OSC DHS Instructor Guide

7/18/2019 OSC DHS Instructor Guide

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Instructor Guide Disaster Services

Disaster Health and Sheltering Course and Tabletop

COURSE PURPOSE

The Disaster Health and Sheltering Course acquaints pre-licensure nursing students with

the role of nurses in disaster relief operations, especially in the shelter environment. This

course provides familiarization with American Red Cross disaster health services

response in a two-part curriculum. Although the course is designed for nursing students,

it can also be used to orient Red Cross partners (e.g., Medical Reserve Corps or public

health nurses) to shelter operations in the communities where they are located.

COURSE DESCRIPTION

The Disaster Health and Sheltering Course contains a total of four (4) hours of

instruction in two parts. Completion of the entire course is required for the certificate of

completion.

• Part I: Online Presentation (a narrated PowerPoint with case studies and a separatevideo on Red Cross history). Part I can be assigned as independent study or presented

in the classroom by the instructor. It provides an overview of the Red Cross DisasterHealth Services activity using interactive content (2 hours).

• Part II: In-Classroom Tabletop Exercise in partnership with a Red Cross nurseinstructor. A tabletop exercise, case studies and class discussion are used to reinforce

disaster health principles and the nurse’s role in addressing community health problems (2 hours).

The Disaster Health and Sheltering Course is based upon the following assumptions:

1. Disaster preparedness is a critical component of the professional development of

nursing students, especially post 9/11/01.2. The American Association of Colleges of Nursing (AACN) requires emergency

preparedness/disaster management content in all baccalaureate nursing programs foraccreditation purposes.

3. Nursing students are encouraged to possess a strong community service record,motivating participation in learning activities that enables them to better serve.

4. Nursing programs may have limited time and resources in their curricula to offer thestandard full-length Health Services Response Workshop (HSRW).



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5. After taking this course, nursing students will gain awareness of how to serve as a

volunteer with their community Red Cross Chapter. If not choosing this route ofservice, they will be better prepared to serve as a spontaneous volunteer during

disasters.

COURSE OBJECTIVES

After completing this course, nursing students will be able to:

1. Describe the role of the Red Cross Disaster Health Services (HS) volunteer in thedisaster shelter setting.

2. Identify HS commitments as a Red Cross HS worker.3. Describe HS disaster relief settings where volunteers may be assigned.

4. Assess disaster client needs, providing appropriate nursing care and client referral.5. Describe possible challenges of working with the community after a disaster incident,

to include strategies for providing assistance to individuals with functional and accessneeds.

6. Explain how HS align with public health nursing practice.

Note: This course does not replace the current American Red Cross Health Services

Response Workshop (HSRW) or other volunteer training courses. It is designed to be an

awareness course only.

PREREQUISITES

Enrollment in a nursing program with: 1) a nursing instructor member who is willing to facilitate

instruction of the course and 2) a partnering relationship with a Red Cross nurse in a nearby local

Chapter.

SCHEDULING, REGISTRATION AND MATERIALS

PART I: Online Narrated PowerPoint and Historical Video

All inquiries regarding initial registration entry go through the Office of the Chief Nurse,

American Red Cross. Contact: [email protected].

Nursing instructor and the partnering Chapter’s Red Cross nurse will schedule training

for a recommended minimum of 10 students and maximum of 30 for adequate

monitoring of and feedback to participants during the exercise.

Part I of the course is housed with the Disaster Resistant Communities Group (DRCG)

LLC. Participants (both instructors and students) will self-register into a 2-hour online

self-study component after obtaining enrollment information from their instructor. The

instructor registers for class registration and tracking purposes. Participants complete a

post-test and present this completion proof to their program instructor.



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COURSE ENTRY IS THROUGH: http://www.DisasterHealthandSheltering.org

After completion of Part I, students who are taking the online portion of Disaster Health

and Sheltering will complete a post-test and print out the results of that post-test for proof

of course completion. Upon course completion, a link to the post-test is found on the

DRCG site. The instructor has discretion on how to use this course completion document

in terms of Part II entry. Please see the key to the post-test later in this document.

**NOTE: The instructor may also choose to present the on-line portion of the course

(Part I) in the classroom setting. In this case, only Part II registration will be used and no

post-test for Part I is required for the student. The entire course of four (4) hours is short

enough to fit into a clinical or practicum day in most nursing programs. An alternative

would be a weekend presentation or two evenings.

For all questions regarding the actual class information, please use the following contact:

[email protected]%

Besides the course materials on the DisasterHealthandSheltering website, back-up course

materials are found on the Nursing Neighborhood (accessed through Red Cross intranet

CrossNet only) under Shared Documents/National Student Nurse Program (NSNP). You

will need your Red Cross nurse partner to access the materials through this site.

An alternative location (last resort) is at www.dropbox.com; please contact:

[email protected] if you are unable to access the materials from the primary

or secondary location.

PART II: TABLETOP EXERCISE

Part II of the course is also provided by the Disaster Resistant Communities Group

(DRCG) LLC. You may access this site at http://www.DisasterHealthandSheltering.org. Part II uses Part I information for application and participants must self-register for this

part of the course as well, but only after the instructor schedules the exercise.

Schedule Exercise

Nursing instructors can schedule an offering of the Operation Shelter Care - A General

Population Shelter Tabletop Exercise for their students by accessing, completing and

submitting a Schedule Exercise Request Form. The request to schedule an exercise must be submitted three weeks prior to the planned date to offer the exercise.

Once the exercise has been scheduled additional information regarding the exercise will

be e-mailed to the instructor.



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Exercise Delivery System

This exercise will be facilitated via an internet based application entitled ON-Line

eXercise (ONX) System which will allow instructor and students to participate in the

exercise from their classroom.

Information on the ONX System can be found at ONXSystem.com.

Exercise Facilitation

On the website instructors can access the exercise facilitation video: This video will help

to gain a thorough understanding of what will be needed to conduct the exercise as well

as how the exercise will need to be facilitated.

Exercise Help Desk Information

If you need assistance anytime during the exercise please call the Help Desk at:

! Phone Number – 605-475-4700

! Account Number – 1076890 #

Nursing Instructor Reminder

It is very important that the nursing instructor reach out and establish an ongoing relationship

with the local Red Cross nurse who can make disaster response for students come alive by

sharing their actual experiences. Please go to www.redcross.org to enter the local zip code and

find the nearest Red Cross Chapter. Also, the State Nurse Liaison (SNL) Network is a volunteer

field structure for Red Cross Nursing and the SNL from your area can help connect you with the

right person in your local Chapter. Once you have located your local Red Cross Chapter, youmay request the State Nurse Liaison for your area. If you cannot locate the local chapter or SNL,

please send an email to [email protected] requesting this information.



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Process for Disaster Health and Sheltering Course

Below are instructions on how to facilitate the Disaster Health and Sheltering Course (DH&S) in

your state. At any time should you have questions please e-mail Kathleen [email protected].

Introducing the Course

Step 1

• SNL - Share course Fact Sheet and DRC DH& Sheltering (DH&S) Course sheet withDHS nurses and Red Cross chapters in your state.

o Resources: Fact Sheet

! Website: http://www.drc-group.com/library/exercise/osc/OSC-DHS-FactSheet.pdf

OR! Google: Disaster Health and Sheltering Fact Sheet

OR

! CrossNet: Nursing Neighborhood -> click Shared Documents -> click

NSNP Disaster Health and Sheltering Course -> click Information

About The Course -> click Fact Sheet

o Resources: DRC DH& Sheltering sheet! Website: www.DisasterHealthandSheltering.org (this will come up as

Disaster Resistant Communities Group which is correct)OR

!

Google: Disaster Health and Sheltering (this will come up as DisasterResistant Communities Group which is correct)

OR! CrossNet: Nursing Neighborhood -> click Shared Documents -> click

NSNP Disaster Health and Sheltering Course -> click Guides -> click

DRC DH& Sheltering Course Site

Step 2

• Local DHS Nurse – Contact nursing programs in your area to introduce them to thecourse and to provide them with informational material. Be sure to explain that the first

part of the course can be completed independently (2 hours) and that a faculty and a RedCross Disaster Health volunteer will co-teach the second part (2 hours).

o Resource: Fact Sheet and DRC DH&S sheet



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Step 3

• Local DHS Nurse – Once a nursing program has agreed to incorporate the course intothe curriculum, identify a contact person/ faculty with whom you will co-teach. Review

the DRC DH&S sheet with the faculty as she/ he will need to register for the course.

Registering for the Course

Step 1

• Local DHS Nurse – Stay in touch with the nursing program faculty to ensure a smoothregistration process.

Step 2

• Nursing Program Faculty – Faculty must register for the course on-line at LEAST 3

weeks prior to the scheduled class date.

o Resource: DRC DH&S sheet -> scroll half way down -> click Schedule Exercise

Request Form -> complete the on-line form -> click Submit

Step 3

• Nursing Program Faculty – Within 24 hours the faculty will receive a confirmation andlogin information for Part 2 from Chris Floyd, Disaster Resistant Communities Group

(not Red Cross).

Step 4

• Nursing Program Faculty – Once the nursing program faculty has received course

confirmation, he/she must promptly provide the students with the DRC DH&S sheet

and instruct them to register for Part 2 of the course; Part 1 does not require

registration.

Step 5

• Nursing Students – Register for Part 2 at LEAST 3 days prior to the scheduled date(no registration is required for Part 1).

o Resource: DRC DH&S sheet -> scroll to the bottom -> click Register Now in thegreen bar next to the appropriate nursing program-> scroll down to the bottom ->

complete registration -> Click Create New Account

o Students should provide their permanent e-mail address, not their school e-mailaddress.



)

Step 6

• Nursing Students – Within 24 hours nursing students should receive a confirmation andlogin information for Part 2 from Chris Floyd, Disaster Resistant Communities Group

(not Red Cross).

Step 7

• Nursing Program Faculty – Approximately 1 week prior to Part 2 being offered, facultywill receive a list of students who have registered for the class.

Completing the Course

Part 1 can be completed independently or in class as a group. Part 2 must be completed in classas a group.

Step 1

• Nursing Program Faculty and Nursing Students – Complete Part 1: Components #1,

#2 and #3 o Resource: Component #1 –Video (15 minutes and 34 seconds)

! DRC DH&S sheet -> Component #1 Introduction to the American RedCross – Video -> click Access The American Red Cross video

OR

! YouTube: Introduction to the American Red Cross

o Resource: Component #2 - PowerPoint! DRC DH&S sheet -> Component #2 Disaster Health and Sheltering for

Nursing Students - Narrated PowerPoint Presentation -> click Access the

Disaster Health and Sheltering narrated PowerPoint Presentation

o Resource: Component #3 – Post-Test

! DRC DH&S sheet -> Component #3 Post-Test -> click Access the Post-Test

Step 2

• Nursing Students – Post-Test Completion Certificate must be printed off and shown tothe nursing program faculty prior to participating in Part 2.

Step 3

• Nursing Program Faculty – Day of Part 2: 10 mins. prior to the start of class, thenursing program faculty needs to login (top right corner) to the site that was provided by

Chris Floyd. Faculty may choose to be the only one who logs in or, with a very smallgroup, each student may be invited to login.



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Step 4

• Local DHS Nurse, Nursing Program Faculty and Nursing Students – Complete Part 2together.

Evaluating the Course

Step 1

• Nursing Program Faculty – Following the slide that says “The End”, there will be aslide for collectively completing the group evaluation (AKA Hot Wash). Please be sureto complete this evaluation. (Individual evaluations will be completed at a later time.)

Step 2

• Nursing Students – Within 48 hours of completing the course students will receive anindividual evaluation to complete. Students MUST complete this evaluation within 48

hours in order to have their Disaster Health and Sheltering Certification of Completionissued to them.

Step 3

• Nursing Program Faculty – Within a week of completing Part 2, the faculty will receiveall the comments from the Hot Wash.

Step 4

• Local DHS Nurse – Follow up with the nursing program faculty to review Hot Washcomments.



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Post-Test Key

1. Bone, muscle & joint injuries2. Suture small lacerations

3. Schools4. Entertainment

5. Builds on the community health skills and training of nurses6. Screen client needs for additional assistance

7. Partner8. Jane Delano

9. Volunteer10. He should check to see if the client has insurance that will cover the cost of replacement

PowerPoint Presentation:

Remember that the PowerPoint Presentation and notes can be found at

DisasterHealthandSheltering.com as well as the Nursing Neighborhood (via Crossnet/Exchange).



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-./01 "

Disaster Health and Sheltering

Part I: Independent Study

National Student Nurse Program

Narration by:

Janice Springer, Red Cross Disaster Health Services Advisor

Cheryl Schmidt, Red Cross Nursing Education Subject Matter Expert

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-./01 )

Joplin Missouri Tornado Response, Courtesy ofAmerican Red Cross, May 2011

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-./01 * PANDEMIC RESPONSE

8

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-./01 + Course Purpose

To familiarize student nurses with

Red Cross Disaster Health

Services through

Disaster Health and Sheltering,

promoting volunteerism and

community preparedness and

post disaster resiliency.

9

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-./01 ", Representing the Red Cross

To each individual

with whom you

come in contact,

you are

the Red Cross!

10

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-./01 "" Personal Preparedness

You might be better prepared to help

in your community if you have your

own preparedness plan.

STOP and take a minute to reviewsome of the must haves in personal

preparedness, both for your family

and in your workplace.

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-./01 "# What’s In YOUR Go Bag?

!"

#"

$"

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&"

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-./01 "$ Role of Disaster Health Services

! Provides health assessments,

treatment, and referrals as needed

to people affected by

disasters.

! Coordinates with local

public health authorities

and local medical, nursing

and other health resources.

13

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-./01 "& In Certain Instances:

Disaster Health Services

may supplement

existing

service delivery

systems for

community health care.

14

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-./01 "' Disaster Health Services Competencies

15

! Critical thinking

! Assessment

! Technical skills

! Illness and disease management

! Information and healthcare technologies

! Ethical behavior

!Character based on values

!Confidentiality

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-./01 "( Client Commitments for

Disaster Health Services

16

! Respect confidentiality

! Accommodate diverse needs

! Follow Disaster Health Services Guidance

! Make effective referrals

! Identify and prevent potential health problems

! Maintain ethics

! Document accurately and appropriately

! Work as a team

! Involve community partners

! Use resources wisely

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-./01 ") Individual Injury and Illness: Sudden Onset

HS Workers Assess and Treat/Refer

Clients most often for:! Bone, muscle, and joint injuries

! Respiratory distress

! Lacerations and puncture wounds

! Exposure to extreme weatherconditions

! Rashes

! Burns

17

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-./01 "* What HS Workers Assess and Treat/Refer (cont.)

Stress-related Symptoms! Fluctuation in normal vital signs

! Gastrointestinal upset

! Headache

! Labor can begin earlier than expected

! Irritability

! Exhaustion

! Presenting symptoms may vary

! Malaise

! Pain

18

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##

-./01 "+ Mini-Case #1

• What will you be considering for care of this

client and her family?

19

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-./01 #, Mini-Case Study #2

• One shelter couple has slept pretty much continuously

for 3 days. You are concerned as the shelter nurse, as

is the Disaster Mental Health worker. As the couple gets

up on the 4 th day, both of them have respiratory viral

infections. Both Disaster Health Services and Mental

Health reach out to them and help them move to a better

sleep/exercise schedule.

• What are your concerns related to this ongoing for 3

days?

20

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-./01 #" Mini Case answers

Concerns include:

•depression

•overwhelmed

•exhausted

•at risk for pneumonia

•blood clots

•dehydration

21

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-./01 ## More disaster-related client needs!

Aggravation of Chronic

Health Conditions

! Hypertension

! Cardiac problems

! Respiratory problems (e.g.,asthma)

! Gastrointestinal problems

! Diabetes

! Allergies

! Mental health changes

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-./01 #$ What HS Workers Do. . .

! Screen and assess clients to meet access/functional needs.

! Care for disaster-related or -aggravated injuries or illnesses.

! Assist to provide durable medical equipment, consumablemedical supplies, personal care assistance for healthmaintenance.

! Provide casework for disaster related health needs, to includefiscal assistance for health and/or medical needs.

! Replace immediate-need prescriptions.

! Replace essential eyeglasses, prosthetic devices, hearingaids and other equipment lost as a result of the disaster.

! Provide referrals to community health agencies.

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-./01 #& What HS Workers Do (cont.)

! Determine whether the conditionor loss of DME is disaster-related and to what extent clientresources are available forimmediate needs .

! Use other available resourcesfirst before Red Cross donateddollars are spent.

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-./01 #' Client Interview

Sample Questions for Replacement

Assessment:

!What happened to the glasses, medication,

equipment?

! Is the loss or need disaster-related?

! Does the client need help with replacement?

! Is third-party coverage available?

!Who is the health care provider who ordinarily

cares for the client? (Is there a prescription?)

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-./01 #( Who are Red Cross Clients?

All members of the affectedcommunity, which include:

• Non-English speaking

• Persons with Disabilities

• Clients who come with or without

care-givers

• Affluent communities

• Culturally diverse communities

** Disaster Health Services may also care for

Red Cross workers when Staff Wellnessvolunteers are not available

26

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-./01 #) Where HS Workers Are

!Integrated Care Teams (for condolence orin-patient visits)

!Emergency Aid Stations

!Outreach

!Community Settings (e.g.,

bulk distribution sites,

Service Centers)

!Home Visits

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-./01 #* Other HS assignment settings (cont’d)

!Emergency Operations Center (EOC) Liaison

! Aviation and Transportation Disaster support

!Repatriation Team

28

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-./01 $, Sheltering

! Short term housing with sites determined by a pre-disaster shelter survey tool

! Sites frequently in churches, schools

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! Partnerships between the local Health Departmentand Disaster Health Services is key

30

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-./01 $"

• Add another photo here

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-./01 $$ Shelter Considerations for Disaster

Health Services

! Registration: Assessment for vulnerabilities or need forextra health or mental health support

! Dormitory set-up and its impact on families, persons whowill need extra care, bathroom proximity

! Communicable disease management

!What other things come to mind???

33

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Identifying client needs

• Begins at Registration

–

Staff makes two observations and asks two questions

Observations for

1. Ability to proceed with registration-medically or

behaviorally incapable of proceeding

2. Support needs-do they use a wheel chair, have a

service animal or need hearing support.



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Two questions:

• Is there anything you or a member of your family needsright now to stay healthy while in the shelter? Yes / No

If NO, is there anything you will need in the

next 6-8 hours? Yes / No

•

Do you/family member have a health, mental health,disability, or other condition about which you are

concerned?

Yes / No

Process Steps

• Cot-to-Cot methodology

•

CMIST as a framework for assessment

• Includes principles of surveillance

CMIST

• CMIST is an acronym that describes a system to helpidentify access and functional needs of clients in

shelters.

• C = Communication

• M = Maintaining Health

•

I = Independence

•

S = Services, Support and Self-Determination

• T = Transportation



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Need: Action:

Maintaining HealthNeed Action



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Follow through

Actions:

• ! No needs identified

• ! Contact Shelter Manager

• ! Contact Disaster Mental Health Services

• ! Agency, please provide agency name ___________________________________________________________

• !Other_________________________________________________________

_______________________________________________________________

• Follow-up/Resolution/date___________________________________________

_______________________________________________________________

• Disaster Health Services print name/signature/date______________________________________



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Cot to Cot

•

Proceed with a systematic plan to meet each familywithin a reasonable time frame.

– The ideal time frame is 6-8 hours, however, due toimmediate needs, it may take a full 24 hours to beginto know your shelter community.

– In a shelter of large population, consider assigningneighborhoods or sections for client support.

– Illness and injury reports use a Client Health Record.Functional support, such as communication, can bedocumented on the CMIST job form which is kept byDisaster Health Services.



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-./01 &) Case study

A shelter has been opened in a community that has justexperienced a flood. Over 80% of the homes and businessesin the downtown area have been affected. You are currentlyassigned to work at the registration desk of t he shelter toassist in interviewing and registering community members asthey enter the building.

Mr. Jones, a single male who lives independently in thecommunity, enters the shelter. He uses a wheelchair for mobility and has great difficulty hearing. In interviewing Mr.Jones, you learn that he has to catheterize himself to empty hisbladder and requires dialysis twice a week at a local facilityunaffected by the flood.

35

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-./01 &*

Mr. Jones

!What are your immediate concerns as a nurse?

!What are his risk factors?

!What are his equipment needs?

!Will he have transportation needs?

! Can he be safely accommodated in this shelter?

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-./01 ', Behavioral health situations that might

require higher level of care

• Clients with serious symptoms, e.g., acute anxiety or

severe depression symptoms, clients who are disruptive toother residents

• Client disclosure of psychiatric condition or past experience

that would make staying in the shelter unsustainable

• Clients experiencing significant distress due to the shelter

environment, even after accommodations have been made

(e.g., increased staffing, medications management)

• Active use of illegal drugs or alcohol in the shelter, which is

against Red Cross sheltering policy

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-./01 '" Prioritizing and Triage

• In a shelter that opens immediately after a disaster, you

may need to prioritize clients and determine who needs

care first, and who may need referral to either theemergency room or to a medical clinic.

• In a shelter that opens pre-landfall, you may have

different levels of urgency but may still need to prioritizeneeds.

• Link here to learn more about principles of triage.

http://en.wikipedia.org/wiki/Triage

39

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CMIST model and Mr. Jones

• Communication---he is hard of hearing

• Medical—health needs include catheterization

– Behavioral Health—does he have risk factors??

• Independence-what is he going to need to remainindependent? Perhaps a care-giver?

– Mobility—will he need help inside the shelter with w/c?

• Supervision—will he be able to self-cath in this setting?

• Transportation—how will he get to dialysis?



&"

-./01 '# Integrated Community Health Response:

PARTNERSHIPS

! Red Cross Disaster Health Services

! Local Public Health Department

! Local clinics and agencies

! Agency on Aging/AARP

! Veterans Administration

! Local hospitals

! Advocacy groups

! Schools/Universities

! Hospice/Home Health agencies

! Voluntary Organizations Active in Disaster (VOAD)

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#"

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-./01 '& Disaster HS Guidelines

42

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! Performing healthassessments

! Providing shelter



&#

surveillance ! Identifying client and

population health needs

! Ensuring a healthyenvironment

! Providing Disaster HealthServices in a shelter.

-./01 ''

Case Study

You have been assigned to a shelter with a capacity to

house 750 residents. A 13-year-old teenager,

accompanied by her mother, arrives at the HealthServices area complaining of itching, headache, poor

appetite, and cold-like symptoms. Upon assessment,

you find that her temperature is 102 oF and her back

looks like this photo. PhotopermissionfromDERMNZ,2011)

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-./01 '( Case Review

!What communicable disease do you suspect?

! Does anyone need to be notified?

!What are the immediate actions that need to take place

inside the shelter?

! Possible alternatives to sheltering?

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Documenting in Disaster HealthServices

• Client Health Record

• Initial Intake Screening form

• Aggregate Morbidity (Surveillance)

• Client Assistance Memorandum--a referral formfor internal partners

• Release of Confidential Information

• CMIST job guide

57



&&

-./01 '*

-./01 '+

HS

Work is

a Public

Health

Wheel

FIT

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Surveillance

A systematic :

Way to assure early identification of illness or

outbreaks

Process to capture illness and injury patterns over

longer time and multiple disaster to look for patterns

and trends,

A way to monitor the categories of CMIST over the

length of the shelter operations.



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-./01 (, Course Summary

!Public Health Nursing involves assessment and care ofindividuals, families and communities.

! HS response in Red Cross shelters is based in public

health nursing.

! Connect with your local Red Cross Chapter if you areinterested in making a disaster response difference in

your community.

47

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-./01 (" Where can I go from here?Take classes (mixture of required and

recommended):

! Shelter Operations and Shelter Simulation

!Mass Care

! CPR (Professional) and First Aid (often free to

volunteers)

! Health Services Response Workshop—core course for

HS activity

! Psychological First Aid

! Client Casework: Providing Emergency Assistance

48

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-./01 (# Questions about nursing in the American

Red Cross?

Find your State Nurse Liaison:

!""#$%%&&&'()*+(,--',(.%&&&/012)-%3,+45)6"-%#*0%74(-16.%8"9"):74(-):<191-,6-'#*0

Find your local Chapter: Input your zipcode in the top right-hand corner

!""#$%%&&&'()*+(,--',(.%

49

-./01 ($ Red Cross Nursing: A future

opportunity.

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