Emergency Operations Plan

Record of Promulgation

List of Acronyms

= Introduction =

Purpose

 * 1) To enable Newark Manor Nursing Home to provide timely, integrated, and coordinated responses to emergency situations involving or impacting the facility.
 * 2) To describe the roles and responsibilities of Newark Manor Nursing Home in preparing for, responding to, and recovering from the impacts of all hazards.
 * 3) To describe the coordination within Newark Manor Nursing Home and other stakeholder groups necessary to provide services to those affected by the impacts of all hazards.

Scope

 * 1) This plan applies to Newark Manor Nursing Home as a facility.
 * 2) Nothing in this plan will alter or prevent Newark Manor Nursing Home from conducting its normal operations or will be construed in a manner that limits the use of good judgment and common sense in incidents not covered by the plan.

Policy

 * 1) It is the policy of Newark Manor Nursing Home to be prepared to respond to a natural, man-made, or other public health emergency or disaster incident in a manner that protects the health and safety of its residents, visitors, and staff, and that is coordinated with a community-wide response to a public health emergency or disaster incident. All employees will know and be prepared to fulfill their duties and responsibilities as part of a team effort to provide the best possible emergency care in any situation.  Supervisors at each level of the organization will ensure that employees are aware of their responsibilities.

= Situation and Assumptions =

Situation

 * 1) All areas of Delaware are vulnerable to hazards.  See the State of Delaware Hazard Mitigation Plan for a detailed analysis of all statewide hazard vulnerabilities. The Hazard Vulnerability Analysis (HVA) provides a general overview of the types of hazards in the state and aid in planning and preparedness activities.
 * 2) The primary hazards for New Castle County include the following:
 * 3) Pandemic  A. A pandemic incident is the top planning priority for New Castle County, due to its impact on the healthcare services and its high probability. The demand for primary care doctors will increase, along with the need for hospital beds that are set up and staffed. This hazard is also ranked first due to its possible continual impact on DPH for more than 14 days. At‐risk populations will also need to be carefully considered in the planning process.
 * 4) Tornado  A. A tornado was ranked second in the planning priority category due to a high human impact. The number of fatalities, emergency room visits, and trauma center injuries will greatly increase after a tornado. Along with these factors, this hazard will have a large impact on the community and will cause interruptions within healthcare services.
 * 5) Hazardous Materials Release  A. A hazardous materials release was scored third in planning priority due to a high human impact score. The scores for mortality and emergency department visits were at least 150 times greater than the baseline data. The community impact score was also higher in business continuity, population disruption, and environment impact. All three would be interrupted for at least 14 days, resulting in an increased score.
 * 6) Radiation Dispersal Release  A. When reviewing the results of an RDD incident, it is evident that this hazard is a planning priority for New Castle County due to its anticipated impact on the community, particularly in the areas of business continuity and population displacement. There was also a large mental health impact score, along with a high at‐risk population score.
 * 7) Biological Terrorism  A. Biological terrorism is ranked fifth in planning priority due to an extremely high human impact score. The number of fatalities will be 139 times greater than the baseline data, along with a greater increase in the number of EMS transports and emergency department visits. Due to these high numbers, healthcare services and public health service will also be impacted. Healthcare facilities and providers have specific vulnerabilities that have been analyzed by the Delaware Division of Public Health (DPH), Emergency Medical Services and Preparedness Section, Office of Preparedness. For hazards specific to healthcare facilities and Delaware State Emergency Operations Plan Emergency Support Function #8: Health and Medical (ESF #8) of the Delaware State Emergency Operations Plan (DE SEOP), please consult Appendix 3: Hazard Vulnerability Analysis in this plan.
 * 8) All disaster incidents are the responsibility of the local jurisdiction, and thus Newark Manor is expected to be prepared for any public health emergency or disaster incident and be self-sufficient for at least 72 to 96 hours after the onset of the public health emergency or disaster incident.
 * 9) The Incident Command System (ICS) is a management system for disaster incidents that employs a logical management structure, defined responsibilities, clear reporting channels, and a common nomenclature to help unify healthcare facilities with other emergency responders. It is a management system made up of positions on an organizational chart.  Each position has a specific mission to address in a disaster incident, with a corresponding checklist of duties. ICS includes forms to enhance this overall system and promote accountability.
 * 10) According to the Delaware Code Title 16, Section 6701A—Authority of Fire Officers-in-Charge, there may only be one incident commander (IC) for a disaster incident. A facility IC will only have authority within the confines of the facility or facilities under his/her direct supervision. Activities external to the facility will fall under responsibility of the local response agency’s IC.

Assumptions

 * 1) A public health emergency or disaster incident may occur at any time, and pre-disaster warning time may vary from no warning time to several days.
 * 2) Public health emergencies or disaster incidents within and/or outside of the facility may impact the facility and require activation of this plan.
 * 3) Public health emergencies or disaster incidents may occur simultaneously in more than one part of a facility.
 * 4) A public health emergency or disaster incident may be of such magnitude that response and recovery requirements exceed facility resources so that assistance from the host county and/or the state may be necessary.
 * 5) A public health emergency or disaster incident may cause shortages, in the local area, of a wide variety of necessary supplies.
 * 6) Throughout the course of a public health emergency or disaster incident, Newark Manor Nursing Home will maintain essential services to its residents.
 * 7) The external human or material resources identified in the response strategy may not be available for 24 to 72 hours following a public health emergency or disaster incident due to jurisdiction-specific considerations of resource management in times of crisis(es).
 * 8) All operational personnel are trained on the EOP and their role within this plan.
 * 9) Newark Manor Nursing Home staff is aware of the hazards faced at the facility, have documented these hazards, and where possible, have taken mitigation actions to protect the facility.
 * 10) Newark Manor Nursing Home staff work with their residents and residents’ families to assist in educating them on personal preparedness.
 * 11) Actions in this plan attributed to a specific person may be delegated to another per the Newark Manor Nursing Home standard operating procedures as outlined in the facility Policy Manual.

= Preparedness =

Newark Manor Nursing Home Emergency Preparedness Committee (EPC)

 * 1) In order to maintain this plan and ensure that all emergency management planning, training, and exercises are properly completed, Newark Manor Nursing Home has created an Emergency Preparedness Committee (EPC)
 * 2) A complete list of internal and external stakeholders and their contact information is listed in Appendix 2: Emergency Preparedness Committee in this plan.
 * 3) This group is charged with the following tasks:
 * 4) Maintaining the Newark Manor Nursing Home EOP.
 * 5) Ensuring that all staff receive up-to-date training and information on ICS.
 * 6) Ensuring that compliance with federal guidance and integrating applicable best practices is maintained in facility emergency mitigation, preparedness, response, and recovery efforts through the utilization of an incident management system consistent with the NIMS.
 * 7) Ensuring that all state and federal regulatory and statutory standards related to emergency management are maintained.
 * 8) Forming the core of the Newark Manor Nursing Home incident command and General staff.
 * 9) Maintaining training records of Newark Manor Nursing Home personnel as they pertain to the ICS and NIMS guidance.
 * 10) Facilitating training opportunities for Newark Manor Nursing Home personnel in ICS and related knowledge and skill areas, through either hosting opportunities or advertising training opportunities available at other facilities.
 * 11) Identifying funding opportunities to support designated initiatives.
 * 12) Identifying mitigation actions based on the Newark Manor Nursing Home HVA for inclusion in future county or facility construction or planning efforts.
 * 13) Ensuring that at least 72 to 96 hours of supplies, including pharmaceuticals, are available on-site or via vendors.
 * 14) Regular testing of backup communications and life safety systems to ensure working status.
 * 15) Tracking and assessing fire drills and related emergency preparedness activities.
 * 16) Ensuring that up-to-date communicable disease information from the Delaware DPH is briefed and assessed for any impact on the facility.
 * 17) The group will meet monthly at a day, time, and location established by the designated EPC Chair.

Mitigation

 * 1) The top hazards and threats specific to Newark Manor Nursing Home and the immediate surrounding community, as identified from the DPH Statewide Public Health HVA, are summarized in Appendix 3: Hazard Vulnerability Analysis in this plan.
 * 2) A floodplain map for the facility is also located in Appendix 3: Hazard Vulnerability Analysis in this plan.
 * 3) Patient mitigation strategies based on the Newark Manor Nursing Home HVA are included in Appendix 3: Hazard Vulnerability Analysis in this plan.

Business Continuity

 * 1) It is the policy of Newark Manor Nursing Home to maintain service delivery or restore services as rapidly as possible following a disaster incident that disrupts those services.
 * 2) As soon as the safety of residents, visitors, and staff has been assured, Newark Manor Nursing Home will give priority to providing or ensuring residents’ access to healthcare.
 * 3) A complete business continuity plan for Newark Manor Nursing Home is available in Appendix 10: Business Continuity Plan in this document.

= Concept of Operations =

The two main components of the facility ICS for Newark Manor Nursing Home are the Command and General staff.
"Command Staff"
 * 1) The Command staff is composed of the following:
 * 2) IC
 * 3) Liaison Officer
 * 4) Public Information Officer
 * 5) Safety Officer
 * 6) Other positions as designated by the Newark Manor Nursing Home IC, such as Medical Officer
 * 7) The Command staff is responsible for the following:
 * 8) Determining the need to open the facility emergency operations center (EOC)
 * 9) Overarching policy decisions
 * 10) Authorizing the implementation of the Incident Action Plan (IAP) developed by the Planning Section
 * 11) Final authority for evacuation or receiving evacuees
 * 12) Authorizing deviations from contractual obligations
 * 13) Authorizing contracts and procurement
 * 14) Liaison with external governmental and regulatory officials
 * 15) The Command staff will consider the following options, depending on the nature, severity, and immediacy of the expected emergency:
 * 16) Reviewing plans and procedures
 * 17) Checking the inventory of supplies and pharmaceuticals, and augmenting as needed
 * 18) Ensuring that essential equipment is secured, computer files are backed up, and essential records are stored off-site
 * 19) Notifying medical professionals, community members, and staff to cancel scheduled appointments
 * 20) If time permits, encouraging staff to return to their homes
 * 21) If staff remain in the facility, taking shelter as appropriate for the expected disaster
 * 22) Ensuring that staff is informed of callback procedures and actions they should take if communications are not available
 * 23) Taking protective action appropriate for the disaster incident
 * 24) Ensuring that follow-up services are available to any residents who have been sent home
 * 25) Closing and securing the facility until the disaster incident has passed; ensuring that residents and visitors can return home safely "General Staff"
 * 26) The General staff comprises the positions designated within this plan as needed for the incident.
 * 27) The General staff coordinates the facility’s response, including but not limited to the following:
 * 28) Developing and revising an IAP (see Appendix 15: Incident Management Resources for forms and job aids)
 * 29) Assessing and monitoring resident census and status
 * 30) Assessing and monitoring vital systems and structural status
 * 31) Assessing and monitoring the status of pharmaceutical and non-pharmaceutical supplies
 * 32) Assessing and monitoring staffing levels and needs for the expected duration of the public health emergency or disaster incident
 * 33) Establishing and maintaining communications with county first responders, as appropriate
 * 34) Establishing and maintaining a flow of communications to the families of residents
 * 35) Establishing and maintaining a flow of communications regarding the facility to the general public in conjunction with the New Castle County OEM and external stakeholder agencies
 * 36) Forecasting the potential impact of the public health emergency or disaster incident on facility residents, staff, visitors, and operations for the duration of the public health emergency or disaster incident
 * 37) Identifying courses of action to mitigate or prevent non-desirable public health emergency or disaster incident-related impact
 * 38) Developing recommendations for the Command staff on courses of action to address policy and/or other legal issues related to the incident
 * 39) Coordinating with external stakeholders and vendors, as appropriate
 * 40) Identifying and implementing protective action decisions if necessary
 * 41) Planning for the resumption of normal services post-public health emergency or disaster incident
 * 42) Maintaining the flow of information to the Newark Manor Nursing Home Command staff and employees on situation status and expectations
 * 43) Maintaining a flow of information to Newark Manor Nursing Home residents and families on situation status and protective actions
 * 44) Maintaining continuity of all programs and services
 * 45) Ensuring coordination with the New Castle County Emergency Management Agency (EMA) and other first responders, including the external IC
 * 46) Providing support for all roles and responsibilities as outlined in Appendix 15: Incident Support Team Resources

Response
xx. Social media xxi. Delaware Health Alert Network (DHAN) AAA. Backup Runners xxii. Plain old telephone service (POTS) xxiii. Other county and state resources
 * 1) General
 * 2) Newark Manor Nursing Home may play a variety of roles in responding to public health emergencies or disaster incidents within this facility, neighboring facilities, or in the host community.
 * 3) Newark Manor Nursing Home may also provide emergency medical care to the injured and serve as a conduit for information dissemination to affected communities and families of residents.
 * 4) Newark Manor Nursing Home’s roles may be constrained by limited resources, technical capability, and/or by the impact of the disaster on the facility.
 * 5) Notification
 * 6) The staff member who initially witnesses or becomes aware of a situation that poses a potential or immediate threat to the safety of residents, staff, or visitors will assess the situation and report the following to their supervisor:
 * 7) Where the public health emergency or disaster incident is located
 * 8) The nature of the public health emergency or disaster incident
 * 9) How large an area is involved (e.g., room, floors, etc.)
 * 10) What actions have been taken to mitigate the impact of the public health emergency or disaster incident and to ensure resident safety
 * 11) What resources are needed to resolve the problem and/or ensure resident safety
 * 12) Who notified them of the situation (if applicable)
 * 13) Notification will be face-to-face or via a communications system as outlined in Section 4.2.4.
 * 14) Activation
 * 15) General
 * 16) Upon notification, the staff member’s supervisor will collect the information on the incident, assess the public health emergency or disaster incident for themselves, and notify the senior staff member on duty, the Chair of the Newark Manor Nursing Home , and the facility’s Chief Executive Officer (CEO).
 * 17) For a  disaster incident requiring external support from emergency services (e.g., fire, law enforcement, emergency medical services [EMS], public health), the supervisor will call 9-1-1 and notify the county of the  disaster incident and request assistance.
 * 18) Regardless of the status of the facility EOC, the Chair of the  will maintain contact with the senior leadership of the facility and follow any corporate health and safety reporting policy beyond facility leadership and outside this plan.
 * 19) Supervisors will be notified of the nature, scope, and location of the incident by the senior staff member on shift. Supervisors will be responsible for accountability for their staff and residents within their area of responsibility.
 * 20) Supervisors will report the staff and resident census information to the facility EOC. If the Newark Manor Nursing Home EOC is not activated, then the supervisors will send the information to the senior staff member on shift.
 * 21) Communication Systems
 * 22) General
 * 23) The formal communications plans are located in Appendix 5: Communications.
 * 24) Information in Appendix 5: Communications will be treated confidentially, as it may contain sensitive and personal information.
 * 25) Additional communications resources are available through an unmet needs request to the New Castle County EMA.
 * 26) The Logistics Section Chief in the facility EOC is responsible for organizing communications during an incident.
 * 27) A Communications Unit may be established under the Logistics Section as required.
 * 28) The Communications Unit is led by the Communications Hardware Unit Leader.
 * 29) The Logistics Section/Communications Unit will be responsible for the following:
 * 30) Incident-specific communications plans
 * 31) Maintaining communications systems for contact with internal and external stakeholders
 * 32) Maintaining the staff contact list during an incident
 * 33) Internal Communications Resources
 * 34) Public address system
 * 35) Phone (landline, cellular, voice, text)
 * 36) E-mail
 * 37) Two-way radio
 * 38) Runners
 * 39) External Communications Resources
 * 40) Phone (landline, cellular, voice, text)
 * 41) E-mail
 * 42) Facility web page