Evaluation of High Priority Establishments’ Readiness for Emergencies in Tulsa County
Aaron Greenquist, MS
Environmental Health Specialist / Special Event Coordinator -
Tulsa County, Oklahoma
Abstract
Many businesses across the United States face the impacts of disasters. Written emergency operation plans at retail food establishments allow the businesses to react quickly to emergency events by having a plan in place and trained staff who know how to respond. Tulsa County, Oklahoma has historically encountered numerous disasters including tornadoes, winter storms, and floods. Between 2019 and 2020, environmental health specialists with the Tulsa Health Department Office of Food Protection conducted Active Managerial Control consultations to assist retail food partners in being prepared for emergencies. A survey was also sent out to owners and operators of food service establishments within Tulsa County to learn more about their preparedness measures. Of establishments that were interviewed, 43% reported having a written emergency operation plan in place. Of establishments that responded to the survey, 57% reported having a written emergency operation plan in place. For those with a plan, loss of power and fire were the most common emergencies noted. Generally, little training is being done on emergency response in food service establishments. Response actions centered primarily around keeping perishable foods safe. The data indicated that more restaurants are implementing emergency operation plans to help assist the establishment in becoming more prepared for emergency response operations. Retail food establishments are prepared to encounter electrical outages and fires but need more preparation for disruption of water services. They also need to continue to develop more comprehensive written emergency operation plans and train staff on mitigation efforts.
Key words: emergency, establishments, food, operation, plan
Evaluation of High Priority Establishments’ Readiness for Emergencies in Tulsa County
Background
Natural disasters may have a significant impact on the integrity of the food safety management system, which can lead to an increased risk of foodborne illness outbreaks. When normal operations are interrupted by emergencies and disasters there is an increased risk to food safety. Developing and following written emergency operation plans in retail food establishments may help mitigate the impacts of these disasters and may help with responding more quickly and effectively. This approach is particularly relevant given Oklahoma’s extensive history of natural disasters. In August 2017, an Enhanced Fujita Scale 2 tornado ripped through midtown Tulsa damaging more than 150 businesses and destroying at least seven food service establishments. The Emergency Medical Services Authority transported 13 injured diners from area restaurants to St. Francis Hospital after the storm subsided (Fox23 News, 2017). In May 2019, Tulsa County experienced its worst flood in decades with more than $12 million in total damage and left an impact on multiple food service establishments throughout the county (Tulsa World, 2019). In February 2021, after a record-breaking deep freeze, a voluntary boil order was in effect for residents of the City of Tulsa who were experiencing water quality issues due to the weather-related event. The Tulsa Health Department (THD) provides recommendations for food establishments to follow to mitigate potential illnesses from ingesting contaminated waters during emergency events (KJRH, 2021). Emergency events can have an immediate impact on the food service establishment, as well as potentially lasting impacts that emerge after the initial impact of the disaster, such as flood waters creating a damp environment that can cause bacteria that could be present to further proliferate or cause new bacteria to be introduced.
Active Managerial Control (AMC) is a term used to describe a food establishment’s responsibility for developing and implementing a food safety management system geared towards reducing the occurrence of foodborne illness risk factors. The top five risk factors contributing to foodborne illness include: food from unsafe sources, inadequate cooking, improper hot/cold holding temperatures, contaminated equipment, and poor personal hygiene. AMC should be used by food service managers to actively lead food workers in safe food handling practices that reduce the occurrence of these foodborne illness risk factors. In 2019, the THD developed AMC management interview checklists to be conducted by inspectors at high priority food service establishments annually to capture information during the visit.
High priority establishments are full-service restaurants with extensive menus and handling of raw ingredients and receive three inspections per calendar year. Complex preparation techniques such as cooking, cooling, and hot holding for many time and temperature control for safety (TCS) foods occur at such establishments. The interviews are recorded on a standardized form by district sanitarians and provide the opportunity for the inspector to interview the person-in-charge and to help assess AMC of the establishment.
The purpose of the AMC visit is to work with the food service management team in an effort to learn more about the establishment’s processes, share knowledge, and evaluate managerial knowledge while working together to ensure that a comprehensive food safety plan is in place. The AMC interview process is an opportunity to assist owners and operators with developing a proactive food safety approach. This technique is also an opportunity to discuss changes and review existing processes to ensure that food safety controls are effective. The interview allows the inspector to review written procedures and provide guidance on implementing practices to reduce the likelihood of foodborne illness(es) from within the establishment. During the interview, the inspector asks whether the establishment has a written emergency operation plan for power outage, sewage backup or flood (Tulsa Health Department, 2019). A written emergency operation plan is required under Oklahoma State Food Code for an establishment to continue operations during extended interruptions of water or power (OSDH, 2021).
High priority establishments are especially vulnerable to incidents of foodborne illness in the aftermath of an emergency event given the types of foods served as well as the types of equipment associated with controlling microbiological hazards such as adequate refrigeration. Assessing active managerial control and written procedures regarding emergency operations before, during, and after an emergency can provide an opportunity for deficiencies to be addressed to mitigate the unwanted effects of a foodborne illness outbreak.
The goal of this research project was to generate data to assist food service establishments as well as food safety regulators in improving food handling practices before, during, and after an emergency event at retail food establishments.
Problem Statement
The status of emergency preparedness in high priority food service establishments in Tulsa County, Oklahoma is unknown.
Research Questions
What percentage of high priority food service establishments in Tulsa County have developed written emergency operation plans to help mitigate the impacts of foodborne illness before, during, and after an emergency event?
What types of emergency events do the written emergency operation plans cover?
What type of trainings have managers and other employees at the food service establishments received on the contents of these plans and mitigation efforts?
During a past emergency what steps were taken by high priority food service establishments in Tulsa County to mitigate risks associated with foodborne illness outbreaks before, during, and after an emergency event?
Methodology
In Step 1, past AMC management interview checklists from 2019 and 2020 were analyzed to identify if any high priority food service establishments in Tulsa County currently have written emergency operation plans, as well as the types of emergencies those plans covered. During the AMC consultation, the management interview checklist designated a section for inspectors to ask whether the food establishment had a written emergency operation plan in the event of a power outage, sewage backup, or flood.
In Step 2, the Qualtrics survey tool about establishment procedures for emergency operations was sent to high priority restaurant owner/operators in Tulsa County. The survey participants were asked to verify that they worked at or owned a high priority food service establishment located in Tulsa County and to identify their title within the establishment. The survey asked respondents whether the establishment had a written emergency operation plan and to identify which types of emergencies the plan covered. Additional questions asked about the physical location of the plan, whether it was in digital or printed format, and what type of training the person-in-charge or other employees had received. Finally, the respondents were asked who was responsible for making critical decisions during an emergency and what types of response actions had been taken by the establishment in the past to mitigate the unwanted effects on food items before, during, or after the emergency event.
In Step 3, survey data from Step 2 was analyzed to determine how high priority food service establishments in Tulsa County were planning for and responding to emergency events.
Results
Between 2019 and 2020, 186 AMC consultations were conducted by registered sanitarians within Tulsa County. Of those interviewed, 43% of the high priority establishments had a written emergency operation plan at the time of the interview whereas 49% of those interviewed did not have a written emergency operation plan. No response was recorded for 8% of the interviews. For establishments with emergency operation plans, loss of power was the most frequently mentioned emergency within the interviews and was identified in 54% of the plans. Other emergencies addressed included fire, sewage backup and floods. Respondents also offered an insight into types of actions the establishment would take in the event of a loss of power to prevent the opportunity for foodborne illness. The most common actions taken, which were reported by 24% of interviewed establishments, were moving TCS food items to the freezer, placing on ice, moving to another unaffected location, or bringing in a refrigerated truck. Closing the establishment temporarily and discarding food was also a common strategy identified by interview respondents, with 31 establishments citing this response action. For establishments facing a loss of power, 15 establishments interviewed about types of response actions identified as having a backup generator on site for cold storage equipment and this was most common among institutional facilities such as hospitals.
The second set of data collected was in the form of a survey sent out to owners and operators of high priority food service establishments. Surveys were sent out to 711 email addresses in December of 2022.
Of the 711 surveys sent, 66 responses were received, correlating to a 9% response rate. The respondents were asked to identify if their business met survey criteria: meaning that where they worked was a high priority food service establishment located in Tulsa County, to which 71% replied affirmatively. For those establishments meeting survey criteria, 85% of those filling out the survey were either the owner or manager. For establishments that met the above survey criteria, 57% identified as having a written emergency operation plan in place.
Respondents with a written emergency operation plan in place were asked to choose which events the plan covered. The top three selected were: electrical outage, disruption of water supply, and fire (see Figure 1). Some of the other emergencies mentioned within these written emergency operation plans were sewage backup, flood, damage to structural integrity, and other, which was specified as tornado. Figure 1 below demonstrates the types of emergencies covered in emergency operation plans gathered from survey results.
Figure 1
Types of Emergencies Affecting Food Establishments
Survey respondents were asked to identify what type of food safety training the person-in-charge had received (See Figure 2). 75% of respondents stated that the person-in-charge had received a Certified Food Service Manager training, such as ServSafe. The remaining 25% had received a food handler training course or other training, such as a dietician certificate. The respondents also were asked what types of training(s) management, such as a manager or shift lead, had received on emergency preparedness. Informing staff that an emergency plan exists was the most common strategy and was implemented by 40% of establishments. Training when an emergency event occurs and an annual refresher training on the emergency operation plan were the second and third most frequent answers from respondents at 25% and 22%, respectively. Finally, 12% stated that there was currently no training on emergency operations and 2% chose ‘other’ and stated that they utilized computer based and scenario training.
Figure 2
Emergency Preparedness Training in Food Establishments
Of those who responded to the survey, 48% owned or worked at a food service establishment that had been affected by an emergency event within the past five years, whereas 52% had not experienced any emergency events within the same time frame. Interruption of electrical service and fire were the most cited emergency event occurrences at 28% each. For those that worked at an establishment that experienced an emergency, respondents were asked what corrective actions the establishment had taken to mitigate the effects from the emergency event in relation to food safety. Several strategies were identified and included: closing for repairs, discarding, and replacing affected foods, purchasing generators, bringing in refrigerated trucks, moving TCS foods to a freezer or using dry ice, and completing a review of emergency procedures.
Conclusions
Comparing survey data collected in December 2022 to AMC consultations conducted from 2019 to 2020, more restaurants are putting written emergency operation plans in place. 43% of establishments indicated that they had a plan during interviews conducted from 2019 to 2020, whereas 57% self-identified as having a written emergency operation plan in 2022, which is an increase of 33%.
Survey data indicated that 48% of respondents that worked at high priority establishments had been affected by an emergency event within the past five years. Of those establishments that were affected by an emergency event, 43% did not have a written emergency operation plan in place, which could correlate that establishments that had been affected by an emergency event in the past were more likely to have a written emergency operation plan. During the AMC interviews, the most frequently indicated emergency event covered in the written emergency operation plan was loss of power followed by fire. Results of the survey revealed electrical outage was the most common identified emergency within the plans, followed by fire and disruption of water supply. Electrical outage and fires are two common emergencies that have affected high priority establishments within Tulsa County resulting in these establishments being most prepared to encounter these types of emergencies.
According to survey data only 75% of persons-in-charge had received a Certified Food Service Manager training. Formal training on emergency operations often was reported as simply acknowledging the plan exists. Response actions related to fire and loss of power were most identified among the written emergency operation plans. Survey data and interview data revealed that common strategies implemented by high priority establishments were closing the business and discarding food. Respondents also were asked if the written emergency operations plan was printed or digital and they reported that one third of all plans were electronic, whereas two thirds of all plans were printed.
Recommendations
Based on the data collected and analyzed during this research project, below are recommendations that high-priority food service establishments may wish to take:
Food establishments should continue to develop emergency operation plans that are all encompassing and always accessible, especially in the event of an emergency.
More training needs to be provided on emergency preparedness/mitigation efforts for food establishment owners/operators to implement to prevent foodborne illness before, during, or after an emergency event.
The THD needs to continue working with food service partners to develop emergency operation procedures and practices for emergencies to be prepared for real life events.
There is a need for additional research on how foodborne illnesses are impacted by emergency events.
Acknowledgements
I’d like to thank the Tulsa Health Department for allowing me to work on this project and giving me access to the data needed to conduct this research. I’d like to give a special thank you to my mentor, Kathy Fedder, who provided such valuable insights during this process and for all the support along the way. I would like to dedicate this research to my mother, Julie Greenquist, who was taken from this world too soon. She was such a wealth of encouragement and I know she would be so proud. Finally, I would like to thank IFPTI staff and the fellows of Cohort XI who stood by my side. Thank you for your friendship.
References
Canfield, K. (2020, April 6). City's list of damages from 2019 flood tops $12 million.
Tulsa World. Retrieved December 16, 2022. Retrieved from https://tulsaworld.com/news/local/citys-list-of-damages-from-2019-flood-tops-12- million/article_298fe89c-ac63-5185-ad94-2ec3fdd8689a.html
FOX23 News. (2017, August 6). More than 150 businesses, 25 homes damaged as Tulsa tornado tore through midtown. FOX23 News. Retrieved December 16, 2022. Retrieved from https://www.fox23.com/news/storms-damage-businesses-in- midtown-tulsa/583174247/
Huggins, C. (2021, February 19). Voluntary boil order for Tulsans impacted by water issues. 2 News Oklahoma KJRH Tulsa. Retrieved December 16, 2022. Retrieved from https://www.kjrh.com/news/local-news/voluntary-boil-order-issued-for-tulsans- impacted-by-water-issues
Oklahoma State Department of Health (OSDH). (2021). Title 310. Oklahoma State Department of Health Chapter 257. Food Establishments. Retrieved from https://oklahoma.gov/content /dam/ok/en/health/health2/aem- documents/organization/proposed-amendments-to-osdh- rules/OSDH%20Chapter%20257.pdf
Tulsa Health Department. 2019. Active Managerial Control Checklist. Unpublished internal company document.
Author Note
Aaron Greenquist, Environmental Health Specialist Tulsa Health Department
This research was conducted as part of the International Food Protection Training Institute’s Fellowship in Food Protection, Cohort XI.
Correspondence concerning this article should be addressed to:
Aaron Greenquist, Tulsa Health Department,
5051 S 129th E Ave Tulsa, OK 74134
Funding for the IFPTI Fellowship in Food Protection Program was made possible by the Association of Food and Drug Officials.