Emergency Preparedness and Acuity Tiers
How patients are prioritised for a disaster, what every patient's emergency plan must contain, and what happens when the power goes out.
Agencies are required to have an emergency preparedness plan covering the whole range of likely events — severe weather, extended power loss, flooding, wildfire, and communicable disease. Your part is smaller and specific: every patient has an individual plan, and you know which patients get reached first.
Acuity tiers
Patients are classified by how urgently they need contact when normal service is disrupted. Agencies use slightly different labels; the logic is the same.
| Tier | Who | In an emergency |
|---|---|---|
| 1 — Highest | Life-sustaining equipment: ventilator, oxygen-dependent, IV therapy the patient cannot miss, unstable and living alone | Must be contacted and seen; may need evacuation or relocation |
| 2 — High | Needs skilled care that cannot safely be deferred — daily wound care, insulin they cannot self-administer | Contacted; visit prioritised |
| 3 — Moderate | Skilled need that can be deferred briefly; some caregiver support available | Contacted by phone; visit as soon as practical |
| 4 — Lowest | Stable, good caregiver support, care can safely wait several days | Phone contact |
Assign the tier at start of care, and review it whenever the patient changes. A patient who starts oxygen moves up. A patient whose spouse dies moves up, whatever their clinical status.
Confirm your agency's exact tier definitions with your Field Supervisor — the numbers and the labels are not standardised across agencies.
Every patient's individual plan
Established at SOC, reviewed at recert, and kept where the patient can find it — not filed in a folder.
- Acuity tier
- Who to call at the agency, and what to do if they cannot reach us
- Where they would go if they had to leave — named place, not "a relative's"
- How they would get there, and who would take them
- Power-dependent equipment listed, with the supplier's emergency number
- Utility company notified if they are power-dependent — many keep a priority restoration register
- Medication supply — at least several days on hand, and a plan for refrigerated medications
- Water and food for several days
- Copies of the medication list and key documents in a grab bag
- Caregiver or neighbour who will check on them
- Pets — because patients will refuse to evacuate without them
Power-dependent patients
The highest-risk group, and the one to think through in advance.
- Oxygen concentrators stop with the power. Does the patient have cylinder backup, and do they know how to switch over?
- Does the DME supplier know the patient is power-dependent, and what is their emergency number?
- Has the electric utility been notified? Registration usually needs to happen before the outage.
- Ventilators and other life-sustaining equipment need a battery plan and a relocation plan
- Refrigerated medications — insulin, some biologics — need a cooler plan
- Powered beds and lifts: how will the caregiver manage without them?
Ask the patient to describe what they would actually do. The gap between the written plan and the answer you get is the useful finding.
Heat and cold
The two most common real emergencies our patients face, and both disproportionately kill people who are homebound.
Heat — no working air conditioning, medications that impair thermoregulation (anticholinergics, diuretics, beta blockers), a patient reluctant to run the AC because of cost. Ask directly about the electricity bill; a cooling centre referral or an MSW referral is often the intervention.
Cold — heating that has been turned off, space heaters used unsafely, a patient wearing a coat indoors. Both are MSW referrals and both are worth raising before the season.
When an event happens
- The agency activates its plan and works down the tiers
- You may be asked to call or visit patients who are not yours — take the list and the context
- Document every contact attempt, with the time
- Report anyone you could not reach
- Report anyone whose situation has become unsafe
- Follow the agency's instructions on whether to travel — do not make that call alone in dangerous conditions
If you are told not to travel, do not travel. A clinician in a ditch helps nobody.
After
- Reassess patients who were affected; missed care and missed medications have consequences that show up days later
- Update acuity tiers where the event revealed something
- Report what did not work — the plan is only useful if it gets corrected