EVACUATION DECISION-MAKING

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Loraine Boyd
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1 HURRICANE SANDY THE EXPERIENCE AND LESSONS LEARNED Michael A. Schrieber Chief Operating Officer Sea Crest Office, Inc. Great Neck, NY EVACUATION DECISION-MAKING Full Building Evacuation or Internal Surge/Relocation Should staff call-backs go into effect (consider potential staff burnout)? Are we moving directly to EMS and other transports or can internal Holding Areas be utilized to stabilize and track? Is the building infrastructure impacted (earthquake, flooding, internal explosion, no power) How does this affect means of travel? Vertical? Is this a regional incident or are we going to have local and state assets supporting us? Are area healthcare facilities prepared for a surge? 1

2 SHELTER-IN-PLACE / EVACUATING SHELTER-IN-PLACE / EVACUATING 2

Infrastructure Failure Partial Infrastructure Failure

3 FULL BUILDING EVACUATION Pre-event Evacuation Hurricane Flooding Emergent Evacuation Impending Infrastructure Failure Partial Infrastructure Failure / Limited Operations Immediate Threat-to-Life Evacuation BACKGROUND 3

4 SEA CREST HEALTH CARE CENTER 320 BEDS SHORE VIEW REHAB & HC CENTER 320 BEDS 4

Recommend Healthcare Evacuation Center (HEC) Decision-making Timeline IRENE - 36 HOURS TILL LANDFALL Landfall - August 28, 2011 (100 Year Storm) Storm predicted to

12 foot swells NYS DOH arranges subsequent conference call with facilities in Zone A (~96 hours before Zero Hour) DOH stands by Mayor s position to evacuate, but

5 Recommend Healthcare Evacuation Center (HEC) Decision-making Timeline IRENE - 36 HOURS TILL LANDFALL Landfall - August 28, 2011 (100 Year Storm) Storm predicted to hit NYC - Mayor Bloomberg calls for a 7pm press conference August 25 Zone A are mandated to evacuate by 5pm on August 26 Category 3: expected storm surge of 8 to 12 foot swells NYS DOH arranges subsequent conference call with facilities in Zone A (~96 hours before Zero Hour) DOH stands by Mayor s position to evacuate, but will hear arguments to shelter in place Both facilities attempted to defend their position of shelter-in-place (SIP) - request was denied 591 residents to evacuate 5

6 GEARING UP FOR THE EVACUATION THINGS DON T ALWAYS GO AS EXPECTED Irene - All evacuations to be completed by 8pm on Friday, August 26 Sea Crest Successfully evacuated by 4:45pm on Saturday, August 27 Shore View Successfully evacuated by 6:45pm on Saturday, August 27 Evacuation is an extended event! 6

SANDY A DIFFERENT SHADE OF GRAY October 29, 2012 (100 Year Storm - AGAIN) Storm predicted to hit NYC Dwarfed Irene in size / 1,100 miles wide (2x size) Zone A mandatory evacuation: Complete by Oct.

7 SANDY A DIFFERENT SHADE OF GRAY October 29, 2012 (100 Year Storm - AGAIN) Storm predicted to hit NYC Dwarfed Irene in size / 1,100 miles wide (2x size) Zone A mandatory evacuation: Complete by Oct. Problem: Zero Hour was 2am on Oct. 29 not enough time to evacuate residents No government authority ordered evacuation Shelter-in-Place (SIP) Ambulatory residents Sent home / High acuity - Hospitals Limited transportation resources available October 30 Sea Crest evacuation commenced Daylight evacuation: 149 of 305 residents safely moved 7

transportation) evacuated final residents Shore View Residual heat OK; mechanical systems flooded

8 SANDY A DIFFERENT SHADE OF GRAY, CONT. Talks about impending Nor easter commence Sea Crest Final 156 residents: secured beds and OEM (with FEMA transportation) evacuated final residents Shore View Residual heat OK; mechanical systems flooded Problem: Hospitals evacuating and using all resources November 2: Enough resources available to evacuate Building loosing heat Eating Meals Ready to Eat (MREs) EFFECTS OF THE STORM 8

9 EFFECTS OF THE STORM EVACUATION 9

10 Sea Crest MOVEMENT OF RESIDENTS Irene Elevators worked Sandy First moved up (flood waters) Vertical movement down primarily by National Guard / staff were exhausted Limited to no equipment to move residents Colleague with ambulette service assisted in move Shore View Hospitals stabilized evacuation commenced Issue Most beds filled in area by evacuation time Spread out residents further than hoped WHAT WENT WITH RESIDENTS Copies of charts (snapshot) Face Sheet MARS/TARS Physician Orders Medications 7 days supply Supplies Sheets, mattresses, incontinent products, etc. Staff Clinical and support service 10

11 PLACEMENT MOU Model in Irene Failed Free for all first come, first serve basis Was a checkbox on the emergency plan to have MOUs overlap with others and no coordination Sandy Pre-Sandy Visited all facilities we had MOUs with and established more binding agreements Not bullet-proof: reimbursement issues raised their ugly head PLACEMENT Why reimbursement issues? 14 months post-irene, policy issues existed on payer approaches State paid receiving facilities immediately pre-sandy Placement issues Unsure who was controlling the situation Some facilities initially said they have no beds (due to funding issues in Irene) Facilities were calling directly offering beds was not taking into account facilities with the greatest need In coordination with Scott Amrhein, President of CCLC, a central network was established for available beds and placement 11

12 TRACKING Irene No issues Lined up, stickers on their body, wheelchairs and belongings (which facility) All cross-checks between transporting agent, transferring facility & receiving facility (triplicate form & workflow) Sandy Some did not end up where expected Redirected to hospitals in transit Wrong receiving facility Issues TRACKING, CONT. Coordination between facilities and gov t agencies Inform DOH where each resident was Not handled via a coordinating centers centrally operated Family issues could not reach them or vise versa 12

13 RECOVERY PROCESS Support from MassMAP member Stewart Goff of Mary Immaculate: Establish recovery teams Human Resources Communications with Staff: Employee needs list, emergency pay policy/procedure and EAP service Financial and Communications: Restore access to Financial and computer systems A/P and cash management systems Oversee insurance for loss Restart billing and collecting Building / Physical Plant Restoration Oversee clean-up company and monitor subcontractors Pack resident belonging Occupancy permits RECOVERY PROCESS, CONT. Public & Community Relations Government relief (legislative, SBA and others) Private financial assistance Address political and legal issues (media, etc.) Work with local, state and federal agencies (OEM, DOH, ASPR) Work with state associations Resident / Family Relations Work with host facilities Support families (personal belongings, mail, concerns, etc.) Serve as elder service liaison Ramp-up, Restore Operations and Repatriate 13

14 FINANCIAL IMPACT $12M to rehab facilities Shore View Out for 5 months Sea Crest Out for 6 months Only benefit Modernization of the facilities Insurance Denial of coverage (in litigation) FINANCIAL IMPACT Impact Lay off 800 employees after 30 days Family pulled out of operations of the buildings after a long history in long term care Positives Most residents wanted to come back upon reopening Out of 611 evacuated residents, 320 wanted to return (between 5-6 months later) 14

15 LESSONS LEARNED Communications / Incident Command Irene FDNY Assessment National Incident Management System (NIMS) Nursing Home Incident Command System (NHICS) Walkie talkies & hand-cranked weather radios Sandy All communications essentially cut-off OEM / NYS DOH Mobile truck for cell phone signal & power to charge phones LESSONS LEARNED Visit to OEM Face-to-face boots on the ground viewpoint of situation Distributed 800 megahertz radios for facilities with no power Radios failed after 1 day due to no power OEM and HEC gave out charged radios each day feeling of hope to facilities Needed additional hand-cranked weather radios (charging stations) Full Building Evacuation Plan Transportation Resources Overall Preparedness 15

16 CONCLUSION 16

Mission. Directions. Objectives

Mission. Directions. Objectives Incident Response Guide: Severe Weather with Warning Mission To provide for the safety of patients, visitors, and staff during a severe weather emergency such as ice storms, snowstorms, rain, flooding,