how to use this curriculum 1 objectives of the training 1...

Table of Contents How to Use this Curriculum .......................................................................................................................... 1

Objectives of the Training ............................................................................................................................. 1

Training Guidelines ....................................................................................................................................... 1

Training Agenda (Template) ......................................................................................................................... 3

Lesson Plan .................................................................................................................................................... 4

Patient Scenarios .......................................................................................................................................... 8

Pre/Post Test ............................................................................................................................................... 12

Pre/Post Test Answers ................................................................................................................................ 14

Evaluation ................................................................................................................................................... 15

Conducting Health Surveillance in

Emergency Shelters

Training for Medical Volunteers Guidance Document

The guidance also includes a section on how to modify this curriculum for non-medical volunteers and trainings with American Red Cross volunteers.

2014

Shelter Surveillance Work Group Participating Organizations: American Red Cross, City of Nashua, NH Division of Public Health and Community Services, Manchester Health Department, New Hampshire Department of Health and Human Services

1

How to Use this Curriculum This training has been developed by the Shelter Surveillance Work Group to train medical

volunteers, such as the Medical Reserve Corps, to conduct health surveillance in emergency

shelters during disasters and large scale emergencies. This training follows the guidance from the

New Hampshire Department of Health and Human Services (NH DHHS) on how to conduct

shelter surveillance in shelters and assists in fulfilling Capability 7, Mass Care, Function 4,

“monitor mass care population health”, Task 2, “during an incident, conduct surveillance at

congregate locations to identify cases of illness, injury and exposure within mass care

populations”.

Objectives of the Training Describe how shelter surveillance has been used in national disasters, such as the

response to Hurricane Sandy.

Understand how health surveillance can be conducted in an emergency shelter to increase

situational awareness of disease and illness during disasters.

Gain a basic understanding of protocol and process for conducting health surveillance in

New Hampshire emergency shelters.

Gain knowledge in preventing and managing disease outbreak in shelters.

Understand how facility-specific environmental health and safety assessments are

performed at emergency shelters during disasters.

Describe how to use Natural Disaster Morbidity Survalance Individual Form (aka

“Individual Form) to doccument individual health visits in shelter.

Describe how to use Natural Disaster Morbidity SurveillanceSummary Report (aka

“Summary Report”) to summarize health visits in shelter.

Training Guidelines The members of the Shelter Surveillance Work Group can present this training to medical

volunteers. It is best that 2 presenters are present to lead the training but it can be done with one

person.

Handouts for Participants:

Copy of the PowerPoint

Copy of the 3 shelter surveillance forms

o Natural Disaster Morbidity Surveillance “Individual Form”

o Natural Disaster Morbidity Surveillance “Summary Report”

o Environmental Health Assessment Form

Evaluation Form

Pre and Post Test

Other Documents:

2

1 copy of the NH DHHS Guidance document for the class, not each person

1 copy of the American Red Cross shelter surveillance form for the class, not each person

Sign-In Sheet

Equipment needs:

Projector and laptop

Blank wall or projector screen

Memory stick with the PowerPoint

Pens

Extension cord

Altering this Training for Use with Non-Medical Volunteers TBC

Incorporating Shelter Surveillance into American Red Cross Trainings TBC

3

Training Agenda (Template)

Conducting Health Surveillance in Emergency Shelters

Agenda

[insert date, time]

[insert location]

I. Welcome and Introductions

II. Pre-Test

III. Overview of Surveillance in Shelters

a. Utilization of health surveillance in national disasters

b. Goals of health surveillance in emergency shelters

c. NH DHHS Guidance Document

d. Preventing and Managing disease outbreaks in a shelter

IV. Case Studies and Form Review

a. Natural Disaster Morbidity Surveillance “Individual Form”

b. Natural Disaster Morbidity Surveillance “Summary Report”

c. Environmental Health Assessment Form

V. Post-Test

VI. Evaluations

Training Developed by the Shelter Surveillance Work Group

Participating Organizations: American Red Cross, City of Nashua, NH Division of Public Health and Community

Services, Seacoast Public Health Network, Manchester Health Department, New Hampshire Department of Health

and Human Services

4

Lesson Plan Objectives Content Teaching

Method

Time Time

Taken

Assessment

Pre-Test Pre-Test Self Evaluation

of Knowledge

of Material

10

minutes

< 5

Minutes

Overview PowerPoint

(Slides 1-4)

Lecture,

Discussion

< 5

minutes

4 Minutes

Describe how

shelter

surveillance has

been used in

national

disasters, such as

the response to

Hurricane Sandy.

PowerPoint

(Slides 5-7)

Lecture,

Discussion

5

minutes

6 Minutes In shelters open after

Hurricane Katrina

and Hurricane Sandy,

health surveillance

was used to identify

acute illness

symptoms and

management of

chronic illness, and

injury in residents.

True/False

Understand how

health

surveillance can

be conducted in

an emergency

shelter to

increase

situational

awareness of

disease and

illness during

disasters.

Gain a basic

understanding of

protocol and

process for

conducting

health

surveillance in

New Hampshire

emergency

shelters.

Gain knowledge

in preventing and

managing

disease outbreak

in shelters.

PowerPoint

(Slides 8-

17)

Lecture,

Discussion

10

minutes

22

Minutes

The goals of

conducting health

surveillance in

emergency shelters

include (circle all that

apply):

Prevent

outbreaks or

implement

infection

control

measures at

the onset of

an outbreak

Prevent the

spread of

communicabl

e diseases

Implement

measures to

prevent

injuries

5

Objectives Content Teaching

Method

Time Time

Taken

Assessment

Prevention measures

to decrease the spread

of illness include all

of the following

except:

triage, hand hygiene,

use of personal

protective equipment,

calling 911, reporting

signs and symptoms

associated with

communicable

disease, isolation and

quarantine

Understand how

facility-specific

environmental

health and safety

assessments are

performed at

emergency

shelters during

disasters.

PowerPoint

(Slides 18-

20) Review

the types of

domains

assessed

using this

tool

(Facility,

Food, etc.)

Lecture,

Discussion,

Handout

“Environmenta

l Health

Assessment

Form”

5

Minutes

8 Minutes When should the

“Environmental

Health Assessment

Form” be completed

during shelter

operations?

24 hours prior

to opening a

shelter, and

then every 12

hours during

shelter

operations

Prior to

opening a

shelter or

within 24

hours of

opening a

shelter, once

per 24 hours

and as

needed

during

shelter

operations

As needed

after an

environmental

6


Method

Time Time

Taken

Assessment

hazard has

been

identified

Describe how to

use Natural

Disaster

Morbidity

Survalance

Individual Form

(aka “Individual

Form) to

doccument

individual health

visits in shelter.

Describe how to

use Natural

Disaster

Morbidity

SurveillanceSum

mary Report

(aka “Summary

Report”) to

summarize

health visits in

shelter.

PowerPoint

(Slides 21-

50),

allowing

participants

to practice

completing

forms on

their own

Lecture,

Discussion,

Handout

“Individual

Form” and

Handout

“Summary

Report”, Case

Studies,

Practice

30

Minutes

32

Minutes

(Group participation

will also assist with

assessment of

comfort level with

form.)

What is an example

of a trigger for the

shelter manager

contact NH DPHS to

discuss shelter

surveillance:

When a

patient has an

oral

temperature

of 100.4

degrees F or

greater

When a

patient has

been

transported to

a hospital for

care

When three

or more

residents

with similar

symptoms

report for

care in a 24

hour period

Wrap Up

Discussion /

Questions

Group

Discussion /

Questions

From

Participants

5-10

Minutes

7


Method

Time Time

Taken

Assessment

Post Test &

Evaluations

10

Minutes

5 Minutes

Total

Time:

60 – 85

Minutes

Approx.

82

Minutes

*Time Taken indicates the amount of time it took during a real-life training with a MRC unit.

8

Patient Scenarios

9

Case # Clinical Presentation

Initial Follow Up

Clinical Follow Up

Clinical Documentation

Shelter Considerations

#1 A 29 yo female shows up at the registration desk with red, watery eyes and states that she has some muscle aches. She has 3 children, the youngest is a 9 mo who is breast feeding and has loose stools.

This person is referred from registration to the medical station.

At the medical station they are found to have a semi productive cough and a fever of 100.4 degrees F. She is given a mask to wear and encouraged to call her doctor. The 9 mo year old is afebrile and has no other symptoms. The mother is educated on hand hygiene and states she has enough diapering supplies for the night.

Under “Acute Illness/Symptoms” Fever and muscle pain and productive cough are checked off for the mother. ILI is checked off at the bottom of the page. A separate form is completed for the 9 month year old, and watery diarrhea is checked off. Disposition is discharge to self care for both mother and child.

The family is given their own room to stay in.

#2 A 12 yo comes in to the medical station with a diffuse rash and an oral temp of 99.9 deg F. Rash is itching and started 2 days prior to coming to the shelter.

This person is already at the medical station.

Questions to this patient include other symptoms present, allergies, immunization history, health of family members, and occupation. If differentials do not lead to diagnosis, then patient is encouraged to call physician.

Rash is checked. Disposition is either discharge to self care or refer to other care, physician.

This person is monitored by shelter medical staff, and they are encouraged to return to the medical station if symptoms change.

10

Case # Clinical Presentation

Initial Follow Up

Clinical Follow Up



#3 The first lunch is being served since the shelter opened; it is hamburgers and salad. The hamburger is properly cooked, but the lettuce is packaged. About 48 hours after this lunch, 4 shelter residents start complaining of nausea, vomiting and diarrhea

These residents are directed to the medical station.

Noticing a pattern of similar symptoms, the workers at the medical station notify their Medical Unit Leader.

(We can tally this any way.)

Since more than 3 shelter residents with similar symptoms in a 24 hour period, the shelter manager calls NH DPHS at 603-271-4496 or (NH only) 1-800-852-3345 ext. 4496 (weekdays) or ext. 5300 (after hours), as it is indicated in the guidance (page3).

#4 A 68 year old male using portable oxygen arrives at the medical station complaining of a cough and runny nose. He has a productive cough and is short of breath, unable to complete whole sentences.

This person is already at the medical station.

The breathing issue is priority over the infectious disease symptoms. 911 is called. The client is encouraged to sit down and is monitored continuously by medical staff until EMS arrives.

Under respiratory section, congestion, runny nose, sinusitis is checked off with productive cough and shortness of breath/difficulty breathing. Disposition is admit/refer to hospital.

The shelter manager is made aware that 911 has been called. A shelter volunteer is sent to the parking lot to receive EMS and direct responders to the patient.

11

Case #

Clinical Presentation

Initial Follow Up

Clinical Follow Up



#5 A 32 yo food worker comes into the shelter c/o fatigue and joint pain. Staff notices that the sclerae are not clear white.

He is sent to the medical station.

He tells the nurse that the discoloration in his eyes is new, and he noticed his stools were “grayish” in color. He has been working at your shelter for a week feeding residents. He is encouraged to call his doctor.

Jaundice is checked under acute illness/symptoms. muscle or joint pain is checked. Disposition is refer to other care.

The shelter manager is made aware a food handler has hepatitis like symptoms.

#6 59 to diabetic with neuropathy c/o ear ache and sore throat.

This person is referred to the medical station.

This person is afebrile. He is encouraged to cough into his arm and frequently wash his hands. He is provided with education related to diabetes management and acute illness.

Cough and sore throat are checked. Disposition is discharge to self care.

This person only requires standard precautions, and does not require spatial distancing at the shelter.

12

Pre/Post Test

Health Surveillance in Emergency Shelters

*Pre* / Post Test

MRC

1. In shelters opening after Hurricane Katrina and Hurricane Sandy, health surveillance was

used to identify acute illness symptoms and management of chronic illness, and injury in

residents.

True False

2. The goals of conducting health surveillance in emergency shelters include (circle all that

apply):

Prevent outbreaks or implement infection control measures at the onset of an outbreak

Prevent the spread of communicable diseases

Implement measures to prevent injuries

3. Prevention measures to decrease the spread of illness include all of the following except:

Triage Hand hygiene Use of personal

protective

equipment

Calling 911

Reporting signs and symptoms associated

with communicable disease

Isolation Quarantine

4. When should the “Environmental Health Assessment Form” be completed during shelter

operations?

24 hours prior to opening a shelter, and then every 12 hours during shelter operations

Prior to opening a shelter or within 24 hours of opening a shelter, once per 24 hours and as

needed during shelter operations

As needed after an environmental hazard has been identified

5. What is an example of a trigger for the shelter manager contact NH DPHS to discuss shelter

surveillance:

When a patient has an oral temperature of 100.4 degrees F or greater

When a patient has been transported to a hospital for care

When three or more residents with similar symptoms report for care in a 24 hour period

13


Pre / *Post* Test

MRC

3. In shelters opening after Hurricane Katrina and Hurricane Sandy, health surveillance was

used to identify acute illness symptoms and management of chronic illness, and injury in

residents.

True False


apply):






protective

equipment

Calling 911





operations?


Prior to opening a shelter or within 24 hours of opening a shelter, once per 24 hours and as

needed during shelter operations



surveillance:



When three or more residents with similar symptoms report for care in a 24 hour period

14

Pre/Post Test Answers


Pre / Post Test ANSWERS

5. In shelters open after Hurricane Katrina and Hurricane Sandy, health surveillance was used

to identify acute illness symptoms and management of chronic illness, and injury in

residents.

True False


apply):






protective

equipment

Calling 911





operations?


Prior to opening a shelter or within 24 hours of opening a shelter, once per 24 hours

and as needed during shelter operations



surveillance:



When three or more residents with similar symptoms report for care in a 24 hour

period

15

Evaluation Conducting Health Surveillance in Emergency Shelters

Thank you for attending today’s training. We welcome your feedback on how to improve

by taking a few minutes to fill out this evaluation form.

THANK YOU!

Strongly Disagree

Disagree Neutral Agree

Strongly Agree

The objectives of this training were achieved:

Describe how shelter surveillance has been used in national disasters, such as the response to Hurricane Sandy.

Understand how health surveillance can be conducted in an emergency shelter to increase situational awareness of disease and illness during disasters.

Gain a basic understanding of protocol and process for conducting health surveillance in New Hampshire emergency shelters.

Gain knowledge in preventing and managing disease outbreak in shelters.

Understand how facility-specific environmental health and safety assessments are performed at emergency shelters during disasters.

Describe how to use the surveillance forms.

The timeframe for this training was appropriate.

The presenters were knowledgeable, organized and effective in their presentation.

The teaching strategies/resources were effective.

The following were satisfactory: food, facilities, and parking.

What did you like best about this session?

What would you do to improve this session?

Additional Comments/Suggestions: