Licensed-care facilities are mandated by state and federal law to write and maintain emergency plans. Most states, however, don't require any specific level of detail, and officials often fail to check whether such plans are workable.
As emergency management agencies in Colorado's north central region learned, many care facilities had what amounted to expanded fire drill policies masquerading as emergency plans.
"People expect first responders to just show up and take care of everything," said Tim Johnson, emergency management coordinator for the Douglas County Office of Emergency Management in Castle Rock, Colo. "But guess what? During an emergency, they're a little busy. So it's important that these facilities know how to take care of their people."
In Colorado, licensed facilities are required to have an emergency plan, but they're not required to go further than that, Johnson confirmed. "It doesn't say what's required to be in the plan," he said. "And what we've found is that while most have a plan to get their people out of the building, they don't know what to do with them afterward."
This fact was highlighted in a 2005 fire in Arapahoe County, just north of the Denver metropolitan area, in a small, eight-bed assisted living facility, Johnson said.
"They had a fire and got them out, but there was no plan on what to do with these folks," he said. "No plan for getting them relocated to another facility ... and these people had medical needs. And it became apparent that the facility had just not thought through the whole evacuation process."
Johnson said the experience prompted a number of cities and counties to band together and start a program to help special-needs facilities strengthen their emergency plans through education and outreach.
The program began in 2006, and covers north central Colorado - a 10-county expanse with a population of about 1 million. It will target both traditional special-needs facilities, like nursing homes and assisted living facilities, as well as private schools and day-care centers, which have their own special needs during an emergency, officials say.
Emergency managers looking to start a similar program in their own area should first take stock of the facilities in their area they think will need assistance, said Deanne Criswell, emergency management coordinator for Aurora, Colo., a suburb of Denver, with a population of 310,000.
"We were surprised at how many we had," Criswell said. "Then we did outreach to each of them, looked at each of their plans and offered our help, because it's easier for us if they're prepared. The better prepared they are, the easier our job will be in a catastrophic event."
Criswell said the biggest obstacles each facility faced is where to take people post-disaster and how to get them there.
"It appeared to us when we first started approaching these places that they didn't have a good idea of how to do this or what it entailed," Criswell said. "Transportation is a big piece, but it's just the beginning piece. Where are you going to take them? Is it short-term shelter or long-term care? Do you have enough oxygen to make the trip? Do you have enough [staff] to go with you?"
Criswell encountered hopelessly outdated plans that harkened back to the Cold War and told facility managers to contact their civil defense office - a reference to the threat of being bombed by the Russians. Such an office, however, no longer exists.
"Many plans did not take into account homeland security or natural disasters," Criswell said, "so we've tried to make the plans an all-hazard type and not disaster-specific."
And Criswell's team ensures facility managers know Aurora has an Office of Emergency Management (OEM), and gives them
police, fire and neighborhood services contacts.
"We created tabletop exercises for them," she said, explaining that the exercise enhances the fire department and the facility's understanding of each other's roles in the event of a fire, for example. "We can re-create that for each agency."
Continuity of Care
When reviewing a facility's emergency plan, Johnson said it's important to put special emphasis on emergency management responsibilities versus facility responsibilities
"Ultimately they're responsible for taking care of their clients," Johnson said. "But there are a lot of things they haven't thought about that you need to."
Chief among the questions to ask facility managers:
"Transportation and what goes into that is just key," Johnson added. "If you have a facility with 100 people, you might have a van or two - but that's not going to get your patients and their medical equipment to another facility. How are you going to do it?
"We encourage them to contact transportation companies prior and make arrangements so that when disaster strikes, [transportation] will come," he continued. "First responders will help, of course, but there'll be a limit to that."
Heather McDermott, emergency management coordinator for the Adams County, Colo., OEM, said she recommends facilities follow the "rule of three" when creating relationships with, and gaining commitments from, similar facilities for the purpose of taking overflow patients during a disaster.
One: Find a like facility in the immediate area to evacuate to; two: Find another facility outside the immediate area as another backup; and three: Establish a third backup facility even farther out than that, which can take your patients if needed, she said
"It's all about building partnerships with people who know your target population's needs best," McDermott added.
Special-needs planning is a continuing effort, echoed Rick Newman, McDermott's co-coordinator at the Adams County OEM.
"We're bringing in the medical community and getting these folks to talk to each other," he said. "These folks need specific equipment and trained personnel, and by forming agreements and such with other like facilities in the area, you [get] that. So that's one of the first steps."
After transportation, staffing is another big issue, Johnson and others agree.
"How are we going to require our staff to stay on the scene of an event to take care of our clients? Have we gone over this with our staff?" Johnson said, adding that not planning for backup staff to come in and relieve tired workers is a common pitfall in many emergency plans.
If patients and staff stay on scene for more than two days after a disaster, Johnson said, plans need to indicate replacement workers who'll play tag team with the original staff so patients can receive uninterrupted care.
"You won't do any good for your clients if your staff walks out," he said.
Although the term "special needs" is often used to refer to elderly or disabled populations, the more apt definition, according to Rick Newman, is "persons who cannot evacuate themselves if the order is given."
That would explain why the Colorado's north central special-needs facilities plan will reach out to day-care centers, and later, to private schools, according to Criswell.
"The educational component has been modified somewhat, but the overall goal is the same," Criswell said, "and that is to incorporate all phases of emergency management into their basic planning process - prevention, preparedness, response and recovery."
For day-care centers, Criswell said, the primary challenge is to reunite the children with their parents and coordinate communication with parents so they know where their children are during an evacuation.
To emergency managers contemplating a program similar to Colorado's, Criswell offers this advice: "Be proactive in trying to do community outreach to those facilities because it will take a lot of time and resources during an actual incident, so take a lot of time in the planning stages with these facilities."
This, she said, will save valuable time later.
Amy Yannello is a journalist based in Sacramento, Calif., where she writes for several publications. She has spent nearly 20 years covering California politics, health care and health-care reform, issues of homelessness, and the public policy and treatment issues surrounding mental illness.