The purpose of this Emergency Operations Plan is to provide planning, training and establish preparedness to reponed to the effects of potenial emergencies whether they are man-made or natural disasters


A. Disaster-The occurrence or imminent threat of widespread or sever damage, injury, or loss of life or property resulting from a natural or man-make cause,such as fire,flood,earthquake, wind,strom wave action,oil spill or other water contamination, epiemic,air contamination,infestation,explosion,riot, hostile military or paramilitary action, or energy emergency.

B. Mitigation - A process in which sustained actions are taken to reduce or eliminate long-term risk from natural and man-made hazards or disasters. Activities include coordinating with state agencies,private sector,and the public following disasters and emergencies.

C. Preparedness - preparing for the potential of a disaster through education and training, integration with community resource, developing disaster respone plans, organizing respone and recovery activities, and conducting exercises

D. Recovery - Activities implemented druing and after a disaster designed to return an agency to its normal operations as quickly as possible.

E. Response - Actions taken immediately before, during or after an impending disaster to adress the immediate and short-term effect of the disaster.These are the details of the plan given for others to follow in order for the emergency plan to be successful.


A. The administrator, supervising nurse, the disaster coordinator and the alernate will be involved with developing, maintaining and implementing the agencys emergency perparedness and response plan.

B. Agency will utilize an Emergency preparedness plan in the event a situation occurs that could potentially affect the needs for its services or its ability to provide those services. Agency employees and contractor will be educated regarding the emergency preparedness and response plan and their responsibility in executing the plan upon hire and annually thereafter.

C. The effectiveness of the Emergency preparedness plan will be evaluated at least annually and after each actual disaster/emergency response. The annual inernal review will consist of testing the response phase of the emergency preparednees and response plan in a planned drill, if not tested during an actual emergency response. A drill may be limited to the agencys procedure for communicating with staff.

E. Agency will designate an employee by tittle,and al least one alternate by tittle,to act as the agencys disaster coordinator.This will be documented is in the emergency preparedness reponse and plan manual.
Staff will follow the "Staff Emergency preparedness plan" in the event of a seen or unforeseen emergency.

F. Agnecy will creat a "Hazard threat analyis" to identify the potential disaster from natural and man-made causes misr likely to occur in the agencys services area. These threats that may potentially create risk inculde,but not limited to:tornados,flash floods,chemical spills or incidents,severe ice storm/blizzards, terrorism, lightening, nuclear power plant incidents, hurricane or tsunami and wild fires.

G. Agency will develop a "Continuity of Operations Planning" to ensure needs of agency,staff ansd patients are met.

H. Agency will maintain docummentation of compilance with the required elements,required forms and agency policies in the Emergency Preparedness Reponse and plan Manual.

I. Agency will make a good faith effort to comply with the policies druing a disaster.If the agency us unable to comply with any of the policies,it will document attempts of staff to follow procedure outlined in the angencys emergency preparedness plan.

J. Agency will not participate in community emergency preparedness plans or exercies but may utilize community resource as needed during an emergency or disaster.

K. Agency will assist the pateint as necssary with registering for disaster evacuation assistance through 211 services provided by the Texas information and Referral Network.

L. Agency staff will counsel a pateint on disaster preparedness during the admission process and as changes are noted.


A. Emergency Preparedness Planning for Natural and Manmade Disaster

1. The hazard vulnerability analyis tool will be completed by agency leader to identify the level of risk and preparedness for a variety of hazardous events that might affect the agency and ability to provide services.
2. A current list of contact information for staff,staff family members,vendors,emergency services, hosiptal and other appropriate community resource will be maintained.

3. Agency leaders will develop the Contiunity of Operations Planningto address the following:

a. Emergency financial needs;
b. Essential function for pateint services;
c. Critical personnel,roles and reponsibities:and
c. How to return to normal operations as quickly as possible.

4. Administrator or designated administrative staff will maintain a current phone list for staff and all applicalbe contact numbers home,phone,cell phone, pager numbers, and contact numbers of family/friend if employee is unreachalbe in event of emergency and establish a communication tree or chain. This list will be maintained in the Business Emergency plan and staff will be responsible to provide current and updated information. Communication tree will communicate with the following:

a. Leaders and owners, if applicable
b. Staff;
c. Pateint or someone reponsible for a pateints emergency response plan;
d. Country and city emergency management officials if needed during and after an event;
e. State and federal emergency management entities if warranted by the nature of the event;and
f. Other applicable entites (i.e. DADS, Emergency Medical Services or other health care providers).

5. Pateint Care and Communication

a. Upon admission to Agency,directly following an emergency response,and on an ongoing basis the following will be assessed:
i. The pateint condition and needs for triage prioritization and
ii. The pateint location for potential natural and/or industrial disaster (to include tornadoes,hurricanes,winter stroms/blizzards, nuclear power plant disaster ,floods,chemical toxicity,pollution,and fire,etc.).

6. Patient Triage

a. Agency will maintain a current list of patienta categorized into based on services provide to the patient by the agency,need for continuity of services being provide, and availability of someone to assume responsibility for a patients emergency response plan if needed by the patient. Patients will be categorized by,but not limited to, the following:

i. Class 1- lifethreatening (or potential) requiring ongoing medical treatment to prevent a life threatening episode, Unable to withstand any interruption in power supply. Unable to evacuate/transport self. No readily available caregiver or caregiver unable to provide needed care. Appropriate arrangements to transfer to an acute care facility will be made by the agency in collaboration with the local country or city autherities (fire department, police,and sheriff), the patient/family and the physician.
ii. class 2 - Not immediately life threatening but patient may suffer adverse effet without services (i.e. new insulin-dependent diabetic unable to self-
inject insulin,IV medications, or sterile woundcare with large amounts of drainage.) Visits may be postponed 24-48 hours with minimal adverse effect. Unable to transfer/transport self or no transportation available from caregiver. Appropriate arrangements may be made if neccssary,to send patient to a facility that can meet their needs. This will be done in collaboration with the patient/family,physician, and local or city authorities.
iii. Class lll - Services may be postponed 48-72 hours without adverse effect on the patient (i.e new insulin-dependent diabetic able to self-inject,cardiovascularand/or respiratory assessments,or sterile wound care to a wound with minimal to no drainage). Transportation available from family ,friend, volunteers or caregiver.
iv. Class iv- Services may be postponed 72 hours or more without adverse effect on the patient (i.e rountine catheter changes or postoperative with no open wound). willing and able caregiver readily avialable or patients independent in most ADLS. Transportation avialable from family,friend,volunteers or caregiver.

b. Staff will asses the availability of someone to assume reponsibility for the patients emergency reponse plan if needed plan if needed by the patient during the admision proces and at any time this information changes.

c. Staff will identify a patient who may need evacuation assistance from local or state jurisdictions and a list of vendor who supply each paitent medical supplies will be obtained and kept in the patients chart. This will be documented in the patient information Emergency/ Disaster Preparedness and Plan.

d. In the event of an emergency,staff will be able to readily acces a patients triage category documented in the list od patient with all categories listed. The list of patient with all classes noted will be documented in the on call list or in other documentation that is easily retrieved.

e. The patient disaster triage class will be reviwed and updated as condition or situation warrants but not less than every 60 days. The updated class will be documented on the OASIS and updated patient Emergency information sheet. Changes will be communicated to staff for any changes made.

f. Upon admission, the agency will provide and educate in the Patient Information & Emergency/Disaster Preparedness Plan which will adress how to handle emergencies in the home related to a disaster. The patient will sign acknowleding information provide.The patient admission packet will include but not limited to the following:

i. List is community disaster resource that may assist a patient during a disaster,including the Transportation Assistance Registry available through 211 Texas,and other community disaster resource provide by DADS,local,state,and federal emergency management agencies.An agencys list of community disaster resource will include informantion.On how to contact the resource directly or instruction to call 211 for more information about community disaster resource.
ii. Materials that describe survival tips and plans for evacuation and sheltering in place;
iii. Identification or person or persons reponsible to assist with evacuation in the event of an emergency/disaster and names of family/friends who may be contacted by agency in an emergency;
iv. Identification of patients current status will 211 registry,requested assistance with 211 registry,declination of 211 registry and completion if 211 registry;and
v. patient reponsibilities and action reponsibilities of agency staff during and Immeediately following and emergency are provide in the admission packet.

g. The patient-specific emergency/disaster preparedness plan will be documented in the patient medical record and communicated to Agency staff. Agency will maintain a copy in patients floder in the home as well.

h. Agency will make appropriate referral to assure continuation of care. This will include but not be limited to:

i. Life-supporting equipment (DME provider, electric/gas company);
ii. Life-sustaining medication and/or nutrition (Pharmacy, infusion company); and
iii. Appropriate emergency reponse systems assist patient as appropriate.
i. Agency will not physically evacuate or transport a patient.Agency staff will not be sent into hazardous areas or contiune to operate in hazardous conditions.

7. Administrative Staff Responsibities of Emergency Preparedness Planning for Natural and Manmade Disasters:

a. The Administrator or designated administrative staff will coordinate services with local,state federal emergency management agencies and with any other healthcare provides or medical suppliers.

b. The Administrator or Disaster Coordinator/Alternate will maintain adequate medical supplies in the event of anticipated disaster or suppliers availble to provide equipment and medical siupplies in the event of disaster.

c. The Administrator or designated administrative.Staff will ensure security and safety of physical facilities which may include maintaining proper functioning fire safety equipment,ensuring exits are accessible,locks are functioning,information on utilities shutdown is readily accesible if applicable and supplies for shelter in place or power failure are available (duct tape, bottle water, nonperishable snacks,flashlights,candles,etc.).

d. The managment staff will ensure that the patients are appropriately triaged and that this is communicated to agency staff.

8. Clinical Staff Responsibilities for Emergency Preparedness Planning for Natural and Manmade Disasters

a. Clinical staff will participate in emergency preparedness drills,in-services and orientaiton related to safety, security or emergency preparedness and in a multidisciplinary critique of each actual disaster or drill.

b. Clinical staff is reponsible for educating patient on how to handle emergencies in home related to a disaster.

9. The Disaster Coordinator/alternate or designee will monitor disaster-related news and information, inculding after hours, weekneds and holidays,to receive warning of immient and occuring disaster. The following methods may be utilized:

a. Local and regional news media through television and radio;
b. Internet;
c. Emergency broadcast channels, weather channels;
d. Governments authorities; or
e. Internal agency communications.

10. Patient will receive call or visits from clinical staff with information for needed preparation or instructions for potential disaster or emergencies that are imminent.

11. Patient,caregiver and staff will receive education on any new or potenial emergencies that may affect patient care and services.

12. An emergency supplies stroage area will be maintained at the agency office foe employees during the time period that they are working in the event of an emergency and will be updated and maintained by the Disaster Coordinator/Alternate.

B. Mitigation

1. Administrative Staff Reponsibilities for Mitigation

a. Administrator will maintain a backup staffing plan and ensure adequate staff is aviable to provide care to patients if agency is not able to provide services to is patients during an emergency.

b. Administrator will ensure a test of the emergency preparedness plan is conducted if no actual disaster have occurred al least annually.

2. Clinical Staff Reponsibilities for Mitigation

a. Clinical staff will participate in the drill annually to test the call tree and to identify opportunities to improve documented in the critique of the drill or actual disaster.

3. Patients who are vulnervable to particular conditions will be indentified with proactive actions taken to reduce risk which may include but not limited to:

a. Increasing monitoring of patient and home environment during certain conditions such as heat wave, drought or winter storms;

b. Providing education to patient and caregiver on measures to keep cool in heat wave, keep warm during winter stroms or other safety measure; or

c. Providing utility companies with a list of potentially vulnerable patient is the event of power failure.

4. Patient and caregiver will be assisted on admission with developing a home emergency plan and provision of materials to assist in planning which are left in home folder.

C. Technological/Utility Failure / Mitigation

1. Administrator or designee will install and provide adequate protection of electronic records including anti-virus software and backup of documents including:

a. Delegation of task for back-up of data on a daily basis:

b. Education of staff on security of electronic records utilizing passwords to access records;

c. Maintenance of adequate supplies in event of power failures (clinical records in paper format, etc).

2. Clinical staff will be compliant with accessing electronic records with passwords and will not share or provide passwords to other. clinical staff will changing passwords per agency policy.

D. Response Phase

1. The Administrator or Disaster Coordinator/Alternate will initiate and terminate the response phase.

2. The Administrator or Disaster Coordinator/Alternate determines facility safety and contiuned operations if alternate site will be utilized.

3. The Administrator or designee wil establish links to local emergecny operations centers to determine mechanism by which to approach specific areas within a disaster area in order for agency staff to reach patients. This will be communicated to staff.

4. Clinical staff will communicate with means available. If the primary modes of communication with phone or cell phone call fail,other methods may be used:

a. Texting;
b. Satellite phones;
c. Internet technologies,email; or
CB radios or HAM radio, if avialable.

5. Local radio and/or televission statios will be contacted by the agnecy as a method of communicating with the patient poplulation and staff, as appropriate.

6. If no means of communication is available, then all staff members who can safely travel will report to the office if operational or alternate site if office is not operational for assignments.

7. The Administrator will determine if staffing is needed to provide or assist with services to its patients from another agency (Back-Up Staffing Contract).

8. Patient visits will be coordinated by the Director of Nurse or Alternate using the triage codes. Scheduled visit may be curtailed but attempts will be made to contact all patients/caregiver.

9. Supplies will be deliverd as needed and will be conserved during an emergency with only requried amount used for each visit. Office staff will keep track supplies availability and delivered.

10. Each nurse or aide making home visits to patient must check in with the Agnecy office and assignments.After completing assignments or for any problem that have accurred,office will be notified,Any new assignments will be made that time. When the nurse has completed the list of patients assigned to them, they will be assigned to specific patiens from the regular case load to complete that days schedule. At least one administrative staff
Member or the Disaster Coordinator/Alternate will be present at the designated check in site. Director of Nurse or Alternate will further assign Agency employess or contractors as they arrive and coordinate the staff members.

a. Calls will be made for Prearranged transportation of patients is need of evacuation.

b. Before entering a patients home, staff will determine if there is a safety issue possible gas leak,exposed electric wire etc.).Assess the situation and export to an Emergency Supervisor,wgho will report to the county emergency planners for proper emergency personal to secure that site.

c. If the patient is unharmed but the home is damaged or unsafe and the telephone system is working, arrangements for the patients transportation will be made.

d. Patient who relocated to a new location will be tracked with contact information including all necessary telephone numbers.

e. Contact the Disaster Coordinator or administrative staff at office if other arrangments need to be maede or contact dounty emergecny planners for transportation to an alternate care facility if other arrangements cannot be made.

f. If the patient is injured and needs transport,contact an Emergency Management System for arrangement to vbe made through the county emergency planners for transport to a hospital/emergency room/triage site. Notify the Disaster coordinator/Alernate or administrative staff office of transport location.

g. if roads are bloacked and alternate routes are not avialable,contact Disaster Coordinator or Administrative staff at office od inability to reach an area.

11. Physicians will be notified of patient status after coordination with disaster Coordinator,who will assign designated staff to contact all physicians with reports of their patienta EMS may be activated as needed.

12. The agency will not continue to provide services to patients in emergency situations that are beyond the agencys control and that make it impossible to provide services (i.e roads are impassable or patient relocates to a place unknown to the agency).

13. Officestaff,if available,will assist with office phones for communication from patient.

a. Patient may contact staff by calling the office number.

b. If the office is not operational, the call will be handled by the on call nurse.

c. If the answering services or the paging service is not operational,the agency will call forward to celluar on call phone.


14. The Disaster Coordinator or Alternate will notify EMS or local authorities assisting in disaster as needed to assist pateints for evacuation.

15. The Disaster Coordinator or Alternate will document all aspects of disaster with times,staff,patient and physician contact and any other pertinent information. Information will be documented when agency is not able to comply with any of the requirements of the emergency plan and attemps of staff to follow procedure outlined in the agencys emergency preparedness and respone plan. Information will be utilized to critique disaster for opportunities to improve.

16. Clinical staff will utilize clinical paperwork when computers are not available and ensure paperwork is submitted per policy.An abbreviated assessment can be completed to assure the patient is receiving proper treatment and to faciliate appropriate payment.

E. Recovery Phase

1. The Administrator or Disaster Coordinator/Alernate will initiate and terminate the Recovery Phase.

2. The Director,in conjunction with the Disaster Coordinator/Alternate will review all activities that were part of the disaster response and will develop a Disaster Recovery Plan to Inculde:

49. You arrive at a clients home that lives alone.He does not answer the door when you knock and the door is locled.What do you do frist?

a. Response actions taken;
b. Necessary modifications to plans and procedure;
c. Traning needs; and
d. Recovery activities to dates.

3. Any incidents that occurred will be documented and action plans will be developed depending on the disaster.

4. The Administrator or Director of Nurse will meet with local emergency response provides to review th disaster response and formulate ongoing plans if applicable.

5. Administrator or designee will initiate counseling for staff,patient or caregiver as necessary by Medical Social Worker,Support Group or outside community resources.Angency will monitoer patient and staff needs for ongoing and preventative care and professional counseling.

6. The Director will assure patient continuity of care by assigning appropriate staff to:

a. Review back-up staffing plans for effectivness if utilized;
b. Ensure that all patient are placed back on schedule and receiving care;
c. Follow up on patient care or ant patient transfer or discharges;
d. Notify physician of Patient status;
e. Review on call logs, and
f. Assist patient/family with updating their emergency/disaster preparedness plan,if appropriate.

7. All office and patient supplies will be replenished.

8. The Administrator or designee will coordinate report from Disaster Coordinator or Alternate. Report will be utilized for interdisciplinary critique and evaluation of disaster plans and response. Action plan and person to be responsible will be initiated.

9. The Administrator or designee will be evaluate avilability of staff for continued patient needs and possible new patients. New patient admission may be halted if deemed necessary.

10. The Administrator or designee will determine location of operation.if relocation is necessary, ISHD will be notified by fax,email or telephone with all required information.

11. The Administrator or owner will determine damages to facility, equipment or property and assign staff to invertory supplies and recorder supplies. Damaged supplies or equipment

12. Insurance claims and plans for recovery of facility will be initiated as soon as possible by the administrator or owner.

13. The Administrator or designee will ensure finacial expectations are met with payroll through established means.

14. Clinical staff will continue to meet patient needs through visits or phone call and continue to coordinate services with the Director of Nurse.

15. Office staff will reproduce clinical records from existing electronic records is possible if needed (written records will not be reproduced)

16. The Disaster Coordinator or Alternate will notify DADS when possible of disaster and other information as required.

F. Patient Records

1. Agency staff members will not jeopardize their own safety for the purpose of removing office contents (e.g., medical records, personnel files) when a disaster has occurred at an Agency site.

2. If an Agency site is affected, Agency Director will detemine if the removal of medical, personnel and financial records is necessary.

3. Written patient records damaged during a disaster will not be reproduced or recreated,except from existing electronic records. Recods reproduced from existing electronic records will include the following:

a. Date the record was reproduced;
b. Agency staff member who reproduced the record; and
c. How the original records was damaged.

4. In the event of an imminent emergency/disaster,where a possibility may exist, that patient will be leaving service area, patienta may receive a copy of their clinical record to ensure continuity of care if signed authorization for release of clinical record is obtained.

5. In the event of an emergency/disaster,where patients may be evacuated or transferred, Protected Health Information may be shared with other healthcare providers or emergency response teams as appropriate to health and safety of patients as allowed by applicable law.

G. Notification

1. Agency will notify ISDH Home and Community Support Services by fax or e-mail, within five (5) working days following temporary changes resulting from the effects of an emergency or disaster.If fax and e-mail are not available, notifications will be provided by telephone,but must be provided in waiting as soon as possible.

a. License number for the place of business and the date of temporary relocation;
b. Physical address and phone number of the temporary location; and
c. The date an agency returns to a place of business after temporary locatio.

2. If temporarily expanding the service area to provide services during a disaster;

a. License number and revised boundaries of the original service area;
b. The date of temporary expansion; and
c. The date an agencys temporary expansion of its services area ends.

H. Community Resources

1. Agency may elect to utilize any, but not limited to, the following community or national resources in an emergency:

a. American Red Cross, United Way, FEMA, CDC, area churches, other community organizations that support victims of a disaster.

I. Emergency Management Review

1. Agency will complete an internal review of the emergency response plan al least annually and after each actual emergency response to evaluate its effectiveness and update the plan as needed. Annual review will be documented on the Emergency Preparedness Plan Review and Checklist as part of the Annual Agency Evaluation.

2. As part of the internal review,an Agency must test the emergecny response phase of the emergency preparedness and response. A planned drill can be limited to the agencys procedures for communucating with staff.

3. After each actual disaster or a planned exercies, a multi-disciplinary team including management and staff will evaluate effectiveness and update emergency plan as needed to improve processes.

4. The Disaster/Drill Critique form will be utilized to evaluate the processes and effectiveness of the Emergency Preparedness Response and Plan.

J. Surge of infectious Patient as a Potential Emergency

1. Agency will implement the pandemic influenza plan for a potential surge of infectious patient located in the Emergency Preparedness Mannual.

K. Disaster Resources Websites:

1. Hurricane information: http://www.dads.state.tx.us/providers/index.cfm http://www.dads.state.tx.us/preparedness/hurricanes. shtm

2. Shelter in place, family disaster plan, business information,etc ...: http://www.ready.gov