Emergency Evacuation Cartoon
An emergency preparedness program changes "what if" to confidence
by Sharon Fredrichs & Stephanie Phillips

When emergencies and disasters happen, home health agencies need to be able to care for patients and employees in the direst circumstances. An emergency preparedness program is a comprehensive approach to meeting the health, safety and security needs of your agency and community in the event of a disaster or emergency.   

Emergency preparedness is an essential part of home health operations. A comprehensive emergency plan acts as a framework to ensure that agency operations continue in an urgent or evolving situation and allows management to seamlessly transition from routine operations to incident command processes. 

An emergency plan should include four basic components: 

  • an all-hazards vulnerability analysis
  • policies and procedures
  • a communication plan
  • training and testing

What kind of crisis?

CMS defines emergency and disaster similarly but with significant differences. Each represents “a hazard impact causing adverse physical, social, psychological, economic or political effects that challenges the ability to respond rapidly and effectively. It requires stepped-up capacity and capability (call-back procedures, mutual aid, etc.).”

An emergency commonly requires change from routine management methods to an incident command process to achieve the expected outcome. In a disaster, despite a stepped-up capacity and capability and change from routine management methods to an incident command/management process, the outcome is lower than expected compared with a smaller scale event.

CMS published emergency preparedness requirements in 2016 for health care facilities with a date of compliance of Nov. 15, 2017. In 2019, these requirements were revised to reduce unnecessary burdens and promote efficiency for health care providers.

Building a Plan

Risks are identified in the all-hazards vulnerability analysis and contingency plans are developed to mitigate these risks. For example, in 2019, the Centers for Medicare & Medicaid Services (CMS) encouraged providers to assess the risk of emerging infectious diseases such as Ebola and the Zika virus and to update core program components in response. 

Policies and procedures guide managers and clinicians during an emergency. Include local/state/federal and accreditation requirements when developing policies. Update policies as needed when regulatory requirements change and utilize policies and procedures when creating the plan.

Contingency plans must address all areas of agency operations including clinical, financial and administrative components. Questions to answer as you create your contingency plan include:

  • Who is responsible for activating the emergency plan? 
  • What is the succession plan if the primary and/or secondary person is unavailable? 
  • Is there immediate access to an active patient list and a list of employees? 
  • How will staff and patients be tracked during an emergency? 
  • Are plans in place for a smooth transition to a new space with adequate and appropriate supplies if the office must relocate? 

In addition, you should know the number of employees you will need to manage in an emergency or disaster. Include vendors’ emergency plans for the continued provision of needed supplies. Know what capabilities your electronic medical record has during an emergency and what contingency plans the vendor has in place; have paper forms available for prolonged power outages. Be aware of patient privacy issues that could arise and the agency’s responsibility for maintaining confidentiality. Have plans in place to track employee work hours and meet payroll needs. Know your policy for handling time off during and after an emergency or disaster. Plan to meet the changing needs of patients and staff after an emergency. Know what community resources are available to help.

Patient and caregiver education is also important. Patients should be assigned a disaster or acuity code upon admission. Patients and caregivers need to be informed of how the agency plans to communicate and to provide services during an emergency or disaster. Ensure that patients and caregivers know how to contact both the agency and emergency services. 

An emergency plan should continuously evolve. Analysis of the agency’s response to an emergency or disaster provides insight into what worked, what didn’t work and what needs to be changed. The emergency plan should be reviewed after every incident and/or exercise and revised if needed. CMS’s revised requirements, which became effective in November 2019, require an emergency plan to be reviewed and updated every two years. 

Communicating With Staff & Patients

The communication plan is critical to managing an emergency or disaster situation. More than one person may be needed to manage emergency communications; consider designating one person for internal communications with staff and patients and a different person to be responsible for external communications with media, first responders, volunteers, etc. A resource should be readily available with contact information for all employees, patients and their physicians, community resources, and local/state/regional/federal/tribal emergency management responders. 

If your community has predesignated evacuation and/or medical evacuation sites, include their contact information in the communication plan. Also, list contact information for volunteer resources for additional help. Ensure that staff know what alternate means of communication will be used if landlines and cellphones are not available (for example, hand-held radios, walkie-talkies or word of mouth). All patients should have an individual emergency plan and a specific evacuation plan. Know exactly who is responsible for contacting emergency responders on behalf of patients who require assistance with evacuation, especially any patients who will need continued medical services or equipment. 

Training Staff to Respond

CMS revised its training and testing requirements in 2019. All employees must be trained upon hire, and then again every two years. Well-trained employees know their role during an emergency and what contingency plans are in place. They know the communication plan and what their responsibilities are. 

Testing must be conducted with at least one exercise annually. Every two years, a community-based—or, if that is unavailable, facility-based—functional exercise must be conducted. In alternate years an additional exercise must be conducted. This can be a community-based exercise, a mock disaster drill, a tabletop exercise or a workshop. Any of these exercises can be replaced if there is an actual emergency that results in the agency activating their emergency plan. All exercises or plan activations must include documented evidence of evaluation of the agency’s response and revisions to the emergency plan as required.

Many resources are available to assist agencies in developing emergency plans. The Federal Emergency Management Agency provides emergency management information and training as well as tabletop exercises. The National Association for Home Care & Hospice has an emergency preparedness packet available. The Assistant Secretary for Preparedness and Response Technical Resources, Assistance Center, and Information Exchange website (asprtracie.hhs.gov) is a health care emergency preparedness information resource provided by the Department of Health and Human Services. Local and state emergency management agencies are also good sources for emergency preparedness information for your specific geographic location. The Ready 2020 Preparedness Calendar is a customizable planning tool that provides activities to help promote preparedness throughout the year. Accreditation agencies also have specific emergency standards and resources to guide accredited agencies. 

The worry of “what if” can be changed to confidence and safety for almost any event with the four components of your emergency plan. Though no one can prepare for every possible event, hazard vulnerability analysis and comprehensive emergency planning make functioning during an emergency or a disaster more organized and effective. Preplanning, knowing your resources, identifying the triggers to activate each component of your plan and engaging patients and staff in safety planning prepares you for the worst that might happen. 

Sharon Fredrichs, BSN, RN, CPHQ. and Stephanie Phillips, BSN, MBA, RN, own S&S Home Care Consulting, LLC. They have presented on emergency preparedness at local, state and national venues. Their services include interim management, start-up assistance, survey prep and recovery, the development and management of quality assurance and performance improvement programs, and leadership mentoring.