(AGENCY NAME)



REGISTRY NAME

Powell Supportive Services, Inc.

COMPREHENSIVE EMERGENCY MANAGEMENT

PLAN FOR NURSE REGISTRIES

(CEMP)

Section 381.0303(7), F.S., states, “The submission of emergency management plans to county health departments by …nurse registry providers is conditional upon receipt of an appropriation by the department to establish disaster coordinator positions in county health departments unless the secretary of the department and a local county commission jointly determine to require that such plans be submitted based on a determination that there is a special need to protect public health in the local area during an emergency.” It is the nurse registry provider’s responsibility to contact the county health department of each of the counties listed on the provider’s license to determine and document whether the Comprehensive Emergency Management Plan (CEMP) should be submitted to that county and, if submission is required, whether the county health department will be reviewing the plan for compliance with Florida Statutes and rules. If the plan is to be submitted, e-mail with ‘read receipt requested’ or certified mail with return-receipt requested is recommended in order to document proof of submission.

In Compliance with: s. 400.506(15), (16), Florida Statutes

59A-18.018, Florida Administrative Code

Date: 03-2012

Table of Contents

Page

I. INFORMATION DISSEMINATION TO STAFF AND INDEPENDENT CONTRACTORS 3

II. IDENTIFYING INFORMATION ON NURSE REGISTRY 6

III. CONCEPT OF OPERATIONS

A. Responsibilities in Emergency Situations 7

B. Informing Patients Prior to an Emergency 7

C. Notification 9

D. During an Emergency 11

E. Evacuation 12

F. The Patients Return Home 13

IV. APPENDICES

A. Agreements and Understandings 14 B. Information for Nurse Registry Patients 14

C. Support Material 16

Instructions: Answer each of the items directly on the form. Once it is completed please e-mail it to the comprehensive emergency management plan (CEMP) reviewer for your county or multi-county area. If any changes are needed, the reviewer will send comments to your nurse registry via e-mail or regular mail with a due date for corrections to be forwarded back to the reviewer. The CEMP reviewer for your area is listed at our website at . Click on “Nurse Registry” Look under Emergency Management Plan for the Emergency Management Plan Review Contacts... The CEMP reviewer will let you know when your plan is approved. Remember to update the plan on an annual basis or as needed.

I. INTRODUCTION

Insert any appropriate introductory or overview remarks.

General Statements:

Powell Supportive Services is registered with the local emergency management agency for Pasco County.

Powell Supportive Services has an Emergency Plan Policy describing the procedures to follow prior to, during, and after an emergency.

Powell Supportive Services has a Training Policy describing the required training for contractors.

The Safety Liaison will register for available CERT training classes.

Powell Supportive Services has Emergency Plan Training for each contractor.

contractors will be oriented and trained on emergency preparedness within 30 days of hire.

Topics covered in the emergency preparedness training:

Types of Emergencies

- Recognition of Emergencies

- Planning for Emergencies

- Creating a Personal Emergency Plan

- Responsibilities for:

- creating the patient’s Personal Emergency Plan

-ensuring each patient has an individualized Personal Emergency Plan

- ensuring each patient is educated and informed about emergencies

- ensuring continuous care is provided to each patient

- ensuring the same type and quantity of continuous care is provided in the special needs shelter that was provided prior to the emergency unless circumstances beyond the control of the contractor make it impossible to continue services

- Communications during an Emergency (main and contingency communication)

- Documentation Requirements

- Special Needs Registry – contractors will ensure:

- Special Needs Registration is completed on Intake for each patient who needs assistance when evacuating or when in a shelter

- Registration will be updated annually for each patient or when there are changes

- The patient is educated and informed about the Special Needs Registry

- The patient has a completed Personal Emergency Plan with all of its components, including a Prioritized List, a Plan of Action, Special Needs Registration information, and Emergency Kit information

- Each patient has a completed Prioritized List, which will be provided to the county health department and county emergency management office on request

Please provide responses for each item describing how the nurse registry will provide the following:

1. The procedures on how key workers/independent contractors will be oriented and informed prior to an emergency, as to their roles and responsibilities during an emergency:

Each contractor will go through Emergency Preparedness Orientation with the Safety Liaison, complete the Emergency Training, answer questions about emergency preparedness, assist each patient with training on emergency preparedness, and assist each patient with creating an individualized Personal Emergency Plan.

2. The person(s) who will provide the orientation, as well as the orientation content (to include a definition of what constitutes an emergency, when the emergency management plan will go into effect, the roles and responsibilities of essential and non-essential staff, the procedures for educating patients about the emergency management plan and the special needs registry):

Person Providing Orientation -

Powell Supportive Services, Inc., Safety Liaison, Karl Powell will provide orientation to each independent contractor on hire, annually, and when there is a change. Each contractor will provide orientation to each patient served on intake, annually, and when there is a change.

Content of Orientation

Powell Supportive Services, Inc., Emergency Management Plan orientation consists of The Nurse Registry Emergency Preparedness Packet which includes:

- Powell Supportive Services Comprehensive Emergency Management Plan

- Powell Supportive Services Emergency Plan Policy

- Powell Supportive Services Emergency Training

- Types of Emergencies

- Preparing for an Emergency

- Getting Informed

- Caregiver Information & Responsibilities

- Creating a Personal Emergency Plan

- Creating a Prioritized List (Contact, Transportation Needs, Skilled Nursing Needs,Pre-Agreements (with physician, utility companies, emergency response teams, etc)

- Creating Equipment-Supply List, and Medication List

- Creating a Plan of Action

- Creating Emergency Kits

- Preparing Your Home

- Shelter vs Stay at Home

Local Emergency Contacts

Community Emergency Response Programs

Resources & Links

Handouts

- Tips for Evacuating Vulnerable Populations- Get A Plan

- SNAPP (Special Needs Assistance Population Program) Form (Pasco Emergency Management)

- The Special Needs Shelter Fact Sheet (Department of Health)

- Hurricane Guide

3. The nurse registry administrative staff person responsible for orientating new independent contractors regarding their disaster related roles and responsibilities:

Person Providing Orientation

Powell Supportive Services, Inc., Safety Liaison, Karl Powell will provide orientation to each independent contractor on hire, annually, and when there is a change.

Each independent contractor will provide orientation to each patient served on intake, annually, and when there is a change.

4. The procedures for informing independent contractors on how they can work (if they choose to do so) with the local, state or county agency which will be managing and staffing special needs shelters during an emergency (pursuant to s. 456.38, F.S., and

s. 381.0303, F.S.,) are as follows:

All independent contractors must be certified in CPR, First Aid, HIV/AIDS, and have training in conditions caused by bioterrorism. In addition, the Nurse Registry Emergency Policy, which each independent contractor signs on hire and annually, will identify any independent contractor who is interested in being available to provide health care services in special needs shelters or to help staff disaster medical assistance teams during times of emergency or major disaster. The Emergency Policy also states that certain termination of or discrimination against a practitioner providing disaster medical assistance is prohibited.

II. IDENTIFYING INFORMATION ON NURSE REGISTRY

1. Basic Information

Nurse Registry Name: Powell Supportive Services, Inc.

Administrator Name: Natasha Powell, Owner, Communications Coordinator

Address: 3632 Land O’Lakes Blvd Ste. 106 Rm. 5 Land O’Lakes, FL 34639

Phone Number: 813-767-3808

2. Person In Charge During Emergency (Key Staff)

Primary Name/Title: Karl Powell/*Safety Liaison, Emergency Plan Coordinator

Home Phone Number:

Work Phone Number: 813-446-4655

Cell Phone Number: 813-446-4655

*Per x. 408.821 (1) F.S., revised 7/1/09: A licensee required to have an emergency operations plan must designate a “Safety Liaison” to serve as the primary contact for emergency operations.

Alternate Name/Title: Nurse Administrator/TBD

Home Phone Number:

Work Phone Number: 813-767-3808

Pager Number:

Cell Phone Number:

Insert additional alternates as appropriate.

Alternate Name/Title: Heather Buchanan

Home Phone Number:

Work Phone Number: 727-326-4565

Pager Number:

Cell Phone Number:

3. Registry Owner

Owner Name: Natasha Powell/Karl Powell

Address: 3632 Land O’Lakes Blvd Ste. 106 Rm. 5 Land O’Lakes, FL 34639

Work Phone Number: 813-767-3808

Pager Number:

Cell Phone Number: 813-767-3808

Insert additional owners as appropriate.

III. CONCEPT OF OPERATIONS

Insert any appropriate introductory or overview remarks.

Please provide responses for each item describing how the nurse registry will provide the following:

A. Responsibilities in Emergency Situations

1. The chain of command to ensure continuous leadership and authority in key positions:

The chain of command to ensure continuous leadership and authority is for all Nurse Registry independent contractors, in the event of an emergency and for all emergency orientation and emergency training, to report to the Safety Liaison, Karl Powell.

2. The procedures to ensure timely activation of the nurse registry plan and staffing of the nurse registry during an emergency:

When an emergency is imminent and during an emergency, the Safety Liaison will notify the Nurse Administrator who will notify all Nurse Registry independent contractors of the emergency and the actions to initiate.

Contact will be maintained between the Safety Liaison and Nurse Administrator to ensure the Powell Supportive Services Emergency Plan is activated.

3. The operational and support roles of all those nurse registry administrative staff who are designated to be involved in emergency measures during times of emergency:

Karl Powell, Safety Liaison

Natasha Powell, Communications Coordinator

Karl Powell, Emergency Plan Coordinator

Nurse Administrator, Emergency Plan Coordinator Alternate

Heather Buchanan, Communications CoordinatorAlternate

4. Management of patients who will continue to receive services in the home, assisted living facilities (ALF) and in adult family care homes (AFCH) by the nurse registry’s independent contractors during an emergency:

Independent contractors will continue to provide care in the same manner, quantity, and quality to patients who were in their care prior to an emergency occurring. Should the independent contractor be unable to continue care provision due to circumstances beyond his control, he will notify the Emergency Plan Coordinator who will make every attempt to replace the contractor with another contractor.

B. Informing Patients Prior to an Emergency

1. The procedures for notifying patients or patients’ caregivers about the nurse registry’s management plan:

Each patient will be provided with emergency training which will include the Nurse Registry’s Emergency Management Plan, on intake, annually, and when there is a change. The independent contractor will assist the patient with training, creating an emergency plan, and understanding what to do if there is an emergency.

2. The nurse registry procedures for instructing nurse registry administrative staff of their responsibilities for discussing with those patients who need continued services either in the home, ALF or AFCH (and who are not registered with the special needs registry), the patients’ plan prior to and during, and immediately following, an emergency:

Each independent contractor will sign the Powell Supportive Services, Inc., Emergency Plan Policy, be familiar with the Emergency Management Plan, and will be trained about emergencies including the contractor’ responsibilities before, during, and after an emergency.

Each patient will be provided with emergency training on intake, annually, and when there is a change. The independent contractor will assist the patient with training, creating an emergency plan, and understanding what to do if there is an emergency. The contractor, the patient, and the patient’s Circle of Support (guardian, family, friends, Attending Caregiver) will be provided with the Nurse Registry Emergency Preparedness Packet in writing.

TBD: Training to be available on the internet is currently being developed to include all of the information in the Nurse Registry Emergency Preparedness Packet.

3. The procedures for instructing nurse registry administrative staff as to their responsibility to discuss the special needs registry with those patients who will require to be evacuated to a special needs shelter (pursuant to s. 252.355, F.S.) during an emergency:

Each independent contractor will receive training on hire and annually on the Nurse Registry Emergency Preparedness Packet which includes all contractor responsibilities. The independent contractor will receive Emergency Orientation from the Nurse Registry Safety Liaison, review the training materials, answer questions about the materials, conduct training for each patient, and assist the patient in developing an individualized Personal Emergency Plan to include information about the special needs registry and the requirement for the contractor to assist the patient with Special Needs Registration.

4. The nurse registry’s procedures for collecting patient registration information for the special needs registry, (pursuant to 59A-18.018 (6), F.A.C.) which must be done prior to an emergency, not when an emergency is approaching or occurring:

Each contractor will follow the information and procedures in the Nurse Registry Emergency Preparedness Packet to complete the patient’s Personal Emergency Plan which will include registration information. This will be done on intake, annually and when there is a change. The contractor will submit the completed Packet to the Nurse Administrator for review, and the Nurse Administrator will submit the completed Packet to the Owner for review. A master Special Needs Registry will be maintained with all patients’ names and each patient’s individualized Personal Emergency Plan will be maintained in the patient’s file.

5. The procedures on how independent contractors and nurse registry administrative staff will be informed of their responsibility to educate patients about maintaining their medication, supplies and equipment list (refer to Appendix B, Section 2):

Each contractor will follow the information and procedures in the Nurse Registry Emergency Training to ensure that the patient is educated about maintaining the Prioritized List, Medication List, and Equipment-Supply List as well as the Emergency Kit and to ensure that all medications, equipment, and supplies are accessible, maintained, and updated annually. The required Personal Emergency Plan for each patient will be completed/updated, submitted to the Safety Liaison and then to the Nurse Administrator and when approved will be submitted to the Pasco Emergency Management Office and Health Department, on request.

6. The nurse registry will discuss important information with those patients registered with the special needs registry (in accordance with Appendix B, Sections 1 and 3). This will also include the limitations of services and conditions in a shelter; that the level of services may not equal what they receive in the home; that conditions in the shelter may be stressful and may even be inadequate for their needs; and that special needs shelters are an option of last resort. Specific procedures for disseminating this information include:

Each contractor will ensure that information and procedures in the Nurse Registry Emergency Training regarding the Special Needs Registry is provided to each patient on intake, annually, and when there is a change. This information includes information about special needs shelters, how, when, and where to register for special needs, and assistance with registering.

C. Notification

1. The procedures on how the nurse registry administrative staff in charge of the emergency plan implementation will receive warnings of emergency situations, including off hours, weekends and holidays:

The Emergency Plan Coordinator, who is in charge of implementing the Emergency Plan, will monitor any emergency situations on radio or television reports and will continue to do this until there is no broadcasting being received. The Emergency Plan Coordinator has available a NOAA Weather Radio to monitor emergency situations if radio and television are no longer working. The Emergency Plan Coordinator, in the event of an imminent emergency, will maintain communications with the Pasco Emergency Management Office, the Health Department, independent contractors, and Patients by phone. In the event an evacuation is ordered, contractors and Patients will be notified immediately.

2. If the nurse registry provides skilled care, the nurse registry’s 24 hour contact number, if different than the number listed in the introduction, is:

813-767-3808

3. The procedures on how those independent contractors who are providing services to patients registered (pursuant to s. 252.355, F.S.) will be alerted:

independent contractors who are providing services to patients will be alerted to possible and imminent emergency situations by the Communications Coordinator who will be notified by the Emergency Plan Coordinator.

4. The policies and procedures for reporting to work for staff and other key workers, when the nurse registry remains operational:

Policies and procedures for independent contractors and other key workers to report to work as long as the Nurse Registry remains operational are found in the Powell Supportive Services Emergency Policy. Each contractor will contact the Nurse Registry every 24 hours in whatever manner is safest (telephone, driving to the office) to determine for a status check for that day.

5. The procedures on how patients will be alerted, and the precautionary measures that will be taken, including but not limited to independent contractors continuing the same type and quantity of services to patients registered (pursuant to s. 252.355, F.S.), unless the emergency situation is beyond the control of the independent contractor:

Each independent contractor and each patient will be trained in the responsibilities of the independent contractor, including alerting the patient of an emergency, confirming each patient’s emergency plan, and continuing service provision before, during, and after an emergency. Training will also include the information that continued care will be provided unless the emergency situation is beyond the control of the independent contractor and in that situation, the Nurse Registry will make all attempts at providing an alternate to continue service provision.

On imminent treat of an emergency or disaster the Nurse Registry will immediately:

- contact those patients needing ongoing services (400.506(12)(a),F.S.) and confirm each patient’s plan

During an emergency or disaster the Nurse Registry will:

- confirm each patient's plan if the patient will evacuate to a special needs shelter

- contact the assisted living facility and adult family care home patients and confirm their plans

- continue the same type and quantity of service provision for special needs registrants in need of continued service provision

Immediately following an emergency or disaster the Nurse Registry will:

- confirm each patient's plan

- contact the assisted living facility and adult family care home patients and confirm their plan

- continue the same type and quantity of service provision for special needs registrants in need of continued service provision

6. The procedures for alternate means of notification should the primary system fail (pursuant to s. 400.506, F.S.):

If telephone service, the primary communication system, is not available during an emergency, the Nurse Registry’s contingency plan to support communication, pursuant to Section 400.506, F.S. includes:

- using cell phones

- staying in contact with a community based ham radio group

- monitoring public announcements through radio or television stations

- driving directly to the patient's home

- contacting police or emergency rescue services in case of medical emergency situations

7. The nurse registry will maintain a current prioritized list of patients that are registered (pursuant to s. 252.355, F.S.) who are located in a private residence, ALF and AFCH and who need continued services during an emergency. This list shall comply with the requirements of s. 400.506(16) (b), F.S. The procedures on how this list shall be furnished to county health departments and to local emergency management agencies, upon request (pursuant to s. 400.506(16) (b), F.S.):

Note: s. 400.506(16)(b) FS does not exist. *400.506 (11) replaces 400.506 (15)

The Prioritized List for the Nurse Registry is part of the process for creating a Personal Emergency Plan. The independent contractor will ensure that each patient who needs continued services during an emergency will have a Prioritized List to be completed on intake and updated annually and when there is a change. The Prioritized List will be submitted to the Nurse Administrator within 30 days of intake who will submit the Prioritized List to the Safety Liaison who will ensure it is copied and provided to the patient, maintained in the patient’s file and submitted to the appropriate agencies, including the county health department and local emergency management agency.

D. During an Emergency

1. During an emergency, when there is not a mandatory evacuation, some patients registered (pursuant to s. 252.355, F.S.), may decide to stay in their homes, ALF or AFCH. The procedures on how the nurse registry will make every reasonable attempt to assure that all patients needing continuing care will receive it, either from the independent contractor referred by the nurse registry or through arrangements made by the patient or the patient’s caregiver:

The Nurse Registry will continue to provide the same type and quantity of services to its patients who decide to remain in private residences which were being provided to those patients prior to evacuation and will document all attempts at continuing service provision. Arrangements will be identified in the patient’s Personal Emergency Plan for receiving continuing care, including the person identified to provide the care (an independent contractor, family member, friend, Attending Caregiver, etc). If the identified person is unable to provide care to the patient in the a private residence, the Nurse Registry will make every attempt to find an alternate.

2. The means by which the nurse registry will continue to provide the same type and quantity of services to its patients who evacuate to special needs shelters which were being provided to those patients prior to evacuation per s.400.506 (16).

Note: *400.506 (12) replaces 400.506 (16)

The Nurse Registry will continue to provide the same type and quantity of services to its patients who evacuate to special needs shelters and those who remain in private residences which were being provided to those patients prior to evacuation and will document all attempts at continuing service provision. The patient will have an Attending Caregiver if evacuated to a Special Needs Shelter who may be the contractor, family member, friend, etc. If the Attending Caregiver is unable to provide care to the patient in the Special Needs Shelter, the Nurse Registry will find an alternate.

3. How the nurse registry will establish links to local emergency operations centers to determine a mechanism by which to approach specific areas within a disaster area per s. 400.506 (16)

Note: *400.506 (12) replaces 400.506 (16)

The Safety Liaison has applied to take a local CERT training class and will also attend any classes provided by the Pasco County Citizen Corps Council and will establish a link to the Pasco Emergency Management Office to determine the best method for approaching specific areas within a disaster area.

E. Evacuation

1. The procedures that facilitate the efforts of the independent contractor to establish, and keep updated, medication, supplies and equipment lists (as defined in appendix B) to be kept in the homes of special needs patients:

Each independent contractor will ensure that a Medication List and an Equipment-Supply List are completed on patient intake and updated annually and when there is a change. This will also involve making sure that an adequate supply of medications is always on hand and that there is a link with the patient’s pharmacy to ensure that in the event of an imminent emergency a 7-day supply or 30-day supply, whichever is appropriate, will be available. In addition, the independent contractor will ensure that equipment and supplies identified on the Equipment-Supply List are at hand or easily accessible in the event of an emergency.

2. The procedures for educating and helping the patient and caregiver, e.g. family members, friends, etc., understand that the caregiver is to remain with the patient in the special needs shelter, and to take the list established by the independent contractor as well as other necessary items to the special needs shelter when there is mandatory evacuation underway due to the emergency:

The patient will be trained on the Nurse Registry’s Emergency Management Plan as well as all topics covered in the Nurse Registry Emergency Preparedness Packet and will develop an individualized Personal Emergency Plan to ensure his safety in the event of an emergency situation. Information in the Training will cover the responsibilities of the Attending Caregiver in the special needs shelter, including remaining with the patient in the special needs shelter and ensuring that the Personal Emergency Plan and its Attachments and all required items are taken to the special needs shelter for the care of the patient. The patient will meet with his Circle of Support as part of this process to go over the Personal Emergency Plan and to ensure that the patient’s guardian, family, Attending Caregiver, friends, etc, are educated as to the requirements of his Personal Emergency Plan.

3. The resources necessary to continue essential care or services or referrals to other organizations subject to written agreement including how the nurse registry will continue to provide care to ALF and/or AFCH patients who relocate in the same geographic service area or relocate outside the geographic service area:

Resources that the Nurse Registry will use in order to continue essential care or services or referrals to other organizations include:

- other local nurse registries

- the Pasco Emergency Management Office

- the Pasco County Health Department

4. The procedures for contacting the emergency operation center after the disaster to report on the registry’s damage, if any, and their availability to continue services to their patients in the special needs shelter:

The Safety Liaison will contact each independent contractor and patient and make a report of any damage or problems and submit this to the Nurse Administrator and the Owner who will then determine the availability of the Nurse Registry to continue to provide services to patients in the special needs shelter. Each patient and independent contractor will be informed by the Safety Liaison as to this determination. After this determination we will contact the emergency center by phone to report any damages or problems reported.

F. The Patients Return Home

1. The procedures on how the nurse registry will re-establish contact with patients in their homes, ALF or AFCH in order that the independent contractor or alternate independent contractor can resume provision of care:

The Nurse Registry will re-establish contact through communication means (i.e. phone, runner…etc.) established in each patient’s Personal Emergency Plan in order to resume provision of care. The Nurse Administrator will be available to connect any alternate independent contractor or other Nurse Registry with the patient in the event that the regular independent contractor is unavailable. If this is not possible due to circumstances beyond the control of the independent contractor or the Nurse Registry, the Nurse Registry will document all attempts at resuming provision of care.

2. The procedures on how the nurse registry will re-establish contact with independent contractors in order that they may re-start patient care:

The Nurse Registry will re-establish contact through communication means established on hire for each independent contractor in order to resume provision of care. In addition, the Nurse Registry Emergency Policy, which each independent contractor must sign on hire and annually, will identify the means for the independent contractor to re-establish communication with the Nurse Registry (phone numbers and contact locations, if necessary). The Nurse Administrator will be available to connect any alternate independent contractor with the patient in the event that the regular independent contractor is unavailable.

3. The procedures on how the nurse registry will provide or arrange for prioritizing care should the emergency result in fewer independent contractors being available immediately following the disaster:

The Nurse Registry will establish a network with other Nurse Registries in order to arrange for and prioritize care should an emergency result in insufficient independent contractors available for care provision. The Nurse Registry will document all attempts at re-establishing care and services.

IV. APPENDICES

APPENDIX A: AGREEMENTS AND UNDERSTANDINGS

No mutual agreements have currently been entered into between Powell Nurse Registry and local, state, or county entities having responsibility during a disaster. The Nurse Registry is currently working on developing relationships with other local nurse registries and has contacted and used the websites for the Pasco County Emergency Management Office and the Florida Health Department (Pasco). In addition, the Safety Liaison for the Nurse Registry has applied to take the Pasco County CERT training in April and May.

APPENDIX B: INFORMATION FOR NURSE REGISTRY PATIENTS

Powell Supportive Services, Inc. has ensured that the information contained in Appendix B (including information about special needs shelters, caregivers, emergency kits, etc) is in the Nurse Registry Emergency Preparedness Packet which is part of each independent contractor’s orientation and each patient’s intake. The information is reviewed annually and when there is a change.

In addition, Powell Supportive Services, Inc. has also ensured that applicable laws are available in the training and internet links to the most current laws are provided in the training.

APPENDIX B: INFORMATION FOR NURSE REGISTRY PATIENTS

Please note: The special needs shelter should be used as a place of last refuge. The evacuee may not receive the same level of care received from independent contractors in the home, and the conditions in a shelter might be stressful.

(1) If the patient has a caregiver[1], the caregiver must accompany the patient and must remain with the patient at the special needs shelter.

(2) The following is a list of what special needs patients need to bring with them to the special needs shelter during an evacuation:

• Bed sheets, blankets, pillow, folding lawn chair, air mattress

• The patient’s medication including the dose, frequency, route, time of day and any special considerations for administration, supplies and equipment list, including the phone, beeper and emergency numbers for the patient’s physician, pharmacy and, if applicable, oxygen supplier; supplies and medical equipment for the patient’s care; Do Not Resuscitate (DNRO) form, if applicable;

• Name and phone number of the patient’s nurse registry

• Prescription and non-prescription medication needed for at least 5 to 7 days; oxygen for 5 to 7 days if needed.

• A copy of the patient’s plan of care, if applicable

• Identification and current address

• Special diet items, non-perishable food for 5 to 7 days and 1 gallon of water per person per day

• Glasses, hearing aides and batteries, prosthetics and any other assistive devices

• Personal hygiene items for 5 to 7 days

• Extra clothing for 5 to 7 days

• Flashlight and batteries

• Self-entertainment and recreation items, like books, magazines, quiet games.

(3) Shelterees need to know the following:

• If the patient has a caregiver, the caregiver(s) shall be allowed to shelter together in the special needs shelter. If the person with special needs is responsible for the care of individuals without special needs, those persons may also shelter together.

• The shelteree caregiver will have floor space provided. The caregiver must provide his or her own bedding.

• Service dogs are allowed in the shelter. However, check with your local Emergency Management office to see if other pets are permitted.

• Bring personal snacks, drinks, and any special dietary foods for 72 hours. It is possible only sparse meals will be provided.

• Caregivers who regularly assist the patient in the home are expected to continue to do the same care in the shelter.

APPENDIX C: SUPPORT MATERIAL

List on this page and insert copies on following pages.

Powell Supportive Services will orient each independent contractor in emergency preparedness. On hire and annually, the contractor will sign the Nurse Registry Emergency Plan Policy, complete training using the Nurse Registry Emergency Preparedness Packet, will train each patient in emergency preparedness, and will assist the patient with creating an individualized Personal Emergency Plan.

Items indicated with * are included in this Comprehensive Nurse Registry Emergency Management Plan as .pdf files.

To ensure the most current versions are available, items indicated with ** are available online through the:

- Florida Legislative website for statutes, constitution, and laws of Florida

- Pasco County Emergency Management website

- Pasco County Health Department website

Powell Supportive Services Nurse Registry Emergency Preparedness Packet

Comprehensive Nurse Registry Emergency Management Plan (this document)

Emergency Plan Policy

Emergency Training

Types of Emergencies

Preparing for an Emergency

During an Emergency

• Staying Home

• Going to a Shelter

• Special Needs Shelter

After an Emergency

Local Emergency Contacts

Local Programs

Resources & Links

Creating the Personal Emergency Plan

* Emergency Kit(s) List

* Equipment-Supply List

* Prioritized List

* Prioritized List - Responsibilities

* Medication List

* Attachments

**Emergency Laws Applicable to the Nurse Registry

Handouts (available in print & on the internet)

**SNAPP Form

**Special Needs Shelter Fact Sheet

**Tips for Evacuating Vulnerable Populations - Get A Plan

**Hurricane Guide “Official Guide for the Tampa Bay Area” Pasco County

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[1] Caregivers can be relatives, household members, guardians, friends, neighbors and volunteers.

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The following information should be supplied by the nurse registry to those patients registered with the special needs registry, so they will be prepared prior to an evacuation to a special needs shelter.

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