Lessons Learned from the Evacuation of a Long-Term Care Facility
Here’s what worked and what didn’t during this long-term care facility’s temporary evacuation of its 144 residents.
The risk of fire in a long-term care (LTC) facility or other facility that houses a vulnerable population is a very serious consideration and one that concerns healthcare security, safety and fire prevention staff. Our fire safety codes are very strict and rigid, and rightly so. Our residents and their families have enough to worry about when they are in an LTC. The threat of a fire should not be another concern.
Over the past several years, there have been a number of fire emergencies in LTCs across North America. Some have tragically resulted in loss of life (including a 2015 fire in Quebec that left 32 dead). Even with stricter fire codes, seniors are still killed in fires at an alarming rate.
These needless deaths prove the ongoing need for long-term care facilities to ensure they adhere to the applicable codes, conduct regular trainings and hold exercises with staff and local emergency personnel.
The following article outlines the recent real-life experiences of a long-term care facility in Lumberton, New Jersey.
Before the Fire
The Virtua Health and Rehabilitation Center has full fire suppression sprinklers, with smoke and fire doors, and has a generator, normally capable of supporting critical services during an outage. During previous drills and events, residents were safely moved from one smoke/fire compartment to another, allowing them to safely remain in the building. (article continue below)
Campus at a Glance
The Virtua Health and Rehabilitation Center is located in Lumberton, New Jersey. Virtua is South Jersey’s largest health system, committed to the mission of helping people be well, get well, and stay well, averaging more than one million patient encounters each year. Virtua’s 13,000-plus employees provide comprehensive care at five hospitals, two long-term care facilities and more than 250 other locations, in addition to bringing health services directly into communities through home health, rehabilitation, mobile screenings, and its paramedic unit. The affected facility provides post-acute services, short-term rehabilitation and long-term care services.
We have a long history of working with county Office of Emergency Management (OEM) regarding planning and exercising, as well as the local fire official. It has been more difficult to plan and exercise with the local volunteer OEM, fire department and EMS units, which played a crucial part in the response to this event.
In April 2018, an emergency exercise was conducted to test staff response to a fire condition that required the evacuation of residents from an entire residential unit. The exercise proved invaluable to identify strengths and opportunities for improvement. Only two months after our April exercise, our facility experienced a real fire emergency.
How the Ordeal Started
On Saturday, June 30, 2018, we were in the second day of a heat wave where temperatures exceeded 95°F (35°C) and the heat index was 101°F (38°C). There were 144 residents in the facility. Because it was the week of the 4th of July national holiday, many employees, senior leaders and key safety and emergency management personnel were on vacation.
The facility has three electrical phases coming into the building. At approximately 9 a.m., a squirrel walking on the wires touched the breaker on the pole and shut down one of the electrical phases. Fortunately, the squirrel became the first and only casualty of the day.
With only two phases working, only two-thirds of the required power was now being provided. The air handler unit was not receiving the necessary power supply, and the motor began to seize. The seizing motor began to emit smoke, and the smoke started to fill the mechanical closet and eventually traveled into the hallway.
The Long-Term Care Facility Evacuation Begins
A staff member smelled and saw the smoke and quickly pulled the fire alarm. The staff member notified other employees, and staff began evacuating the residents in the immediate area of the smoke.
Within minutes, the residents were evacuated to their pre-identified relocation destination in the resident dining hall. Shortly after evacuating the unit, the power to the entire building was lost. The emergency generator did not come on to provide alternate power. With only battery-powered lights and no electricity, the staff quickly switched residents on oxygen concentrators to portable oxygen tanks.
The fire department arrived approximately 8 minutes later. Upon arrival, they confirmed that all residents were safely evacuated from the impacted unit where the smoke condition existed. Based on the presence of “a heavy smoke condition,” and being unable to find the source, the fire department ordered a complete evacuation of the building.
Fire Department Orders Complete Evacuation
Residents from all units were then evacuated. All residents were staged either in the dining room or moved outside the facility to the employee parking lot and the streets surrounding the facility. Some residents were able to ambulate with assistance, while others required transport by their bed or wheelchair.
As part of our fire plan, we have pre-identified evacuation locations, both internal and external to the building. In the event of an evacuation, we have pre-identified surge areas at all of our other Virtua facilities and maintain a matrix that lists the site, how many evacuees can be accommodated at the site (in beds or chairs), as well as any equipment needed to support the reception site (oxygen, commodes, computers, bedside trays, etc.).
One of the relocation destinations identified was the Virtua Memorial Hospital, which is two blocks from this facility. They were able to accommodate several of the higher acuity residents, as well as the largest group of evacuees, by using non-clinical surge areas, such as conference rooms and other suitable spaces.
The LTC nursing supervisor began to conduct evacuation triage to determine the residents who could be safely transported to the hospital or other similar facilities. The fire department contacted the local and county office of emergency management to request a mobile command post and transport assets. The mobile command post arrived, and a unified incident command staff was assembled. The nursing supervisor was instructed by the fire department incident commander to determine which residents could be transported to other facilities. This incident commander also initially suggested all residents be temporarily housed at a local school.
Since Virtua had no knowledge or awareness of the facility or its accommodations, the plan was aborted; however, it was later successfully used as a gathering site for resident’s families awaiting word about their loved one’s transfer location. Utilizing Virtua’s evacuation plan, bed availability and available surge space were received from all of our hospitals and LTC. Disaster cots and other supplies were delivered to facilities where non-clinical space was going to be utilized. This is part of our emergency operations plan and has worked well in the past.
Transportation resources were requested from both county and state volunteer 911 EMS agencies, including several ambulance busses, capable of carrying multiple residents at a time. Our own privately contracted EMS provider was also requested in accordance to our plan and helped to coordinate transfers with both the volunteer and contracted agencies.
By this time, our Virtua corporate emergency operations center (CEOC) had been opened at one of the hospitals to work with the LTC facility and coordinate transfers to the other facilities based on acuity and bed availability.
Over the next several hours, all residents were safely transported to other Virtua facilities. Once all residents had been safely placed in other facilities, the county and municipal OEMs turned over the incident to Virtua.
During that time, power was restored, the smoke cleared, food replenished, and the facility was thoroughly cleaned. Once the power restoration and cleaning had occurred, our contracted EMS provider began assisting with moving the residents back into the facility. By 11 p.m. that evening, the majority of the 144 residents were returned to the facility. Forty-four residents would remain overnight at other Virtua facilities simply because residents were safely tucked in to bed for the evening. The next day, all residents would be returned to their homes by 4 p.m. using only our EMS provider.
Lessons Learned: What Went Right
There were incredible lessons learned following this incident. The most important outcome was that there were no injuries to any residents or any of the hundreds of first responders and employees who assisted and supported the operation.
We conducted a large debrief several days after the event to capture our successes and opportunities for improvement.
There were many successes identified during and after this evacuation, including: