1. Rhode Island Long Term Care Mutual Aid Plan (LTC-MAP)
Staff Orientation 1

2. What Led to Mutual Aid in New England:
Learning from experiences in:
NY State – 1st Plan (began in 1983)
2001 Tropical Storm Alison (Houston)
2001 9/11
2005 Hurricanes Katrina / Rita
Massachusetts Disasters (1st New England State)
May 2006 Flooding (Mother’s Day Storm)
November 2006 Chemical Explosion (Danvers)
2008 Ice Storm in Central & Western MA
In 1982, a 404 bed nursing home evacuated in Western NY. The first Mutual Aid Plan in the nation (long term care) was built by Russell Phillips & Associates in That plan is still in existing today at the Greater Rochester Mutual Aid Plan. Multiple disasters solidified the reason to have mutual aid. The New England plans then started based on several events in Massachusetts. See next slide for the Mothers Day storm.

3. Mary Immaculate Evacuated (250 beds) (Evacuation: May 2006 / Recovery: Sept. 2006) Source: Boston Globe.com
FOLLOWING A RAIN STORM, NOW KNOWN AS THE MOTHER’S DAY STORM IN 2006, DAMS WERE OVERFLOWING IN THE SOUTHEAST AND NORTHEAST SECTIONS OF THE STATE. VERY SIMILAR TO THE FLOODING DEVASTATION VERMONT EXPERIENCED IN IRENE.
EVENT DESCRIPTION: THIS IS A PICTURE OF ONE OF THE LARGER NURSING HOMES IN MASS, MARY IMMACULATE. DURING THE MOTHER’S DAY STORM THIS HOME, WHICH ABUTS THE SPIGOT RIVER, EVENTUALLY HAD TO BE EVACUATED WHEN A DAMN IN NEW HAMPSHIRE BECAME OVERWHELMED RESULTING IN THE FLOODING YOU SEE HERE. EVENTUALLY, THE BASEMENT AND FIRST FLOOR OF THE FACILITY BECAME FLOODED AND RESIDENTS HAD TO BE RESCUED. RESIDENTS WERE LITERALLY FLOATED OUT OF THE BUILDING IN LINEN HAMPERS WHICH BECAME MAKE SHIFT RAFTS FOR RESCUE WORKERS.
THERE WAS NO MUTUAL AID PLAN IN PLACE AT THIS TIME: DPH AND THE FACILITY WORKED WITH AREA NURSING HOMES, ONE AT A TIME, TO ACCEPT THEIR RESIDENTS FOR SHORT TERM AND THEN PERMANENT PLACEMENT. EXTENDED TIME TO ACCOMPLISH THIS AND THE INITIAL EVACUATION PUT ALL OF THE RESIDENTS IN MULTIPLE AREA HOSPITAL BEFORE THE MOVE TO THE NURSING HOMES.

4. Other Incidents where Mutual Aid Plans were Activated
Aug/Sept Tropical Storm Irene/Lee Flooding
Oct/Nov “Halloween Storm” - Snowstorm/ Power Failure
Oct/Nov Superstorm Sandy
Jan 2013 Influenza Event – Boston & Hartford, CT Activations for Hospital Resident Decompression
Feb 2013 – Blizzard (NEMO)
Jan 2014 – Snowstorm
In recent years, New England’s mutual aid plans have proven to be up to the challenge during actual events.

5. OVERVIEW of the RI LTC-MAP

6. Plan Operation is 1st within your town/city. Additional Support will
come from your Region
then other regions in a widespread
disaster.
~500 LTC / 30 Hospitals / 4 LTACs or Rehab Hospitals
213 LTC / 11 Hospitals
Regions 1, 3, 4 & 5
Sister Mutual Aid Plans are currently operating in Massachusetts and Connecticut. In a widespread disaster, these Sister MAPs have all promised to support one another.
151 LTC

7. Northern & Southern Region

8. The Basics
Identify needs and provide supplies/ equipment/pharmaceuticals as necessary
Assist with transportation of supplies / staff / equipment / evacuated residents
Provide staffing support (whether a facility is evacuating or isolated)
Place and support the care of evacuated residents (continuity of care / surge locations)
LTC-MAP provides a framework within which LTC facilities can efficiently and effectively give and receive assistance during disasters.

9. Disaster Struck Facility

10. Actions of Disaster Struck Facility
NOTIFY: Call 911 / begin Internal Activation process
ACTIVATE: RIDOH Duty Officer (CEPR) at to activate the LTC-MAP and Critical Partners through the alert notification system
ACTIVATE: Emergency Reporting System
(Could be done by RIDOH)
This information is all from the Algorithm. Review your LTC-MAP binder and the first pages include the activation algorithms (1.1 and 1.2). 10

11. Transportation Evacuation Surveys (transportation tab on website)
Provides Department of Health, Fire, EMS and Emergency Management with strong knowledge of the resources needed to evacuate our facility (Ambulances, wheelchair vehicles and buses)
Consider completing with monthly fire drills (each resident care area)
On website for an automated tool
We recommend you complete this with monthly or quarterly fire drills, when there is a pre-storm alert and during disaster exercises. You will log-in (see the next slide) to complete this electronically, but the hard copy piece to gather the information is at on the right hand side of the page under “Statewide Tools”. No log-in is necessary to get the hard copy tools.

12. Pre-established Evacuation Sites
Primary sites should be pre-selected using the LTC Patient Care Categories (next slide – from website)
Address highest acuity residents first
Who matches up best with you (memory care)
Address their surge numbers next
Always assume they have no open beds
How many of your residents can they accept at 110% surge
Process to communicate with them
Know where they are
Know who the point people are and contact information
Pre-select evacuation sites. Up to 10 that best fit with your organization. 12 12

13. Cross reference other facilities in the region against your own facility. Run the Report entitled LTC Patient Care Categories for your region and see who best matches up with your facility.

14. Resident Tracking – What goes with the Resident
Resident Emergency Evacuation Form
1 per resident - info and acuity / mobility / risks
Current Service Plan
Include MAR/Med List and Meds/Controlled Substances
Wristband (name / DOB)
Resident, MR, Staff & Equip Tracking Sheet
List of residents; by facility they evacuated to
Transportation vehicle info and time departed
What (and whom) went with them
Photo, if possible
DNR Bracelets / Personal Belongings
Five essential tracking tools are used in the LTC-MAP.
The Resident Emergency Evacuation Form tracks INDIVIDUAL residents. You should have these on hand for 150% of your residents. These are 3 part NCR forms.
The Resident, Medical Record, Staff and Equipment Tracking Sheet tracks GROUPS of evacuating residents, and the items that may be traveling with them. You should have these on hand for about 1/3 of your residents. These are 3 part NCR forms.
The Influx of Residents Log mirrors the Resident, Medical Record, Staff and Equipment Tracking Sheet , and is used by receiving facilities. You should have these on hand as well. Maximum of 5-10 are necessary. These are 3 part NCR forms.
If you don’t have these forms click HELP on the home page of an address box will appear addressed to Russell Phillips & Associates. Please inform them of the forms that your facility needs
Some of the other tools, such as the LTC Facility Tracking Board, is primarily used by the LTC Group Responders, but could be used by any member facility.
All of these forms are available for download from the LTC-MAP website under DOCUMENTS / LTC-MAP PLAN DOCUMENTS

15. Resident Accepting Facilities/Lenders

16. Actions of Resident Accepting Facilities/Lenders
Prepare to receive residents
Open beds vs. Surge Area
Complete Emergency Reporting
Complete the Influx of Resident Log - residents arrive
Confirm with DSF or LTC Group Responders that the residents are received – “CLOSE THE LOOP”
Start a new chart for resident
Notify RIDOH and your local AHJ about activating a Surge Plan (Influx / Surge Guidelines)
If Lender: Prepare to provide Resources/Assets
During an emergency, most member facilities will perform the role of Resident Accepting Facility (RAF), or Lender.
RAFs and Lenders have specific responsibilities to discharge during activations. 16

17. What happens at 2:00 AM? Anyone who might answer the phone:
Basic knowledge that RI LTC-MAP exists (there is a plan)
Get the name of the person calling, facility, contact number and issue or request
OR – Listen to the automated message and take down directions for what it tells you to do
Inform the Nursing Supervisor or Person-in-Charge ASAP
Person-in-Charge – Scope will determine actions
Immediate analysis - how many residents can you take
Activate internal emergency notification tree
Complete Emergency Reporting-
Evacuation? Prepare to receiving incoming residents
Resource & Asset Request: Prepare to provide staff, equipment, supplies or transportation
The call to “activate” might come in at any time. Therefore, at least some rudimentary training across the shifts must take place at each member facility.

18. (all tabs are specific to our facility based on data we enter)
RI LTC-MAP Website
(all tabs are specific to our facility based on data we enter)
The LTC-MAP website functions as a repository of information that is collected from members well in advance of any disaster.
It also performs as a high tech tool that can be used to collect “real time” information from members during emergencies (Emergency Reporting)

19. Example above shows where you can house your generator information
Example above shows where you can house your generator information. But, look at all tabs.
Contacts – 3-7 people we need notified in a disaster and check off the name of the Executive Director or Administrator as the Licensure contact.
LTC Bed – Your categories of care you provide and surge information.
Evacuation Sites – Pre-selected evacuation sites.
Stop Over Points – Areas you could move to rapidly to shelter residents (very close proximity to your facility).
Equipment and Supplies – Not your inventory, but what you have that could be used in emergencies (extra or emergency stock).
Transportation – This is your transportation evacuation survey tab.
Vehicles – Vehicles that you own.
Vendors – Select list of vendors that populates a master index of vendors by category for all plan members.

20. Emergency Reporting
Designated Facility Leadership or Nursing Supervisor (complete for LTC-MAP when requested)

21. Internal Situation-Status Report & Emergency Reporting: What You Should Know (and WHY)
Operational Issues at your facility (other plan members)
Open Beds
Available Transportation for
Resident Transportation
Movement of Supplies and Equipment
Resources & Assets (needed)
Resources & Assets (you could provide)
Equipment
Supplies
Staffing
HANDOUT
HANDOUT
This was made available as a tool at the 2014 LTC-MAP annual meeting. Provide to all parties who are attending your education session.

22. RIDOH Department Operations Center (LTC Group Responders)
RIDOH has equipped multiple sites to function as the LTC Group Responders.
Some LTC-MAP Steering Committee Members have volunteered to serve as LTC Group Responders. These Responders are trained and divided into groups that will work in shifts whenever the LTC Group Responders is activated.
If you would like more information on being a LTC Group Responder or a Steering Committee Member contact Jim Garrow, Scott Aronson or Darren Osleger at Russell Phillips & Associates at

23. Function of the LTC Group Responders “Air Traffic Control”
Staffed by RIDOH & volunteers from the LTC-MAP
Assist with resident placement
Support resident tracking - “Close the loop”
Assist with obtaining staff, supplies and equipment
Assist with transportation of residents, staff, supplies and equipment
Support interaction with local and state agencies
ENSURE ALL MEMBERS ARE ACCOUNTED FOR
The LTC Group Responders performs these basic functions for the LTC-MAP. It is helpful to think of the LTC Group Responders as “air traffic control” for the long-term care facilities.

24. Who to go to with Questions?
Department of Health
Center for Emergency Preparedness & Response
Alysia Mihalakos Joseph Reppucci
Russell Phillips & Associates
Jim Garrow Scott Aronson
Lori Cheever Darren Osleger
David Hood
Scott Aronson 24