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Challenges When Sheltering Displaced Populations During Natural & Manmade Disasters July 15, 2010 Webinar Sandra Schoenfisch, RN, PhD Sandra Schoenfisch, RN, PhD

Challenges When Sheltering Displaced Populations During Natural & Manmade Disasters July 15, 2010 Webinar Sandra Schoenfisch, RN, PhD Nursing Consultant

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Page 1: Challenges When Sheltering Displaced Populations During Natural & Manmade Disasters July 15, 2010 Webinar Sandra Schoenfisch, RN, PhD Nursing Consultant

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

Page 2: Challenges When Sheltering Displaced Populations During Natural & Manmade Disasters July 15, 2010 Webinar Sandra Schoenfisch, RN, PhD Nursing Consultant

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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

Page 3: Challenges When Sheltering Displaced Populations During Natural & Manmade Disasters July 15, 2010 Webinar Sandra Schoenfisch, RN, PhD Nursing Consultant

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Displaced Population NeedsDisplaced Population Needs

HousingHousing Food/MedicationsFood/Medications ClothingClothing FundsFunds TransportationTransportation EmploymentEmployment OtherOther

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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

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Partnerships

Emergency ManagementEmergency Management

CommunityCommunity

Other state agenciesOther state agencies

Faith basedFaith based

OtherOther

Page 6: Challenges When Sheltering Displaced Populations During Natural & Manmade Disasters July 15, 2010 Webinar Sandra Schoenfisch, RN, PhD Nursing Consultant

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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

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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.)

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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)

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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

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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

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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.

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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

Page 13: Challenges When Sheltering Displaced Populations During Natural & Manmade Disasters July 15, 2010 Webinar Sandra Schoenfisch, RN, PhD Nursing Consultant

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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

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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

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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)

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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?

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Special Needs Shelter Operations

Group similar patients together if ableGroup similar patients together if able

Use standard precautionsUse standard precautions

IsolationIsolation

CaregiversCaregivers

SuppliesSupplies

CotsCots

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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)

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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

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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

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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

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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

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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

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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…

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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

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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

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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

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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

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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

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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

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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

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PREPAREDNESS PREPAREDNESS CYCLECYCLE

Evaluation

Plan

Eq

uip

Train

Exe

rcis

e

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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

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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.

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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

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Leadership & Management in Leadership & Management in SheltersShelters

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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

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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

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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

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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]

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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)