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We all know it’s coming; nevertheless, each year winter weather manages to catch people unaware. Late last year, a powerful blast hit the Plains states and the Northeast with a vengeance. For many people, a sudden snowstorm might mean an unexpected day off from school or work, but for home health patients and their nurses and aides, such weather can pose serious problems.
The greatest problem, of course, is for patients who must be seen on a daily basis. For these patients — and because it’s a good idea in general — it’s vital that home care agencies have a winter emergency plan and that they become ready to put it into action at a snowflake’s notice. If your agency serves areas that frequently experience heavy snow or ice storms, having a winter weather emergency plan in place can be invaluable — provided it’s the right plan. Here, some winter weather experts share their thoughts and tips on preparing for and coping with Mother Nature’s wrath.
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, so it’s a sure bet that your agency has, at the very least, an all-purpose emergency plan. What many agencies don’t have, unless they’re in areas where floods, tornadoes, and the like are common, are plans geared to specific emergencies.
Having a winter emergency plan, however, is a good idea. After all, most areas of the country are at risk for some sort of winter storm, whether ice or snow, and while the degrees to which these storms hit will vary, so does a community’s level of preparedness. It may take one-story high drifts to bring down a city such as St. Paul, MN, while a few inches of snow can bring cities such as Charleston, SC, to a grinding halt.
So where do you begin making your winter emergency plans? The best plan is not to reinvent the wheel. See what kind of winter emergency plan your hospital has or what other agencies in your area have. Consult with the local fire and police authorities, Red Cross representatives, and members of your local utility companies to garner their advice, and don’t forget to ask patients for their input. Do they like the idea of a phone tree? Would they want a neighbor assigned to check on them and if so, who?
As for the details, "one of the more pressing issues is making sure there’s an adequate supply of medications and patient supplies, and maybe even a set of written instructions to give to family members who may have to take over if a health care worker can’t get there," explains Madelyn Quattrone, senior risk management analyst with ECRI (formerly known as the Emergency Care Research Institute), a nonprofit international health services research agency based in Plymouth Meeting, PA.
To make sure patients get the care they need, she advises triaging them according to the severity of their problems. "Use the standard assessment that you would do normally. For those people who really are on the edge and likely to fall into a danger area if they aren’t seen, perhaps it would be a good idea if their physician were contacted. That way [the physician] could assess them and if need be, the patient could be admitted for a day or two or placed in a facility pending the storm," Quattrone says.
You’ll also want to make certain that patients have adequate food supplies. She suggests that patients be given extra instructions and reminders. "They might not understand all the problems that can arise from having oxygen in the house, for example," she points out. "Sometimes people don’t understand that avoiding open flames also applies to holiday candles and kerosene heaters they might be using for extra warmth. You want to make sure you alert the homebound person to those issues."
Quattrone points out that another important consideration, especially for those areas where it may be difficult for a pharmacy to deliver, "is knowing the pharmacy’s stocking and delivery system in your area." This, she adds, is especially critical with pain medication.
The key to a successful emergency preparedness plan is good communication, says Greg Solecki, vice president of home health care for Henry Ford Health System Home Health in Detroit. When parts of Detroit lost power for three days several years ago, 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 whom 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 that the last person on the list report back to the first. And because you can’t always be certain that phones will be in service, he and others recommend that any contact list include updated cell phone and pager numbers.
Not only is it important to get in touch with your employees, but you’ll also want to alert your patients that a winter emergency plan is in effect. Depending on your area and your preference, there are a number of ways this can be accomplished. If you have a local radio station with a broad listening audience and an especially strong signal, you might consider announcing that your plan has gone into effect over the radio, suggests Quattrone.
Of course, in the case of power outages, that’s not always possible, so you’ll want a backup plan — and perhaps a patient version of the phone tree, where each employee is responsible for contacting each of his or her patients. Some agencies choose not to make a public announcement but request that their patients call a specially designated 800 number to check on weather updates and agency emergency operations.
The key to all of this, though, is knowing when to kick that winter emergency plan into effect. Is it when snowdrifts reach two feet in height? Is it when weathermen start predicting a blizzard? What happens if that promised winter blast never arrives? When do you cancel the emergency plan? Just because there are no guarantees with the weather doesn’t mean your agency can’t have a guaranteed point when the winter emergency plan is put into action.
Quattrone recommends that agency managers pay close attention to local and national weather forecasts and visit the National Weather Service Web site at www.nws.noaa.gov. This site ranks storms in terms of severity and likelihood, she explains, adding, "It’s a good idea to decide in advance at what level your emergency plan kicks in."
Preparing your patients for a storm is as important as preparing your staff. Agency staff also need to be reminded of the worth of an ounce of prevention.
"If staff have to get out there in bad weather," Quattrone points out, "common sense advice would be that they have a good car battery, extra flashlight batteries, a shovel, and that they carry some cat litter or sand." (See "Survival in a can" in this issue.)
In the event of a worst-case scenario, staff will want to make sure they have some supplies — dried fruit and high-energy foods or juices — on hand, she adds. "It’s not a bad idea to have in your trunk an extra layer of clothing and an overnight bag with all your necessities," she notes. "And, it can’t be stressed enough that staff know the safest routes to take and have a full tank of gas."
Throughout it all, Quattrone stresses that the most important element of developing a winter emergency plan is to think through a reasonable plan. "As long as you have acted reasonably . . . thought ahead and tried to identify potential problem areas . . . you might be second guessed; but if the justification can be shown, then that should insulate you from most problems that might arise."
[For more information, contact:
• Gregory P. Solecki, Vice President, Henry Ford Home Health Care, 1 Ford Place, 4C, Detroit, MI 48202. Telephone: (313) 874-6500.
• Madelyn Quattrone, Senior Risk Management Analyst, ECRI, 5200 Butler Pike, Plymouth Meeting, PA 19462. Telephone: (610) 825-6000.]