Unreliable communications, no gasoline challenge HHAs
There is nothing like an emergency to test your emergency plan, as agencies in an area east of New York City, north to Toronto, and west to Detroit discovered on Aug. 14 as a rolling blackout affected almost 50 million people.
"We are calling the event Y2K plus three," says Greg Solecki, vice president of Henry Ford Home Health Care in Detroit. "Many things that we expected to happen for Y2K happened on Aug. 14," he says. Traffic lights, gasoline pumps, store cash registers, automated teller machines, and water systems didn’t work, making everyone’s personal lives more complicated, he points out.
From a home health agency perspective, there were other problems that traditional emergency plans did not take into account, he adds. "Although our governor encouraged people not to go into work, my employees were ready to work," he says. The difficulties were communications and finding employees with enough gasoline in their cars to make patient visits, he adds.
"Cell phone coverage was intermittent. My phone worked part of the day, then quit, and other employees’ cell phone service would come and go as well," explains Solecki. It took a few hours, but someone discovered that a traditional, land-line phone plugged into the fax line, which is analog rather than digital, would access telephone service, he says. "Prior to making this discovery, we were constantly updating employees at home and at other offices with the cell numbers that were working," he adds.
Even after establishing reliable phone service in the office, Solecki and his staff realized that they were not able to reach employees who had portable phones that relied upon electricity to work. "We’ve now updated our telephone list to identify which employees have traditional land-line phones," he says.
The staff members at Comprehensive Care Management, the home health service agency for Beth Abraham Health Services in Bronx, NY, also discovered the fax lines, but did not have any telephones they could use, says Virginia Murray, RN, BSN, MSN, director of quality management at the agency. "Now, each of the offices has a princess phone in the closet for this type of emergency," she adds.
The telephone system at Comprehensive Care Management does have a battery backup, but the agency discovered that it lasted only four hours out of the 24 they were without power. "We are talking with our information system people to see how we can beef up the telephone backup," says Murray.
Although her agency’s area was out of power for only four to eight hours on Thursday evening, Susan Schulmerich, RN, MS, MBA, vice president of community health services for Elant Choice in Newburgh, NY, says that the uselessness of convenient portable phones was quickly recognized by her staff as well.
"We are going to consider adding a question to our initial interview about the type of phone that is available in the house," she says. Most of their patients are older than 55 and less likely to purchase a portable phone, but family members might give them as a gift, Schulmerich explains. "A portable telephone is fine as long as there is a traditional phone in the house as well," she adds. "We had no problem getting staff members in to work; in fact, we had no absentees on Friday," Murray points out. Employees reported to the center nearest their homes, she says.
Keep some paper records
Fortunately, priority patients and their contact information are kept on paper lists, but because all of the agency’s care plans are computerized, Murray says that they were lucky that one of the on-call nurses’ laptop had all of the current care plans. "We had never thought about the need to access current care plans because we didn’t think about areawide power outages that exceeded our backup systems," she says. Now, each office has one laptop that is updated every day with current care plans and has the battery fully charged, she adds.
Because many people didn’t go to work on Friday, family members were with most of the patients, says Murray. Patients who were on oxygen were sent to hospitals, she adds. Water became a real concern for some people, so nurses delivered water to patients in high-rise buildings who may not have had anything to take with medications, Murray continues. "We stock some water in our day-care centers and medical clinics, but it went quickly. This is one area her agency is going to study further, she adds.
Another basic piece of equipment that Murray discovered was an AM transistor radio. "It’s old-fashioned but everyone in the office has a new respect for my little radio," she says. "It became an important way to stay on top of the news and keep people informed as to what was happening," she adds. Now, all branch offices have a radio with extra batteries, Murray says.
Branch office managers at Henry Ford had to be creative in terms of managing their staffs, says Solecki. "Our Lincoln Park office had no phones or power, but the manager’s home that is located south of the office had power," he says. "She designated her home as her control center and was able to receive faxes from referral sources with power and use her phone to stay in touch with staff," he explains. "Our Southfield office managers had to work out of their cars in the parking lot of the office building in which they are located because the building uses electronic card access and had no backup system for entry," Solecki points out. "This was no problem for the other tenants, who are not health care organizations and had no employees reporting to work on Friday, but it pointed out an area that we need to address in future leases," he says.
Long hours and going the extra mile
At the main office, intake staff members went back and forth to the three main hospital referral sources to hand carry paperwork for admissions, Solecki says. In fact, one employee worked a 12-hour shift, walking eight blocks between the hospital and the office the whole day, he adds. Hospitals were trying to clear beds so patients requiring oxygen or other support that could be provided by the hospital generators could be admitted, and it was important that the home health agency be able to evaluate and admit patients, he points out.
Although the agency admitted new patients, it wasn’t a smooth process, Solecki adds. "Unfortunately, we were admitting patients who were sent home without supplies they needed and our nurses didn’t have admission packets and paperwork they would have had if they could have come by the office first," he says. "We also learned that it’s not a good idea to eliminate all paper records," Solecki says. Laptops, office-based computers, and even the electronic discharge program between home health and hospital referral sources were useless.
"We were handwriting referral and admission information in duplicate," he points out. "We all started wishing that we kept a supply of carbon paper on hand and even wondered if carbon paper is still available," he jokes.
Although all of the agency’s Priority 1 patients were seen or contacted by telephone to ensure their safety, scheduling visits required more than just calling a nurse, Solecki says. "Because gasoline pumps were not working, we not only had to find out where the employee was located but also how much gasoline was in the car," he says. The agency’s Y2K plan recommended that employees not let their gas tanks go below the half a tank mark, and Solecki says that they, once again, are recommending that to employees.
"Since 9/11, New York agencies have been very aggressive in developing extensive emergency plans," Schulmerich adds. Even with the glitches in plans that were discovered during the power outage, the result of the planning was evident, she says. "No one panicked, and everyone approached their jobs in a professional manner," she points out.
Solecki agrees and adds that even after the power was restored, the agency continued in an emergency mode because computers would go on- and off-line erratically, and data needed to be backed up more frequently. The event also pointed out the need to continually review emergency plans. Solecki says. "We’ve reconvened our disaster planning task force to evaluate this event and look at all variations of disasters. The lessons we learned from this emergency will only strengthen our plan."
For more information on disaster preparation, contact:
• Greg Solecki, Vice President, Henry Ford Home Health Care, One Ford Place, 4C, Detroit, MI 48202. Telephone: (313) 874-6500. E-mail: firstname.lastname@example.org.
• Susan Schulmerich, RN, MS, MBA, Vice President Community Health Services, Elant Choice, 31 Cerone Place, Newburgh, NY 12550. Telephone: (845) 291-3700. E-mail: email@example.com.
• Virginia Murray, RN, BSN, MSN, Director of Quality Management, Comprehensive Care Management, Beth Abraham Health Services, 668 Allentown Ave., Bronx, NY 10467. Telephone: (718) 519-5483. E-mail: firstname.lastname@example.org.