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Are you Ready ???


Items such as; thickened liquids, food blenders, diabetic items, and special diet needs. ... beds with key information such as, O2, diabetic, diet, etc... – PowerPoint PPT presentation

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Title: Are you Ready ???

Are you Ready ???
  • Evacuation of a 130 Bed Skilled Nursing Facility

Linden Grove Health Care Center Puyallup, WA
  • Flood Evacuation January 2009
  • Dianna Hart, ARNP, Interim Administrator
  • Lisa Johnson, RN, DNS
  • Erwin Steinlein, Director
  • Environmental Services, Health Safety

  • The Puyallup River river is approximately ½ mile
    from the facility
  • The initial estimated flood crest of 39 feet
    could have resulted in 1-2 feet of water in our

Due to the situation an evacuation order was
initiated by the City of Puyallup Emergency
  • To relocate 99 wheel chair bound residents to a
    shelter required the assistance of Pierce County
    Transit Shuttles.
  • Each shuttle transported 5 wheel chair bound
    residents 1 employee
  • In addition 24 of our most acute residents
    required ambulance transportation to our sister

  • Nursing Medical 1st Priority
  • Dietary 2nd PriorityThese items included
    specialty needs which Red Cross would not have
    been able to supply. Items such as thickened
    liquids, food blenders, diabetic items, and
    special diet needs.

  • Due to limited time, resident personal items
    could not be packed for evacuation. Using the
    unmarked clothing racks allowed us to gather warm
    cloths for immediate use.

  • Preparing resident loading.
  • One check out station for residents going to the
  • Resident charts medication cards were placed in
    bags attached to the back of each wheel chair.
  • A triple check of residents was accomplished
    prior to departing the facility.

  • A single line operation was used for loading of
    residents. This allowed one side of the hall to
    remain open for other emergency operations.

Evacuation ShelterInitial Set-up Bed down
Nurse Station Set-up Organization
Sleeping ArrangementsNOTE Cots are grouped in
clusters of Four
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  • We began transporting residents back from the
    shelter using our facility bus. As we waited for
    assistance from Pierce County Transit Shuttles.

Pierce County Transit Support during Recovery
Recovery with aid of Puyallup Central Pierce
Co. Fire Departments
Department/Manager Debrief 1/12/09
  • During the months of October and November 2008
    Department/Manager staff had completed Incident
    Command System (ICS) training and Table Top

Department/Manager Roundtable Debrief
  • Key Points.The facility Incident Command (ICS)
    should have been activated when the situation
    elevated from flood watch to flood warning. If
    the facility IC had been activated many of the
    problems we encountered would not have occurred.
  • NOTE The facility was given 45 minutes to begin
    the evacuation process.

  • Some residents felt we could have had more direct
    communications with them. They felt more updates
    of the situation could have been provided.
  • Family Notifications The facility could not
    contact some families due to disconnected
    numbers, etc...
  • Handling high volume of incoming calls
    dissemination of messages received. During the
    process the main lobby area became very congested
    and loud making it difficult for the
    receptionist.-- Suggest forward calls from the
    main lobby reception desk to an office area.--
    Advise sister facilities Corporate offices to
    call an alternate number. We have two fax line
    numbers that can be used with analog phones in
    the Nurse Case managers office.
  • Difficulties with communicating with Command
    General Staff The facility does not have
    radios so we had to physically hunt down and
    send runners to communicate.

Communications cont....
  • Lack of direct contact with key personnel of the
    ICS Command staff and the co-located Director of
    Nursing (Operations) at the Shelter.
  • The use of personal cell phones created
    communication breakdowns. At one point the DNS
    (Operations _at_ Shelter) was using three different
    cell phones
  • Dissemination of key information was hampered
    because of busy signals
  • Most of the cell phones did not have chargers
  • No way to Talk group (three way call) all key
    staff at one time.-- One suggestion is
    standardizing all Revera cell phones or a minimum
    of three per facility to one carrier that has,
    Push to Talk and Blackberry capabilities. Such
    as Nextel/Sprint. The Push to Talk can be
    configure to reach out Nationwide provides the
    capability to one touch group call.
  • Lack of IT support at the Evacuation Shelter. The
    Administrators lap top should have wireless
    capability. If this situation would have been
    expanded in time the ability to access internet
    operations and other reporting and information
    agencies would be non-existent.

Administration Issues
  • Missing payroll edit slips for employees _at_
  • Office support items at the Shelter, i.e.... hole
    punch, pens, paper, etc...
  • A system to identify resident sleeping
    arrangements at the Shelter.
  • --- To address these issues we will assemble a
    Mobile office deployable kit. The kit(s) will
    be stocked with necessary items and located in
    the Emergency supplies shed.
  • Lack of accountability of who was in or out of
    the facility during the evacuation (family,
    friends, employee spouses and volunteers).--
    The facility will go into a full secure condition
    for all exit doors. One person will be stationed
    to monitor the facility door alarms and advise if
    they are breached. Exits used for evacuation will
    be monitored by a single staff member. All
    non-emergency responders will sign in/out.
  • Residents discharged in care of family members
    will assemble at a predetermined location for the
  • Nurse to provide discharge instructions,
    discharge documentation, final check of
    medication requirement, ensure medical records do
    not go with resident for all that will NOT be
    evacuated to a shelter.

Medical Supplies
  • Shortfalls in the central supply area.
  • The Central Supply person was out ill. Preparing
    needed supplies took a long time to ready for the
    evacuation (labeling issues).
  • Cross training was already started but not fully
    in-place to address this issue.
  • Lack of organization.
  • -- For some supplies we did not have enough and
    others entirely too much-- Hard to locate items
    that were on-site at the shelter-- No tracking
    mechanism of what went out in support of shelter
    operations.-- Missing items _at_ shelter, i.e....
    IV pumps, TF pump, IV supplies, just to name a
  • -- Workable method to store and dispense
    medications _at_ shelter
  • -- Workable method to transport medications.--
    Separation of personal care items from other
    medical supplies
  • -- No means of keeping required medications
    cool. (We were lucky that this shelter had a
    refrigerator we were able to use)

Medical Supplies
  • The following are to address some of the
    shortfalls we encountered.
  • 1. Inventory and reorganize the medical supplies
    shed.2. Reorganize the medical supplies
    storage.3. Establish minimum supply levels for
    Attends, wipes, and personal care items and
    store in Emergency Supply shed.4. Separate
    ALL items using color coded bins. Example, O2
    items in green bins, syringes and flush items in
    white bins. These bins will be filled and located
    in the Emergency Supplies shed.5. Develop
    required supplies inventory list and deployment
    checklists6. Laminated inventory lists in
    numerous locations such as, the administrative
    deployment kit, central supply, Emergency supply
    shed.7. Develop supplies check out/in list.
    Tracks what, when and with who8. Using the
    facility ICS assign staff to fill departing and
    receiving positions9. Procure specialty bins
    for medications which can be effectively utilized
    for transport and to disperse medications.10.
    Procure small ice chest for each unit to store
    refrigerated medications.11. Procure and store
    Dry Ice in the facility Walk-in Freezer for
    emergencies12. Procure sets of cotton sweats
    (100-120). Store in vacuum sealed bags.13.
    Develop a supply rotation spreadsheet of items in
    Emergency shed with a shelf life.

Supplies Laundry, Activities, Dietary
  • Laundry Too much for the location, need better
    transport mechanism, need to separate by item
  • Items were transported in can liners and was very
    bulky and hard to handle.-- Without knowledge of
    receiving shelter assets, more blankets, sheets,
    and pillows were deployed than needed from the
    facility. -- Supplies, such as, blankets,
    sheets and pillows, will be placed in vacuum
    sealed bags and stored with deployable items in
    the Emergency shed.
  • Dietary Deployable assets came from inventory
    stock. Means of transport and organization is
    required.-- Procure bins for emergency use.
    Empty bins will be stored in the Emergency
    shed.-- Develop master supply checklist for both
    food and equipment needs. Note, we will always
    prepare to feed altered textures and special
    needs diets.
  • Activities comfort and activity items.--
    Develop a master checklist of supplies.--
    Procure bins. Empty bins will be stored in the
    Emergency shed

Nursing/Medical Records/Documentation
  • Minor issues with transportation. Ambulance
    priority based on medical such as, acuity,
    isolation, etc... .
  • Documentation requirements for EMR transport. It
    was uncertain if standard EMR transport documents
    would be required during an emergency.
  • Issues with resident arm bands. We had to remake
    a few arm bands during the evacuation.
  • Lacked extra forms at the shelter.-- Extra Forms
    to track who had meals _at_ shelter-- Extra Forms
    to manage altered and special diets _at_ shelter
  • Means to label resident beds with key information
    such as, O2, diabetic, diet, etc...
  • Provide a better means of holding medications and
    records. Paper bags were used which worked, but
    are not good in the rain

Nursing/Medical Records/Documentation cont...
  • Suggestions to address issues--- Modify daily
    census to include clinical issues with resident.
    Examples IV, TF, infections, and extra equipment
    needs.--- Assign Case Manager/Unit Nurse to
    perform discharge of residents leaving with with
    family to further enhance our current procedures
    to expedite discharge to home.
  • --- Develop checklist for required documentation
    by type of transport.--- Procure different types
    of arm bands for residents.--- Assemble Medical
    Forms deployable kit with extra forms.---
    Procure water proof bags to hold charts

ICS Command
  • Problems with relocating high acuity residents to
    our Sister Facility. --- Revise facility daily
    census sheet to reflect acuity of residents. This
    would give anyone in the facility information
    needed for transportation request and sheltering
    needs.When given an Evacuation order numbers
    are critical for transportation sheltering.
  • First team out did not have medical equipment
    needed. (i.e. BP cuffs, scanners, test
    equipment).--- Reassess the Medical 1st out
    team equipment list and assemble a 1st out
    Medical deployable kit to store in the Emergency
  • No master list available for deployable
    assets.--- Develop IC books for Command staff.
    These will have copies of all the department
    checklist, Command instruction checklist
    Emergency phone lists. Basically a TO-DO step
    by step check off list by priority.
  • At the initial notification to evacuate we
    experienced some confusion. --- STOP, assess the
    situation, and then proceed with actions
    required. --- The IC Command staff books will
    assist us with moving in the right direction
    regardless of the type of emergency.

Sheltering Issues
  • Some cots were 30-36 inches high which created
    transferring issues to and from wheel chairs to
    cots. In addition we were unsure of cot weight
  • Toileting of residents was difficult with only 2
  • Space limitations. Once cots were assembled very
    little space remained open.
  • Unknown if emergency power was available in the
    event of a power outage. KEY ISSUE power is
    needed for IV pumps, Concentrators, and feeding
  • Need for additional electrical support. As a
    precautionary measure we deployed our facility
    emergency power kit to the shelter. The kit
    contains extension cords, extra flash lights,
    glow sticks, and surge suppressors that were all
    used through the evening to support operations.
  • Although there were issues, the shelter staff and
    volunteers provided a safe warm environment for
    our residents and staff.

  • Even though we had some minor shortfalls the
    overall Evacuation went extremely well. The mass
    evacuation of over 120 residents with
    disabilities is not an easy task to perform.
  • The facility had recently begun training on the
    change over from the Chain of Command to the
    Incident Command System for Disaster Response.
    Having the base knowledge of the workings of the
    ICS is one reason we were able to perform as well
    as we did. The other key factors for our success

Questions Discussion
Revera Health Systems
400 29th St NE Puyallup WA 98372 (253) 840-4400