RESPONDING TO AND REPORTING INCIDENTS AND EMERGENCIES IN MINNESOTA

Responding to All Incidents

When an incident as defined above occurs:

An employee who is working at the time of the incident: 

1. Immediately call 911 if there is a medical emergency or a physical or sexual assault in progress - Do not wait!  You do not need to call the administrative cell phone or your manager first.
2. Provide emergency first aid and/or CPR.  Location of the first aid kit:____________________
3. If hospital treatment is required bring the following information if accessible:

• Medical Assistance Card
• Information About Person Receiving Services Document
• Medication Sheet, if applicable
• Medication Administration and Emergency Medical Authorization Form

4. Call and report the incident to the on-call administrative personnel:  612-598-5700
5. As soon as possible and before leaving the shift notify the assigned manager or senior manager
6. Complete an Incident Report and any other related documentation
7. When an incident involves more than one person receiving services, employees do not disclose personally identifiable information about the other person involved when reporting to the legal representative and case manager, unless we have their consent.
8.    Medical emergencies require a direct call to the on call nurse 612-644-0615

Additional procedures for responding to specific incidents and emergencies are provided on the following pages. In addition, you will receive customized training, based on the unique needs of the person or people you will be working with.

Responding to a Power Outage

1. ​If structural damage or extended power outage occurs, call the on-call administrative person, at 612-598-5700, who will work with the senior manager to coordinate alternative housing if relocation is necessary.  Maintenance personnel will assess the reported damages, if any.  Call to notify the on-call administrative person when power is restored.  
2. If services need to be relocated for more than 24 hours, an incident report is completed and submitted by the manager.  The manager or their designee personnel notify the person’s legal representative or emergency contact 
   and case manager within 24 hours of the incident.  They also notify 
   licensing personnel as appropriate.
3. The location of the flashlight and battery radio is__________________________________________.
4. If the power should go out in the 7000 office building, the building is equipped with a roof top  mounted emergency backup generator which will power the server room and portions of the building. The generator panel is equipped with a monitoring instrument which notifies designated staff of the outage and backup power.  The monitoring instrument will a

Responding to Fire

 Depending on where you are at:

1.    Follow the site evacuation plan/evacuate the home.
2.    Lead people to the designated safe place, using the nearest exit away from the fire.  
3.    The designated meeting place for this person’s home is _____________________________________ 
      (at least 75 feet away from the home)
4.    Call 911
5.    Location of fire extinguishers at this person’s home is _______________________  
Do not attempt to use extinguishers on any fire larger than a small wastebasket.  
6.    Call to report to on-call administrative person:  612-598-5700.  
They will assist if relocation is necessary.
7.    The employee working at the time of the fire completes an incident report

Fire Drills: When we support people in community residential settings the manager initiates/assigns completion of fire drills according to the printed agency schedule and based on the services being provided.  The schedule is designed to vary the staff participating and the times of day the drill is conducted.  Actual simulation of a variety of fire locations and responses are practiced. Following the completion of a drill, the Fire Drill Report is completed and submitted to the assigned senior manager who evaluates the response and makes recommendations for additional safeguards as needed.

Responding to a Carbon Monoxide Alert

a.    When the carbon monoxide detector sounds, and people are showing symptoms* associated with carbon monoxide poisoning:
1.    Immediately evacuate the building as quickly as possible. The designated safe place is: ___________________________________________________________________________
2.    Call 911.  Do not reenter the building until it has been aired out and the problem has been corrected.
3.    Call the on-call administrative person for assistance and to report: 612-598-5700; call again to report when you are allowed to re-enter the home.  

b.    When the carbon monoxide detector sounds, and people are not 
Showing symptoms associated with carbon monoxide poisoning:

1.    Press the test/reset button.  
Note:  If dangerous levels are present, the unit will re-sound.
2.    If unit does not re-sound, you may remain in the home, but 
watch for any signs that the monitor is faulty or for other symptoms 
of carbon monoxide (above).
3.    If the unit does re-sound:  

    Evacuate the individuals from the home
    Turn off all appliances, vehicles, or other sources of combustion immediately.  These could include a furnace, water heater, vehicles, and other sources
    Immediately get fresh air into the home by opening doors and windows
    Call your service provider to make a report
    Do not restart appliances until the service provider, or maintenance personnel, has stated the problem has been corrected

4.    Call the administrative on-call person for assistance:  612-598-5700. 

Responding to Severe Weather/Tornado 
a.     National Weather Service alerts to possible tornado or severe storm developments.

b.    The designated safe area for severe weather/tornado at this home is:_______________________

Severe Weather/Tornado Drills: When we support people in community residential settings, during tornado season, at least two practice drills in response to severe weather/tornado occur.  The drills are initiated/assigned by the manager, according to the printed agency schedule.  Following the completion of the drill, a Tornado Drill report is completed and submitted to the assigned senior manager who evaluates the response and makes recommendations for additional safeguards as needed. 

Responding to Severe Winter Weather
a.    During the cold winter months, remain alert to changing weather conditions.  Regularly check the weather reports on TV, radio, or internet.  Also, advisories may be issued internally across e-mail.  
b.    When the National Weather Service announces an extreme cold or blizzard warning it means that these conditions will occur within 12 hours of the initial advisory.
c.    During actual blizzard warnings, no unnecessary transportation is permitted.  Necessary travel i.e., medical appointments, may occur only with the approval of the manager after consultation with the senior manager.
d.    Be aware and prepared for other closing that may affect the 
Schedule of the person you support and make necessary arrangements.
e.    Call 911 and report your position if there is an accident or the vehicle goes off the road during the winter months. Stay in the vehicle unless it is not safe to do so. 
f.    The location of flashlight and battery radio is_________________
g.    If structural damage or extended power outage occurs, call the on-call administrative personnel at 612-598-5700.  They work with the senior manager to coordinate alternative housing if 
relocation is necessary.  Maintenance personnel will assess the reported damages, as necessary.  
Also call to notify the on-call administrative person when power is restored.  
h.    If services need to be relocated for more than 24 hours, an incident report is completed and submitted by the manager.  The manager or their designee notifies the person’s legal representative or emergency contact and case manager within 24 hours of the incident.  They also notify licensing personnel as appropriate.

Emergency Evacuation and Emergency Sheltering/Relocation of Services
People may need to be relocated due to structural damage after a storm or fire, furnace malfunction (including carbon monoxide), gas explosion, power outage, or other physical plant concerns.

When there are concerns for the health and/or safety of the persons who live there the following steps should be taken:

1.    If additional staff is needed to meet the emergency, staff on duty should call the manager, senior manager, and/or on-call administrative personnel for assistance at 612-598-5700.
2.    If relocation is necessary, call the manager, senior manager and the on-call administrative personnel.  They will work together to determine where the individuals can go most immediately, as well as assist with a long term plan, if that is needed.  If relocation exceeds 24 hours, the manager completes an incident report.
3.    The on-call administrative personnel works with the manager and senior manager to notify all employees, agency maintenance personnel, insurance company, parents, guardians, case managers, and county satellite and state licensors.
4.    Maintenance personnel work with law enforcement to secure the property and assess damage and, if possible, complete needed repairs so people may return to their home as soon as possible.

Responding to a Mental Health Crisis
You have a few options:

1.    Call 911 if the concern is life threatening.
2.    Call a mental health crisis intervention team or 
line that you can search on the internet. 
3.    A person can also call their individual therapist, 
when the situation does not require an immediate 
911 emergency response. 

Responding to a Missing Person
No two missing people are the same. Consequently, it is vital to find out as much about the missing person as possible before initiating a particular response. 

1.    If a person is suspected missing, note the time and location 
when and where the person is expected to be.

2.    Check the persons Community Supports and Services Plan 
(Support Plan) and/or Personal Safety Plan for guidance and the 
length of time the person can be on their own.

3.    Attempt to locate the person by calling people or agencies 
he/she may be with, and search the immediate area and 
nearby areas of potential interest to the person.

4.    If the person cannot be located, immediately call the on-call administrative personnel at 612-598-5700.  The on-call administrative personnel provides direction for notifying the person’s legal representative or designated emergency contact, case manager, and police.

5.    The employee working at the time the person was determined missing completes an Incident Report and any related documentation, i.e., Health Care Progress Notes, communication notes, police report, etc.

6.    The manager or their designee follows up with the case manager and the person’s legal representative or designated emergency contact within 24 hours of the incident.  They also notify licensing personnel as appropriate.

Responding to Physical Aggression between People Receiving Services
1.    Follow the approaches you have learned in Behavior Intervention Policy and Procedure and your individualized training and seek assistance from other staff if available. 
2.    If injury to an individual has occurred or there is imminent possibility of injury to another person and:
a.     you have been trained in the emergency use of manual restraint, immediately implement emergency use of a physical intervention, likely a manual restraint.  (Refer to Emergency Use of Manual Restraint Policy and Procedure). 
b.    you have not been trained in the emergency use of manual restraint or it isn’t effective and you cannot make the situation safe for people, immediately call 911.
3.    After the situation is under control, question the people as to any injuries and look for any signs of injury.  If injuries are noted, provide necessary treatment, contacting medical personnel if needed.  
4.    Notify the manager and administrative on-call person (612-598-5700) as soon as everyone is safe and the individuals’ immediate needs have been met.  
5.    The staff that was most directly involved at the time of the incident completes an incident report before completing their shift.  If the incident involved emergency use of a manual restraint, a call to law enforcement or other first responders, emergency psychiatric hospitalization, or a prn psychotropic medication was administered, this staff completes a Behavior Intervention Reporting Form (BIRF) and submits it to the site manager prior to leaving the shift.  
6.    The manager or their designee notifies the case manager and the person’s legal representative or designated emergency contact within 24 hours of the incident.  They also notify licensing personnel as appropriate.

Responding to Sexual Exploitation or Assault
1.    If you witness what you think is sexual exploitation or sexual assault, talk to the persons involved in a calm manner and ask them to separate.  If there has been obvious force or intimidation, based on your knowledge of the individuals, physically intervene or call 911 if necessary. If the individuals are unclothed, provide them with a robe or other clothing, but they should not redress in the clothing they were wearing and they should not bathe or shower.  
2.    Talk to each of them separately, to the extent possible, to determine what led to the interaction and what happened.  Assess whether the person is experiencing any physical or emotional discomfort.  Ask what, when, where, and how questions.  Do not ask “why” questions.  Document your initial observations and the information provided by the persons as soon as possible after talking with them.

3.    In a respectful manner, look for any signs of physical injury (e.g. bruising, bleeding, etc.) and document your observations as soon as possible.  
4.    If medical personnel and/or law enforcement have been contacted, follow all instructions they provide.
5.    If it is determined unnecessary to involve medical and/or law enforcement personnel, the person(s) may resume their normal activities.
6.    Call the manager and the on-call administrative person at 612-598-5700 as soon as appropriate arrangements have been made to meet the person(s) needs.
7.    The staff most directly involved at the time of the incident completes an incident report before completing their shift.  If the incident involved emergency use of a manual restraint, a call to law enforcement or other first responders, emergency psychiatric hospitalization, or a prn psychotropic medication was administered, this staff completes a Behavior Intervention Reporting Form (BIRF) and submits it to the manager, before the end of the work day. 
8.    The manager or their designee will notify the case manager and the person’s legal representative or designated emergency contact within 24 hours of the incident.  They also notify licensing personnel as appropriate.

When Law Enforcement is Requested
1.    In the event staff have summoned law enforcement or fire department to the home (e.g. due to possible criminal activity, security/safety concerns, individual’s behavior, fire etc.) or to the site of an incident or emergency, staff will explain, in detail the reason for requesting them, upon their arrival.  Answer all questions asked of you and follow any instructions provided.  Document the event on an incident report as soon as possible after the fact, and notify the on-call administrative personnel immediately.  
2.    If law enforcement was requested for security/safety concerns or behavior this staff also completes a Behavior Intervention Reporting form (BIRF) and submits it to the site manager prior to leaving the shift.
3.    The manager or their designee notifies the case manager and the person’s legal representative or designated emergency contact within 24 hours.

Unannounced Law Enforcement
1.    If law enforcement officers arrives unannounced to the home or the site of an incident or emergency, staff first ask for proper identifications as warranted (i.e., non-uniformed officer).  Ask how you can be of assistance and be cooperative with the official.  Answer all questions asked of you; offer additional information after the officer’s questions have been answered.  Before they leave, ask the official for his/her business card and a case number if one is being assigned.
2.    Document the event on an incident report as soon as possible after the fact.  
3.    Call the manager and on-call administrative person immediately.
4.    The manager or their designee notifies the case manager and the person’s legal representative or designated emergency contact within 24 hours.
5.    Submit a photo or the front and back of the officer business card if a case number is being assigned to the vice president of administration.

Vehicle Crash
1.     If involved in a vehicle crash, provide all information requested of you and provide officials with the necessary insurance information.  Also, be sure to obtain insurance information from the other drivers involved. (See Accident Protocol posted at the site).  Always call the police- never leave the scene until given permission by law enforcement.
2.    Document the event on an incident report as soon as possible after the fact.  Notify the manager and on-call administrative personnel immediately.
3.    The manager or their designee notifies the case manager and the person’s legal representative or designated emergency contact within 24 hours.

Contact with Law Enforcement in the Community
1.    If you have contact with law enforcement or the fire department while in the community, as a part of your work, follow the procedures described in “Requested Law Enforcement” or “Unannounced Law Enforcement” above, depending on who initiates the contact.  
2.    Document the event on an incident report as soon as possible after the fact.  Notify the manager and on-call administrative personnel immediately.
3.    The manager or their designee notifies the case manager and the person’s legal representative or designated emergency contact within 24 hours.

Reporting Incidents and Emergencies

When an incident occurs:
a.     The employee who is supervising at the time of the incident:
o    Immediately calls 911 if there is a medical emergency or a physical or sexual assault in progress;
o    Immediately (before leaving the shift) notifies:
    The assigned manager or senior manager;
    The on-call RN, if the incident resulted in an injury to the individual; and
    The administrative on-call personnel
o    Completes an Incident Report and any other related documentation, i.e., Health Care Progress Notes, Entry Notes, communication book, and a BIRF, if applicable
b.    The manager:
o    Reviews each incident report and related documents the next working day for accuracy and thoroughness, to identify any patterns and to determine corrective action.  The manager will ask for the incident report to be rewritten if the content is not accurate or not written factually or professionally.  
o    The manager is responsible for completing the incident report and for any follow-up related to the incident, i.e. retraining, disciplinary action, etc.
o    Faxes or brings the incident report to the senior manager the next working day following the incident
c.    The senior manager:
o    Reviews the incident report for accuracy and thoroughness, returning it to the manager if changes or additions are needed.
o    They sign/initial the report, below the designated coordinator’s signature
o    Scans or e-mails the incident report to the “Incident Reports” e-mail address at Mains’l

d.    The manager, or senior manager in their absence, reports the incident to the person’s legal representative or designated emergency contact and case manager within 24 hours of:
o    An incident occurring while services are being provided
o    Within 24 hours of discovery or receipt of information that an incident occurred, unless we have reason to know that the incident has already been reported, or
o    As otherwise directed in a person’s Coordinated Services and Support Plan (Support Plan) or Coordinated Services and Support Plan Addendum
o    A copy of the incident report is sent to these persons, if requested
o    The senior manager sends a copy of the incident report to the county satellite licensor for any incident that involves serious injury, death, or change in health status that may affect continuation of services

e.    When the on-call administrative personnel receives the call from the employee:
o    They must verify whether the employee has reached the manager or senior manager to provide the notice to the legal representative or designated emergency contact and case manager, within 24 hours of the incident
o    Notify the following agencies as appropriate, within 24 hours:

    Death or Serious injury            Office of Ombudsman for Mental Health and
Developmental Disabilities FAX 651-797-1950
    AND
Department of Human Services, Division of Licensing FAX 651-431-7673

    Maltreatment                Minnesota Adult Abuse Reporting Center
(MAARC) at 1-844-880-1574 or online at mn.gov/dhs/reportadultabuse/ or for minors call law enforcement of the county Child Protection Agency Death, Serious Injury, or fire    County Satellite Licensor that causes structural damage or requires the fire department

f.    All employees receive ongoing training regarding emergency response procedures and responding and reporting incidents and emergencies. 
g.    When reporting a maltreatment incident, specifically, the person’s legal representative and case manager must be notified unless there is a reason to believe that either party is involved in the suspected maltreatment.  The information that must be disclosed is the nature of the activity or occurrence reported and the agency that received the report.
h.    The on-call administrative personnel notifies Chuck Jakway, vice president of administration, about any incidents report to MAARC, death, serious injury, police or fire rescue.  In the absence of the vice president of administration, John Jakway, shall be notified.  The vice president of administration, or his designee, initiates an internal review of incident reports of death and serious injuries that occurred while services were being provided and those that were reported by the program as alleged or suspected maltreatment, for identification of incident patterns, and implementation of corrective action as necessary to reduce occurrences.  The internal review will include an evaluation of whether:
1.    The policies and procedures were adequate
2.    Related policies and procedures were followed
3.    There is need for additional staff training
4.    The reported event is similar to past events with the persons or the services involve to identify incident patterns
5.    There is need for corrective action by the program to protect the health and safety of the persons receiving services and to reduce future occurrences
i.    Based on the results of this review, a corrective action plan is developed, documented, and implemented to correct current lapses and prevent future lapses in performance by staff or the agency, if any.  Internal Reviews are completed within 30 calendar days of the report.  
    When the initial reporter believes the incident was maltreatment, the on-call administrative personnel sends a Status of Report of Suspected Maltreatment letter to the initial reporter at their home address, with two working days.  
j.    The person conducting an internal review of maltreatment follows the Reporting and Responding to Maltreatment Policy and Procedure.
k.    The person conducting a review of emergency use of manual restraints follows the Emergency Use of Manual Restraint Policy and Procedure.

Record Keeping: 
1.    The review of an incident will be documented on the incident reporting form and will include identifying trends or patterns and corrective action, if needed.
2.    Incident reports will be maintained in the person’s record.  They will also be e-mailed/scanned into the incident report e-mail address ireport@mainsl.com.  Incident reports and corresponding documentation (MAARC reports, Internal Reviews, DHS determination letters, Status of Maltreatment Status Letters and Ombudsman Reports will be stored in this e-mail box.  

Critical Incidents

A critical incident is any incident that: involves illegal activity, results in significant injury to a person receiving services or staff, the death of a person or staff, has significant negative impact on a member of the neighborhood or community or is judged to potentially have a high level of risk/exposure for the agency.   

The procedure for managing critical incidents is as follows:
1.    Call 911 if appropriate.
2.    The staff present and most immediately involved in the incident calls the administrative on-call personnel.
3.    The administrative on-call personnel call the assigned senior manager; together they determine whether this is a critical incident. If it is determined to be a critical incident, the senior manager contacts one of the persons listed below in #4.  If the senior manager is not available, the administrative personnel will proceed to step # 4. 
4.    Critical Incident Lead-  Notify one of the following in the order listed:
 
In Minnesota:
Anne Roehl         612-597-9486 (c)
John Jakway        612-240-7642 (c)
In California:
Anne Silcher         530-723-2901 (c) Jamie Markey        530-723-0322 (c)
 
5.    When one of the above persons is contacted, they become the critical incident lead and the primary contact.  It is this person’s responsibility to direct all agency activity to the incident until it has been resolved. 
6.    Media Lead- When there is request or potential requests for comment from any external stakeholders or media agencies, only the following people should provide comments, in the order listed:
Corporate (Minnesota, California)
Tracy Hinkemeyer    612-987-3910 (c)
Anne Roehl         612-597-9486 (c) 
The media lead will work, together with the critical incident lead and senior leadership team, to respond to any media requests or questions.
7.    No other staff should initiate or respond to any contact from external stakeholders or the media unless specifically requested to do so by a member of the Executive Team.  Any written reports or correspondence are to be reviewed by the critical incident lead and media lead prior to release. 
8.    Critical incidents could occur at the Mains’l offices.  The Mains’l offices will keep a current emergency response contacts list of whom to call in case of specific kinds of emergencies such as damage (internal or external), disturbances, fire alarms, gas interruption, etc.  This list will be reviewed and updated at least annually by the vice president of administration.