Kentucky LTC Lessons Learned During Catastrophic Earthquake Disaster Exercise

1. Kentucky LTC Lessons LearnedDuring Catastrophic Earthquake Disaster Exercise Betty Shiels, PhD-C, LCSW Institutional Director OVAR/Geriatric Education Center University of Louisville Kent School of Social Work

2. Session Objectives Upon completion of this session, learners should be able to: 1. Identify the scope of National Level Disaster Exercise 2011 (NLE 2011) 2. Describe issues of special interest for Long Term Care in a no-notice catastrophic disaster, such as an earthquake 3. Discuss lessons learned from the experience of KY LTC in the May 2011 National Level Exercise (NLE)

3. National Level Exercise 2011 • Congress mandates annual national level disaster exercise (NLE) • NLE is --directed by the White House --involves all appropriate federal level departments and agencies --involves regional, state, county and private sector participation

4. National Level Exercise 2011 • May 16-20, 2011 • Scenario based on the New Madrid Earthquake of 1811-1812 • 8 states impacted TN, KY, IN, IL, MO, AR, AL, MS • Population larger than CA • Scenario 7.7M Image courtesy of U.S. Geological Survey

5. Earthquake Hazards, U.S. Image courtesy of U.S. Geological Survey

6. Impact felt over a much larger area Source: U.S. Geological Survey

7. New Madrid Earthquake Scenario • Effect 8 states and 4 FEMA regions • 715,000 buildings damaged • 42,000 search and rescue personnel working in 1500 teams • 425,000 breaks and leaks to both local and interstate pipelines • 3,500 Damaged bridges • 2.6 million households w/o power • 86,000 injuries • 3,500 fatalities

8. Earthquake Response Time Phases Steady State Immediate Response Deployment Employment & Sustained Response Short-Term Recovery E Phase 1 - (no notice event) preparedness activities Phase 2a - local/regional response, gaining situational awareness, activation, and the movement of resources to incident support bases Phase 2b - deployment of resources to staging areas near the incident site Phase 2c – utilization of resources and sustained response Prior to Earthquake (E) E to 24 hours 24 hours to 72 hours 72+ hours to 30 days 30 days to 60 days Phase 1 Phase 2a Phase 2b Phase 2c Phase 3a

9. KY LTC and Medically Fragile Surge Vulnerability

10. KY LTC Earthquake Initial Response Three likely options: • Facility is so damaged it must evacuate to the nearest safe building and operate as a self-sustained LTC shelter for up to 4 days with no power, water supply, communications capability, etc. and facility is ultimately evacuated to long term evacuation camps of 5,000 persons for up to 6-12 months. Facility will never reopen • Facility is significantly damaged and must evacuate to other LTC outside of the area for up to 4 weeks. • Facility has some damage and access/egress are blocked by trees and downed power lines. Sheltering conditions include generator power, no communications capability, depleting fuel supply with no resources available for up to 2 weeks.

11. Case Study II: LTC Evacuating During a No-Notice Catastrophic Disaster Scenario--The long term care facility cannot sustain operations due to the catastrophic nature of the disaster and unsafe conditions of your building. All ambulances and emergency response vehicles are being utilized for community injured or fatalities. Your facility must evacuate to the closest safe building and take all equipment, supplies and records necessary to operate for up to 4 days. After that, residents will be evacuated to regional evacuation camps of 5,000 evacuees for up to one year. The long term care facility will never reopen. • What equipment, supplies, medications, etc. will you want to take in order to be self-sustaining for 4 days? • What transportation options might you consider to move residents and supplies? • What facility records would you want to take and/or have available off-site? • What resident information would you take to prepare for long term evacuation?

12. KY LTC Preparedness Activities 1. Damage Assessment templates, Life Safety reports, and Resource requests 2. Communications Planning -- locations of satellite phones in each county -- LTC protocols for sending damage assessment, life safety report, available bed count and supply needs to satellite phones and county emergency operations center 3. Evacuation and Shelter-in-Place Planning 4. LTC surge to LTC and Hospital Surge to LTC

13. NLE Earthquake Exercise Outcomes for Long Term Care • KY Emergency Operations Plan now includes LTC emergency planning and response protocols • KDPH Emergency Operations Center added LTC representatives to provide support and assistance to statewide LTC disaster response • Kentucky Div. of Emergency Management added LTC to the KY Critical Infrastructure (Tier-Two) for priority response

14. NLE Earthquake Exercise Outcomes for Long Term Care • Recent flooding across western KY provided real-life application of effectiveness of LTC/KDPH earthquake preparations • LTC in Kentucky unable to respond to surge needs during disasters due to regulatory barriers • NLE activities created dialogue and partnerships with the KY licensing authority regarding existing surge barriers • Change may be occurring as Kentucky long term care facility accepted surge evacuees from Missouri during the most severe Midwest flooding

15. NLE Earthquake Exercise LTC Key Collaborations • State LTC Associations • KY Dept. for Public Health (KDPH) • Hospital preparedness Program • KY Division of Emergency Management • County Emergency Managers • Departments of Veterans Affairs • KY Hospital Association. • KY Office of Inspector General • KY LTC Ombudsman Program • KY ESF #8 (FEMA Emergency Support Function for hospitals and healthcare)

16. NLE Earthquake Exercise KY LTC Lessons Learned • Know what is in your state’s Emergency Operations Plan (EOP) • Make sure it adequately covers frail elders and those with functional needs • Ensure the state EOP includes protocols for when and how to request Presidential Declaration of Emergency and Public Health Emergency • Ensure the state EOP includes protocols for when and how to request DHHS 1135 Waiver • Educate LTC and hospitals about DHHS 1135 Waiver

17. NLE Earthquake Exercise KY LTC Lessons Learned 6.Evacuation and surge planning cannot start soon enough—Exercise, exercise, exercise! 7. Hospitals may be as uninformed as LTC about surge expectations, nursing staff, supplies, etc. 8. Work with the state’s Alternate Care Site and Special Medical Needs shelter planning group 9. Incorporate shelter protocols for LTC evacuation regardless if shelter is ad hoc or established special medical needs shelter 10. Create LTC job action sheets for public health nurses and medical volunteers at shelters

18. NLE Earthquake Exercise KY LTC Lessons Learned 11.Know the local, state and federal systems involved in disaster response and their roles, particularly • County and state Div. of Emergency Management • State ESF#8 Coordinator • U.S. Public Health Service

19. NLE Earthquake Exercise KY LTC Lessons Learned • Bariatric LTC residents among the fastest growing population in Kentucky nursing facilities. Many facilities have 5 or more bariatric residents. Issues specific to bariatric evacuees include: --not enough ambulances that can hold bariatric patients, insufficient bariatric stretchers or wheel chairs --shelters do not have enough bariatric cots to fill the demand --take air mattresses to shelters to put under bariatric residents as they fall through the cots or break cots and can be injured --take facility blankets, pillows and wedges to help assist in turning bariatric evacuees for skin/wound care. --use manual lifts at shelters to move bariatric evacuees

20. NLE Earthquake Exercise KY LTC Lessons Learned • LTC evacuee records need to include last physical exam information, medications, dietary issues swallowing condition, allergies, special services received, i.e. feeding tubes, dialysis, etc. • Resident evacuee identification needs name, etc. and current photo for matching 2 IDs to receive medical care. • Develop a coterie of volunteers and family members to assist at shelters for one-on-one attention for cognitively impaired. • Bring cards, games, bubbles, children’s games and toys to entertain cognitively impaired.

21. NLE Earthquake Exercise KY LTC Lessons Learned 17.Plan on 5-days supply 0f food for 3 days of sheltering-in-place as disaster response requires added caloric content in order to sustain responders/staff. 18. Expect resident and staff family members to show up to help if the facility shelters in place and they may need food and shelter. 19. Assess the facility’s emergency supply of food, water and fuel every 3-4 months . 20. Review the facility’s security plan before a disaster as the facility can become a target for drug-seekers.

22. More Information Betty Shiels, PHD-C OVAR/GEC at UL 426 W. Bloom St. Louisville, KY 40208 (502) 852-8003 betty.shiels@louisville.edu OVAR/GEC Website: http://www.mc.uky.edu/aging/gec.html Funding through KCHFS/KDPH 2010-2011 grant #PON2-728-1000004025-2 UK and UL Emergency Preparedness for Aging Training Grant