Challenges When Sheltering Displaced Populations During Natural & Manmade Disasters July 15, 2010

1. Challenges When Sheltering Displaced Populations During Natural & Manmade Disasters July 15, 2010 Webinar Sandra Schoenfisch, RN, PhD Nursing Consultant Tallahassee, Florida picsas@comcast.net

2. Learning Objectives Upon completion of the program, participants will be able to: • Identify needs of displaced populations • Describe strategies to address special needs & appropriate triaging • Discuss individual roles and responsibilities of shelter staff • Identify training and educational needs for staffing the shelter • Describe the importance of partnerships, discharge planning & case management • Incorporating lessons learned

3. Displaced Population Needs • Housing • Food/Medications • Clothing • Funds • Transportation • Employment • Other

4. Clients’ Perspective • Expectations • Level of Need • Care Givers/Family Needs • Complex Medical Regimens • Special Equipment • Accommodations • Pets • Safety • Other

5. Partnerships • Emergency Management • Community • Other state agencies • Faith based • Other

6. Shelters • Refuge of last resort • Not a hospital, nursing home, rehabilitation center or a hotel

7. Types of Shelters • General Shelters • Special Needs/Medical • Combination • Pediatric • Special Sub-populations • Pet Friendly • “Gypsy” Shelters • Other (hotels, community centers, etc.)

8. Emergency Management Role • Identify locations appropriate for special needs shelters • Maintain Client Registry • Supplies • Staffing (non-medical)

9. Shelter Checklist • Connect with local emergency management • Ensure shelter sites are still acceptable & will accommodate client population • Ensure equipment & supplies are available • Review your staffing plan • Request any needed training and/or updates • Review any unique provisions for your area

10. Public Health Roles • Community & responder education (on-going) • Health & Medical (ESF8 response) • Medical & support staffing of special needs shelters

11. Coordination of Health & Medical • Assessment of health/medical needs* • Health/medical personnel & supplies* • Patient evacuation* • Emergency Medical Services • Mental health & crisis counseling for responders* • Victim identification/mortuary services *Key roles and responsibilities that public health nurses fill.

12. Dialysis Oxygen Dependent Electrical Dependent CPAP, Nebulizer Non-Ambulatory Walkers Wheelchairs, Scooters Bed bound Wound Care Complicated medication regimens Hospice Trach Care & Suctioning Incontinent Various stages of dementia Special Needs Children Many very frail elderly Types of Special Needs Evacuees

13. Special Needs Shelter Triage • Initial rapid assessment determines placement • Respiratory illness triage • Obtain client history once special needs placement is determined to be appropriate

14. Triage Suggested Tools • Color coding of identification bracelets • Link between color coding and interaction with other health care providers • Triage Tags

15. Appropriate Clients • Ambulatory (with or without assistive devices) • Dependant on others for routine care (eating, walking, toileting, etc.) • Need assistance with medical care (medication administration, nurse monitoring, dependant on electrical equipment)

16. Questions for Consideration • Can the client sleep on a cot or mat? • Does the client have a stable medical condition? • Does the shelter have power backup for electrically dependant clients? • Does the client have disabilities?

17. Special Needs Shelter Operations • Group similar patients together if able • Use standard precautions • Isolation • Caregivers • Supplies • Cots

18. Staffing Special Needs Shelters • Asset typing • Guidelines • Volunteers • Medical Reserve Corps • Student volunteers • Retired persons • Strike teams • Local, Regional, State Resources • Federal Resources (US Public Health Service)

19. Special Needs Shelter Training • Special Needs Shelter Operations Training • Special Needs Shelter Management Training • Skills Refresher Training for PHNs • Team Leader Orientation • Psychological First Aid • Other

20. Education & Training • Basic Training for All Staff • Refresher Training for All Staff • Seek Assistance from Partners • Operations/Management • NIMS • Attendance: required, strongly recommended, strictly voluntary

21. Challenges & Issues • Changing Scenarios • Equipment (satellite phones, direct connect, 800 MHz radios) • Decreased Comfort Zone • Adverse environments

22. Challenges & Issues cont. • Need to recognize limits of one’s own knowledge • Creative problem solving & flexible thinking • The need to participate in drills/exercises is important and needs to be done

23. What DOES Work? • Training for new staff & partners • Just in time training • Triage • EMT onsite • Security • Mentoring/Coaching • Shifts/Rotations • Translators/ASL onsite • Other

24. Other Things That Work! • Case Managers/Discharge Planners • Placement of all that are financially & medically eligible • Work to get FEMA dollars for temporary placement in Assisted Living Facilities, Skilled Nursing Facilities, & congregate adult living facilities • Use of Nursing Home Administrators to Expedite Placement (contracted) • Client Tracking System – who came in, who left, and where did they go…

25. Discharge Planning/Case Management • Should start when you plan to open a shelter!! • Partners are essential • Short-term & Long-term solutions • Think outside the box • Points for creativity 

26. Placement Options • FEMA Funding for 90-180 days, with possible expansion to 18 months. • Level 1 – In home with health/personnel care services • Level 2 – Hotel with home health or wrap around services • Level 3 – Mobile home, no wrap around services • Level 4 – Mobile home, wrap around services • Level 5 – Respite Care / Adult Day Care • Level 6 – Assisted Living • Level 7 – Skilled Nursing Facility

27. Mental Health Issues • Crisis Response Teams • CISD – Department of Health • Community Mental Health – Department of Children & Families • Served both at the special needs & general shelters • Medication needs • Mental Health Infrastructure destroyed • Counseling centers damaged • Crisis lines down – forwarded to call centers for mental/behavioral services

28. Addressing Safety/Security • Staff safety issues – body mechanics, fatigue, hydration, and injury • Elderly issues – mobility, medication security, conflict, stress, fatigue • Transportation issues – feed and medicate prior to transport, bring snacks & fluids • Equipment issues – trip risks, wet surfaces, oxygen tank security, generators, extension cords • Uncooperative evacuees • Other

29. Staff Augmentation • Medical Reserve Corps • Regional Public Health Response Teams • Emergency Management Assistance Compact (EMAC) • Federal Assistance

30. Boiled water notices Carbon Monoxide Poisoning Mold Flood Waters Special Needs Updates DEET Distribution & Mosquito Protection Food Safety Heat Exhaustion Home Repair Safety Evacuation Routes Resource Access Other Provide emergency health advisories

31. All Hazards Preparedness Rules of Engagement • Meet the Needs of Victims • Meet the Needs of the Responders • See Rule #1

32. PREPAREDNESS CYCLE Plan Evaluation Exercise Equip Train

33. Association of State and Territorial Directors of Nursing (ASTDN) Position Paper The Role of Public Health Nurse (PHN) in Emergency Preparedness and Response first version in 2002, revised 2007 • Applied twelve (12) selected EP core competencies to PHN practice

34. Phases of Disaster Linked to the Nursing Process

35. Documents & Forms • Special Needs Shelter Walkthrough Survey • Supply & Equipment List • Oxygen Packs • Staff & Volunteer Line list • Shelter Isolation Precautions • Shelter Guidance Respiratory • Shelter Intake Form • Daily Census Report • Media Relations Guide • Job Action Sheets • Level of Care Matrix • And Much More http//:www.doh.state.fl.us/PHNursing/SpNS/SpecialNeedsShelter.html

36. Leadership & Management in Shelters

37. Resources • 252, F.S.; 381, F.S. www.leg/state/fl.us/statutes • 64-C, F.A.C. www.flrules.org • Regional Public Health Response Teams Recruitment and Deployment Guidelines for CHD • Public Health Preparedness Training Catalog www.doh.state.fl.us/demo/PHPTrainingCatalog • Columbia University School of Nursing Center for Health Policy. (2002). Bioterrorism and emergency readiness competencies for all public health workers. Atlanta (GA): Centers for Disease Control and Prevention. • Council on Linkages Between Academia and Public Health Practice (2001). Core competencies for public health professionals. Retrieved April 29, 2007 from http://www.phf.org/competencies.htm#view • Incident Command and NIMS Training/FEMAhttp://training.fema.gov/emiweb/IS/crslist.asp • American Red Cross http://www.redcross.org • Medical Reserve Corps http://www.medicalreservecorps.gov

38. Recommended Reading • Gebbie, KM & Qureshi, K. (2002). Emergency and disaster preparedness: Core competencies for nurses: what every nurse should but may not know. American Journalof Nursing.102:46 Medical Reserve Corps • California Public Health Nursing Disaster Handbook www.phncalifornia.org • ASTDN Position Paper “The Role of Public Health Nurses in Emergency Preparedness and Response” www.astdn.org

39. Recommended Reading • Columbia University School of Nursing Center for Health Policy. (2002). Bioterrorism and emergency readiness competencies for all public health workers. Atlanta (GA): Centers for Disease Control and Prevention • Council on Linkages Between Academia and Public Health Practice (2001). Core competencies for public health professionals. Retrieved April 29, 2007 from http://www.phf.org/competencies.htm#view • FEMA. (21 March, 2006a). State and Local Guide (SLG) 101:Guide for All-Hazard Emergency Operations Planning. Retrieved April 29, 2007 from http://www.fema.gov/plan/gaheop.shtm • US Department of Homeland Security. (2006). National Response Plan. Retrieved April 29, 2007 from http://www.dhs.gov/xprepresp/committees/editorial_0566.shtm

40. Contact information for Dr. Sandra Schoenfisch Sandra Schoenfisch, RN, PhD Nursing Consultant Tallahassee, Florida Email: picsas@comcast.net

41. Acknowledgements New England Alliance for Public Health Workforce Development Boston University School of Public Health Massachusetts Association of Public Health Nurses (MAPHN)