Participant Emergency Plan

Mildura Disability Support Services I Participant Emergency Plan
This emergency plan is designed to provide comprehensive information to ensure the participant's safety during an emergency. All workers involved in the participant's care should be familiar with this plan and know where it is located. This plan should be updated annually or as changes occur in the participant's condition or circumstances.

The actual plan should be tailored to the specific needs and circumstances of each individual, considering their physical, emotional, and communication needs. It should be created in collaboration with the participant, their family, and their care team.
Participant Full Name*
Participant Date of Birth*

DayMonthYear
Date
Participant Address*
Participant Primary Language
Participant Health Insurance Company Details (if known)
Development Date*

DayMonthYear
Date
Involvement in Plan Development:
Was the Participant involved in the Plan Development - Yes | No*
Stakeholders were involved in the plan management- Yes | No
If Stakeholder (Yes). Provide details of those involved
EMERGENCY CONTACT INFORMATION
Primary Emergency Contact - Name*
Relationship*
Phone Number*
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState

Postcode
Secondary Emergency Contact (if applicable):
Name
Relationship
Phone Number
Email
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Medical Information
Primary Physician Name*
Contact Information*
Participant Medical Condition*
Allergies If Applicable *
Pharmacist Name*
Contact Information*
Current Medications*
REQUIREMENTS AND ACCOMMODATION
Does the Particpant have Mobility Needs, (e.g. wheelchair, walker)?*
Does the Participant have Communication Needs (e.g. hearing impaired non-verbal)?*
Does the Participant have Dietary Requirements?*
Other Requirements*
Emergency Procedures
Fire - What steps to take and who to contact*
Medical emergency - What steps to take and who to contact*
Natural disaster - What steps to take and who to contact*
Infectious/hazardous exposure - What steps to take and who to contact*
Power outage - What steps to take and who to contact*
Worker Emergency Instructions

Fire

Steps to take:

- Remain calm and raise the alarm immediately.
- Evacuate the area using the closest safe exit.
- Assist participants and colleagues if safe to do so.
- Move to the designated assembly point and wait for instructions.

Who to contact:

000 – Fire Brigade
Supervisor if within an MDS Facility (On-Call Worker if past office hours)

Medical Emergency
Steps to take:

- Check for danger and ensure the scene is safe.
- Provide first aid within the worker scop of practise.
- Do not move the person unless there is immediate danger.
- Stay with the person and keep them comfortable.

Who to contact:

000 – Ambulance
Nurse on Call

Supervisor if within an MDS Facility (On-Call Worker if past office hours)

Natural Disaster (e.g., earthquake, flood)
Steps to take:

- Follow the organisation’s emergency plan and any official warnings.
- Move to a safe location (indoors for storms, high ground for floods).
- Keep participants together and remain calm.
- Evacuate only if instructed by authorities or if the building becomes unsafe.

Who to contact:

000 – Emergency Services
Local SES (132 500)
Supervisor if within an MDS Facility (On-Call Worker if past office hours)

Infectious / Hazardous Exposure

Steps to take:

- Remove yourself and others from the area.
- Isolate the hazard if trained and safe to do so.
- Wash or sanitise exposed skin immediately.
- Record details of the exposure and affected individuals.

Who to contact:

Supervisor if within an MDS Facility (On-Call Worker if past office hours)
Poison Infomation Centre - 13 11 26
000 if exposure is life-threatening

Power Outage

Steps to take:

- Stay calm and ensure participants are safe.
- Use torches, not candles.
- Turn off electrical appliances to prevent surge damage.
- Follow the site’s evacuation plan if required.

Who to contact:

Supervisor if within an MDS Facility (On-Call Worker if past office hours)
Building Management / Maintenance (refer to emergency contact chart in MDS Hub)
Energy provider (refer to emergency contact chart in MDS Hub)
Emergency Evacuation Kit Preparation

An emergency evacuation kit is essential in any emergency situation. Workers should encourage participants to prepare an evacuation kit and it should be kept in an easily accessible location known to the participant and all workers involved in their care. Below are instructions for preparing a kit:

1. Container

Choose a durable and waterproof container for storing your emergency evacuation kit. It should be easy to carry and large enough to hold all necessary items.

2. Food and Water

Include at least a three day supply of non-perishable food items and water. Consider any dietary restrictions the participant may have.

3. Medications and Medical Supplies

Pack a seven-day supply of necessary medications and other medical supplies. Do not forget to include a first aid kit. Always check the expiry dates and replace as needed.

4. Personal Care Items

Include essential items such as spare glasses, hearing aid batteries, toiletries, sanitation supplies, and any other personal care items the participant may need.

5. Documents

Keep a set of copies of important documents in the kit. These might include identification, insurance cards, medical records, and a copy of the individualised emergency plan.

6. Comfort Items

Add items that might provide comfort during a stressful situation, such as a favourite book, a set of warm clothing, or a blanket.

7. Communication and Lighting

Pack a battery or crank powered radio, spare batteries, and a flashlight. A whistle can also be useful for signalling help.

8. Special Needs Items

Consider the participant's unique needs. This might include wheelchair batteries, oxygen, catherters, or other specialised equipment or supplies.

9. Cash and Keys

Include a small amount of cash and coins, and an extra set of keys to your home and vehicle.

Check and update your emergency evacuation kit regularly (at least once per year). Replace expired items and update the kit according to the participant's changing needs. All carers should be aware of the kit's location and contents.
PLAN REVIEW
Scheduled Emergency Plan Review Date*

DayMonthYear
Date
Actual date of emergency plan review

DayMonthYear
Date
Reason for review
Outcome of review

New plan developedNo changes required
If no changes required, date of next scheduled review:

DayMonthYear
Date
Signatures:
Was the participant or their representative available to sign this plan?*

YesNoDeclined
Who filled out this form?*

MDSS WorkerParticipantRepresentative
Participant/Representative Name
ParticipantRepresentative Signature

Clear
Date

DayMonthYear
Date
MDSS Worker Name
MDSS Worker Signature

Clear
Date

DayMonthYear
Date
Should be Empty:

EMERGENCY CONTACT INFORMATION

Medical Information

REQUIREMENTS AND ACCOMMODATION

Emergency Procedures

PLAN REVIEW

Signatures: