Annals of Long Term Care

Hurricane Katrina of 2005 affected 120 of 300 nursing homes in the state of Louisiana, causing evacuation to other areas of the state. Many lessons were learned from this disaster.

DISASTER PLANS
Disaster plans should be reviewed every year, and disaster drills practiced on a regular basis. The plan should include verification of the evacuation shelter with which the nursing home contracts. When evaluating a shelter (or other facility) for evacuation, keep in mind that several rooms will be necessary for housing the staff and their children. There should be a written bus service contract in place for evacuation of residents. Emergency tags should be available and in place for buses providing the transportation, since nonemergency transportation to or from a disaster area is likely to be restricted.

Emergency supplies should always be kept separate from regular supplies and regularly inspected. A pharmacy provider for the facility should be chosen that maintains backup electronic pharmacy records in a separate geographic location to enable access to vital information after the disaster.
Emergency kits for each bus should be prepared in advance. A staff person should be designated to be the first one arriving to the evacuating site to direct activities. Other staff should be designated to stay to close up the facility and to be there to reopen it before the residents return after the disaster. To notify families regarding the evacuation, notification technology can be used (www. notification.com). This phone service enables recording of a message and delivering it to hundreds of preprogrammed telephones.

TRIAGE
Residents should be triaged for specific buses. Ambulatory residents should be loaded first, then wheelchair residents who need minimal assistance. Loading the most dependent residents last provides the capability of caring for them until departure and unloading them off the bus first. Buses should be staffed according to acuity of the residents, using at least two staff members per bus. When possible, roommates should be placed together on the bus, as familiarity has been shown to reduce anxiety and agitation. When time allows, completion of a walk-through check, including all bathrooms, should be performed to ensure that no resident is left behind.

RESIDENT VITAL MEDICAL INFORMATION
Resident identification and vital medical information is critical. A notebook with pictures of each resident and copies of resident face sheets should be prepared with insurance carrier and current physician orders to accompany residents on the bus. A CD file with digital pictures of residents with name and contact information can be sent to any facility or hospital.

Identifying color-coded armbands (according to acuity level of the resident) should be placed on the residents during the disaster. Information should include the name of the resident, facility, cell phone contact number, code status, diet, and attending physician. Families who remove their loved ones from a facility prior to mandatory evacuation should be given copies of medical records for use for admission to another facility outside of the disaster area, or when returning to the facility after the disaster event is over.

ADVANCE NOTICE OF A PENDING DISASTER
When there is advance notice of a disaster, extra medications and supplies should be ordered and organized in the medication carts. Proper storage of insulin and other refrigerator medications is critical, using necessary checklists. Each bus must have enough supplies, food, cold water (due to lack of air conditioning in some buses), towels, and oxygen tanks to operate independently for a period of 8-10 hours during transportation. Large equipment should be sent ahead of the buses with residents. Proper loading of equipment onto the buses is essential, since equipment necessary for use on arrival should be loaded last (eg, medication carts, oxygen tanks).