One flaw is that most nursing homes have a way to evacuate patients locally but no plans if the local options are washed out.

01:00 AM EDT on Tuesday, July 18, 2006

BY FELICE J. FREYER
Journal Medical Writer

The stream that runs behind Silver Creek Manor in Bristol gave the nursing home its picturesque name. It also poses its greatest natural threat.

In a big storm, Silver Creek Manor -- sandwiched between Bristol Harbor and the widest part of the river -- could quickly become an island. No food or medicine or doctors would be able to reach its frail residents.

That's why Gerald Romano, the nursing home's administrator and owner, has an expertise that may be unique in Rhode Island. He knows how to evacuate a nursing home. In fact, he's done it three times.

The nursing home has never been isolated by flooding. But on three occasions when a major storm was brewing, Romano and his staff moved everybody and everything out. The 128 residents, the entire kitchen, all the food, all the medical supplies, all the laundry supplies, even the mattresses went out in moving vans, school buses and ambulances. It took about three hours each time.

They went a mile up the road to the Rhode Island Veterans Home, a place that won't flood and that has an empty wing.

Romano's evacuation plan has been distributed to all the nursing homes that are members of the Rhode Island Health Care Association, to guide them in their own disaster-planning efforts, says Alfred Santos, president of the nursing home trade group.

Every spring, Romano contacts all the people who help the nursing home move, and makes sure the vehicles will be ready if needed. He stocks up on supplies in case the power goes out. He asks relatives of patients whether, in the event of an evacuation, they want to come get their relative or have the person moved. A day or two before the evacuation, members of his staff go to the Veterans Home to make sure it will be ready. On the day of the evacuation, half the staff goes ahead to begin setting up -- and to make sure familiar faces greet evacuated residents.

Every nursing home has an evacuation plan, and most of the plans have just about all the necessary elements, Santos said.

But there's one flaw he frequently sees. Most nursing homes don't have a Plan B. They have a way to evacuate patients locally, but no plans if the local options are washed out. That's even true of Silver Creek. Asked what alternatives he had to the Veterans Home, Romano said, "None." He considers it unlikely that anything could happen to the brick building at the highest point in Bristol.

"That's what they said about Pearl Harbor," Santos said. "We're going to have to deal with those issues as an industry."

"Aside from that, I think our nursing homes have pretty good evacuation plans," Santos said. "If something happened right now, I'm sure they'd be able to handle it."

Hospitals have also been working on improving their disaster-response capabilities, said Gina Rocha, vice president of clinical affairs for the Hospital Association of Rhode Island.

A key aspect of that effort has been gathering hospital officials around the same table, communicating in ways that were rare in the past. A disaster planning committee involving all the hospitals meets regularly, Rocha said.

"If we should need to evacuate patients from a hospital, there is a plan in place," she said. "If we need to evacuate everyone out of state, there is a plan in place as well."

Each hospital has devised its own plan. For example, if any part of Rhode Island Hospital had to be evacuated because of storm damage, people would be moved among the 33 buildings.

Rhode Island, according to Rocha, is the first state to adopt a uniform set of definitions for emergency situations. Previously, a phrase such as "code blue" meant something different at every hospital. Now there is agreement on what all the words mean.

Meanwhile, the state has applied for financing for a system that would track patients as they enter the health-care system so no one would get lost in the shuffle, said Maria Wah-Fitta, state Health Department spokeswoman.

A patient would be assigned a number whenever he or she entered an ambulance or hospital. This number would go into a system that makes sure the patient's whereabouts are known.

Rocha said the hospitals will soon adopt a tracking system for bed availability -- a fast way to know which hospitals have available beds. This system will eventually hook up with hospitals in neighboring states.

Rocha didn't know which hospitals are at greatest risk of flooding, but said each has done its own analysis and made plans accordingly.

Rhode Island Hospital, the state's largest hospital and its only trauma center, is not at great risk of flooding, said Peter Ginaitt, the hospital's director of emergency preparedness.

"We feel very confident that we're not in a highly risky situation," Ginaitt said.

"You never say never," he added, pointing out that in the hospital's newest building, which houses the emergency department and operating rooms, all the facilities are on the third floor.

Rhode Island Hospital has also adopted the Hospital Emergency Incident Command System, an organizational structure in which people have defined roles and duties. If a hurricane were looming, the system would be activated, and the responsible people would gather at the operations center -- a conference room at Hasbro Children's Hospital equipped with fax machines, Nextel emergency phones and-- soon -- satellite phones.

"We will have the things that were missing in New Orleans," Ginaitt said. "I feel very confident this facility is ready."

The hospital's own power plant, and its two backup generators, can operate independently even if the rest of the state is without power.

Additionally, all the hospitals in the state have signed a memorandum of understanding for the relocation of patients, materials and staff in an emergency, Ginaitt said.

ffreyer@projo.com / (401) 277-7397