PREPARE: Kansas. Introduction Module Appendices

PREPARE: Kansas Introduction Module Appendices Appendix I-1: Federal Disaster Occurrences in Kansas, 14 October 1998 through 9 March 2010 Source: Kansas Hazard Mitigation Plan, 2010, p.3.32

PREPARE: Kansas Introduction Module Appendices Appendix I-2: Long-Term Care and Assisted Living Facilities in Kansas Source: KDHE, KDonA, US Census

PREPARE: Kansas Introduction Module Appendices Appendix I-3: Distribution of Elderly Population in Kansas

Source: Kansas Hazard Mitigation Plan, 2010, p.3.91

PREPARE: Kansas Introduction PREPARE: Kansas Introduction The vulnerability of long term care facilities was demonstrated during Hurricane Katrina and the events that followed. Those who care for vulnerable populations must be aware of and prepare for all types of disasters. Facilities are required to plan for various emergencies. All hazard planning is the most effective means to respond to and recover from the challenges faced during disasters and is the recognized national standard for plan development. Planning begins with: Identifying possible hazards Determining the probability that they will occur in a specific location Assessing the risk to the facility and residents Evaluating current levels of preparedness Once completed, these hazards are prioritized and the analysis becomes the foundation for the Emergency Operations Plan and guides all planning efforts. This program was developed specifically for care providers in the State of Kansas. PREPARE Kansas provides participants: Information required to plan effectively based on hazards faced throughout the State of Kansas. A tool to assist in the risk assessment process. This instrument was provided by the Kansas Bureau of Public Health Preparedness and Emergency Response and is currently being used by organizations throughout the state. Hazard information provided by the Adjutant General s Department, Kansas Division of Emergency Management related to probability of occurrence, severity, and warning time. Reference sites to obtain additional information. Forms and worksheets that are used in Kansas and throughout the United States. Contact information. A well developed All Hazard Emergency Operations Plan, coordination with community planners and responders, redundant communication systems, an administration and staff knowledgeable of incident command, and a well trained and exercised workforce are key components to a successful response. In any emergency, it is imperative that all involved know the chain-of- command. The Incident Command System assures decisions are made in a timely manner and facilitates coordination with responding agencies. Acknowledgments Many of the materials included in this document were created by others, those who have intimate knowledge of the hazards and vulnerabilities of the state of Kansas, as well as experts in emergency preparation and management. Page 1

PREPARE: Kansas Introduction Mather LifeWays would like to thank the Kansas Association of Homes and Services for the Aging and all of the agencies who participated in the development of the 2010 Kansas Hazard Mitigation Plan. In particular the staff of the: Adjutant General s Department Kansas Division of Emergency Management and the Bureau of Public Health Preparedness Kansas Department of Health and Environment It is only through information, coordination, and cooperation that hazards can be identified and mitigated. The content also includes important information from these and other sources: Federal Emergency Management Agency (FEMA) National Oceanic and Atmospheric Association (NOAA) National Weather Service Various Public Health Agencies, including the Centers for Disease Control and Prevention (CDC) Ready.gov Flu.gov Minnesota Department of Public Health, the Aging Services of Minnesota, Ready to Respond and Care Providers of Minnesota Leading Age Centers for Medicare and Medicare Services (CMS) Kansas Association of Homes and Services for the Aging (KAHSA) Others noted throughout the modules. Long-Term Care Facilities In this document, the term long-term care facilities is used as a grouping term for long-term care, assisted living, and other facilities that provide residential services for vulnerable populations. PREPARE: Kansas PREPARE Kansas is an off-spring of PREPARE, the award winning preparedness training program developed and presented by the staff of Mather Lifeways, Evanston, IL. PREPARE was created to equip senior living and long-term care professionals with the core competencies to address the medical and psychosocial consequences of natural disasters and other public health emergency preparedness and response concerns. Due to the efforts of KAHSA and a grant from the Kansas Department of Health and Environment, PREPARE was made available to the long term care and assisted living facilities throughout the state. PREPARE Kansas was created as the next step and provides more specific information related to the hazards faced by those who care for the frail and the elderly in long-term care and assisted living facilities all over the State of Kansas. Through data, maps, charts, and references, we provide some of the background information necessary to develop a Risk Assessment for your facility, the basis for your Emergency Operations Page 2

PREPARE: Kansas Introduction Plan. However, it is important to note that it is only one portion. Risk Assessments must include facility risks, as well as those unique to your county and state. These may include: others They possess knowledge and the abilities to assist in planning and responding. the age and working of heating/air conditioning systems wells and water systems fire alarm and sprinkler systems roof age and repair staffing issues security and safety issues union strikes intruders bomb threats subsidence proximity to highways, railroad tracks, nuclear power facilities, airports, and underground pipelines health and acuity of residents To identify the risks requires team work. Utilizing internal and external teams is beneficial. Professional assistance may be necessary to critically assess your facility. Also paramount to the success of any emergency response, is that facilities plan and regularly communicate with those expected to respond: local emergency management agencies police fire emergency medical services hospitals public health political leaders community businesses volunteer agencies Page 3

PREPARE: Kansas Introduction Maybe Not Everyone BUT YOU! Introduction When developing this guide, the critical hazards faced by most residents were addressed. There are many more. The Adjutant General s Department, Kansas Division of Emergency Management in the Kansas Hazard Mitigation Plan created the following list. Hazards were ranked by: weighing the probability of occurrence, plus the magnitude or severity, plus the warning time, and duration. Many considerations are addressed in PREPARE Kansas. It is the responsibility of your planning team to decide your facility s vulnerabilities and plan accordingly. There are hazards that may not have a high rating. However, if you are facing this problem, it requires you develop an annex to your Emergency Operations Plan (EOP). Different communities in Kansas have different vulnerabilities to the identified hazards. Disasters may not affect the entire population but your facility may be very much at risk. Hazards In 2010 flooding was the hazard of most significance to the State of Kansas. Tornadoes were ranked second. 1 The others, in order are: Major Disease Outbreak Windstorm Hailstorm Winter Storm Lightning Hazardous Materials Utility Infrastructure Failure Drought Terrorism, Agri-terrorism, Civil Disorder Land Subsidence Agricultural Infestation Extreme Temperatures Dam and Levee Failure Landslide Expansive Soils Soil Erosion and Dust Radiological Earthquake Fog One hazard can result in a different hazard. For example: Drought can lead to wildfire, soil erosion, and dust storms. 1 Kansas State Hazard Mitigation Plan, p. 3.27 Page 4

PREPARE: Kansas Introduction Severe winter storms and high wind event often may cause utility and infrastructure failures. Some hazards can occur simultaneously, as a result of the same storm, such as: Tornado, hailstorm, lightning, flood, and windstorms. Presidential Declarations The extent of storm damage and devastation may cause the Governor to request disaster assistance from the federal government. Many Kansas disasters have received Presidential Declarations. Some of the most recent were the Severe Winter Storms and Snowstorms experienced by 45 Kansas counties in March of 2010. 2 Once a disaster has occurred, and the State has declared a state of emergency, the State will evaluate the recovery capabilities of the State and local governments. If it is determined that the damage is beyond their recovery capability, the governor will normally send a request letter to the President, directed through the Regional Director of the appropriate FEMA region. The President then makes the decision whether or not to declare a major disaster or emergency. After a presidential declaration has been made, FEMA will designate the area eligible for assistance and announce the 2 FEMA, Public Entity Risk Institute types of assistance available. FEMA provides supplemental assistance for State and local government recovery expenses, and the Federal share will always be at least 75 percent of the eligible costs. 3 The following maps illustrate the number of Federal Presidential Declarations that have occurred in Kansas during the period of October 14, 1998 through March 9, 2010. 4 Appendix I-1 To be eligible for any federal assistance requires appropriate documentation. Before an event, check with your local Emergency Management Agency to determine: information required, procedures, and forms that require completion. Long-Term Care and Assisted Living Facilities in Kansas The following illustrates that there are vulnerable populations residing in long-term care and assisted living facilities throughout the state. 3 FEMA.gov/presidential declarations 4 Kansas Hazard Mitigation Plan, 2010 Page 5

PREPARE: Kansas Introduction Appendix I-2 There are approximately 2,818,747 residents of Kansas, of that number 13%, more than 360,000 residents are 65 years and over. 5 Appendix I-3 5 Quickfacts.census.gov. U.S. Census Page 6

PREPARE: Kansas Introduction Introduction to PREPARE Conducting a risk assessment to identify the hazards to which the LTC is most vulnerable. Identifying individuals to fill key roles and assure they understand the Incident Command System. Respond Responding includes: The PREPARE train-the-trainer modules and inperson workshops introduced long-term care/senior living (LTC) facility management and staff to the essential elements of developing and implementing effective emergency plans. Prepare: Getting Ready Respond Recover: Putting it Back Together Implementing Incident Command. Activating the plan. Performing necessary tasks to react appropriately to the event and assure continuity of operations. Taking steps to assure the safety of staff and residents. Communicating with staff, residents, responders and necessary others. This recap of PREPARE, provides a short review of these essential elements. In PREPARE: Kansas these principles are applied to hazards that have a high probability of occurring in Kansas. Prepare: Getting Ready Getting Ready refers to: identifying risks; developing an emergency operations plan; identifying personnel to perform critical roles; training and exercising all staff; procuring necessary supplies and equipment; building relationships and planning with community partners. For LTC facilities Getting Ready includes: Recover: Getting Back to Normal Recovery incorporates the necessary steps to reestablish a safe, familiar environment for residents and staff. It includes: Assuring safe re-entry. Administering Psychological First Aid to residents and staff who were affected by the event. Holding an after- action conference to identify areas where disaster response went well and areas of weakness. Vulnerabilities of Older Adults Developing a plan that considers the special vulnerabilities of older adults. The aftermath of Hurricane Katrina and other disasters have highlighted the unique needs of the frail and elderly residing in LTC facilities during emergencies. Studies show that older Page 7

PREPARE: Kansas Introduction adults are vulnerable and at risk for physical and psychosocial problems. Aging changes may increase older adults vulnerability to biologic agents, confound early diagnosis, and increase the severity of responses to the disaster. Also contributing to the risks to older adults is the prevalence of chronic health conditions, such as heart disease and arthritis. In developing an effective emergency operations plan, it is important to identify strategies that address their special vulnerabilities and incorporate those strategies into the emergency operations plan. 1. Sensory deprivation 2. Delayed response time 3. Chronic illness and medication use 4. Mobility impairment 5. Memory disorder 6. Hyper/hypothermia vulnerability 7. Issues pertaining to diversity 8. Generational differences in accepting assistance 9. Fear of victimization 10. Mental health stigma 11. Fear of loss of independence 12. Fear of evacuations The PREPARE training manual provides a more detailed explanation of these vulnerabilities. The Emergency Planning Process Emergency planning is not a one-time event. It is a continual cycle of planning, training, exercising, and revising. A comprehensive, effective emergency operations plan is an important tool and necessary to improve the preparedness and response by managers and staff of LTC facilities to all types of hazards. Determining who will be in charge, staff member roles and responsibilities, how all will communicate during the event, and the chain-ofcommand is part of the Incident Command System (ICS). By Presidential Directive, all responding agencies must implement ICS. It is necessary that all staff of LTC facilities know and utilize ICS during an emergency situation. It is essential that the various components of the plan are regularly tested and improved. This process of continuous improvement relies on updating procedures and contact information, reevaluation, development of an improvement plan and continuous testing of the plan. There are federal requirements for LTC facilities to have detailed, written emergency and disaster procedures and that managers and staff are regularly trained and tested. This must be an all hazards approach to address natural and manmade external hazards, as well as, internal hazards, such as fire, intruders, strikes, heat/air conditioning failure, and others. Who Should be Involved in Emergency Operations Planning? Emergency planning is a team effort. A successful response may require coordination between many community agencies and organizations. Each type of emergency requires different expertise and response capabilities. Therefore, the first step in emergency planning is identification of all that may be involved. Page 8

PREPARE: Kansas Introduction The specific individuals and organizations involved in the response to an emergency will depend on the type and magnitude of the event. Law enforcement will probably have a role to play in most events, as will Fire, Emergency Medical Services (EMS), voluntary agencies, and the media. On the other hand, hazardous materials (HazMat) personnel may or may not be involved in a given incident but should be involved in the planning process due to their specialized expertise. Input from local public health, emergency management, and community hospitals is also vital to the success of your planning and response. What is an Emergency Operations Plan? According to the Federal Emergency Management Agency (FEMA), an Emergency Operations Plan (EOP): Conducting a Risk Assessment A risk assessment is the foundation: for the development of strategies to deal with potential disasters, both manmade and natural; for determining and allocating resources; and for establishing priorities and standards to assure the safety of residents and staff. Identifying potential emergencies requires the use of all available information to determine the type, magnitude, effect, and time to react. Effective Emergency Operations Plans (EOP) should begin with a risk assessment based on the location and characteristics of the LTC. Possible considerations: rural or urban location; age of the facility, the roof and heating system; in flood zone; susceptible to winter storms, tornadoes, or wildfires; wooden or cement structure; one story or high-rise building. Assigns responsibility to organizations and individuals for carrying out specific actions at projected times and places in an emergency or disaster. Sets forth lines of authority and organizational relationships and explains how all actions will be coordinated. Describes how people and property will be protected in emergencies and disasters. Identifies personnel, equipment, facilities, supplies, and other resources available, within the jurisdiction or by agreement with other jurisdictions, for use during response and recovery operations. Identifies steps to address mitigation concerns during response and recovery activities. Other major events including: fire, terrorism, infectious disease outbreaks, floods, intruder, chemical spill, radiological accident, and labor strikes must be considered. Module 2 of PREPARE Kansas describes the key elements in conducting a risk assessment and includes a Kansas-specific risk assessment tool. Developing a Disaster Preparedness Plan Planning can help save lives, reduce injury, protect property, and help the facility and residents recover more quickly. It is never easy to care for the frail and those with functional needs. In a time of crisis it can become especially difficult. Unfortunately disasters, whether acts of terrorism, violent weather, Page 9

PREPARE: Kansas Introduction infectious disease outbreaks, or other unforeseen event, are part of our lives and we must be prepared to respond. Advantages of Using an All-Hazards Model All-hazards planning has several advantages: Need for geriatric mental health services, post-disaster, to address the psychological impact of the disaster. Plan with local EMS so they are aware of the unique needs of your population. Cost effective in terms of time and money. Builds capacity to deal with the most probable events. Encourages managers and staff to think with a broader perspective about real and potential emergencies. Key Components of an Emergency Operations Plan There are fundamental components that need to be addressed in an emergency operations plan. These components include: Direction and control Critical Issues in Planning Events of 9/11 provided lessons learned regarding critical issues necessary in disaster preparedness. Some of these issues are important to consider in developing an effective Emergency Operations plan. o Designate who has the authority to make decisions; system for managing resources; and analyzing information. Internal and external resources Need for backup communication systems to receive and disseminate emergency information. Arrangements for continuation of essential services (i.e., food and water, healthcare, medications, shelter). System to identify and track residents. Need for Memorandum of o Internal resources may include: personnel; equipment; communications devices; and emergency supplies. External resources include: transportation, supplies, community support, and volunteers. Understanding among LTC facilities, businesses, and other agencies to provide a coordinated response. 24/7 communication and contact information System to identify those with mobility issues and to assure proper modes of transportation is based on their limitations. o A well-designed Emergency Operations Plan should clarify flow of communication with 24 hour coverage, seven days a week. Page 10

PREPARE: Kansas Introduction Life safety, evacuation and shelters o Evacuation plans should be part of the facility s Emergency Operations Plan. Section 4 of this manual discusses evacuation considerations and planning. Agreements o The organization s relationship with the community may impact the ability to protect residents, staff, and property. To avoid confusion and conflict mutual aid agreements or memorandum of understanding with local response agencies and businesses should be developed pre-event. Property protection o During a disaster or emergency situation safety and security conditions may be unfamiliar and unpredictable. Standard security may be inadequate. Procedures for additional security or lock down may be necessary. Response and recovery o Response and recovery includes procedures for reacting to various disasters and returning your facility to normal operations after the disaster. Responding to Emergencies We are all vulnerable to a variety of hazards. Each day emergencies occur. Most are handled locally, within the organization or with the assistance of those who respond to emergency calls. Many require the support of agencies with additional resources and/or different skills. These may include: tornadoes, wind, rain, snow and ice storms, fires, floods, earthquakes, power outages, hurricanes, tsunamis, civil unrest, hazardous material spills, personnel issues, vehicle accidents, violent intruders, terrorism, or highly communicable diseases, such as a pandemic influenza. Those who respond must be able to coordinate their activities. Success is based on everyone who responds being aware of accepted procedures, terms, and communication methods. Through a Presidential Directive (HSPD5), all Federal, State, local, and tribal entities are required to adopt and utilize the National Incident Management System, of which Incident Command System is a key element. Hospitals and health care organization have also realized the importance of a coordinated effort and have adopted the Hospital Incident Command System (HICS). Businesses, faith-based and other volunteer organizations, social services agencies, and all who may respond to an emergency or disaster, are expected to know and use Incident Command. It is equally important that those who care for vulnerable populations know and utilize this nationally accepted method to manage incidents. It is critical for all involved, staff and those who may be called upon to assist, to clearly understand who is in charge. The rapid establishment of the chain-of- command and knowing how to communicate during the event Page 11

PREPARE: Kansas Introduction promotes timely actions, reduces stress, and may save lives. Activating Your Emergency Operations Plan According to the Federal Emergency Management Agency (FEMA) an Emergency Operations Plan will do the following: Assign responsibility to organizations and individuals for carrying out specific actions at projected times and places in a disaster. Set forth lines of authority and organizational relationships. Explain how all actions will be coordinated Describe how people and property will be protected. Identify personnel, equipment, facilities, supplies, and other resources available. Identify steps to address mitigation concerns during response and recover activities. The Incident Command System The Incident Command System allows all sectors within the LTC and those who may be called upon to assist during an emergency or disaster, to respond effectively. Through command and control, communication, and utilization of common terminology, all involved can form a well functioning team. All levels of government, private businesses, health care and volunteer organizations have adopted this system. Utilization of ICS by those who care for this vulnerable population, establishes the foundation for an integrated response. The system is a standard, yet flexible, framework that allows Federal, State, local and tribal governments, private entities, and nongovernmental organizations to work together to prepare for, respond to, and recover from domestic incidents regardless of their size, cause, or location. This includes acts of terrorism. ICS provides a means for coordinated and collaborative incident management. ICS may be used in any event that requires actions to prevent or minimize loss of life, damage to property and/or the environment. A detailed description of the structure and function of the Incident Command System, as well as guidelines on how to implement the Incident Command System are included in Section 6 of the PREPARE: Kansas manual. Evacuation The decision to move residents from a long term care facility is not easy and in many cases must be made with little time for contemplation. Many considerations must be factored into the decision. The hazard, time to react, staffing, number and condition of residents, transportation, shelter location, and available resources all must be considered. With this in mind, the primary concern must always be the safety of staff and residents. Those caring for vulnerable populations have an obligation to plan for emergencies and respond appropriately. Due to the nature of emergencies, no guidance document is perfect for every event. This module discusses the risks and provides suggestions from numerous experts. However, at the time of the emergency, the decision is yours. Page 12

PREPARE: Kansas Introduction Guidelines for developing an effective evacuation plan for your Kansas-specific geographic area and your facility are outlined in detail in Section 4 of this manual. Sheltering-in-Place As with evacuation, the decision to shelter-inplace requires considering many factors. Guidelines for developing an effective shelter-inplace plan for your Kansas location are discussed in Section 4 of this manual. Recovery Mental Health Issues Once the immediate danger of the disaster or emergency has passed, LTC facilities will face the challenge of returning to normal operations and helping residents and employees cope with the consequences of the disaster. It is necessary to understand the unique psychological effects of disasters on older adults and be prepared to provide support and/or interventions to ease the trauma for this at-risk population. The emotional effects of the aftermath of disasters have the potential to be long-lasting and the resulting trauma can reverberate to those not directly affected by the disaster. Emergency operations plans need to include methods to manage potential psychological issues related to the disaster. This section discusses the psychological impact of catastrophic events and how to deal with them. Methods for dealing with potential psychological aftermath of disasters should be included in the emergency operations plan. Typical Reactions to Disasters There are a number of typical reactions that have been documented in crisis situations. While many of these reactions are found across population groups, these reactions may be exacerbated or may present differently in older adults. Knowledge about the typical psychological reactions to disasters help LTC staff offers a proactive response to residents in distress. Some typical psychological reactions to disasters are: Anxiety and depression Withdrawal and isolation Irrational fears Problems going to sleep Alcohol or other drug use Demoralization Sensitivity to loud noises Somatic complaints Guilt, anger and grief Understanding Older Adults Recovery Process All age groups experience a range of reactions to disasters. Older groups, however, may have barriers to asking for and accepting mental health support. Older adults grew up during a time when any emotional issues were a source of embarrassment. Bringing older adults together to talk about feelings and reactions to a crisis situation can be helpful in helping emphasize that these feelings are normal. Discussing how people have coped with past crises serves as an example of how group members may begin to draw on their own strengths in the current situation. Functioning older adults can be a community resource to help others in the healing process. Page 13

PREPARE: Kansas Introduction Facts to remember about the older adult s recovery process include: Reactions are similar among all age groups. Reactions to a disaster are normal. Acknowledging feelings helps recovery. Focusing on strengths is helpful. Asking for help is important in the healing process. Accepting help is healthy. People heal at their own pace. Psychological First Aid Psychological First Aid is an evidence-based strategy for assisting people in the immediate aftermath of a disaster or emergency that can be used with any aged population. Psychological First Aid is intended to decrease initial distress caused by the trauma of disaster events to promote short and long term adaptive functioning. The principal areas of Psychological First Aid include: Contacting and engaging Providing comfort care, recognizing basic needs, and maintaining safety Helping with problem solving and providing practical assistance Validating feelings and thoughts Connecting people with their support systems Providing information about anticipated stress reactions and reinforcing strengths and positive coping strategies Guidelines for Delivering Psychological First Aid Politely observe first, don t intrude. Initiate contact only after you have observed the situation and resident and have determined that contact is not likely to be an intrusion or disruptive. Speak calmly. Be patient, responsive, and sensitive. Speak in simple, concrete terms; don t use acronyms or responder jargon. If necessary, speak slowly. If survivors want to talk, be prepared to listen. Acknowledge the positive features of what the person has done to keep safe and reach the current setting. Give information that is accurate and age-appropriate for your audience, and correct inaccurate beliefs. If you don t know, tell them this and offer to find out. When communicating through a translator or interpreter, look at and talk to the person you are addressing, not at the translator or interpreter. The goal of Psychological First Aid is to reduce distress, assist with current needs, and promote adaptive functioning, not to elicit details of traumatic experiences and losses. Referrals to Mental Health Professionals There may be survivors who need more additional help; those exhibiting symptoms of: Depression Aggression Alcohol and drug use Page 14

PREPARE: Kansas Introduction Homicidal or suicidal threats Healthcare Workers During and After a Disaster Engaging in rescue and recovery efforts in the wake of disasters is inevitably stressful for healthcare workers. The long hours, breadth of needs and demands, and exposure to human suffering can adversely affect even the most experienced professional. While the work is personally rewarding and challenging, it also has the potential for affecting workers in harmful ways. Too often, the stress experienced by healthcare workers is addressed as an afterthought. Steps should be taken to minimize the effects of stress. Evaluating Plans Post-Disaster For an emergency management system to be effective, it is critical that the personnel, plans, procedures, facilities, and equipment are evaluated to identify successes and shortfalls. Evaluation can help the organization identify: Whether the plan needs improvements. If there are training and staffing deficiencies. If needed equipment was available. If additional training and exercising of the plans are necessary. Documentation Developing a log during the disaster is an important tool for documenting any observed action. Events and problems can then be analyzed after the disaster to determine if corrective action is required. Emergency Management may assist in determining documentation necessary for any reimbursement. After Event Debriefing The debriefing is an opportunity for participants to talk immediately after the disaster. Participants can have their say about how things went, what they think should be changed, and commitments they need to make to improve competencies. A Debriefing Log may be used to document a summary of problems, actions recommended, and responsible persons/departments. After Action Conference The After Action Conference is a more formal meeting of key administrators and managers, post- event, to analyze the response and develop an accurate account of what worked and what did not. The team analyzes responses, logs, any other data, and discusses how well objectives were met. The After Action Report An individual is identified to prepare the After Action Report. This report documents effectiveness of the plan and staff during the disaster, actions required to improve the process and outcome. Recommendations for future actions are the primary reason for evaluating the plan after a disaster. The purpose of the evaluation is to improve the Emergency Operations Plan and staff performance. Page 15