Medical Needs Shelter Planning for Hudson County

1. Medical Needs Shelter Planning for Hudson County Monique Davis, MPH, MCHES Hudson Regional Health Commission

2. Priority Considerations • 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

3. Shelter Client Definitions • 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)

4. Steering Committee Participants • 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

5. Five Working Groups • Facility & Equipment/Supplies • Staffing and Training • Public Outreach and Education • Public Health Advisory • Plan and SOG Development

6. Facilities and Equipment/Supplies • 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

7. Staffing and Training • 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.

8. Public Outreach & Education • 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

9. Public Health Advisory Committee • 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.

10. Plan and SOG Development • 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

11. Potential Sources for Shelter Staffing • 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

12. Some final thoughts based on lessons learned by others… • 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.

13. More thoughts…cont’d • 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)

14. Contact Information: Monique Davis, MPH, MCHES Hudson Regional Health Commission 201-223-1133 mdavis@hudsonregionalhealth.org