On an administrator’s first day on the job, a call reaches him at home: There is a fire in the building!
February 2006 wasn’t an unusually cold month for Illinois, but a lack of insulation near the business office of an assisted living community in Illinois was a recipe for disaster.
When a fire broke out, below-freezing temperatures, followed by a brief thaw, caused the plastic fire sprinkler piping to fail, sending water cascading through the ceiling and down the walls onto the floor. One hundred thirty-two gallons (as measured by the water meter) flooded the office, lobby, and adjacent offices. Quick thinking by the staff, generous help from the local hardware store, and expert handling by the fire department’s salvage and damage control personnel limited the damage to $36,000. There were no injuries, no evacuation or relocation of residents. So, were staff perfect in planning for the unexpected? Certainly not. Here’s what they learned.

What Is Required By Law

Local or state laws may require fire department and emergency management services to review and sign off on an assisted living community’s emergency plan. Not to enlist the expertise of these folks is a big mistake—for, after all, it is what they do. Getting input from firefighters before tornadoes, evacuations, power outages, blizzards, or even fire drills occur can help administrators understand what the authorities expect to see in a plan. And most emergency plans should be tailored specifically to each building the company owns or manages.

Local firefighters can provide valuable information on variables such as weather extremes, geographies, and personnel. They can also help administrators develop a specific system that is easy to implement and modify.

A simple approach used by firefighters since the 1970s is called incident management. The Illinois community has, since its emergency, adapted the model to create a simple yet effective and feasible way to respond in the event of another one.

The Centralized Tub System

The plan is straightforward: All the information needed to manage an emergency incident is stored in a plastic tub in the nursing station on each floor. Each tub contains five packets of information with step-by-step instructions and the resources to follow them for fast implementation.

All staff know that when disaster strikes, they should “get the tub.”

Based on incident management principles, the Illinois community divided responsibilities into five sectors, each with its own “commander” and simple assigned duties. Sectors used at the community include Incident Commander, Assistant, Safety Officer, Staging Officer, Financial Officer, and Supply Officer. The sector names can vary, but the plan needs to distribute the responsibilities evenly and keep them simple for each sector. In an emergency, the first certified nurse assistant (CNA) who can get to the tub becomes the Incident Commander. The next CNA becomes the Assistant, and kitchen staff fill the other positions. This simple approach gets the response started even before alerting the corporate office to the situation.
The information packets include key information on no more than two sheets of paper. Packets answer questions such as how to shut off water sprinklers, who has the key to access the water valves, calling 911, an employee contact list, and the administrator’s cell phone number.

Each packet contains information about the specific sector. For example, the Supply Officer’s packet includes instructions for procuring a walkie-talkie, arranging for event-dependent supplies (such as food and water), directing residents to safe havens, procuring an emergency contact list, notifying the hospital house supervisor if evacuation is a possibility, contacting utility companies, and having a face-to-face meeting with the Incident Commander. List all necessary phone numbers on a single sheet of paper, including emergency and after-hours telephone numbers.

Including a master key to the building in the tub was controversial at first, but it is important to trust staff. To slow access to the master key and other content at nonemergency times, the tubs are sealed with wire ties, and a wire cutter is taped to the top.

The Plan In Action

Staff at the Illinois building participate in practice sessions with the tubs every six weeks, with frequent changes to the scenarios. Information in the tubs is reviewed annually. The tubs have helped manage emergencies at the facility, including tornado warnings, a record flood, and six lightning strikes.

This incident management system works for any disaster and can be tailored to any need. However, emergency preparedness is about more than information, so also plan to have emergency supplies on hand. For the Illinois community, supplies include five-gallon jugs of water in the sprinkler room, a portable generator, rechargeable flashlights and batteries for walkie-talkies, and a gas grill big enough to serve 60 residents with food for eight days. Providers have to ask the question, “If we are to be stuck here for a week, what provisions do we need?”     

Being prepared for an emergency needs to be more than just a collection of differently colored binders or a tabbed notebook placed strategically in the business office. A simple plan—with some help from local fire department experts—can help assisted living communities be prepared for any disaster so staff can respond easily and with confidence.
TIM LEADER, RN, RAC-CT, has been a nurse for 25 years. He also has 20 years of experience as a firefighter and paramedic. He can be reached at tfireemsrn@aol.com or (352) 419-7278.