Challenges When Sheltering
Displaced Populations During
Natural & Manmade DisastersJuly 15, 2010
Webinar
Sandra Schoenfisch, RN, PhD Sandra Schoenfisch, RN, PhD Nursing ConsultantNursing ConsultantTallahassee, FloridaTallahassee, Florida
[email protected]@comcast.net
22
Learning ObjectivesLearning ObjectivesUpon completion of the program, participants will beUpon completion of the program, participants will beable to: able to:
Identify needs of displaced populationsIdentify needs of displaced populations Describe strategies to address special needs & Describe strategies to address special needs &
appropriate triagingappropriate triaging Discuss individual roles and responsibilities of Discuss individual roles and responsibilities of
shelter staffshelter staff Identify training and educational needs for staffing Identify training and educational needs for staffing
the shelterthe shelter Describe the importance of partnerships, discharge Describe the importance of partnerships, discharge
planning & case managementplanning & case management Incorporating lessons learned Incorporating lessons learned
33
Displaced Population NeedsDisplaced Population Needs
HousingHousing Food/MedicationsFood/Medications ClothingClothing FundsFunds TransportationTransportation EmploymentEmployment OtherOther
44
Clients’ PerspectiveClients’ Perspective
ExpectationsExpectations Level of NeedLevel of Need Care Givers/Family NeedsCare Givers/Family Needs Complex Medical RegimensComplex Medical Regimens Special EquipmentSpecial Equipment AccommodationsAccommodations PetsPets SafetySafety OtherOther
55
Partnerships
Emergency ManagementEmergency Management
CommunityCommunity
Other state agenciesOther state agencies
Faith basedFaith based
OtherOther
66
Shelters
Refuge of last resortRefuge of last resort
Not a hospital, nursing home, Not a hospital, nursing home,
rehabilitation center or a hotelrehabilitation center or a hotel
77
Types of SheltersTypes of Shelters
General SheltersGeneral Shelters Special Needs/MedicalSpecial Needs/Medical CombinationCombination PediatricPediatric Special Sub-populationsSpecial Sub-populations Pet FriendlyPet Friendly ““Gypsy” SheltersGypsy” Shelters Other (hotels, community centers, etc.)Other (hotels, community centers, etc.)
88
Emergency Management Role
Identify locations appropriate for Identify locations appropriate for special needs shelters special needs shelters
Maintain Client RegistryMaintain Client Registry
SuppliesSupplies
Staffing (non-medical)Staffing (non-medical)
99
Shelter ChecklistShelter Checklist
Connect with local emergency managementConnect with local emergency management Ensure shelter sites are still acceptable & will Ensure shelter sites are still acceptable & will
accommodate client populationaccommodate client population Ensure equipment & supplies are available Ensure equipment & supplies are available Review your staffing planReview your staffing plan Request any needed training and/or updatesRequest any needed training and/or updates Review any unique provisions for your areaReview any unique provisions for your area
1010
Public Health Roles
Community & responder education Community & responder education (on-going)(on-going)
Health & Medical (ESF8 response)Health & Medical (ESF8 response)
Medical & support staffing of special Medical & support staffing of special needs sheltersneeds shelters
1111
Coordination of Health & MedicalCoordination of Health & Medical
Assessment of health/medical needs*Assessment of health/medical needs* Health/medical personnel & supplies*Health/medical personnel & supplies* Patient evacuation*Patient evacuation* Emergency Medical ServicesEmergency Medical Services Mental health & crisis counseling for Mental health & crisis counseling for
responders*responders* Victim identification/mortuary servicesVictim identification/mortuary services
**Key roles and responsibilities that public health nurses fill.Key roles and responsibilities that public health nurses fill.
1212
Types of Special Needs EvacueesTypes of Special Needs Evacuees DialysisDialysis Oxygen DependentOxygen Dependent Electrical DependentElectrical Dependent
– CPAP, NebulizerCPAP, Nebulizer
Non-AmbulatoryNon-Ambulatory– WalkersWalkers
– Wheelchairs, ScootersWheelchairs, Scooters
– Bed boundBed bound
Wound CareWound Care Complicated medication Complicated medication
regimensregimens
HospiceHospice Trach Care & Trach Care &
SuctioningSuctioning IncontinentIncontinent Various stages of Various stages of
dementiadementia Special Needs ChildrenSpecial Needs Children Many very frail elderlyMany very frail elderly
1313
Special Needs Shelter Triage
Initial rapid assessment determines Initial rapid assessment determines placementplacement
Respiratory illness triageRespiratory illness triage
Obtain client history once special Obtain client history once special needs placement is determined to be needs placement is determined to be appropriateappropriate
1414
Triage Suggested Tools
Color coding of identification braceletsColor coding of identification bracelets
Link between color coding and Link between color coding and interaction with other health care interaction with other health care providersproviders
Triage TagsTriage Tags
1515
Appropriate Clients
Ambulatory (with or without assistive Ambulatory (with or without assistive devices) devices)
Dependant on others for routine care Dependant on others for routine care (eating, walking, toileting, etc.)(eating, walking, toileting, etc.)
Need assistance with medical care Need assistance with medical care (medication administration, nurse (medication administration, nurse monitoring, dependant on electrical monitoring, dependant on electrical equipment)equipment)
1616
Questions for Consideration
Can the client sleep on a cot or mat?Can the client sleep on a cot or mat?
Does the client have a Does the client have a stablestable medical medical condition?condition?
Does the shelter have power backup for Does the shelter have power backup for electrically dependant clients?electrically dependant clients?
Does the client have disabilities?Does the client have disabilities?
1717
Special Needs Shelter Operations
Group similar patients together if ableGroup similar patients together if able
Use standard precautionsUse standard precautions
IsolationIsolation
CaregiversCaregivers
SuppliesSupplies
CotsCots
1818
Staffing Special Needs Shelters Asset typingAsset typing
GuidelinesGuidelines
VolunteersVolunteersMedical Reserve CorpsMedical Reserve CorpsStudent volunteersStudent volunteersRetired personsRetired persons
Strike teamsStrike teams
Local, Regional, State ResourcesLocal, Regional, State Resources
Federal Resources (US Public Health Federal Resources (US Public Health Service)Service)
1919
Special Needs Shelter TrainingSpecial Needs Shelter Training
Special Needs Shelter Operations TrainingSpecial Needs Shelter Operations Training
Special Needs Shelter Management TrainingSpecial Needs Shelter Management Training
Skills Refresher Training for PHNsSkills Refresher Training for PHNs
Team Leader OrientationTeam Leader Orientation
Psychological First AidPsychological First Aid
OtherOther
2020
Education & Training
Basic Training for All StaffBasic Training for All Staff
Refresher Training for All Staff Refresher Training for All Staff
Seek Assistance from Partners Seek Assistance from Partners
Operations/Management Operations/Management
NIMSNIMS
Attendance: required, strongly Attendance: required, strongly recommended, strictly voluntaryrecommended, strictly voluntary
2121
Challenges & IssuesChallenges & Issues
Changing ScenariosChanging Scenarios
Equipment (satellite phones, Equipment (satellite phones, direct connect, 800 MHz radios)direct connect, 800 MHz radios)
Decreased Comfort ZoneDecreased Comfort Zone
Adverse environmentsAdverse environments
2222
Challenges & Issues cont.Challenges & Issues cont.
Need to recognize limits of one’s Need to recognize limits of one’s own knowledgeown knowledge
Creative problem solving & flexible Creative problem solving & flexible thinkingthinking
The need to participate in The need to participate in drills/exercises is important and drills/exercises is important and needs to be doneneeds to be done
2323
What DOES Work?What DOES Work?
Training for new staff & partnersTraining for new staff & partners Just in time trainingJust in time training TriageTriage EMT onsiteEMT onsite SecuritySecurity Mentoring/CoachingMentoring/Coaching Shifts/RotationsShifts/Rotations Translators/ASL onsiteTranslators/ASL onsite OtherOther
2424
Other Things That Work!Other Things That Work!
Case Managers/Discharge Planners Case Managers/Discharge Planners – Placement of all that are financially & medically Placement of all that are financially & medically
eligible eligible Work to get FEMA dollars for temporary placement Work to get FEMA dollars for temporary placement
in Assisted Living Facilities, Skilled Nursing in Assisted Living Facilities, Skilled Nursing Facilities, & congregate adult living facilitiesFacilities, & congregate adult living facilities
Use of Nursing Home Administrators to Expedite Use of Nursing Home Administrators to Expedite Placement (contracted)Placement (contracted)
Client Tracking System – who came in, who left, and Client Tracking System – who came in, who left, and where did they go…where did they go…
2525
Discharge Planning/Case ManagementDischarge Planning/Case Management
Should start when you plan to Should start when you plan to open a shelter!!open a shelter!!
Partners are essentialPartners are essential Short-term & Long-term solutionsShort-term & Long-term solutions Think outside the boxThink outside the box Points for creativity Points for creativity
2626
Placement OptionsPlacement Options
FEMA Funding for 90-180 days, with possible FEMA Funding for 90-180 days, with possible expansion to 18 months.expansion to 18 months.
Level 1Level 1 – In home with health/personnel care – In home with health/personnel care servicesservices
Level 2Level 2 – Hotel with home health or wrap around – Hotel with home health or wrap around servicesservices
Level 3Level 3 – Mobile home, no wrap around services – Mobile home, no wrap around services Level 4Level 4 – Mobile home, wrap around services – Mobile home, wrap around services Level 5Level 5 – Respite Care / Adult Day Care – Respite Care / Adult Day Care Level 6Level 6 – Assisted Living – Assisted Living Level 7Level 7 – Skilled Nursing Facility – Skilled Nursing Facility
2727
Mental Health IssuesMental Health Issues
Crisis Response TeamsCrisis Response Teams– CISD – Department of HealthCISD – Department of Health– Community Mental Health – Department of Community Mental Health – Department of
Children & FamiliesChildren & Families Served both at the special needs & general sheltersServed both at the special needs & general shelters
Medication needsMedication needs Mental Health Infrastructure destroyedMental Health Infrastructure destroyed
– Counseling centers damagedCounseling centers damaged– Crisis lines down – forwarded to call centers for Crisis lines down – forwarded to call centers for
mental/behavioral servicesmental/behavioral services
2828
Addressing Safety/Security Addressing Safety/Security
Staff safety issues – body mechanics, fatigue, Staff safety issues – body mechanics, fatigue, hydration, and injury hydration, and injury
Elderly issues – mobility, medication security, conflict, Elderly issues – mobility, medication security, conflict, stress, fatiguestress, fatigue
Transportation issues – feed and medicate prior to Transportation issues – feed and medicate prior to transport, bring snacks & fluids transport, bring snacks & fluids
Equipment issues – trip risks, wet surfaces, oxygen Equipment issues – trip risks, wet surfaces, oxygen tank security, generators, extension cordstank security, generators, extension cords
Uncooperative evacueesUncooperative evacuees
OtherOther
2929
Staff AugmentationStaff Augmentation
Medical Reserve CorpsMedical Reserve Corps
Regional Public Health Response TeamsRegional Public Health Response Teams
Emergency Management Assistance Emergency Management Assistance Compact (EMAC)Compact (EMAC)
Federal AssistanceFederal Assistance
3030
Provide emergency Provide emergency health advisorieshealth advisories
Boiled water noticesBoiled water notices Carbon Monoxide Carbon Monoxide
PoisoningPoisoning MoldMold Flood WatersFlood Waters Special Needs UpdatesSpecial Needs Updates DEET Distribution & DEET Distribution &
Mosquito ProtectionMosquito Protection Food SafetyFood Safety Heat ExhaustionHeat Exhaustion Home Repair SafetyHome Repair Safety Evacuation RoutesEvacuation Routes Resource AccessResource Access Other Other
3131
All Hazards PreparednessAll Hazards Preparedness
Rules of Engagement Rules of Engagement
1.1. Meet the Needs of VictimsMeet the Needs of Victims
2.2. Meet the Needs of the RespondersMeet the Needs of the Responders
3.3. See Rule #1 See Rule #1
3232
PREPAREDNESS PREPAREDNESS CYCLECYCLE
Evaluation
Plan
Eq
uip
Train
Exe
rcis
e
3333
Association of State and Territorial Directors of Association of State and Territorial Directors of Nursing (ASTDN) Position PaperNursing (ASTDN) Position Paper
The Role of Public Health Nurse (PHN) inThe Role of Public Health Nurse (PHN) in
Emergency Preparedness and Response firstEmergency Preparedness and Response first
version in 2002, revised 2007 version in 2002, revised 2007
Applied twelve (12) selected EP core Applied twelve (12) selected EP core
competencies to PHN practicecompetencies to PHN practice
3434
Phases of Disaster Linked to the Nursing Phases of Disaster Linked to the Nursing ProcessProcessDisaster
Phase Definition Assessment Planning Implementation Evaluation
Mitigation
Prevent a disasteror emergency;Minimizevulnerability toeffects of an event.
Assess a group ofelderly citizens fortheir awarenessabout preventingheat stroke.
Develop communityeducation plan toincrease awareness about preventingheat stroke.
Conduct communityeducation activitiesto increaseawareness aboutpreventing heatstroke.
Evaluate communityeducation activitieson preventing heatstroke.
Preparedness
Assure capacity torespond effectivelyto disasters andemergencies.
Assess thepopulations at riskfor special needsduring a disaster.
Develop plans tocare for specialneeds populationsduring a disaster.
Conduct training,drills and exercisesrelated to care ofspecial-needspersons.
Evaluate plans forserving populationswith special needs.
Response
Provide support topersons andCommunitiesaffected bydisasters andemergencies.
Serve on a responseteam to determinethe impact andspecific health needsof hurricanesurvivors. Triagevictims.
Develop plans torotate staff onresponse teams toprevent stress andburnout amongresponders.
Deploy staff toshelters after ahurricane, inaccordance withlocal and/or stateemergency responseplans.
Participate in afteraction reviewsand/or debriefings toevaluate quality ofhealth servicesprovided andlessons learned.
Recovery
Restore systemsto functional level.
Serve on team toassess communityassets and potentialfor recovery from arecent flood.
Collaborate withpartners andcommunity leadersto plan long-termrecovery prioritiesafter a flood.
Participate inrestoring communityservices after aflood.
Serve on team toevaluate long-termimpact on personsdisplaced by a flood.
3535
Documents & FormsDocuments & Forms Special Needs Shelter Walkthrough SurveySpecial Needs Shelter Walkthrough Survey
Supply & Equipment ListSupply & Equipment List
Oxygen PacksOxygen Packs
Staff & Volunteer Line listStaff & Volunteer Line list
Shelter Isolation PrecautionsShelter Isolation Precautions
Shelter Guidance RespiratoryShelter Guidance Respiratory
Shelter Intake FormShelter Intake Form
Daily Census ReportDaily Census Report
Media Relations GuideMedia Relations Guide
Job Action SheetsJob Action Sheets
Level of Care MatrixLevel of Care Matrix
And Much More And Much More
http//:www.doh.state.fl.us/PHNursing/SpNS/SpecialNeedsShelter.html http//:www.doh.state.fl.us/PHNursing/SpNS/SpecialNeedsShelter.html
Leadership & Management in Leadership & Management in SheltersShelters
3737
ResourcesResources 252, F.S.; 381, F.S. 252, F.S.; 381, F.S. www.leg/state/fl.us/statuteswww.leg/state/fl.us/statutes
64-C, F.A.C. 64-C, F.A.C. www.flrules.orgwww.flrules.org
Regional Public Health Response Teams Recruitment and Deployment Guidelines for CHDRegional Public Health Response Teams Recruitment and Deployment Guidelines for CHD
Public Health Preparedness Training Catalog Public Health Preparedness Training Catalog wwww.doh.state.fl.us/demo/PHPTrainingCatalogww.doh.state.fl.us/demo/PHPTrainingCatalog
Columbia University School of Nursing Center for Health Policy. (2002). Columbia University School of Nursing Center for Health Policy. (2002). Bioterrorism Bioterrorism and emergency readiness competencies for all public health workersand emergency readiness competencies for all public health workers. Atlanta (GA): . Atlanta (GA): Centers for Disease Control and Prevention.Centers for Disease Control and Prevention.
Council on Linkages Between Academia and Public Health Practice (2001). Core Council on Linkages Between Academia and Public Health Practice (2001). Core competencies for public health professionals. Retrieved April 29, 2007 from competencies for public health professionals. Retrieved April 29, 2007 from http://www.phf.org/competencies.htm#viewhttp://www.phf.org/competencies.htm#view
Incident Command and NIMS Training/FEMAIncident Command and NIMS Training/FEMA http://training.fema.gov/emiweb/IS/crslist.asphttp://training.fema.gov/emiweb/IS/crslist.asp
American Red Cross http://www.redcross.orgAmerican Red Cross http://www.redcross.org
Medical Reserve Corps http://www.medicalreservecorps.govMedical Reserve Corps http://www.medicalreservecorps.gov
3838
Recommended ReadingRecommended Reading
Gebbie, KM & Qureshi, K. (2002). Emergency and Gebbie, KM & Qureshi, K. (2002). Emergency and disaster preparedness: Core competencies for nurses: disaster preparedness: Core competencies for nurses: what every nurse should but may not know. what every nurse should but may not know. American American JournalJournal of Nursingof Nursing.102:46.102:46 Medical Reserve Corps Medical Reserve Corps
California Public Health Nursing Disaster Handbook California Public Health Nursing Disaster Handbook www.phncalifornia.orgwww.phncalifornia.org
ASTDN Position Paper “The Role of Public Health ASTDN Position Paper “The Role of Public Health Nurses in Emergency Preparedness and Response” Nurses in Emergency Preparedness and Response” www.astdn.orgwww.astdn.org
3939
Recommended ReadingRecommended Reading
Columbia University School of Nursing Center for Health Policy. (2002). Columbia University School of Nursing Center for Health Policy. (2002). Bioterrorism and emergency readiness competencies for all public health Bioterrorism and emergency readiness competencies for all public health workersworkers. Atlanta (GA): Centers for Disease Control and Prevention. Atlanta (GA): Centers for Disease Control and Prevention
Council on Linkages Between Academia and Public Health Practice (2001). Council on Linkages Between Academia and Public Health Practice (2001). Core competencies for public health professionals. Retrieved April 29, 2007 Core competencies for public health professionals. Retrieved April 29, 2007 from http://www.phf.org/competencies.htm#viewfrom http://www.phf.org/competencies.htm#view
FEMA. (21 March, 2006a). State and Local Guide (SLG) 101:Guide for All-FEMA. (21 March, 2006a). State and Local Guide (SLG) 101:Guide for All-Hazard Emergency Operations Planning. Retrieved April 29, 2007 from Hazard Emergency Operations Planning. Retrieved April 29, 2007 from hhttp://www.fema.gov/plan/gaheop.shtmttp://www.fema.gov/plan/gaheop.shtm
US Department of Homeland Security. (2006). National Response Plan. US Department of Homeland Security. (2006). National Response Plan. Retrieved April 29, 2007 from Retrieved April 29, 2007 from http://www.dhs.gov/xprepresp/committees/editorial_0566.shtmhttp://www.dhs.gov/xprepresp/committees/editorial_0566.shtm
4040
Contact information for Contact information for Dr. Sandra Schoenfisch Dr. Sandra Schoenfisch
Sandra Schoenfisch, RN, PhD Sandra Schoenfisch, RN, PhD
Nursing ConsultantNursing Consultant
Tallahassee, FloridaTallahassee, Florida
Email: [email protected]: [email protected]
4141
Acknowledgements Acknowledgements
New England Alliance for Public Health New England Alliance for Public Health Workforce DevelopmentWorkforce Development
Boston University School of Public Boston University School of Public Health Health
Massachusetts Association of Public Massachusetts Association of Public Health Nurses (MAPHN) Health Nurses (MAPHN)