Incidents like the one that is about to be summarized emphasize the importance of hazard analysis as required by the Center for Medicare & Medicaid Services Emergency Preparedness Rule. Knowing the potential threats and perils both inside of a facility as well as outside of the built-environment will help healthcare providers appropriately plan for emergencies and disasters.
Conducting a Hazard Vulnerability Assessment (HVA) and reviewing it annually as required by CMS will help nursing homes and other long-term care facilities plan for the next inevitable emergency or disaster. The following is a summary of a real incident that occurred at a nursing home just like yours.
It was a normal day at a skilled nursing facility in suburban Chicago in late June 2021; until it wasn’t. The fire department received a call for a natural gas leak just before noon caused by a cable company utility crew trenching along a state highway.
Upon arriving on the scene, a battalion chief and engine company from the local fire department encountered a high-pressure natural gas leak that was filling the atmosphere with a potentially explosive vapor mixture. All that was needed was a specific concentration of air and gas within its explosive limits along with an ignition source to cause a major explosion. Within a hundred yards of the leaking gas line was a fully occupied skilled nursing facility downwind from the incident.
Traffic in all directions around the leak was immediately shut down causing significant congestion in the entire area. Extra resources were requested by first-responders to focus on the threat that the leak posed to the nearby nursing home. While first-responders had to focus on the impact this potentially deadly scenario had on the entire community around the gas leak, they knew that nursing homes are required to have emergency plans in place to address a variety of internal and external hazards that could impact their operations. The fire department expected that the nursing home would be in emergency management mode addressing the immediate threat.
Upon entering the facility, the fire department was not disappointed as they learned that staff had already taken measures to mitigate a potential explosion within the building. Air conditioning units were already shut down by maintenance staff to limit gas-laden vapors from entering the structure. Even with the HVAC system turned off, firefighters detected elevated levels of natural gas within the building.
The battalion chief who was the Incident Commander requested more firefighting equipment as well as a fleet of ambulances to the scene through the area’s mutual-aid system in case the facility needed to be evacuated. A community center operated by the city near the facility was put on standby as a potential re-assembly location. Busses were also brought to the scene to accommodate ambulatory residents if evacuation of the facility was required.
Fire departments around the nation are aware that healthcare facilities including nursing homes are required to implement comprehensive plans to prepare, respond and recover from adverse events while maintaining continuity of care and services. These requirements are not designed to simply promote compliance for compliance-sake but equate to levels of readiness that first-responders count on during an emergency or disaster.
Through the use of a unified incident command system between the multiple fire departments, several law enforcement agencies and the affected nursing home, it was determined that relocating residents to the opposite side of the facility away from the leak was the best initial strategy to implement as gas company personnel worked to cap the leak. Air quality inside of the facility was monitored on a continuous basis throughout this protracted event. If levels greater than 5% of the lower explosive limit (LEL) of natural gas were detected, the fire department’s Incident Commander would have ordered complete evacuation of the facility.
Regulated healthcare providers must understand that compliance does not take a break, especially when a facility is in the midst of a crisis. During this emergency, regulators from the department of health arrived at the facility to monitor other health and safety issues including safe operating temperatures within the building. There was some concern that temperatures in the facility were rising because the HVAC system was shut down.
The gas leak occurred on a day where environmental conditions included seasonably hot temperatures with high humidity along with intermittent storms. Outside weather conditions directly impacted the LEL readings that the fire department was monitoring inside of the facility. During periods when it was raining or storming, the levels detected inside of the building lessened. When the weather cleared and winds calmed down, elevated LEL levels were detected in the building.
The incident ended approximately 6 ½ hours after the first emergency call was received. Through a well-coordinated effort by first responders and the staff of the facility, collaborative decisions were made and implemented through the use of “unified command” to help ensure the safety of the residents and all occupants of the building, according to the fire department’s battalion chief.
Fire departments, emergency medical services (EMS) and law enforcement agencies operate on the premise that healthcare providers including nursing homes have a thorough understanding of the Incident Command System (ICS) and incorporate that specific management process into their Emergency Operations Plans (EOP). ICS is the same emergency management framework used by first responders, hospitals, schools and other well-prepared occupancies around the nation to handle all types of emergencies and disasters.
While the initial onset of this particular incident was a surprise to everyone involved, the possibility of such an event should never be a surprise to any of the community’s stakeholders including healthcare providers, first responders and businesses that operate within the range of multiple hazards that exist in every community. This includes underground utility pipes, overhead electrical transmission lines, railroad crossings, busy transportation routes, flight paths into airports, industrial complexes, refineries, mining operations, shopping malls, banks, government buildings and any other type of occupancy or potential peril that could impact your facility’s normal operations.
Long-term care providers need to know the hazards that exist within their communities by conducting a comprehensive HVA and updating it annually so their operation is compliant with CMS regulations and ready for the next emergency incident. Additionally, a practical understanding of the Incident Command System and knowing how it is used to promote an “All Hazards” approach to emergency management is essential to help safeguard the vulnerable population our nation’s skilled nursing facilities are given the privilege and responsibility to serve.
Stan Szpytek is the president of the national consulting firm, Fire and Life Safety, Inc. based in Mesa, Arizona, and is the Life Safety/Disaster Planning Consultant for the Arizona Health Care Association, California Association of Health Facilities (CAHF) and Utah Health Care Association. Szpytek is a former deputy fire chief and fire marshal with more than 40 years of experience in life safety compliance and emergency preparedness. For more information, visit www.FLSafety.org or e-mail Szpytek at [email protected].
The opinions expressed in McKnight’s Long-Term Care News guest submissions are the author’s and are not necessarily those of McKnight’s Long-Term Care News or its editors.