Smoke Zones vs. Fire Zones

 

We have recently noticed several facilities that have used their fire alarm zones as part of their evacuation plan. The fire alarm zones are the zones on the fire alarm panel used to help staff identify the location of the fire. These are different from smoke zones, which are the zones in the building created to prevent the spread of smoke and fire and allow staff time to complete a full evacuation of the building. Many facilities have fire alarm zones that do not match the smoke zones in the facility. Often times there are more fire zones to help staff identify the location of a fire.

To start a smoke zone evacuation, it may be necessary to evacuate multiple fire alarm zones at the same time. The evacuation plans need to have these smoke zones clearly labeled and all staff need to know where they will move the residents in the event of a fire. The facility cannot base their evacuation plans on the fire alarm zones.

In this example, the facility has eight fire alarm zones (Fire Zones 1-8). The facility has a smoke barrier wall that divides the facility into two smoke zones (Smoke Zones A and B). The facility also has a secured unit, but the controlled egress doors (locked keypad doors) are not a part of the smoke barrier wall, so the secured unit is part of Smoke Zone A.

If a fire occurs in Fire Zone 4, it means that an evacuation of all residents would need to occur throughout Smoke Zone B, which would include all residents in Fire Zones 3, 4, and 5. The evacuation plan may mention things like room number, dining rooms, etc., but should avoid using fire zones to describe the smoke zones. Although it is important to know which smoke zone activated the fire alarm system, staff cannot move the residents from Fire Zone 4 to Fire Zone 5, as they are still within Smoke Zone B. Staff must completely move the residents out of Smoke Zone B.

In addition, it is significant to note if a fire occurred in Smoke Zone A (i.e. Fire Zones 1 or 6), the staff would need to move residents in the secured unit from Smoke Zone A. Staff cannot leave the residents in the secured unit since a smoke barrier wall does not protect the secured unit and it is not its own smoke zone.

The facility must have the evacuation plans posted on at least every floor of the facility [19 CSR 30-85.022 (33)(B)(2)] which directs all staff, residents, and visitors where to go in the event of a facility evacuation. The policy and procedure for evacuations also needs to be in the emergency preparedness manual.

NFPA 99, 2012 edition
15.7.4.3.1: Where buildings are required to be subdivided into smoke compartments, fire alarm notification zones shall coincide with one or more smoke compartment boundaries or shall be in accordance with the facility fire plan.

CMS Memo: QSO-21-15-ALL: Updated Guidance for Emergency Preparedness-Appendix Z of the State Operations Manual (SOM)

CMS has provided updated guidance for the emergency preparation regulations (Appendix Z). This update is effective immediately.

  • Burden Reduction Final Rule Interpretive Guidelines: The Centers for Medicare &Medicaid Services (CMS) is releasing interpretive guidelines and updates to Appendix Z of the State Operations Manual (SOM) as a result of the revisions of the Medicare and Medicaid Programs; Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction (CoPs) (CMS 3346-F) Final Rule.
  • Expanded Guidance related to Emerging Infectious Diseases (EIDs): CMS is also providing additional guidance based on best practices, lessons learned and general recommendations for planning and preparedness for EID outbreaks.

Please see the full memo at https://www.cms.gov/medicareprovider-enrollment-and-certificationsurveycertificationgeninfopolicy-and-memos-states-and/updated-guidance-emergency-preparedness-appendix-z-state-operations-manual-som.

Potter Electric Recalls Addressable Pull Stations Single/Dual Action Due to Failure to Alert to Fire

This recall involves Potter Electric Addressable Pull Stations. When manually pulled, these red-colored devices are intended to activate a fire alarm in commercial and other buildings. Recalled models include: (1) Potter Electric Addressable Dual Action Pull Station, Model PAD100-PSDA, Part Number 3992720, with a date code Dec 03 2020; and (2) Potter Electric Addressable Single Action Pull Station, Model PAD100-PSSA, Part Number 3992721, with date codes Nov 10 2020, Nov 25 2020, Dec 01 2020, and Dec 03 2020. “Potter” is printed on the front of all devices. The date code is located inside the device.

https://www.cpsc.gov/Recalls/2021/Potter-Electric-Recalls-Addressable-Pull-Stations-Single-Dual-Action-Due-to-Failure-to-Alert-to-Fire

N95 Info

Fit Under Fire: Situational Strategies to Achieve the Best Respirator Fit During Crisis

To aid healthcare facilities experiencing shortages of N95 respirators due to high demand across the nation, CDC developed the Strategies for Optimizing the Supply of N95 Respirators in Healthcare Settings which provides options on how to optimize supplies of disposable N95 filtering facepiece respirators (commonly called “N95 respirators”) in healthcare settings when there is limited supply. Proper fit of N95s is critical to your infection control/respiratory protection program.

For more information, please visit https://blogs.cdc.gov/niosh-science-blog/2020/03/16/n95-preparedness/.

Child Care Needs Assessment

A state-wide team is working to develop a list of childcare needs for healthcare and other critical staff across the state to ensure that those individuals are able to work. The intent is to try to see if local school districts are able to provide the care. 

The next step is to develop a list of childcare needs from the critical employees. The link below will take people to an online form to fill out if they need childcare in order to be able to work.

https://stateofmissouri.wufoo.com/forms/m1cs1vfl1dde8dt/

Once we have the information gathered, we will create a list of needs by school district to send to each district and see if they are able to help provide care. At this point this is information gathering to see what options might be available.

Please ensure all long term care employees submit this form if they have a need.

MHCA Webinar – Maintenance and Testing of Fire Sprinkler Systems

February 13, 2019: Maintenance and Testing of Fire Sprinkler Systems
Presenter: Skip Johnson

In this module we will discuss the importance of maintaining water based fire sprinkler systems and how sprinkler system neglect can affect the systems from operating as they were originally designed and approved. This module will incorporate NFPA 13 & NFPA 25.

  • Brief touch on common sprinkler system types, component & descriptions/ definitions.
  • Why install sprinkler systems.
  • How to identify common problems effecting sprinkler systems and why they prevent systems from operating correctly.
  • Responsibility of the property manager and their sprinkler systems.

Winter Weather Planning

Snow and ice are a mainstay of Missouri winter weather. Because of the variety of weather conditions as well as other events, facilities must have an emergency preparedness plan and be ready to act in an emergency to ensure they are to adequately prepared to meet the needs of patients, clients, residents, and participants during disasters and emergency situations. Here are a few things to consider in examining your emergency preparedness plan, specifically as it relates to snow, ice, and power outages.

  • If there is a loss of the primary power, how will the facility ensure adequate temperatures of the facility will be maintained during the emergency situation?
  • Is the plan feasible?
    • Plan for the worst. Most events do not occur on a sunny Tuesday afternoon and the plan should account for things such as poor weather, road conditions, weekends/holidays, evenings, staff ability to travel to work, and other obstacles that may cause issue during the actual emergency.
  • Are staff knowledgeable of the plan and have access to what is needed in order to implement the plan?
    • Phone numbers, contact persons, contracts.
  • Do staff know what to do during an emergency and know who is in charge? If the administrator is not onsite, who is in charge and does that person know all their duties?
    • This may be the DON, but it may also be a charge nurse (or another designated onsite staff) if the event happens in the “middle of the night”. Depending on when the administrator or someone higher up on the order of succession can arrive at the facility, that person (i.e. night charge nurse) may be in charge for an extended amount of time.
  • Is the plan detailed enough?
    • Is there a detailed plan that describes when the residents will evacuate during an emergency? If loss of power, does the plan instruct the staff to start the evacuation prior to the point when the facility is below appropriate air temperatures and to maximize their safety during travel? What is the distance to the emergency evacuation site? What types of roads do they have to traverse, such as “side roads”, bridges, or interstates; all of these roads can have their challenges. Does the facility have more than one contracted emergency site?
      • Is it likely that emergency events will also impact the surrounding areas? It is also possible that the evacuation site may be so far away, residents may not be able to get there when road conditions are less than optimal. Does the contracted site meet all the criteria to allow the residents to shelter in place at that location?
    • Is there a contract for transportation and will that transportation be able to get the residents to and from their current location to the contracted emergency location in a snow/ice storm? If the services have other contracted uses, such as school buses, will they be available at 3:00 P.M. on a school day or can they get drivers at 3:00 A.M. on a Wednesday?
  • Does the facility have a generator?
    • Is there enough fuel, a contract to get more fuel, and a list of what it does and does not operate?
      • Facilities (and the staff in charge) need to know in advance, what their generator will operate. At a minimum, this listing must include whether it runs: Life safety equipment (such as E-lights and fire alarm system(s)), magnetic door locks/door alarms (where applicable for safety), HVAC systems, cooking systems, what outlets residents and staff will be able to be use, and computer equipment/Wi-Fi (if electronic medical records (EMR) are utilized).
      • This list needs to be detailed so staff will know specifically what items will and will not work during a power outage. Many generators will run every second or third ceiling light for emergency lighting, but not all lights in the facility will work during a power outage. This needs to be listed so all staff will know that information.
  • If a facility does not have a generator, what are the plans when it may not be easily able to evacuate due to poor road conditions or other factors that may prohibit a smooth transition from a facility to another location?
    • If the facility plans to have a generator delivered during a loss of power, does the facility have a contract with the generator company to deliver one to them? This contract should include the size of the generator that the facility will need in order to ensure the safety and care needs of the residents are met during the emergency.
      • The building will need to be wired and ready to accept the generator in advance. The facility will not be able to install a generator during the emergency event unless the wiring for the generator has already been completed.
  • Facilities must maintain at least their fire safety equipment (E-lights, fire alarm, sprinkler system, range hood (if any cooking occurs), food, water, heating and cooling, and sewage disposal to shelter in place.
    • There must be a plan of how this will be achieved, emergency supplies, the detailed list of what the generator will run, and any contracts that will be needed during the emergency to ensure these services can continue during the emergency event.
      • Sometimes trucks will not be able to run regular schedules and it may take several days before the facility can get their first delivery after an emergency starts; depending on the extent and severity of the disaster.
  • A power outage may be as simple as a blip, may last for hours, or may last for days – depending on the extent of the power grid damage and when the crews can access the problem(s).
    • The facility needs a plan of when, how, and where they will evacuate if they cannot provide at least the components of the previous bullet point.

During a disaster is the least ideal time to learn an emergency plan will not work or to search for a contracted service. All contracted services including, but not limited to, transportation, fuel needs, evacuation location, food, and water needs to be in the emergency plan. The emergency preparedness team needs to consider and plan all services and contract prior to an actual emergency. During an emergency, it may be very difficult or impossible to get a contracted service due to volume of request, road conditions, and/or other factors.

If your facility experiences a loss of a necessary service (electricity, water, gas, phone, etc.), contact SLCR via the Regional Office emergency phone line and keep them informed of their status. If, for some reason, the facility cannot contact SLCR staff through the regional office phone number, you should contact the hotline. The emergency protocol is attached. When you call, be prepared to answer to the following:

Facility name

Census, including staff assessment of current needs of the residents and monitoring of the ill.

Contact person and emergency contact number that is not the facility main line.

Has the facility called the fire department and central monitoring company if phones, alarm systems are down?

Generator: Y/N

  • If yes, what equipment does the generator serve (fire alarm, HVAC systems)?
  • If yes, amount of fuel onsite and/or system for delivery? How long will fuel last?
  • If no, what is fire watch plan?
  • If no, how will the facility ensure resident needs are met, including maintenance of room temperatures in a safe manner?
    • Obtain generator- is the home set up to receive generator power once delivered? Estimated time for delivery? Estimated time when generator power will be established.
    • Evacuation- Where is facility relocating to, distance from facility, transportation to get there, staffing, sufficient supplies/medications, how will the facility ensure resident needs are met, including maintenance of room temperatures in a safe manner (does the location have a functional emergency generator?) If relocating to a SNF – will the home be over capacity? Is there sufficient beds/space in the receiving facility to house the extra residents?
  • Documentation may be requested, including:
    • If evacuated, a list of residents and were they went
    • Room temperature logs
    • Fire watch documentation

Thank you for preparing in advance and keeping us informed!

New QIPMO Newsletter – November 2018

New QIPMO Newsletter – November 2018

The Quality Improvement Program for Missouri (QIPMO) has published MDS Tips and Clinical Pearls – Volume 6, Issue 1.

In this issue:

  • Resident Rights on Discharge
  • Emergency Preparedness Program
  • Vaccinations
  • Gastronomy Tube and the Nursing Plan of Care
  • Alzheimer’s and Dementia

Please visit QIPMO’s website here for this and other previous newsletters.

CMS Fire Safety Information

CMS Fire Safety Information

CMS provided updated Fire Safety information for distribution to surveyors and providers. Please see the information here.

Note: Missouri’s state regulation for implementation of an approved fire watch in a SNF is more stringent than the federal regulations.  Facility’s must comply with state requirements:

19 CSR 30-85.022(11) (E) requires: When a sprinkler system is to be out of service for more than four (4) hours in a twenty-four- (24-) hour period, the facility shall immediately notify the department and the local fire authority and implement an approved fire watch in accordance with NFPA 101, 2000 edition, until the sprinkler system has returned to full service. I/II

Emergency Protocol Reminder

Emergency Protocol Reminder

This protocol provides the telephone numbers corresponding to the region in which your home is located if you experience a loss in a necessary service that has the potential to affect resident safety or well-being. You are encouraged to contact the regional office main office telephone number during normal business hours as survey staff carry the cell phone and may be conducting a survey or inspection during working hours and may not answer immediately.

Remember – this protocol is not to be used to self-report incidents normally reported to the Elderly Abuse and Neglect Hotline.

Please see the attached Emergency Protocol for complete directions. The document and information is also available anytime at ltc.health.mo.gov/safety-emergency.

Delayed-Egress Locking Systems

Delayed-Egress Locking Systems

National Fire Protection Association (NFPA) 101 2012 Delayed-Egress Locking Systems. 7.2.1.6.1.1  shows: Approved listed delayed-egress locking systems shall be permitted to be installed on door assemblies serving low and ordinary hazard contents in buildings protected throughout by an approved, supervised automatic fire detection system in accordance with Section 9.6 or an approved supervised automatic sprinkler system in accordance with Section 9.7 and where permitted in Chapters 11 through 43, provided that all of the following criteria are met:

  1. The door leaves shall unlock in the direction of egress upon actuation of one of the following:
    1. Approved, supervised automatic sprinkler system in accordance with Section 9.7
    2. Not more than one heat detector of an approved, supervised automatic fire detection system in accordance with Section 9.6
    3. Not more than two smoke detectors of an approved, supervised automatic fire detection system in accordance with Section 9.6
  2. The door leaves shall unlock in the direction of egress upon loss of power controlling the lock or locking mechanism.
  3. *An irreversible process shall release the lock in the direction of egress within 15 seconds, or 30 seconds where approved by the authority having jurisdiction, upon application of a force to the release device required in 7.2.1.5.10 under all of the following conditions:
    1. The force shall not be required to exceed 15 lbf (67N).
    2. The force shall not be required to be continuously applied for more than 3 seconds.
    3. The initiation of the release process shall activate an audible signal in the vicinity of the door opening.
    4. Once the lock has been released by the application of force to the releasing device, relocking shall be by manual means only.
  4. *A readily visible, durable sign in letters not less than 1 in. (25 mm) high and not less than 1⁄8 in. (3.2 mm) in stroke width on a contrasting background that reads as follows shall be located on the door leaf adjacent to the release device in the direction of egress: PUSH UNTIL ALARM SOUNDS DOOR CAN BE OPENED IN 15 (or 30) seconds.

 

Facilities may receive approval for 30 second release egress doors from the Authority Having Jurisdiction.  For the facility to receive 30 second release approval, the facility must submit in writing to the Section for Long-Term Regulation (SLCR), a letter detailing the risk(s) to the residents and/or hardship.  It will be the SLCR’s final decision on the approval of the extension and will be reflected in a letter to the facility.  It will be the facility’s responsibility to retain the SLCR approval letter for future reference.

 

Failure to obtain an approval letter from the SLCR will place the facility in noncompliance with Federal participation requirements and in the event of a recertification survey or federal monitoring survey for life safety code, result in a citation.

 

The facility letter detailing the risk(s) to the residents and/or hardship and facility layout indicating affected doors, can be submitted to be Scott.Wiley@health.mo.gov

NFPA Notes

NFPA Notes

All areas of the building shall be accessible:  All areas of the facility must be accessible during all shifts by the charge nurse (or another designated staff, i.e. security) so that in the case of a fire, staff (including emergency response staff) can find and fight the fire (when possible). Reports show that recently facilities in varying areas of the country have had fires in areas that were locked (such as laundry rooms or the kitchen) during the evening/night shifts. When the fire alarm system sounded, staff did not have a key accessible to gain entry into the locked areas causing a delay in the response time.

 

  • NFPA 2012 101, 19.7.2.1.1

For health care occupancies, the proper protection of patients shall require the prompt and effective response of health care personnel.

 

  • NFPA Standard: 2012 NFPA 101, 19.1.1.3.1

All health care facilities shall be designed, constructed, maintained, and operated to minimize the possibility of a fire emergency requiring the evacuation of occupants.

 

  • NFPA 101 2012, 4.8.2.1

Emergency plans shall include the following:

(1) Procedures for reporting of emergencies

(2) Occupant and staff response to emergencies

(3) Evacuation procedures appropriate to the building, its occupancy, emergencies, and hazards (see Section 4.3)

(4) Appropriateness of the use of elevators

(5) Design and conduct of fire drills

(6) Type and coverage of building fire protection systems

(7) Other items required by the authority having jurisdiction

 

  • NFPA 2012 101, 7.2.1.1.3.2

Where means of egress doors are locked in a building that is not considered occupied, occupants shall not be locked beyond their control in buildings or building spaces, except for lockups in accordance with 22.4.5 and 23.4.5, detention and correctional occupancies, and health care occupancies.

Fire Reporting

Fire Reporting

19 CSR 30-85.022 (2) (F) for Skilled Nursing Facilities/Intermediate Care Facilities (SNFs/ICFs) and 19 CSR 30-86.022 (2)(C) for Residential Care Facilities (RCFs) and Assisted Living Facilities (ALFs) require that all facilities shall notify the department immediately after the emergency is addressed if there is a fire in the facility or premises and shall submit a complete written fire report (attached) to the department within seven (7) days of the fire, regardless of the size of the fire or the loss involved.

 

The Section for Long-Term Regulation defines fire as used in relation to fire/safety requirements as follows:  Fire is the active principle of burning, characterized by combustion.  This energy is evident when heat and/or smoke and/or light are present as the result of combustion.  Smoke is a product of combustion, and any time smoke is given off, combustion has occurred whether or not there has been a visible flame. Besides the obvious, some often-overlooked examples of fire include but are not limited to the following:

  • Smoking air conditioner unit or heater (whether or not the fire department responded);
  • Smoking pads or mop heads in the dryer (whether or not the fire department responded); and
  • Smoking trash in a waste receptacle (whether or not the fire department responded).

 

The facility submitted fire report must include the following:

  • A brief narrative of the event in the comments section of the report or in an attachment;
  • Documentation regarding whether or not the fire alarm and/or sprinkler system activated (if applicable) and if/when the system was back in service (if applicable);
  • In addition, the narrative must show whether or not fire extinguishers were used, and if so, when they were recharged or replaced;
  • A copy of the fire department report if the fire department responded; and
  • If a fire can be attributed to a particular person, the report must include identifying information for that person.

Emergency Protocol Update/Reminder

Emergency Protocol Update/Reminder

SLCR developed a protocol for communication between long-term care homes and the Section for Long-Term Care Regulation (SLCR), in the event a disaster occurs that results in a loss of a necessary service (electricity, water, gas, telephone, etc.). This protocol was established to streamline communication so that homes can focus on what is most important – the safety and well-being of the residents.

 

The phone number for Region 5 (Macon) has changed. This is the only change to the document attached.

MLN Emergencies, Disasters, and Lessons Learned: Are You Really Ready?

MLN Emergencies, Disasters, and Lessons Learned: Are You Really Ready?

  • November 16, 2016:  Macon
  • November 17, 2016:  Jefferson City

This presentation will discuss emergencies, disasters, risk assessment, and lessons learned from case studies. The presentation will provide participants with specific suggestions to help be better prepared in the event a disaster does occur.

Please see the Workshop brochure and more information including registration here.

Hurricane Sandy: A Lesson in Survival

Why it is important to have an emergency plan in place.  This article focuses on October 22, 2012 and sometime following, when the largest Atlantic hurricane on record left the East Coast in a state of emergency.  Read and understand what it was like as nursing homes were evacuated.  You also get a description of some challenges crews faced as well as the lessons learned from the experience.

Please see the full article from Long Term Living – July/August 2015 here.

Missouri Severe Weather Awareness Week

March 3 – 7, 2014:  Missouri Severe Weather Awareness Week

March 4, 2014:  Annual Missouri Severe Weather Drill

The annual drill will be held on March 4th, 2014, at 1:30 p.m.  In case of actual severe weather on March 4th, the drill will be postponed until Thursday, March 6th, also at 1:30 p.m.  For more information, visit SEMA at http://sema.dps.mo.gov/.

Emergency Preparedness Winter Weather Special Update February 4, 2014

LTC Information Special Update  February 04, 2014 

The Section for Long-Term Care Regulation is sending the following weather-related reminders in light of Missouri’s considerable snowfall and ice accumulation across the state.  Please take time to familiarize yourselves with your home’s emergency plan, double-check your emergency reserves of food and other disaster-related preparedness items, and know that your service to the elderly in all types of weather is appreciated.

Winter Weather Information

http://health.mo.gov/emergencies/ert/naturaldisasters.php

http://stormaware.mo.gov/

http://www.nws.noaa.gov/view/states.php?state=MO

Emergency Protocol for Long-Term Care Homes

The Emergency Protocol was developed in 2007 for communication between long-term care homes and the Section for Long-Term Care Regulation, in the event a disaster occurs that results in a loss of a necessary service.  (Electricity, water, gas, telephone, etc.)  This protocol was established to streamline communication so that homes can focus on what is most important – the safety and well-being of the residents.

This protocol provides the cellular telephone number corresponding to the region in which your home is located if you experience a loss in a necessary service that has the potential to affect resident safety or well-being.  You are encouraged to contact the regional main office telephone number during normal business hours, as survey staff carry the emergency cell phone and may be conducting a survey or inspection during working hours and may not answer immediately.

Please remember, this protocol is NOT to be used to self-report incidents normally reported to the Elderly Abuse & Neglect Hotline (1-800-392-0210).

Region Main Office Emergency Only Cell Number
#1 Springfield (417) 895-6435 (417) 425-8780
#2 Poplar Bluff (573) 840-9580 (573) 778-6495
#3 Kansas City (816) 889-2818 (816) 719-0089
#4 Cameron (816) 632-6541 (816) 632-9371
#5 Macon (660) 385-5763 (660) 651-1468
#6 Jefferson City (573) 751-2270 (573) 619-3338
#7 St Louis (314) 340-7360 (314) 623-2852

Missouri regional map: http://health.mo.gov/seniors/nursinghomes/providerinfo.php – click on Long Term Care Regions

Disaster and emergency planning resources: http://health.mo.gov/emergencies/

If you have any questions about the Emergency Protocol for Long-Term Care Homes, please contact the Section for Long-Term Care Regulation at 573-526-8524.

Ensure Your Local EMD has a Copy of Your Home’s Current Emergency Plan

Missouri is again experiencing extreme weather conditions, and there is a chance of even more inclement weather in the forecast.  The Section for Long-Term Care Regulation would like to remind you there are emergency preparedness representatives in your community to help you with emergency planning and are there to help in the event of a disaster.

You can find your local emergency management director (EMD) on the State Emergency Management Agency’s (SEMA) website at www.sema.dps.mo.gov.  Scroll down to Contact Your Local Emergency Management Agency and choose your county.

State regulations require all long-term care homes to provide a copy of their emergency plan to their local EMD.  Please reference the following regulations:

19 CSR 30-85.022 (33) and 19 CSR 30-86.022 (5)(A) All facilities shall have a written plan to meet potential emergencies or disasters and shall request consultation and assistance annually from a local fire unit for review of fire and evacuation plans.  If the consultation cannot be obtained, the facility shall inform the state fire marshal in writing and request assistance in review of the plan.  An up-to-date copy of the facility’s entire plan shall be provided to the local jurisdiction’s emergency management director.

For additional information regarding emergency preparedness, please contact Melissa Hope, Planner II, Division of Regulation and Licensure at melissa.hope@health.mo.gov.

Resources are also available on the Department of Health and Senior Services website, http://health.mo.gov/emergencies/readyin3/adultcare.php.