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Facility Evacuation Plan

It shall be the policy of Inter-Lakes Health to develop and test plans to evacuate all or portions of the facility. It should be understood that, depending upon the scope of the
disaster/event, evacuation of resident's/personnel might require intermediate relocation stops until a final destination is reached.

The Facility Evacuation and Emergency Management Plan provide a structure and chainof-command to determine when facilities must be evacuated; in the sequence patients/residents should be evacuated, how residents/patients should be relocated from ILH and to where patients/residents could be transferred.

Any disaster may be categorized by degrees ranging from minor to major and to include but not limited to immediate threat such as Fire, Hazardous material spill/exposure, and
long-term disruption of utility services, significant structural damage. This also will include any disaster that precludes the continued safe use of the building or a portion of the building will necessitate the evacuation of all residents/patients to a safe area. Activation is based on findings of the Incident -Commander. Evacuation requiring longer that 3 days will necessitate the placement of the residents/patients in other facilities as approved by the NYS department of health.

1. Total Facility Evacuation the relocation of all Residents, Patients, Visitors and staff from ILH facility & buildings, resulting from a natural disaster or other

2. Partial Facility Evacuation the relocation of resident's, patients, visitors and staff from a Nursing home building or Hospital, resulting from a natural disaster
or other emergency.

3. Incident commander/IC is the senior ILH representative. When an emergency has been declared, the IC will activate the Disaster/Evacuation procedure and plans and function as the initial Incident Commander (IC) the Hospital Emergency Incident Command (HICS) system will then be in effect.

The general alarm is to be activated should the entire building require evacuation. This is a constant tone. Notification will also be made verbally by the paging
system. Both will include the phone and overhead communication route.

The general alarm can only be activated with a special key carried by the Nursing Supervisor. A key is also kept at the Registration Desk. The activation alarm can
also be activated at the main panel by depressing the all evacuation switch.

Upon Evacuation Order any non essential personal, visitors, vendors or contractors on campus will be asked to sign out in the disaster log, this log will be monitored by a designee of the incident commander to assure that all are
accounted for.


In case of a emergency in the ADULT LIVING (upper level-north end),people will be evacuated thru the stairway or the North End Doors alternate exit South End Doors at emergency exit.

In case of an emergency in PATIENT CARE UNIT, people would be evacuated thru the north end doors at the ADULT LIVING or the south end doors at the EMERGENCY ROOM EXIT.

In case of an emergency in the EMERGENCY ROOM, X RAY, CLINIC
AREA, OPERATING ROOM, or AMBULATORY RECOVERY AREA, people will be evacuated thru the north end doors at the ADULT LIVING, or the south end doors at the EMERGENCY ROOM EXIT.

In case of an emergency in the LOBBY or CAFETERIA, people may evacuate thru the CAFETERIA EXIT or the LOBBY EXIT.

In case of an emergency in the GIFT SHOP AREA, people may be evacuated thru the LOBBY EXIT, or the north side HALLWAY DOORS toward nursing home.

In case of an emergency in the PHYSICAL THERAPY DEPT, people will evacuate thru the COURT YARD EXIT, or LOBBY EXIT.

In case of a emergency in ADMINISTRATION or DME people will evacuate thru the LOBBY EXIT or BULK STORAGE EXIT or DOORS #9/#10.

In case of an emergency in the PHARMACY, CENTRAL SUPPLY,
KITCHEN, MAINTENCE, or IT DEPT people will evacuate thru the LOBBY EXIT or the BULK STORAGE EXIT at loading dock.

NOTE: Do not use the elevator unless specifically instructed by the First Response or Fire Department.

These evacuation plans are subject to modification as the emergency incident dictates and at the discretion of the Fire Marshall.

Relocation for the Patriot would be to Adirondack side, Hospital, than the Methodist Church.

In case of emergency in [A] wing relocate through the entrance to physical therapy or to door #1Adirondack Lakes and Hospital, or B wing area, or to evacuate through Door #2, 3, 5, and # 4.

In case of emergency in [B] wing relocate through physical therapy, exit doors to A wing Door #1, or evacuate through the emergency exits located in B wing Door #2, #3, or Door to courtyard #5 last C wing exit Door #4.

In case of emergency in [C] wing relocate into physical therapy or through lobby Door a wing Door #1, or evacuate through the emergency exit located in C wing area Door # 4 or door to courtyard #5 central nurses station area B wing exits Doors #2 & #3.

In case of emergency in the center core, nursing station or offices may Relocate into physical therapy or through the A wing Door #1, or in the event to evacuate use the door to courtyard Door #5 or B wing Doors #2 & #3, C wing Door #4.

In case of emergency in the lower level to include Dental, Mental health and Accounting may evacuate using the main entrance to the lower parking lot or the bulk head in back of accounting or the stairwell to the upper level and follow the exit signs.

Relocation for Adirondack would be to the Patriot, Hospital, then to the Methodist Church.

In case of emergency in Lake placid lodge rooms A-225-A-219: relocate through exit-ways leading into unit door #13 to evacuate as well as lobby door #1 and B wing door #6, then to door #5 or then to door #4.

In case of emergency in Section B room B201 B204: relocate through lobby door main entrance door #13 of Adirondack lakes or into Lake placid lodge Door & B wing door # 6, next door #4 or door #5

In case of emergency in Section C room C218-C216 may exit through main entrance to lobby from Adirondack lakes door #13, may relocate in Lake Placid Lodge or to evacuate C wing door #4, or E wing door #5, B wing door #6.

In case of emergency in section D room D215 D-209 may relocate through main entrance of Adirondack lakes door #13 or into Lake Placid Lodge to evacuate E wing Door #5, or D wing door #4, or B wing door #6.

In case of emergency in Section E room E 208 E 205 may relocate through main entrance of Adirondack lakes door #13 or into Lake Placid Lodge. To evacuate E wing Door #5, D wing Door #4, or B wing Door #6.

In case of emergency in main Nurses station area: may relocate through main entrance of Adirondack lakes Door # 13 or into Lake Placid lodge. To evacuate B wing Door #6, E wing Door #5, D wing Door #4.

In case of a need to relocate or evacuate in the lower level, Housekeeping Office, Education room, Billing, HIM, Mental Health, Human Resources and Laundry department. Relocate or evacuate using the main entrance Door #11 or
the stair well to the upper level, or the Exit between Billing/HIM, Mental Health and main Storage room. Note the last two exits are not Handicap accessible.

Incident Commander will determine when an evacuation is necessary. (Exception: when there is an immediate threat of life and safety a unit leader can make the decision to
evacuate a unit). Once the evacuation order has been announced, medical and nursing staff in each Resident/ patient care unit will confer to determine the priority order for resident/patients to evacuate from their unit. Charge Nurses will be responsible for determining priority of patient movement. Nursing designees will confer with the senior nursing staff and the Operations Section Chief to coordinate the evacuation sequence of acutely ill patients.

The Liaison Officer will contact Essex County Emergency Services (9-911) and inform them that the facility is being evacuated. The Essex County Emergency Services will have coordinated emergent ambulance and bus services in order to meet immediate transportation needs. Residents who require no more than assistance of two or who are not able to use wheel chairs and do not require manual lift will be transported via bus.

All others will be removed via stretcher and ambulance service. These individual residents needs, will be assessed during care plan process and on an ongoing basis. The information is kept current with MDS assessments and through continual periodic review.

Ticonderoga Central School District Bus Garage (tentative
agreement), Contact dial 9-585-6256

Crown Point Central School District Bus Garage (tentative
agreement), Contact dial 9-597-4208

The Logistics Chief will contact local private ambulance services in order to mobilize transportation resources for non-emergent transportation.

Ticonderoga EMS
Contact # dial 9-873-2116 or 911

Lamoille Ambulance service (tentative agreement)
Contact # dial-9-873-2223

The Liaison Officer will update Essex County Public Health (9-873-3500) and NYS DOH to assist in placement of ILH residents, & patients. DOH Regional Office (Business Hours9-518-408-5300) Evening/Weekends 9-1-866-881-2809 CDRO
Pager: 518-484-7181

When an evacuation is announced, Heritage Commons/ILH will print a current resident/patient status for delivery to the Planning Chief to ensure proper tracking of all current patients. This will be accomplished by using Resident care
identifier census reports generated by Keane software and kept current with census changes. This report will be kept available in disaster manual. Disaster tags along with medical information will be sent with Residents to track medical record and time of dispersement. Incident commander may authorize the utilization of alternative care facilities as defined below. Alternate care facility
plans will be kept updated on an annual review basis to maintain contact and status information. Predetermined evacuation destinations will go by below criteria unless agreements made prior to incident where responsible family party will provide transportation & be responsible for those arrangements made.

Tracking of evacuation and Destination will be kept on the Tracking relocation log completed by charge nurse or designee. * (See disaster tag & relocation log)

Another building on campus

Methodist Church, Wicker St. Ticonderoga, N.Y. 12883

Contractual agreement
Contact # - dial 9-585-7995

EMA center, shore airport Rd. Ticonderoga, N.Y. 12883
(Tentative agreement)
Contact # - dial 9-585-7859

Armory, Champlain Avenue. Ticonderoga, N.Y. 12883
(Tentative agreement)
Contact # - dial 9-585-7709

Ticonderoga Central School, Elmhurst Ave. Ticonderoga, N.Y. 12883 (Tentative agreement)
Contact # - dial 9-585-7442

  Horace Nye Nursing facility-Elizabethtown
(*Contractual agreement)
Contact # - dial 9-518-873-6764

  St. Mary's School- Ticonderoga
(Tentative agreement)
Contact # - dial 9-585-7433

The Switchboard Department will contact the Ticonderoga Police Department to assist in traffic control to/from the facility.

Contact # dial 9-911

Ward clerks or designee of Incident Commander will make every attempt to contact Resident's responsible parties to notify of situation using Keane software census reports updates. All prior arrangements made by families to take resident's home will be tracked via census reports and tracking sheets. (See Social Worker Responsibility
page 7.)

The Incident Commander or designee will designate an alternative staging area for ambulances picking up evacuated resident/patient, if unable to access main exit

Resources for evacuation will be utilized from resident care areas. These assistive devices shall remain with residents at all times and are available to staff 24/7. Staff will all have training regarding the use of assistive devices upon hire and review of skills will be performed annually thereafter for each employee. Environmental Care
Director will maintain inventory of assistive devices. Using Care-plan and careguide sheets will identify residents who require the use of assistive device for
transport. All care information sheets will remain under review on an ongoing basis and continue to follow review with the MDS schedule.

Complete room evacuations shall be marked using blue tape across doorframe onto door handle to clearly mark door and to prevent re-entry. This training will continue to be provided with all disaster and fire evacuation techniques per policy. Staff will be trained on this practice upon hire with ONE training and annually thereafter. Ticonderoga fire responders are aware of current fire policy and procedure and evacuation protocols.

Transportation of resident's medical record and medication administration records will incorporate with the evacuation process. As soon as the Disaster Plan is placed into effect, all records of residents shall be transferred to a secure location. It is imperative that the records are intact and ready to accompany the resident wherever he/she should be transferred. This will be tracked using Disaster tag and evacuation accountability log (see page 13.

As soon as the disaster plan in placed into effect, all records will be assigned to an employee(s) of the facility so that the employee shall transfer said records to a safe location. A person must be designated to remove resident charts and other pertinent medical records.

Charts are located at the nursing desk. These records are current and must be with the resident. Also, more records are in file cabinets, which cannot be housed in chart and must be removed, if possible.

Other records to be preserved must be maintained for a period of seven years from the discharge of a resident.

The primary concern at the time of the disaster is to transfer an entire record history to a new location. This record should include the resident's medical information and support items like eye glasses, teeth, etc, .if realistically possible depending upon the situation.

All employees' have signed confidentiality statements and have been trained on HIPAA in Accordance with federal regulations. 

Assignment of personnel for residents at new location:

Each incident is different and changes will be occurring as condition prevails.

The charge nurse or designee shall be responsible to ensure residents /patients will be provided with necessary medications following the evacuation to a different location. The Medication nurse is responsible for securing the medication cart, which contains most resident meds along with the MAR (medication administration record). Medications on shelf in medication room along with insulin, antibiotics, controlled medications and other supplies necessary in administering such. The emergency kit and medication keys are also needed.

A person must be designated to remove medication cart,
med supplies and equipment.

A person must be designated to identify residents/patients
and other employees. Disaster tags are used for resident
identification (see page 10).

Medication and Medication cart to be taken to the
resident/patient relocation area...(see page # 5)

In the event that medications are needed, a designated person is to contact the following sources for such:

Moses Ludington Pharmacy 585-3755

Rite Aid Pharmacy 585-6787
Contractual agreement

Wal-Mart Pharmacy 585-6486

Medical supplies to be gathered by designated personnel as time permits such as dressing, supplies, thermometers, BP cuffs, stethoscopes, etc.

Linens and equipment necessary to care for residents to be obtained. If no available, then contact the above sources for supplies. To transport supplies use any available means: hall carts, wheelchairs, cartons, laundry carts, ECT. All medical supplies should be taken to evacuation area until decisions are made for
more permanent locations.

Specialty Equipment if not available such as oxygen concentrators, continuous suction portable units will be utilized for evacuation and transportation of

PPE (I; e; masks, gowns and gloves) is available from central supply for staff and patients during evacuation and transport.

For requests of medical supplies and equipment, contact:

Director of environmental services - 3744
Central supply - 3725
DME - 3734
Rite aid Pharmacy - 585-6787
Wal-Mart pharmacy - 585-6486.

Police Department and volunteer services can also be utilized for assistance.

1) Social Worker is to function as advisor to medical staff and nursing staff regarding placement status such as, i.e. home. Should temporary placement be medically advised, there are some residents who might be temporarily housed
with families. In such instances families may require supportive services from Public Health Nursing.

2) Families will be identified with census additions and care-plan process to track, which families intend, on taking there loved ones home.

a. Tentative family mailings sent to communicate their wishes.

3) To provide reassurance to the resident/patients and families and to serve as a liaison between Inter-Lakes Health & Heritage Commons, residents and families.

4) To participate in finding placement facilities should the nature of the catastrophe require this?

5) The social worker is to report to the IC or Administration at regular intervals. The Social Worker will contact and serve as a liaison to families in conjunction with any other designated assistant.

6) In the event of a nighttime catastrophe, the social worker, as other staff, shall be on call. Social worker is to report directly to the Communication Center where
They shall report to the Incident Commander/IC in charge and begin there assigned duties.

7) In the event there are patients or residents that cannot communicate for them selves a wrist bracelet will be utilized along with the Disaster Tag. Applied by the
charge nurse.

When the facility is operational all resident's and patient's shall be returned via campus buses for ambulatory and private ambulance for non-ambulatory. The tag system
would be utilized for identification and tracking of patients return to the facility. Any necessary equipment used for transport will be portable for continuity of care. PPE will be utilized for isolation precautions as needed.

The training and ongoing drilling of the evacuation plan shall be on an annual and semi-annual basis. The original training will be during ONE (Orientation of New Employee's) and annual during employee evaluation's. Drills will be held bi-annually on a scheduled basis all aspects of the plan will be covered.

The purpose of the recall plan is to obtain maximum staff assistance from off duty personnel in the event of emergency or disaster. Such emergency would include the

1) The need to evacuate Residents/patients from the facility.

2) To provide professional care for the residents/patients previously removed to alternate locations.

3) To provide professional care for casualties resulting from emergencies.

4) To provide ancillary and support services.

5) The need to relocate Residents/patients to other areas of the facility.

The Incident Commander, in accordance with the Chain of command, activates the recall plan.

Director of Nursing
Nursing Shift Supervisor
RN Nurse manager of Adirondack Lakes
RN Nurse manager of Patriot
Social worker
Hospital staff (by calling the switchboard)
All other staff necessary to promote manpower.

*Please see the recall list.

This policy must be distributed to all Administrative Staff members, Department Managers, and Nurse Managers by their immediate supervisor. This policy will be reviewed by the Policy review committee and will remain open for changes based on facility needs post-approval.

All recipients of this policy must acknowledge their receipt and understanding of the policy by referring any questions or problems with the policy within ten days of the issue date to their immediate supervisor in writing with any concerns. If no questions or problems are stated, it will be assumed that the policy has been read and understood.

All questions regarding this policy or its implementation may be referred to your immediate supervisor. The continued functioning of any and all departments at the evacuation point will be the responsibility of the Incident commander designee or respective department heads.

Click Here for Printable "Disaster Tag"

The investigation Committee will consist of the CEO, Administrator, director of Nursing, and Maintenance Supervisor, Safety Committee and county disaster coordinator.

The NYS FIRE will conduct legal or arson investigation. This will occur at the request of the Local fire chief or the county coordinator.

This committee will function as follows:

1) All fire incidents must be investigated and reported to the NYS dept. of health in writing.

2) All incidents must be reported at the time by phone as soon as possible after the incident occurs, DOH Regional Office (Business Hours9-518-408-5300) Evening/Weekends 9-1-866-881-2809 CDRO Pager: 518-484-7181

3) The initial call must state the type, extent, and nature of the incident.

4) The initial call must include injuries sustained and whether or not the facility is usable.

5) Post phone report must conclude with a full written report of the incident along with the results of the Committee investigation of the incident.

6) Any post incident committee recommendations must be included in this report.

7) Report to be sent to: New York State Department of Health
Office of Health System management Capital District Regional office-frear BLDG., 2nd floor 2 Third Street
Troy, N.Y. 12181-3298

This report should be forwarded within three working days of the incident. Copies should be sent to CEO, Administrator, Safety Committee, file and Chairman of the

This written report must cover the following areas as a minimum:

1) Cause of fire or disaster
2) Injuries sustained by residents/patients, staff or visitors
3) Analysis of staff reaction/responses.
4) Names of persons investigating the incident.
5) Fire Department response and actions.
6) Physical Damage and structural damage.
7) Whether installed fire safety equipment operated properly.
8) Whether or not the fire was controlled/extinguished by the installed equipment.
9) Recommendations to prevent a recurrence if possible.

The NYS Dept. of Health and U.S. Department of Health and Human Services/ have mandated the above reporting and investigating requirements.

The telephone report mentioned above is to be made by the Person-In-Charge of the facility when the incident occurs. The Investigation Committee will handle the written