IV. Need for Extra Help - means that there is specific evidence that more than one staff member may be needed to evacuate the resident.  Specific evidence means that two or more persons have been previously needed to assist the resident, and that the resident could require assistance from two persons in a real fire emergency.

When rating the resident on whether there is a need for additional assistance, the rater should disregard the presence of staff members who appear unusually strong or weak. (For example, a staff member who is exceptionally strong or an unusually small staff member would be disregarded when rating the resident on Need for Extra Help.)

(a) Needs Only One Staff - means that there is no specific evidence that the resident might need help from two or more persons in a fire emergency.

(b) Needs Limited Assistance from Two Staff - means that the resident might require some initial or brief intermittent assistance from two persons, but will otherwise need help fro no more than one person.  The following are a few examples of capabilities that fall within this category.  The resident would require help from no more than one person except that:

(1) The resident needs two persons to get into a wheelchair.

(2) The resident needs two persons to descend stairs that are present in the building.

(c) Needs Full Assistance from Two Staff. This means that the resident might require assistance from two persons during most of the resident's evacuation from the building.  The following are a few examples of capabilities that fall within this category:

(1) The resident may need to be carried from the building and this would require two persons, or

(2) The resident would need two persons to get into a wheelchair and to get the wheelchair down a flight of stairs, or

(3) The resident may vigorously resist an evacuation and two persons would be required to get the resident out of the building.

V. Response to Instructions (Staff-Directed Evacuation) - means the resident's ability to receive, comprehend and follow through with simple instructions.  Residents often do not respond equally well to all staff members. Therefore, residents should be rated on their responses to staff members whose directions they are least likely to follow.

(a) Follows Instructions. This means that the resident can usually be depended on to receive, comprehend, remember and follow simple instructions.

(b) Requires Supervision. This means that the resident is generally capable of following instructions, but is not dependable. Therefore, the resident may need to be guided, reminded, reassured or otherwise accompanied during his or her evacuation, but will not require the exclusive attention of a staff member. (For example, a staff member can simultaneously lead two or more residents who fit this classification.)

This category includes elderly persons who sometimes show early signs of senile dementia or cerebral arteriosclerosis (for example, confusion, disorientation, frequent "misplacement" of possessions) and young children who cannot be depended on to follow through with instructions.  Some examples of resident capabilities that fall within this category are as follows. The resident is generally capable of following instructions except that:

(1) The resident is deaf or hearing impaired and sometimes misinterprets communications from staff using sign language, or

(2) The resident sometimes forgets instructions after a brief period of time, or

(3) The resident is sometimes distracted or confused and fails to follow through with instructions, or

(4) The resident is sometimes groggy and may fail to listen carefully or follow through with instructions, or

(5) The resident is sometimes uncooperative without apparent good reasons, or

(6) The resident is elderly and sometimes becomes "lost" in a familiar place, or

(7) The resident is a young child who may become frightened and not follow through with instructions.

(c) Requires Considerable Attention or May Not Respond - means that the resident may fail to receive, understand or follow through with instructions; that is, the resident may not respond to instructions or general guidance. Therefore, the resident may require most of the attention of a staff member during his or her evacuation.  Some examples of resident capabilities that fall within this category are as follows:

(1) The resident sometimes does not understand simple instructions, or

(2) The resident may not respond to instructions from a particular staff member, or

(3) The resident is sometimes emotionally upset and is therefore unwilling to follow instructions, or

(4) The resident is deaf or hearing impaired and the staff cannot communicate reliably with the resident, or

(5) The resident is very forgetful, easily confused or easily distracted.

VI. Waking Response to Alarm - means that the fire alarm may fail to awaken the resident.  Residents should be rated as "response probable" unless any of the following four conditions is true:

(a) The building does not have an alarm system meeting the requirements of Chapter 21 or the alarm is not very loud where the resident sleeps (doors should be closed and barriers kept in place when testing the loudness of the fire alarm), or

(b) Medication taken by the resident before retiring differs in type or amount (increased) from the medication taken for waking hours, or

(c) The resident has a readily apparent hearing impairment or the resident removes his or her hearing aid when sleeping, or

(d) There is some specific evidence that the resident may be an exceptionally sound sleeper. (Examples of specific evidence are: the resident did not wake up during some particularly loud clamor or racket and staff members have had to vigorously shake the resident to awaken him or her.)

When any of the four conditions is true, then the resident should be rated as "response not probable" unless the resident's ability to wake up has been demonstrated. The demonstration of the resident's ability to wake up to the fire alarm should be conducted after the first half-hour of sleep and during the first three hours of sleep. Also, the resident's ability to wake up to the alarm should be demonstrated on two different nights under usual conditions (for example, without hearing aid, under usual medications, and so forth). Also, the resident should be alert enough to follow simple instructions within one minute of waking up. In order to avoid awakening other residents, a device that makes a sound that is similar to but not louder than the fire alarm may be used (for example, an alarm clock can be used instead of a bell alarm).

(1) Response Probable - means that none of the four conditions is true for the resident or, when any of the conditions is true, the resident's ability to wake up has been demonstrated.

(2) Response not Probable - means that one or more of the conditions is true for the resident, and that either the resident has not been tested for his or her ability to wake up to the fire alarm, or the resident failed to demonstrate his or her ability to wake up to the alarm.