Emergency Preparedness

​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​​AHCA/NCAL provides information and resources to help members respond to an emergency in a timely, organized, and effective manner. ​​​


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What You Need to Know​​​ ​

Monkeypox
In August 2022, the United States declared the ongoing monkeypox outbreak a public health emergency. Learn more about the disease and the warning​ signs you need to watch out for in LTC.​  

COVID-19 Updates​
​​Find the latest information on COVID-19 for long term care providers. This includes infection control practices, regulatory requirements and resources on COVID-19 vaccinations for long term care staff and residents. 

To meet Emergency Preparedness requirements, providers must be able to demonstrate their experience activating their emergency plans through written documentation. This is most commonly accomplished through ​an After-Action Report (AAR) and Improvement Plan. AHCA has developed a COVID-19 AAR Template that members can utilize to document their response and recovery efforts during the pandemic. 
Long term care facilities should prepare to manage potential flu outbreaks and double efforts to encourage residents and staff to take the influenza vaccine. Individuals 65 years or older are one of the high risk groups who can experience serious complications, even death, from influenza infection. Learn more on how to minimize the flu for residents.​ ​
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Active Shooter Preparedness​
HealthCap® offers a free webinar that focuses on key aspects of active shooter events and what to do if your long term care community experiences a threat or real-life active shooter.

 

 

 

Are You Prepared for a Tornado Emergencyhttps://www.ahcancal.org/News-and-Communications/Blog/Pages/Are-You-Prepared-for-a-Tornado-Emergency.aspxAre You Prepared for a Tornado Emergency6/4/2024 4:00:00 AM<p>Each year, hundreds of health care facilities across the nation respond to tornado emergencies with limited warning of potentially catastrophic events. According to the National Oceanic and Atmospheric Administration (NOAA), there were nearly 1,200 confirmed tornado reports in 2023. While much of this activity occurs in the South and Midwest, often referred to as Tornado Alley, numerous tornadoes also impacted other locations across the country where tornadic activity is generally considered rare. Locations in California, New York, New Jersey, Delaware, Massachusetts, Pennsylvania, and Virginia were all affected by tornadoes in 2023. In one case, an EF-3 tornado caused significant damage along a 16-mile path in Lewis County, New York, the county's strongest tornado on record.</p><p>As tornadic activity is already making headlines this spring, long term care facilities should be assessing their preparedness for such events. This includes reviewing procedures, mitigating hazards, providing training, and testing plans through drills and exercises. Tornadoes are a unique emergency event requiring comprehensive procedures specifically tailored to an organization's needs, resources, and capabilities.</p><p>Consider some of these key questions while self-assessing your organization's readiness:</p><ul><li>Do you have specific procedures that address response actions for when a Tornado Watch or Tornado Warning is issued in your area?<br></li><li>Have you identified designated interior rooms or hallways on the lowest level of the building that can serve as tornado shelter spaces?<br></li><li>Are tornado alerts included in your emergency preparedness training program, including how to receive severe weather notifications and how to assist residents with sheltering in the building?</li><li>Do you maintain a weather alert radio or monitor <a href="https://www.weather.gov/nwr/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">NOAA Weather Radio</a>​ in a constantly attended location to ensure you receive timely communications of weather watches and warnings?</li><li>Have you identified where you will place exterior furniture, signs, and other outdoor items if there is the potential for them to be swept away or become projectiles?</li><li>Are utility shut-off locations clearly identified, with tools and instructions available, so that any staff member can access these locations around the clock if they need to be shut off during an emergency?</li><li>Do you have a full building evacuation plan that includes an agreement with a local stop-over/staging location if immediate evacuation is required?</li><li>Do you have agreements with other healthcare providers, both neighboring and distant, if you cannot return to your building in the short term?</li><li>Do you maintain essential supplies to support a prolonged need to shelter in place, such as water, non-perishable food, flashlights, batteries, first aid supplies, and medications?</li><li>Do you have a quick and reliable method to communicate with staff and resident families to provide information and instructions?</li></ul>The National Weather Service (NWS) provides numerous tornado safety resources. They can be accessed directly at <a href="https://www.weather.gov/safety/tornado" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Tornado Safety (weather.gov)</a>. Additionally, you can find a variety of helpful emergency preparedness tools and resources on AHCA's emergency preparedness webpage at <a href="/Survey-Regulatory-Legal/Emergency-Preparedness/Pages/default.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">Emergency Preparedness (ahcancal.org)</a>.   <br><p>​<br><br></p>
Conducting Effective and Compliant Fire Drillshttps://www.ahcancal.org/News-and-Communications/Blog/Pages/Conducting-Effective-and-Compliant-Fire-Drills.aspxConducting Effective and Compliant Fire Drills3/1/2024 5:00:00 AMFire drills are a key component of any fire safety program. While the Life Safety Code® (LSC) requirements for fire drills are not complicated, fire drill compliance consistently lands on the list of top cited deficiencies during life safety surveys (K-712). As such, let's walk through the key requirements and best practices around fire drills.<br><br>Fire drills in healthcare occupancies are required to be conducted quarterly on each shift. This is commonly accomplished by facilitating a fire drill each month on a different shift. However, there is nothing that precludes an organization from running multiple fire drills in a single month as long as each shift receives a drill during the quarter. <br><br>Fire drills should be conducted at varying times and under varying conditions. While the LSC is not specific regarding what constitutes “varying times," it is wise to consider varying drills by at least one hour for drills conducted on the same shift. Similarly, drills should be facilitated in different parts of the building and with different scenarios.  Simulating the same fire scenario in the same location limits the involvement of staff from other areas of the building. It can be beneficial to develop a fire drill schedule at the on-set of each year that outlines fire drill dates, time, locations, and scenarios. This will provide a helpful roadmap to the fire drill facilitator and ensure compliance is maintained regarding the variance in time, location, and conditions. <br><br>While not specifically required by the LSC, there is an implied expectation that fire drills will be documented. Documentation is your mechanism to prove fire drill compliance during survey. An effective fire drill report will include all the details around the drill including date, time, location, facilitator, and actions taken by staff…specifically any areas for improvement. The reports can be an effective tool for assessing staff competency and identifying trends. It is also wise to maintain a sign-in sheet for each drill to document the staff that were involved. <br><br>Fire drills require activation of the fire alarm system including the normal audible and visual notification devices. However, for nighttime fire drills that occur between the hours of 9:00pm-6:00am, a coded announcement (commonly an overhead page) is permitted in lieu of activating the fire alarm system audible devices. Visual devices are still required to be activated. If and when CMS adopts a newer edition of the LSC, both audible and visual devices will be permitted to be omitted during overnight fire drills.  Overnight fire drills always require staff response and implementation of the fire procedures. <br><br>Compliance aside, fire drills can be an extremely effective educational opportunity. Realtime implementation of the fire procedures in a staff member's normal work area can be more memorable and impactful than a training lecture, video, or on-line course. Completing the drill may check the compliance box, but investing the time to facilitate a well-organized drill that includes a comprehensive staff critique will pay dividends during a true fire emergency occurrence.  <br><br>As always, knowledge of the applicable codes and standards is your best tool for ensuring compliance. You can purchase a copy of the Life Safety Code® (NFPA 101) online at <a href="http://www.nfpa.org/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">www​.nfpa.org</a>. The <a href="/Survey-Regulatory-Legal/Pages/Fire-Life-Safety.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">AHCA/NCAL website</a> is also a good source for on-going life safety education, tools, and resources. ​<br><br>
Managing Hazardous Area Compliance – Life Safety Compliance https://www.ahcancal.org/News-and-Communications/Blog/Pages/Managing-Hazardous-Area-Compliance-Life-Safety-Compliance.aspxManaging Hazardous Area Compliance – Life Safety Compliance 2/22/2024 5:00:00 AM<div><div>The Life Safety Code® has long required special protections for “hazardous areas."  Locations commonly considered under this designation include storage rooms, soiled utility rooms, boiler rooms, maintenance workshops, and bulk laundry areas. While the provisions for these areas have not greatly changed in the Life Safety Code® over the years, compliance with the requirements specific to hazardous areas continues to be a top five finding nationally (K-321). <br><br>For existing hazardous areas (in place prior to July 2016), these spaces are required to be enclosed with smoke resisting construction (assuming the room is provided with sprinkler protection). This means no louvers, half-walls, open alcoves, or any type of unprotected opening to the corridor. Doors shall be self-closing and positive latching. However, doors are not required to be rated. <br><br>If the hazardous area was constructed after July 2016, or the space lacks sprinkler protection, a 1-hour fire resistance rated enclosure is required. This includes a ¾ hour rated door assembly that is self-closing and positive latching.<br><br>Like so many new focus areas and challenges brought on by the pandemic, the emphasis on personal protective equipment (PPE) has created some unintended consequences regarding Life Safety Code® compliance. With various states mandating significant PPE quantities to be on-hand, some organizations have been forced to create new storage locations. This sometime involves the repurposing of existing spaces that were utilized differently in the past. In many cases, this essentially creates “new" hazardous areas.</div><div><br></div><div>Historically, if an organization looked to convert an existing space into a storage room, for PPE or any type of combustible storage, the conversion of the space triggered the provisions for “new" construction in the Life Safety Code®. However, such rooms or spaces usually do not have 1-hour rated enclosures. <br>​<br>The 2012 edition of the Life Safety Code® provides some potential relief to organizations who are converting existing spaces into storage areas. The 2012 edition includes a new chapter (Chapter 43 – Building Rehabilitation) that clarifies the requirements applicable when implementing repairs, renovations, changes of use, or even changes in occupancy type. In particular, Section 43.7.1.2(2) provides guidance on the requirements around converting existing spaces into newly designated hazardous areas. Essentially, a 1-hour enclosure of the newly created hazardous area is not necessary if the following criteria are met:<br><ul><li>The area is not greater than 250 square feet.</li><li>The room is being converted to a location used for storage.</li><li>The building is fully sprinklered.</li></ul>This provision in Chapter 43 provides much more flexibility when reallocating space and developing additional storage locations, a common practice as organizations continue to maintain greater stocks of PPE. All door provisions for hazardous areas still apply. <br><br>As always, knowledge of the applicable codes and standards is your best tool for ensuring compliance. You can purchase a copy of the Life Safety Code® (NFPA 101) online at <a href="http://www.nfpa.org/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">www.nfpa.org</a>. </div><div> </div><div>The <a href="/Survey-Regulatory-Legal/Pages/Fire-Life-Safety.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">AHCA/NCAL website</a> is also a good source for on-going life safety education, tools, and resources.</div><br></div>
Why Sprinklers Keep Leading to Survey Tagshttps://www.ahcancal.org/News-and-Communications/Blog/Pages/Why-Sprinklers-Keep-Leading-to-Survey-Tags.aspxWhy Sprinklers Keep Leading to Survey Tags2/6/2024 5:00:00 AM​Since August 2013, CMS has required all regulated nursing homes to be fully sprinklered.  This has resulted in a decline in serious healthcare facility fires, along with the injuries and fatalities that can be associated with them.  However, the increase in sprinkler systems has accompanied an increase in life safety deficiencies.  CMS K-tags related to sprinkler system design, components, inspection, testing, and maintenance are consistently in the top five K-tag findings list nationally.  <br><br>There are two (2) commonly cited K-tags that address sprinkler systems.  K351 addresses sprinkler system installation and K353 addresses sprinkler system maintenance.  <br><br>Common survey findings related to sprinkler system installation (K351) include:<br><ul><li>Obstructions (18" rule) – Items are not permitted to be stored within 18" of sprinkler heads.  This is a common problem in areas such as commissaries and storage rooms.  Placing items too close to a sprinkler head could impede the spray pattern from the head.  However, the requirement does not limit the ability to have shelving and storage around the perimeter of a room that extends to the ceiling assuming there are no sprinkler heads directly above the storage or shelf.  </li><li>Piping – Wire, conduit, cables, and similar items are not permitted to be attached to, supported from, or even laid across sprinkler piping.  This is a common issue above the ceiling.  </li><li>Overhangs / Awnings – Any overhang or awning considered combustible and spanning more than four (4) feet from the side of the building is required to have sprinkler protection provided to the space below.  This can include porticos, porte-cochères, and entry/exit awnings and overhangs.  There are special designs and specialty sprinklers that can be utilized to protect these unique areas.               </li></ul>Common survey findings related to sprinkler inspection, testing, and maintenance (K353) include:<br><ul><li>Testing, Inspection, and Maintenance – NFPA 25 outlines very prescriptive inspection, testing, and maintenance (ITM) requirements for sprinkler systems.  Survey findings often relate to incomplete documentation, missing ITM components, or lack of remediation when the vendor identifies an issue.  Make sure your vendors are using the 2011 edition of NFPA 25, providing comprehensive documentation, and clearly notifying you if there is a problem requiring attention.  </li></ul><ul><li>Sprinkler Head Testing or Replacement – NFPA 25 also dictates when sprinkler heads must either be tested or replaced.  The interval depends on the type of sprinkler head.  Standard response sprinklers require testing at the 50-year mark and then again every 10 years thereafter.  Fast response sprinklers, including quick response heads that are commonly found in healthcare facilities, require testing 25 years after installation and then again every 10 years thereafter.  Rather than send out a grouping of sprinkler heads to be tested, you can also replace them at the first or subsequent testing mark.  This will reset the clock for future testing requirements.  Your sprinkler vendor should be knowledgeable in determining the age of your sprinkler heads, when they require testing/replacement, and what labs can provide the testing service.  </li><li><span style="font-size:11pt;">Painted / Dirty Sprinkler Heads – Sprinklers may not operate as intended if they are dirty, grease laden, or painted.  Usually, a simple cleaning or dusting does the trick.  However, if paint or grease won't remove easily, the heads may need to be replaced. </span></li></ul><div><span style="font-size:11pt;">Sprinklers are proven to save property and lives.  Ensuring they are installed and maintained appropriately will keep you in compliance and keep your system in a state of readiness should a fire occur. </span><br></div><div><br><span style="font-size:11pt;"></span><div>Detailed sprinkler system requirements can be accessed via the National Fire Protection Association's (NFPA) website at <a href="http://www.nfpa.org/" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">www.nfp​a.org</a>.  The <a href="/Survey-Regulatory-Legal/Pages/Fire-Life-Safety.aspx" data-feathr-click-track="true" data-feathr-link-aids="60b7cbf17788425491b2d083" target="_blank">AHCA/NCAL website</a> is also a great resource for on-going life safety education, tools and resources.  <br><br></div></div>

 Featured Video

 Top Resources

 Planning Ahead

​In order to effectively handle disasters and emergencies, it is important for centers to plan ahead and prepare in advance. Long term and post-acute care centers can use a targeted approach to addressing vulnerabilities and hazards to help them best respond to and recover from events. This site seeks to assist centers in creating a plan to address its greatest risks:
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Hazard Vulnerability Assessment
The Hazard Vulnerability Assessment (HVA) is a tool designed to assist centers in evaluating vulnerability to specific hazards. The tool uses various categories, such as probability of experiencing a hazard, human impact, property and business impact and response, to create a numeric value based on various hazards.

 Incident Command System

The Incident Command System is part of the emergency management system in many levels (federal, state, and local). Every significant incident or event, whether large or small, and whether it is even defined as an emergency, requires certain management functions to be performed.

The Nursing Home Incident Command System (NHICS) and Assisted Living Incident Command System (ALICS) outline a management framework that empowers long-term care staff to improve the effectiveness and efficiency of their incident response -- no matter what shift, or what day of the week the event occurs. ​​

Resources


 

 ‭(Hidden)‬ CMS Emergency Preparedness Rule

The Emergency Preparedness Final Rule was released on Friday, September 16, 2016. AHCA, along with guest speakers, will hold a webinar series event​ this year on the new emergency preparedness final rule impacting Skilled Nursing Facilities (SNF), Nursing Facilities (NF) and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID). This final rule is not applicable to Assisted Living Providers. 

Providers will need to be in compliance by November 15th 2017. The webinar series will include, special guest speakers, an overview of the key new requirements, a list of tools to assess if you are prepared for the rule, steps to take now to prepare.

On Friday, September 1st, CMS released a memorand​um to State Survey Agency Directors announcing that the Emergency Preparedness Training is now available. All surveyors are required to take the training prior to surveying the Emergency Preparedness requirements. Surveying for requirements begins November 15th, 2017. 

The online course is now available on the Surveyor Training Website On-Demand. Once in the course catalog for provider training, search “emergency” and the course information will appear. Providers will have continued (ongoing) access to the course, so they can review it anytime.

Members are strongly encouraged to review and complete the training as it includes quizzes and exercises to check understanding. The training states to surveyors that the requirements do not prescribe or mandate specific technology or tools nor detailed requirements for how facilities should write emergency plans. The training includes the questions surveyors will ask and how documentation will be reviewed and checked. Links to resources and glossary terms are also included.​

​Emergency Resources

In addition to planning for natural disasters, staff and facilities must be prepared for other emergencies, such as pandemics, influenza, active shooters and more. All emergency situations must be handled swiftly, diligently and with the utmost care for staff and patients.

 Active Shooter

​While many emergencies are caused by natural disasters and are, staff and facilities should also be prepared for other types of emergencies. One emergency for which facilities should have plans in place is an active shooter.
Please note: The policies below are models only and should be modified and tailored to meet the needs of individual communities. 

 
AHCA/NCAL's Active Shooter Resources
External Resources

 Assisted Living Resources

The Emergency Preparedness Guide for Assisted Living is a comprehensive resource that will assist members with developing emergency operations plan and includes the planning process. The guide includes templates and numerous resources for members to utilize.

 

Assisted Living Incident Command System (ALICS)

The Incident Command System (ICS) is one component of the National Incident Management System or (NIMS). The Assisted Living Incident Command System or “ALICS” is a simplified ICS and through its use, long-term care providers can become part of this standardized system of efficient response. ICS was modified by two consultants for assisted living and reviewed by AALNA board members and then reviewed by the NCAL Workgroup of the AHCA/NCAL Emergency Preparedness Committee.

ALICS offers long-term care providers a flexible framework for command and control that is based on the standardized system of ICS. It does this through a system that is designed to:
  • Manage all emergency, routine, or planned events, of any size or type, by establishing a clear chain of command and a process for communication, decision‐making and delegation.
  • Allow personnel from different agencies or departments to be integrated into a common structure that can effectively address issues and delegate responsibilities.
  • Provide needed logistical and administrative support to operational personnel.​

 Shelter In Place

Shelter In Place: Planning Resource Guide for Nursing Homes

For the purposes of this resource guide, shelter in place (SIP) is defined as: A protective action strategy taken to maintain resident care in the facility and to limit the movement of residents, staff and visitors in order to protect people and property from a hazard.

Shelter In Place Guidebook (PDF)

 State Resources

Wisconsin

 Winter Weather

The Centers for Disease Control and Prevention published a comprehensive winter weather health and safety site. Owners and administrators can take tips to prepare for extreme cold conditions and winter storms.​

 In Case of An Emergency

AHCA/NCAL regularly publishes and distributes informative documents for members regarding emergency preparedness, response, and recovery.

During public health emergencies, CMS will post updates on waivers on their Emergency Response and Recovery page. Members should check this page for updates during an event.