It’s hurricane season again, and the fear of such weather-related disasters typically raises concerns about emergency preparedness plans and drills, especially among long term care administrators. But being prepared for reality starts with knowing what the threats are. And hurricanes and fires are not the only threats to facilities.
Each facility is unique, and each should arrange for a hazard analysis performed by a qualified health care disaster preparedness professional to identify the threats that are unique to it.
In doing so, many administrators may be shocked at the number of unique threats that a long term care center faces and must prepare for.

Determine Potential Hazards

A hazard analysis incorporates both identification of the potential hazard and the likelihood of such an event. Depending on a facility’s geographical location, the type of threats may include the following: natural, technological, human, and chemical, just to name a few.
Because of a center’s location, it is important to note that boilerplate programs seldom work; what may be a hazard in Vermont may not be a hazard in Arizona. The facility has to prepare for the threats and potential perils that are common to its location and operations if the plan is going to work.
In addition, for every hazard identified, a written Emergency Operations Plan (EOP) must address the threat and how the facility will respond, mitigate, and recover from the event.
A nursing home’s response to a fire emergency will be much different than its response to an armed intruder or a swollen river a block away.
Keep in mind as well both the fiduciary obligation and risk management implications associated with being the keeper and the caregiver of residents: There must be plans in place for all possibilities, and they must be specific to the facility’s risks.

Drills Versus Exercises

A drill differs from an exercise in that a drill focuses on a single operation, while an exercise focuses on an entire sequence of events. Emergency preparedness drills draw their life blood from what is called the preparedness cycle, which is the process of “planning, training, equipping, exercising, evaluating, and taking action to correct and mitigate flaws in the plan.” What’s more, contrary to popular belief, one per shift per quarter is not the end-all answer. For the hazards that are identified in a facility’s assessment, an administrator must not only develop a plan around the hazard, but also test the plan and train staff.
Drills serve a variety of purposes, including testing the plans, training and testing staff, training residents and family members, and identifying where a plan is weak and needs improvement. Administrators must realize that a plan is always a “work in progress” that continually needs to be updated and maintained.
Drills help to identify where the updates are needed, or more simply stated, where they need to be tweaked in order to make it work the way it needs to work. And drills, to be successful, should be broken down into steps that can later be put together to create an exercise.
Drills should also involve community emergency response/public safety agencies whenever possible. For example, when drilling for a potential workplace violence incident, consider inviting the police to participate in planning the drill, executing the drill, and the post-event review.
Local community agencies can serve as excellent resources in developing an effective plan that creates a state of readiness for virtually all of the hazards a facility may face.
There can be no dispute that drills require planning.

Prepare, Prepare, Prepare

All EOPs should be drilled in four critical areas: planning, response, mitigation, and recovery. All four are critical components of a plan, yet most drills typically focus only on response.
No matter the geographic location, every long term care facility is vulnerable to some type of equally harrowing event and must be prepared for it.
The importance of identifying, planning, drilling, and readying for all hazards a facility can face cannot be over-emphasized. Not only is it prudent from a risk management perspective, but it is something residents and their families trust and count on the facility to do.
Steve Wilder, CHSP, STS, is president and chief operating officer of Sorensen, Wilder & Associates, a Bourbonnais, Ill.-based health care safety/security/risk management consulting group. Wilder can be reached at (800) 568-2931 or at Stan Szpytek is president of Fire and Life Safety, based in Mesa, Ariz., and a consultant for Magnolia LTC Management, a firm that provides loss control, fire and life safety compliance, and emergency preparedness consultation. Szpytek can be reached at or (708) 707-6363. Calvin Groeneweg, RN, C-AL, is director of the Risk Management Department of Northern California Presbyterian Homes & Services, a company that operates and manages facilities for seniors in Northern California. Groeneweg can be reached at or (415) 351-3640.