By Jessica Kunkler, MA
In September 2018, Wendy DeCarvalho, RN, DNS-CT, QCP, and her team watched as Hurricane Florence approached their facility, which is located just two hours from the Carolina coast, nestled in a rural area in the flood zone. They banded together to keep their residents, staff, and families safe.
Here’s her advice, based on that firsthand experience, for how to handle emergencies before, during, and after they happen.
Before an emergency:
- Hold mock trainings well before disaster season. “Because we were located near the coast, most facilities in the area had practiced evacuations at some level previously, including ours,” says DeCarvalho. For hurricanes, emergency drills should be held before the season begins (June 1 – Nov. 30) each year. Similarly, if you are in an area that’s at risk for fires, hold mock evacuations well before fire season begins in your area.
- Hold tabletop drills with all of the key players. “In a tabletop drill, gather all of the key players and say: Okay, if a hurricane hits, how does each department respond?” says DeCarvalho. The purpose of the exercise is to identify your facility’s weaknesses before an actual emergency so that you can then plan for how to defend against it. For the drill to be effective, it’s imperative to include key players, including the EMS managers, hospital leaders, and local utilities staff. “If there is no electricity in your city, water pumps may be affected. How will your facility handle this? That’s why a utility like the water department is crucial to include in the conversation,” says DeCarvalho. “Consider everything. Who is your backup doctor? Is there a backup pharmacy that can provide medications?”
- Have extra supplies to accommodate for water and electrical outages. This includes extra linens, disposable wipes, and lots of LED batteries and flashlights. “Although purchasing these items in advance of a potential disaster might seem like a financial hardship, if a federal disaster is declared, you may be able to submit receipts for reimbursement. Keep your receipts,” says DeCarvalho.
- Plug into red outlets. As part of quality checks, make sure that critical equipment—including refrigerators holding medication and food, oxygen concentrators and/or ventilators, powered beds and mattresses, and electric wheelchairs and other life-saving equipment—is plugged into the outlets that will maintain power with generators in case of emergency. Conduct walking rounds to determine if there are adequate supplies of red outlets to meet the needs of the residents and keep them safe.
- Check dates. “During the hurricane, our staff realized that some of the water bottle supplies we were counting on had previously expired,” recalls DeCarvalho. Having learned that hard lesson, she suggests adding date checks to monthly inspections to make sure that the supplies you need aren’t expired when you need them. Plan to rotate your supply of water to avoid this from occurring.
- Plant your generator on high ground. DeCarvalho recalls watching the flood waters inch toward the generator that was powering her facility. “It had been placed in a discreet location rather than on higher ground where it would have been better protected against flood waters.”
- Plan to transfer residents with as much equipment as possible. “Even though the facility you are transferring to might have space available such as conference rooms that can be utilized in an emergency, they likely won’t have beds or specialty equipment that your residents might need.” DeCarvalho also recommends carefully considering how specialty equipment such as, beds, med carts, oxygen concentrators, etc. will be physically transferred with residents if need be.
- Plan to transfer out of the danger zone. Although it might seem easier to coordinate with local facilities, in an emergency, nearby facilities might also be at risk of the same natural disaster. DeCarvalho recommends planning to transfer residents to locations, such as other counties, that you anticipate will remain unaffected.
- Consider a FEMA course. Many leadership staff members at DeCarvalho’s facility completed an introductory online FEMA course on the basics of an incident command system. She stresses how helpful it was: “It taught our leaders a command system that was organized and helpful with planning. The system clarifies who does what, helping leaders to detail an organization assignment list, radio communication plan, and more.”
During an emergency:
- Keep an activity log. Each manager should keep an action log of all activities that they are charged with for their department, maintaining a written record of issues as they develop and are resolved, says DeCarvalho.
- Communicate regularly. She also recommends holding daily stand up and stand down meetings that update everyone on the status of issues. These can become an opportunity for idea sharing and collaboration.
- Use everyone’s ideas. At DeCarvalho’s facility, they were unable to flush toilets when the water system failed in the county. Using the facility’s swimming pool water to flush was an idea that came from a member of the maintenance team. “In emergencies, you will find that everyone becomes solution-oriented and inventive, especially if you encourage them to,” she says.
- Help your staff. “I knew that I wouldn’t be able to work if my family was unsafe and so I didn’t feel like I could ask that of my staff,” recalls DeCarvalho. She invited essential staff to bring their families to shelter at the facility. They were asked to bring coolers with provisions and bedding. “Spouses even babysat small children. The experience made it feel like the facility was everyone’s home, helping everyone to feel invested in keeping it safe.”
- Train on-site. “We offered a quick class on how to serve resident meals to every available staff person—including those from housekeeping and human resources—when we didn’t have enough dietary staff,” recalls DeCarvalho. “Everyone was eager to help however they could.”
After an emergency:
- Debrief on successes and failures. In the calm after the storm, DeCarvalho recommends that you bring together leadership and staff alike to discuss the experience, recording successes and failures. “Use what you’ve learned by building it into the planning for the next emergency.”
- Keep historical data. When you plan for an emergency, keep the information you develop in a shared place in case you move on or are not available for some other reason when it’s needed, suggests DeCarvalho. Detailed plans will help others to keep your residents safe in case an emergency happens when you aren’t there. “Keep notes as if they’re a map for the next person,” she stresses.
- Build safety needs into future budgets. Experiencing an emergency can make very apparent those items that may need to be budgeted for. “After an emergency, build a clear list of supplies and training that should be budgeted for to prepare for the next emergency,” recommends DeCarvalho.
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