Emergency Preparedness Planning and Implementation (EPPI) Study Guide Overview An agency must have a written emergency preparedness and response plan that comprehensively describes its approach to a disaster which could affect the need for the agency s services or its ability to provide those services. Although DADS does not require an agency to physically evacuate or transport a client, the agency will make a good faith effort to comply with 97.256 Emergency Preparedness Planning and Implementation (Texas). For ACHC accredited agencies, this plan also meets the criteria of HH7-3A, 3B, 3C and HSP7-4A, 4c, 4D. If the agency is unable to comply with any of the requirements, it will document in the agency's records attempts of staff to follow procedures outlined in the agency's emergency preparedness and response plan. This agency is not required to continue to provide care to clients in emergency situations that are beyond the agency's control and that make it impossible to provide services, such as when roads are impassable or when a client relocates to a place unknown to the agency. In certain emergency situations, the agency will establish links to local emergency operations centers to determine a mechanism by which to approach specific areas within a disaster area in order for the agency to reach its clients. The Goal of Accolade Home Care and Hospice in an emergency or disaster situation is to allow for smooth transition of patient services and ensure continuity of care for all patients served by this agency. Objectives: To allow for the timely identification of the patients who are affected in the case of an emergency. To provide those patients with the care and assistance they need in the event of an emergency. To be readily available to assist emergency responder personnel in first aid care for those in the community. To assess the patient s home environment for safety and assist them to a safe environment if needed. To coordinate Agency staff members in patient care and evaluation, as well as care of those in the community who are affected by the emergency.
Annual Internal Review As part of the annual internal review, this agency will complete an internal review, including planned drill of the plan at least annually, or after each actual emergency response, to evaluate its effectiveness and to update the plan as needed. Risk Assessment The written EPP plan is based on a risk assessment that identifies the disasters from human, natural or technological causes that are most likely to occur in the agency's service area. Through the use of the Risk Assessment Tool, located in the EPP Binder and saved in electronic format, this agency has identified the probability of occurrence along with the risk and level of threat they carry. Accolade Home and Hospice Care has identified the following events to be the most likely to occur: Tornados Hurricanes Floods Hazardous Materials Severe Winter Storms Wildfires Thunderstorms & Lightning Power Plant Emergency Terrorism Extreme Heat Responsibility The Administrator, Agency Director (Supervising Nurse) and other Agency personnel as designated will be involved with developing, maintaining, and implementing the agency's emergency preparedness and response plan. The Agency Director (Supervising Nurse) and alternate are designated as the Agency s Disaster Coordinator and alternate respectively. Designated Disaster Coordinator: Agency Director Designated Alternate Disaster Coordinator: Alternate Agency Director The Disaster Coordinator/Director is the liaison for the local, State, and Federal Emergency Management Departments. These are the agencies for your state: Texas Division of Emergency Management/Texas Department of Public Safety 5805 North Lamar Blvd. Austin, Texas 78752-4422 Duty Hours: (512) 424-2138 Non-Duty Hours: (512) 424-2000 Oklahoma Department of Emergency Management 2401 Lincoln Blvd - Suite C51 Oklahoma City, OK 73105 Local: (405) 521-2481 New Mexico Department of Homeland Security and Emergency Management 13 Bataan Blvd., Santa Fe, NM 87504 or PO Box 27111 87502 (Phone) 505-476-9600
Business Continuity In a major emergency, response systems will be overwhelmed (e.g. police & fire departments, hospitals, utility companies, etc.) The following items must be considered when you plan and prepare to meet the needs of both your staff and the people you serve in this event. Emergency Financial Needs There must be a mechanism to track costs during an emergency or adverse situation by utilizing an individual who is responsible for tracking and oversight of the processing and documentation of all disaster-related costs (includes keeping track of all receipts, etc.). Essential Functions To return to business as soon as possible after an emergency, Accolade Home Care and Hospice keeps a current list of the following in the EPP Binder and in an electronic file. Landlord/facility owner; Routine checks and back up systems in place in the event of a power/utility failure; Utilities management plan including assessment of running water, lights, heat/airconditioning and electricity in the case of a power outage; Where Agency can rent or borrow a generator in the event of an extended power outage; Location of nearest pay phone in the case of non-working phones at your facility. (A pay phone may operate sooner than a normal business phone). Availability of coins in petty cash; Location of posted fire escape plans in the agency. Neighborhood Resources and Monitoring for Disasters Identification of neighborhood resources can improve the response to emergencies. Contact with each of these entities will strengthen communication and procedures for monitoring disaster-related news and information, including after hours, weekends, and holidays. These neighborhood resources are notified of the agency s role in the community and home health and hospice requirements. They will partner with, monitor, and share warnings of imminent and occurring disasters. Your agency plan contains a list with name, address and phone for each of the following: Nearest public health clinic Nearest place to go for help, if phones are not working Nearest fire station Nearest police station Neighboring agencies or businesses, other than those listed above, that you can join with to share resources in an emergency, maintain operations, and ensure the care of people you serve.
Additional ways to monitor disaster related news include NOAA Weather Radio or Police Scanner. When use of this equipment is available and applicable, the Disaster Coordinator is responsible for monitoring with these devices. Critical Personnel To assure the agency EPP includes a continuity of operations business plan that addresses emergency financial needs, essential functions for client services and critical personnel must be identified. Your Disaster Coordinator (Agency Director) will meet with you to discuss the following: How many employees/clients could possibly be at our site in a disaster? In an emergency, who else needs information about the status of people you serve? Off site staff; Families of clients; Family members that live out of town; Family members that live alone Realistically, how many staff will work after a disaster, if strikes during work? If during a work week, but before the day begins? If it happens on a weekend? Which staff should automatically report to work in a disaster? Client Records Accolade Policy and Procedures for the release of client information in the event of disaster are followed in accordance with the agency's written policy required by 97.301 Release of Clinical Records Information. Staff Actions and Responsibilities The actions and responsibilities of agency staff in each phase of emergency planning, including mitigation, preparedness, response, and recovery are described in this section. Every staff member receives EPP education during orientation and Accolade has established a continuing EPP education schedule. Every September, a mandatory EPP activity is offered. Each staff member must attend this activity. Additionally, an EPPI study guide and test are completed by every staff member, volunteer and contractor. Staff is educated on and encouraged to develop personal/family emergency plans. The Disaster Coordinator (Agency Director) or Alternate Disaster Coordinator (Alternate Agency Director) will initiate each phase of emergency. If the Disaster Coordinator or Alternate is unable to initiate, the Administrator or designate will initiate. These employees have the authority to activate and deactivate this Emergency Preparedness Plan based on information known to her/him at the time which indicates such need. Each office will keep and maintain a current list of contact information for staff, staff family members, vendors, emergency services, hospitals and other appropriate community resources. This information is kept current in a hard copy of the EPP binder as well as in an electronic version saved on a server housed in an alternate location and accessible if the hard copy is destroyed. The Disaster Coordinator will identify staff roles and responsibilities.
When Warning is not provided Through the process of Risk Analysis, it is evident that some weather emergencies can be anticipated thereby providing some amount of time for preparation. However, in many cases, emergencies arise and warning is not provided. In these situations, the agency will step into the EPP as the required education has instructed. Once the EPP is activated, the Disaster Coordinator/Director will initiate the staff call down procedure. Each staff member will notify persons listed below them on the calling list. If they are unable to reach an employee on the telephone, they will proceed to the next person on the list. Once the Disaster Coordinator identifies the employees available for assistance, they will be instructed to report to one of the command centers. Upon arrival, the Disaster Coordinator or designee will attempt to contact those employees not found during the first call procedure and identify any other employees found to be available on standby. They will also manage calls upon arrival at either command center. The primary mode of communication or alert system will be telephone and cellular phone. In the event of telephone or power failure, the agency will resort to use of generators and two way radios (as available). In the event that these devices fail, employees will follow predetermined plans that employees have been made aware of through orientation, EPP drills, and annual education. After staff members are put on alert, they will wait for a call back with their assignment and meeting site. The Disaster Coordinator will make assessments regarding the security of the office, the safety and travel conditions for staff, and make arrangements for relocation of the alternate site and transportation as needed. If possible, the Disaster Coordinator will also ensure all staff has required identifying badges and/or uniforms which will allow them access to their agency and identify them to other emergency care providers. Command center: Unless the emergency renders the agency office unusable, the Incident Command Center will be located at the main office. Alternate Site: (per Agency EPP) Procedures for Communication Staff In a situation where staff might be in two agency locations, both locations will maintain data backup through internet connection, hard wired phones, and emergency generators and two-way radios if available. Every effort will be made to communicate between both locations and with staff members. Responsibilities will be assigned to staff members by person or by organizational role per the Disaster Coordinator. Assignments will be communicated to office staff and clinical staff. Procedures will also be established to communicate with clients or persons responsible for a
client's emergency response plan; local, state, and federal emergency management agencies; and other entities including DADS and other healthcare providers and suppliers. Communication Steps: Establish/maintain command center Disaster Coordinator Inform staff of the responsibilities required of each function and assign as appropriate. Site Security: Check and turn off gas and/or electricity only if you can smell gas or if other damage/danger is evident. Turn off water if pipes are broken or leaking. Search and Rescue: If evacuation is required, ensure everyone has evacuated. Quickly search the facility for people who may be trapped or injured. First Aid: Administer first aid to injured persons. NOTE: This may require provision of first aid training for selected staff persons. Evacuation/Transportation: Fire or structural damage may require evacuation of your building during an emergency. Check for people who will need assistance evacuating your facility. If building/facility must be evacuated, staff will be assigned to take a head count to ensure all staff and program participants have exited. Public Information: Disaster Coordinator will obtain and maintain a list of contacts for possible local resources and contact them as needed. Safety & Security: Office Manager or designee as available anticipates, detects, and corrects unsafe situations. Central Point for Information Dissemination: Disaster Coordinator and Alternate Disaster Coordinator and Alternate will be the point of contact for other agencies including local, state, and federal emergency management agencies. Contact information for each of these agencies is recorded in this EPP. Team Leaders (clinicians) will be assigned to assist in identification of patients affected by the emergency and assigning clinical staff members to check on those patients by utilizing the pre-arranged priority classification system. The Disaster Coordinator will initiate the procedure to triage clients. The agency readily accesses recorded information about active clients triage category in the event of an emergency in order to implement the agency's response and recovery phases. Clients are categorized into groups based on the services the agency provides to the client and their need for continuity of these services. It also specifies
the availability of someone to assume responsibility for a client's emergency response plan as needed by the client. A patient roster (on-call list) for each area serviced by the Agency will be maintained and updated at least weekly with the following information: o Patient's name o Address o Diagnosis o Emergency Preparedness Plan (EPP) classification The Disaster Coordinator or designee will keep an updated copy of the patient roster. Any supervisors of outlying areas will also keep a copy of the roster. Patients will be classified into categories at the admission visit and documented on the Start of Care form. Classification will be entered on the patient roster. The classification will be evaluated for appropriateness at time of recertification/reassessment. o Class I -- Patients who require daily or b.i.d. nursing services and would suffer adverse effects if care were to be interrupted. This classification includes, but is not limited to, patients requiring insulin injections, oxygen-dependent bedbound patients, patients requiring sterile wound care of open wounds draining moderate to large amounts of drainage, infusion patients, and those with enteral feedings. o Class II -- Patients who require home health care services less than daily, but more than twice a week, for assessment, instruction of insulin administration, sterile wound care to wounds open and draining minimal drainage, and those who possibly would have adverse consequences if services were delayed. o Class III -- Patients who require services less than twice a week and who would not suffer adverse effects if services were delayed. When classifying patients, the age of the patient, mental status, diagnosis and availability of a caregiver in the home or nearby shall be considered. A list of clinical personnel phone numbers and cellular numbers shall be kept at the Agency Location and at the Disaster Coordinator s home. A call down process/line of communication will be specific in each location. Copies of each list are kept in the Emergency Preparedness Plan. The list will be reviewed quarterly for accuracy. Evacuation Assistance and Transportation Assistant Registery The agency s admission process for every patient includes procedures to identify a client who may need evacuation assistance from local or state jurisdictions due to the client
cannot provide or arrange for his or her own transportation; or client has special health care needs requiring special transportation assistance. Every patient receives a Patient Education Booklet that contains a questionnaire to help identify patients with this need. When the admitting clinician identifies a client who may need evacuation assistance, agency personnel will provide the client with the amount of assistance the client requests to complete the registration process for evacuation assistance, if the client wants to register with the Transportation Assistance Registry (2-1-1). Client Awareness and Responsibility Through the admission process and in a Patient Education Booklet provided to every patient, the agency will provide and discuss the following information about emergency preparedness with each client: o The actions and responsibilities of agency staff during and immediately following an emergency; o The client's responsibilities in the agency's emergency preparedness and response plan; o Materials that describe survival tips and plans for evacuation and sheltering in place; and A list of community disaster resources that may assist a client during a disaster, including the Transportation Assistance Registry available through 2-1-1 Texas, and other community disaster resources provided by local, state, and federal emergency management agencies. o A list of community disaster resources is provided and includes information on how to contact the resources directly or instructions to call 2-1-1 for more information about community disaster resources. Written Records and Electronic Information If written records are damaged during a disaster, the agency will not reproduce or recreate client records except from existing electronic records. Records reproduced from existing electronic records will include the date the record was reproduced; the agency staff member who reproduced the record; and how the original record was damaged. All electronic information including patient medical records is stored offsite in a secure location and backed up daily. Access is available from other locations in the event of a disaster. Agency Relocation or Expanded Service Should the Agency temporarily relocate the place of business or expand its service area due to the effects of a disaster, the Agency will notify and provide the following information to the DADS Home and Community Support Services Agencies licensing unit no later than five working days after temporarily relocating or temporarily expanding service (Texas agencies only): If temporarily relocating a place of business: the license number for the place of business and the date of relocation; the physical address and phone number of the location; and the date the agency returns to a place of business after the relocation; or If temporarily expanding the service area to provide services during a disaster: the license number and revised boundaries of the service area;
Date the expansion begins; and the date the expansion ends. This information will be provided by fax or email. If fax and email are unavailable, the agency will notify the DADS licensing unit by telephone, and will provide the notice and information in writing as soon as possible. If communication with the DADS licensing unit is not possible, the agency will provide the notice and information by fax, e-mail, or telephone to the designated survey office. Tips for Staff Members: After Receiving Notification of an Emergency - Direct Care Staff o Do not leave your home until you receive your assignment. o Do not ask questions when you are called. This will only slow down the rate of calling and response time to the emergency. o When you receive a call with your assignment, you will receive all of the necessary information about the emergency and those affected. o Please wear your name tag and Agency shirt so you can be easily recognized by other cooperating agencies. o Stay off of the phone so your second call can come through uninterrupted. o If phone lines are down, listen to radio stations for instructions. If You Are Away From Home When an Emergency Happens - Direct Care Staff o Call the Agency office to let the Disaster Coordinator/Director know that you are available to help. You will receive an assignment at that time. o If there are no working telephones, either come to the agency or to the alternate site (whichever is closest) for assignment. In the event that the telephones are not working, the Disaster Coordinator/Directors will be at the agency and all assignments will be made from there. If an Emergency Occurs During Working Hours - Direct Care Staff o When you report for assignment of emergency patients, give a list of those patients you have yet to see to the Disaster Coordinator/Director. A decision will be made by one of the Disaster Coordinator/Directors as to whether you will be pulled to help with emergency assessments, be assigned to continue with your regular assignments, or to assume some patients left from those nurses who are assigned to work on the emergency assessments. Those staff members who have had first aid training will be high priority for assignment to emergency assessments.
Other patient scenarios: 1. If the patient is unharmed but the home is damaged or unsafe and the telephone system is working, contact family or friends requested by the patient to make arrangements for the patient s transportation. Keep track of where the patient is going along with necessary telephone numbers, or contact the Disaster Coordinator/Director to make arrangements through the county emergency planners for transportation to an alternate care facility if other arrangements cannot be made. 2. If the patient is injured and needs transport, contact the Disaster Coordinator/Director for arrangements to be made through the county emergency planners for transport to a hospital/emergency room/triage site, depending on the need as determined by the county emergency planners. Be sure to have a complete list of the patient s needs when notifying the Disaster Coordinator/Director. Remember, the official personnel who are at the site (police, ambulance personnel, etc.) have had training in handling emergencies, as well as potentially hazardous situations. If they tell you not to go to a certain area, don t go. In the event of damaged, blocked or impassable roads, staff members will take alternate routes or notify a Disaster Coordinator/Director of inability to reach an area. 3. Unsafe Home Situation - Before entering a patient s home, determine if there is a safety issue such as a possible gas leak, exposed electric wire, etc. Assess the situation and report to a Disaster Coordinator/Director who will report to the local emergency planners for proper emergency personnel to secure that site.