EMERGENCY PREPAREDNESS PLAN READING PEDIATRICS

Adopted: January 1, 2015

Revised: October 3, 2017

Office Location: 320 Abington Drive

Reading, PA 19610
Borough of Wyomissing
Berks County

Director: Christopher David

Reference: Bayada Home Health Care Policy/Procedure 9-583

POLICY:
Bayada Home Health Care, Reading (REA), has an emergency management plan
designed to provide continuing care or service in the event of an emergency that would
result in an interruption of client service. This plan may be implemented during
emergent events including business interruption, weather related situation or heightened
states of alert or actual acts of terrorism, including bioterrorism.

A. LIST OF POTENTIAL EMERGENCIES Rev. 10/3/2017

Based on geographic location, information provided via the media and pattern of
emergencies within the past year, this plan is designed to manage the following
emergencies listed in order of priority. These events are most likely to occur and impact
our ability to continue service.

Prioritization of Emergencies

1. Severe Winter Storms:. Severe winter storms with significant accumulation of

snow/ice occur in our service area. These storms have in past years significantly
impacted travel for our staff. During these events nurses/HHA were delayed in
arriving for their scheduled shifts a few hours or at maximum one day.
Accumulation of ice also may result in prolonged power outages which affect
client care and communication.

2. Power and Utility Failures (phone, electric): During the summer months we
are prone to severe thunderstorms and over the winter months ice storms may
result in lost of power. Our office has experienced brief power outages. During
these periods we maintained contact with our clients via cell phone. The power
companies were notified that our clients needed to be high priority for restoring
power. Some of our client purchased or have generators other clients went to
family members home until power was restored. The office has a power outage
flashlight in the event the flood lights do not operate.

3. Hurricanes There have been two in our area over the past 15 years.
Hurricane could potentially cause power outages and flooding.

4. Tornados There has been 2 tornados in Berks counties since the office has
been operational. One in 2012 and one recently in 2017.

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 5. Flooding Our office is located on the first floor and is at risk for flooding. Our
service area may get heavy rains and remnants of hurricanes or tropical storms.
Flooding may impact our ability to reach our clients.

6. Office Building Fire: Our office building has a doctors office in the building. To
date there have been no fires in our office complex. We have evacuation plans
posted throughout the office and have a designated meeting spot in front of the
office right on Abington Drive.

7. Pandemic Influenza- quarantine could directly increase demand for home care
services and at the same time significantly impact the ability of staff to travel,
staffing capacity and availability of necessary supplies for a prolonged period of
time.

8. Earthquake: Likelihood of occurrence is minimal. There has been one

earthquake which occurred in 2007 resulting in little damage. This is according to
earthquaketrack.com

9. Terrorism including biological and chemical attacks: Likelihood of

occurrence is based on the terrorist threat levels issued by the Federal
government, state of Pennsylvania and media reports.

10. Nuclear Accident/Incident, Failure: Likelihood of occurrence is based on

close proximity to office and clients and as a potential target for terrorism. There
have been no reported accidents or incidents within the last 28 years.

11. Influx of infectious clients This could compromise the staffing capability of
current clients and/or new admission that could require temporary suspension of
new admissions and/or implementing abbreviated admission and documentation
procedures.

B. MITIGATING ACTIVITIES:
The following procedures are in place on an ongoing basis to minimize the impact of any
type of emergency.

1. REA office and field employees are oriented to the emergency plan at hire
including office specific plan upon hire and annually.

2. Field employees are instructed on the signs, symptoms and caregiving precautions of
diseases with bio-terrorism (i.e. anthrax, botulism, plague and small pox). This
information is included in the annual infection control in-service packet. Field employees
will be updated on potential bioterrorism and infection control annually via mailed in-
service packets that are completed by the employee and returned. The office will
maintain these in-service records in each field employee file.

3. At time of admission, the Clinical Manager reviews the emergency plan with the client.
They are informed of our on-call system and response procedures based on the priority
level assigned to them.

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4. Prioritization of Care
Upon admission the Clinical Manager evaluates and assigns a Priority Level to every
client, based on his or her level of acuity and social support. The priority level is also
evaluated at each reassessment. The following levels are utilized:

Priority Level 1: Clients, who need to have care, cannot be alone and have no
able caregiver in the home. This may include but is not limited to clients with
infusions, ventilators / trachs and those receiving round the clock care.

Priority Level 2: Clients whose need for service can be delayed, or are able to
care for themselves, and/or have a qualified caregiver in the home.

Priority Level 3: Clients who have good social supports, trained caregivers
and/or can be left alone until the emergency subsides.

5. A client list with assigned priority levels is kept off-site by the On-Call Manager and
easily accessed at the time of an emergency.

6. An emergency phone tree is maintained and illustrates the chain of command for the
Reading office. The Director or designee is identified at the head of the emergency
command structure and is responsible for initiating the emergency plan, establishing the
order of communication among the office employees, and communicating with the
community agencies and authorities as needed.

7. Clients receiving respiratory, oxygen or infusion therapy will receive specific

emergency instruction from the supplier at the time of admission.

8. An adequate supply of personal protective equipment (PPE) is in stock and available

for use at all times. During states of heightened alerts of a potential emergency (i.e.
bioterrorist act, pandemic influenza outbreak, influx of infectious disease) additional
supplies of personal protective equipment are obtained. Bayada Home Health Cares
Nursing Office centrally coordinates and arranges for emergency transport of additional
personal protective equipment with medical supply vendor(s) through a standing
arrangement. Shipments can be made via next day air or ground travel to clients homes,
employees homes or to the service offices, as needed. Panel provider (Healthworks)
can test fit employees after OSHA questionnaire is complete.

9. Company leaders monitor federal, state and local emergency threat levels and remain
informed of heightened alerts or threats of terrorism, or other emergencies that
could impact Bayada Home Health Care offices through the news media, public
announcements, and through consultation with appropriate agencies (i.e. CDC,
Department of Health). The Infection Control Program Coordinator, housed in
Moorestown, NJ, specifically monitors infection related threat activity alerts from the
CDC, WHO, and APIC and provides consultation to the offices that could be directly
affected by these threats. (i.e. bioterrorist attack, pandemic influenza outbreak or other
infectious disease influx).

C. PREPARATION ACTIVITIES
1. All field employees are provided with a photo ID badge at hire that is to be worn
when on assignment. It is used for identification when traveling to client homes
during emergencies when authorities have restricted travel.

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 2. All office staff has the capability to institute on-site and remote call forwarding so
that calls can be forwarded to the answering service or another location where
telephone service is unhampered. Instructions are detailed on the emergency
phone tree list. If telephone service is not available, email, text and lastly radio
contact on WEEU 830AM (610-376-7335) may be utilized and Channel 69 News
WFMZ (610-372-6969)

3. The Director, Clinical Manager and On-Call Manager and office staff have cellular
phones and will coordinate communication with other office staff members.

4. The Bayada Home Health Care Reading Adult Office (RAD) will be used as a
back-up data center should a disaster strike the REA Office Site and prevent
access to the office. In the event that communication with RAD is compromised
then BRK will be used as the data back-up center. Contact information for the
RAD and BRK Offices are included on the emergency phone tree list. The
BEARS system is installed and available on the Office Directors laptop
computer. CSMs have BEARS on work laptops.

5. On-Call Managers have printed schedule for the week in the event that the
computer access is interrupted. The following are printed:

Visit list by Client

Visit list by Employee
Employee Availability Report
Client List Emergency Plan

6. In the event of a community or weather-related crisis, all staff are expected to

work. During periods of severe weather, when it is possible to anticipate the
crisis, office Managers are instructed to take client demographic, clinical and
scheduling information to their homes in the event they are not able to get into
the office.

7. On Call Clinical Manager has a laptop with access to 485s and emergency
phone numbers.

8. The Emergency Phone Tree List includes the contact information for office staff,
fire, police and rescue (911). Emergency Management Information Systems
recommends the use of 911 for all fire, rescue and police emergency; they
discourage use of any direct calls to police stations, fire houses, etc. to report an
emergency as it may actually delay response time.

9. Employees with 4-wheel drive vehicles are identified (see emergency phone
tree.)

10. Emergency exits are clearly marked in our office and throughout out building.

11. Fire extinguishers are checked and serviced annually by the buildings landlord
and maintenance manager. Director or designee checks fire extinguishers during
annual fire drill.

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 12. CSMs are to take their client schedule books that include an employee
availability list.

13. In the event of a bioterroristic threat or event, pandemic influenza outbreak, or

other potential influx of infectious clients, contact CSQ to arrange for immediate
shipment of additional personal protective equipment either to the employees'
homes, clients' homes, or to the office. Order enough additional supplies in
anticipation that the influx could be sustained over a period of time. PA Dept of
Health will be contacted for obtaining and availability of Antiviral for Healthcare
workers and to process for obtaining them. The PA Dept of Health will coordinate
pods within the commonwealth to obtain antiviral. The pods will be managed by
the local County Emergency Mgmt Coordinator and local health bureaus
Emergency Preparedness Coordinator.

D. Response Activities
Procedure for Administrative and Patient Continuity of Care:

1. The Director or designee is responsible for determining when the emergency

plan is to be implemented and will coordinate communication with the other office
staff members.

2. The Director or designee will contact Bayada Home Health Care IS office and
Division Director. IS will communicate this information throughout the company,
including support offices, as needed.

3. If an emergency is declared after hours, the On-Call Manager will remain on-call
continuously until relief can be provided. The director will initiate the phone chain
and communicate instructions to all office employees.

4. If an emergency is declared during business hours and the office must be

evacuated all office staff should contact the office for specific instruction. When
leaving the office during an emergency the phone lines will be forwarded to the
answering service, a cell phone, or office employees home. Client Services
Managers and Clinical Managers will bring scheduling books and client travel
charts with them.

5. The On-Call Manager, On Call Clinical Manager and Director will maintain
contact throughout the emergency. Client Services Managers and Clinical
Managers are expected to be available to assist in coordinating field employees
and client coverage.

6. In the event a clients home must be evacuated while a field employee is present,
the employee should:

a. Evacuate client and self to a safe location, call 911 for help, report
incident to Bayada office immediately afterwards.
b. If there is no evacuation route accessible to the employee and client, then
the employee should move the client & self to the safest and most easily

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 rescue accessible area of the home, call 911 for help, report incident to
Bayada office immediately afterwards.
c. If the evacuation route is only accessible to the employee but not the
client (i.e., due to physical limitation), then the employee will move the
client to the safest, most easily rescue accessible location in the home
and call 911 for help. If the danger is imminent, the employee should
evacuate themselves and immediately call 911 for help to be sent to the
client, report incident to Bayada office immediately afterwards.

7. All field employees should report to their scheduled cases as normal unless
otherwise instructed by the office. During an emergency, field employees should
contact the office for specific instructions and possible reassignment to priority
needs clients. In the event that telephone service is interrupted all office and
field employees should listen to RADIO STATION WEEU 830AM

8. If a client cannot be serviced due to an emergency, the client or clients family is

instructed to provide care. The staff will provide individual phone instruction and
guidance on the specific treatment or procedure.

9. In addition to accessing fire and police, clients with emergency needs that staff
or client cannot meet, may need to be referred to hospital emergency
departments or other community resources (physician, other home health
agencies, American Red Cross, Utility Management Companies, etc. / see
Emergency Phone Tree).

10. In the case of an emergency when telephone service is interrupted, the Director
and On-Call Managers (designated persons with cellular telephones) should call
police or emergency rescue squad in the community. Private Ambulance
services may also be utilized. They must be alerted to the needs of the high-risk
clients and their situation. Should cell phone service be interrupted, back-up
modes such as fax 610-927-3948 and rea-office@bayada.com , radio / TV
broadcasts, and messenger or in-person communication can be utilized (see
Emergency Phone Tree).

11. Clients with non-life-threatening problems or questions are instructed to call the
office when telephone service is restored. In the meantime, the administrative
staff will be making every attempt to provide the service required within the
restraints present.

12. Any client receiving respiratory, oxygen, or infusion therapy will receive specific
emergency instruction from the supplier at the time of admission.

13. If a staff emergency arises, every effort will be made to replace the staff person
prior to the scheduled visit. If this is impossible, the client or the family will be
informed and the steps outlined above will be followed.

14. The following procedures will be considered when dealing with an emergency
that effects transportation (i.e. transit strike, suspension of public aggregation
due to infectious outbreak such as Pandemic Influenza). The procedure (s)
selected depend on the situation:

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 a. identify those that have 4-wheel drive vehicles; assemble a crew of
emergency drivers (see Emergency Phone Tree for 4-wheel vehicle
listing)
b. reassign cases to employees that can walk to the clients homes, in every
case possible, (i.e., in the event of a public transportation strike)
c. utilize police as emergency drivers
d. coordinate care with other agencies
e. identify and secure alternate caregivers
f. employees at clients homes can remain there, even overnight
g. arrange to have clients moved to safer locations
h. administrative / management staff can remain at the service office to help
coordinate emergency activity
i. re-deploy office staff to other offices which may be unmanned
j. drive to clients homes if telephone lines are down

15. In the event of a confirmed bio-terrorism outbreak or threat, designated staff

members will:

a. Remain informed through the media and consultation with appropriate

agencies (i.e., CDC, Department of Health),
b. Use standard precautions to manage all clients, including symptomatic
clients with confirmed or suspected bioterrorism-related diseases, and
any other transmission based precautions as instructed by Clinical
Managers.
c. Limit the transport of clients with bioterrorism infections, unless medically
necessary, to reduce risk of transmission. If the client is stable, contact
the physician before calling 911.
d. If a client is not stable, call 911 and provide pertinent information to the
emergency services.
e. Consult the CSQ and Infection Control Program Coordinator when
advising clients and staff.

16. In the event of a Pandemic Influenza outbreak, influx of clients with another
infectious disease upon admission or infectious disease outbreak among current
clients, Clinical Managers and other designated office staff will:

a. Instruct field staff and caregivers on any necessary transmission-based

precautions.
b. Provide staff with adequate PPE and Hand Hygiene Products.
c. Assist with outbreak surveillance activity of infections in both clients and
employees. Educate staff on recognizing symptoms for early
identification of infection and reporting process (policy # 0-1575,
Reporting and Tracking Client and Employee Infections)
d. Exclude Personnel from working during suspected incubation period and
acute phase of infection. (policy# 0-1440, Contagious Disease
Management)
e. Prepare for the continued provision of care to clients during periods of
sustained influx of infectious disease (i.e. pandemic influenza, or outbreak
of another infectious disease) or condition that would prohibit them from
caring for these clients, so staff can be appropriately assigned to clients
during period of contagion.

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 f. Identify and contact other Bayada offices, home care providers in the
community to pre-arrange back-up for anticipated client overflow in the
event of sustained overflow.
g. Keep abreast through e-mail, memoranda, and phone communication any
current information related to the influx that is provided to the service
offices by the Infection Control Coordinator based on communication with
CDC, health departments and other agencies.
h. Disseminate current information related to the influx of disease and
infection prevention strategies to the field staff and clients.
i. Maintain contact with local, state and county Health Departments for any
recommendations/required actions related to a regional/statewide influx.

E. Recovery Activities
1. The director or designee will remain in contact with community and office building
management to determine when the staff may return to the office. Depending on
the time of day the emergency occurs, the office staff will be instructed to report
to the office the next business day or the same day. The Director will notify
Bayada Home Health Care Headquarters, the IS Office, and the Division Director
of the plan to resume office operations.

2. Client Services Managers and Clinical Managers will contact their clients to
assess status, safety and ongoing scheduling needs.

3. Field employees with work schedules that were affected by the emergency will be
contacted and instructed to resume regularly scheduled service to their clients.
Every effort will be made to provide replacements for employees who remain
affected by the emergency.

F. Drills
1. The REA office will test their emergency management plan at least once
annually, either in response to an actual event or in a planned drill.
2. The drill will include a realistic emergency that is likely to occur based on the
office-specific list of potential emergencies and likely to effect continuation of care
and services.
2. The annual drill must include mobilization and response of staff, and a sampling
of clients and field staff.
3. A description of the drill or actual emergency and critique of the response
activities will be conducted and documented. (0-3218, Annual Emergency Plan
Drill Analysis) The critique should be conducted through a multidisciplinary
process.
Next review due: 2018

G. References and Resources

Bayada Home Health Care Policy & Procedures 9-583 Emergency Preparedness Plan
Bayada Home Health Care Policy & Procedures 0-1575 Reporting & Tracking Client &
Employee Infections
Bayada Nurses Policy & Procedures 0-1440 Contagious Disease Management
REA Office Phone Tree/Chain of Command
REA Office Important Phone Numbers
REA Office Emergency Management Numbers by County
REA OFFICE Emergency Management Home Health Services/Agencies

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Bayada Home Health Care Office List
Call Forward Remote Access Directions

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