Caregiver Refresher- Fire Prevention and Emergency Planning

Caregiver Refresher- Fire Prevention and Emergency Planning

Author: Mark Parkinson RPh: President AFC CE

Credit Hours 1.5 - Approximate time required: 90 min.

Educational Goal:

To supplement caregivers knowledge of disaster planning and home fire control.

Educational Objectives:

1. Discuss what is involved in disaster planning

2. List what is in a 72 hour kit

3. Enumerate the three aspects of disaster planning

4. Teach about the attributes of a house fire.

5. Tell about how to prevent house fires

Procedure:

1. Read the course materials. 2. Click on exam portal [Take Exam]. 3. If you have not done so yet fill in Register form (username must be the name you want on your CE certificate). 4. Log in 5. Take exam. 6. Click on [Show Results] when done and follow the instructions that appear. 7. A score of 70% or better is considered passing and a Certificate of Completion will be generated for your records.

Disclaimer

The information presented in this activity is not meant to serve as a guideline for care home management. All procedures and planning discussed or suggested in this article should be only used by care providers after consultant with local emergency preparation officials. Some conditions and possible contraindications may be of concern. All applicable manufacturers’ product information should be reviewed before use. The author and publisher of this continuing education program have made all reasonable efforts to ensure that all information contained herein is accurate in accordance with the latest available scientific knowledge at the time of acceptance for publication.

Caregiver Refresher- Fire Prevention and Emergency Planning

Each year in the U.S., more than 2,500 people die and 12,600 are injured in home fires, with direct property loss due to home fires estimated at $7.3 billion annually. Add to that floods, hurricanes, ice storms, power outages, etc. Stay in business long enough, and you’ll most likely have to face an emergency or two. Unlike disaster planning for other businesses (where they just send every home), care homes have to remain open and functioning. To do that, you must develop a plan and practice it to be able to stay open in times of crisis.

This CE is not intended to replace, supplant or supersede existing AFC basic training. It is written as a continuing education article, intended to add to and refresh in the mind of the reader about certain aspects of the topics written about. This article does not cover all required information as set forth by the State of Oregon. If you need the complete basic training on these subjects please refer to the approved sources.

Emergency Planning

By law, planning and preventing disasters are part of the care home’s operation. Most care homes don’t have the resources that big skilled-nursing facilities have, so you have to use your head instead of your wallet to be prepared. With a little bit of thinking and some ingenuity, you can have a pretty good plan in place for common disasters that could come your way.

Let’s see, what does a care home absolutely need to stay open for a couple of days during a catastrophe. Well, there’s the house. Let’s start with that. There are times when you might have to evacuate the entire home. Flood, fire next door, train full of toxic gas wrecks nearby, these and other events could force you to empty the home.

Do you have enough vehicles, wheel chairs, and the like to get everyone out of the home? Where would you go? Local church, other care home, hospital, or local school would do. Do you need to ask permission to show up there or are you just going to pop up and say, Hi? You might want to get that permission in writing. People get kind of forgetful during a crisis. When you’re on your way out the door, you might also want to bring a cell phone with a charger and the list of emergency phone numbers for your clients. Don’t forget to call the case workers and all the others. You know, all the people who are going to want to know where your clients are once you leave.

You are also going to want to bring your 72-hour emergency kit. “What is that,” you say? I’m glad you asked. A 72-hour kit is all the essential supplies you need to survive for, you guessed it, 72 hours. You can buy one for each of your residents or make them yourself. Back packs or an action packer plastic tote are usually the container of choice. You should include the following:

Water, enough for drinking and sanitation, if required
Food, non-perishable
Battery-powered or hand-crank radio
Flashlight and extra batteries
First aid kit
Whistle
Dust masks
Duct tape, an unusual item but very handy in a pinch
Moist towelettes, garbage bags
Can opener
Local maps
Sanitary products, diapers and the like
Sleeping bags or blankets
Camp stove, fuel, matches
Mess kit for every person, or paper plates, cup, utensils, etc.
Paper, pen, and entertainment items (optional but very handy)
Medications
Copy of patient records

I have listed several items that can be stored but will expire over time. I would suggest a yearly inspection of the kits. Pay attention to the water, food, and first aid supplies. You’ll want to air out the sleeping bags every couple of years too. If you buy a 72-hour kit, you are still going to have to inspect it for outdates and usability. The kit is not going to be much use if don’t know what’s in it and how to use it. They are not made for care homes, so you’ll still have to consider things like adult diapers, medicine, and patient records.

OK, what else does your care home need to plan for in order to operate in an emergency? Power, or more specifically the lack thereof. In operating my adult foster care homes I have had to go without electricity a couple of times. When the power goes out, you are going to have to compensate for the lack of it in:

Cooking. Hot meals are still needed, even more so with the power out. Fortunately, they are easily prepared with the right camp stove or propane grill. A couple of things to consider though. 1. Fumes - set up your emergency kitchen on the porch or in the garage. 2. The menu will have to be adjusted for camp conditions. 3. Hot water for cleanup. Chose items for the menu that won’t require a lot of washing afterward. Paper plates will come in handy.
Heat. Cold houses are problematic but doable. Fireplaces are an obvious resource, but for those who don’t have one, you can buy either a portable propane camp heater or gas-powered generator. Of course, they are no good if you don’t have the fuel stored, including wood for the fireplace. Extreme caution should be used when using any portable heater. Never leave them employee unattended. Your residents can’t take care of themselves let alone a heater that could burn down your home. I recommend an oil-filled space heater. They are much safer to operate, though they do require electricity.
Beds. There was a time before electricity that there was no heat at night. Everyone just dressed appropriately and piled on more blankets. Proper planning includes sleeping with the appropriate bed clothes and having extra blankets available.
Lights. Candles are fun, but open flames are really not appropriate for care homes. Propane lights can give nasty burns and burn a house down, too, if not used correctly. They should be for trained employee use only.
Entertainment. I recommend age-appropriate puzzles. They don’t require supervision to operate. Of course, there is the old standby of roasting hot dogs, marshmallows, and the ever-so-delightful s’mores.
Batteries will be very important. Make sure you always have more than enough. Battery testers are not very expensive, and they can take some of the guess work out of emergency preparation.
Phones. Cordless phones die when the power goes down, but land lines have their own power supply. If you have chosen to go completely cordless, it would be wise to store an old land line phone in your e-supplies.

If handled correctly, loss of power can actually be a fun experience for your residents, like camping without having to go to the campground. Proper planning and the right employee attitudes will be needed to make it fun.

We have talked about what is needed to keep a care home open and functioning during an emergency. The most important resource, by far, is a well-trained, prepared, and flexible staff. Emergencies come in all shapes and sizes. There is no way to plan for all contingencies. What is actually needed is someone to take charge, who can think on their feet and cooperate with others in what needs to be done.

In general, emergency preparedness has three aspects, recognizing, general plan of reacting, reacting to what happens.

Recognizing. Man-made and natural disasters occur all the time. On average, the federal government declares disasters 70 times a year. What might happen in your area? Do you live in a flood plain, by a train track, airport landing flyway, nuclear reactor, chemical plant, tidal wave zone? How does your community make disaster alerts? Is there a TV or radio broadcast? Is there a public alarm? Is there an emergency text to all cell phones? Call your local fire department or police and find out.
Plan of action. Each emergency is unique. A lot of what you do will have to be decided on the fly. If you have a well-thought-out plan, the chaos can be held to a minimum. I recommend writing a decision flow chart. You can use this one or make your own.

What is the emergency? ____________________________

Do you need to call 911?

Is it safer to stay or go?

Flee

Stay indoors

How long will you be gone?

Short time ___ Overnight ___

Where are you going?

_______________________________

Do you need to call anyone?

Case workers, family, emergency responders, extra employees

Who is to call? _______________

What resources do you need?

Flee Stay

Cell phone and charger ___

Patient records and MARs ___

Medications ___

Medical equipment /supplies ___

72-hour kit ___

Bedding Yes ___ No ___

Kitchen equipment Yes ___ No ___

Camping equipment Yes ___ No ___

Breathing filter masks ___

Camp stove/ grill ___

Portable heaters ___

Fireplace fire ___

Extra blankets ___

Portable lights ___

Entertainment items ___

Land Line/ cell phone ___

Who is in charge of what?
Flee Stay
Residents preparations Resident transportation Equipment/ supplies Communications/ Calling First Aid	Residents preparations Resident transportation Equipment/ supplies Communications/ Calling First Aid

Reacting to what happens. Having an action plan makes the job easier, but you still have to take care of the unexpected details. Be flexible, and have a clear understanding of who is in charge of what. Things to consider:

Does the family of the resident want to pick them up? If so, do you wait for them or have them meet you somewhere?
What needs to be turned off - water main, gas main, electric breakers at the fuse box?
Do you need to document what’s going on? Need pictures?
During disasters, texts and data services are sometimes easier to use to get a message through.
Is there someone with special dietary needs?
In air-born disasters like gas or chemical leaks, the public is often told to stay indoors. If such is the case, close all windows, doors vents, and chimney dampers. Have the particle masks from the emergency supplies handy if needed.
Gases can kill. They can also turn your home into a potential bomb. If you smell gas, assume it might explode and get out, and then call the utility company. Having your gas appliances and furnace inspected regularly greatly reduces the chance of an accident.
If you live in a flood plain, evacuation routes to high ground should be included in your emergency plan. Pay attention to the route chosen, planning a route through an area that would flood first wouldn’t be very useful.
After a flood, it would be safest to: 1. Throw away food, have your household water tested before use. Make sure electrical appliances are completely dry before turning them on, or even plugging them in.
In the event of an earthquake, get you and your people to the floor and protect yourself from falling objects. Get under a table, desk, or bench. Even a blanket will protect you from glass shards. It is recommended that you stay away from windows and outside doors. Basements are a preferred safe place but next to a wall will do in a pinch. If you get separated from your residents, shout to them instructions so they know what to do.
After the tremors are over, assume there is a gas leak until proven otherwise. Assume any loose wires are active. Pooled water around plugged-in appliances should also be assumed to have live current going through them. Check areas where flammable liquids were stored for spills and leaks.
If you use a portable generator, keep it outside to avoid problems with exhaust fumes. Never plug it into the house. It could cause a fire or electrocute someone working on the house to restore power.

Care homes should periodically review their disaster plans and customize them to meet the needs of their ever-changing resident population. Practice the plan so that everyone will know what to do when things go crazy and thinking clearly will become harder to do.

Fire!

Beside power outages, fire is probably the most prevalent and, by far, the most serious threat that care homes face on an ongoing basis. I have saved writing about fire until last and will cover it in the most detail.

I don’t think it would be too far off the mark to say that today we live in the equivalent of a box of matches. One spark at the wrong place and the whole house will go up in flames literally in a matter of minutes. According to a study done by a fire safety department, a 12x16 foot room could experience a flashover fire in as little as 166 seconds.

Fortunately, most care home owners and employees have never experienced a really bad house fire. Usually the only thing care providers know of fire is what they see on TV and movies, not exactly the best sources of information. The basic characteristics of fire are quite different than what is generally presented in the mass media.

Learning about fire

Fire is fast. A fire starts small but, within 30 second it can grow till it’s out of control. Our reaction time needs to be even faster than the fire. Ironically, the very items that fill our houses with comfort and convenience are extremely flammable, reducing the amount of time we get to react. If you factor in the time it takes to discover the fire, your effective reaction time is reduced to where literally every second counts. What it boils down to is -do what is absolutely necessary to save lives, leaving possessions and property behind. Even time for heroism is only within the first few seconds after the fire discovery.

Fire is HOT-

Heat rises. During a fire, the temperature at floor level could be 100 degrees while at eye level it measures 600 degrees. Heat kills, hot air can scorch lungs, melt clothes and jewelry to your skin. A fire can get so hot that everything in a room ignites all at once in what’s called a flashover.

Fire is dark-

Home fires produce thick black smoke, filling rooms with darkness. If you or your residents wake up to a room full of smoke, things will get confusing and disoriented very quickly. It would not be uncommon to lose your way in a house you have lived in for years.

Fire is deadly in more ways than one-

Smoke and toxic fumes kill more people than flames do. Fire uses up oxygen as it grows. Breathing fumes and the lack of oxygen can make you disoriented. There might not be time for you to even find out what’s going on. The odorless, colorless fumes of a fire can lull you into a deep sleep before the flames even reach your door. You or your residents might not wake up in time to escape.

Only when you know and respect the true nature of fire can you begin to react in survivable ways.

Reacting to fires

Before the fire- Practicing fire drills is a real pain. There is always griping and complaining, and I’m not even talking about the residents yet. Seriously though, fire drill practice is the only way to ensure fast enough reaction times. You can’t count on everyone reacting rationally during a fire. Bottom line- fire drills saves lives, repetition saves lives. Complaining and avoiding fire drills in contrast- kills.
During the fire- When the smoke alarms go off, get yourself and your residents out fast - seconds count. As you move around the house, shout instructions to the residents. The lower to the ground you are, the safer from smoke and gases you are. Chose smoke-free exit routes. Before opening a door, feel if it is hot. Open it slowly and be ready to shut it again quickly if needed. If you can’t get yourself or one of your residents out, call 911 and tell them the location of the trapped persons. If you get trapped, cover the vents and door cracks with tape or cloth to prevent smoke from entering. If your clothes catch on fire, stop, drop, and roll. If you can’t, smother the flames with a blanket. Use cool water to treat any burns immediately. Once out of the house, use extreme caution in going back in. Most often you can be more help if you spend your efforts calling 911, organizing the survivors, coordinating neighborhood help, and being an information source to the firefighters when they arrive. The more information they have when they arrive, the faster they can work at rescuing anyone trapped inside.
After the fire- You survived. Now it’s time to recover from the disaster. Work with the case workers to take care of your residents. Contact emergency relief agencies like the Red Cross or your church. Contact the fire department to see if your house is structurally safe to enter. Get the insurance agency to the house. Write down and follow their instructions. Conduct an inventory of damaged goods before you throw anything away. Make it a priority to locate important paperwork. Get a copy of the police report. It will come in handy when you try to get medications replaced without having to pay for them. Get the pharmacy to do all the leg work. The same goes for any medical devices and their suppliers. Save any receipts related to the fire or recovery. They may be needed by your insurance company or to account for the loss on your income tax. Notify your mortgage company of the fire. Get in touch with your accountant or the IRS to see about the benefits available to people recovering from a fire.

Fire prevention tips for care homes

Reaction times must be very fast, even at night. You only get fast if you practice. Take practice fire drills seriously. It’s part of being professional.

At this point, your home has already been inspected and approved by the fire marshal, so let’s cover the items that happen after inspections.

Electrical fires- Do not cover electrical wiring with rugs. Heat can build up and start a fire. I know cords are trip hazards, so you’ll have to rearrange things to prevent both tripping and fire hazards. Buy surge protector power strip plug ins instead of using multiple extension cords.
Bedroom fires- Six-hundred people lost their lives in bedroom fires in one year. There are no caregiver eyes in the bedrooms, so no open flames. No smoking, no incense, no candles, no tea lights, and no matches or lighters. By definition, your residents can’t take care of themselves so don’t assume they can handle flames.
Chemical/ stored flammables fires- Don’t be lazy or stupid. Why would anyone store bulk flammables or rags by flames or a heat source? Convenience is not a good reason. Having your house burn down is very inconvenient.
Alternative space heaters- They need their space. Keep anything combustible at least three feet away. I would think very long and hard before I would allow one in a bedroom.
Batteries- They are a power source and can be actually used as a fire starter if used with steel wool. Pay attention to how they are stored. Don’t just throw them in a box with a lot of other metal objects

In 2010, the American Red Cross responded to more than 63,000 home fires - that’s one every eight minutes! But unlike other disasters, most home fires can be prevented. Be professional and pay attention to the details, then fires won’t start in the first place. Practice, practice, practice – just do it. It saves lives.

Conclusion

In-home care providers accept an unusually large amount of responsibility for the welfare of those in their charge. By letting them come to your home, you are promising to take care of them no matter what happens. They are counting on you to save them in case of emergency. Be prepared, be knowledgeable, be professional, and be responsible.

As always, good luck in your caregiving efforts.

Mark Parkinson RPh

References:

1. Home Fire Safety Checklist. National Fire Protection Association. http://www.hackettstown.net/doc/home-fire-safety-checklist.pdf

2. Home Fires. Ready.Go, FEMA, 4/3/13. http://www.ready.gov/fires

3. Home Fire Prevention and Safety Tips. US Fire administartion FEMA,7/19/13. http://www.usfa.fema.gov/citizens/home_fire_prev/

4. Myths vs Facts. Fire Sprinkler Initiative, National Fire Protection Association

http://www.firesprinklerinitiative.org/resources/fact-sheets/myths-vs-facts.aspx

5. Planning and responding to workplace emergencies, OSHA Fact Sheet. Occupation Safetyand Health Administration, OSHA.

https://www.osha.gov/OshDoc/data_General_Facts/factsheet-workplaceevergencies.pdf

6. Emergency Preparedness. National Safety Counsel http://www.nsc.org/safety_home/EmergencyPreparedness/Pages/EmergencyPreparedness.aspx

7. Emergency Preparedness, Merit Badge pamphlet. Boy Scouts of America http://www.troop1043.org/books/eprep.pdf

8. Plan & Prepare. American Red Cross http://www.redcross.org/prepare/location/home-family/tech-ready

9. Home Fire Prevention. Liberty Mutual Insurance http://www.libertymutual.com/home-insurance/tools-resources/home-fire-prevention

10. Ki Mae Heussner,. With Modern Furnishing, Homes Burn Faster. ABC News, Good Morning America.2/2/11

http://abcnews.go.com/Technology/modern-furnishing-homes-burn-faster/story?id=12806666

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