ML20149E921

Applicant Exhibit A-25,consisting of Undated Document from Seacoast Health Ctrs,Inc Re Environ Control Policies

ML20149E921
Person / Time
Site:	Seabrook
Issue date:	12/15/1987
From:	SEACOAST HEALTH CENTERS, INC., HAMPTON, NH
To:
References
OL-A-025, OL-A-25, NUDOCS 8802110318
Download: ML20149E921 (56)

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053. SAFETY - FI 053.1 EVIRCllMENTAL CCNTROL POLICIES A. ENVIRONMENTAL C0 ITROL This institution endeavors to meet federal, state and local standards for good health and safety and meets all the requirements stated in the laws governing patient care.

1. Humidity and Temperature Humidity and temperature in patient areas shall be kept at a level that is conducive to the maintenance and promotion of good health.

2. Lighting There shall be adequate lighting for general use and for reading and all traffic areas shall be well lighted.

3. Ventilation There shall be adequate and. p2 oper ventila-tion in all areas of the ins titutien. .

4. Pest Control 0

There shall be adequate pest control and ade-quate screening of windows in patients rooms.

6. Sanittition The institution must be kept clean and sanitary at all times.

6. Fcod Handling and storage: all prov'isions of New Hampshire Sanitary Ccde apply.

. B. SAFETY

1. Appliances If a patient insists on bringing his own appli-ances such as radios, fans, etc. , the equipment must be checked out by the maintenance depart-rrent for safety in use, for overicading of pwer lines, and for safe installation.

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2. Containers under Pressure

) These must always be stored and disposed of as per instructions on the can in order to prevent explosions.

3. Debris , Waste Debris and waste materials must be disposed of quickly as possible and not left standing in patient care or general traffic areas. Adequate covered containers are available for storage until waste can be removed.

4. Disposable Items -

Disposable equipment such as medicine cups, needles, etc. may be used only once and properly disposed of.

5. Doors

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Doors shall not be locked from the inside by the person occupying the rcem.

6. Drugs

/ ', Extemal and Internal medications must be kept

-' in separate canpartments of medicine cabinet.

All medications must be properly labeled and the label checked and rechecked before adminis- ,

tration to a patient. Controlled drugs must be kept under double lock. ,

7. Equipment All equipment, especially that used in the care of patients must be kept in good working coa-dition and checked frequently and kept in scod rapai r. Extension cords are not pennitted.

8. Fire Control and Patient Evacuatien .

This facility has a written plan for the orderly evacuation of patients and residents which is periodically reviewed, and is posted at all strategic places. All perscnnel must be f ami-liar with fire and disaster plans and regulations and their specific duties should such occur.

Specific duties are posted in each department where they can be easily referred to. Inservice meetings are held periodically to acquaint w

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, i O U personnel with rules and changes. Fire and Patient Evacuation Drills are held MCNTHLY; 12 per year, 4 drills per shifts.

- 9. Fire Equipment and Mounting All fire protection equipment is maintained in readily usable condition and inspected annually.

An additional fire extinguisher suitable for gmase fires is provided in or adjacent to the ki tchen. Each extinguisher is provided with a tag for the date of inspection. Extinguishers are mounted on wall or post where they are clearly visible and at a convenient height.

They are not tied down or locked in a cabinet or placed in a closet c. on the floor.

10. Fire Inspection There is several inspections annually by local fire authorities of the physical plant and equipment (including sprinkler system: for fire safety and control, and of the adequacy ,

of evacuation plans. A report of these in-spections and certification of sprinkler are kept on file in the administrator's office.

11. Floors Traffic areas must be clear and dry at all times.

Scatter rugs and high polish are prohibited.

Equipment may not be left standing in halls or corridors where it might cause accidents.

12. Lights Open flame lights are not permitted at any time.

, 13. Patient Suppli,es and Equipment Patient supplies and personal equipment may not be used comonly. Each patient shall have his

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own supplies and equipment such as storage space for clothing, linens and bedding, bed-pan, others.

14. Poisons All poisonous or dangerous chemicals and com-pounds must be labeled so as to be easily identified and must be stored independently under lock and key and separately from food and kitchenware and drugs and medicines.

15. Roads - Walks The facility is accessible to good roads and

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O O these are kept passable and open at all times.

_ Sidewalks, fire escapes and entrances are kept

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free of ice and snow.

16. Siderails Protective siderails must be applied under any of the following circumstances: Upon written order of the attending physician; after administra-tion of medications such as sedatives or any controlled drug or others, when the patient may not be nomally alert or in full use of his reflexes; if patient is disoriented either con-tinuously or intermittently; and any other time if the nurse deems it necessary for the protection of the patient. Should the patient or menters of his family refuse to permit the use of siderails , listing of. the refusal. One copy is placed on patient's chart and the other is sent to the Administrator. A relative may then be requested to remain at the bedside of the patient or be prepared to pay a private sitte r.

17. Smoking Smoking is pemitted only where visual super-O, vision is provided and is forbidden in restricted areas such as where oxygen is in use, patient's rocm, halls , etc. Restricted areas are posted with obvious 'NO SM0 KING" signs.

C. ACCIDENTS In the event of an accident involving a patient, personnel or public, an Incident Report is cortpleted by the person involved in the accident, or a wit-ness er nurse, no matter how trivial the incident may be. The patient is treated in his rocm or

. nearest available rocm with first aid. The person's cwn physician or the physician on-call is notified of the accident in compliance with the state and home policies and his orders are carried out. Treat-ment is recorded on the form. The Incident Report is then sent to the Administrator for proper dis-position.

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053.4 IN CASE OF FIRE

1. REMOVE PATIENTS IN FIRE LOCATION OR ROOM

2. CLOSE D0 ORS

' 3. CALL FIRE DEPARTMENT TEL: 926-3315-

4. SOUND FIRE ALARM

5. START ORDERLY EVACUATION i

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CUATION AND DISASTER FLL.)

TABLE OF CONTENTS ITEM PAGE Certification Fire Evacuation Plan Nursing Home Floor Plan Signal for Fire Discovery of a Fire Assignments Notification of Fire Department Practice Drills Essential Records and Reports Fire Prevention Rules ,

Fire Evacuation Chart

• Orientation Fighting the Fire Importance of Fire Fighting Fighting the Fire Personal Safety Fighting Small Fires Classification of Fire Extinguishers Soda-Acid Fire Extinguishers Pressurized Water Fire Extinguishers Carbon Dioxide Fire Extinguishers Dry Chemical Fire Extinguishers Fire Extinguisher Facts

,_., Chain of Command .

Supervisor's Duties Phone Numbers and Special Equipment The Evacuation Plan ,

Assignments Administrator .

Nursing Departaent .

Dietary Department Housekeeping Department Laundry Department Maintenance Department Activity and Social Department

- Fire Department Police Department '

Floor Evacuation Plan Fire-Stations - 1st Shift Fire Stations - 2nd and 3rd Shift Fire Evacuation Exits - East Wing Fire Evacuation Exits - West Wing Fire Evacuation Exits - Center Area Fire Evacuation Exits - Tuck Wing Fire Evacuation Exits - Club Francouer Wing Layout of Evacuation Floor Plan Disaster Plan General Purpose Types of Disaster t

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' (~s PAGE ITEM Internal External Basic Policies Community Cooperation in case of a Disaster Responsibilities: Community Disaster Administrative Nursing Service Dietary -

Housekeeping Central Supply .

Pharmacist Laundry Maintenance Volunteers Bomb Threats Contingency Planning for Bomb Threats

- Our Responsibility Telephone Procedures Information from other sources Publicity Evacuation Procedures Floor Plan -

.- Law Enforcement Responsibility Search Teams Suspicious' Objects Preventive Considerations Form - Bomb Threat Calls Tornado Procedures -

Tornado Watch Tornado Warning If the Nursing Home is Hit Personnel The Plan Tornado Watch '

Tornado Watch in a Nursing Home -

Smoking Regulations Emergency. Generator Test Procedures Fire Alarm Test Procedures .

Emergency Water Supply Agreement Ofsaster Agreement Emergency Telephone Numbers Emergency Physician Numbers Record of Fire Drills a* Disaster Kit Procedure v

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POLICIES AND PROCEDURES FIRE EVACUATION PLAN ,

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CERTIFICATI0fl This is to certify that we have assisted in the devel'opment of the Fire Evacuation and Disaster Plan of th'is facility and af ter reviewing its contents find that it is adequate and reflicts the actual evacuation plan needed for proper and safe' evacuation of patients, staff and visitors.

4 DATE (Signature of Fire Chief) 0 ATE (Signature of Civil Defense Direc, tor)

DATE , (Signature of Rescue Squad Director)

DATE (Signature of Police Chief) 4 e

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, ()0LICIESANDPROCEDURES FIRE-EVACUATION AND DISASTER PLAN

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FIRE AND EVACUATION PLAN:

The greatest danger in any fire is PANIC. It is the duty of every employee' to prevent patients f rom being unneccessarily f rightened in any emergency.

If there is a fire in the nursing-home, every effort must be made to confine it to the immediate section in which it starts. If this can be done, it may not be wise or necessary for patients in remote parts of the building to be told of the emergency.

KNOW YOUR NURSING HOME AND ITS FLOOR PLAN: ,

Know the locations of fire extinguishers and how to use them. Know the type of extinguisher to be used in dif ferent types of fires.

Know the location of all exits in the area in which you work, and the areas through which you travel f requently. All employees shall be trained in the use of fire extinguishers and the use -

on each type of fire by the Fire Department or other Rescue Personnel.

KNOW THE SIGNAL FOR FIRE. BE CALM. Remember that fear and panic can do much damage.in iny emergency situation. Assure your patients if they are already aware of the fire, or emergency, that there will be plenty of help to assist them if and when necessary. (The

, . . fire alarm system will alarm a continuous ringing sound when ev'dence of fire or smoke is in the building.)

There is no substitute for common sense and good judgement in any emergency. No fire or disaster plan, no matter how carefully prepared can contemplate all the emergency situations which may arise and require your positive and immediate action. - -

IF YOU DISCOVER A FIRE:

If the fire is of an extremely minor nature, such as a small fire contained in and confined to a waste basket:

1. Put out the fire, using proper fire fighting techniques.

EXAMPLE: In a waste paper basket fire, smother it out by covering the waste basket. Other small fires can be smothered out with a wet blanket. -

. 2. Assure patients who may have smelled the smoke'that they are in no danger.

3. Report the incident to your supervisor. If the fire is of a larger nature, but is confined to a patient's room, or other relatively restricted area:

a. Announce the CODE WORD: "0R. RED and give the location such as room 125." It is not necessary to sound the fire alarm if the fire is of a minor nature. Use the code work "0R. RED."

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b. Notify your charge nurse - who would probably have heard your code announcement and be on her way to your location.

IMPORTANT: Keep your voice calm. Be sure to announce the Code Word "Dr. Red" and the location of the fire.

c. Remove patients from immediate dange.r.

d. Keep lists of patients and see that all are accounted for,

e. Close doors and windows, including those in bath-rooms. If at night, turn on all lights.

f. Check exits to make certain there is free access.

g. Place wet blankets under doors of patient's rooms to prevent smoke from entering.

h. Begin fighting the fire, using proper fire fighting procedures, until help arrives. Remove patients from the immediate danger ar.ea to a safe area.

Nove patient's chart with patient. Direct fire fighting operations until arrival of fire department.

Then let fire department direct fire fighting operations.

i. Station one person at telephone or paging system to relay instructions.

's j. Make certain that each patient's chart is evacuated with the patient.

NOTE: The fire alarm is connected to the main fire station.

Should the alarm go off, the fire trucks will arrive automatically.

Always call the fire department and inform them what area of ,

the facility has been activated.

IF THE TIRE APPEARS TO EE OF A MAJOR NATURE AND IS GETTING OUT OF CONTROL:

1. Sound fire alarm. t

2. Notify Charge Nurse.-

3. Check exits to make certain there is free access.

4. Close windows and ocors and turn on all lights at night. Fire doors in corridors will close automatically.

5. Remove patients f rom immediate danger area. Move patient's cha rt with pa tient.

6. Keep list of patients and see that all are accounted for.

7. Begin fighting the fire, using proper fire fighting procedure until help arrives.

8. Turn off any equipment with blower fans (heating system or cooling system is an example.)

9. Station one person at telephone or paging system to relay instructions.

10. Direct the removal of patients when authorized as follows:

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First: Those nearest the danger area of fire.

Second: Walking or ambulatory patients.

Third: Wheelchair Patients Fourth: Helpless Patients.

KEEP CALM, ALWAYS REASSURE YOUR PATIENTS USE ONLY CODE WORD WHEN REPORTING "0R. RE0" AND BE SURE TO GIVE YOUR LOCATION WHEN FIRE IS OF A MINOR NATURE.

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' When the Nursing Home fire alarm is sounded, all employees will respond as indicated below:

DEPARTMENT REPORT TO: ASSIGNMENT Charge Nurse Your wing Coordinate patient evacuation Nursing Personnel Your wing Wait for further instructions or evacuate patients when authorized Maintenance Any location Report to affected area and assist in fire control and/or in patient evacuation Laundry Personnel Your area Wait for further instructions (Center area) or evacuate patients when authorized Kitchen Personnel Your area Wait for further instructions (Center area) or evacuate patients when authorized

• Housekeeping Your wing Wait for further instructions or assist Nursing in patient evacuation

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Administrative Office Move patient records out of facil'ity. Vital office records

. in Fire Safe file The location of any fire can be determined by reporting directly to either Nurse's Station. Look at Zone Indicating Lights.

All evacuation traffic will move on the right hand side of corridors in.a single file. REMEMBER, WALK - DO NOT RUN. Patients will be moved to the assembly areas indicated on the fire evacuation charts.

. The following methods shall be bsed in evacuating patients f rom

. the Nursing Home: -

1. Saddle Carry - Two persons locking hands and wrists to form a chair.

2. Blanket Carry - Four persons carrying one patient.

3. Cradle Drop - One person drop

4. Double Cradle Drop - two person drop ,

5. Wheel Chairs and Beds (Beds to be used only when absolutely s, necessary).

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O O NOTIFICATION OF FIRE DEPARTMEN': T

1. During normal office hours, the Charge Nurse will notify the Fire Department by calling 926-3315,

2. In the event a fire is discovered which has not activated the alarm system, notify the Administra, tion Office, or Administrator, the Fire Department and active alarm.

BE CALM - REMEMBER THAT FEAR AND PANIC CAN 00 AS MUCH HARM AS

• THE FIRE - CALM YOUR PATIENTS - ASSURE TPEM THAT THERE WILL BE PLENTY OF HELP TO ASSIST THEM IF NECESSARY.

Every employee shall be thoroughly familiar with the location

. of fire exti.nguishers within his department and be capable of operating them effectively.

PRACTICE ORILLS:

Practice drills shall Ebe held monthly and will be scheduled on a shif t basis in order to afford all personnel an opportunity to participate and to become familiar with fire and evacuation procedures. The extent of practice drills will be determined by the Nursing Home Administrator. Drills will not be announced and will be under the supervision of the Administrator or his designee.

ESSENTIAL RECORDS AND REPORTS:

Of fice Personnel: If fire or water threatens the general business of fice, collect all cash together in one receptacle. Also collect all valuables from the files and arrange to have them taken from the building. Next, gather the ledgers and important books and be ready to have them removed. Be sure that you have the patients ledges as a check against the evacuation list. Gather the card files and be prepared to remove them from the building upon direction.

FIRE PREVENTION RULES:

(a) The best fire control is preventi'n.

o All personnel .

must be alert in noting and reporting fire hazards. Carelessness in disposing of lighted cigarettes is a frequent cause of fire.

Smoking in bed is prohibited (except for bed patients) and bed patients may smoke in bed only under the direct supervision of patient-care personnel or a responsible ambulatory patient.

(b) Employees are prohibited from smoking in all areas except the television room or employee lounges.

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c. Inflammable trash and rubbish will not be permitted to

'5 accumulate in or near patient areas, offices, or other work areas. It will be collected in non-flammable re-ceptables and emptied when full or at last once each day,

d. Paints, oils, gasoline, kerosene and other combustible materials will be stored only in approved containers and approved storage locations. Open paint cans will not be permitted in wards, office, or general storage rooms.

e. Hot plates, cof fee makers, etc., will be used only on non-flammable surf aces. No such appliances will be used unless inspected and approved by the Maintenance Department. .

f. NO SMOKING signs shall be conspicuously posted in ali

. areas which are considered fire hazards. ALL NO SM0 KING signs shall be strictly obeyed,

g. Vehicle parking is prohibited within fifteen (15) feet ,

of fire hydrants, Fire Department connections and the ,

building.

h. Cylinders containing compressed gases and cans containing volatile liquids shall be kept away from all sources of heat and out of proximity to cylinders containing oxidizing gases such as oxygen.

s i. The fol. lowing regulations based on those of the Compressed Gas Association shall be observed:

1. Nevar permit oil, grease, or readily flammable materials to come in contact with oxygen cylinders, valves regulators, gauges or fittings. ,

2. Never lubricate regulators, fittings, valves, gauges with oil or any flammable substance.

3. Never handle oxygen cylinders or apparatus with oily hands, greasy gloves or rags.

4. Always clear particles of dust and dirt from cylinder

' valve openings by slightly opening and clos,ing the -

valve before applying any fitting to the cylinder.

5. Open the high pressure valve on the oxygen cylinder

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before bringing the apparatus to the patient.

6. Open the cylinder valve slowly, with th'e face of the gauge on the regulator away from any person.

7. Never drape any oxygen cylinder with any materials such as hospital gowns, masks, or caps.

8. Never use oxygen fittings, valves, regulators, or gauges for any purpose other than on oxygen cylinders.

9. Never . mix gauges of any type on an oxygen or an other cylinder.

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(10) Never at'_")mpt to use regula tors w( )h a re in need

• of repak (11) Transfer of gas from one cylinder to another on T the nursing home premises or by nursing home

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(12) Covers or'any form of sheeting shall not be used '

on oxygen cylinders.

FIRE EVACUATION CHARTS:

Fire Evacuation charts are posted throughout the building for all employees, visitors and patients to review.

ORIENTATION:

All employees of this facility shall.be oriented to the Fire '

Evacuation and Disaster Plan for this institution. Periodic raview of the Fire and Disaster Plan and Fire Drills shall be made to determine the effectiveness of the Fire Evacuation and Disaster Plan. -

FIGHTING THE FIRE  ;

THE IMPORTANCE OF FIRE FIGHTING:  !

A small blaze is the easiest to control, therefore, fire fight-ing with a hand extinguisher should take precedence over all  !

activities except the removal of patients from immediate danger and giving the alarm.

, .) FIGHT THE FIRE AS SOON AS POSSIBLE: ,

A fire which does not receive the necessary attention in the -

first five (5) minutes or less can assume serious proportions from then on. Professi'onal firemen either confine or rubdue a blaze in that length of time or are forced to call for

• additional equipment and manpower. Fighting fire is waging war against smoke, heat, flame and whatever panic may exist.

PERSONAL SAFETY WHEN FIGHTING A FIRE:

The average person has the ability to use a fire extinguisher effectively to put out or control a small fire. However, there are circumstances which make it difficult or dangerous to fight a fire with an extinguisher. The person who has to fight a fire must consider his personal safety at all times. .

If the fire, heat or smoke endangers the person using the fire extinguisher, he should stop fighting the fire and move out of the fire area. Remember to be careful and use good judgement when fighting a fire--00 NOT---unnecessarily endanger YOUR life to extinguish a fire.

FIGHTING SMALL FIRES:

Portable fire extinguishers are installed at various locations throughout the building. Extinguishers are positioned within this facility so that wherever you stand, you will not have g

to travel more than seventy-five (75) feet in any direction to obtain a fire extinguisher. The proper extinguisher must i

be used in an effective and efficient manner to extinguish ,

or control a small fire. '

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O A fire extinguishePis uselesP',if it is not used by the people in the nursing home when a ' fire breaks out. Many times the personnel in the building hesitate to use a fire extinguisher

-n because they do not know how. Become f amiliar with the types I

. of extinguishers in the building and how they operate.

In-Service training shall be taught at least s.emi-annually to all personneloon how to operate and the use of each fire extinguisher.

Read the operating instruction on the fire extinguisher. A fire inspector or fireman will explain the use of the extin-guishers during in-service training classes.

Many materials give off poisonous gases when they burn, so move about to avoid inhaling the smoke.

When the fire is out, open windows to ventilate the fire area; if you cannot ventilate the area quickli and easily, stay out of the fire area until the' smoke i s cle.ared away.

A fire in bed should be handled in the following manner:

Use a blanket to smother the fire. Hold the blanket in front of you so it will become a shield and carefully lay it on the burning bed. The flames will be extinguished, however, pat the blanket to eliminate any air pockets. ,

The bed will continue to smolder, but the fire will be <

confined to the bed until it can be extinguished with water. A bed that is on fire should never be pulled into a corridor where drafts may increase the seriousness of the fire and the sight of fire by patients may cause

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All fire extinguishers are not equally effective on all types of fires. Therefore, study should be given to the three (3) classifications of fires and the best extinguisher for that ..

particular type.

CLASS OF FIRE , DESCR!pTION OF CLASS FIRE E*tTINGUISHER Class A Fires in crdinary Use: Soda-Acid combustibTe ma terial s Fire Hose such as wood, cloth Pressurized

'and paper.* Water Class B Fires in flammable Use: Carbon Dioxide liquids such as Dry Chemical gasoline, fuel oil.

Alcohol, grease and anesthetics.

Class C Fire in energized Use: Carbon Dioxide electrical equipment Dry Chemical s

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o O I Suitability: Class A (wood, paper, trash, rubbish), Class 8 flammable liquids), Class C (energized electrical equipment).

Maintenance: They should either be weighed or pressure gauge checked for proper pressure semi-annually. They shall be recharged immediately after use, even though only partly discharged.

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S00A-AC10 FIRE EXTINGF:ERS:

Siz_e_: 21 gallons Contents: li pounds bicarbonate of soda and 4 ounces of sulfuric acid. 21 gallons of watar.

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Method of Operation: Must be carried by top handle to fire and turned upside down.

The sulfuric acid is mixed with the soda water creating a pressure which expels the water through a hose which is directed at the fire.

Range and duration:

the extinguisher is empty. 30 tc 40 feet and in about one (1) minute Suitability: Class A fires (Wood, paper, textiles, rubbish).

Caution: Not to be used on flammable liquids or energized electrical equipment fires..

Maintenance: Should be visually inspected quarterly and must be recharged annually.

PRESSURIZE 0 WATER FIRE EXTINGUISHERS:

Size: 21 gallons.

Contents: 2) gallons of water under air pressure.

Method of Ooeration: A pin, which locks the handle, is pulled out and the handles are pressed together. The hose is directed at the fire and the stored air pressure in the extinguisher expel s the water.

f, Ranoe and Duration: 30 to 50 feet and about one (1) minute duration.

Su i ta bil i ty : Class A # ires (wood, paper, textiles, rubbish).

Caution: Not to be used on flammable liquid or energized electrical equipment fires.

Maintenance: Should be examined semi-annually to determine that the pressure as indicated on the extinguisher gauge is in the operable range.

CARBON O!0XIDE FIRE EXTINGUISHERS:

Size: 2 to 25 pounds. -

Contents: Carbon dioxide gas.

, Method of Ooera tion: A pin, which locks the handle is pulled out and the handles are pressed together. The horn is directed at the fire and a cloud of carbon dioxide gas is expelled.

Range and Duration:

3 to 8 feet and about 30 seconds.

Suitability: Class B fires (flammable liquid) and Class C fires (energized electrical equipment)

Maintenance: They should be weighed semi-annually to determine whether or not the extinguisher is fully charged. They shall be recharged immediately af ter use even though only partly discharged.

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DRY CHEMICAL EXTINGUISHERS: '(TYPE ABC)

Size: 1 to 30. pounds.

Contents: Bicarbonate of soda and other components producing '

free flow and water repelliency. .

Method of Operation: A pin, which locks the handle, is pulled out and the handles are pressed together. The nozzle is directed at the fire and a cloud of dry chemicals is released.

Range and Duration: 8 to 10 feet and 10 to 25 seconds.

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FOR WHAT DURATION OF XT INGUI SilE R KINDS OF FIRE CONTENTS Il0W TO START RANGE OPERATION CLASS A 1. Water solu- 1. Inversion Wood tion of bi- Type--Turn carbonate of over, bump on dha-Acid 3pe e les s da and sulfur- ground. 30 to 40 ft. 50 - 55 seconds

'##55U#*** ic acid. 2. Pressurized--

Etc. -

(21 gal. size

c. Plain water Pull locking pin, squeeze lever.

CLASS B

!arb n- Oil '

H xide I" faso

, nt Carbon Dioxide Pull pin and 3 to 8 feet 30 Seconds Grease Open Valve.

(15 l b. size)

CLASS C Pull pin er g fve Bicarbor.3te of c liar, then:

hemcal [lectrical E soda with other 1. Open valve or 8- 10 ft. 10-25 seconds Equipment dry chemicals 2. Press lever, then squeeze - (30 lb. size) lever, ype ALL Dry Chemical Remove hose, dBC CLASSES push on lever , 20-50 feet 10-25 seconds and squeeze no z zl e .

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C H A . .'i 0 F C O MM AN D :

SUPERVISOR'S DUTE S: Get the 3ASIC FACTS about the EXTENT OF 7'

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3 THE FIRE f rom perso;n calling, or f rom the scene.

\- 1. Make immediate contact with Fire Department.

2. Call the following people and simply tell them what 15 happening, nothing more:

a. Adm i n i s t ra t o r . . . T wdL TIA HAN Tel. M

b. D i r ec to r o f N u r s e s cer.~ 7 rr Tel. 6

c. Charge Nurse (individual on duty)

3. Keep telephone lines as clear as possible. 00 NOT attempt to answer any questions from casual cailers.

Station one person at the telephone arc paging ry= tem to relay instructions.

4. You, as Charge Nurse are in charge of the administrative portion of this plan and ara responsible for the coordina-tion of the overall procedure, UNLESS persons listed above under #2 are present to take over command.

The following persons, in the order listed, are in charge and responsible for implementing the disaster procedure. direction

.of the nursing preparations and the general supervision of the functions' of the Nitrsing -Service:

1. Al1 Superv dors-

2. All Charge Ju'rses

3. All other personnel, including housekeeping, laundry 3 and kitchen jersonnel will report to their place of REGULAR assignment and remain there until officially assigned el sewhere.

4. The Supervisor will assign personnel to disaster. area und the area in which the patients have been evacuated,

5. Whoefar is AC7ING SUPERVISOR at the time of any diaster is in authority and will keep that authority until someone higher up in the Chain of Command arrives on the scene .and assumes the authority.

PHONE NUMBERS ANO 3PECIAL EQUIPMENT:

1. A list-of all A.dministrative personnel phone numbers, including Emergency call physicians, Fire Department, Police Department, Ambulance Service, etc. is located at'each nurse's station.

2 A stendby call list of off-duty personnel to be called

• o assist in any emergPNry Or eV4Cuation is always kept at the Nurse's Station Disa;ter Kit.

3. An adequate number of blankets 'to. assure warmth and comfort of the patienti, while.the/ are being transported are kept in the Laundry Departmeat and the Central Supply building.

23

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g V An adequate number of hand lights for use in removal and transportation are kept at each nurse's station.

The emergency generator will go on automatically if

.:, there is an electrical failure.

5. Emergency first-aid equipment is kept at the nurse's station. -

KEEP CALM AND DON'T PANIC ALWAYS USE CODE MESSAGE "DR. RED" WHICH MEANS FIRE AND GIVE YOUR LOCATION.

THE EVACUATION PLAN:

The Administrator or the next person downward in the Chain of Command is responsible for deciding whethen it is necessary to evacuate patients from ALL or PART of the. nursing home. Of course this does not mean that any personnel in any area would leave patients in a dangerous area awaiting direct orders to move patients to a safe area if they were near a fire. If the decision is made to evacuate an area of the building, the specific responsi-bilities of departmental personnel and volunteers are as follows:

1. Four people working in a team start with the patients closest to fire or dis' aster area, lif t mattresses with all bedridden patients and carry them to a sa fe area, and line them up on even side of the corridor.

Be sure they are left warm and with sufficient

, blankets.

2. Or, two (2) people working as a teem lif t the entire bed clothing from the bed including the mattress pad or cover, rolling the edge in a roll close to the patient and lifts the patient putting them on the floor and' turns them over to another person. They they pull this patient to a safe area. This method applies to bedridden patients. ALWAYS start with the ones CLOSEST to the disaster area of the fire.

3. Or, one (1) person lif ts a patient on their back and carries them to a safe area.

4. Or, the ones that go in wheelchairs may be placed in a chair by one person, while another person keeps a chair ready. Another person does the transportirg of the patient to the safe area.

5. Or, the ambulatory patients may be lead to the saf e area. One employee can take several of this type patient at one time.

WHEN GOING THRU SMOXE, have a wet blanket, sheet or towel around the face to keep the smoke from being breathed in and burning their eyes.

DON'T PANIC - TALX WITH. PATIENTS IN A REASSURING VOICE ADMINISTRATOR:

1. Make certain that business office personnel take care of cash, accounts, ledgers, valuables, receipt books, etc. Keep track of file containing names and accounts of patients in the nursing home. Q4

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2. If tine permits, ef ter patients have been evacua ted, assign persons to remove valuable equipment and

,s supplies from the building, especially close to area of disaster.

3. Call the staff physicians and advise them of having to evacuate patients to the hospitals, nursing homes or shelters and if they need to see their patients.

4. Make certain all narcotics are removed safely.

5. Af ter all evacuation has been completed and assurance of such must be entirely .certain, all personnel will proceed to front of building - or the safest area out-side the building.

NURSING DEPARTME'T:N ,

1. Follow Fire Evacuation Plan.

DIETARY DEPARTMENT:

I

1. Shut off all electri' cal and gas equipment. (Stoves, fans, etc.)

2. Close all doors and windows.

3. Report to designated area and wait for further instructions.

s HOUSEXEEPING.0EPARTMENT:

1. Report to designated area and wait for instructions.

LAUNDRY DEPARTMENT:

1. Shut off all washers and dryers. ,"

2. Close all doors and windows.

3. Report to designated area and wait for further instructions.

MAINTENANCE DEPARTMENT:

l. Shut off all air-conditioners, blowers, etc.

2. Check exits for free excess.

i

3. Report to area involved.

ACTIVITY AND SOCIAL SERVICES

1. Shut off all electrical and gas equipment.

2. Close all doors and windows.

3. Report to person in charge for further instructions.

FIRE DEPARTMENT:

1. Take charge of situation and direct evacuation.

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O O POLICE DEPARTMENT:

l. Dispatch policemen to f ront and rear entrances of the building to admit ONLY fire trucks, ambulances, rescue squad crews,and their equipment, doctors and personnel.

2. Keep all driveways clear for ambulances and public transportation vehicles. Do not allow any vehicles to block driveways.

FLOOR EVACUATION PLAN:

The floor plan gives you the location of ALL EXITS, TELEPHONES, AND FIRE EXTINGUISHERS. -

STUDY AND LEARN THIS FLOOR PLAN:

The most important element of this drawing is that it il'lustrates the need for a definite evacuation plan which avoids bottlenecks at particular exits. .

( Also framed and posted on your. floor for visitors to see and -

use as reference in case of any disaster.)

STUDY AND CHECK THIS FLOOR PLAN AND ALL DETAILS OF THIS FIRE AND EVACUATION BOOKLET OFTEN.

REMEMBER:

'- 1. Always use code message "DR. RE0" and give your location.

Never announce "FIRE" as a code word.

2. Forcompleteevacuation,thepatientsarecarrie[to the nearest exit. There will be transportation stationed' at each exit to receive patients.

3. Make certain each patient's chart is evacuated with the patient.

4. Be sure that ALL patients are removed BEFORE YOU LEAVE.

5. When the fire has been extinguished, an all clear signal will be given to you to bring the patients back to the nursing home. Do not bring or let any patient return to building until the all clear signal has been given.

The code for "ALL CLEAR" is "MR. GREEN."

REMAIN CALM NEVER PANIC REASSURE YOUR PATIENTS Qb

O O FIRE STATIONS 1ST SHIFT AFFECTED WING:

Should a fire occur, that is to say a major fire, your primary duties would be to evacuate patients nearest the danger area.

You will be working as a team. Sound the Fire Alarm.

Get the fire extinguisher nearest to the fire and try to extinguish the fire. If you cannot put the fire out, close all doors and windows and place a wet blanket under the door to prevent smoke from entering the other rooms.

The Charge Nurse shall call other personnel as outlined in the Fire Evacuation Plan.

All other personnel will assist where needed, as outlined in the Fire and Evacuation Plan.

0'RDER OF EVACUATION:

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1. Patients in the affected area

2. Ambulatory Patients

3. Wheel Chair

4. Bed patients.

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o O FIRE STATIONS l 2ND AND 3RD SHIFT AFFECTED WING: Should a fire occur, a major fire, your primary  !

duties would be to evacuate patients neare,st to the danger area  ;

and to sound the Fire Alarm.- -

Get the fire extinguisher nearest to the fire and try to extinguish the fire. If you cannot put the fire out, close all doors and windows and place a wet blanket under the door to prevent smoke from entering the other rooms.

The Charge Nurse shall remove patient's charts and call other

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personnel as outlined in the Fire Evacuation Plan. .

All other personnel will assist where needed, as outlined in the Fire Evacuation Plan.

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ORDER OF EVACUATION:

1. Patients in the effected area. .

2. Effected wing (patients closest to the danger area. ) ,,

Patients are all treated the same as bed patients. i

3. Other wings. ,

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SEACOAST HEALTH CENTER, INC.

22 Tuck Fload l Hampton. NH 03642-1298 Tet (603) 928-455:

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Evacuation

! Zone 4 Sprinkler 87 Meeting Area Zone 5 Administration #

Zone 6 East Zone 7 Francoeur i s .

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FIRE EVACUATION EXITS EAST WING .

Should a major fire occur and evacuation seems inevitable, the following routes shall be used. It is suggested that a study be made of the Fire Evacuation Routes posted at the Nursing Station. It will be necessary for Employees to study the plan of evacuation patients.

so as to increase the efficiency of evacuating Room 101, 102, 103 and 200, -

bathroom through the side East Exit door.

Rooms 104 - thru IM evacuate through East and Exit door.

If fire is blocking hallway then you must evacuate the other way by going through the smok.e doors and use the East side exit

, door.

Periodic on-the-spot checks will be made to determine if the fire evacuation plan has been studied by employees.

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w WHEN EVACUATING PATIENTS MEET AT PARXING LOT AT THE FAR CORNER M

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l FIRE EVACUATION EXITS - l WEST WING Should a major fire occur and evacuation seems inevitable, the following routes shall be used. It is suggested that a study be made of the Fire Evacuation Routes, posted at the Nursing Station. It will be necessary for Employ of evacuation so as to increase the effic,ees toof iency study the plan evacuating patients.

Rooms: 201 - 212 and Bathroom, e'vacuate through West Exit door.

If fire is blocking hallway. Then you must evacuate through the front lobby exit. .

Periodic on-the-spot checks will be made of employees to see ,

if they know the evacuation route's of the fire evacuatica. plan.

It is of utmost importance that employees know this plan. Study it carefully, i

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MEET AT THE PARKING LOT AT THE FAR CORNER -

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1 FIRE EVACUATION EXITS CENTER AREA Should a major fire occur and evacuation seems inevitable, the following routes shall be used. It is suggested that a study be made of the Fire Evacuation Routes posted at the Nursing Station.

Rooms: Dining Room,* Smoking Room, evacuate through the Patio exit doors.

If fire is blocking Patio area then you hiust evacuate the other way by going through th.e Fire Doors and use the Tuck Side Exit door.

Periodic on-the-spot checks will be made of employees to see if they know the evacuation routes of the fire evacuation plan.

It is of utmost importance that employees know this plan. Study it carefully.

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FIRE EVACUATION EXITS TUCK WING '

Should a major fire occur and evacuation seems inevitable, the following routes shall be used. It is suggested that a study be Station. made of the Fire Evacuation Routes posted at the Nursing Rooms: 301 - 312, evacuate through Tuck 'end Exit door.

If fire way by g.is oingblocking throughhallway the Smoke thendoors you must and evacuate use the Tuck the other side exit door.

Room Private F2.tBathroom, evacuate through the Tuck side exit

- door.

Periodic on-the-spot checks will be made of employees to see if they know the evacuation routes of the fire evacuaticn plan.

It is of utmost importance that employees know this plan. Study it carefully.

WHEN EVACUATING PATIENT MEET AT THE PARKING LOT AT THE FAR CORNER .

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D O 4 FIRE EVACUATION EXITS

.i EAST WING Should a major fire occur and evacutation seems inevitable, the following routes shall be used. 'It is suggested that a study be made of the Fire Evacuation Routes posted at the Nursing Station. It will be necessary for Employees to study the plan of evacuation so as to increase the efficiency of evacuting patients.

Rooms 400, 401, 402, 403, 404, 405, and 407 have two options for evacuation.

They can exit through either wing or hallway exit. If a hallway or wing exit is block you must exit through the other direction.

Rooms 406, 408, 410, 412 will evacuate through exit door if block by fire then through fire doors in opposite dire.ction.

. R'ooms 409. 411, and laundry room will evacute through exit door, if block .

by fire then through fire doors in opposite direction. '

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Periodic on-the-spot checks will be made to determine if the fire evacuation plan has been studied by employees.

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, WHEN EVACUATING PATIENTS 4c8 '

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MEET AT PARKING LOT AT THE FAR CORNER 406 t: 410 2ona.7 Y

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404 / 3 roos 401 405 409 411 3M 402 2.one.7m EXIT ( EXIT - '

l 403 407 t.cundry roora A .5 c-

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i FIRE EVACUATION EXITS ADMINISTRATION AREA Should a major fire occur and evacutation seems inevitable, the following routes shall be used. It is suggested that a study be made of the Fire Evacuation Routes posted at the Nursing Station. It will be necessary for Employees to study the plan of evacuation so as to increase the efficiency of evacuting patients. .

WHEN EVACUATING PATIENTS

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MEET AT THE PARKING LOT AT THE FAR CORNER -, mIm n un -

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E.xit Door .

FIRST M R Aantnistration Area 1.cbby Arec .

Conference P4cra Nursing cnd -

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) .. ) - ~i Rec Off!ce- Recrectlen Rcon Social Services

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.,M FIRE EVACUATION EXITS s

ADMINISTRATION AREA Should a major fire occur and evacutation seems inevitable, the following routes shall be used. It is suggested that a study'be made of the Fire Evacuation Routes posted at the Nursing Station. It will be necessary for Employees to study'the pla.n of evacuation so as to increase the efficiency, of evacuting patients.

WHEN EVACUATING PATIENTS '

MEET AT THE' PARKING LOT AT THE FAR CORNER

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! I EXIT Area Second Flcor l h i

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Vending Area -

A2itnistrator

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6 POLICIES AND PROCEDURES DISASTER PLAN b

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• DISASTER PLAN O  ;

1. GENERAL: '

4. PURPOSE:

To provide a written plan of action to be used in time of disaster.for=the Nursing Home, utilizing its maximum resources. Therefore,-by this action, the Nursing

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Home will be in position to render the greatest possible  !

service to the care and safety of moving patients to.

a place of safety.or possible evacuation.

b. TYPES OF OISASTER:

(1) Internal: Those disasters that may occur within  :

the Nursing Home such as fire, explosions, etc.  !

(2) External: Those disasters, that may occur out-- I side of the Nursing Home such as storms, tornadoes etc.

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2. BASIC POLICIES:

a. The entire Nursing Home personnel will function on ,

a team basis.  !

b. Teams necessary for the proper functioning of the Nurs- i

ing Home in time of disaster will be as follows

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(1) Administrator .j r .

(2) Director of Nurses '

(3) Chief of Police l (4) Chief of Fire Department . a .

(5) Medical Director (6) Civil Defense or Rescue Squad ,

c. Personnel will be assigned specific positions and it i

! will be. their responsibility to assume those positions -

in time of disaster. .

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COMMUNITY COOPERATION IN CASE OF A DISASTER Each public institution in a community must be willing and able l to receive as many injured people as possible in case of a  ;

disaster. This f acility shall serve the public in any capacity l

, possible in case of a disaster affecting the community.  ;

I This nursing home f acility shall: l

1. Receive casualties that do not need specialized attention, j

2. Provide casualty care and treatment that we are ,

able to administer.  !

l l 33

. .. . - - . - - . _-- .-. -- -- - a

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3. Perform the duties as outlined in Disaster Agreement.

.4 All off duty personnel shall be called back to duty.

RESPONSIBILITIES: COMMUNITY DISASTER ADMINISTRATIVE DEPARTMENT:

1. Responsible for identifying, receiving, tagging and placing patients.

2. Prepare a list of disaster victims treated and admitted.

3. Assist where needed.

NURSING SERVICE DEPARTMENT:

1. Assign personnel.

2. Initiate and maintain minimum charging procedures.

'3. Prepare first-aid equipment.

4. Assist doctors and carry out their orders.

5. Assist where needed.

DIETARY DEPARTMENT:

1. Prepare to furnish quantities of cof fee, fruit juices, soup, etc.

2. Contact local merchants or wholesalers to obtain an emergency food supply.

3. Assist where needed.

HOUSEKEEPING DEPARTMENT:

1. Prepare large quantities of first-aid supplies and dressings.

2. Prepare to help nursing service personnel make available our reserve supply of disposable needles and syringes.

3. Keep work areas as neat and clean as possible.

MAINTENANCE DEPARTMENT:

> 1. Prepare to issue large quantities of nursing supplies and equipment.

39

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2. Assist'where needed. .l

3. Maintain records of equipment and supplies l l issued. l

' t i 4. Be prepared to keep emergency generator and l

' power units-activated. j

5. Assist where needed.

l PHARMACIST:

a i Prepare to issue emergency quantities of drugs - as ordered  !

by staff physicians. l

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LAUNDRY:

! 1. Prepare to keep a continuous staff in the-i-

Laundry Department to keep a supply of linens e and laundry.

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2. Assist where needed.  !

VOLUNTEERS: i l

l Assist where needed. .

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4 POLICIES AND PROCEDURES BOMB THREATS y

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< s CONTINGENCYPLANN!ilh?ORBOMBTHREATS: _

The current nationel situation of increased bombings, bomb threats, and bomb scares and the recent increase in bomb threats must be given immediate consideration.

The following plan for handling bomb threat situations in the nursing homes was discussed and approved by a representative group of health care and law enforcement officials in the areas where bomb threats have been received. This plan shall be furnished to all local law enforcement officials and is recomm-ended for use where bomb threats are a problem.

In the past, the vast majority of bomb threats turned out to be hoaxes. However, the current trend nationally is that more of the threats are materializing than in the past. It is practi-cally impossible upon receipt of a bomb threat to determine immediately whether it is a hoax or a reality. The safety of the patients is paramount.

OUR RESPONSIBILITY:

Whenever the Administrator or other of ficials or personnel receive threats or warnings about bombs in the building, they are responsi-ble for immediately notifying (1) the Police Department (PHONE:

926-3333) and (2) the Administrator or Assistant. The Administrator (or person of decision making responsibility in his absence) is responsible for making the decision as to evacuation. This decision must be made promptly. Evacuation must be orderly so that no panic resul ts. In some situations it may be desirable to obtain the advice of local law enforcement authorities.

Advice received will be given strong weight in this decision.

Keys will be available so that searchers can inspect all lockers and rooms.

The Administrator or Assistant Administrator shall remain with the Search Commander during the entire search to provide assist-ance and counsel during the search.

If a suspected bomb is located within the building the responsi-bility for investigation will be that of the law enforcement officials having jurisdiction over such matters.

All personnel who might receive a bomb threat call have readily available the names and telephone numbers of the police department and other personnel to be called. (A list of Emergency Phone Numbers are posted in each department.)

TELEPHONE PROCEDURES:

All personnel who normally receive telephone calls fron, the general public shall be instructed in the following procedures:

1. Keep the caller on the line as long as possible. Ask the caller to repeat the message. Record every word spoken by the person making the call. Record time call was received and terminated. Ask the caller his name.

42

2.

O If the caix- r does not indicate the location of the bomb or the time of possible detonation, the person receiving the call should ask the caller to provide this information.

3. It may be advisable to inform the caller that the building is occupied and the detonation of a bomb could result in death or serious injury to many innocent people.

4. Listen for any strange or peculiar background noises such as motors running, background music and the type music snd any other noises which might given a remote clue as to the place from which the call is being made.

5. Determine whether the voice 'is male or female; listen for accents and speech impediments. Immediately after the caller hangs up, the person receiving the call should report this information to the Police Department (PHONE: 926-3333) and prepare a personal memorandum of all details of the episode while they are fully recalled.

INFORMATION FROM OTHER SOURCES:

Notification of bomb threats or related acts may also be relayed to the nursing home through other sources. All threats must be immediately reported to the Administration, if present, or reported to the Police Department.

PUBLICITY: ,

Avoid publicity as this generally generates additional bomb threats.

EVACUATION PROCEDURES:

When evacuation is ordered by the Administrator, or person in charge, the Fire Evacuation routes will be used. The Admini-strator, or the person in charge, will make the decision whether to evacuate all of the relevant parts of the nursing home based upon information available and the advice of the local law enforcement authorities. Search the areas which people will use to evacuate the building. Once this is accomplished, the building can be evacuated. An option not to evacuate may be made when sound local judgement and experience indicates there is no real threat. The evacuation signal for bomb threats will be over the Paging System made directly to the charge nurse.

The normal procedure in evacuations incident to bomb threats, leave all windows and doors open to minimize damage in the event of a bomb explosion.

FLOOR PLAN:

The Administrator, or person in charge, shall make available to the search commander copies of the building floor plan in order that the search commander can readily make search assignments.

43

w LAWENFORCEMENTRE((NSIBILITY:

The law enforcement agency having primary jurisdiction will have the responsibility of promptly notifying (1) the Fire Department (2) the State Troopers (3) the FBI.

The law enforcement agency having primary jurisdiction will be responsible for the orderly search of the building ard the investigation of the bomb threat matter. In the event a bomb or suspect object is located, the responsibility for removal will be that of the bomb detachment unit. The search commander will have the responsibility of giving the "ALL CLEAR" signal at the completion of the search.

SEARCH TEAMS:

The search commander will assign areas to be search'ed, utilizing the administrator or other official f amiliar with the particular areas. Search team leaders are to be trained on search techniques, to include how to search, what to look for, to whom and where to report if anything is found. Assure that each search team member understands and responds promptly and properly when called upon. Time and thoroughness are of the essence.

When forming search teams decide on needed equipment and have it on hand. This could include such items as flashlights, ropes, knives, two-way radios, items to . isolate a suspected object, etc.

Give particular attention to all areas accessible to the public, i.e. , outside window ledges, behind shrubbery, platforms, lobbies ,

waste paper cans, rest rooms, stairways, telephone booths, ceiling lights, souventer stands, corridors and closet a reas.

While this list of areas to be noted with particular emphasis is not complete, it is sufficient to give an idea of those areas where a time-delayed explosive or an incendiary device might be concealed. If during a search you find one explosive or incendiary item, complete the search, as there could be more than one.

It is imoerative that eersons involved in the search be instructed that their mission is only to search for and report susoicious objects, not to move, jar or touch the objects or anytning attached thereto. The removal / disarming of a bomo must be left to the orofessionals in expl6sive ordinance disoosal.

Have one or more areas. selected to which a bomb or suspected parcel could be taken, by Bomb Disposal Unit, if they do not have a bomb disposal tank or equipment with them to be disposed o' without undue danger to personnel, buildings, equipment, etc.

SUSPICIOUS OBJECTS:

If a search discloses a suspicious object, promptly notify the search commander who will have the Bomb Disposal Unit remove the object from the building. DO NOT MOVE. JAR OR TOUCH THE OBJECT OR ANYTHING ATTACHED TO IT.

If the building has been evacuated, do not permit re-entry by anyone not connected with the search or removal of objects until the suspected item has been removed or otherwise declared safe by the search commander or the Bomb Disposal Unit. 44

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U PREVENTIVE CONSIDERATIONS:

Determine that unauthorized persons do not have access to the boiler rooms, maintenance areas and other areas where an explosive might be deposited.

All staff personnel should be alert for suspicious looking and acting people. Watch for foreign or suspicious objects, items or parcels which do not appear to belong in the area which such items are observed. Insure that doors and access ways to such areas as boiler room, supply and Janitor closets are securely locked when not in use.

Determine that fire exits are not obstructed.

Alert medical personnel to standby during a search to be conducted in bomb threat situations.

SAMPLE FORM TO RECORD BOMB THREAT CALLS:

Attached is a form which suggests information to obtain by the person receiving the bomb threat call. The information on this form is not all inclusive and other information might be offered or obtained that would be of value to the search teams and investigators.

It must be noted that all this information may not be obtained.

Remain calm and get as much information as possible.

BE CALM:

BE CALM, as excitement tends to create panic.

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1. When is the bomb going to explode?

_6 2. Where is bomb right now?

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- 3. What kind of bomb is it?

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4. What does it look like?

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5. Why did you place the bomb?

Description of Caller's Voice:

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_ Male Female Yound Middle Age Old Accent 3

Tone of voice Background Noise

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Is voice familiar? If so, who did it sound like?

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_ Name of Person Receiving Call

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4 POLICIES AND PROCEDURES  :

1 TORNADO PROCEDURES

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(_/ TORNADO PROCEDURES

1. TORNADO WATCH:

This means that conditions are right for Tornados. No special procedures are required at this time. Continue to listen to News Reports.

2. TORNA00 WARNING:

This means that a Tornado has been sighted. It also means that safety measures are to be taken immediately. The following action will be taken when a call is received from the Civil Defense Department or when local stations issue TORNADO WARNINGS: .

a. Hove all patients to hallways. Leave bed patients in bed. Roll bed out into hall,

b. Place all patients next to wall. Have ambulatory and wheelchair patients sit on floor. Give each patient blankets to keep warm.

c.

Personnel on duty open every other window about six (6) inches. Open all exit doors to the building. Leave open during Tornado Warning. Keep drapes closed. This will help stop flying glass,

d. Remain in hallway until notified Tornado Warning has ended.

A Tornado warning is serious. Do NOT take it lightly. Keep patients in hallways until on ALL CLEAR signal has been released from the Civil Defense Department or local Radio and T-V stations.

These procedures may seem to cause work or be uncomfortable on our patients and staf f, but it is better to be uncomfortable and a little exhausted than to loose unnecessary lives.

In the event a Tornado does strike the building or cause damage to the building, all of f-duty personnel shall be required to report to the Nursing Home immediately.

The 2nd and 3rd shif t Charge Nurse will be in charge of implementing these procedures when a Tornado warning is issued when the Administrator is not usually at the'home.

REMAIN CALM, DON'T PANICl REASSURE YOUR PAT!ENTS THAT EVERYTHING IS 0.X.

1 TORNADO WARNING:

This will Le broadcast immediately. It means there IS a tornado in the area . . . NOW!

These storms are so erractic in movement, it is hard to know where they will strike, but if a warning is given, don't waste time looking for the funnel. Quickly disconnect the T.V.

Get the patients O

into a central hall, away fro windows.

See that each has a blanket to cover himself, head included.

Always try not to alarm the pa tients. Reassure them and be calm mann'ered even if you are terrified.

Should damaging wind strike the butiding, help the patients to take cover in any way possible, in closets, central bathrooms, even under beds or sofas.

When lights go out during a storm, panic may follow. Keep flash-lights handy and be sure the batteries are reliable. This facility is equipped with an emergency generator. Should the poer go 0FF, the Emergency Lights will come on' automatically. iee procedures for annually starting the generator when auxillary power f ails.)

Along with your transistor, first-aid supplies, medication and flashlights, have drinking water available.

Keep l'istening to the radio for information and instructions.

IF THE NURSING HOME IS HIT:

Don't panic. Tell yourself and your patients that Civil Defense in full force, is right behind you . . . ambulances, rescue uni ts , firemen, police, heavy equipment, doctors, nurses, units from the water, gas and electrit companies. The minute disaster strikes, they're on their way.

And remember, that the storm may not be as bad as it sounds.

The crash of a single limb against a building can sound like Doomsday.

PERSONNEL:

NOTE:

The average torne lasts from 8 to 10 seconds. In this pa rt of the country, a.aat tornados strike between 3 p.m. and 7 p.m.

While tornados can occur in any month, they are most likely to strike from March through Septedber, especially in April, May and June.

THE PLAN:

TORNADO WATCH:

Whenever the National Weather Service detects an area where wea ther conditions are right for a Tornado, it issues a TORNADO WATCH:

It is not possible to know exactly where or when a tornado will strike, but it could happen here, and the WATCH gives us time te prepare for one.

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TORNADO WATCH IN A NURS!NG HOME:

1. A Tornado can strike without warning, sure. But as a rule, several hours elapse between the time a WATCH is called and the time the storm reaches the area.

2. During these hours, keep tuned to your local radio

', or T.V. station. If the TV weather service shows radar' screening, you can readily see where the storms are headed.

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Check outdoors and Indoors for any objects which might become missiles if blown about in high wind.

4. Outside, these include lawn che:rs, metal trays, raken, hoes, etc.

5. Inside, they include drinking glasses and any other objects made of glass, bases, mirrors, trays, bottles and sharp objects.

6. It is best to put such objects away in a safe place, but do this unobtrusively, so as not to alarm the patients.

7. See that windows on the east and north are open at least partly to reduce air pressure and keep the build-ing from exploding if a tornado should occur in the neighborhood. Keep drapes closed.

8. Patients who are bedfast should stay away from the windows.

9. Have plenty of blankets ready. If a severe storm strikes, the patient can be quickly covered with these to avoid injury by flying glass or splinters.

10. Keep your transistor and flashlights handy. Have firs t-aid kits and emergency medication where you can reach them quickly.

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- - O O SMOKING REGULATIONS LIFE SAFETY CODE REGULATIONS, NFPA 101, requires that we adopt SM0 KING REGULATIONS. The following Regulations shall be adopted by this facility:

1. SM0 KING shall be prohibited in any room, or compart-ment where flammable liquids, combustible gases, or oxygen is used or stored and in any other hazardous location. Such areas are posted with NO SMOKING signs. (Such areas include Patient Rooms, Bathrooms, Hallways, Kitchen, etc.) Smoking shall be allowed only in the television room, Employees' Dining room, or Office areas by employees and visitors.

2. Smoking by patients classified as not responsible shall be prohibited, except when the patient is under direct supervision. ,

The attending physician and the director of nurses shall make the determination as to which patients are classified as respon-sible and non-responsible and the restrictions placed on their smoking. '

Any restrictions on smoking privileges shall ~ be noted on the Patient Care Plan in order that all staff. members may be alert to required safety considerations.

Smoking articles, cigarettes, pipes, matches, lighters, lighter fluid, etc., of patients not deemed responsible shall be retained at the nurse's station. pighter fluid and matches shall be kept only at the Nurs5's station.'Only Bic or Cricket lighters shall be kept by the residents of this facility.

It is not the intent of the above safety precautions to prohibit or restrict smoking privileges. 6afety precautions are of primary concern.

These Regularions SHALL BE FOLLOWED by all employees, patients, sponsors, and visitors alike.

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POLICIES AND PROCE0'URES FIRE ALARM AND EMERGENCY GENERATOR TEST PROCEDURES A

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EMERGENCY GENERATOR TEST PROCEDURES i

In accordance with Federal and State Regulations, this facility i has an emergency power system. '

Should normal power services be interrupted, auxillary power will be provided by an emergency powered generator that will start automatically once a power failure occurs.

To ensure that this emergency power source is maintained in good working order, monthly test during the good weather season and weekly test during the foul weather seasons shall be conducted and written records maintained of the. results.

The following procedures shall be used id conducting test of the emergency power system:

1. Throw test switch in transfer box located in the Electric Room. When the circu.it is broken, the generator should start automatically.

2. Should the generator fail to start automatically from the throw switch, it has a manual start to manually start the generator located at the generator site.

3. To start the generator manually, open front panel of generator and throw remote switch to manual position and generator should start.

4. Should both the automatic and manual start procedures fail to start the generator, immediately contact:

'DWEL TR A NM PHONE: lM ,

and inform him of the troub e.

5. Once the generator is started, it will run until you activate the same test switch for automatic shut-down, this normally takes approximately 15 minutes.

6. While the generator is running, the person conducting the test shall check lights and equipment in the building to ascertain th61r working condition.

7. Results of test are documented on the Test Record by the person conducting the test. The Maintenance Department or the Administrator shall conduct these tests on a weekly basis during foul weather,

8. After testing, put generator switch back into normal stand-by position.

The Emergency Generator is operated by batteries and LP gas.

When tests are conducted, batteries and LP gas levels are checked to insure that an adequate amount of charge and LP gas is available.

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All personnel shall become familiar with the operating procedures of the Emergency Power System so as to react swif tly when such system is needed. In-service education and Orientation programs

,. shall be conducted to insure that_this procedure is maintained.

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V FIRE ALARM TEST PROCEDURES This facility is protected by an Automatic Fire Alarm and Heat and Smoke Detector System. Should a fire occur within this facility, the fire alarm system will automatically alarm. It will also sound an alarm at the Fire Station.

In order for this facility to insure proper working condition, monthly test shall be conducted by th'e Fire Department.

The following test procedures are used in testing the Fire Alarm system of this facility:

1. Person conducting the test shall observe closing of Smoke Doors and the sounding of the Fire Alarm Signal.

2. Sights for testing the Fire Alarm System shall be rotated on a monthly basis.

3. Once test has been made, the Alarm System and Pull Station used will be re-set by person conducting the test.

4. Smoke Doors shall be positioned against wall to all personnel when test is concluded.

5. Personnel are notified over the paging system that the '

tes t is concluded. ,

6. Test results are posted on the, Monthly Test Record by person conducting the test.

All personnel shall become familiar with the operation of the Fire Alarm System.

Ih-Service education and Orientation programs shall be conducted to ensure that personnel have a working knowledge of this sys. tem.

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