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Home My WebLink AboutBUSINESS PLANi ~ LIFECARE SOLUTIONS, INC. 4300 RESNIK COURT, UriIT #101 ~ -- ~= .~,•__ (HMMP} WAZARDOUS MATERIALS MANAGEMENT PLAN (UNIFIED PROGRAM CONSOLIDATED FORMI APPLICATION BUSINESSOWNER/OPERATOR ~ENTFIC~'-TION FORM (fiAZARDOUS MATERIALS FACILITY INFORMATION) BAKERSFIELD FIRE DEPT.. Q ` Prevention Services A~ H R P i rl~L D 900 Tz'uxtun Ave., Suite 210~~ F~RF Bakersfield, CA 93301 DB ARTM T Tel.: (661) 326-3979 ~~ Fax: {661) 852-2171 /J,l.~ Page 1 of 2 d 1.,,FACILtTY IDENTIFICATION . ±` FACILnY ID N0. 1 YearHe irminp ~O~ to ~ Yeas Ending ~ D a ,m BUSINESS NAME (Same as FACILITY NAME or DBA-Doing Business As) a BUSINESS P y~z 102 ~ ~ - SITE ADDRESS Y OD i .d i+ b / top clrr p KeM /G' LdP 1pc CA ~+ 9 iP / J ~ tos DUNN & HRADSTREET / ~ 9 7S w /~ •C• ,p 1~ 9 Q (4 D giOt~) ~ (G. ~ 107 COUNTY / 7~ OPERATOR NAME C ~ /~£ ~ ~ G t05 P~~ PHONE_ ' D/ tt0 [Ir OVIINER-INFbRMATiON. OWNER NAME !oar Rabb%as ,,, 0 NER PHONE sSs y5/-l 8'00 n2 OWNER MAILING ADDRESS 119 O l( ~ L L C/a•v •cJ ~oA ,D clrY ,,, srarE ~/` 1,s IP ~~/~ „e Ill , ~ ~ ~ ~ ~ ~ ENVIRONMENT9L•GONIACT.. ~ ~ ~ ~ CONTACT NAME l /~ ,t7 NTACT PHONE s 6 39-0/7/ 17a o,~ o CONTACT MAILING ADDRESS „s S oL; v s P.ir2/f ,2. arY d~~~~.A r~ srarE ,a1 c,~/.~'. zIP ?3c~a3 122 'PRIMARY `. . ' ~ iv:. ~MERGENCY~cONTACTS; -SECONl7ARX= NAME 123 NAME Q^ 128 TITLE !~ CCotc Mk.J,9 6E 124 TITLE ~ev ~ .g,~J.~6~e ~ 129 BUSINE S PHONE r D = ~ O 6 ~ 3 S 125 BUSINESS PHONE SoS G39- o~ 130 24-HOUR ~ ~ 126 24HOUR PHO7~ ~ 131 ~ .. ~ ~ 8D ~ ~ ~/ _ ~ ~ 0 PAGER N0. 127 PAGER N0. 132 133 ., , . V. EERTIEICATION Certification: Based om my inquiry of those individuals responsible fbr obtaining the information, ]certify under penalty of law that 1 have personally examined and am familiar with fhe information submitted in this inventory and believe the information is true, accurate, and complete. SIGNATURE OF SIGNER 136 DATE 134 7- zg a6 NAME OF DOCUMENT PREPAR R 1ea~ /<~ / 135 NAME OF OWNER/O ERATOR (SDIG RIN'r) 137 rRLE OF OWNERIOPERATOR 138 kt f ~ ~~l df ~ ~~ ~~ ~~ 55 aanaaS x~3 9T0/E00 HO~'d Ti7~OT 9002/SZ/L FD 2142 (Rev. 09105) x~ed~u~?'!i Q : ~+~ ~; ,~~~ ~o ~u.-~. ~r~.ss N 84 Y2' 4d' YJ EXHIBIT A ~~ N 89 17' M' l~ d7.~G' LESSOR LESSEE 4,~ y ~O '~` /~ `~ ~ C~ :~ `~P yam! -~ ~~ (HMMP) FIAZARDOUS MATERIALS MANAGEMENT PLAN SITE 8~ FACILITY DIAGRAM Page 2 oft i ,~~~ BAKERSFIELD FIRE DEPT. Prevention Services S ~ L E R 5 P I ~ D g00 Truxtun Ave., Suite 210 F/RF g~ersfield, CA 9330 J. ~~ A/~~~ ~ Tel.: (661) 326-3979 ~/~ Fax: (661) 852-2x71 S1TE DIAGRAM FACILITY DIAGRAM Business Name: /.~'~Cq,Ye___ S'o u */ o~S` Business Address: /~ .zanaaS x'~d 9T0/9T0 ~JHd Tip ~ OT 9002/~Z/L ~'~3~ti~?i3 UNIFIED PROGRAM INSPECTION CHECKLIST! SECTION 1: Business Plan and Inventory Program ~! Prevention Services e E R 3 F, 0 900 Truxtun Ave., Suite 210 FIRE Bakersfield, CA 93301 ARTM r Tel.: (661) 326-3979 Fax: (661) 872-2171 AGILITY NAM ~/~~ ~ INSPECTION DATE / Z7rdL INSPECTION TIME c,c,r~z~ ~~L ~ ADDRESS (,,/ ~.~y ~f J ~- PHONE jNO~. ~r~ e1 NO OF EMPLOYEES FACILITY CONTACT te' BUSINESS ID NUMBER ^ r ~ ~~~ 15-021- ~7L.~S-~. Section 1: Business. Plan and Inventory Program /~ 1 ~ ROUTINE ^ COMBINED ^ JOINT AGENCY ^ MULTI-AGENCY ^ COMPLAINT ^ RE-INSPECTION ~~ C V ( C=Compliance OPERATION V=Violation COMMENTS ^ APPROPRIATE PERMIT ON HAND ~,® ~~ ^ BUSIt1eSS PLAN CONTACT INFORMATION ACCURATE ^ VISIBLE ADDRESS U ^ CORRECT OCCUPANCY ~ ^ VERIFICATION OF INVENTORY MATERIALS O ~/ L^1 ^ VERIFICATION OF QUANTITIES ^ VERIFICATION OF LOCATION ~^ PROPER SEGREGATION OF MATERIAL ^ VERIFICATION OF MSDS AVAILABILITY ~,/ yr ^ VERIFICATION OF HAZ MAT TRAINING ^ ^ VERIFICATION OF ABATEMENT SUPPLIES AND PROCEDURES /~ ~ ~ ~ \ ^ EMERGENCY PROCEDURES ADEQUATE ^ CONTAINERS PROPERLY LABELED ^ HOUSEKEEPING L7 ^ FIRE PROTECTION ^ SITE DIAGRAM ADEQUATE & ON HAND ANY HAZARDOUS WASTE ON SITE? ^ YES Ld~NU EXPLAIN: Kbr-bola QUESTIONS REG DING THIS INSPECTION? PLEASE CALL US AT (661) 326-3979 -ti ~ Inspector (Please Print) Fire Prevention / 1 ` In /Shift of Site/Station # White -Prevention Services Yellow -Station Copy Pink -Business Copy f ~~y~` FD 2155 (Rev. 09/05 .. ~, ~ -; F LIFECARE SOLUTIONS INC Manager RON KELLY Location: 4300 RESNIK CT 101 City BAKERSFIELD CommCode: BFD STA 09 EPA Numb: SiteID: 015-021-003457 BusPhone: (866) 844-6472 Map 123 CommHaz Low Grid: 17B FacUnits: 1 AOV: SIC Code:4925 DunnBrad:14-275-8726 Emergency Contact / Title Emergency Contact / Title JOSH ROYAL / ACCOUNT MANAGER RON KELLY / GENERAL MANAGER Business Phone: (661) 431-0880x Business Phone: (805) 639-0171x 24-Hour Phone (661) 431-0880x 24-Hour Phone (805) 331-2509x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: Fire ImmHlth DelHlth Contact RON KELLY Phone: (805) 639-0171x MailAddr: 5757 OLIVAS PARK DR State: CA City VENTURA Zip 93003 Owner TOM ROBBINS Phone: (858) 444-2800x Address 10119 CARROLL CANYON RD State: CP; City SAN DIEGO Zip 92131 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT EN`f'D J u ~, ~ 3 zoos i3ased on my inquiry of those individuals respon,s'si,ie for ob~`aining the information, I r.,ertify under penaity of i~.~a that I have pe•sona.lly examined ar,d am familiar with the information su5mitted and h~iiPire the information is true, accurate, and ^omplete. - 7-~/~ba Signature Gate -1- 07/12/2007 i F LIFECARE SOLUTIONS INC ~ Hazmat Inventory ~ MCP+DailyMax Order = = SiteID: 015-021-003457 ~ By Facility Unit ~ Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP OXYGEN F IH DH G 5000.00 FT3 Low -2- 07/12/2007 -3- 07/12/2007 F LIFECARE SOLUTIONS INC SiteID: 015-021-003457 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME OXYGEN Days On Site 365 Location within this Facility Unit Map: Grid: CAS# 7782-44-7 STATE T TYPE PRESSURE ~~ TEMPERATURE ~~ CONTAINER TYPE ~GaS I Pure Above Ambient I Ambient i PORT _ PRESS _ C'YT~TN'I~ER I AMOUNTS AT THIS LOCATION Largest Container Daily Maximum Daily Average 4284.00 FT3 5000.00 FT3 2000.00 FT3 _-- riHGKtGLVU.7 1.V1~lYV1V~1V1 %Wt. RS CAS# 100.00 Oxygen, Compressed No 7782447 IIHGKKL HJ.7L' .~.71~1L' 1V 1.7 TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Low -4- 07/12/2007 F LIFECARE SOLUTIONS INC SiteID: 015-021-003457 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 08/18/2006 ~ WITH IMMEDIATE VENTILATION OF THE BUILDING AND STEPS TAKEN TO MINIMIZE POTENTIAL IGNITION SOURCES, CHANCE OF MAJOR ISSUES REDUCED SIGNIFICANTLY. Employee Notif./Evacuation 08/18/2006 1. LIFECARE SOLUTIONS GENERAL MANAGER WILL BE CALLED. 2. FIRE DEPARTMENT WILL BE NOTIFIED AND AREA SECURED BY NOTIFYING EMPLOYEE. Public Notif./Evacuation 08/18/2006 STORAGE OF OXYGEN. IF A LEAK OCCURS, FACILITY WILL BE VENTILATED AND AREA SECURED. MANAGEMENT WILL BE NOTIFIED AND AUTHORITIES NOTIFIED. Emergency Medical Plan 08/18/2006 ALL EMERGENCIES AND MEDICAL REQUIREMENTS TO BE REPORTED TO AUTHORITIES IMMEDIATELY. -5- 07/12/2007 F LIFECARE SOLUTIONS INC SiteID: 015-021-003457 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 08/18/2006 ~ CYLINDERS WILL BE SECURED IN A CYLINDER CORRAL. CYLINDERS WILL BE CHAINED TO PREVENT TIPPING OVER. Release Containment BUILDING VENTILATED AND AREA SECURED TO LIMIT IGNITION SOURCES. 08/18/2006 Clean Up 08/18/2006 OXYGEN WILL EVAPORATE. V1.11Ct 1CCSVULCrC HLI.LVdl.1V11 -6- 07/12/2007 =~ .. P LIFECARE SOLUTIONS INC SiteID: 015-021-003457 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ ~~o~;lal na~aiu~ Utility Shut-Offs NATURAL GAS: NW SIDE OF BLDG ELECTRICAL: MAIN PANEL FOR ENTIRE BLDG NW SIDE OF BLDG WATER: UTILITY ROOM NE SIDE OF BLDG LOCK BOX: NO 08/1$/2006 Fire Protec./Avail. Water PRIVATE FIRE PROTECTION: SPRINKLERS IN BOTH WHSE AND OFFICE. FIRE HYDRANT: 2 FIRE HYDRANTS IN PARKING LOT. 02/02/2007 Building Occupancy Level 12/11/2006 ~~ `7 E~-1P1 oYe~s -7- 07/12/2007 ~'. .L , _ ~ _ :r f ,~°~F LIFECARE SOLUTIONS INC SiteID: 015-021-003457 ~ Fast Format ~ ~ Training Overall Site ~ ~ ~ Employee Training 02/02/2007 ~ MSDS ON FILE IN WHSE BINDER. BRIEF STJNlMARY OF TRAINING PROGRAM: COMPANY REQUIRES ANY EMPLOYEE WHO HANDLES OXYGEN TO COMPLETE A COMPANY-APPROVED COURSE THAT INCLUDES VIDEOS AND COMPLETION OF SEVERAL QUIZZES. A SUPERVISOR IS REQUIRED TO SIGN-OFF ON ALL TRAINING. LIFECARE SOLUTIONS POLICY AND PROCEDURE REQUIRES ALL LOCATIONS HAVE AN EMERGENCY PREPAREDNESS PLAN IN PLACE AND ALL EMPLOYEES TRAINED AND SIGNED OFF. 9~E~. RoN Ktlt~, ~oSh RoyA~~ ~4~,ber P:~ree~ TiQic~~ WI~aR%s, Svc kGysi (,,uiS ~orrto ~ a.~. D 8a t,~~ Wekl~ a.Ae a u,~.¢.•.f ~.n p 1 ~ y ~ ~.s. rayC ~ Held for Future Use Held for Future Use -s- 07/12/2007 ~f - ~~ `~ ~ ~ - F~° ~',_ LIFECARE SOLUTIONS INC Manager :: k'eP1 /~~ ~Ly _ Location: 4300 RESNIK CT 101 City BAKERSFIELD CommCode: BFD STA 09 EPA Numb: SiteID: 015-021-003457 (866) 844-6472 CommHaz Low FacUnits: 1 AOV: SIC Code:4925 DunnBrad:l4-275-8726 Emergency Contact / Title Emergency Contact / Title JOSH ROYAL / ACCOUNT MANAGER RON KELLY / GENERAL MANAGER Business Phone: (661) 431-0880x Business Phone: (805) 639-0171x 24-Hour Phone (661) 431-0880x 24-Hour Phone (805) 331-2509x Pager Phone ( ) - x Pager Phone ( ) - x Hazmat Hazards: ~ Fire ImmHlth DelHlth Contact RON KELLY Phone: (805) 639-0171x MailAddr: 5757 OLIVAS PARK DR State: CA City VENTURA Zip 93003 Owner TOM ROBBINS Phone: (858) 444-2800x Address 10119 CARROLL CANYON RD State: CA City SAN DIEGO Zip 92131 Period to TotalASTs: = Gal Preparers TotalUSTs: = Gal Certif'd: RSs: No ParcelNo: Emergency Directives: PROG A - HAZMAT , ENT'p ~~B ~ 6 2007 Based on my inquiry of those individuals responsible far obtaining the information, I certify under penalty of law that I have personally examined and am familiar with the information submitted and believe the information is true, accurate, and complete. ~r~-(~~ Signature Date BusPhone: Map 123 Grid: 17B -1- 02/02/2007 l~ T F LIFECARE SOLUTIONS INC SiteID: 015-021-003457 ~ ~ Hazmat Inventory By Facility Unit ~ ~ MCP+DailyMax Order Fixed Containers at Site ~ Hazmat Common Name... SpecHaz EPA Hazards Frm DailyMax Unit MCP OXYGEN F IH DH G 5000.00 FT3 Low -2- 02/02/2007 -3- 02/02/2007 ' F LIFECARE SOLUTIONS INC SiteID: 015-021-003457 ~ ~ Inventory Item 0001 Facility Unit: Fixed Containers at Site ~ COMMON NAME / CHEMICAL NAME OXYGEN Days On Site ', 365 Location within this Facility Unit Map: Grid: CAS# 7782-44-7 I~ STATE T TYPE T PRESSURE ~~T TEMPERATURE ~1~ CONTAINER TYPE Gas I Pure I Above Ambient I Ambient I PORT. PRESS. CYLINDE~ AMOUNTS AT THIS LOCATION Largest C4284100rFT3 Daily5000100m FT3 I Daily2000r00e FT3 nric~t~rcLVt~~ ~:vt~irvivr~ivta oWt. RS CAS# 100.00 Oxygen, Compressed No 7782447 nr~atucL t~~ ~~~~i~ir,ly 1 a TSecret RS BioHaz Radioactive/Amount EPA Hazards NFPA USDOT# MCP No No No No/ Curies F IH DH / / / Low -4- 02/02/2007 r. / F LIFECARE SOLUTIONS INC SiteID: 015-021-003457 ~ Fast Format ~ ~ Notif./Evacuation/Medical Overall Site ~ ~ Agency Notification 08/18/2006 ~ WITH IMMEDIATE VENTILATION OF THE BUILDING AND STEPS TAKEN TO MINIMIZE POTENTIAL IGNITION SOURCES, CHANCE OF MAJOR ISSUES REDUCED SIGNIFICANTLY. Employee Notif./Evacuation 08/18/2006 1. LIFECARE SOLUTIONS GENERAL MANAGER WILL BE CALLED. 2. FIRE DEPARTMENT WILL BE NOTIFIED AND AREA SECURED BY NOTIFYING EMPLOYEE. Public Notif./Evacuation 08/18/2006 STORAGE OF OXYGEN. IF A LEAK OCCURS, FACILITY WILL BE VENTILATED AND AREA SECURED. MANAGEMENT WILL BE NOTIFIED AND AUTHORITIES NOTIFIED. Emergency Medical Plan 08/18/2006 ALL EMERGENCIES AND MEDICAL REQUIREMENTS TO BE REPORTED TO AUTHORITIES IMMEDIATELY. -5- 02/02/2007 /, ~~ 3/ F'LIFECARE SOLUTIONS INC SiteID: 015-021-003457 ~ Fast Format ~ ~ Mitigation/Prevent/Abatemt Overall Site ~ ~ Release Prevention 08/18/2006 ~ CYLINDERS WILL BE SECURED IN A CYLINDER CORRAL. CYLINDERS WILL BE CHAINED TO PREVENT TIPPING OVER. Release Containment 08/18/2006 BUILDING VENTILATED AND AREA SECURED TO LIMIT IGNITION SOURCES. Clean Up OXYGEN WILL EVAPORATE. 08/18/2006 V1.11Ct 1CC.7VULUC HLl,1Vd1..1CJ11 -6- 02/02/2007 t i`i~ w F LIFECARE SOLUTIONS INC SitelD: 015-021-003457 ~ Fast Format ~ ~ Site Emergency Factors Overall Site ~ aNcc_:ia.~ nac,a.LU~ Utility Shut-Offs 08/18/2006 NATURAL GAS: NW SIDE OF BLDG ELECTRICAL: MAIN PANEL FOR ENTIRE BLDG NW SIDE OF BLDG WATER: UTILITY ROOM NE SIDE OF BLDG LOCK BOX: NO Fire Protec./Avail. Water PRIVATE FIRE PROTECTION: SPRINKLERS IN BOTH WHSE AND OFFICE. FIRE HYDRANT: 2 FIRE HYDRANTS IN PARKING LOT. 02/02/2007 Building Occupancy Level 3 EMPLOYEES 12/11/2006 -7- 02/02/2007 /~ _ ~p~LIFECARE SOLUTIONS INC SiteID: 015-021-003457 ~ ,` ~` Fast Format ~ ~ Training Overall Site ~ ~ ~ Employee Training 02/02/2007 ~ MSDS ON FILE IN WHSE BINDER. BRIEF SUMMARY OF TRAINING PROGRAM: COMPANY REQUIRES ANY EMPLOYEE WHO HANDLES OXYGEN TO COMPLETE A COMPANY-APPROVED COURSE THAT INCLUDES VIDEOS AND COMPLETION OF SEVERAL QUIZZES. A SUPERVISOR IS REQUIRED TO SIGN-OFF ON ALL TRAINING. LIFECARE SOLUTIONS POLICY AND PROCEDURE REQUIRES ALL LOCATIONS HAVE AN EMERGENCY PREPAREDNESS PLAN IN PLACE AND ALL EMPLOYEES TRAINED AND SIGNED OFF. JOHN ROYAL AND RON KELLY ARE CURRENTLY THE ONLY EMPLOYEES. ruyc a riciu tvi ru~.utc ~~c nc.LU ivi ru~uic vac -8- 02/02/2007 __ . _~~ ~-- J// LIFECARE SOLUTIONS Bakersfield Branch 4300 Resnik Court Unit 101 Bakersfield, CA 93313 DISASTER AND EMERGENCY PREPAREDNESS PLAN REVIEWED AND REVISED 7/25/2006 Ron Kelly General Manager 1 TABLE OF CONTENTS I. INTRODUCTION A. PURPOSE AND INTENT B. BUILDING DESCRIPTION II. EMERGENCY ACTION 4 4 5 A. EMERGENCY INFORMATION/RESOURCE PHONE NUMBERS 6 B. IN CASE OF FIRE 7 C. IN CASE OF EARTHQUAKE 8 D. IN CASE OF CIVIL DISORDER/RIOT/PUBLIC DISTURBANCE 9 E. IN CASE OF BOMB THREAT 10 F. IN CASE OF MEDICAL EMERGENCY 11 G. IN CASE OF NUCLEAR ATTACK 11 H. IN CASE OF EXPLOSION 12 I. IN CASE OF HAZARDOUS MATERIAL EXPOSURE 12 J. IN CASE OF POWER FAILURE 13 K. IN CASE OF SECURITY CONCERNS WITHIN THE BUILDING 14 L. IN CASE OF LOSS OF BUILDING ACCESS 14 M. IN CASE OF LOSS OF ANSWERING SERVICE 15 N. IN CASE OF DISASTER DURING NON-BUSINESS HOURS 15 O. IN CASE OF LOSS OF TELEPHONE SERVICE 16 P. IN CASE OF DELIVERY/VISIT IN UNSAFE AREA 16 Q. IN CASE OF LOSS OF COMPUTER SYSTEMS 16 R. IN CASE OF LOSS OR CONTAMINATION OF WATER SUPPLY 16 III. EMERGENCY RESPONSE TEAM AND DUTIES 17 A. PERSONNEL ASSIGNED TO DUTIES 17 B. DUTIES OF EMERGENCY RESPONSE TEAM 20 C. EMERGENCY EQUIPMENT -VEHICLES 21 IV. SAFETY PLAN/FIRE PREVENTION V. EVACUATION AND RELOCATION 22 23 A. EVACUATION AND RELOCATION PROCEDURES 23 B. FACILITY MAPS AND EVACUATION ROUTES 23 C. EVACUATION OF THE HANDICAPPED 23 2 7 VI. EMERGENCY PROCUREMENT OF PRODUCTS A. Oxygen B. Supplies C. Equipment 24 25 25 25 VII. PATIENT NEEDS FOLLOWING A COMMUNITY EMERGENCY 26 A. PROCESS FOR PRIORITIZING PATIENTS 26 B. PATIENT .PRIORITY CRITERIA 27 APPENDIX.A -FACILITY MAPS AND EVACUATION MAPS APPENDIX B -FIRST AID/EARTHQUAKE SURVIVAL GUIDE APPENDIX C -EMPLOYEE TELEPHONE TREE APPENDIX D -SOUTHERN CALIFORNIA LIFECARE SOLUTIONS BRANCH LISTING APPENDIX E -LIFECARE SOLUTIONS ISSUED CELLULAR PHONES I. INTRODUCTION A. PURPOSE AND INTENT In the event of an emergency, the safety of each individual is of paramount importance. In order to provide for the safety of our employees and patients, it is essential that: 1. There is awell-developed and properly implemented emergency plan. 2. There are emergency teams that have been identified and trained as to their responsibilities 3. There is cooperation and participation by each and every employee. It is the responsibility of all employees to familiarize themselves with the locations of emergency exits and the evacuation routes from the building. ,When requested, all employees are to participate willingly and cooperatively in any and all scheduled drills. In the event of an-internal disaster, the removal of patient medical records, pharmacy records, and supplies should be delegated to appropriate personnel only if there is no risk to the personal safety of the employees. It is the purpose and intent of the emergency plan to establish and maintain emergency procedures for building occupants which will to the extent possible minimize danger to life and property from the effects of fire, earthquake, civil disorder, bomb threats, medical crisis, nuclear attack, explosion, exposure to hazardous materials, power failures, riots and building security concerns. 4 B. BUILDING DESCRIPTION LOCATION 4300 Resnik Court Unit 101 Bakersfield, CA 93313 The building is constructed of concrete, and exterior walls are of concrete block or brick as required by state and city codes. The building is a single story structure with the front of the building facing west on Resnik Court. At the front of the building there is one step to the entrance, which is clearly marked. The building is accessible to handicapped persons via the front entry door located on the west side of the building. Parking is available in the lot on the west side of the building with designated parking spaces available for use by LifeCare Solutions personnel and visitors. One handicapped parking space is provided and is clearly marked and posted. There are three emergency exits: 1) Door at the main entrance (Ste. 101) of the building which exits the parking lot; 2) Roll-Up door at the main entrance (Ste. 101) of the building and exits to the parking lot. 3) Door on the north side of the building which exits to the North property line. There are multiple fire extinguishers located in the branch. Each fire-extinguisher is marked with a sign above the unit. The location of each fire extinguisher is indicated on the area maps posted throughout the facility. (See APPENDIX A) The main security system consists of infrared motion detectors located throughout the building. All outside doors have contact detectors as well. Monitoring, maintenance and routine testing of the security system is handled through a contractual relationship with Dial Security. The company can be reached at (805) 485-0528. The alarm system is duly licensed by the city of Bakersfield. i,. II EMERGENCY ACTION A. EMERGENCY INFORMATION/RESOURCE TELEPHONE NUMBERS CITY OF BRANCH -Bakersfield COUNTY OF BRANCH -Kern STATE OF BRANCH -California Fire Department/Rescue Police Department Highway Patrol Road Conditions Ambulance/Paramedics Mercy Hospital Bakersfield Memorial Hospital San Joaquin Comm. Hospital American Red Cross State Board of Pharmacy Sunset Communications Pacific Gas & Electric Company Water Company Earthquake Solutions Salvation Army (661) 326-3979 or 911 (661) 326-3815 or 911 (661) 334-3926 or 911 (800) 427-7623 (661) 716-4250 or 911 (661) 632-5000 (661) 327-4647 (661) 326-4160 (661) 324-6427 (916) 445-5014 (559) 734-5678 (800) 743-5000 (661) 326-3715 (626) 795-4000 (661) 836-8487 6 B. IN CASE OF FIRE Incase of fire the following procedures are to be followed. 1. DISCOVERING PARTY Notify receptionist immediately that there is a fire and give the location. Receptionist will call the fire department (911) and make an overhead announcement of the fire and location. If the receptionist does not answer promptly make arrangements to call 911 and notify the staff. Notify safety officer and supervisor of the area of the fire. Clear all employees from the immediate area. Close but do not lock all doors leading to the fire area in order to isolate the area and prevent the spread of the fire. If the fire is small, attempt to extinguish the fire using the nearest fire extinguisher according to operational procedures and training. Do not risk personal safety with futile attempts to put out a fire. 2. SAFETY OFFICER Notify all area leaders of the situation and give instructions for evacuation if needed. (Refer to Evacuation Maps in APPENDIX A) Assure that the fire department has been summoned. Assist in the discovering party as needed in above named activities. 3. AREA LEADERS Upon notification, inform employees of the situation and supervise the evacuation of all employees through the emergency exits and out of the building. Remember to check restrooms and service areas. Call handicap monitor for assistance with any handicapped persons in the area. ~.. 4. ALL PERSONNEL Remain calm. Do not panic. Listen to instructions. Do not open-hot doors. Before opening any door, touch it near the top to see if it is hot. Do not break windows unless that is your only escape route. Afresh supply of oxygen will feed the fire. Evacuate your area when instructed through your assigned emergency exit. If your exit route is inaccessible, use the nearest available exit. Do not run. Walk. Keep quiet and follow instructions of the area leaders. Do not attempt to assist the fire fighters unless requested to do so. Do not leave the area or return to the building until you have been instructed to do so by the fire department, safety officer or the area leaders. C. IN CASE OF AN EARTHQUAKE In case of earthquake, the following procedures are to be followed: 1. IF YOU ARE INSIDE THE BUILDING Take cover under a desk, strong table or in a doorway; or sit or stand against an inside wall. Stay inside of the building. Stay clear of windows, glass, bookcases and outside doors. Do not use telephones. If a fire should start, follow the "in case of fire" procedures. Do not strike a match or light a cigarette until gas lines are confirmed to be intact. Turn radio to emergency radio station KNX 1070 AM. s 2. IF YOU ARE OUTSIDE A BUILDING Move away from buildings, streetlights and utility wires. Stay in an open area until shaking stops Watch for falling debris, electrical wires, poles. 3. IF YOU ARE IN A VEHICLE Pull over and stop in a safe area away from trees, freeway overpasses and power lines. Stay in your vehicle. Once shaking has stopped, proceed with caution. Avoid bridges or ramps that may have been damaged. 4. SURVIVAL GUIDE All personnel should be familiar with "Survival Guide" in the front of the Pacific Bell Telephone Book. This guide addresses many important emergency procedures including how to turn off gas if needed. This guide is included as APPENDIX B in this plan. D. IN CASE OF CIVIL DISORDER/RIOT/PUBLIC DISTURBANCE Civil disorder is a breach of the peace, which could result in a riot or mob action directed against the company or its property. This could result in disruption of the routine work and functioning of the company. 1. ALL PERSONNEL Remain in your work area and continue to perform regular work duties until otherwise instructed. No employee will be permitted to leave the building until the safety officer has determined that it is safe. If participants enter the building, notify the safety officer. Be courteous and do not provoke an incident. Avoid unnecessary inquiries that will tie up the communications system. Remain calm and do not become a spectator. Close all drapes and outside window coverings. 2. SAFETY OFFICER Consult with police to coordinate necessary action for protection of the building and personnel. Inform the area leaders of the situation. Post appointed employees at each door and confirm that all entrances are secured and locked. Carefully screen all personnel entering or leaving the building. Keep all employees inside the building until it is deemed safe to allow their exit. E. IN CASE OF A BOMB THREAT In case of a bomb threat, the following procedures are to be followed: DISCOVERING PARTY Attempt to ask the following questions to get as much information as possible: When will the bomb explode? Where is the bomb now? What does the bomb look like? What kind of bomb is it? What will cause the bomb to explode? Why did you place the bomb? What is your name and address? Notify the Safety Officer and your supervisor immediately. SAFETY OFFICER Contact the police immediately. Assist them as needed with coordinating a search of the building. Coordinate providing information to the police as gathered from employees and managers. Coordinate evacuation of the building as required. 10 ~o Notify departmental managers of the situation. DEPARTMENTAL MANAGERS Interview employees to determine if any suspicious people have been seen in the branch that day or if anyone might have other pertinent information. Relay any pertinent information to the Safety Officer. Take a count of departmental personnel and report to Regional Director of Operations and Safety Officer. ALL EMPLOYEES Upon instruction of your area leader of supervisor, evacuate the building using your assigned exit. If your assigned exit is not accessible, use the nearest available exit. Do not return to the building until instructed to do so. F. IN CASE OF A MEDICAL EMERGENCY In case of a medical emergency in the building, contact the receptionist. Give the name-and location of the injured or ill person as well as the nature of the illness or injury. The receptionist will call the needed department or call 911 as needed. Receptionist will notify employees trained in CPR of the location and type of emergency. The following personnel are trained in CPR and are usually based in the office. At least one of these people should be called while waiting for emergency assistance to arrive. Other nurses and respiratory therapists are available if they are in the office at the time of the medical emergency. Josh Royal Respiratory Therapist Keep the victim warm and comfortable until help arrives. The First Aid Kit is located in the RT/HME warehouse wall close to the computer room. Refer to APPENDIX B for specific guidelines on handling various first aid and survival situations including: 11 Rescue breathing Choking Drowning. Electric Shock Heart Attack Bleeding Broken bones Seizure Poisoning Drug Overdose Burns G. IN CASE OF NUCLEAR ATTACK STRATEGIC WARNING This is a warning that enemy initiated hostilities may be possible. Announcements will be made by the media. No audible alarm will be sounded. ATTACK WARNING An audible alarm will be sounded. A 3 to 5 minute wavering tone of short blasts on horns will be repeated as necessary. This means that an attack by the enemy is imminent. Take cover and. remain in secure area until advised. Turn to local EBS radio station KNX 1070 AM for further information and instructions. H. IN CASE OF EXPLOSION In the event of a threat of explosion due to an external threat such as falling aircraft or internal problem (such as a problem with liquid oxygen bulk tank), the security officer will arrange for evacuation of the building as time allows. (refer to Section V. A. in this plan) If time does not allow an evacuation, take cover under sturdy furniture and stay away from glass and windows. If the source of the explosion is inside the building, move as far away from the source as possible and take cover as indicated above. Do not light matches or cigarettes until building has been inspected by appropriate personnel and it has been determined to be safe. I. IN CASE OF HAZARDOUS MATERIALS EXPOSURE 1. In case of a liquid oxygen spill or leak: a. Follow instructions to evacuate the building avoiding all warehouse exits. Do not take time to gather personal belongings. 12 b. Avoid any skin contact with the liquid oxygen. Seek immediate medical attention if skin should make contact with liquid oxygen. Administer first aid if needed as directed in the Material Safety Data Sheets. c. Do not light a match or cigarette until the area has been secured and deemed safe by the police and/or fire departments. 3. In case of a spill of any other hazardous material, consult MSDS for instructions regarding proper handling of the situation. 4. Material Safety Data Sheets (MSDS) are located in the warehouse and are accessible to all employees. J. IN CASE OF POWER FAILURE In case of a power failure, it is recommended that personnel turn off all electrical equipment in their immediate work area. This would include computers, typewriters, photocopiers and Laminar Flow Hoods. This will lessen the load when power is restored and will protect the computers and other equipment from further damage. Exits are indicated with self-illuminated signs. Each area leader will have access to a flashlight if needed to illuminate area during evacuation. The Safety Officer will attempt to determine the cause and possible length of the failure and will notify the departmental managers and the Regional Director of Operations. If necessary, the receptionist will call the electric company to notify them of the failure. The telephones will stay on line by use of the back up power system. However, use of the phones should be minimized. Use of cellular phones may be required. (Refer to Section II.O. of this plan) As part of the admission process, patients using electrical equipment are educated as to appropriate actions to take in case of power failure in their homes. Instructions may include utilizing back up equipment, back up batteries,' transportation to a facility equipped to provide needed medical emergency services, or calling 911 to elicit an emergency medical team response. Patients are provided with back up equipment and batteries as deemed appropriate according to company policies and procedures. LifeCare Solutions does not provide back up electrical generators. LCS will provide information to patients instructing them how to notify electrical company of their need for electricity to 13 power life sustaining equipment. During times or increased likelihood of power failure (e.g., energy shortage), patients will be provided with written information reviewing the importance of understanding emergency procedures in the event of power failure in their home. All field personnel will be reminded of appropriate back up equipment for patient situations and will review emergency procedures with patients during routine home visits. K. IN CASE OF SECURITY CONCERNS WITHIN THE BUILDING Access to the building should be limited to visitors with official business in the building. All visitors are to check in at the front desk and sign the visitors' register. Solicitors are not permitted on the premises. Suspicious or intoxicated persons should be reported to the Safety Officer or Regional Director of Operations immediately. Police will be called if needed to assist with security concerns. L. IN CASE OF LOSS OF BUILDING ACCESS In the event that the building should be destroyed due to an explosion, fire or other disaster, all employees are to meet at the branch parking lot across from the building. M. IN CASE OF LOSS OF ANSWERING SERVICE In the event of an interruption of phone service to the answering service, The Pasadena branch has a 24 hour customer service line available at (800) 767-1107. This number can be called to make arrangements for coverage alternatives as needed. N. IN CASE OF DISASTER DURING NON-BUSINESS HOURS Due to the high level of critical patients serviced by this facility, the following guidelines are to be followed when a disaster occurs after regular business hours. 1. All managers are required to report to the branch as soon as possible after assuring their own safety and the safety of their families. Managers will be responsible for assisting with patient triage and mobilizing other employees as resources. 2. Each manager will be responsible for initiating the telephone tree (see APPENDIX C) in order to make contact with employees and determine 14 availability. Employees who have not been contacted should attempt to contact a member of the management team. 3. All employees who work in the field including distribution technicians, drivers, respiratory therapists, and nurses should report to the branch as soon as possible after assuring their own safety and the safety of their families. 4. The Regional Director of Operations will be responsible for contacting the other LifeCare Solutions locations to determine resources available for back up. (see APPENDIX D) 5. All other staff must, if possible, make telephone contact with the branch or a member of the management staff to determine if they are needed in the branch. If possible, they may report to the branch to assist as needed. 6. These are mandatory requirements. Any employee who does not fulfill this obligation will be subject to disciplinary action, which could include termination of employment. O. IN CASE OF LOSS OF TELEPHONE SERVICE In the event that regular telephone service is disrupted, cellular phones may be required. Cellular service may still be available even when traditional phone service has been interrupted due to downed lines etc. All employees who have been issued a cellular phone by LifeCare Solutions should activate the phone to determine if service is available. A list of employees who have been issued cellular phones by LifeCare Solutions is included in Appendix E. Employees with personal cellular phones should also determine service availability in case needed. P. IN CASE OF DELIVERYNISIT IN UNSAFE AREA The safety of LifeCare Solutions' employees and patients is our primary concern. When an employee travels to a patient's home and determines that in his/her judgment the area is not safe to proceed, helshe will notify his/her immediate supervisor in order to evaluate available options. These may include contacting the local police department for escort, contacting an outside security company for escort into and out of the area, consulting with the patient's physician to determine the best course of action and/or instructing the patient to proceed to a medical 15 facility for treatment. At no time is an employee expected to compromise their personal safety by going into an unsafe area. Q. IN CASE OF LOSS OF COMPUTER SYSTEMS In the event that computer access is lost in the branch, appropriate manual systems will be used as alternative measures. These include .manual generation of tickets for deliveries. R, IN CASE OF LOSS OR CONTAMINATION OF WATER SUPPLY In the event of a loss of water supply, all non-essential functions requiring water will be suspended until the water supply has been restored. Waterless hand cleaners (e.g., Isagel, etc.) may be used to wash and disinfect hands as needed. Waterless cleaners (e.g., dispatch) may be used to disinfect equipment as needed. Availability of drinking water will be assessed and outside sources will be used as necessary. If loss of water supply is for an extended period of time, the management team will identify the most appropriate alternatives which may include identifying other facilities to assist with routine operations (see APPENDIX D). The safety of patients and employees will be given the highest priority in determining the best course of action. 16 III. EMERGENCY RESPONSE TEAM AND DUTIES A. ASSIGNED PERSONNEL TO HANDLE DUTIES 1. Safety Officer Ron Kelly 2. Area Leaders Area 1 Josh Royal Front Office Account Manager Office Adjoining Restrooms Conference Room Genral Managers Office Exit via main entrance door onto the parking lot Area 2 Ron Kelly Vehicles Warehouse Exit via employee entrance door into rear parking lot 17 B. DUTIES OF THE EMERGENCY RESPONSE TEAM SAFETY OFFICER 1. Assist the Regional Director of Operations with creation of a fire safety' and prevention plan. 2. Coordinate training of all support teams as required. 3. Plan briefing meetings with support teams as required. 4. Coordinate routine alarm checks with Dial Security 5. Check and arrange recertification of all fire extinguishers on the premises and in LifeCare Solutions vehicles. 6. Arrange for fire safety drill at least annually and other disaster drills as needed. 7. In the event of fire: a. Have a reliable method of promptly notifying the. fire department or other agency as appropriate b. Be prepared to advise the fire department officials of the operation of equipment in the building as well as any other pertinent information about the facility c. Be aware of fire department procedures in regards to command post establishment d. Be prepared to provide the fire department with keys to any locked areas as needed e. Maintain up to date set of floor plans and assure they are posted in designated areas. These must indicate the location of hazardous materials, liquid oxygen, and compressed gas. ALTERNATE SAFETY OFFICER 1. Shall assume all duties and tasks of the Safety Officer in his absence 2. Shall assist the Safety Officer in performing assigned duties AREA LEADERS 1. Assure there is an alternate for the designated area 2. Be familiar with floor arrangements, the number of people normally in the area and the designated exits for evacuation 3. Be prepared to divide the floor population and assign exits if needed. 4. Confirm daily by observation that exits are not blocked and assure that all doors are operable. Know where alternative exits are located 5. Spot check fire extinguisher in area periodically 6. Be aware of personnel who may need special assistance during evacuation Zs 7. Take actions as needed to avoid panic 8. Assure that all personnel are notified of the situation and the need to evacuate to safety when applicable 9. Close office doors as areas are cleared SEARCH MONITOR Assist the area leaders in searching offices, conference room, remote offices, restrooms, and closets to assure that all employees and visitors are out. Check visitor log at front desk. HANDICAP MONITOR Assist any staff or visitor who would be unable to move themselves rapidly to a designated exit GENERAL EMPLOYEES 1. DO remain calm; exercise caution, and follow instructions `2. DO NOT panic or spread rumors 3. DO NOT light a cigarette or a match 4. Know your area leader and alternate and follow their instructions 5. Avoid using the telephone 6. Use only designated exits or determined alternates when leaving the building 7. Report any situation that could cause an emergency to your area leader 8. Relocate to designated area when asked. Do not waste time attempting to bring personal or unnecessary items. 9. All employees are considered on call for the duration of the emergency unless otherwise instructed by the Safety Officer or the Regional Director of Operations. C. LIFECARE SOLUTIONS VEHICLES -EMERGENCY EQUIPMENT All LifeCare Solutions vehicles are required to be equipped with the following emergency equipment: 1. First Aid Kit 2. High Beam Flashlight and extra batteries 3. Reflective Triangles 19 IV. SAFETY PLAN/FIRE PREVENTION The safety and fire prevention. plan is included as a part of our branch disaster plan. As such it must be approved by the Regional Director of Operations and reviewed and revised as needed at least once each year. State and Federal law as well as company policy make the safety and health of our employees the first consideration in operating our business. No employee is required to work in an unsafe or dangerous environment. A. ROLE OF THE REGIONAL DIRECTOR OF OPERATIONS The Regional Director of Operations will be available via pager or cell phone at all times should an emergency arise. The Safety Officer and the designated manager in charge will be aware of any exceptions. The Regional Director of Operations will work with and assist the Safety Officer in handling all emergencies including fires. The Regional Director of Operations must be aware of all fire exits and the location of all fire extinguishers. The Regional Director of Operations will assure that there is an escort service available to employees when we are required to visit areas that require that precaution: The Regional Director of Operations will assure that a Facility Inspection and a Fire Drill occur at least annually and as needed. The Regional Director of Operations will assure that employees have regularly scheduled education on safety related issues. B. PAPER/FLAMMABLES Large quantities of paper and combustible liquids should not be stored in the same area. Combustible fluids such as duplicating solvents, cleaning solvents shall be kept in minimal quantities and shall be stored separately and in metal cabinets whenever feasible. These items shall not be stored with paper. C. ELECTRICAL EQUIPMENT Electrical equipment shall be kept in good working order. Equipment must be grounded and all cords must be in good working condition with no exposed wires. All employees are responsible for reporting any unsafe or suspicious electrical equipment to the Safety Officer. Equipment should not be used if there is any doubt as to its safety. D. OFFICE FURNISHINGS All office furniture must be cleaned and well maintained. Work areas are to be kept orderly and safe at all times. Aisle ways are to be kept free of clutter in order 20 to assure safe clearance. All employees are responsible for notifying the Safety Officer of any potentially dangerous situations including fire hazards. E. FIRE SAFETY AND PREVENTION Multipurpose fire extinguishers are placed strategically throughout the building. All fire extinguishers will be inspected periodically by the Safety Officer as needed. All extinguishers will be tested and re-certified at least annually or whenever used. All fire doors shall be maintained in good condition and will remain unobstructed and protected from obstruction. F. SMELL OF SMOKE All employees are responsible for reporting any smell of smoke or gas to the Safety Officer immediately. Do not assume that someone else-has already reported it. The Safety Officer must investigate all such reports and inform the Regional Director of Operations of all such situations. The fire department or other outside agency will be contacted if necessary. G. CHEMICAL SAFETY Chemical hazards in the work place must be identified and Material Safety Data Sheets must be kept in an area readily accessible to employees. Employees will be trained regarding any agents routinely used in assigned tasks and employee must agree to follow precautions as outlined. Eye wash stations are located in the RT/HME warehouse near the recertification room and in the pharmacy in the workroom area. H. VEHICLE SAFETY Driving records for all employees operating company vehicles will be reviewed initially upon hire and at least annually thereafter. All such employees will receive annual defensive driving training. Employees are responsible for assuring that vehicles are maintained in safe working order at all times by inspecting the vehicle daily and reporting any problems to his/her manager. All employees are expected to follow safe driving procedures including wearing seat belts at all times. I. EDUCATION 21 The staff will receive regularly scheduled an educational programs reviewing work related safety issues including the safety plan, hazard communication, universal precautions, back safety, driving safety, weather-related safety, fire safety, fire prevention and the operation of fire extinguishers upon initiation of employment and at least annually. Afire drill with evacuation of the building will be held at least annually. J. ROLE OF THE EMPLOYEE Every employee is expected to inform his/her supervisor should any hazardous or potentially unsafe situation arise in the work place. These reports can be made without fear of retaliation of discipline. Employees are expected to use all personal protective equipment for any tasks requiring such equipment and are also expected to follow accepted policies and procedures at all times. 22 V. EVACUATION AND RELOCATION A. EVACUATION AND RELOCATION PROCEDURE The building is to be evacuated only upon the instruction of the Safety Officer or the designated area leader. All employees are to refrain from use of the telephone so that they will be available for announcing instructions. The following procedures are to be followed once notified by the area leader. 1. Walk (DO NOT RUN) directly to your designated exit and remain in the designated area until you are told to do otherwise. Clear the area immediately around the building so the building can be reached by emergency services. 2. Do NOT take the time to gather personal belongings. 3. Do NOT panic. Do NOT push or shove others while exiting. 4. Refrain from talking so that you can listen carefully to instructions being given. 5. Follow all instructions and do not argue with members of the Emergency Response Team. 6. Do NOT smoke or light matches. B. FACILITY MAPS AND EVACUATION ROUTES A map of the facility is posted in each primary area. Evacuation routes are clearly indicated on these maps. The maps will also identify the location of all fire extinguishers, designated emergency exits, liquid oxygen vessel, and compressed gas storage. Please refer to APPENDIX A for facility maps indicating evacuation routes. C. EVACUATION OF HANDICAPPED OR INJURED PERSONS In preparing for evacuation of handicapped and/or injured persons, it is always best to inform the area leaders whenever there are handicapped persons visiting the branch. In the event a handicapped person needs evacuation, inform the area leader and the Safety Officer of the situation. The handicap monitor and alternate (if needed) should be summoned. Staff should always follow guidelines presented in the Back Safety Program and the Protecting Your Back video when carrying handicapped or injured persons. Carries should be performed by 2 persons whenever possible. Do not attempt to carry a handicapped or injured individual who is too heavy on your own. Summon help as needed. 23 V1. EMERGENCY PROCUREMENT OF PRODUCTS Other LifeCare Solutions locations may be used when appropriate as an emergency source for products or services. A complete listing of Southern California LifeCare Solutions branches, key contact personnel and phone numbers are provided in APPENDIX D. 24 B. OXYGEN For short-term situations, other LifeCare Solutions locations within the Southern California area could be contacted to obtain back up supplies of oxygen (see APPENDIX D). In cases where back up outside vendors are needed, the following sources can be contacted to obtain the oxygen products needed. GAS Primary Vendor -Airgas/Puritan Medical Gas (626) 964-3415 Back up vendor -Continental Hospital Supply (818) 242-4171 LIQUID Primary Vendor -Airgas/Puritan Medical Gas (626) 964-3415 Back up Vendor - MG (Messer) Industries (626) 334-2905 C. SUPPLIES Other LifeCare Solutions branches can be contacted to obtain medical supplies if needed on an emergency basis (see APPENDIX D). If outside sources are needed, the following vendors can be contacted: AMP Abbott McKesson (After hours) Novartis Ross D. EQUIPMENT (800) 876-4001 (847) 937-7970 (800) 711-5608 (800) 7598888 PIN 1306786 (626) 644-9371 (Rep's cell) (800) 227-5767 Other LifeCare Solutions branches can be contacted if medical equipment is needed on an emergency basis (see APPENDIX D). If outside sources are needed, the following can be contacted: Freedom Medical (866) 567-4350 Mallinckrodt (800) 635-5267 Respironics (800) 345-6443 McKesson (800) 711-5608 (After hours) (800) 7598888 PIN 1306786 25 VII. PATIENT CARE FOLLOWING A COMMUNITY EMERGENCY A. PROCESS FOR PRIORITIZING PATIENTS All new patients will be assigned a tentative priority level in the patient huddle. Patients will be categorized as P1, P2 or P3. P1 patients would be the most critical and would require the most rapid response from LifeCare Solutions. P3 patients would be the least critical in terms of a rapid response from LifeCare Solutions. Once determined, The Customer Service Representative will enter the priority level for each patient into the MestaMed Customer Master File in field 27 on the first screen. When the LifeCare Solutions representative visits the patient home to make the initial delivery or visit, he/she will make note if the patient priority is different than that assigned in the huddle. If the priority level needs to be changed, a change of status form will be completed and sent to morning meeting the following day for communication to all departments. The Customer Service Representative will be responsible for changing the priority level in the Customer Master File. If the priority level of a patient changes (e.g., therapies are added or discontinued, oxygen rate changes) at any time during the patients admission to LifeCare Solutions, a Change of Status form must be completed and processed as described above. This is the responsibility of whichever employee becomes aware of the change. In the event that access to medical records and/or the computer system is limited, the following documentation will be used to identify and prioritze patients and their service needs: 1) Emergency Rental List (MestaMed Report 17-5) is printed weekly and kept as aback up for RT/DME patients and infusion patients using a pump; 2) The MestaMed Home Health Census report is printed weekly and will be used to identify nursing patients; 3) The Schedule Order report is printed weekly and will be used to identify pharmacy patients. Telephone numbers for patients and physicians are available in the hard copy prescription file. 4) New patients admitted since the last report was run will be identified from the referral log. Patients will be contacted via telephone if possible including use of the emergency contact person telephone number if available. If telephone contact, cannot be made, a visit to the home will be made based on priority levels. 26 B. PATIENT PRIORITY CRITERIA General criteria to be considered when prioritizing patients will include: 1. Dependence on electricity for therapy continuation 2. Hours of use per day 3. Risk to patient for break in therapy/service 4. Patients ability to be transported to medical facility In addition to the order of service priorities, immediate patient needs including but not limited to the following will receive top priority: 1. Injured patients requiring equipment 2. Patients with malfunctioning critical equipment 3. Patients with immediate re-supply needs 4. Patients with critical need for charging of batteries or back up batteries Unless there are extenuating circumstances or special patient needs (e.g., a patient living alone) patients will be prioritized as follows: PRIORITY 1 -All patients on oxygen concentrators with orders for continuous flow rates -Patients using oxygen at a rate of 2.5 LPM or higher continuously -Patients using oxygen on a PRN basis at a rate of 3 LPM or higher -Invasive ventilator patients that are completely dependent on the equipment for life support -Patients receiving continuous total parenteral nutrition, pain management or dobutamine infusions PRIORITY 2 -Ventilator and BiPAP patients who use the equipment for assisting their breathing invasively less than 16 hours per day -Oxygen patients receiving a rate of 1.5 to 2 LPM -Patients using Oxygen on a PRN basis at a rate of 2 to 3.5 LPM -Patients using an enteral or infusion pump for administering therapy PRIORITY 3 -Non-invasive ventilator/BiPAP patients -Patients with Apnea Monitors, Compressors, Suction machines, Nebulizers, Oximeters, or CPAPs only -Patients using continuous oxygen at a rate of 2 LPM or less -Patients using oxygen on a PRN basis at rate of 2 LPM or less. -Patients using a gravity infusion system or on service for respiratory medications, catheter maintenance or supplies only. 27