TAYLORSVILLE — It’s the sort of scenario that keeps nursing home administrators up at night: an event that requires the immediate evacuation of dozens of frail patients in their care.
That played out in real life Wednesday night when an explosion leveled a fertilizer plant in West, Texas, and badly damaged a nearby nursing home. Witnesses said Sheetrock fell on patients, ceilings collapsed and darkened hallways filled with water.
Thirty to 40 people are believed to be dead from the explosion and more than 160 injured, although official numbers have not yet been released.
Ron Kapp, administrator of Avalon West Health & Rehabilitation, watched news reports of the explosion with intent interest.
In January, the staff of the Taylorsville nursing home, in conjunction with area hospitals and government emergency response agencies, conducted a drill eerily similar to the Texas explosion.
“It really did bring back the training and experience we went through. It made the experience so much more meaningful,” Kapp said Thursday.
Operation Icy Hot, conducted Jan. 26, was based on this scenario: A meth lab in a residential area near the skilled nursing facility explodes. That explosion triggers a natural gas explosion, which necessitates the evacuation of the nursing home in the dead of winter.
It’s no small undertaking.
Many nursing home patients are acutely ill and medically fragile. Among Avalon West's 76 residents, all but six require wheelchairs. Moving them to other care facilities or large-scale evacuation centers without access to information about their conditions or medications could imperil them.
“If we don’t do that right, we could do more damage than good,” said Deb Burcombe, deputy director of the Utah Health Care Association, the state’s long-term care facility industry organization.
While patient care and safety are paramount concerns, the drill also tests communication capabilities among other skilled nursing facilities where displaced residents could be placed during emergencies, communication with first responders as well as keeping patients’ families apprised of developments.
The drills are all-hands-on-deck exercises. For example, the nursing home’s maintenance director, Joe Singleton, was tasked to guard the facility’s front door. As it turned out, the “meth cooker” attempted to enter the facility to seek medical help for his burns and chemical exposure.
The man was so persistent that Singleton had to tackle him to keep him out of the building. In the process, Singleton, too, was "contaminated" with caustic chemicals.
“He said, ‘I may have been, but he didn’t get in the front door,’” Burcombe said.
To prepare for the unexpected, the nursing home stores supplies in a cargo trailer parked near the facility. It holds blankets, first aid kits, lanterns, duct tape, flashlights and a water purification system, among other supplies. A federal grant helps fund the equipment purchases.
The staff can also pitch tents to serve as triage units and temporary shelters until decisions are made whether to move residents to another facility or to hospitals.
The nursing home has a large portable propane grill that can be rolled outside to prepare hot meals for residents and heat water.
In an actual emergency, Kapp said the facility would need as many of its 80 employees on the job as possible. “We tell them ‘Bring your family here, then you don’t have to worry about them.’”
While drills cannot anticipate every real-life scenario, the nursing home association has also trained operators to accept patients diverted from overwhelmed hospitals during mass-casualty events.
Kevin MacGilvery, admissions director for Avalon West, said disaster drills help prepare the staff for the worst-case scenario.
“We’re going to prepare as if Godzilla attacked. If you prepare for that, every little thing takes care of itself,” he said.
Kapp said during the January drill, one nurse struggled in the early moments of the exercise. A nurse from St. Mark’s Hospital also taking part in the exercise offered immediate assurance and direction. “She told her, ‘You know this. What do you do first?’”
The training provides “a safe environment” for those teaching moments, Kapp said.
Burcombe said the nursing home industry has been part of the community's emergency response training for about six years.
One of the benefits of working with first responders is that they become familiar with the facility and staff. Because nursing home employees have undergone the same training, first responders tend to respect their expertise and instructions for transporting and caring for fragile residents, Burcombe said.
Kapp said his staff exceeded his expectations. While they were aware of some details of the “incident,” new twists were revealed throughout the day to further test participants’ mettle and ability to solve problems.
“It was almost like a proud father moment how great my staff did and how well they responded.”