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Case Study in Community Based Response – H1N1 Outbreak in Homeless in Salt Lake City. Kevin McCulley Emergency Preparedness Coordinator Association for Utah Community Health, Utah’s Primary Care Association . Association Background.

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case study in community based response h1n1 outbreak in homeless in salt lake city

Case Study in Community Based Response – H1N1 Outbreak in Homeless in Salt Lake City

Kevin McCulley

Emergency Preparedness Coordinator

Association for Utah Community Health, Utah’s Primary Care Association

association background
Association Background
  • Represent Federally Qualified Health Centers and other accessible providers of care in Utah
  • The FQHC system in Utah provides a health care home to over 113,000 Utahns annually
    • 60% in poverty, 59% uninsured
  • Includes general population Community Health Centers, Migrant Health Care, and Homeless Health Care grantees
  • Provide ~60-70% of “Safety Net” visits in UT
wasatch homeless health care
Wasatch Homeless Health Care
  • Located in Downtown SLC
  • Know as the Fourth Street Clinic
  • Adjacent to other homeless services
  • In 2009
    • 6,371 patients
    • 98.5% at 100% FPL or below
    • 80% uninsured
    • 56% living in shelters or on the street
    • 52% Caucasian, 10% Hispanic
2009 h1n1 outbreak
2009 H1N1 Outbreak
  • High rates of suspected H1N1 in homeless
  • High visitation rates impacted clinic’s regular primary care service delivery
  • Compounding the problem was the question of where to send suspect patients
    • Back to the shelter? Not good
    • 4th Street provided motel rooms and food delivery to suspected cases, which further impacted service delivery
finding solutions
Finding Solutions
  • Key assumptions
    • Critical to minimize spread of H1N1 among homeless, to both ensure safety of sheltered population and public
    • To minimize the spread, aggressive outreach, education, and vaccination was needed
    • To minimize spread, a system must be designed to segregate suspected/confirmed cases from general shelter populations
minimizing the spread
Minimizing the spread
  • High rates of chronic and untreated disease leave homeless population more vulnerable to poor outcomes
  • Homeless populations cannot be directed to “go home and stay in bed”
  • Homeless populations inhabit the same public spaces (library, stores, etc.) as general public
  • It is our responsibility to take care of those who need it the most
outreach and vaccination
Outreach and Vaccination
  • ACIP recommendations did not include homeless populations in “priority target groups” for initial vaccination campaign
  • Worked with SL Health Department to allow all homeless to be a priority for vaccination, regardless of age or other ACIP standards
  • Massive vaccination campaign in soup kitchens, shelters, at clinic site, and housing units
  • Successfully vaccinated 4,000 homeless (~63%)
outcomes
Outcomes
  • 4th Street was second only to Health Department for number of vaccines administered
  • High vaccination rate reduced suspected case presentation and minimized impact on normal clinic primary care operations
  • Procedures now in place for the next big thing
alternate care site planning
Alternate Care Site Planning
  • As the outbreak grew, and the impact on the clinic rose, the need for an ACS was clear
  • In the absence of vaccination, clinic could not in good faith send suspect cases back to shelters
  • Worked with SL Health Department and others to plan and design a respite facility for flu cases
  • Three components
    • Triage Center
    • Respite Care Facility Service
    • Infirmary at Road Home Shelter
triage center
Triage Center
  • At the point of entry into the clinic, patients with symptoms or suspected cases will be directed to a separate screening and assessment area
  • Serves to minimize disease transmission within the clinic and clinic waiting room
  • Initial estimates were for 50 patients each day during high outbreak period
flu infirmary at shelter
Flu Infirmary at Shelter
  • Part of scaled response, use existing facility first by segregating a part of the shelter
  • Would still require staffing, medical supplies, and other services
  • Funding provided for planning activities and purchase of supplies through State Department of Health using ASPR funding
respite care facility services
Respite Care Facility Services
  • Temporary housing for up to 80 infected patients
  • Combined effort of 4th Street, Road Home Shelter, and EMS and nursing student volunteers from University of Utah
  • Needed full coordination of medical care, food services, housekeeping, and other materials
  • Site identified on 4th Street campus
  • Estimated operational time of 4-5 months
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Thank You!

  • Kevin McCulley
  • Emergency Preparedness Coordinator
  • Association for Utah Community Health
  • kevin@auch.org 801-716-4612