Shelter-in-Place (SIP)

Depending on circumstances and the nature of the emergency, one of the first important decision administrators must make is whether to stay in place or evacuate the facility. It is important to understand and plan for both possibilities. In any emergency, local authorities may or may not immediately be able to provide information about what is happening and what action the facility should take. Therefore, closely monitoring local television and radio stations, the NOAA weather radio and reliable internetsources may provide the most accurate, breaking information about a situation as it develops.

Shelter-in-Place – Weather Related Reasons

There are several weather related reasons to Shelter-in-Place as some situations would make it difficult or dangerous for staff to leave or report to work:

  • flooding in the immediate area around the facility or locally
  • flash flood watches and warnings
  • tornado watches and warnings
  • severe winter weather event (ice and/or snow storm)
  • fire in the immediate area around the facility or locally

Shelter-in-Place – Non-Weather Related Reasons

Hazards in the environment could make Shelter-in-Place necessary:

  • chemical, biological, or radiological contaminants may be released into the environment in such quantity and/or proximity that it is safer to remain indoors rather than to evacuate. Examples include:
  • explosion in an ammonia refrigeration facility nearby
  • a derailed and leaking tank car of chlorine on the rail line
  • release or spill of hazardous materials from a tanker truck on a highway or expressway
  • law enforcement activity such as an active shooter event or a bomb threat in the immediate area around the facility or locally

Information taken from:

Shelter-in-Place Considerations

______(facility name) realizes it is essential to plan for Shelter-in-Place well in advance of a crisis or disaster situation whenpartial or complete evacuation is unsafe or unwarranted. The facility should identify and assess the length of time it can realistically support SIP before a decision is made to fully evacuate. Hospitals may have to transfer patients to LTC facilities during catastrophic events if they reach overcapacity. This is integrated into the Surge Plans for hospitals.

The following potential situations have been identified, in which Shelter-in-Place might be necessary: Listtop two potential situations based on Facility and Community Risk Assessment.

  • ______
    ______
  • ______
    ______

The following areas within the facility have been identified as suitable spaces that are structurally sound and away from potential exposure areas for residents, staff, and visitors to seek shelter (Area of Refuge): List primary and alternate spaces.

______
______

______
______

  • Consider all factors that may cause a secondary event following the initial need to SIP. Example: building collapse post-tornado.
  • Identify all SIP-specific materials and inventory items that may be needed to facilitate the SIP procedure due to a contaminated or hazardous environment outside of the facility. Examples: plastic sheeting, tarps, duct tape, extra blankets and pillows, etc.
  • Identify all aspects of the facility’s physical plant and infrastructure that need to be evaluated during the SIP procedure, and immediately following the SIP, to ensure the safety of residents, staff, visitors, volunteers and vendors.
  • Identify any roles that volunteers could play to assist in SIP based on:
  • Skills and training
  • Emergency Plan Policies enabling volunteers to take on non-medical tasks during an emergency

Shelter-in-Place Procedures—Weather Related

______(facility name) has emergency Shelter-in-Place policies and proceduresthat guide decision making when SIP is necessary due to weather related conditions:

  1. Activate Incident Command System (ICS), discuss preparations for the emergency and make staff assignments.
  2. Notify staff, residents, visitors, volunteers and vendors to remain in the facility in order to ensure safety.
  3. Notify Division of Health Services, Emergency Management Office, Medical Director, LTC Ombudsmanof the decision to Shelter-in-Place. (See Communication Tab for required contacts).
  4. Notify residents’ family members and resident representatives of administration’s decision to Shelter-in-Place.
  5. Department heads contact employees to determine who will be available to work during the Shelter-in-Place, if time warrants such planning. Consider how employees might be transported to work if they are unable to drive themselves. Confirm expected availability, as well as the number of family members, if policy permits, joining the staff members:
  • Before the emergency strikes
  • During the emergency
  • After the emergency
  1. Unless there is an imminent weather threat, allow staff, volunteers, visitors, and vendors to communicate with family members.
  2. Close and lock all windows, exterior doors, and any other openings to the outside.
  3. If danger of damaging winds is suspected, close the window shades, blinds, and/or curtains.
  4. Create water supply—rule of thumb is three gallons per person, per day for seven days.
  • Fill tubs, pitchers, and as many containers as possible with water
  • Bag up as much ice as possible and place in the freezers
  • Purchase ice (if possible) and place in freezers
  • Gallon Ziploc bags can cool individuals during a severe heat emergency, then be used as drinking water as the ice melts
  1. Be prepared to access essential disaster supplies, such as nonperishable food, battery-powered radios, first aid supplies, flashlights, batteries, duct tape, plastic sheeting, and plastic garbage bags.
  2. Implement facility check of emergency heating and lighting systems (conventional and alternate) to ensure resident health/safety and safe storage of provisions
  1. Check fire detection, extinguishing and alarm systems
  1. Determine how facility will process sewage and waste disposal
  1. Identify and access support systems
  2. Need not treat on-site
  1. For flooding, designate an Area of Refuge on the highest level of the facility, and move residents to the area.
  • Track residents, staff, visitors, and volunteers assigned to various SIP locations within facility.
  • Avoid overcrowding by selecting several rooms as necessary. Consider large storage closets, utility rooms, pantries, and office and conference rooms.
  • Avoid selecting rooms with mechanical equipment like ventilation blowers or pipes, because this equipment may not be able to be sealed from the outside, as water could enter through these spaces.
  • When possible, locate landline in the area of refuge. Cellular telephone equipment may be overwhelmed or damaged during an emergency. With cellular service, texting can sometimes get through when phone calls cannot.
  • Do not leave the Area of Refuge until instructed to do so by the Facility Administrator or designee.
  • See Disaster Template: Flooding
  1. For tornado watch or warning, designate interior spaces on the lowest level of the facility as an Area of Refuge.
  • Avoid overcrowding by selecting several rooms as necessary. Consider large storage closets, utility rooms, pantries, and office and conference rooms without exterior windows.
  • Avoid selecting a room with mechanical equipment like ventilation blowers or pipes, because this equipment may not be able to be sealed from the outside.
  • It is ideal to have a landline telephone in the relocation areas. Cellular telephone equipment may be overwhelmed or damaged during an emergency. With cellular service, texting can sometimes get through when phone calls cannot.
  • Do not leave the Area of Refuge until instructed to do so by the Facility Administrator or designee.
  • See Disaster Template: Tornado
  1. Be alert for leaking water or gas, broken windows, fire hazards, and electrical wires.
  2. Evaluate resident status changes and needs, especially if power is lost. Activate hot or cold weather procedures if necessary.
  3. See Disaster Template: Severe Heat/Severe Cold

Shelter-in-Place Procedures—Non-Weather Related

______(facility name) has emergency Shelter-in-Place policies and proceduresthat guide decision making when SIP is necessary due to non-weather related conditions:

  1. Activate Incident Command System (ICS), discuss preparations for the emergency and make staff assignments.
  2. Notify staff, residents, visitors, volunteers and vendors to remain in the facility in order to ensure safety.
  3. Notify Division of Health Services, Emergency Management Office, Medical Director, LTC Ombudsman of the decision to Shelter-in-Place. (See Communication Tab for required contacts).
  4. Notify residents’ family members and resident representatives of administration’s decision to Shelter-in Place.
  5. Unless there is an imminent threat, allow staff, volunteers, visitors, and vendors to communicate with their family members.
  6. Close and lock all windows, exterior doors, and any other openings to the outside.
  7. If danger of explosion is suspected, close the window shades, blinds, and/or curtains.
  8. Create water supply—rule of thumb is three gallons per person, per day for seven days.
  • Fill tubs, pitchers, and as many containers as possible with water
  • Bag up as much ice as possible and place in the freezers
  • Purchase ice (if possible) and place in freezers
  • Gallon Ziploc bags can cool individuals during a severe heat emergency, then be used as drinking water as the ice melts
  1. Turn off all fans, heating, and air conditioning systems. Activate other shut-down procedures if necessary due to a chemical, biological or radiological event.
  2. Be prepared to access essential disaster supplies, such as nonperishable food, battery-powered radios, first aid supplies, flashlights, batteries, duct tape, plastic sheeting, and plastic garbage bags.
  3. Implement facility check of emergency heating and lighting systems (conventional and alternate) to ensure resident health/safety and safe storage of provisions
  1. Check fire detection, extinguishing and alarm systems
  1. Determine how facility will process sewage and waste disposal
  1. Identify and access support systems
  2. Need not treat on-site
  1. Designate an Area of Refuge with the fewest windows or vents available, and move residents there.
  • Track residents, staff, visitors, and volunteers assigned to various SIP locations within facility.
  • Avoid overcrowding by selecting several rooms as necessary. Consider large storage closets, utility rooms, pantries, and office and conference rooms without exterior windows.
  • Avoid selecting rooms with mechanical equipment (ventilation blowers or pipes) because this equipment may not be able to be sealed from the outside.
  • When possible, locate landline in the area of refuge. Cellular telephone equipment may be overwhelmed or damaged during an emergency. With cellular service, texting can sometimes get through when phone calls cannot.
  1. Use duct tape and plastic sheeting (heavier than food wrap) to seal all cracks around the doors and any vents into the room.
  2. Be alert for leaking water or gas, broken windows, fire hazards, and electrical wires.
  3. Evaluate resident status changes and needs, especially if power is lost.
  4. Do not leave Area of Refuge until instructed to do so by Facility Administrator or designee
  5. See Disaster Templates: Bomb/ Bomb Threat, Epidemic/Pandemic Episode, Hazardous Material/Spill/Release (Internal or External), Nuclear Power

Emergency Job Tasks Shelter-in-Place (SIP)

Specific tasks should be assigned to staff members during an emergency based on the following criteria:

1.Administrator/Incident Commander

a.Meet with management team to activate Incident Command System (ICS) and discuss preparations to Shelter-in-Place.

b.Notify ownership, Corporate Contact, Division of Health Service Regulation, Emergency Management Office, Medical Director, and Ombudsman of the decision to Shelter-in-Place (see Communications Tab for complete list).

c.Notify staff members, residents, and residents’ family members/resident representatives.

d. Remain calm to not upset the residents.

e.Move residents to Area of Refuge.

2.Director of Nursing

a.Ensure doors, blinds, drapes are closed.

b.Guide staff in creating water supply.

c.Notify pharmacy and vendors.

d.Assist in moving residents to Area of Refuge and frequently monitor their conditions.

e.Connect O2 concentrators to all residents requiring oxygen.

f.Shut off oxygen or other medical gasses.

g.Remain calm to not upset the residents.

h.Ensure all residents and staff are accounted for.

i.Be prepared to assist where needed at the direction of the Incident Commander.

3.Nursing Staff

a.Close doors, blinds, and drapes, and filling up tubs and sinks with water.

b.Assist in moving residents to the Area of Refuge and frequently monitor their conditions.

c.Close all doors and windows.

d.Connect O2 concentrators to all residents requiring oxygen.

e.Shut off oxygen or other medical gasses.

f.Remain calm to not upset the residents.

g.Be prepared to assist where needed at the direction of the Incident Commander.

4.Certified Nursing Assistants

a.Initiate preparations by closing doors, blinds, and drapes and filling up tubs and sinks with water.

b.Prepare to move residents to Area of Refuge.

c.Remain calm to not upset the residents.

d.Be prepared to assist where needed at the direction of the Incident Commander.

5.Medical Records

a.Protect and gather resident records to relocate to centralized Area of Refuge if necessary.

b.Ensure complete data backup.

c.Remain calm to not upset the residents.

d.Be prepared to assist where needed at the direction of the Incident Commander.

6.Office Staff

a.Protect and gather vital employee and facility records for transport if necessary.

b.Ensure complete data backup.

c.Unplug all computers and equipment.

d.As directed by Incident Commander, continue to notify families/resident representatives

e.Document all emergency actions taken and notifications.

f.Ensure telephone/emergency phone coverage for facility.

g.Remain calm to not upset the residents.

h.Be prepared to assist where needed at the direction of the Incident Commander.

7.Social Services/Activities

a.Notify families/resident representatives of decision of Shelter-in-Place.

b.Remain calm to not upset the residents.

c.Work closely with nursing staff to meet the needs of the residents.

d.Be prepared to assist where needed at the direction of the Incident Commander.

8.Maintenance

a.Make final rounds of the facility and grounds.

b.Make emergency repairs of the facility.

c.Secure windows and other building openings.

d.Ensure that all windows are closed. Pull shades and close all drapes.

e.Check equipment for functionality.

f.Secure the facility and ensure all electronics and computers have been turned off and unplugged.

g.Activate shut-down procedures.Why shut down?

h.Secure all potential flying debris (above, below, around, and in the facility).

i.Secure supplies, such as radios, flashlights, batteries, etc.

j.Remain calm to not upset the residents.

k.Be prepared to assist where needed at the direction of the Incident Commander.

9.Food Services

a.Set refrigerator and freezers on the coldest setting.

b.Unplug non-essential equipment.

c.Secure emergency food, water, cooking utensils, and food disposal supplies for transport.

d.Secure vital resident and departmental records.

e.Fill zip top bags with ice and place in freezers.

f.Notify vendors to deliver supplies, including ice and water.

g.Determine the number of residents, visitors, volunteers, employees, and their family members for whom food service will be provided.

h.Remain calm to not upset the residents.

i.Be prepared to assist where needed at the direction of the Incident Commander.

10. Housekeeping/Laundry

a.Secure an adequate supply of linens.

b.Unplug all equipment.

c.Notify vendors to deliver supplies.

d.Secure linens, blankets, trash cans/liners, mops, rags, buckets, cleaning supplies, toilet paper, etc.

e.Create water supply.

f.Assist in moving residents to Area of Refuge.

g.Remain calm to not upset the residents.

h.Be prepared to assist where needed at the direction of the Incident Commander.

11.Transportation

a.Check fuel, oil, and water levels for each vehicle.

b.Move vehicles away from trees.

c.Remain calm to not upset the residents.

d.Be prepared to assist where needed at the direction of the Incident Commander.

12.Medical Director

a.Will be notified and will assist if available.