HQIN: Simple Strategies for Summer Emergency Preparedness

 
July 2024

Simple Strategies:
Summer Emergency Preparedness

Emergency preparedness is important in every season, but it is especially important in the summer. Summer storms, tornadoes and hurricanes often come with damaging winds and rain, and have similar preparations even though they occur in different areas of the country.
 

In This Newsletter:

Learning Opportunities

 
Extreme Heat
Across the nation we have been experiencing heat waves. Extreme temperatures can negatively affect people, especially populations like nursing home residents. Both staff and residents must take necessary precautions to prevent complications related to excessive heat. Nursing home residents are among the most vulnerable to heat exhaustion and heatstroke.
 
Some suggested interventions for your facility may include the following:

  • Establish a facility protocol with guidance from the medical director about when outdoor activities can/should occur. If residents must be out, such as for transport to medical appointments, etc. be sure they are dressed appropriately for extreme temperatures and be sure to pack them with hydration materials. 
  • Alert staff to monitor residents for the signs and symptoms of heat exhaustion and heatstroke. Notify the resident’s physician of such observations and obtain medical services as needed.
  • Request clinical pharmacist monthly reviews to highlight potential medications that might create higher risks. Review resident medications and identify those that may cause residents to become more susceptible to harm from heat and sunlight.
  • Assure that facility policies and procedures for heat emergency situations are current, complete and staff are trained.
  • Monitor temperatures in care areas and resident rooms.
  • Monitor residents’ choice of clothing to ensure it is appropriate in extreme temperatures. Loose-fitting, light-colored cotton clothing is best to allow the skin to breathe.
  • Help decrease temperatures by closing window blinds and turning off unneeded lights in the daytime.
  • Assist residents to maintain adequate fluid intake. In addition to water, consider popsicles, Jell-O, sherbet and juices to keep residents hydrated.
  • When outside, encourage residents to sit in shaded areas and to use sunscreen.
  • Close windows, doors and blinds during the daytime and open them at night after the outside temperature cools sufficiently.

Check out the following resources to take proactive steps in ensuring you stay cool, hydrated and recognize signs and symptoms of heat-related illness:

Extreme heat should be treated as a major weather emergency, just like an extreme storm and the possibility of power outages. Now is the time to pull out the facility emergency and disaster plans, ensure they are up to date, and be sure staff are educated about what to do.

 
Safe Temperatures in Nursing Homes
There are regulations requiring long-term care facilities to maintain safe temperatures.

F-Tag 584 pertains to comfortable and safe temperature levels in nursing homes. According to the regulation, facilities initially certified after October 1, 1990, must maintain an air temperature range of 71°F to 81°F. Ensuring a comfortable environment is crucial for residents’ well-being, minimizing susceptibility to hypothermia or hyperthermia.

Residents with a history of dehydration, cardiovascular disease or pulmonary disease are particularly susceptible to heat-related illnesses and complications. All staff should be aware and monitor for signs, symptoms and consequences of heat exhaustion, heatstroke and heat cramps.

Use this NHICS response guide as a checklist to ensure tasks are addressed and completed regarding severe weather.

 
Power Outages
Nursing homes across the country may experience power outages for various reasons. Many of these reasons are centered on natural disasters, such as hurricanes and tornadoes. Electrical interruption may also be caused by failing systems, such as electrical grid brownouts or blackouts. When nursing homes lose power, especially for extended periods of time, disaster can strike.

How can nursing homes prepare for the possibility of a power outage? The Federal Emergency Management Agency (FEMA) has published guidelines to facilitate the preparation process.

Among the preparation steps, FEMA recommends:

  • Analyzing risks, particularly those systems and components that can interfere with the ability to deliver care when power outages occur.
  • Identifying specific at-risk residents, such as those receiving temperature-stabilized medications or who may need power-operated support systems.
  • Securing temporary power support, including the use of generators.
  • Setting up redundant cooling systems for food supplies and medications, including off-site or temporary refrigeration facilities.
  • Establishing a maintenance and resupply chain for emergency power systems.
  • Establishing a plan to access resident records during power outages.
  • Establishing communication with organizations like emergency services, local or state health departments, emergency management agencies and evacuation shelter facilities.
  • Enhanced staff training to develop emergency-response skills and to ensure that all staff members understand their specific duties during a power outage.
  • Ensuring that nursing home insurance policies provide coverage for natural disasters that result in loss of electrical service.
  • Identifying shelters that are able to maintain healthcare services for residents if they are forced to evacuate.

By taking these steps in advance of a power outage, nursing homes will be better equipped to provide continuous and safe care to residents, all without subjecting residents and staff to the risks associated with electrical service interruption.

 
Hurricanes
Hurricanes are dangerous and can cause major damage from storm surge, wind damage, rip currents and flooding. They can happen along any U.S. coast or in any territory in the Atlantic or Pacific oceans. Storm surge historically is the leading cause of hurricane-related deaths in the United States.

Hurricane season is here, take time to understand and prepare for how a hurricane could affect you. You can start your hurricane preparedness efforts by downloading FEMA’s Hurricane Hazard Information Sheet.

Visit Ready.gov/hurricanes for more information and tips about hurricanes. You can also download the FEMA app (free of charge) to learn how to prepare for common hazards, receive real-time alerts from the National Weather Service and search for additional disaster preparedness guidance.
 
Tornadoes
Tornadoes are violently rotating columns of air that extend from a thunderstorm to the ground. Tornadoes can destroy buildings, flip cars and create deadly flying debris.

A tornado can:

  • Happen anytime and anywhere.
  • Bring intense winds, over 200 miles per hour.
  • Look like funnels.

The National Weather Service (NWS) provides numerous tornado safety resources. They can be accessed directly at Tornado Safety.

 
 

Shelter In Place: A Critical Component of Your Emergency Operations Plan: Updates from an Expert

by HQIN Consulting Subject Matter Expert Jordan Rennie, Owner and Principal of Rennie Consulting

Jordan assists the Health Quality Innovation Network (HQIN) as a subject matter expert working with nursing homes on emergency preparedness plan reviews and emergency preparedness education.

In the face of emergencies, healthcare facilities must be prepared to make quick and informed decisions to protect residents, staff and resources. A well-crafted Shelter in Place (SIP) section within your Emergency Preparedness Plan (EPP) is essential to ensuring operational continuity and safety. Here is a concise guide on key elements your SIP strategy should cover:
 

1. Preparation and Planning
 
Risk Assessment: Conduct a thorough risk assessment to identify potential scenarios that may necessitate SIP, such as severe weather, hazardous materials incidents or infrastructure failures. Tailor your SIP plan to these specific threats. This can be done while completing your annual Hazardous Vulnerability Assessment (HVA).

SIP Locations: Identify and designate safe areas within the facility where residents and staff can gather. These areas should be protected from external hazards and have access to necessary resources.

Supplies Inventory: Ensure a robust inventory of emergency supplies, including medications, food, water and medical equipment. Stock enough to sustain operations for at least 72 hours.

Upstaffing: Plan for increased staffing levels in anticipation of an SIP event. Arrange for additional clinical and support staff to be on site to handle increased demands and resident care needs.

Family: Ensure your family is prepared at home with their own shelter in place plan. You will not be able to adequately respond to an emergency at your facility if you are worried about folks at home.

2. Decision-Making: Shelter or Evacuate?
 
Criteria for SIP vs. Evacuation: Establish clear criteria to guide the decision on whether to shelter in place or evacuate. Consider factors such as the nature and scope of the threat, the condition of the facility and the safety of evacuation routes.

Decision Authority: Define who has the authority to make the SIP or evacuation decision. Ensure this individual or team is trained and has access to real-time information and communication channels.

Communication Plan: Develop a communication strategy to relay the decision to staff, residents and their families. Ensure everyone understands the protocol and their specific roles during an SIP event.

3. Proactive Measures
 
Resource Management: Maintain increased levels of critical supplies. Establish relationships with vendors to ensure quick resupply of essentials such as food, water, fuel and medical supplies. In addition, consider having a list of vendors both in your area and outside. This will increase resilience should vendors in your area be impacted as well.

Generator Capacity: Verify that your backup power systems, including generators, are functional and can support critical operations for extended periods. Regularly test these systems and ensure fuel supply arrangements are in place. Consider installation of generator “quick connects” that allow easy deployment of external generators.

Environmental Controls: Ensure that HVAC systems and other environmental controls can be managed during an SIP to maintain safe and comfortable conditions for residents and staff.

4. Communication with External Entities
 
Local Emergency Management: Establish and maintain open lines of communication with local emergency management agencies. Share your SIP plans and seek alignment with community emergency response strategies. Local emergency management leaders can assist you in making the decision to shelter in place or facilitate evacuation.

Vendor Coordination: Develop agreements with vendors for emergency delivery of essential supplies, including fuel, water, food and medical goods. Ensure contact information is current and establish protocols for rapid response.

Information Sharing: Implement mechanisms to share and receive information with external partners during an SIP event. This includes updating local authorities on your facility’s status and needs and receiving critical updates from emergency management agencies.

5. Training and Drills
 
Regular Training: Conduct regular training sessions for all staff on SIP procedures. Ensure everyone understands their roles and responsibilities during an SIP event.

Drills and Exercises: Perform regular SIP drills to test your facility’s preparedness. Use these exercises to identify gaps in your plan and refine your strategies.

6. Regulatory Requirements and Resources
 
Planning and preparation are great practices. They can assist in creating a more resilient and safer environment for staff and residents. However, it is also important to keep regulatory requirements in mind. The following E-Tags are covered by the CMS Emergency Preparedness Rule relating to SIP and Evacuation.

Regulatory E-Tags: E0018, E0020, E0022, E0015, E0041

For more information, refer to the CMS Emergency Preparedness Rule Webpage.
 

Conclusion
A comprehensive SIP plan is vital to the resilience of healthcare facilities during emergencies. By focusing on preparation, clear decision-making processes, proactive measures and robust communication with external entities, you can ensure that your facility is ready to protect and care for residents and staff when the unexpected occurs.

 
Training and Education Importance
Emergency Preparedness Plan training and education is crucial for both staff and residents in nursing homes.

You want your staff to be prepared and you want your residents to feel safe.
You can accomplish this by providing staff with:

  • Knowledge and Skills: Staff need to be well trained in emergency procedures, including evacuation, communication and response protocols. Training ensures they know what to do during various emergencies.
  • Drills and Exercises: Regular drills and exercises help staff practice their roles, understand evacuation routes and learn how to handle different scenarios.

Trained staff can respond efficiently, minimizing risks to residents and themselves.

For resident safety, providing residents with:

  • Awareness: Residents should be informed about emergency plans, evacuation routes and safety measures. Training helps them understand what to expect during emergencies.
  • Shelter In Place and Evacuation Readiness: Residents need to know how to safely shelter in place, evacuate safely and how to follow instructions from staff.
  • Reducing Panic: Proper training reduces panic and confusion during emergencies, ensuring residents can follow procedures calmly.

Remember, ongoing training, exercises and evaluation are essential to ensure staff and residents respond appropriately during emergencies.

 
Is Your Emergency Preparedness Plan Survey Ready?

See What People Are Saying About Our EPP Review Assessment Tool:

“I truly appreciate your insights. This was extremely helpful as I get my EPP updated.”
“Thanks for your insight and expertise.”
“I’m so grateful for your help.  This review was exactly what I needed.”
“Time well spent.”

Are You in Need of a Turnkey,
Ready to Implement, Tabletop Exercise?

The team of experts at the Health Quality Innovation Network (HQIN) is offering free support to ensure your facility’s emergency preparedness plan meets all the necessary criteria.
 
Take our online assessment, which guides you through a series of questions that will quickly identify what could be missing in your current emergency preparedness plan. After you submit your responses, an HQIN quality improvement advisor will review your responses and provide you with tools and resources to help support survey readiness. In addition, we will send you a complete, ready to implement, Tabletop Exercise and After-Action report.

Ready to get started? Scan the QR code or click the button below:

 
Click HERE to Take the Assessment
 
After Action Report Improvement Plan Template
Download our After Action Report Improvement Plan Template, which is a tracking form that allows teams to record real emergency events and exercises to document the scenario, capabilities tested, strengths, areas for improvement and more.

Nursing Home Excellence:
Prepare, Prevent, Protect (3P) Top Performer Program
The Health Quality Innovation Network’s (HQIN) Prepare, Prevent, Protect (3P) Top Performer Program recognizes participating nursing homes who are proactive in delivering high quality care to their residents and ensuring a safe environment for residents, staff and visitors.

The 3P Top Performer facilities achieve success in the following three designations:

  • PREPARE: Implement planning, policies and training on emergency preparedness and infection prevention.
  • PREVENT: Prevent avoidable resident emergency department visits, readmissions and hospitalizations.
  • PROTECT: Commit to ongoing, proactive immunization program.

Congratulations on achieving success in all three designations! Share with your staff and recognize them for their contributions.

Download the list of nursing home facilities being recognized.

 
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 (SLCR), in the event a disaster occurs resulting 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 office main office telephone number during normal business hours because survey staff carry the cell phone and may be conducting a survey or inspection during working hours and may not answer immediately.

Download the Emergency Protocol Handout for Facilities for the phone number to use in your area.

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

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.

 
 

Learning Opportunities

Facility Assessment: More Than a Regulatory Requirement

Learn CMS Required Regulatory Components Due by August 8!

July 17 at 10 a.m. ET
Join us on July 17 where we will focus on the new facility assessment requirements from the Centers for Medicare & Medicaid Services (CMS). You will not want to miss this opportunity to learn what needs to be done by August 8 to ensure your facility assessment meets all required regulatory components
 
The facility assessment is referenced 172 times in the 329-page staffing rule and is also the first requirement in preparation for the staffing requirement. F838 has been in play since 2016 but is taking on a new shape and focus with less than a month to make the required updates by August 8.
 
At the end of the session, you will:

  • Understand the revised facility assessment requirements and regulatory updates.
  • Understand how to complete the facility assessment process with your team.
  • Understand how to identify resources that are necessary to care for residents competently during normal day-to-day operations and emergencies.
  • Understand how to link the facility assessment to your emergency preparedness plan (EPP) and QAPI program.

Learn how the Health Quality Innovation Network (HQIN), as your Quality Improvement Organization, can provide assistance.

Register Here
 
 

Learning Modules for Nursing Home Staff, Visitors and Residents Teach Infection Prevention

Infections can be deadly in nursing homes. Solid infection prevention practices, coupled with the COVID-19 vaccine, are key to protecting those who live and work there.

Download our flyer and post it in your nursing home to encourage staff, visitors and residents to learn how to prevent infections. The brief learning modules, which are accessible through a link on the flyer or by scanning the QR code, review the dangers of infections and how to prevent them.

 
 

Newly Updated CMS Training for Frontline Nursing Home Staff and Management – Modules 5 and 8

Learn about the impact of dementia in caring for nursing home residents with COVID-19 and how to protect the emotional health of nursing home staff through this no-cost, updated Quality, Safety & Education Portal (QSEP) online training developed by the Centers for Medicare & Medicaid Services (CMS).

View scenarios In Module 5: Caring for Residents with Dementia to gain more understanding of the special needs that residents with dementia have and how to best care for them. Master content at your own pace, learning anytime and anywhere, even on your mobile devices.

While many concerns rest on the physical health and well-being of nursing home staff and residents, emotional health is also important. Module 8: Emotional Health, is designed for nursing home managers to learn how to develop creative strategies to promote and support emotional health for staff and residents.

 
 

New Learning Modules on Diabetes Available Now!

We are pleased to announce the release of our comprehensive new learning modules on diabetes. These modules are designed to enhance your knowledge and skills in identifying, treating and managing diabetes, providing you with the latest best practices for optimal resident care. To access these modules, and others on a variety of topics, visit HQI Academy, our online learning management system.  
 
New to HQI Academy? After you follow the link, click “SIGNUP” in the upper right. Fill out the short form to create your account. Once logged in, you’ll have access to a variety of courses on the main dashboard. Simply click on the cover of any course to start learning.
Access HQI Academy
 
 
About the Health Quality Innovation Network
Led by Health Quality Innovators and its quality improvement partners, Constellation Quality Health, KFMC Health Improvement Partners and the Kansas Healthcare Collaborative, HQIN is the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Kansas, Missouri, South Carolina and Virginia. To learn more about HQIN visit https://www.hqin.org.
 

Staying Healthy and Safe in the Summer’s First Heat Wave

In 2023, 34 Missourians died due to heat-related illnesses. Heat is the number one cause of weather-related deaths in the United States.

The Missouri Department of Health and Senior Services (DHSS) urges Missourians to take precautions as heat and humidity rise to dangerous levels. In 2023, 34 Missouri residents, ranging in age from 11 months to 96 years, died due to heat-related illness.

“Heat and humidity can place a lot of stress on the body,” said DHSS Director Paula F. Nickelson. “Heat exhaustion can come on suddenly, with little warning, and lead to heatstroke which becomes a very dangerous situation.”

This early wave of extended extreme heat may not have given Missourians the time to adjust to higher temperatures. This is especially true for some groups like pregnant women, very young children or older adults.

During excessive heat, Nickelson urges Missourians to check on friends and neighbors, especially those who are elderly and chronically ill. To report a senior citizen or an adult with disabilities who is in need of assistance due to the heat, call the state’s toll-free abuse and neglect hotline at 1-800-392-0210, or make a report online.

People who are working or exercising outside in the heat or have certain chronic health conditions such as heart disease, lung disease or diabetes may need to take extra care in the heat. Medications, as well as those with substance use disorder, can impair a body’s response to heat, making one more vulnerable to the heat. Additionally, those experiencing homelessness are at a greater risk of experiencing heat-related illness.

Never leave a child or pet alone in a vehicle. Even on a cooler day, the temperature inside a vehicle can rise by 20 degrees in 10 minutes and is life threating to anyone left inside.

Heat-related illness can affect anyone. Take steps to stay cool in the hottest hours of the day:

  • Prepare your home—Use air conditioning and change air conditioner filters; cover windows that receive morning or afternoon sun with drapes or shades.
  • Stay indoors—Stay in air-conditioned places as much as possible. At home, take a cool bath or shower, use stoves and ovens less often, and keep window blinds and curtains closed to help maintain cooler temperatures. During prolonged periods of high temperatures, use air conditioning – either at home or by seeking shelter in a local cooling center. Don’t rely on fans to keep you cool. Fans are generally okay for providing comfort in temperatures less than 90° F. But at temperatures over 90° F, a fan can make body temperature rise.
  • Schedule activities carefully—Plan outdoor activities for morning or evening hours when the temperatures are cooler.
  • Wear appropriate clothing—Do not over-dress. Good choices are lightweight, light-colored, loose-fitting clothing.
  • Pace yourself—Reduce exercise or physical activity as much as possible during the hottest part of the day and take frequent breaks in the shade or in an air-conditioned place.

Take steps to stay hydrated:

  • Drink plenty of fluids—Take a drink break every 20-30 minutes regardless of your activity level, and do not wait until you are thirsty. Water or hydrating sports drinks are best. Avoid sugary, caffeinated and alcoholic beverages, which actually cause you to lose body fluids.
  • Wear sunscreen—Sunburn affects your body’s ability to cool down and can cause you to become dehydrated.

Take steps to stay informed:

  • Check on friends and neighbors—Especially older adults and individuals with a disability or chronic health conditions, as heat is more likely to affect their health. If you find an emergency situation – call 911. In a non-emergency situation, if a senior or disabled adult is suspected of being in need of assistance due to warm weather, make a call. Make a difference. Call the toll-free Missouri Adult Abuse and Neglect Hotline at 1-800-392-0210
  • Know the signs and symptoms of heat-related illnessWhat to do matters, depending on type of illness occurring. Signs of heat exhaustion may include heavy sweating; cold, pale and clammy skin; dizziness; headache; muscle cramps; tiredness or weakness; nausea or vomiting; or fainting (passing out). If you think you or others are experiencing heat exhaustion, you should stop physical activity and move to a cool place that is preferably air-conditioned, loosen clothing, and sip cool water.

Seek medical attention immediately if you or others are throwing up, your symptoms get worse or symptoms last longer than one hour. Heat stroke is life-threatening and occurs when the body is unable to control its temperature or cool down. Signs of heat stroke may include extremely high body temperature (103°F or higher); hot, red, dry skin with no sweat; fast, strong pulse; throbbing headache; dizziness; nausea; confusion; or loss of consciousness (passing out). You should call 911 right away, as heat stroke is a medical emergency. Then, if you are able, move to a cool place that is preferably air-conditioned. Help lower the person’s body temperature with cool cloths or a cool bath until medical personnel arrive. Do not give the person anything to drink.

  • Pay attention to weather forecasts and heat advisories- CDC’s HeatRisk map is one tool that provides local heat risk information to keep you and others safe.

For more information regarding heat-related illness and prevention, visit the websites of DHSS or the CDC.

New QIPMO Newsletter – May 2024

The Quality Improvement Program for Missouri (QIPMO) has published MDS Tips and Clinical Pearls (Volume 11, Issue 3).

In this issue:

Are You Being Proactive?
Immunization Billing Assistance
QIPMO and ICAR Education Resources
Recognizing a Resident’s ACOC
ICAR Corner
Emergency Management

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

Is Your Emergency Preparedness Plan Survey Ready?

Our team of experts at the Health Quality Innovation Network (HQIN) offers free support to ensure your facility’s emergency preparedness plan meets all the necessary criteria.

Take our online assessment, which guides you through a series of questions that will quickly identify what could be missing in your current emergency preparedness plan. After you submit your responses, an HQIN quality advisor will review your responses and provide you with tools and resources to help support survey readiness.

Ready to get started? Click HERE to Take the Assessment

Preventing Frozen Sprinkler Pipes/Systems

Across the state, sprinkler pipes are freezing and breaking due to the extreme temperatures making it difficult to maintain building temperature.  Below is a quick list of items you can use to help prevent sprinkler systems from freezing/breaking.

  • Per NFPA 13, facilities must maintain a minimum of 40 degrees F in the spaces containing the systems
  • Check attic insulation. Tradesmen may have moved the insulation and not replaced it.
  • Add additional insulation.
  • Install temperature sensors to check for cold spots.
  • Possible heat tracing for branch lines per NFPA 13. Remember these are not allowed on valve bodies.
  • Re- balance HVAC to ensure adequate coverage in all areas.
  • Install additional permanent heaters (temporary heaters (such as space heaters) are not allowed)

 

NFPA 13, 2010 edition

  • 16.4 Protection of Piping.
  • 16.4.1 Protection of Piping Against Freezing.
  • 16.4.1.1 Unless the requirements of 8.16.4.1.2 are met, where portions of systems are subject to freezing and temperatures cannot reliably be maintained at or above 40°F (4°C), sprinklers shall be installed as a dry pipe or preauction system.
  • 16.4.1.2 Small unheated areas are permitted to be protected by antifreeze systems or by other systems specifically
  • listed for this purpose, including but not limited to listed heat tracing systems.
  • 16.4.1.3 Where aboveground water-filled supply pipes, risers, system risers, or feed mains pass through open areas, cold rooms, passageways, or other areas exposed to temperatures below 40°F (4°C), the pipe shall be protected against freezing by insulating coverings, frost proof casings, listed heat tracing systems, or other reliable means capable of maintaining a minimum temperature between 40°F (4°C) and 120°F (48.9°C).
  • 16.4.1.4 Where listed heat tracing systems are used, they shall be supervised.
  • 16.4.1.5 Where listed heat tracing is utilized for branch lines, it shall be specifically listed for use on branch lines.

Dangerous Heat Warnings for Missouri

The National Weather Service has issued a heat advisory for portions of Missouri for Thursday, June 29 and Friday, June 30. As temperatures rise this summer, it is important to prioritize heat related safety measures. Heat-related illnesses can have serious consequences, but with some precautions and awareness, we can create a safer work environment.

Heat-related illnesses often affect the very young, the elderly and the chronically ill, but summer temperatures can also take a toll on healthy young and middle-aged adults. In 2022, 23 people died from heat exposure in Missouri, ranging in age from 2-83 years.

During prolonged periods of high temperatures, using air conditioning – either at home or by seeking shelter in a local cooling center – is the best preventive measure.

“Heat and humidity can place a lot of stress on the body,” said DHSS Director Paula Nickelson. “Heat exhaustion can come on suddenly, with little warning, and lead to heatstroke which becomes a very dangerous situation.”

During excessive heat, Nickelson urges Missourians to check on friends and neighbors, especially those who are elderly and chronically ill. To report a senior citizen or an adult with disabilities who is in need of assistance due to the heat, call the state’s toll-free abuse and neglect hotline at 1-800-392-0210, or make a report online. Medications, as well as use of drugs or alcohol, can impair a body’s response to heat, making one more vulnerable to the heat.

Never leave a child or pet alone in a vehicle. Four of Missouri’s heat-related deaths in 2022 were individuals in vehicles. Even on a cooler day, the temperature inside a vehicle can rise by 20 degrees in 10 minutes and pose a real threat to anyone left inside. Stress, distraction and being out of a normal routine can all contribute to forgetting a child in a car seat. Check the back seat each time you exit your vehicle.

There are a number of steps individuals can take to stay cool including:

  • Stay hydrated. Drink plenty of water regardless of your activity level, and do not wait until you are thirsty to do so. Avoid sugary and alcoholic beverages; these actually cause you to lose body fluids.
  • Wear appropriate clothing. Wear lightweight, breathable, and loose-fitting clothing that allows air circulation. When outside, consider wearing a hat and sunglasses to protect yourself from the sun.
  • Stay cool indoors. Stay in air-conditioned places as much as possible. Find a local cooling center if needed.
  • Schedule outdoor activities carefully. Try to plan outdoor activity for morning or evening hours when the temperature is coolest.
  • Pace yourself. Reduce exercise or physical activity during the hottest part of the day, and take frequent breaks in the shade or in an air-conditioned place.
  • Wear sunscreen. Sunburn affects your body’s ability to cool down and can make you dehydrated.
  • Prepare your home. Change air conditioner filters, and cover windows that receive morning or afternoon sun with drapes or shades.
  • Stay informed. Pay attention to weather forecasts and heat advisories. Stay informed about the local heat index and adjust safety measures accordingly.

Knowing the signs and symptoms of heat related illness and how treat them is also important. Signs of heat exhaustion may include muscle cramps; heavy sweating; cold, pale and clammy skin; dizziness; headache; nausea or vomiting; and fainting or passing out. If you think you or a loved one are experiencing heat exhaustion, you should stop physical activity move to a cool place – preferably air-conditioned, loosen clothing, and sip cool water. Seek medical attention immediately if you are throwing up, your symptoms get worse or symptoms last longer than one hour.

Signs of heat stroke may include high body temperature (103°F or higher); hot, red, dry or damp skin; fast, strong pulse; headache; dizziness; nausea; confusion; or loss of consciousness. If you think you or a loved one are experiencing heat stroke you should call 911 immediately. Heat stroke is a medical emergency. Move the person to a cool place – preferably air-conditioned. Help lower the person’s body temperature with cool cloths or a cool bath until medical personnel arrive. Do not give the person anything to drink.

For more information regarding heat-related illness and prevention, visit the websites of DHSS or the CDC.

MANHA-ICAR Seminar

Seminar: Public Health Emergency Ending – What’s Next?

April 6, 2023: Holiday Inn Route 66, St. Louis
April 13, 2023: Courtyard by Marriott, Columbia
April 26, 2023: Stoney Creek Hotel & Conference Center, Independence

The Public Health Emergency (PHE) is scheduled to end as of May 11, 2023. Moving forward it will be essential to apply pandemic lessons learned to maintain and improve processes that will benefit residents/families, staff and facility leadership.

HQIN Offers No-Cost Emergency Preparedness Plan Reviews

Unsure if Your Emergency Preparedness Plan Meets Infection Prevention and Control Requirements. HQIN Can Help!

Health Quality Innovators (HQI) serves as the CMS-designated Quality Improvement Organization for Missouri. Facilities throughout the state partner with our Health Quality Innovation Network (HQIN) on various projects to improve operational processes and clinical outcomes.

Based on lessons learned throughout the pandemic, HQIN is offering a no-cost virtual review of participating nursing homes/ emergency preparedness plans with a focus on integration of infection control and prevention. This support is intended to enhance emergency response and survey readiness.

An HQIN representative will contact you to schedule a review or you may request a review by emailing LTC@hqi.solutions.

New Release: Heat and Humidity can be a Dangerous Combination

(JEFFERSON CITY, MO) – The Missouri Department of Health and Senior Services (DHSS) urges Missourians of all ages to take precautions as heat and humidity rise to dangerous levels.

Heat-related illnesses often affect the very young, the elderly and the chronically ill, but summer temperatures can also take a toll on healthy young and middle-aged adults.

In 2021, 18 people died from heat exposure in Missouri, ranging in age from 35-105 years. Half of the deaths occurred among those between the ages of 35-64.

During prolonged periods of high temperatures, using air conditioning – either at home or by seeking shelter in a local cooling center – is the best preventive measure.

“Heat and humidity can place a lot of stress on the body,” said DHSS Acting Director Paula Nickelson. “Heat exhaustion can come on suddenly, with little warning, and lead to heatstroke which becomes a very dangerous situation.”

During excessive heat, Nickelson urges Missourians to check on friends and neighbors, especially those who are elderly and chronically ill. To report a senior citizen or an adult with disabilities who is in need of assistance due to the heat, call the state’s toll-free abuse and neglect hotline at 1-800-392-0210, or make a report online.

Medications can impair a body’s response to heat, making them more vulnerable to the heat.

There are a number of steps individuals can take to stay cool including:

  • Wear appropriate clothing – wear lightweight, light-colored, loose-fitting clothing.
  • Stay cool indoors – stay in air-conditioned places as much as possible. Find a local cooling center.
  • Stay hydrated – drink plenty of fluids regardless of your activity level, and do not wait to until you are thirsty. Avoid sugary and alcoholic beverages; these actually cause you to lose body fluids.
  • Schedule outdoor activities carefully – try to plan outdoor activity for morning or evening hours when the temperature is coolest.
  • Pace yourself – reduce exercise or physical activity during the hottest part of the day, and take frequent breaks in the shade or in an air-conditioned place.
  • Wear sunscreen – sunburn affects your body’s ability to cool down and can make you dehydrated.
  • Prepare your home – change air conditioner filters, cover windows that receive morning or afternoon sun with drapes or shades, and make sure you have portable fans if necessary.

Knowing the signs and symptoms of heat related illness and how treat them is also important. Signs of heat exhaustion may include muscle cramps; heavy sweating; cold, pale and clammy skin; dizziness; headache; nausea or vomiting; and fainting or passing out. If you think you or a loved one are experiencing heat exhaustion, you should stop physical activity move to a cool place – preferably air-conditioned, loosen clothing, and sip cool water. Seek medical attention immediately if you are throwing up, your symptoms get worse or symptoms last longer than one hour.

Signs of heat stroke may include high body temperature (103°F or higher); hot, red, dry or damp skin; fast, strong pulse; headache; dizziness; nausea; confusion; or loss of consciousness. If you think you or a loved one are experiencing heat stroke you should call 911 immediately. Heat stroke is a medical emergency. Move the person to a cool place – preferably air-conditioned. Help lower the person’s body temperature with cool cloths or a cool bath until medical personnel arrive. Do not give the person anything to drink.

For more information regarding heat-related illness and prevention, visit the websites of DHSS or the CDC.

 

Emergency Protocol for Facilities
The Emergency Protocol was developed in 2007 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.

This protocol (Emergency Protocol Handout for Facilities) provides the cellular telephone number corresponding to the region in which your home is located if you experience a loss in a necessary service – for instance Air Conditioning – 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.

Life Support and Life Safety Code

There has been some confusion about the definition of “life support”, specifically related to the type of generator required. Life support refers to any function performed by equipment, which if stopped, could result in loss of human life or serious injuries. NFPA 99, 2012 edition: 3.3.42 defines Electrical Life Support Equipment as an electrically powered equipment whose continuous operation is necessary to maintain a patient’s life.

Life support is not limited to a ventilator. For example, it can be a BiPAP or suctioning machine. Facility staff should receive clarification from the physician prior to admission as to whether or not the equipment is necessary to maintain the resident’s life.

If a facility accepts a resident who requires life support, it is important to ensure all the following requirements are met per NFPA 99 and 110:

  • The facility must have a definition of life support;
  • The admission agreement must state the facility will accept a resident on life support;
  • The generator must comply with the standards of a Type 1 Essential Electrical System (ESS) (a Type 1 EES has the most stringent requirements for providing continuity of electrical service – the Acceptance Testing paperwork will show the type), complying with the National Fire Protection Association (NFPA);
  • Testing and maintenance must be maintained as outlined in the NFPA;
  • Depending on the generator, the power must be split into two or three branches, that would include critical care, life safety and mechanical;
  • There must be plans to show which rooms/areas are supported by the life support electrical system;
  • All outlets must be marked (such as a red outlet cover) to show which plugs will support life support functions.

NFPA 110, 2010 edition:

4.4-Level. This standard recognizes two levels of equipment installation, performance, and maintenance.

4.4.1-Level 1 systems shall be installed where failure of the equipment to perform could result in loss of human life or serious injuries.

4.4.2-Level 2 systems shall be installed where failure of the EPSS to perform is less critical to human life and safety.

4.4.3-All equipment shall be permanently installed.

K915

 Electrical Systems – Essential Electric System Categories

Critical care rooms (Category 1) in which electrical system failure is likely to cause major injury or death of patients, including all rooms where electric life support equipment is required, are served by a Type 1 EES.

**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.

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 located here.

 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

 

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.

Thank you for preparing in advance and keeping us informed!

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.

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