EVACUATION: READY OR NOT

1. EVACUATION: READY OR NOT Presented by: Pat Lee, Administrator Pruitt Health Columbia

2. ARE YOU READY FOR EVACUATION • TALL TALE TIMELINE • 5/11/18: 1pm Administrator leaves Pine Mountain GA; Callaway Golf and Spa heading back to Columbia • 3pm Received phone call from Maintenance that unable to cool the facility; outside temp was 100 degrees; inside temp was 82 degrees • 3pm Sent maintenance to purchase portable air conditioners for 12 high temp rooms and hallways: ended up with purchase of 52 portable air units • 6pm: Administrator arrived at facility and it was determined that we were unable to cool the facility. Began to call staff regarding potential evacuation • 9:30pm: Ombudsman arrived at facility and basically ordered the evacuation or an IJ and evacuation • 3am on 5/12/18: Facility is back in temperature compliance • 4:30am Management left to go home for a few hours. • 7:30am team returned to begin evacuation procedure per the emergency manual; Health Care Coalition Called for resources • Buses began to arrive at 10am: 8 Pruitt Buses came to pick up the assigned residents • 6pm: 85 residents were evacuated to 9 different facilities; 44 residents remained in other wing of the facility. • 7pm: Staff schedules were completed and all nursing staff knew where they needed to go to attend to our residents for the next three days.

3. ARE YOU READY FOR AN EVACUATION Items needed for fast emergency evacuation • Bracelets for identification • Name badges for identification • Wheelchairs or geri chair for every resident • Foot pedals for all wheelchairs • Containers for personal items for moving; bags, boxes etc. • Clothing to fit the weather; coats, hats etc. • Bottled water for staff and residents • Incident command vests • Identification of Special Needs Shelters • Emergency Manual with all necessary policy and procedures

4. ARE YOU READY FOR AN EVACUATION • FACILITY EMERGENCY ITEMS • FLASHLIGHTS • PEN AND PAPER • WEATHER GEAR • EMERGENCY CORDS • NOAA RADIO • WALKIE TALKIES • COMS RADIO; health care coalition assistance with this • EMERGENCY PHONE NUMBERS FOR DHEC, OMBUDSMAN AND HEALTH CARE COALITION • EMERGENCY PHONE NUMBERS FOR ALL STAFF • BLACK MARKERS • TAPE • CLIP BOARDS FOR INCIDENT COMMAND STAFF • POP UP TENTS FOR STAGING AREAS • EMERGENCY PLAN FOR EVENT • MEDICAL EQUIPMENT FOR LIFE SUSTAINING PATIENTS • PORTABLE OXYGEN • MUTUAL AID AGREEMENTS

5. ARE YOU READY FOR AN EVACUATION • WHO TO CALL • DHEC LICENSURE; Daily calls • DHEC CERTIFICATION: Daily Calls • OMBUDSMAN PROGRAM: Daily Calls • MIDLANDS HEALTH CARE COALITION: Daily communication • Emergency Management Service County/city • AMBULANCE PROVIDERS • DIALYSIS PROVIDERS • MEDICAL DIRECTORS • USE STAFF PHONE TREE TO CALL ALL STAFF INTO FACILITY TO ASSIST • CORPORATE OFFICE • VENDORS OF SUPPLIES • DOCTOR OFFICES • HOSPITAL EMERGENCY PLANNING OFFICES • HOSPICE COMPANY

6. ARE YOU READY FOR AN EVACUATION • Training for all staff, residents and families • Disaster training is a must for any successful evacuation; Training must include: • Actual movement of patients into safe areas by staff on duty; This teaches them the process and allows the facility to work through any issues that may arise during the training • Location of the emergency manuals and how to properly use the emergency manual tabs • All staff must be trained including the night and evening shifts; housekeepers as well as dietary staff need the training so that they understand their role in an evacuation • Family council meetings to share the evacuation process and the responsibilities of the families in an evacuation as well as how we communicate during the emergency • Resident council meetings to share the evacuation process and how they will be communicated with during an evacuation • Training to take place twice a year with two different focus; examples: Active shooter training and hurricane evacuation training ; table tops are fine but an actual drill to simulate the evacuation is a better learning tool. HVA top 5 training • Do the Health Care Coalition’s OPEN/CLOSED POD training; Assess your facility for flow of access during the evacuation • Incident Command Training is a MUST for the supervisors and those who would be in charge until administrators arrive. • Training for ambulance personnel on their role in an evacuation; This could be a brief one page hand out for them to keep. • Train the staff to know who to call to assist with immediate needs to prepare for the evacuation

7. ARE YOU READY FOR AN EVACUATION • Evacuation Two Parts • Evacuation departing facility • Evacuation returning to facility • DEPARTURE READINESS • Ensure that Incident command is set up and functioning; Are you trained on Incident Command • Ensure that special duty assignments are being followed as set out in your emergency plan • Ensure that Transportation is set up and on alert with a timeline for evacuation • Ensure that Families and residents are notified through the communications policy and procedures; make sure you have a call in number for individual questions by families and residents • Ensure that DHEC knows of evacuation plan and has a daily report on progress • Make sure that all vendors are aware of plan and timeline associated with departure as well as vendor responsibilities in providing supplies and service during the evacuation. • All Receiving facilities are prepared for patients with briefings assigned by incident command • All Receiving facilities have the necessary supplies for the evacuated patients • Medical chart, medicine and personal items are prepared for departure and linked to the resident; Make sure patient equipment is labeled with facility name and resident name; DO NOT forget hearing aides, glasses and dentures. Batteries for hearing aides should also be remembered • Director of Nurses or designee determines which patients are evacuated to which facility; Master sheet is created; Determine if any patients conditions need hospital admission during evacuation or need for an immediate special needs temporary shelter • Ambulance transfer patients are designated and Stretcher transport is arranged. Medical equipment is prepared for transport. • Oxygen supply is on hand for evacuation. • Prior Arrangements are made to transport supplies to the receiving facilities; • Evacuating patients have water for hydration during process; sandwiches or finger food is available for transport • Director of Nurses establishes staffing schedule to follow patients to the evacuated facilities. • Have emergency transfer logs prepared and sent with departing buses • Contact Health Care Coalition Leader to determine what resources they can assist with • Emergency Drug kits are available to evacuated staff to use while in transport or upon arrival at receiving facility • Follow emergency shut down procedures if facility is being closed during the evacuation

8. ARE YOU READY FOR AN EVACUATION • RETURNING READINESS • Ensure that incident command is set up and functioning with strong communication between receiving and departing facility • Ensure that Transportation is set up and on alert for the stretcher transport patients; Establish a timeline for transport • Ensure that Families and residents are notified by following the communications plan ; • Communicate with DHEC so they know of the returning plan and has cleared the facility to be able to return patients • Ensure that All vendors are aware of returning plan and know when to resume regular service • Returning facility must have staging areas set up for receipt of patients; • Ensure that the Facility has enough staff in facility to accommodate the returning patients; • Ensure that vitals are checked upon return as well as verifying that all items sent are returned; • Ensure that a Listing is begun for items that did not return to facility. • Staff assignments are communicated on who will unload buses and take personal items inventory prior to the return of patients to their rooms • Verify that all Medical charts, medicines, personal items are all returned to home facility and checked at the staging area before returning to their resident rooms;; INCLUDE an inventory of glasses, dentures and hearing aides • Notify local hospitals that patients are returning to facility and the facility can begin to admit again • Notify Dialysis centers and Hospice companies that the residents have returned.

9. ARE YOU READY FOR EVACUATION • RESOURCES AVAILABLE • Health Care Coalition Team has a list of resources available to any member of the coalition from SLEEPING COTS to FANS to TENTS • Transportation contracts; Enlist a separate contract for buses to ship supplies or patients depending on the type of evacuation; This allows you to depend on your own transportation in case of a mass evacuation • Staff on leave should be called back to facility to assist with evacuation • Families and volunteers should be called to assist with the evacuation if they are able to get to the facility, this depends on the type of evacuation • Local EMS has resources to assist with emergencies • Local Hospitals for emergency admissions; a previous contract should be in existence prior to the emergency • DHEC will provide situational awareness information if the emergency is wide spread • SCDOT has traffic control equipment and resources available with any traffic management issues that may arise • South Carolina Healthcare Emergency Amateur Radio Team (SCHEART) can assist with communications • Special Medical Needs Shelters are available throughout the state through the DHEC Public Health Department

10. ARE YOU READY FOR AN EVACUATION • LESSONS LEARNED FROM A REAL EVACUATION • Facility needs to make sure that the open/closed POD training is done with facility staff. This will assist the facility with the traffic flow during the evacuation. We did not do this training and our flow was opposite during the evacuation of what it should have been. We did reverse the flow during the return of residents and it was much easier to remove residents from the buses. • Facility needs to understand the resources that the Health Care Coalition has available. Facility must not be shy to ask for the resources. • Ambulance Providers must communicate at the beginning of the evacuation the resources they have available for the evacuation. A count of wheelchair and stretcher ambulances that will be available must be communicated to the Incident Command as soon as possible. • Keep a detailed listing of resources available in the emergency manual not in another binder or file. The list needs to be very specific as to who has the resources and the number of resources available such as cots, water, oxygen etc. • Keep an accurate list of volunteers who can assist in an emergency. Keep the phone numbers current by verifying the numbers annually. • Identify those residents whose family is willing to take them home for a few days during an evacuation. This list makes it much easier during the evacuation to track resident discharge destination. • Develop a form to report daily to DHEC. The form should contain information that DHEC is asking for such as changes to the status of the residents discharged; example; if a resident goes to the hospital or dies this must be reported to DHEC on the daily report. This form is done at the time of the evacuation because DHEC dictates what is needed based on the evacuation type. • Use labels to put on the belongings boxes or bags of the resident. A Marker rubs off and it difficult to read. Box of Labels should be in the emergency supplies box. • Develop a copy team: This team will copy the pertinent parts of the chart to send with the resident. We sent the chart and upon return, parts of the chart were missing. These copies will prevent loss of chart paperwork.

11. ARE YOU READY FOR AN EVACUATION • FINAL ITEMS FOLLOWING EVACUATION • After action report should be completed and copies sent to the following: • A copy of the after action report goes into your fire drill book; your emergency book and a copy to each receiving facility. • Each Evacuation receiving facility can use this as part of their evacuation drills compliance for DHEC • Health Care Coalition gets a copy of after action- Midlands goes to Karen Hutto • DHEC Licensure and Certification: Both need a copy of the full report and documentation- be ready for a follow up visit from Licensure • Ombudsman Program: This goes to the State Director of the Program