CODE: PLAIN SPEECH/TEXT
Floods are the most common and widespread of all natural disasters. Most communities in the United States can experience some degree of flooding after spring rains, heavy thunderstorms, or winter snow thaws. Flash floods and floods are the #1 cause of death associated with thunderstorms, more than 90 fatalities each year.
Flash flood — occurs within a few hours (usually less than 6) of heavy or excessive rainfall, a dam or levee failure, or the sudden release of water impounded by an ice jam. Flash floods are like walls of water that develop in a matter of minutes.
Flood — is the inundation of a normally dry area caused by abnormal high water flow. Floods develop more slowly than flash floods, normally greater than 6 hours.
Flash Flood Watch — is issued when conditions are favorable for flash flooding. It does not mean that flash flooding will occur, but it is possible.
Flash Flood Warning — is issued when flash flooding is imminent or occurring.
Flood Watch — is issued when conditions are favorable for flooding. It does not mean flooding will occur, but it is possible.
Flood Warning — is issued when flooding is imminent or occurring.
River Flood Watch — is issued when river flooding is possible at one or more forecast points along a river.
River Flood Warning — is issued when river flooding is occurring or imminent at one or more forecast points along a river.
- Monitor facility’s weather alert radio, television, and broadcast radio for changing conditions, alerts, and warnings.
- Be prepared to relocate residents to safe areas well in advance of a storm; be proactive in planning and do not wait for the situation to become dire.
- Ensure windows and draperies are closed and distribute appropriate equipment to staff members (flashlights, first aid supplies etc.).
- Secure the outside of the facility and cancel any outside activities.
- Activate the facility’s ICS, if needed.
Common Staff Assignments
- Close all interior doors.
- Shut down non-essential equipment.
- Relocate residents, staff members, and visitors to safe, pre-designated locations.
- Monitor residents closely.
- Remain calm to not upset the residents.
- Brace for storm impact.
Specific Staff Assignments
- Notify Administrator and Director of Nursing if not on the premises.
- Activate the Incident Command System (ICS) to manage the incident. The most qualified staff member (in regard to the Incident Command System) on duty at the time will assume the Incident Commander position.
- Facility management staff should report to the Incident Command Post for a briefing and instruction.
- Evaluate the need to shut off electricity/utilities/water main/collect fresh water.
- Incident Commander must decide whether to flood proof or evacuate based on geographical location and history of flooding of the facility. If evacuation is necessary, Evacuation Emergency Procedures will be followed.
- It is essential that all internal emergency operations are coordinated with the local authorities. They will be able to quickly assist in controlling the situation provided that a good line of communication is established between them and the Incident Commander.
- Account for all staff members and residents.
- Activate the Recall Roster, if needed.
- Ensure that the fire department and County Emergency Manager have been notified and are responding following storm impact.
- Ensure that the specific procedures defined in the facility’s Severe Weather Response Plans are utilized to internally manage the incident.
- Utilize appropriate sections of the Kentucky LTC Emergency Preparedness Manual to manage the incident as needed.
- Maintain all operations in accordance with the ICS until the incident is officially terminated.
- The situation should only be deemed “under control” after the local authorities have concluded emergency operations and the Incident Commander has declared the situation “safe.”
- Consult with (county name) Emergency Management officials if facility is located in a flood plain and to review the history of flooding in the area.
- Purchase a National Oceanic and Atmospheric Administration (NOAA) Weather Radio with a warning alarm tone and battery backup. Listen for flood watches and warnings.
- Review the community’s emergency plan. Learn the community’s evacuation routes. Know where to find higher ground in case of a flood.
- More than half of all flood-related drownings occur when a vehicle is driven into hazardous flood water. Educate staff about vehicle use and rising water:
- Six inches of fast-moving water can knock you off your feet.
- Two feet of rushing water can carry away most vehicles, including SUVs and pickups.
- Many flash flood fatalities occur at night when streets are less visible.
- Show National Weather Service video Turn Around, Don’t Drown.
- Inspect areas that may be subject to flooding. Identify records and equipment that can be moved to a higher location. Decide where to move records and equipment in case of flood.
- Ensure insurance policy provides coverage for flooding. Evaluate the feasibility of flood proofing your facility.
- Permanent flood proofing measures are to be taken before a flood occurs and require no human intervention when floodwaters rise. They include:
- Filling windows, doors, or other openings with water-resistant materials such as concrete blocks or bricks. This approach assumes the structure is strong enough to withstand floodwaters.
- Installing check valves to prevent water from entering where utility and sewer lines enter the facility.
- Have sand and sand bags on hand and train on sandbagging techniques.
- Reinforcing walls to resist water pressure and sealing walls to prevent or reduce seepage.
- Building watertight walls around equipment or work areas within the facility that are particularly susceptible to flood damage.
- Constructing floodwalls or levees outside the facility to keep flood waters away.
- Elevating the facility on walls, columns, or compacted fill. This approach is most applicable to new construction, though many types of buildings can be elevated.
- Emergency flood proofing measures are generally less expensive than those listed above, though they require substantial advance warning and do not satisfy the minimum requirements for watertight flood proofing as set forth by the National Flood Insurance Program (NFIP). They include:
- Building walls with sandbags.
- Constructing a double row of walls with boards and posts to create a “crib,” then filling the crib with soil.
- Constructing a single wall by stacking small beams or planks.
- Participating in community flood control projects.
- Evaluating the need for backup systems, such as:
- Portable pumps to remove flood water.
- Alternate power sources such as generators or gas-powered pumps.
- Battery-powered emergency lighting.
- Contingent flood proofing measures are also taken before a flood but require some additional action when flooding occurs. These measures include:
- Installing watertight barriers (flood shields) to prevent the passage of water through doors, windows, ventilation shafts, or other openings.
- Installing permanent watertight doors.
- Constructing movable floodwalls.
- Installing permanent pumps to remove flood waters.
Clean Up and Reentering Facility
Prior to reopening a healthcare facility that has undergone extensive water and wind damage; inspections need to be conducted to determine if the building is salvageable. If the decision is made to proceed with recovery and remediation, building and life safety inspections must be completed before any restoration work is done to the facility. See section on guidance for infection control review of facilities to be performed before reopening.
Prior to opening any portion of a facility, adequate support services need to be available to provide quality care in a safe environment. Contracting with outside services could be considered.
Certification for occupancy must be obtained prior to reopening the facility. Regulations regarding healthcare facility certification and licensing differ from state to state. Refer to specific state and local government resources for more information.
Before and while entering the facility
Be cautious around electrical lines, downed lines, outlets and appliances. Do Not assume that the electricity has been turned off.
Avoid floodwaters – water may be contaminated by oil, gas, raw sewage. Water may also be electrically charged from underground or downed power lines.
Note where floodwaters have receded. Roads may have weakened and could collapse under the weight of a car.
Boil drinking water before using. Wells should be pumped out and the water tested for purity before drinking. Call your local public health authority or listen for reports on community’s water supply safety.
Watch for animals. Small animals like rats and snakes that have been flooded out of their homes may seek shelter in yours. Use a pole or stick to poke and turn items over and scare away small animals.
Look before you step. After a flood, the ground and floors are covered with debris including broken bottles and nails. Floors and stairs that have been covered with mud can be very slippery.
Wear face mask and gloves.
- Safety EvaluationThe following should be evaluated by facilities experts:
- Structural integrity and missing structural items
- Assessment of hidden moisture
- Electrical system damage, including high voltage, insulation, and power integrity
- Water distribution system damage
- Sewer system damage
- Fire emergency systems damage
- Air handling system damage
- Medical waste and sharps disposal system
- Water RemovalWater should be removed as soon as possible once the safety of the structure has been verified.
Pump out standing water.Wet vacuum residual wetness from floors, carpets, and hard surfaces.Clean wet vacuums after use and allow to dry.
- Water Damage Assessment and Mold RemediationOpen the windows in the damaged areas of the building during remediation. Remove porous items that have been submerged or have visible mold growth or damage.Minimize dispersion of mold spores by covering the removed items and materials with plastic sheeting (dust-tight chutes leading to dumpsters outside the building may be helpful). Dispose these items as construction waste.Seal off the ventilation ducts to and from the remediation area and isolate the work area from occupied spaces, if the building is partially occupied.Scrub and clean hard surfaces with detergents to remove evidence of mold growth (if a biocide is used, follow manufacturer’s instructions for use and ventilate the area. Do not mix chlorine-containing biocides with detergents or biocides containing ammonia).
- Get rid of mud as soon as possible.
- Clean everything that got wet.
- Don’t risk contamination. “If in doubt, throw it out.”
- A solution of one part household bleach and four parts water will kill surface mildew and, if used as part of a regular maintenance program, will prevent mildew from returning.
- Dry the area and remaining items and surfaces.
- Evaluate the success of drying and look for residual moisture in structural materials (Moisture-detection devices [e.g., moisture meters] or borescopes could be used in this evaluation).
- Remove and replace structural materials if they cannot be dried out within 48 hours.
- Inspect, Repair, Disinfect where Appropriate, or Replace Facility Infrastructure. Include:
- HVAC system (motors, duct work, filters, insulation)
- Water system (cold and hot water, sewer drainage, steam delivery, chillers, boilers)
- Steam sources (if piped in from other places, e.g., utility companies, it will impact autoclaves)
- Electrical system (wiring, lighting, paging and patient call systems, emergency generators, fire alarms)
- Electronic communication systems (telephones, paging and resident call systems, computers)
- Medical gas system
- Hazardous chemicals/radioactive storage
- General Inventory of Areas with Water and Wind Damage
- What furniture can be salvaged? Discard wet porous furniture that cannot be dried and disinfected (including particle board furniture). Disinfect furniture with non-porous surfaces and salvage. Discard upholstered furniture, drapery, and mattresses if they have been under water or have mold growth or odor. Discard all items with questionable integrity or mold damage.
- What supplies can be salvaged? Salvage linens and curtains following adequate laundering. Salvage pre-packaged supplies in paper wraps that are not damaged or exposed to water or extreme moisture, or in a molded environment. Discard items if there is any question about integrity or mold exposure. Dry essential paper files and records (professional conservators may be contacted for assistance).
- Electrical medical equipment. Check motors, wiring, and insulation for damage. Inspect equipment for moisture damage. Clean and disinfect equipment following manufacturer’s instructions. Do not connect wet electronic equipment to electricity.
- Structures. Inspect, repair, or replace wallboard, ceiling tiles, and flooring. Repair, replace, and clean damaged structures.
- Disposal of Contaminants
- Dispose of all foods and canned goods that came in contact with flood waters.
- Do not dispose of hazardous chemicals and materials (those marked “danger, caution, poison, warning, flammable, toxic, keep out of reach of children and hazardous”) in the trash, down the drain or into standing water as they can contaminate groundwater and sewer lines. Take these items to the designated hazardous materials waste site.
- Review Issues for Reopening Facilities
- Requirements needed prior to opening a facility: potable water, adequate sewage disposal, adequate waste and medical waste management.
- Have all areas to be opened been thoroughly dried out, repaired, and cleaned?
- Does the number of air exchanges in areas of the facility meet recommended standards?
- Are negative-pressure rooms functioning properly?
- Post-Reoccupation Surveillance
- Focused microbial sampling may be indicated to determine if:
- The water in the facility’s water distribution system meets the microbial standards of the Safe Drinking Water Act; See information on Boil Water Advisory.
- Mold remediation efforts were effective in reducing microbial contamination in the affected areas of the facility (see: http://www.epa.gov/mold/mold_remediation.html);
- Residents who are receiving care in the reopened facility acquire infections that are potentially healthcare associated and that may be attributed to Aspergillus spp. or other fungi, non-tubercular mycobacterium, Legionella, or other waterborne microorganisms above expected levels.