Sonoma County Disaster Planning Guide

for

Individuals with Developmental Disabilities,

Their Families,

and for

Those Who Serve

Individuals with Developmental Disabilities

 March 2001 

Preparation of this manual was originally funded by a grant from

North Bay Regional Center, 2351 Mendocino Avenue

Santa Rosa, California  95403 - (707) 569-2000

 

The manual originally written by Edward R. Lupton, Jr.

Discover Living, 10532 Spenceville Road, Suite 321,

Penn Valley, CA  95946 - (530) 432-7530

 

March 2001 Edition

Revised by the Sonoma County Special Needs Disaster Preparedness Team

 

Table of Contents

 

Summary of the Basics

Sonoma County………………………………………………..Page    3       

Special Needs People…A Definition…………………………….         4       

The Challenge……………………………………………………        4

Organization and Communication……………………………….         5

Continuing Education Class……………………………………..                   6

Personal Information Binders……………………………………                  6

“Like” Facilities…………………………………………………          .         8       

Special Needs Shelter…………………………………………….        9

Monitoring Consumers at the Evacuation Site……………………        10

Transfer Trauma………………………………………………….       11

Recovery After a Disaster/Evacuation……………………………        12

Identification……………………………………………………..        14     

Medication……………………………………………………….        15

Residential Care Facility Supplies……………………………….                   15

Medical Supplies and Equipment………………………………..         16     

Pets………………………………………………………………                  16     

Appendix…………………………………………………………       17

Consumer Packet for Independent Living Consumers…….        18-29           Questionnaire for Licensed Facilities………………………          30-39

          Emergency Telephone Numbers……………………………      40                Identification Sheet…………………………………………        41                Medication Sheet……………………………………………    42                Emergency Evacuation Questionnaire………………………   43-44           Special Needs Resident Form……………………………….   45                Supplies For A Special Needs Shelter………………………    46-51           Inventory Your Home……………………………………… 52                Water Barrels……………………………………………….       53

          Gravity Fed Water Filter……………………………………      54-56

          Regular and Special Needs Cots         ……………………………      57-59

Light Sticks…………………………………………………      60                Emergency Planning Resources…………………………….     61                Resource Material…………………………………………..  62                Possible Concern For NBRC Consumers In A Disaster…….  63-64           Emergency Alert Sentinel (EAS) Radio…………………….        65-66

Summary of the Basics:

The planning and preparing for any and all disasters is an ongoing process requiring continuing education and the continual updating of disaster preparedness plans and equipment.  It is understood that being prepared for a disaster is the responsibility of everyone within the service delivery system, whether that person is a consumer or service provider.  Being prepared will reduce stress and trauma, save lives and save property.  In the case of a service provider, being prepared may save the business.  Plans on paper will not save lives.  Being trained, prepared, and equipped will save lives.

Since each emergency is unique, no one plan is going to cover every contingency as it unfolds. Some recommendations are as follows:

1.    Everyone should go through a disaster planning training to learn how to appropriately prepare for a disaster.

2.    The Personal Information Sheet with photo, Medication Sheet, and Questionnaire should be maintained for all consumers and updated for all appropriate parties.

3.    Each individual, family and service should gather and regularly inspect adequate emergency supplies.

4.    Individuals, families and facilities should establish reciprocal agreements with like individuals, families, and facilities, one nearby and two in opposite outlying areas, in case of a disaster requiring evacuation.  Out of state contacts should be identified in case local phone lines become inoperable. 

5.    Everyone should hold regular and scheduled disaster or emergency drills and once or twice a year have a test evacuation and test their “calling tree” system.  Remember, early warning is key to the success of an evacuation. 

6.    Everyone should keep their vehicle gas tanks at least half full at all times.

7.    Everyone is invited to participate on the Sonoma County Special Needs Disaster Preparedness Team, which includes representatives of American Red Cross and the Office of Emergency Services.  Contact Richard Ruge, North Bay Regional Center at (707) 569-2017 or email richardr@nbrc.net for further information.

8.    After a disaster, consumers may be eligible for government funds for home repair, essential appliances, cooking stoves, refrigerators, space heaters, certain moving expenses, etc. It is important that each individual and facility carefully document all expenses and losses resulting from the disaster for submission as a claim for reimbursement or to qualify for financial support.

Sonoma County - An Introduction:

Sonoma County is the most northern of the San Francisco Bay counties.  With a population of a little over 450,000 (167,000 in unincorporated areas), it covers over 1500 square miles.  It is located approximately 40 miles north of San Francisco along the Pacific coastline.

The county is unique in that it has been subjected to a variety of natural disasters over the years.  The 1906 earthquake caused more per capita fatalities in Santa Rosa due to building failures than in San Francisco.  To this day it is the deadliest per capita earthquake disaster ever in an American city.  The San Andreas Fault goes up the coastline.  The Rodgers Creek/Healdsburg Fault lies in the most heavily populated areas in the middle of the county, which includes hospitals, government buildings, and licensed facilities.  Due to fine soil composition, it is prone to greater shaking intensity and settling.  Earthquakes are an ever-present threat, and must be taken seriously in Sonoma County.  The USGS has assigned a 70% probability of a major Bay Area earthquake in the next 30 years. 

The highest flood loss rate in California is in Sonoma County.  Floods occurred in 1986, 1993, 1995, 1997, and in 1998.  Areas affected most are by the Russian and Petaluma Rivers.  With forty-four dams in the county and the Coyote Dam near the head of the Russian River in Mendocino County, there is danger of dam failure in an earthquake or flooding if water goes over a spillway due to heavy rains.  However, this has never happened. 

Wildfires in 1996 and the Rio Nido landslides of 1998 add to the variety of potential disasters.  Perhaps, the most common disaster is power outage due to downed trees or lines.  With more frequent intense winter storms in recent years, power outages have become a common occurrence and with longer duration.

 

Special Needs People…A Definition:

Individuals who, due to physical, mental, developmental conditions, or advanced age, are functionally limited in their ability to independently carry out activities of daily living; or such individuals who, due to a disaster (actual or impending), are at increased risk of being functionally limited in their ability to independently carry out activities of daily living.

 

The Challenge:

The North Bay Regional Center (NBRC), located north of San Francisco in the counties of Sonoma, Napa, and Solano serves people who have the following developmental disabilities: cerebral palsy, mental retardation, epilepsy, autism, and/or disabling conditions closely related to mental retardation or requiring similar treatment to that required for individuals with mental retardation. 

The purpose of this manual is to address the needs of those NBRC consumers and their caregivers in Sonoma County if a disaster takes place.  These special needs people must not only be given every opportunity to survive a catastrophe, but also to minimize the trauma of the physical and emotional stresses of the following months. 

Organization and Communication:

The Sonoma County Office of Emergency Services (OES) is responsible for the planning, coordination of response and recovery activities related to countywide emergencies and disasters.  OES serves as the primary coordination point for emergency management’s communication flow between the Federal, State, and local levels; developing emergency operations plans for the county, cities, and districts; conducting training and educational outreach programs related to emergency preparedness; and sponsoring emergency management training.  This is the lead agency for the Sonoma County Operational Area.  Under the State of California’s Standardized Emergency Management System (SEMS), the operational area is the primary level of coordination for the response and recovery activities following an emergency or disaster.  SEMS works from the bottom up.  This means that the city first and then the county must use up all of its resources, including medical staff, supplies, ambulances, and other resources, before requesting assistance from the region, State, or Federal agencies.

Sonoma County utilizes the Community Alert Network (CAN) computerized telecommunications system at their Emergency Operation Center (EOC). It can be programmed to call thousands of homes an hour, and is currently programmed to call only local listed telephone numbers with addresses.  During an emergency the EOC is staffed with key local, county, and state agency personnel.  The EOC public information hotline is:  (707) 565-3856.  If there is a question or need, this hotline number can be utilized.

Emergency information is broadcast through radio stations KSRO 1350 AM and KZST 100 FM. 

It is recommended that individuals and organizations purchase Emergency Alert Sentinel (EAS) radios programmed to turn on if there is a local emergency broadcast.  This will ensure early warning in an emergency, and can be kept at a receptionist’s desk or other appropriate location.  Additional information about the EAS system is at the back of this manual.

 

The Need for Training:

One of the key elements in the success of implementing a successful disaster plan is individual preparation.  Administrators of licensed facilities have many considerations that need to be addressed before a call to evacuate is heard.  Administrators must know that if they use county resources in an emergency, they may be billed for these services.  Facilities must plan in advance and be prepared to act on their own. 

In addition, administrators of day services will need training to know how to proceed with an evacuation and/or disaster while their day programs are in session.  They need to realize that their facilities may become a shelter if their attendees are not able to evacuate.  Therefore, they will have to provide temporary care and supervision to make sure their attendees survive.

Contact the Sonoma County Special Needs Disaster Preparedness Team for the next scheduled training in our area.

 

Personal Information Binders:

It is important that each facility and day program maintain a binder that includes information on all of the individuals who they serve.  In the event of the need to evacuate, this information will be used to identify consumers’ personal and medical needs.  Drivers providing transportation should also have a binder of information on consumers who they are transporting.

It is the responsibility of the administrator of each licensed residential facility to provide the necessary information on each consumer to the coordinator of the day/work program.  It is recommended that the information include the following:

1.    A Personal Information Sheet that provides place of residence, telephone numbers, responsible parties, insurance information, doctor, etc.  The Personal Information Sheet should also include a picture of the individual taped to the backside, and placed in a plastic sleeve for added protection.  Proper identification is a serious problem in shelters, and that is why this sheet is a key part of the preparation process.  A master copy is included in the Appendix.

2.    Two Identification Labels that peel off and can stick on a person’s shirt or blouse.  The label will list the person’s name, facility name, and telephone number, and across the bottom their diagnosis.  If there is a special situation regarding the person’s health or behavioral needs, place a big “red” dot in the lower right hand corner. Such conditions as seizure, allergy, heart condition, special diet, behavioral issues, etc. would need to be identified so that a caregiver or volunteer can follow proper procedures in meeting the needs of a particular individual.  If all the critical information can not be included on the label, write “See Personal Information Sheet” to signal the fact that the Personal Information Sheet needs to be reviewed before proceeding with personal care. This extra bit of communication may avoid injury to the consumer or the caregiver. 

3.    A Medication Sheet.  Each residential facility needs to supply the day/work program with a current medication sheet that is updated with each change of medication.  In addition to the medication sheet, the facility needs to include a copy of the doctor orders for each medication.  It is critical that the day/work program coordinators has current medical information and maintain it in assessable binders.  The binders must be taken with the consumers during an evacuation in case emergency medication needs to be ordered.

Special consideration should be taken for those consumers on medication, and how the necessary medication will be obtained in case of an emergency.  Mental Health or Health and Human Services cannot guarantee medication assistance in advance.  However they have a system to coordinate with pharmacies and may be able to transport medication where it is needed in case of a disaster. Through the Emergency Services hotline number, the appropriate medication can possibly be delivered.  During a disaster doctors will need to assess medical needs and handle emergency refills.  With proper documentation, a doctor should be able to order emergency medications.  Due to the physical and mental stress caused by the trauma of being in a disaster, consumers may also need a medication reassessment, and may need additional medication to bring their situation back into balance.

4.    Advance Directive.  Certain consumers need to be identified who are not appropriate in a public shelter or a special needs shelter.  Individuals with heavy care needs living in intermediate care facilities might be an example.  It may be better for these individuals to be temporarily placed in a hospital setting or a skilled nursing facility.  Therefore, it would be necessary to have a doctor prepared and signed Advance Directive stating that in the event of an evacuation, the named individual should be admitted to a hospital, skilled nursing facility, or other acute care setting.  Providing necessary supplies as well as caregivers for these consumers is an important issue that must be addressed.  A form is in the Appendix for individuals with acute needs.

If appropriate, each consumer must be trained to understand his or her role in case of a disaster.  It is critical that every consumer understands his or her responsibilities, which may include the signing of a release of personal information.  Consumer information is highly confidential, and is a serious public trust that must be undertaken with care and with the clear and complete understanding of the consumer and/or his/her conservator. 

 

Like Facilities:

Community Care Licensing requires that licensed facilities be responsible for the care and supervision of their residents.  This includes meeting the needs of their residents in an emergency.  State law requires that each licensed facility have an emergency plan.  The use of reciprocal agreements with other like facilities to receive each other’s residents in time of an evacuation is a necessary part of disaster planning in Sonoma County.  Each facility needs to have a written agreement with at least three other facilities.  One alternate facility should be in the same area to cover the contingency of a disaster happening in one facility or in one small area.  Moving residents to another like facility close by would be advantageous in this instance.  If the evacuation is of a larger scale, consumers may need to be moved to another city or county to get out of the danger area.  It is recommended to have reciprocal agreements with two facilities in different areas.  This will give the evacuating facility an alternative if one direction is blocked.  It is recommended that facilities in other counties be utilized to be more certain of having a relocation site out of the danger area.

Since there will probably be no beds available at the relocation facility, day and residential services should prepare to supply their own beds.  In the Appendix there is information about the Westcot, a special needs cot, which is ideal for individuals with acute needs.

 

Supplies:

There are multiple reasons why roads may not be passable after a major Sonoma County disaster.  Therefore, one of the primary elements of a disaster plan is for everyone to prepare and plan as if they have to remain at their location until search and rescue directs them to move to another location.  Supplies should include:

1.     Licensed facilities are required to have at least a week’s supply of food.  That is a good rule for everyone. 

2.     If there is no water, you are going to need a back-up supply.  Figure at least one gallon of water per individual per day for a minimum of three days to a week, if possible.  If you have a swimming pool, well, lake, river, or pond nearby, a gravity fed water filter can filter 30 gallons of water per day.  (See Appendix.)

3.     A portable commode should be available to replace a toilet that will not flush during a period of no water.  Simply line the commode with a large garbage bag and replace after each use.

4.     In case there is no electricity, obtain a supply of light sticks that can last up to twelve hours.  They are very handy in an emergency situation indoors and outdoors.  Keep a supply in your vehicles.  (See Appendix.)

5.     Licensed facilities need to provide cots for their residents or they will be subjected to sleeping on the floor, which can cause trauma as well as an immediate deterioration in health. (See the Appendix for the Westcot.)  It is also recommended that independent living consumers bring their own cot to an evacuation site to assure proper sleeping..

 

Medical Supplies:

During an evacuation it is difficult to obtain needed medical supplies.  Since people may not be able to return to the danger area, it could be difficult to obtain needed equipment and supplies.  Plan and obtain projected medical supplies for your evacuation kits.

 

Pets:

If a consumer has a pet, a consumer-approved plan should be in place so that the consumer knows what will happen to the pet when the consumer evacuates.  Preplanning for pets can relieve a great deal of stress, in the event of an emergency

 

Special Needs Shelters most likely will not be an option:

Certain consumers may not be able to survive in a public shelter.  The responsibility for care of consumers lies squarely on the care provider.  Depending on the severity and location of the disaster area, a special needs shelter may be chosen as an extreme last resort from a pre-approved list of shelters.  Again, licensed residential facilities need to move their residents to pre-arranged like facilities to limit the consumers coming to the shelter.

 

Monitoring Consumers at an Evacuation Site:

It is important to realize that there is internal trauma taking place among those at an evacuation site.  Again preplanning is essential.  Which trained personnel will be attending the consumers?  Have these individuals been trained in shelter management? Contact the Sonoma County Special Needs Disaster Preparedness Team for the next scheduled Shelter Management training in our area.

The following is a list of the primary fears and anxieties during a crisis: the consumer or someone else will die, the consumer will be separated from loved ones, the consumer will be left alone and/or the disaster will happen again.  To help consumers cope in the aftermath, the caregivers at the shelters should include the following daily routines:

1.    Bond with the consumers.  Touch and hugs are as good if not better than medication to control anxiety and fear.

2.    Keep the consumers involved.  Give them something to do.  Make them feel that they are helping to restore the situation back to normal.

3.    Spend extra time with them in the evening.

4.    Be honest and talk about what happened and what is being done to help them.

5.    Encourage them to talk about their feelings, and keep progress notes of their responses for later review.

6.    Praise them and give them support for their normal behavior

7.    Understand that it is good for the consumers to release their emotions, but not at the expense of disrupting others.

8.    Re-establish a daily routine that includes work, play, meals, and rest.  Hopefully, they will have relocated to a facility that is similar to the one they had to evacuate. 

 

Transfer Trauma:

With some planning and common sense, most people will live through an evacuation unless the disaster is massive.  Barring this major catastrophe where most people would stay where they were until they could be rescued, most consumers should be moved to a like facility.  Being uprooted from routine and familiar surroundings is going to have an extreme affect.  The fear and panic that can surround a catastrophe will pay a toll.  This is why planning is so critical.

Every effort should be made to make this uprooting of the consumers and staff go as smooth as possible.  Transfer trauma can destroy the well being of anyone.  Everyone will react differently.  It is best to create a comfortable routine and try to plan activities and tasks for the day to complete during the evacuation.  It will be important that familiar people are with the consumers.  Therefore, it is essential that staff plan to follow residents.

Some emotional sign of stress are anticipation of harm of self and others, anxiety, depression, grief, irritability, identification with victims, and feeling overwhelmed.  Some cognitive signs of stress are confusing trivial with major issues, decision-making difficulties, memory loss, calculation difficulties, reduced attention span, concentration difficulties, and distractibility.  The physiological signs of stress are fatigue, fine motor tremors, gastrointestinal upset, nausea, muscle aches, profuse sweating, chills, frequent urination, dizziness, itching, heart palpitation, and choking or smothering sensations.  The behavioral signs of stress are insomnia, crying easily, gait change, substance abuse, ritualistic behavior, and an unwillingness to leave the scene.

There are six good ways to relieve stress.  They are to increase physical activity, eat well-balanced meals, set realistic goals and prioritize them, reduce environmental stress, ventilate, and use relaxation techniques.

 Few studies have been done of the impact of a disaster on the frail, elderly, and disabled.  Ed Lupton’s own experience during the evacuation of elderly from a facility during the 1997 floods was having seventeen of forty-five elderly leaving the facility in the following twelve months due to death or deteriorating health.   This is 37% of the census.  Based on the events during the evacuation, this excessive loss of residents was due to the trauma of transferring the residents to shelters and living in the shelters. 

 

Recovery After a Disaster/Evacuation:

Everyone must have a role in the recovery process after a disaster/evacuation.  There are going to be material and non-material needs.  For some it will be finding a place to stay and providing food, clothing, and other belongings to begin anew.  Those facilities and individual consumers and staff who have lost everything need to be guided and assisted in dealing with the agencies that will restore and replace their necessities.  The Sonoma County service delivery system must be prepared to guide those in need to professionals who can help complete the necessary paperwork to get the recovery process started.  Both Community Care Licensing and the Regional Center will be involved in assisting in the placement of consumers if homes have been destroyed.

Even though a material loss impacts immediately, the greater loss and sometimes the devastating loss is the loss of one’s emotional equilibrium.  Confusion, anger, frustration, and grief are going to cause many problems.  Whether it is an outburst of rage or withdrawing, emotional needs must be addressed and released.  Otherwise, depression, guilt, and sickness will follow.  There can be recurring nightmares and flashbacks.  There will not be a quick recovery for some.  The more we educate and prepare ourselves, the better we coordinate our efforts, the less stress will occur.

Immediately following the re-entry back to homes and facilities after evacuation, the service delivery system should make an assessment of all independent living consumers as well as those in licensed facilities.  Some of the key areas that must be addressed are:

1.    Is there any structural damage to the home?  If so, it should be reported for further investigation.  Licensed facilities are required to report structural damage to Community Care Licensing to evaluate whether it is necessary to remove consumers from the facility until it is safe to return.

2.    Are the consumers going to be properly fed?   Because of the trauma of the crisis, there may be a breakdown in the normal mealtime routine.  It may be necessary to arrange for meals to be delivered.

3.    Encourage an early doctor visit to review medications and to re-assess the needs of the patient.

4.    It is important to document and address any changes in eating habits, sleeping habits, disposition, anxieties, depression, etc.

5.    If there are damage claims or other forms to be filed, assistance needs to arranged, if necessary, to assist the consumer.

6.    Encourage re-establishing of former routines.  Consumers may need to restore their self-confidence and their self-worth.  Strive for as many supportive relationships as possible for each consumer.

7.    Always remember that each consumer may not be the same person as prior to the disaster.

8.    As the months following the disaster pass, there may be nightmares, flashbacks, loss of energy, and self-doubt.  That is why it is important the consumers be contacted regularly and problems reported immediately.

9.    As part of this plan, it is recommended that each consumer be individually tracked for one year after the major disaster, and that a statistical analysis be made to evaluate the results of disaster preparation. 

Appendix

Date:

 

Dear

 

As an individual living independently or with your family, it is critically important that you and those that support you have developed a plan in case of an emergency or a disaster.  You live in Sonoma County and therefore you know that on occasion we have earthquakes and floods that could disrupt services to you.  Most of us think that if a serious disaster occurred, the police or fire department would come to our rescue.  Or we may think our IHSS worker or Independent Living Skills worker or our Regional Center Case Manager will be by to support us in a disaster.  None of this may happen.  The police and fire department and your regular support team may be trying to survive themselves and unable to reach you.  You need to think about what you will do if your support team is prevented from coming to your aid in case of a disaster.  We have prepared questionnaires and lists to support you in being prepared. 

 

We want you to be independently ready and prepared to save yourself.  We suggest you encourage those you love to be prepared as well.

 

 

The Sonoma County Special Needs Disaster Preparedness Team

P r e p a r a t i o n   f o r   c o n s u m e r s   a t   h o m e : 

Š      Prepare your own plan.  Know who will be available to support you in case of a disaster.  Know where you will go, who will take you and how you will get there in case you have to evacuate.

Š      Develop an evacuation route from each room of your home.  It is important that every member of the household be familiar with each way out.  Designate a location for everyone to meet outside.  If you have a second floor, a rescue ladder will create an escape route from a second floor window.

Š      Have an evacuation drill with ever member of the household at least every three months.

Š  Complete the Medication Sheet, Personal Identification Sheet, and Questionnaire.  Make certain that appropriate support persons know where these documents are maintained.  Give your day/work program a copy of your current Medication Sheet, copies of current doctor medication orders, and the Personal Identification Sheet.       

Š  Inventory all your furnishings and items of value throughout your home.  It is also a good idea to take pictures for proof of the contents of your home. Have a fireproof container for all important documents. This would include birth and marriage certificates, wills, durable powers of attorney, conservatorship, security certificates, deeds, etc.   Keep a list of bank accounts, brokerage accounts, credit card numbers, social security and Medicare numbers, important telephone numbers, and make an inventory of the contents of your house for insurance verification. (See Appendix)  It is important to have this information all together in order to be able to remove it quickly in an emergency.

Š Have the name and telephone number of a relative or friend far away from your  home for everyone on your support team to call for their location and condition in case of an emergency.  Someone out of state would be best, as local calls may not be possible.

Š      Prepare a backpack or suitcase to use when evacuating, bring clothes appropriate for the season.  This would include a jacket, sweat pants and sweat shirts, underwear and socks for the week, thermal underwear (winter), heavy and lightweight shoes, bed clothes, comb, brush, tooth brush, tooth paste, soap, wash cloth, towel, denture cup, deodorant, female necessities, shaving necessities, sun glasses, sun screen, etc.

Š      If the disaster is such that you remain at home, you will need a sufficient supply of food, stored water, and alternative sources of light as basic supplies to meet primary needs. It is recommended to have supplies for three days at minimum, but preferably for a week to ten days.  Figure on one individual using a gallon of water per day at minimum and store accordingly.  Remember that quality water in a crisis is a valuable commodity.  A water filter can filter swimming pool water, ponds, lake, creeks, etc. Remember to replace your stored water on a regular basis (at least every six months) to ensure usability.  Use common sense in storing sufficient food.  Freeze-dried food serves the purpose of emergency food, but is not something you will utilize other than for emergency purposes.

Š      Have back-up emergency light.  This could be a portable generator, extra flashlights, camping light and light sticks.  Store extra batteries.  Do not depend on candles or a lantern because of fire and explosion dangers. 

Š      Additional items would include a portable commode in case water is shut off.  Simply line the commode with a large plastic garbage bag and replace it after each use. Have a good First Aid Kit with extra gauze, tape, aspirin, plastic garbage bags, fire extinguisher, duct tape, firewood for a fireplace, portable heater (non-electric), twine, wire, paper face mask, manual can opener, matches, knife, sleeping bag(s), cot(s), clothes for the season including extra jacket and shoes, various tools, plastic sheeting, aluminum foil, pet food, extra eye glasses, contact lens, sun glasses, extra prescriptions, etc.

Š      Each person should carefully assess their needs and set aside the appropriate supplies. Realize that your home may be damaged, and you may not have complete use of your home.  Therefore, it is good to set supplies aside so that you can gather them quickly during a crisis.

Š      Remember food and water spoil, batteries become out-dated, etc.  Keep going over be your plans and emergency materials on a regular basis with your support team.  You will be thankful for your efforts if a disaster ever does occur.

Š   Know where and how to shut off your water, gas, and electricity.

Checklist For When You Get The Call To Evacuate

Š      When you are advised or directed to evacuate, you will put into motion your plan to relocate.  You may need to quickly move to another home outside the danger area.  You should already have determined the transportation and location well in advance.

Š      Turn on radio station KZST 100 FM or KSRO 1350 AM for current emergency information.

Š      If possible, telephone your contact person(s) in the distant area letting this person(s) know where you are going and how you are going to be transported.  If possible, give them a telephone number and address.  The information would also include your telephone number at new location (if possible), and anticipated time of arrival.

Š      If there is a home health agency assisting with care, contact them and inform them of the location of the shelter or place you will stay.  They will want to continue with their plan of care as best as possible during the evacuation.

Š  Carry your completed Identification Sheet, a picture of yourself, insurance information, and copies of doctor’s prescription orders all in a plastic pouch.  You should keep your Identification Sheet, Medication Sheet, Emergency Evaluation Sheets, insurance cards, and other important information in an envelope attached to the refrigerator or other central location where it can be found and taken easily. It would be helpful to have a copy of all Doctor’s orders for current medication in the envelope as well.  This will make it easier to order refills, if necessary.

Š  Bring all current medication including refills and as needed medication.

Š Bring your fireproof container with all your important documents.

Š      If you have a pet and are going to a special needs shelter, take it with you.  There should be an arrangement for your pet to be cared for during the evacuation.

Š      Bring underclothes for a week and outer clothes for at least three days.  Easy fitting clothes like sweat pants and shirts, also a jacket, and an extra pair of shoes.  Toiletries such as comb, brush, tooth brush, tooth paste, soap, wash cloth, towel, denture cup, deodorant, female necessities, shaving necessities, sun glasses, sun screen, etc.  Take a blanket, sleeping bag, cot, and pillow. Bring incontinent supplies, inhalers, diabetic kits, portable oxygen tanks and concentrator, if necessary.

Š  Be sure to bring some petty cash with you since banks will be closed and ATM machines may not be working.

Š   Be sure to fill your gas tank early if you know that you may be evacuating.

Š      Bring reading material and games to pass the time during the evacuation.

Š      ________________________________________________________________________________________________________________________________     ________________________________________________________________________________________________________________________________________________________________________________________________

     ________________________________________________________________________________________________________________________________

     ________________________________________________________________________________________________________________________________________________________________________________________________

     ________________________________________________________________________________________________________________________________

     ________________________________________________________________________________________________________________________________

 

Identification Sheet_____________________________________________

 

Last Name                                             First                                        Middle                                   Sex                          Age

Social Security No.                              Medicare No.                        Medical No.                          Date of Birth

Diagnosis

 

Physician                                               Address                                                                                 Phone

 

 

___  Mentally Alert             ___  Ambulatory                  ___  Diabetic                                        ___  Incontinent

 

___  Slightly Forgetful        ___  Walker                          ___  Requires Special Diet ___  Bladder

 

___  Confused                      ___  Wheelchair                   ___  Requires Oxygen                         ___  Bowel

 

___  Private           ___  Welfare         ___  Medicare/Welfare       ___  Medicare/Private         ___  Other

Pharmacy                                               Address                                                                                 Phone

Allergies

Responsible Party                                                                                Relationship

Address                                                                                 City                         State                       Phone

Alternate Physician                             Address                                                                                 Phone

Dentist                                                   Address                                                                                 Phone

Mortuary To Notify                             Address                                                                                 Phone

 

Next of Kin or Other Responsible Persons to Notify in an Emergency (Name, Relationship, Phone No.)

 

 

Additional Information

  

Medication Sheet

 

Name____________________________________Ph. No._________________

 

MEDICATION                      DOSAGE                      DOSAGE SCHEDULE

 

__________________  _______________________   _____________________

__________________  _______________________   _____________________

 

__________________  _______________________   _____________________

 

__________________  _______________________   _____________________

 

__________________  _______________________   _____________________

__________________  _______________________   _____________________

__________________  _______________________   _____________________

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EMERGENCY TELEPHONE NUMBERS

1.        North Bay Regional Center (Santa Rosa):  (707) 569-2000

2.        Office of Emergency Services: (707) 565-1152

3.        Police Department:  911 OR ________________________________________________________

4.        Sheriff Department: 911 OR ________________________________________________________

5.        Fire Department: 911 OR __________________________________________________________

6.        Hospital: (Emergency): ____________________________________________________________

7.        Transportation

Contact Person: __________________________________________________________________

Telephone Number: _______________________________________________________________

8.        Alternative Transportation

Contact Person: __________________________________________________________________

Telephone Number: _______________________________________________________________

9.        Predetermined Location to Evacuate

A.      Name: ______________________________________________________________________

              Address: ____________________________________________________________________

              Contact Person: _______________________________________________________________

              Telephone Number: ____________________________________________________________

B.       Name: ______________________________________________________________________

              Address: _____________________________________________________________________

              Contact Person: _______________________________________________________________

              Telephone Number: ____________________________________________________________

C.       Name: ______________________________________________________________________

             Address: _____________________________________________________________________

              Contact Person: _______________________________________________________________

              Telephone Number: ____________________________________________________________

10.     Home Health Registry

Name: ____________________________________________________  Ph. No. ______________

11.     Emergency Public Information Hotline:  (707) 565-3856

12.     Salvation Army: ____________________________________________  Ph. No. ______________

13.     Fuel Provider: ______________________________________________  Ph. No. ______________

14.     Electric Company: __________________________________________  Ph. No. ______________

15.     Water Company: ___________________________________________   Ph. No. ______________

16.     __________________________________________________________ Ph. No. ______________

17.     __________________________________________________________Ph. No. ______________
EMERGENCY EVACUATION/SPECIAL NEEDS QUESTIONNAIRE

Personal Information

Name: __________________________________________  Spouse: ___________________________

Home Address: _________________________________________________ Apt. No.: ____________

Mailing Address: ____________________________________________________________________

City: _____________________________________  Zip Code: _____________  Phone: ___________

Age: ____________  Date of Birth: _______________________  Sex                  o   Male             o  Female

Residence Type:                  o   Private Home                             o   Apt/Condo                    o   Mobile Home

Name of Complex/Subdivision: ________________________________________________________

Yearly Resident?  o   Yes         o   No                                If no, from: _____________  to: ______________

Type of Medical Disability:  ___________________________________________________________

Are you a Hospice Patient:  o   Yes                       o   No

(If yes, include a copy of your physician’s “No-Code” with this form.)

 

EVACUATION INFORMATION:

Type of shelter requested:                                 o   Standard                o   Special Needs

Do you:  o   Care for yourself              o   Have Caretaker                o   Need Assistance

Name of Caretaker: __________________________________________  Phone #: _______________

Are you ambulatory  o   With              o   Without Assistance

Please answer the following:                                              Yes                         No                           Sometimes

Are you confined to a bed?                                               o                o                o

Do you use a wheelchair?                                                  o                o                o

Do you use a walker or cane?                                            o                o                o

Do you require a special diet?                                           o                o                o

If yes, what type? ____________________________________________________________________

 

Are you on a life-support system requiring electricity?                o   Yes         o   No

If yes, which type?              o   Oxygen                  o   Respirator

If you use oxygen, how many hours do you use it per day? ___________________________________

Do you have a portable oxygen tank?                              o   Yes         o   No

Are you on any medication(s)?                         o   Yes               o   No

If yes, what kind? ___________________________________________________________________

 

Are you allergic to any medication(s)?            o    Yes         o   No

Name of your physician _____________________________________________ Ph. No. __________

Eligibility for the Special Needs Shelter:

(Please check any item applicable)

 

o          Oxygen therapy                    o          Indwelling catheter(s)

o          Life support equipment       o          Bedridden

o          ‘Ostomy management         o          Heavy medication use

o          Injectable medications (shots) or IV therapy

o          Frequent dressing changes (at least daily)

o          Dependent on others for care and assistance

o          Terminally ill

o          Unstable medical condition; needs regular nursing or monitoring (please specify) ___________

________________________________________________________________________________________________________________________________________________________

o          Other _______________________________________________________________________

Please list the types of disposable medical supplies you u se on a daily/weekly basis:

 

 

Do you have any other comments or suggestions that may assist us in your care during an evacuation?

 

 

Nearest relative or friend to contact in the case of an emergency:

 

Name: _________________________________________________________  Phone #:___________

 

The undersigned individual grants permission for the North Bay Regional Center to release this information to emergency response agencies.

______________________________________________________  Date: _________________

                                Signature

 

If the person filling out this form is different from the named individual, please answer the following:

 

Name: _________________________________________________  Phone #: _______________

 

Agency: ________________________________________________

You should keep a copy of this form in your records and copies should be given to those who support you.

 

INVENTORY YOUR HOME

The first thing you need to do is to check your homeowner’s policy to see if the insurance company is going to replace the contents based on their purchase price or their replacement value.  As long as you are aware of the coverage you own, you won’t be surprised with the payment.  The next best thing is to go room to room and take pictures of all items of value.  If you have a log of the purchase prices or even the receipts of valuable items, it would be very helpful to retain this information in one place.  Valuable collectibles should have recent appraisals to substantiate their value.  Store this information in your safety deposit box and/or your fire proof/waterproof box.  Now, make a list of important items in each room:

 

LIVING ROOM

 

 

 

BEDROOMS

 

 

 

 

OFFICE/DEN

 

 

KITCHEN/LAUNDRY

 

 

 

GARAGE

 

 

 

 

FAMILY/RECREATION ROOM

 

 

 

Make a list of collections, valuable paintings and sculptures, heirlooms, and other items of special value.  This will make it easier to substantiate your claim to the insurance company.