Winter Safety Measures
The purpose of this document is to provide information regarding winter
safety measures to be taken by providers.
It is also to alert all
providers to the dangers that exits when persons with
confusion or dementia wander away from health and
residential care facilities. Wandering becomes more dangerous during
winter months because exposure to cold temperatures can be life
threatening.
This document addresses the following issues related to winter safety:
Hypothermia
Hypothermia: Definition and Over-all Risk Factors
Hypothermia is an unintentional lowering of the body temperature to 95
degrees Fahrenheit (F) or below.
Hypothermia is most likely to occur at
very cold temperatures; however, it can occur even at cool temperatures
(above 40 degrees F) if a person becomes chilled from rain, sweat, or
submersion in cold water.
Warning signs of hypothermia in adults are
shivering, confusion, memory loss, drowsiness, exhaustion, fumbling hands,
and slurred speech. In infants, warning signs include bright red, cold
skin and very low energy.
Hypothermia is a medical emergency that needs immediate treatment.
During hypothermia, all body systems function in an increasingly sluggish
manner. Heart and respiratory rates decrease, reflexes slow, muscles
become soft and flaccid, and shivering ceases.
Tissue anoxia (deprivation
of oxygen) further robs the brain of awareness of the emergency that is
occurring, and the individual may not be aware enough to seek warmth and
shelter or may not be able to verbalize how they feel.
Statistics show that approximately one-half of all hypothermia deaths
occur among persons 64 years old and older. The elderly are at greater
risk for hypothermia than the general population because the body’s
ability to produce its own heat declines with age.
Additionally, there is
a loss of subcutaneous fat, impaired thermoregulation, and a decrease in
the ability to feel cold as intensely as when young. These factors result
in little motivation to seek warmth.
Other factors that increase the risk
for hypothermia include:
- diabetes
- cardiovascular and cerebrovascular diseases
- infections (bronchopneumonia)
- falls
- fractures
- confusion
- dementia
- mental illness
- mental retardation
- certain medications, (e.g.,
phenothiazines or antidepressants)
- consumption of alcohol.
Hypothermia Prevention – High-Risk
Persons
Victims of hypothermia are most often:
-
elderly;
-
persons with cognitive or judgement
impairments who leave a warm environment unsupervised and unnoticed;
-
persons with inadequate food, clothing or
heating;
-
infants sleeping in cold bedrooms;
-
persons who remain outdoors for long
periods, e.g., the homeless or those who do not have access to or use
of motor transportation and rely on walking, sometimes for great
distances;
-
persons who are uninformed about
precautions and actions they should take to protect themselves from
the extreme cold;
-
persons with acute alcohol intoxication
who are exposed to extreme cold;
-
persons with serious mental illnesses,
developmental or cognitive disabilities who may not hear temperature
or weather advisory warnings broadcast on TV or radio or may not fully
recognize the significance of the cold weather warnings;
-
persons with diabetes or other medical
conditions that require medications; and
-
persons who are non-English speaking who may not be able to
interpret warnings broadcast only in English.
All providers need to evaluate each resident, client or patient and
ensure that environmental safeguards, staff training, policies, procedures
and practices are in place that will protect vulnerable people from the
dangers of cold weather, especially those with impaired cognition or
judgment.
Persons who are dependent on others for safety and protection,
regardless of the type of provider, must be prevented from leaving alone
without the appropriate apparel and personnel to protect them from
hypothermia and other dangers.
Of additional importance is that all safety
exits must remain functional.
Persons Who Wander or are At Risk of Wandering
The following preventive measures are recommended for the care and
supervision of persons who are apt to wander:
-
Identify all persons who have a history of
confusion with associated wandering. Also evaluate those who are at
risk but may not yet have had an episode of wandering.
Persons with
cognitive impairment or judgment impairment who are ambulatory or have
wheelchair mobility are at particular risk of hypothermia in every
setting, even if they have not yet exhibited a history of wandering.
-
Evaluate all instances of wandering and
all at-risk persons to establish individual interventions that will
prevent the person from leaving the warm environment or will provide
staff with foolproof signals and procedures if someone starts to leave
unexpectedly.
-
For nursing home residents, certain sections of the Minimum Data Set
(MDS), version 2.0, may help identify individuals with potential risk
for wandering who need further assessment.
Some pertinent MDS sections
are as follows: (This list is not all-inclusive. A comprehensive
assessment is needed for resident evaluation).
-
Wandering (Section E-4a)
-
Mood and behavior patterns (Section E)
-
Alterations in cognitive patterns (Section B)
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Difficulties in communication (Section C, especially C-6)
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Incontinence (Section H-1b)
-
Hypothyroidism, diabetes mellitus, cardiovascular disease,
arthritis, Parkinsonism, Alzheimer’s disease, dementia, mental
illness (Section I)
-
Dehydration, unsteady gait (Section J)
-
Antipsychotic, antianxiety or antidepressant medications (Section
O-4)
-
For each individual at risk, regardless of the type of provider, a
comprehensive assessment of the person should identify the areas
needing attention in order to develop and implement an effective care
plan or service plan. The preventative plan should:
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Establish a pattern and root cause for wandering and proactively
eliminate triggers.
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Promote participation in group activities.
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Encourage communication with persons who have similar interests.
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Work with family members or other volunteers to establish visit
patterns if possible, especially at times when the person is most
restless.
-
Promote comfort, meaningful activities and programming, safe
ambulation and mobility, as well as good nutrition, hydration and
elimination assistance that will meet his/her needs.
Often a person
who wanders is searching to find a way to meet unmet needs, such as
hunger or loneliness.
-
Promote increased exercise and fresh air to combat restlessness
and sleeplessness.
-
Review the care or service plan to assess effectiveness and ensure
that it contains sufficient measures to prevent wandering or
elopement.
-
Assure that persons are dressed in appropriately warm clothes,
even when indoors, as hypothermia can also occur in indoor settings
among individuals who are at risk.
Provider Responsibility for Staff Education
– Hypothermia Awareness and Prevention
It is the provider’s responsibility to ensure that all staff,
especially direct-care staff in all residential facilities and
community-based programs, know the dangers of extreme cold and the
importance of assessing and planning for prevention for each patient,
resident or client.
-
Staff on duty should frequently observe
the location of each potential wandering person according to an
interval that is safe for protecting that person.
It may be necessary
to transfer responsibility for these observations at certain times of
the day, for instance, when the person goes to a therapy department.
Transfer of responsibility must be formally carried out and not
assumed by either party.
-
All facility and contracted staff,
including dietary, housekeeping, office and administrative staff and
maintenance, should recognize the identified persons and be prepared
to intervene according to the plan of care and with emergency safety
measures if needed.
-
If provided, all existing
surveillance/monitoring devices, e.g., door alarms, must operate 24
hours a day. These devices should routinely be scheduled for
maintenance checks.
-
Ensure the ability of staff to act quickly
and prudently should an elopement occur. For example, evaluate how
staff respond to alarms and the actions they take (or fail to take)
when locating a missing person or resetting an alarm system.
An alarm
system may be electronically functional, but how staff use the system
and what they do when an alarm sounds is critical.
Be aware that more
than one person who wanders may be involved in an incident that
triggers an alarm, therefore when an alarm sounds, the whereabouts of
all persons should be quickly ascertained.
-
Do all staff know how to proceed if
someone is missing? Could someone elope without staff awareness?
-
Prior arrangements with community
resources, e.g., the local police, sheriff or wilderness patrol,
should be reflected in the policy and procedure formulation with
timetables for notification specified.
Many local law enforcement
departments or community canine club volunteers have effective canine
rescue patrols that can be called into action to search for
individuals when given a timely alert.
Quick action by staff and the
sharing of critical information about any missing persons is
essential.
-
In case of accidental hypothermia,
treatment must begin immediately. Staff competency in assessing for
hypothermia and taking quick appropriate action is essential. This
must also be done for persons who are unable to verbalize how cold
they are.
The severity of the exposure will determine the
interventions to be taken, but treatment should not be delayed while
establishing the severity of the exposure. Any amount of hypothermia
is an undesirable outcome.
-
A rectal temperature of 95 degrees F or lower indicates a medical
emergency that is likely to be fatal.
If persons are discovered
outdoors in cold weather, staff should treat them as if they are
hypothermic even though their symptoms may not be obvious, especially
if they are cognitively impaired and cannot express how they feel.
The
symptoms of hypothermia may not be obvious, but can occur in a very
few minutes, especially if the person is elderly, frail or poorly
clothed.
Indoor Safety
Staff in community based programs can help clients prepare their homes
for the winter season.
Prevention plans can include making referrals to
local power companies or energy assistance programs for tips on safely
heating homes and home safety checks, monitoring inside temperatures, and
devising home emergency plans in case a power failure occurs.
If your area
is prone to long periods of cold temperatures, or if clients’ homes are
isolated, plans might also include the stocking of additional amounts of
food, water and necessary medications.
Clients should be instructed to eat
well-balanced meals, avoid alcoholic beverages, and drink warm beverages.
In extremely cold temperatures, heating systems may be pushed beyond
their capacity to maintain warmth in all resident rooms.
Extra measures
may be needed; however, portable space heating devices are prohibited in
hospitals, nursing homes, facilities for the developmentally disabled and
community based residential facilities and are not recommended for use by
other providers due to safety concerns.
Portable space heaters have been
the cause of accidental fires. Any heating device, other than a central
heating plant, shall be so designed and installed that it or its
appurtenances (accessories) will not ignite combustible material.
If a
heating device is fuel fired, it is to be connected to a vent or chimney
and must operate by taking air for combustion directly from the outside.
It also shall be designed and installed to provide for complete separation
of the combustion system from the atmosphere of the occupied area.
Any
heating device shall have safety features to immediately stop the flow of
fuel and shut down the equipment in case of either excessive temperatures
or ignition failure (Life Safety Code (LSC 2000 edition), Chapter 18.7.8).
Outdoor Safety
When the weather is extremely cold, especially if there are high winds,
clients should be encouraged to stay indoors or to make any trips outside
as brief as possible.
Prevention plans might include tips on how to dress
safely for winter weather - always wear several layers of loose-fitting
clothing, a hat and scarf to cover one’s face and mouth, mittens, and
water-resistant coat and shoes.
Help clients understand wind chill—as
the speed of the wind increases, it can carry heat away from the body more
quickly. When there are high winds, serious weather-related health
problems are more likely, even when temperatures are only cool.
Avoid ice - many
cold-weather injuries result from falls on ice-covered sidewalks, steps,
driveways and porches. Assist clients by keeping these areas free of ice.
Finally, instruct consumers and staff to carefully watch for signs of
cold-weather health problems such as hypothermia and frostbite for
themselves and their neighbors.
The federal Centers for Disease Control and Prevention (CDC) offers
information entitled, "Extreme Cold: A Prevention Guide to Promote your Personal Health
and Safety" at: http://www.bt.cdc.gov/disasters/winter/guide.asp
(exit DHFS)
Another
CDC document entitled "Winter Storm Facts" is available at: http://emergency.cdc.gov/disasters/winter/factsheet.asp
(exit DHFS)
Clear Exits and Exit Door Safety
Winter ice, snow and drifting snow conditions can complicate fire
egress/exiting. Nursing homes, facilities for the developmentally disabled
and hospitals must comply with the following exit requirements.
They are
also recommended for other community service providers, such as community
based residential facilities, adult family homes and all other providers.
All exits from a building must be provided with safe access to a
street, alley or parking area (public way) (LSC 2000 Edition Chapter
7.7.1).
Facilities with an exit that discharges to yards that do not have
a public drive around the building shall make provisions to ensure that a
cleared path from each exit is maintained that is free of ice and snow to
a public way that is at least 28 inches wide for existing facilities and
36 inches wide for new buildings, with 48 inches recommended.
Facilities
that do have a surrounding drive shall keep the drive clear, i.e., free of
ice and snow, and shall provide at least a 48-inch wide clear path to the
drive.
For facilities with non-ambulatory residents, the cleared path will
be a "hard surface pathway" of sufficient structural capacity to
maintain safe egress of wheelchair or bedridden residents.
Note: Local
fire departments should also be contacted to ensure there are no local
rules that may be more restrictive.
All exit doors shall be checked frequently to ensure that freezing
conditions have not caused any exterior concrete, asphalt pads or
thresholds to heave up and block the exit door from opening.
All doors
shall be capable of being opened freely and normally to full opening width
without sticking in the doorframe.
Holiday Decoration Safety
Nursing homes, facilities for the developmentally disabled and
hospitals must comply with the following requirements related to
combustibles.
They are also recommended for other community service
providers, such as community based residential facilities, adult family
homes and all other providers.
Many of the holiday decorations that are used can be highly flammable
or pose an unusual fire hazard. The references cited in parentheses are
from the National Fire Protection Association (NFPA) Life Safety Code (LSC)
Standard 101, 2000 Edition.
The following precautions are advised:
-
Combustible decorations are prohibited
unless they are flame-retardant (LSC Chapter 18.7.5.4).
-
No furnishings, decorations or other
objects shall be placed so as to obstruct exits or exit signs (LSC
Chapter 7.10.1.7).
-
No open flame devices, such as candles,
shall be used (LSC Chapter 18.7.8).
-
Christmas trees shall not be used unless
flame-retardant (LSC Chapter 18.7.5.4).
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Decorative power lighting will be
permitted if power circuits do not become overloaded and light strings
are listed and in good condition.
The number of light strings in
series shall not constitute an electrical hazard and manufacturer’s
safety precautions must be followed. Please be mindful of the tripping
hazards associated with electrical cords or other holiday
paraphernalia.
Questions about the information in this document may be directed to the following
contact persons:
-
Nursing Homes and Facilities Serving
People with Developmental Disabilities should contact the
appropriate Nursing Home
Resident Care regional office.
-
Community Based Residential Facilities,
Adult Family Homes, Adult Day
Care Providers and Residential Care Apartment Complexes should contact
the appropriate Assisted Living regional office.
- All Other Providers Should Contact:
Cremear Mims, Director, Bureau of Health Services
2917 International Lane, Suite 300
Madison, WI 53704
(608) 243-2028
FAX: (608) 243-2026
Last Updated: August 13, 2009 |
