Medical Needs Shelter Planning for Hudson

CountyMonique Davis, MPH, MCHES

Hudson Regional Health Commission

Identify what type of shelter you will activate◦ Co-located◦ Stand-alone

Identify and secure funding sources as early in the process as possible

Secure Medical Director- needed in order to issue standing orders for clinical staff to provide services to evacuees & write Rx’s

Define the level of care your shelter will provide

Priority Considerations

◦ General Population Shelter (Tier 1): Individuals who are independent prior to the disaster or emergency. Some of these individuals may have pre-existing health problems that do not impede activities of daily living (ADLs) and do not exceed basic first aid capabilities of community shelters

◦ Medical Needs Shelter (Tier 2): Evacuees (patients) who have no acute medical conditions but require some medical surveillance and/or special assistance beyond what is available in a traditional shelter

◦ Hospital Facility (Tier 3): Evacuees who need acute medical care such as people experiencing significant trauma, injury, or who have acute medical condition(s)

Shelter Client Definitions

Multidisciplinary Steering Committee suggested◦ Health & Human Services Representative (ESF #6)

Include Mental Health Administrator◦ Office of Emergency Management◦ Public Health Representative

Include clinician◦ Hospital Representative◦ EMS Representative◦ Facilities/Engineering◦ Red Cross Liaison◦ Transportation Coordinator◦ AFN Representative

Steering Committee Participants

Facility & Equipment/Supplies

Staffing and Training

Public Outreach and Education

Public Health Advisory

Plan and SOG Development

Five Working Groups

Identified and assessed potential sites within the county◦ Committee members present included OEM, Red Cross Liaison,

County Administration, Facilities representative, LINCS representative

◦ Must be ADA compliant (General Population Shelters also) Created equipment and supplies list based upon the suggested list

in the South Jersey Medical Needs Shelter Standard Operating Guidelines (now the statewide adopted template)◦ Identifying funding sources early in process is essential◦ Become familiar with UASI projects relevant to sheltering

FY 2012: Trailer, cots (including bariatric), “basic medical equipment” - ?? For 25 patients + 25 staff

FY 2013: Will build on MNS supplies; O2 Concentrator◦ Work with clinical staff/MRC volunteer to select supplies; discuss

special needs menus (low sodium/diabetic, etc.)◦ Don’t forget to identify storage location for all

equipment/supplies◦ Have plan in place for medication procurement

Facilities and Equipment/Supplies

Committee identifies potential staffing sources within county (ie: Schools of Nursing, Medical Schools, Home Health Agencies, county employees, hospital staff, etc.

Training needs and instructor resources for same are identified◦ Feedback statewide is that courses on caring for chronic

conditions such as diabetes, asthma, cardiac conditions, etc. in elderly populations is needed. Many volunteers do not regularly work with geriatric populations. Know your MRC! Are they school nurses, hospital

employees? Hudson used Survey Monkey to do “Skillset Survey”. Tailor training to results of survey and gaps in recent experience

Consider asking local hospitals to teach one or two courses; spread request around to all hospitals in county. Remind them that shelters decrease surge for them – WIN/WIN for everyone.

Staffing and Training

Goal of this committee is to draft an outreach and education campaign◦ Targeted towards both public and professional

audiences Public: general education about who goes to a MNS,

what they should bring Professional: eligibility criteria, procedures for

referral, etc. EMS personnel Hospital ED/Discharge Planners

◦ Proposed awareness campaign to include press releases, PSA’s, social media

Public Outreach & Education

Purpose of this committee is to develop SOP’s for the following:◦ Environmental Assessment/Enforcement: Local health

responsible for assessment of site relative to compliance with sanitary conditions, ie: availability of handwashing facilities, toilet facilities, food temperature and storage compliance, etc.

◦ Local Health strongly encouraged to have periodic presence at shelter during activation period

◦ Communicable Disease Surveillance and Reporting: Shelter Management must be educated regarding

surveillance and reporting of communicable diseases. Especially important in congregate settings.

Public Health Advisory Committee

South Jersey template is good starting point; however, it does not include a clinical concept of operations or SOG◦ PHEP Public Health Nurse Group is currently developing

SOG’s for the clinical piece. Includes the following: Standing Orders Medication Procurement Forms/Triage/Registration/Discharge Planning Special Needs Menu Planning Patient Tracking Training Level of Care/Patient Ratio

Goal is to have Draft by June 2014

Plan and SOG Development

◦ Medical Reserve Corps (clinical and non-clinical)◦ County Employees

Department of Health and Human Services personnel (should be ESF #6 Lead – Mass Care)

County Hospital?◦ Local Health Department Staff◦ FQHC Personnel◦ Board of Education Nurses◦ School of Nursing Faculty/Students?◦ Hospital Emergency Dept staff on off hours??◦ EMS Personnel◦ Community Organizations – ie. Doctors Without Borders◦ Clergy Representation

Potential Sources for Shelter Staffing

Consider phone triage, as once evacuees arrive at doorstep, it’s difficult to turn them away

Begin case management/discharge planning upon admission to shelter – often takes that long to plan adequately!

Consider having MOU’s with LTC’s. LTC’s often have “respite” bed rates ~$200/day. Staff, O2, meals, laundry – all in place

Include facilities management in planning. Experts in HVAC issues. Need input regarding temperature control and generator use.

Some final thoughts based on lessons learned by others…

Plan for social services involvement and mental health component as well◦ Social services – Discharge Planning◦ Mental Health – contact County Mental Health

Administrator to request Disaster Recovery Crisis Counselors (DRCCs) and planning for clients with substance abuse history

Track personnel hours/other resources for possible FEMA reimbursement!◦ MRC volunteer hours can possibly be counted towards

“in-kind” match for FEMA reimbursement application if it is a declared emergency. (NJMRC has Deployment Tool for tracking volunteer hours)

More thoughts…cont’d

Contact Information:

Monique Davis, MPH, MCHESHudson Regional Health Commission

201-223-1133mdavis@hudsonregionalhealth.org