheltering in place?” Plans will be different for hurricanes, tornados, and terrorist attacks.
• Staffing concerns: Will there be enough staff to carry out the evacuation plan during all shifts? What are the training procedures for staff related to emergency evacuations?
• Coordination with other resources: Are there contracts in place with transportation and other facilities to provide housing for displaced residents? How has the plan been coordinated with community resources and city, county, and state Emergency Management facilities?
• Supplies: What type and how much emergency supplies (food, generators, flashlights, water, oxygen, medicines etc.) does the facility have on hand? If the facility needs to be evacuated, are there plans for supplies to be transported? How can residents have their own emergency supplies in their rooms, if they wish?
• Resident information: How does the facility discuss the plan with residents? How will residents be identified in an evacuation? How will information about the resident be communicated? Will supplies such as medications be transported with the resident or separately?
• Role of the family: How and when will family members be notified about evacuation plans? How can family members be helpful in an emergency situation? Can family members meet the residents at a designated location and/or can they come to the facility to assist? If family members live out of town, is there an off-site phone number to call to get information?

Crisis Situations

When it comes to Emergency Preparedness, health care facilities have a number of factors in their favor. Management is no stranger to crisis situations and staff members tend to keep cool heads and an ample amount of logic and common sense. Despite these elements, disasters can often overwhelm health and nursing facilities when they are required to contend with both injuries caused by the emergency as well as the chronic conditions of their patients. Another problem faced by facilities during an emergency is the influx of people, with and without disabilities, who, due to the disaster, have been unable to obtain the normal care needed to manage their conditions at home. As the result of an emergency, facilities are usually required to operate above their intended capacity for an extended time period, causing a severe financial impact.

The National Disaster Medical System

The National Disaster Medical System (NDMS) is the primary federal program that that supplements state and local emergency response capabilities by supporting the evacuation of patients in need of hospital care during disasters, such as hurricanes. NDMS has agreements with participating hospitals to receive patients needing hospital care in the event of an emergency. The program helped evacuate almost 3000 people during recent hurricanes, including Hurricane Katrina. Unfortunately, the program was not designed, nor is it currently set up, to move nursing home residents.

Resources for First Responders, Doctors and Emergency Management Officials:

Disaster Preparedness for Emergency Physicians

http://www.acep.org/webportal/PatientsConsumers/HealthSubjectsByTopic/DisasterPreparedness/disprep.htm

The American College of Emergency Physicians posts a webpage with a Question-and-Answer forum that deals with many preparedness-related topics. Also included in the online document is their 10-Point Plan to increase capacity and alleviate overcrowding in the nation’s Emergency Management facilities.