DISASTER-RESPONSE ISSUES

Your facility disaster-response plan is vital to the safety and well-being of special-needs residents and staff during and following any emergency or disaster. How you organize and assign responsibility for these functions depends on your staffing pattern, the number of residents under your care, their level of physical mobility, and the size of your facility.

Be sure to address and assign responsibility for each function in terms of a staffing schedule. Adapt procedures to fit your needs—daytime, evening, and nighttime coverage or by alternative shift schedules, according to your facility. When a disaster response is activated, each shift should plan at least six hours ahead so the next shift will be able to continue the work already underway and have the benefit of the information posted on the walls to provide a picture of the most current situation (e.g., number of residents injured, locations of damage, availability of drinking water, etc). It is important to remember that the situation will be changing, and planning must be flexible to adjust to and reflect these changes.

Command Center

The command center should be located in a secure area and have sufficient space to accommodate necessary staff. An alternate site should also be selected as a backup. Communications equipment should include telephones, fax machines, cellular phones, and two-way or ham radios, if available. A status board—white board, flip chart, bulletin board—must be available to track response actions, decisions made, staff schedules, status of facility/resident needs, and other disaster- and facility-specific information. Laptop computers and printers are helpful tools, as long as power is available to operate them. A conference room can easily be converted into a command center with the equipment and supplies prepositioned and stored until needed.

Staffing Priorities

If adequate staff are available, disaster-response activities should be undertaken simultaneously, as appropriate depending on the incident, with staff preassigned their primary responsibility. You may wish to establish a preparedness committee of residents, if their physical condition allows, and include members of this committee in both preparedness and response planning for the facility. Involving interested and capable residents and assigning them responsibilities in planning efforts and organized response functions can greatly enhance your overall capability.

If adequate staff members are not available to undertake response functions simultaneously, those functions should be carried out in the following order:

1. Direction and control Determine who is in charge of the emergency response at the time of the disaster. Evaluate the situation and activate response staff as needed. Activate the command center to coordinate emergency activities.

2. Site security. Check and turn off gas and/or electricity. Make sure the emergency generator is functioning and emergency power is on. Turn off the water supply if pipes are broken or leaking.

3. Fire suppression. Check for fires and suppress small fires. Notify the fire department.

4. Search and rescue. Quickly search the facility for people who may be trapped or injured. Assist if possible. Note and record the situation for other responders, including name and location of those trapped.

5. First aid. Administer first aid to injured persons. Note and record injury for assistance from other responders, including name and location.

6. Damage assessment. Inspect facility. Record damage and report to the command center. Request barricades, off-limits signs, and additional support from security or law enforcement as needed.

Community resources will be overwhelmed in a major disaster, and you could be on your own for a long time. Self-sufficiency is required.

Considerations for Handling Special Populations During a Catastrophic Event

Regardless of the size and type of facility, a catastrophic event that requires an evacuation of clients will challenge facility staff in many ways. By thinking of the worst-case scenarios, safeguards and redundancies can be included in your planning that will make the experience much easier for you, your staff, your clients, and the receiving facility. The following are provided for consideration as you plan to manage clients and provide necessary resources and supplies when evacuating from special-care environments.

Planning should ensure

• proper identification and monitoring of patients or clients once they are relocated;

• mechanisms for patient data transfer to continue regularly scheduled treatments and medications after relocation;

• sufficient number of caregivers to ensure proper care of relocated patients/clients at the receiving facility; and

• sufficient support of staff in stressful conditions with time off for proper rest and time with families. Remember: staff at both the receiving and sending facility may be victims of the disaster, too.

Be aware and plan for lack of services and other problems, such as

• water, sewer, gas, and electrical services;

• supplies such as linens, food, medicine, and water for days;

• creative planning for proper nutrition in lieu of hot meals for several days;

• delivery of meals and provision of services in multistory facilities if elevator not operational;

• assistance for patients who need help with activities of daily living;

• fluid loss in patients and staff due to lack of power, air conditioning and/or heating; and

• communication within the facility and to the outside if phones lines or cell connections are down.

Needs of Pediatric Patients

HRSA reiterates that a host of special anatomical, physiological, and psychological considerations leave children more susceptible to the effects of disasters and acts of terrorism. Planning must consider, but not be limited to, special treatment areas for mass pediatric casualties in hospitals, triage areas, and health centers; development of pediatric response protocols, paying special attention to appropriate medications and dosages; pediatric-specific training and exercise procedures; and provision of psychological support to children and families, including methods to ensure reunification of children with family members, as needed (HRSA 2003).