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ANATOMY OF AN EVACUATION

August 1, 2007
by DENNIS GREGORY
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A major fire forced this New Jersey nursing facility to trigger its disaster response plan sooner than it expected

When the Pine Barrens in southeastern New Jersey caught fire in May, residents and staff of Genesis HealthCare's Southern Ocean Center in adjacent Man-ahawkin were faced with the alarming mission of evacuating the facility. But with a solid emergency plan in place, Southern Ocean Center's staff who able to safely transfer its 119 residents to other Genesis centers and a local shelter. “I've never been through anything like this in my 17 years as a healthcare administrator,” says Administrator Shelley Wyatt of the coordinated effort that yielded valuable lessons about the importance of a careful response plan.

As the fire began in the late afternoon of May 15, columns of smoke rose above the Pine Barrens, with the fire eventually consuming more than 19 square miles and closing several local highways. Local Emergency Management authorities decided to evacuate the area's northwest neighborhoods first, leaving Southern Ocean Center unaffected during the first few hours of the fire. However, the fire could not be contained, and the threat of shifting winds caused the authorities to expand their evacuation area to include Southern Ocean Center.

The Center's adventure began with staffers implementing the facility's emergency response plan and readying residents for the daunting task of a potential evacuation. “One of the first things we did was shut down all the HVAC units to minimize the smoke entering the Center,” explains Wyatt. “Then, in preparation for an evacuation, we separated each patient's chart, medications, and a change of clothing into packages that were secured to each patient's wheelchair.”

Many nursing centers prepare for evacuation with the scenario of evacuating to just one location such as a local nursing center or shelter, with a few of the most critical transferring to a hospital. In this case, all three area nursing facilities faced a similar evacuation and the hospital was on standby to evacuate, as well.

As 19 of the most medically complex patients were being transferred to an available facility a safe distance away, Center personnel made plans for others to be transferred to one of 30 other Genesis centers in New Jersey. However, local EMS commandeered all transportation and made the remaining 100 residents, as well as the residents and staff of two other area nursing centers, transfer to the local high school.

The situation at the local high school was less than ideal for providing care, even though Southern Ocean staff had brought enough food and medical supplies—and smiles—to keep patients comfortable. The facility was allocated only 10 cots and the use of only one handicapped bathroom, so the organization knew it would be better for everyone to get their patients to Genesis nursing centers. Overnight, while staff cared for patients, Wyatt worked with Genesis regional employees to find suitable transport from the Philadelphia area to move patients from the high school to the centers.

As the sun rose the day after the evacuation, a caravan of wheelchair vans arrived at the evacuation center. After a brief argument with a state EMS staffer who wanted to commandeer the vans, Southern Ocean Center started moving the frailest residents. Luckily, as part of the emergency plan, multiple sets of driving directions were kept in a folder at the main reception desk. These directions proved invaluable as ambulance crews from Philadelphia moved patients from the high school to other Genesis centers. “Preparing detailed directions to multiple facilities in advance helped our transport process run smoothly,” notes Wyatt.

Timely communication was imperative during the Southern Ocean Center crisis. When the Center determined it would need to evacuate and call for support from Genesis regional management, administration discovered that the area emergency team was at a Philadelphia Phillies baseball game that evening. However, the team quickly came together and activated its emergency operations center in Kennett Square, Pennsylvania. A conference call line was established and kept open for nearly 24 hours so that anyone involved with the evacuation could call for updates. At the start of the evacuation, family members were notified of their loved one's location and were kept in contact over the course of the evacuation. At the high school, officials allowed Wyatt to set up a command center to provide a central location for communication.

Throughout the process, staffers discovered that their advance preparations had proved vital to preventing any communication breakdown. “I would recommend that all administrators purchase a police scanner, should telephone or cell phone lines become unreliable,” advises Wyatt. “During our crisis, limited information came from emergency responders, and another means of receiving information would have been helpful.” She has also since purchased a portable crank generator with universal cell phone charger adapters.

“Our staff were amazing during the crisis,” says Wyatt. Staffers executed their respective jobs virtually without a hitch, and Wyatt was impressed with the suggestions and proactive approach employed by the entire team on duty at the time. “Everyone was thinking on their feet—their contributions exemplify the professionalism and skill of our staff,” she adds.

One lesson learned was the value of preserving a number of staff should the crisis continue for a prolonged period. Naturally, in a crisis, employees may call up and offer their help for the immediate future. A successful alternative approach used by Southern Ocean Center was to ask some of the staff not to report to the center immediately.

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