Battle strategies for blizzards

Emergency plans that will weather the storm

When it comes to emergencies such as earthquakes, fires, and tornadoes, no one is ever truly immune. Nor can anyone ever be totally prepared since those phenomena usually strike out of nowhere, leaving you only a few hours or seconds to prepare. The good news is that those kinds of emergencies are fairly rare. However, that’s not true when it comes to winter weather emergencies.

If you live in an area that frequently experiences heavy snow or ice storms, having a winter weather emergency plan in place can be invaluable, providing it’s the right plan. Here some winter weather experts share their thoughts and tips for coping with subfreezing temperatures and blowing snow.

HCFA, JCAHO require emergency strategies

As both the Health Care Financing Administration and the Joint Commission on Accreditation of Healthcare Organizations require health care agencies to have written emergency plans and procedures in place, it’s a good bet your agency has implemented an all-purpose emergency plan. But what some agencies don’t have, unless they are in areas such as flood zones, are plans geared to specific emergencies. The variety of disasters precludes tailoring emergency response plans to meet each one.

Having a winter emergency plan, however, is a good idea. After all, most areas in the country are at risk of some sort of winter storm, although the severity of storms may vary. As meteorological conditions vary, so does a community’s level of preparedness.

If you are starting the process of designing a winter emergency plan or decide that yours could do with some updating, the best place to start is by asking others for their advise. Consult a panel of emergency experts, suggests Amy Goldberg-Alberts, senior risk management analyst with ECRI, a nonprofit international health services research agency based in Plymouth Meeting, PA. She recommends involving people not just from your agency and hospital but from the community at large.

Employees of the local Red Cross, police officers, firemen, and representatives from the local utility companies can serve as an excellent resource and sounding board. After all, coping with disasters is a major part of their jobs. Another good idea, says Goldberg-Alberts, is to include members of the local media in your emergency preparedness planning committee. In the case of a natural disaster, for example, having a media contact can facilitate getting messages out to not only your patients but your staff as well.

Greg Solecki, vice president of home health care for Henry Ford Health System Home Health in Detroit, uses two local AM stations to announce that his agency has shifted to a winter emergency plan and ask that his staff call to check in. "We’ve picked the stations with the highest power signals. It’s my responsibility to make sure we’re delivering a consistent message to our staff and patients and letting them know we’ll keep them posted as things change."

Know who’s who among your patients

Whereas nursing homes and hospitals have their patients all under one roof, home health agencies face the challenge of reaching and communicating with patients and nurses spread over a broad geographic area, some of which may be hit harder than others. In some cases, certain neighborhoods or towns may be nearly impossible to reach physically thanks to unplowed roads and high drifts or, in the case of power outages, by phone or e-mail.

The last thing an agency manager wants to do then is sit down and start sorting through which patients will need ongoing care throughout the winter storm and which patients may be able to wait until the weather has improved. (See related story on putting your priorities in order.)

Make it a practice to identify all patients upon admission for such factors as susceptibility to extreme temperatures, reliance on any electrically powered equipment, daily medicine needs, and the like. Says Cynthia Runner-Heidt, RN, MSN, administrator of Lehigh Valley Home Care and Lehigh Valley Hospital Patient Care Service in Allentown, PA, "We identify urgent care patients. We have to know who’s who."

Let your patients know what you’re doing and why. In the end, this list can help local authorities should they need to come to the aid of any of your agency’s patients. It’s a good idea to keep a record on file at the local department of emergency services; therefore, it’s vital that it be kept updated as patients’ situations change.

Even meticulous records won’t do any good if no one knows you’re operating under emergency plans. The key to a successful emergency preparedness plan, says Solecki, is good communication.

When parts of Detroit lost power for three days last year, Solecki and his agency were ready to hit the airwaves — with cell phones and pagers. Solecki, along with the clinical and operations directors, relied on "a well-understood and routinely maintained telephone tree," he says. Together the three directors set the agency’s emergency plan into action.

"We knew who to call because we each have updated versions of the telephone tree and organizational charts at home," he says. "The tree is updated every month, and while some months it seems like something you’d just as well skip, I can’t tell you how happy I was to have it in my briefcase when the emergency actually hit." To make sure the word trickled to every employee, Solecki’s telephone tree requires the last person on the list report to the first.

Because phone service was nonexistent in those areas affected by the power outage, Solecki says he "learned to make sure the tree includes pager numbers, cell phones, and car phones so we could get hold of people in a variety of ways. When I couldn’t reach one person on the phone, I paged her."

Agency directors may also want to consider a dedicated information line, such as the one used by Lehigh Valley. "We have a phone tree but don’t use the radio to broadcast schedule changes because we don’t want to give our patients the idea that we’re closing. Instead, we have a dedicated phone line that people can call to get information," says Runner-Heidt. No matter the communication method, she points out, patients and physicians need to be informed of the agency’s plans as well.

In Solecki’s case it was obvious that his agency should switch to its emergency plan. But when it comes to weather, it’s not always so clear.

Runner-Heidt and her staff stay tuned to the radio and weather channels for constant updates on moving storm fronts and road conditions. If you’re unsure whether to call a state of winter emergency, determine in advance at what point you will put your plan into action. Will it be when the National Weather Service classifies a storm as a blizzard? Or when the Highway Patrol urges motorists stay off the road?

Prepare both staff and patients

Preparing your patients for a storm is equally as important as preparing your staff. "Let your patients know that their visits may need to be rescheduled because of severe weather," says Runner-Heidt. She also encourages her nurses to help their patients ready their homes for winter.

"We tell [patients] not to let their supply of heating fuel get too low and to keep extra blankets and food on hand," she says. Her staff also teaches self-help skills — such as wound care — to the patients’ families so that in a storm they can pitch in to help if aides are unable to make their visits.

Agency staff also need to be reminded of the worth of an ounce of prevention. Runner-Heidt sends out a memo reminding her staff to plan ahead for winter weather. "I remind them to wear appropriate clothing. People need to wear heavy, insulated clothing — boots, gloves, layers." she says. "They should have ice cleats on hand and the car should be stocked with a shovel and kitty litter. And they should never allow the gas tank to get below half-full." (See "Survival in a can," below)

Runner-Heidt points out that inclement weather can make people do things they otherwise wouldn’t do. "You’d be surprised at the number of staff that locked themselves out of the car during winter storms," she says. "They wouldn’t be able to find a parking spot and would keep the car running and would end up locking themselves out. They put themselves at risk."

To prevent such incidents, she keeps a log of staff that have four-wheel-drive vehicles and allows for double staffing, so that while one nurse goes into a home to care for a patient, the other can stay with the car.

Runner-Heidt has other ways to ease employee stress. "On a severe weather day, I tell staff they are paid from the time they initiate patient care, which includes phone calls and charting done at home. For those of us who have to stay in the office and work a full day, we keep supplies like food and blankets on hand in case we get stuck."

She allows staff to adjust their hours to allow for digging their cars out of snow, for example, or if icy conditions are predicted for the late afternoon, to reschedule patients so that they are all seen in the morning.

Better safe than sorry, says Runner-Heidt, referring to why she encourages employees to get off the road if they deem conditions are too dangerous. "I will follow what the state police decide. I won’t put my employees at risk."

Runner-Heidt is only too familiar with the dangers of winter storms. She has experienced the loss of one of her employees who died when the car she was driving hit a patch of ice and crashed into a tree. The bottom line, she says, is, "You always want to be mindful of caring for your employees."

Survival in a Can

The Illinois State Police uses the following emergency kit:

- A 2- or 3-pound coffee can with three evenly spaced holes punched in the top edge.

- A 60-inch piece of twine cut into three equal pieces. (These will be used to suspend the can.)

- Two large safety pins to suspend the can.

- A 2-inch diameter candle that will be placed under the suspended can to melt snow.

- A sharp pocket-knife or pair of scissors.

- Three pieces of bright cloth, roughly 2 inches by 36 inches, to tie to the car antenna and door handles.

- A small package of peanuts and a small pack of fruit-flavored candy (avoid chocolate.)

- A pair of cotton athletic socks.

- A pair of cotton glove liners.

- Two books of matches.

- A sun-shield blanket or two large plastic leaf bags. (The bags will reflect body heat and reduce heat loss from the wind.)

- A pen light and batteries (kept separately).

- Personal medications.

- If room allows, adhesive bandages, aspirin, and a small radio.