Emergency Procedures

Purpose of Emergency Plan for St. Ann’s:

This plan is designed to prepare employees, residents and family members of employees in the event of a facility, community and/or large catastrophic disaster. Through preparation, knowledge and practice, facility staff can manage disasters in such a way as to promote safety and security of all involved.

The emergency planning manual is designed to be a user-friendly resource in times of educating, preparing and managing disasters. Updates will be made annually and more often as necessary in order to ensure accurate information.

Any time this facility initiates its disaster plan, the Administrator will contact the Residential Care Services Hotline at 1.800.562.6078.

Facility Details:
Trouvés St. Ann’s
6602 S. Alaska Street
Tacoma, WA
253.359.0529
Year of Construction: 2011
Property Owner: 6602 S. Alaska LLC
Administrator: Tom Gallucci
Number of licensed beds: 48 beds over three phases beginning with 15 residents
Maximum facility capacity: 48 beds over three phases beginning with 15 residents
Types of Residents Served: Mental Illness
Proximity of Location to railroad or other major transportation artery:
I-5 is .5 miles from the facility.
Location is not within 50 miles of an operational nuclear plant.

Organizational Chart

Administrator: Tom Gallucci 253.359.0529
Role: Emergency/Disaster Director. Initiates emergency protocols; determines level of response; delegates tasks; oversees response; interacts with press as needed.

Director of Nursing: TBA
Role: Core leaders. Oversees caregivers in monitoring residents; ensures medication/treatment availability; sets up and manages emergency first aid/health clinic; triages residents and staff based on injuries; assesses residents and staff for injuries; delegates health-related tasks. Ensures all contact with residents is calm and reassuring.

Shift Manager: TBA
Role: Core leaders. Manages contacts with outside emergency personnel; calls off-duty staff and takes incoming calls; manages evacuation; plans and implements practice emergency/disaster events. Coordinates closely with the Administrator and Director of Nursing. Serves as the Communications Center.

Maintenance Supervisor: TBA
Role: Core leader. Surveys grounds and building for damage; controls water, gas and generator operations. Manages all contracts and supplies needed for the physical plant.

Kitchen Supervisor: TBA
Role: Support Staff. Coordinates closely with dietary, housekeeping and maintenance staff, who also function as support staff to check and maintain emergency water and food; manage waste disposal during and after emergency/disaster; prepares food during and after emergency/disaster; cleans areas and ensures a safe environment for residents and staff.

Activities Director: TBA
Role: Support Staff. Contacts resident responsible parties; manages staff family accommodations; manages visiting resident’s families/guests/staff in case of “host” opportunities.

General Guidelines: This facility will implement and maintain emergency and disaster preparation and response systems for internal and external occurrences.

The facility will:

1. Protect residents and maintain living accommodations during disasters such as fires, explosions, earthquakes, flooding, hazardous environmental contaminations, and other events that jeopardize the safety of residents.
2. Maintain plans for evacuating residents.
3. Maintain plans for alternative accommodations.
4. Maintain plans for providing for essential resident needs, supplies and equipment.
5. Maintain plans for summoning emergency assistance.
6. Maintain an emergency communication plan.
7. Perform regular preparedness drills.

In all emergencies that affect the facility or residents, staff will respond immediately, and in a manner which most directly protects the residents from harm or danger. Resident health and safety is the primary concern of all emergency response.

When an emergency occurs or an alarm/signal is sounded, staff should remain calm and report to a designated response station immediately. A copy of the emergency response procedures is available in each department. Staff are encouraged to take a copy of the procedures with them to their response area. If a staff member is unsure of his/her responsibility or response area, he/she should report to the Administration area immediately for direction.

The Administrator must be contacted in any emergency situation. Contact should be made as soon as possible or as soon as is feasible after the emergency begins. If contact can only be made through a pager, or text leave the facility phone number followed by 911. If the Administrator cannot be reached by phone, he/she will respond to the facility.

The Administration area is located off the entrance of the facility and will be utilized as the command center, except if that area is damaged. The following items should be maintained in the Command Center and be accessible:

1. A map of the facility
2. A current resident list
3. A current employee list
4. Emergency phone numbers
5. Flashlights and extra batteries
6. Walkie-Talkies
7. Battery powered Radio
8. Cell phones?

Responsibility for leading emergency response procedures will be assigned in order of availability as follows:

1. Administrator
2. Director of Nursing
3. Shift Manager
4. Maintenance Supervisor

If the Fire Department responds, emergency response and evacuation directives will be taken from Fire personnel.

During an extended emergency situation or disaster, management staff should remain in the building or with the residents at all times until the situation has been returned to normal.

The following occurrences are checked as potential hazards that are specific to this facility’s location, local weather conditions and geographical location.

NATURAL

1. Floods
2. High Winds
3. Winter storm/heavy snow/ice
4. Earthquakes
5. Volcanic eruptions
6. Landslide/debris flow
7. Building Fires
8. Wild Fires
9. Drought
10. Communicable disease
11. Other

MANMADE THREATS

1. Hazardous material spill
2. Nuclear power plant
3. Other

TERRORISM

1. Explosion
2. Biological threats
3. Chemical threats
4. Armed threats (shooter)
5. Other

Anticipated Events

Events that are anticipated or predicted to occur (i.e. a winter storm, high winds) will be evaluated by the Administrator using all available resources in order to determine level of response.

If the event is anticipated to limit access to local transportation and/or communication devices, the Administrator will first seek employees to voluntarily remain at the location during the event. Based on response, the Administrator may initiate the Emergency call list. The Activity Supervisor is designated to manage the Emergency call list.

The Administrator will call a meeting of all members on the Organizational Chart to plan levels of response. All members on the organizational chart will be required to remain onsite during the event to manage the emergency plan.

Unanticipated Events
Events that cannot be predicted (i.e. earthquakes, building fires) will be evaluated immediately by the Administrator using available resources to determine level of response.

All employees currently onsite will be required to remain onsite during and after the emergency. Based on the level of the emergency, the Administrator may initiate the Emergency call list.

The Administrator will call a meeting of all members on the Organizational Chart to plan levels of response. All members on the organizational chart will be required to remain onsite during the event to manage the emergency plan. If a member is not on site, it is their responsibility to arrive at the facility as quickly as possible, if able to do so.

It is the policy of St. Ann’s that all available staff will work together to manage an emergency/disaster and its impact on the location and residents. Each staff member will have a role to enhance the operation of the facility during an emergency. See page 2 for assigned roles.

It is the policy of St. Ann’s to ensure that essential items are procured for emergency purposes, in order to maintain services and care with a level of comfort for residents and staff alike.

FOOD and WATER

1. Dietary Supervisor will ensure there are adequate stores of potable water for residents and staff hydration and hygiene, as well as cooking and cleaning purposes. The water will be stored in a predetermined area, and replaced prior to expiration.
2. Non-perishable food will be maintained by the Dietary Supervisor in a predetermined area and replaced prior to expiration.
3. A 72 hour supply of food and water will be stored onsite at all times.

SLEEPING ARRANGEMENTS

1. When possible, residents will remain in their rooms in order to enhance comfort.
2. If for reasons beyond the location’s control, residents are unable to remain in their rooms, a common sleeping area will be created in the chapel and staffed to ensure resident needs are met.
3. Extra blankets are stored in the linen closet. Individual resident bedding will be taken from resident rooms as needed.

EMERGENCY POWER

1. This location does have a generator. The maintenance supervisor or his/her designee will be responsible for ensuring proper operation of the generator, and ensure appropriate use. In case of a power outage, battery operated lamps are located in the emergency preparedness cabinet.
2. Extra blankets for residents and staff are stored in the linen closet.

TRANSPORTATION

1. Transportation will not be provided unless the need for evacuation is determined and declared. This issue is addressed in the Evacuation section of this manual.

Certain emergencies or disasters may cause damage to utility lines. These lines should be shut off as quickly as possible when warranted by the situation. Training on location and procedures for shut-offs should be provided to at least two people on each shift. Shut-off locations are as follows:

Water: Shutoff Procedures

Gas: Shutoff Procedures

Electric:

Water Supply: In emergencies where utility lines may potentially have been damaged, do not use water or toilets until lines have been checked for breakage. Hot water heaters may serve as a good source of emergency water supply. Bottled water regularly maintained in the facility should also be available.

Gas Supply: In most instances where utility lines may potentially have been damaged, it is advisable to shut off gas lines. If you smell gas, evacuate the area and shut off gas lines.

In all emergency or evacuation situations, a full accounting of residents must be completed at designated gathering/check points and after an all clear. A resident list is maintained on the emergency call panel in the administrative office, along with a list of residents who may require additional assistance to evacuate. The emergency response leader is responsible to take both lists and carry out final resident verification, or delegate this task directly to another staff member.

Following evacuation, Resident verification should be completed at the check points to determine that all residents have exited the building. If evacuation location changes, this check must be completed again.

Once the emergency situation is over and the all clear is given, the residents return to the facility, a complete room by room check is required.

It is critical in any disaster or emergency; emergency assistance is summoned as quickly as possible. The emergency response leader is generally responsible to contact emergency personnel. In most instances a telephone call to 911 should be made immediately. The Emergency response leader should notify other staff through the communication system.

The Fire alarm system is connected directly to the Fire Department. If the system is activated and alarms begin to sound, the fire department will be notified automatically and will respond immediately.

During an emergency, one person should remain near the main entrance to meet emergency response crews and direct them to the area. This person should make sure the front door is unlocked so emergency crews can enter.

Alternative Methods of Summoning Assistance

Certain situations may occur in emergencies which make standard communication difficult. The facility telephone system is electronic. As a result, the business phones will not work in a power outage. However, cell phones typically will work as will FAX telephones. If emergency assistance cannot be summoned through the telephone staff should proceed as follows:

1. Identify an available cellular phone and call 911
2. Try to call 911 from a resident phone
3. Pull the fire alarm if telephone contact cannot be made, the fire department will be contacted upon activation
4. If the fire alarm system does not activate, a staff member should immediately be assigned to leave the building and find the nearest telephone or other method to summon help.

Vulnerable adults are in need of round the clock staff. To ensure appropriate care and services, St. Ann’s is dedicated to ensuring residents receive care and services needed at all times.

1. In times of emergency, all staff currently onsite will remain at the location until the Disaster Director indicates that they may leave.
2. All managers who are not on site when an emergency occurs will promptly report to work unless threat to life and safety preclude this form occurring.
3. The communication Center will initiate calls to off-duty staff and volunteers in times of emergency.

In the event that the elevator stalls and someone is trapped inside please call 911.

Certain emergencies and disasters may require partial or full evacuation of the facility. Each situation will dictate how and when evacuation is carried out. It is imperative during evacuations that staff remain calm and assist residents in leaving the building in a safe manner.

During evacuations, do not allow residents to gather personal belongings before leaving. Time is of the essence. If the weather or temperature conditions are a potential hazard, residents should quickly locate protective garments if time allows. However, if the danger of an emergency situation is imminent, residents must evacuate without delay.

If electricity is available, the intercom will be used to notify staff of the area of emergency along with other directives.

During power outages, the Emergency Response leader or delegated staff person will respond to the entry of each area and announce directives. Verification that personnel in the area have understood the directives should be completed. This procedure should initiate in the direct area of the emergency and proceed to the remaining areas of the building.

Evacuation routes for the specific areas are posted on the back of each room door and in the common area hallways for each wing. Do not use the elevator during emergencies or for evacuations.

During an exterior evacuation, Residents should be instructed to exit the building and remain outside at a check point or gathering area. The areas are as follows:

If it is dangerous to remain in the general area, outside the building, residents should be instructed to report to the Secondary area immediately.

During an emergency which originates in a confined area of the building, a partial evacuation may be appropriate. Generally, residents may be evacuated inside the building to a safe area of the facility. In an interior evacuation route would take a resident near the origin of the emergency, the resident should be evacuated outside the building.

During incidents of temporary evacuation (less than 24 hours) which require residents to be outside the building for more than 30 to 60 minutes, or when temperature or weather may pose a danger to residents evacuated outside the building, immediate contact should be made with the alternative site to provide temporary shelter. Arrangements for such accommodation have been pre-arranged.

Community and local warnings of impending disasters will assist the facility to provide a calm and organized response. It is the policy of St. Ann’s to notify all involved parties of an anticipated or unanticipated disaster so that appropriate interventions can be put into place.

1. Warning of impending disaster will come through a variety of methods including:
2. Radio
3. Local television
4. Internet
5. Visitor
6. Community warnings
7. Telephone
8. The staff person or volunteer first hearing of an impending disaster must immediately notify the Administrator. During off-hours and/or weekends, the administrator will be contacted by cell phone.
9. The Administrator will determine the level of impact based on the information provided.
10. The Administrator will initiate the Disaster Plan and call a meeting of the managers listed on the Emergency List. Direction will be given by the Disaster Director. The Disaster plan will be monitored by the Disaster Director and adjusted accordingly.
11. The Core Leaders will initiate calling off-duty staff to report to work.
12. Residents will be notified of impending situations as determined by the Disaster Director.
13. Alternative communication methods during a disaster.
14. If telephones do not work, use cell phones.
15. If necessary, staff may drive to a nearby business or pay phone to make contact as needed.
16. Alternative accommodations: If evacuation is pending or planned, the Core Leader will contact the alternative accommodation representative of the estimated time of arrival, as well as detailed information regarding the number of residents and staff to be accommodated.
17. Notification of resident families of evacuation.
18. Once disaster Director declares the need for a partial or full evacuation, the Core Leader will contact the families of all residents who will be evacuated. Family information is located on each resident face sheet.
19. Messages will be left if contact cannot be made. Information will include date, time of evacuation, location of alternate accommodations and conditions of resident.

Residents will remain in the facility unless unsafe. If the residents must be moved to safer accommodations, the facility will organize and conduct a smooth transition to an approved alternative accommodation.

The Disaster Director will implement the evacuation based on outside emergency authority’s directions and internal facility conditions.

Transportation for residents and accompanying staff will be provided by emergency personnel and St. Ann’s staff.

Each staff member assigned to accompany residents to evacuation destination will be assigned to accompany 3 residents.

1. Staff will gather all needed medication, medical record/face sheets, three bottles of water, and three snack foods for each resident and themselves.
2. Three days’ worth of food and water for each resident and staff member will be transferred to the alternative location. The kitchen supervisor is responsible to ensure this is completed.
3. Staff will initial by the names of each resident on a centralized roster, as each resident is placed in a transport vehicle.
4. The Core Leader will do a final work-through of the facility, checking each room to ensure all residents and staff have evacuated. As rooms are checked, a sticker of pre-determined description will be placed on the upper right-hand corner of the door.
5. Resident family members will be contacted by designated staff members upon resident arrival at the alternative accommodations.

Destination
Alternative accommodations have been arranged with Alaska Gardens. A current written agreement is signed and attached to this procedure.

The Core Leader will contact the representative at the alternate accommodations and notify him/her of resident and staff estimated time of arrival and number of people en route.

1. Primary evacuation routes to the alternative location are established. The routes are attached to this procedure.
2. Secondary evacuation routes are included with this procedure, should primary routes be deemed impassable.
3. Estimated time to transfer residents/staff from current facility to alternative location is 15 minutes.

1. The Disaster Director, along with emergency authorities, will determine authorization for residents return to the facility.
2. A walk-through inspection will be conducted to ensure structural safety, as well as operational electricity, heating and water.
3. When return is authorized, residents will be transported back to the facility following similar processes used to evacuate.
4. All staff will be notified by the Core Leader of the facility’s re-entry status.

This facility has entered into an agreement with Alaska Gardens to be a host for St. Ann’s should it need to be evacuated.

1. A designated staff member will be responsible for preparing accommodations for and welcoming and receiving residents and staff.
2. A floor plan that designates accommodation locations for sheltering residents and staff is attached to this procedure.
3. The evacuating facility will be responsible for providing its own food and medical supplies for its residents and staff. Ann’s will provide water, toiletries and blankets.
4. Ann’s staff will be responsible for all their residents during this time of sheltering.

During incidents of extended evacuation (more than 24 hours) Management staff will make arrangements for alternative accommodations for displaced residents as follows:

Partial Evacuation (Portion of the building affected)

1. Contact family or resident representatives to provide temporary housing.
2. Arrange shared accommodations with residents in apartments that were not evacuated.
3. Arrange for temporary accommodations including Sixth Ave Baptist Church or hotels.

Full Evacuation

1. Contact family or resident representative to provide temporary housing.
2. Contact alternative accommodation site for emergency housing.

Contact the local Emergency Management Office for assistance with Emergency Shelter or supplies: American Red Cross.

Providing for resident food, water and supplies during emergency situations is essential. If necessary supplies or other needs cannot be obtained by facility personnel, contact should immediately be made with the local Emergency Management Office: American Red Cross.

The dietary department should ensure that a minimum of 72 hours of non-perishable food supply is maintained in the facility at all time.

During evocations of more than 3 hours’ duration, a plan for obtaining adequate food and water must be implemented. If the facility food supplies are accessible and undamaged, staff will retrieve an adequate supply of non-perishable food to sustain evacuated residents for the expected duration of the emergency.

If facility food supplies are not available, an effort should be made to procure needed supplied from local vendors as quickly as possible.

If facility personnel are unable to identify food sources, contact the local emergency Management office/the American Red Cross immediately for assistance.

Resident medication schedules should be addressed immediately during emergency and evacuation situations. If St. Ann’s medication storage is accessible and undamaged, staff will retrieve adequate supplies of medication to sustain residents for the expected duration of the emergency.

If St. Ann’s medication storage is not available or adequate, the pharmacy should be contacted immediately and procedures begun for obtaining needed medications.

Kirk’s Pharmacy 253-848-2011

If personnel are unable to readily obtain medications, contact the local Emergency Management Office immediately.

Facility personnel should provide for any other resident needs during emergencies and develop a plan to obtain required items.

If items are accessible and undamaged form the facility, staff should retrieve items in quantities large enough to sustain residents through the duration of the emergency.

If items are not available from the facility, staff should obtain them form local vendors.

If items are not obtainable, contact the local Emergency Management Office immediately.

During emergencies which effect larger areas of the city, the Red Cross will coordinate area-wide emergency efforts through the Emergency Management Office. They will coordinate requests for assistance with other agencies and will evaluate various shelters for use during evacuation.

In the event of a wide-spread emergency, staff should tune a radio to the Emergency Broadcast Station for further instructions:

KIRO 710 AM

If emergency assistance in evacuating or obtaining medical assistance is required, immediately contact: The American Red Cross or 911.

Contact the American Red Cross for locations of designated shelters.

It is important that staff, residents, and resident family members are aware and prepared for possible emergency situations. For this reason, this facility provides training opportunities on each individual’s emergency role before, during and after disaster.

1. During orientation, new employees will be given training in their roles and responsibilities during times of disaster. All current employees review these roles and responsibilities during their annual evaluation.
2. The facility trains with planned, unannounced fire drills quarterly on each shift. The Facilities Maintenance Manager implements these drills, and provides training as needed based on the results of the drills.
3. The facility provides a planned earthquake drill annually. The Facilities Maintenance Manager implements this drill, and he or she and the Administrator provide training based on the results of the drill.
4. Residents and their families are educated on the facility’s disaster plan upon admission, at care conferences, and occasionally during resident council meetings.
5. The following is the facility’s annual schedule for implementing all or part of the disaster plan:
6. Fire Drills: March, June, September, November
7. Earthquake Drill: July

Fires can be a major disaster or an efficiently handled emergency. Always be on the alert for fire or smoke. Know the location of firefighting equipment and the correct way to operate them. Using prompt action, small blazes can be extinguished with a minimum of harm to persons and property. Remember to remain calm.

1. When fire is discovered: Remove all residents from area as quickly as possible.
   1. Activate the nearest fire alarm box.
   2. Contain the fire by closing all windows and doors in the area.
   3. Notify someone to alert all staff and notify the Disaster Director or person in charge as soon as possible.
   4. Return with a fire extinguisher if it is safe to do so.
   5. Do not enter a closed fire room if the door knob is warm
2. When the alarm sounds
   1. The Disaster Director/person in charge will proceed to the fire control panel if the fire location is not known.
   2. The Disaster Director/person in charge will evaluate the situation and determine any evacuation needs.
   3. The Disaster Director/person in charge will direct someone to call 911 Ito report the problem and then report back to the Director/person in charge.
   4. Direct care staff will start at the area of the fire and work away in all directions to move residents beyond fire doors. Close all doors and keep hallways clear; ensure fire doors are closed and shut off any circulating air systems.
3. Staff responsibilities
   1. Core Leaders report to the area of the fire with fire extinguishers. Await instructions from the Disaster Director/person in charge.
   2. Nursing personnel will stay in their assigned area with residents unless advised by a Core Leader to do another task. Close all windows and doors; shut down any equipment in your work area. If you are not securing an exit door, report to the Disaster Director/person in charge.
4. Evacuation: When the Disaster Director/person in charge orders evacuation, follow evacuation process.
5. Fire drill log
   1. All fire drills will be documented on state issued forms and maintained for review by the state Fire Marshal.
   2. Fire drills must be planned and unannounced.
   3. Each shift shall participate in a fire drill at least quarterly.

The first employee at an explosion site will:

1. Announce the disaster—locate a phone, activate the intercom, and say, “Explosion in (give exact location).” Announce three (3) times.
2. All staff report to the Front Desk
3. Protect residents – if it is safe to do so, remove residents from the immediate area of danger. Always act with caution, as there could be additional explosions.
4. When the announcement is heard – the person in charge will immediately report to the disaster location and assess the situation. Once s/he confirms that an explosion did occur, he/she will then activate fire procedures.
   1. Protect the residents-ensure all residents are away from immediate danger.
   2. Seal off the area – Depending on the severity of the explosion, the person in charge may activate evacuation procedures. All doors to the immediate area of the explosion will be closed. The area will then be sealed off due to the possibility of further explosions.
   3. Pull the fire alarm – The person in charge will assign a staff member to activate the alarm at the nearest pull station. At this time the person on charge will assign this individual to call 911.
      1. Speaking clearly and distinctly, explain the problem-“l want to report an explosion,” giving the following information:
         1. Facility Name
         2. Facility Address
         3. Nearest Cross Street

If this is NOT in the area of the disaster – Close doors and windows, clear hallways, calm the residents, turn on the lights. Remain in your assigned section to safeguard the residents and wait for further instructions. Be prepared to active the evacuation procedures if instructed to do so by the person in charge.

1. Maintenance -Immediately report to the explosion site and if safe to do, assess structural damage to the facility. Utilities must be shut off immediately if required.
2. In the event there is also a fire – Keep only enough of the staff with fire extinguisher in the area to contain the fire until the arrival of the fire department.
3. Administer first aid- seriously injured will be evacuated to the nearest hospital: CALL 911
4. If gas is smelled:
5. Open all windows and doors leading to the exterior of the building.
6. Immediately shut off main gas valve (See “Utility Shut Off Procedure: Gas Supply Shut Off). Do not use any flammables.
7. Evacuate the area of immediate danger. The person in charge will determine whether to activate the facility evacuation procedures. If evacuation is implemented, then do not re-enter the building until the gas company representative declares it safe.
8. Notify the gas company immediately. See “Emergency Telephone List” section in this manual. EACH BUILDING MUST HAVE-AN EMERGENCY TELEPHONE LIST.
9. If the explosion is in any of the service areas, kitchen, laundry or boiler room, follow the above procedure keeping in mind that there is gas piped into these areas. Do not go any nearer to these areas than absolutely necessary.
10. Possible sources of explosions in the facility include stove gas line leak and water heaters.

When an explosion takes place:

1. Shut off appliances and the gas line, water line, and electricity. ii. Evacuate persons in the immediate area.
2. Call 911 and report the explosion and describe the damage or emergency needs.
3. Notify the Disaster Director.
4. Notify the utilities company. See Emergency Phone Numbers list. vi. If a fire breaks out, follow the fire procedures. vii. Administer first aid as necessary.
5. The Disaster Director will assess damages and direct staff accordingly.
6. The explosion area is off limits to all personnel until determined to be safe again by the Disaster Director after all repairs have been made.

In the event of a power outage the following procedures should be followed:

Elevator
Check to see if anyone is on the elevator. Identify all of the individuals who are on the elevator and write down the names. Calmly inform the occupants that there has been a power outage and that emergency personnel will help get them out as quickly as possible. Inform the occupants of the availability of a flashlight, located in the telephone box next to the elevator door. Suggest that the occupants sit down while they wait. Contact with anyone on the elevator should be made every 5 to 10 minutes until they can be removed from the elevator.

Verification
Identify if the outage is isolated to our building or if it affects the whole neighborhood. If it is dark outside, check the streetlights. If the streetlights are out, the whole neighborhood is out. If it is daylight, a designated employee should go to WinCo and see if the businesses have lost power.

Notification
Call Maintenance and Administration immediately.

TELEPHONES – The business telephones do not work during a power outage. Possible telephone options are:

House Cell Phone

Fax Telephone

LIGHTING – Emergency lights in the hallways operate on battery backup for approximately 90 minutes. Flashlights are located in the linen closets, nursing supply closet, nurses’ station, med carts, and the telephone box in the elevator. With resident permission, room doors can be opened and blinds raised to let more light into hallway.

Earthquakes may pose many hazards to Residents, Employees and the facility, including structural damage, power outages, fires, explosions and environmental contamination. Effective response requires Employees to be attentive to resulting conditions and to determine necessary actions quickly.

During An Earthquake
Drop, cover, and hold. Move away from glass walls and windows or any wall mounted storage, etc. Hold on to furniture legs if furniture moves. The best place to be is under a desk or table, or standing in a doorway away from glass. Do not leave the building.

If you are outside, move away from buildings, trees, and power lines.

If other Employees or Residents are in your range of sight, instruct them to take cover appropriately.

After An Earthquake
Following an earthquake, Employees should report to designated areas as outlined for FIRE response. Quickly make a visual assessment of your area to determine what actions are immediately required. If more than one Employee is at a station, one should be dispatched to the Business Office to report damage and emergency assistance needs. Remaining Employees should begin a room by room search and implement first aid or evacuation procedures as needed.

When performing room searches, do a visual scan of all areas of the room, listen for any movement or voices, call out and listen for response, and physically walk through all parts of the room which are accessible to determine if anyone is in the room in need of assistance.

In the event of fatalities, cover the bodies and move on to the next room. Do not move bodies. Report all fatalities and locations to the Emergency Response Leader.

Earthquakes are frightening to most people, especially elderly and/or confused people. They tend to panic very easily. In the event of an earthquake, the following procedures will be followed.

1. During the Tremor
   1. Keep residents calm and away from windows, skylights and large over headlight fixtures. Be aware of furniture or equipment that can tip over or fall down on someone. Try to remain in your respective area and seek protective shelter under tables and desks or doorways.
   2. Do not run outdoors, falling debris or electrical wires may hit you.
2. After the Tremor
   1. Do not take residents outside of the building unless instructed to do so by the manager
   2. Keep residents in their own rooms and out of hallways as much as possible
   3. Try to remain calm. Talk and act in your usual manner, this will instill confidence and reduce panic to residents and staff.
   4. Administer first aid as necessary. Seriously injured will be evacuated to the nearest hospital.
   5. Turn off utilities until an assessment can be made. Refer to the “Utility Shut Off Procedures” in this manual.
   6. Maintenance, housekeeping, kitchen and laundry will inspect all utility lines for damage. Maintenance will make an assessment of the damage and report to the person in charge. Flashlights will be available in the office in case of electrical failure. They will be issued on a priority basis and per the instruction of the person in charge. Be sure to keep the residents calm at this time.
3. If Gas Is Smelled
   1. Open all windows and doors (Doors leading to the exterior of the building)
   2. Immediately shut off the main gas valve (See” Utility Shut Off Procedure: Gas Supply Shut Off”).
   3. Do not use any flammables, (candles, matches or other open flames).

Evacuate the area of immediate danger. Staff will determine whether to activate the wing or use facility evacuation procedures. If evacuation is implemented, then do not re-enter the building until the gas company representative declares it safe.

1. When gas is smelled notify the gas company immediately.

Emergency Response
The Emergency Response Leader/Disaster Coordinator should immediately organize response teams and begin procedures to:

1. Check for and confirm existence of fires
2. Determine if evacuation is necessary

If the structural integrity of the building is in doubt, an outdoor evacuation should be implemented

3. Check utilities and do whatever is necessary to minimize any danger
4. Determine the need for emergency assistance and summon if needed
5. Check every room (visually, vocally, physically) and account for all Residents and employees
6. Administer first aid and record all cases and treatments
7. Immediately clean up dangerous materials which may have spilled
8. Check that all telephones are correctly “on hook” so system does not indicate “busy” to incoming or internal calls
9. Set up emergency sanitation system or procedures if necessary and do not use water or toilets until lines have been checked for breakage
10. Monitor use of emergency water supplies (including water from hot water heaters)
11. Inventory supplies of food and water and begin planning distribution of food, if situation warrants

Utility line or system damage can further endanger the conditions in the facility after an earthquake. A check of these systems should be initiated as quickly as possible.

Determine which utilities still work and which don’t. Make a note of structural and non- structural damage when checking utilities. Check water and sewage lines, gas lines, and electrical systems.

In most instances, it is advisable to tum off gas lines. If the power is off, flashlights should be used since sparks from a match or light switch could ignite leaking gas. If you smell gas, evacuate the area immediately.

In instances of flooding where Resident rooms are affected, Residents should be evacuated to unaffected areas if possible, or to a temporary site away from the building if necessary.

A room by room check should be made when evacuating Residents during flooding. Do not delay in removing Residents even if water is only a few inches deep. Drowning can occur in very shallow water. If a Resident falls and is unable to get up, shallow water could pose a serious danger.

A broken water main, excessive rain, river flooding, or a broken dam can cause flooding.

1. All residents must be evacuated to safe and higher ground.
2. If flooding is internal, the main water valve shall be closed.
3. Contact the Disaster Director.

The Disaster Director shall contact Core Leaders to arrange for transportation to alternative, safe shelters if necessary.

In the event of chemical or other toxic contamination in the facility, an assessment should quickly be made to determine if fumes or other effects may be dangerous to Residents and Employees. If an imminent danger exists, Residents and Employees should be evacuated from the area immediately. If the situation cannot be contained to a confined area of the building, full evacuation may be warranted.

If spills or other contaminations can be cleaned up or removed without danger, Employees should begin such removal immediately, following manufacturer instructions if available. If removal cannot safely be completed by Employees, emergency assistance should be summoned immediately.

If you smell gas or noxious fumes, evacuate the area.

When you are aware of a hazardous materials contamination, evacuate the area immediately. If appropriate, stand upwind from any fumes.

1. Call 911, identify the problem and give the facility address and location of the contamination.
2. Follow procedures as if it were a fire.
3. Fire or police will assume command.
4. Notify the Disaster Director.

If a bomb threat is received, stay on the phone and follow these guidelines:

1. Prolong the conversation as long as possible.
2. While you are on the phone, try to flag someone down or attract his or her attention.
3. Do not alarm the caller so that she or he hangs up.
4. It is imperative that you get as much information as possible.
5. Let staff person know there is a bomb threat call and to call 911 immediately.

Make notation of any clues or evidence that can later be used to identify the caller, including:

1. Date and time call was received
2. What telephone line the call came in on
3. Distinguishing background noises (music, voices, airport, church bells, etc.)
4. Distinguishing voice characteristics (young/old, man/woman, accent, breathing, angry, vocabulary, raspy, etc.)
5. Ask where the bomb is placed and when it is to explode.
6. Did the caller indicate knowledge of the facility by location description?

Previous experience has shown that publicity generates threats. Therefore, it Is imperative that publicity be minimized (see Bomb Threat Report).

1. Call 911 to report a bomb threat.
2. Do not tell anyone except the person in charge that there has been a bomb threat.
3. Call all staff to front desk.
4. Begin evacuation procedures.
5. When emergency personnel arrive, assist as directed.

Bomb Threat Report

1. Prolong the conversation as long as possible.
2. While you are on the phone, try to flag someone down or attract his or her attention.
3. Do not alarm the caller so that she or he hangs up.
4. It is imperative that you get as much information as possible.
5. Let staff person know there is a bomb threat call and to call 911 immediately.
6. Date and time call was received
7. What telephone line did the call come in on?
8. Distinguishing background noises (music, voices, airport, church bells, etc.)
9. Distinguishing voice characteristics (young/old, man/woman, accent, breathing, angry, vocabulary, raspy, etc.)
10. Ask where the bomb is placed and when it is to explode
11. Location
12. Time bomb is to explode
13. Did the caller indicate knowledge of the facility by location description?
14. Name of person receiving the call

All residents will remain in the building until the Disaster Director receives instructions from the local fire department, police department or emergency broadcast system.

If it becomes necessary for residents to be moved to a fallout shelter, the charge person will activate the appropriate evacuation procedure.

Any resident injured should be immediately evacuated to the nearest local hospital.

All residents should remain in the building until the focal authorities have given instructions.

The Disaster Director will activate the evacuation procedures after notification that evacuation is required.

Procedure Ash Fallout
The person in charge will direct the following procedures:

1. Close all windows and doors.
2. Turn off all outside fans and air conditioning units.
3. Put wet towels along the bottom of doors and windows.
4. Check on those people with oxygen tanks and make sure they have an adequate supply.
5. Maintenance will check to insure the emergency generator has a backup supply of filters.
6. The charge person, if required and upon notification, will activate the evacuation procedures.

The Disaster Director will direct the following procedures.

1. Close all windows and doors.
2. If evacuation becomes necessary, activate the evacuation procedure and transport to the off-site location.
3. Assist and follow instructions of local emergency personnel.

Staff should be prepared to be indoors during all wind storms, staying away from all windows.

1. Contact the facility administrator.
2. All staff shall assist all residents in taking cover in safe areas.
3. In the event of a need to evacuate, the staff shall contact the administrator. The administrator will initiate the evacuation procedure

Quickly determine the most reasonable way to protect residents, yourself and staff:

Get out

1. Exit quickly as possible
2. Leave all belongings behind
3. Get as many residents and staff out of building as fast as possible. When safe call 911

Hide out

1. Hide in inconspicuous places
2. Cover yourself and residents
3. Call 911 if possible
4. Remain quiet and still

Keep out

1. Lock/deadbolt all entrances/exits
2. Block all entrances /exits with heavy objects Call 911

Cooperate and assist emergency police/fire once they arrive.

Stay calm

It is the policy of the facility to have a disaster kit on each floor of the building.

The following items are located in kit:

1. Emergency Telephone List
2. Disaster Tags (3×5 cards, tie strings)
3. Notebook with Admission Face Sheets
4. Envelopes for valuables
5. Pens, pencils
6. Writing tablets
7. Battery operated radio
8. Flashlight and extra batteries
9. Safety pins
10. First Aid Kit
11. Plastic bags, different sizes
12. Evacuation location agreements
13. Copy of the Disaster Plan

The Maintenance Supervisor is responsible to ensure that the Disaster Kit is updated with current supplies and information.

During facility-wide or isolated emergencies, it is important that staff act quickly when coming upon individuals in need of medical assistance. Staff must be prepared to provide temporary assistance to an injured or sick individual until a physician’s aid can be obtained. Each situation will dictate the full course of action required. However, during most instances of injury or other medical emergency, 911 emergencies should be contacted, and the individual examined by a physician,

If staff encounter someone in need of assistance or who is not responsive, the following actions should be taken immediately:

1. Keep calm – do first things first
2. Examine the victim
3. Call for help – arrange for medical assistance (911)
4. Begin necessary action
5. Protect against further injury
6. Avoid unnecessary movement or action that might cause further damage
7. Continue necessary action until medical personnel take over

Quick reference First Aid guides are included with these policies, and should be posted in areas readily accessible to Employees.

Notification Procedures

During medical emergencies, contact and notification should be made under the following guidelines and order:

1. Emergency 911
2. P.N. if on duty
3. Administrator
4. Medical Services Director (as appropriate)
5. Relatives or Representative (contact made by Administrator, Assistant Administrator or Medical Services Director when possible)
6. DSHS as appropriate

Examining A Victim
If a staff member finds a collapsed or injured person, a quick assessment of condition and emergency needs should be made immediately. The staff member should then call for assistance, giving any information regarding the victim’s condition. Staff should look for signs of injury, speak to the victim, listen for a response, and scan the immediate area for any identifying clues to the situation.

Conscious Victim
If the person is conscious, ask if he/she is hurt. If the person has fallen, broken bones may be involved. If there is any possibility of broken bones, do not move the person until medical help arrives, except to perform life saving techniques. Find out where it hurts. If that area cannot be moved by the victim, do not move him/her.

If bleeding or signs of other conditions exist, act accordingly for the situation. If possible have the victim quickly explain how the situation occurred. This may assist your actions.

Determine that the conscious victim is coherent if necessary. Ask his/her name, where he/she is and what day it is. If the victim is not coherent, take added caution before moving.

Unconscious Victim
If the victim does not respond to verbal approaches, further determination of responsiveness is required.

1. Shake the individual’s shoulder and ask if he/she is all right.
2. If there is no response, determine if he/she is breathing.

Look at the chest and stomach for movement.

Listen for sounds of breathing.

Place your cheek near the victim ^l s mouth and nose and feel for breath on your cheek.

3. If the victim is not breathing, roll him/her onto his/her back (if not already in this position).
4. Check again for breathing.
5. If the victim is not breathing, begin artificial respiration.
6. 6) Check for a pulse – begin CPR if there is no pulse.

If the victim is unconscious but still breathing and has a pulse, determine if an immediate injury exists. Look for bleeding, bruises and contusions, or burns. Take appropriate actions.

Major Emergencies
Major emergencies are acute life-threatening situations, including non-responsiveness (no pulse or respiration), severe bleeding or amputation, blocked airway„ convulsions, shock, etc. Immediate and correct action in these situations may save a life. 911 should be called immediately in a major emergency.

General Action (See the Quick Reference guide)

1. Breathing has stopped – Start CPR
2. Bleeding is heavy – Control blood loss
3. Shock is present – Treat the prevailing injury and counteract shock

Minor Emergencies
Minor emergencies are non-life threatening injuries, which may or may not require emergency response assistance. However, most minor injuries should be followed up through the individual private physician if the person is not treated by paramedics or hospital personnel.

Minor scrapes, cuts or burns may be appropriately treated by facility personnel trained in First Aid. However, each incident must still be documented and followed up as called for by the condition. The Administrator or the Resident Care Director will make the final decision if the individual should be referred for further medical attention.

Broken bones, sprains, dislocations, moderate or severe burns, eye injuries, moderate or severe cuts, scrapes and punctures should be referred immediately for medical attention.

An incident report must be completed after any emergency situation in the facility; after any incident jeopardizing or affecting the health, life or safety of a Resident, staff member or visitor; or in any incident of neglect, abuse, exploitation or accident involving a Resident.

All incident reports must be completed by staff directly involved or personally witnessing the incident. Staff involved in the incident are responsible for fully documenting the incident. All reports should be to the point and indicate what was seen not what someone believed to have happened. All pertinent information that may affect the situation or follow-up to the incident should be included. Relative information should also be included in Resident Progress Notes.

Staff are required to follow Trouves Policy 4.02 Report of Incident.

Artificial Respiration (Mouth-to-mouth)

1. Wipe out foreign matter in mouth.
2. Tilt head back so chin is pointing upward.
3. Pull jaw into jutting out position.
4. Open your mouth, place tightly over victim’s mouth. At same time pinch nostrils shut.
5. Blow into victim’s mouth.
6. Remove your mouth.
7. Repeat blowing effort 12 times per minute for adults. 20 times per minute for children.

Bleeding – Hemorrhage

1. Apply firm, steady pressure with gauze pad or clean cloth, directly over wound.
2. Elevate bleeding part whenever possible.
3. Use tourniquet only for life-threatening bleeding that cannot be controlled by any other means.
4. When bleeding is controlled, apply pressure bandage over gauze pad.

Amputations

1. Control bleeding with direct wound pressure or tourniquet if necessary.
2. Tourniquet – Use only as a life-saving measure.
   1. Select a wide, flat strip of rubber or wide band of cloth.
   2. Place tourniquet above wound as close to it as possible.
   3. Once applied, tourniquet should be released by a physician only.
   4. Label or tape prominently on person the word “tourniquet” and the time applied.
   5. Do not cover or obscure tourniquet.
3. For partial amputation, support injured part with bandages and splints.
4. For complete amputation, preserve severed part; wrap in sterile or clean material and send to hospital with person.

Shock

1. Treat underlying cause.
2. Keep person lying down with feet elevated and head low. (Exception: in case of head or skull injury, do not lower level of head)
3. Preserve body heat. Do not over-heat.
4. Give artificial respiration as needed

Seizures – Convulsions

1. Convulsions or epileptic seizures usually end spontaneously.
2. Do not restrain individual, but protect from injury. Do not place any object in the victim’s mouth.

Heart Attack

1. Keep person warm and quiet in position most comfortable.
2. If breathing and pulse have stopped, begin CPR.

Continue these procedures until the person is under competent medical care.

Fractures – Dislocations – Sprains

1. Because these three conditions can easily be confused, and because the signs of a fracture aren’t always obvious, treat all as though they were fractures.
2. Avoid all unnecessary movement.
3. Support limb in as natural a position as possible without causing discomfort.
4. Splint limb so that broken ends do not move. Immobilize joints above and below injury. Use boards, layers of newspaper or pillow.
5. If no open wound, cold compresses or ice bag may be applied.

Burns – Chemical

1. Immediately flood burned area with water. Continue for 15 minutes.
2. Remove any chemical soiled clothing.
3. Apply sterile dressing to the burn.

Burns – Thermal

1. Place burned part in cold water, or cover directly with cold, moist compresses.
2. Avoid use of ointments or grease, especially if person is being sent to physician or hospital.
3. If large area is burned, cover with clean, cool, moist material.
4. 4) Treat shock and refer for medical care.

Eye Injuries – Chemical Splashes

1. Wash eye immediately and thoroughly with plentiful amounts of water for 15-20 minutes.
2. Apply sterile bandage and send to physician.

Cuts – Scrapes – Punctures

1. Wash wound with soap and water.
2. Cover with sterile dressing.
3. Check with physician for punctures, dirty or soil-contaminated wounds.

Bruises – Contusions

1. Apply cold compresses or ice bag.
2. Keep injured part at rest.
3. Refer to physician if unusual soreness persists, or if injury is extensive and an underlying structure has possibly been injured.

Situation 1
Status:

1. No safe water.
2. No refrigeration.
3. No cooking or serving facilities.

What to Do:

1. Rely on canned and packaged foods eaten cold, directly from the container. Save tin cans for possible future use as eating utensils.
2. Use juice from canned fruits and vegetables for water.
3. Serve foods only in containers that can be held in the hand.

Situation 2
Status:

1. Safe water.
2. Some kind of improvised or existing cooking facilities.
3. Some safe receptacles for food and drink (tin cans or paper serving supplies.)

What to Do:

1. Serve a simple one dish meal such as hot soup, stew, bread or crackers and a hot drink.
2. If water for cooking is rationed, use vegetable juice and canned soups as liquid for cooking
3. Use water ration for coffee and tea.

Situation 3
Status:

1. Some water.
2. No utilities.
3. Central kitchens with cooking facilities converted to LP gas.

What to Do:

1. Some water.
2. Serve one dish meal, bread or sandwiches with fillings not subject to quick spoilage and an easily handled beverage.

* If Safe Water Supply Is Unlimited, FrozenConcentrate, Reconstituted Is More Desirable.

> Repeat this menu pattern if necessary.

> Plan to use foods in order of their keeping qualities. Perishable fresh foods — prepared foods on hand, etc.

St. Ann’s has emergency food kits on hand to meet emergency food needs. The Dietary Manager will monitor and replaced expired food kits.

This procedure establishes minimum procedures for responding to various emergencies in our facility. This procedure applies to all of our company employees, all contractors and vendors performing work on company property, and all other individuals who are visiting or have business with our company.