2014
Conducting Health
Surveillance in
Emergency Shelters
Table of Contents
How to Use this Curriculum .......................................................................................................................... 1
Objectives of the Training ............................................................................................................................. 1
Training Guidelines ....................................................................................................................................... 1
Training Agenda (Template) ......................................................................................................................... 3
Lesson Plan.................................................................................................................................................... 4
Training for Medical Volunteers
Guidance Document
Pre/Post Test Answers ................................................................................................................................
14
Patient Scenarios .......................................................................................................................................... 8
Pre/Post Test ............................................................................................................................................... 12
Evaluation ................................................................................................................................................... 15

The guidance also includes a section on how to modify this curriculum
for non-medical volunteers and trainings with American Red Cross
volunteers.
Shelter Surveillance Work Group
Participating Organizations: American Red Cross, City of Nashua, NH
Division of Public Health and Community Services, Manchester Health
Department, New Hampshire Department of Health and Human Services
How to Use this Curriculum
This training has been developed by the Shelter Surveillance Work Group to train medical
volunteers, such as the Medical Reserve Corps, to conduct health surveillance in emergency
shelters during disasters and large scale emergencies. This training follows the guidance from the
New Hampshire Department of Health and Human Services (NH DHHS) on how to conduct
shelter surveillance in shelters and assists in fulfilling Capability 7, Mass Care, Function 4,
“monitor mass care population health”, Task 2, “during an incident, conduct surveillance at
congregate locations to identify cases of illness, injury and exposure within mass care
populations”.
Objectives of the Training







Describe how shelter surveillance has been used in national disasters, such as the
response to Hurricane Sandy.
Understand how health surveillance can be conducted in an emergency shelter to increase
situational awareness of disease and illness during disasters.
Gain a basic understanding of protocol and process for conducting health surveillance in
New Hampshire emergency shelters.
Gain knowledge in preventing and managing disease outbreak in shelters.
Understand how facility-specific environmental health and safety assessments are
performed at emergency shelters during disasters.
Describe how to use Natural Disaster Morbidity Survalance Individual Form (aka
“Individual Form) to doccument individual health visits in shelter.
Describe how to use Natural Disaster Morbidity SurveillanceSummary Report (aka
“Summary Report”) to summarize health visits in shelter.
Training Guidelines
The members of the Shelter Surveillance Work Group can present this training to medical
volunteers. It is best that 2 presenters are present to lead the training but it can be done with one
person.
Handouts for Participants:




Copy of the PowerPoint
Copy of the 3 shelter surveillance forms
o Natural Disaster Morbidity Surveillance “Individual Form”
o Natural Disaster Morbidity Surveillance “Summary Report”
o Environmental Health Assessment Form
Evaluation Form
Pre and Post Test
Other Documents:
1



1 copy of the NH DHHS Guidance document for the class, not each person
1 copy of the American Red Cross shelter surveillance form for the class, not each person
Sign-In Sheet
Equipment needs:





Projector and laptop
Blank wall or projector screen
Memory stick with the PowerPoint
Pens
Extension cord
Altering this Training for Use with Non-Medical Volunteers
TBC
Incorporating Shelter Surveillance into American Red Cross Trainings
TBC
2
Training Agenda (Template)
Conducting Health Surveillance in Emergency Shelters
Agenda
[insert date, time]
[insert location]
I.
Welcome and Introductions
II.
Pre-Test
III.
Overview of Surveillance in Shelters
a. Utilization of health surveillance in national disasters
b. Goals of health surveillance in emergency shelters
c. NH DHHS Guidance Document
d. Preventing and Managing disease outbreaks in a shelter
IV.
Case Studies and Form Review
a. Natural Disaster Morbidity Surveillance “Individual Form”
b. Natural Disaster Morbidity Surveillance “Summary Report”
c. Environmental Health Assessment Form
V.
Post-Test
VI.
Evaluations
Training Developed by the Shelter Surveillance Work Group
Participating Organizations: American Red Cross, City of Nashua, NH Division of Public Health and Community
Services, Seacoast Public Health Network, Manchester Health Department, New Hampshire Department of Health
and Human Services
3
Lesson Plan
Objectives
Content
Pre-Test
Pre-Test
Overview
PowerPoint
(Slides 1-4)
PowerPoint
(Slides 5-7)
Describe how
shelter
surveillance has
been used in
national
disasters, such as
the response to
Hurricane Sandy.
Teaching
Method
Self Evaluation
of Knowledge
of Material
Lecture,
Discussion
Lecture,
Discussion
Understand how PowerPoint Lecture,
health
(Slides 8Discussion
surveillance can 17)
be conducted in
an emergency
shelter to
increase
situational
awareness of
disease and
illness during
disasters.
Gain a basic
understanding of
protocol and
process for
conducting
health
surveillance in
New Hampshire
emergency
shelters.
Gain knowledge
in preventing and
managing
disease outbreak
in shelters.
Time
10
minutes
<5
minutes
5
minutes
10
minutes
Time
Taken
<5
Minutes
Assessment
4 Minutes
6 Minutes In shelters open after
Hurricane Katrina
and Hurricane Sandy,
health surveillance
was used to identify
acute illness
symptoms and
management of
chronic illness, and
injury in residents.
True/False
22
The goals of
Minutes
conducting health
surveillance in
emergency shelters
include (circle all that
apply):
 Prevent
outbreaks or
implement
infection
control
measures at
the onset of
an outbreak
 Prevent the
spread of
communicabl
e diseases
 Implement
measures to
prevent
injuries
4
Objectives
Understand how
facility-specific
environmental
health and safety
assessments are
performed at
emergency
shelters during
disasters.
Content
PowerPoint
(Slides 1820) Review
the types of
domains
assessed
using this
tool
(Facility,
Food, etc.)
Teaching
Method
Lecture,
Discussion,
Handout
“Environmenta
l Health
Assessment
Form”
Time
5
Minutes
Time
Taken
Assessment
Prevention measures
to decrease the spread
of illness include all
of the following
except:
triage, hand hygiene,
use of personal
protective equipment,
calling 911, reporting
signs and symptoms
associated with
communicable
disease, isolation and
quarantine
8 Minutes When should the
“Environmental
Health Assessment
Form” be completed
during shelter
operations?
 24 hours prior
to opening a
shelter, and
then every 12
hours during
shelter
operations
 Prior to
opening a
shelter or
within 24
hours of
opening a
shelter, once
per 24 hours
and as
needed
during
shelter
operations
 As needed
after an
environmental
5
Objectives
Content
Teaching
Method
Time
Time
Taken
Assessment
hazard has
been
identified
Describe how to
use Natural
Disaster
Morbidity
Survalance
Individual Form
(aka “Individual
Form) to
doccument
individual health
visits in shelter.
PowerPoint
(Slides 2150),
allowing
participants
to practice
completing
forms on
their own
Lecture,
Discussion,
Handout
“Individual
Form” and
Handout
“Summary
Report”, Case
Studies,
Practice
30
Minutes
Group
Discussion /
Questions
From
Participants
5-10
Minutes
Describe how to
use Natural
Disaster
Morbidity
SurveillanceSum
mary Report
(aka “Summary
Report”) to
summarize
health visits in
shelter.
Wrap Up
Discussion /
Questions
32
Minutes
(Group participation
will also assist with
assessment of
comfort level with
form.)
What is an example
of a trigger for the
shelter manager
contact NH DPHS to
discuss shelter
surveillance:
 When a
patient has an
oral
temperature
of 100.4
degrees F or
greater
 When a
patient has
been
transported to
a hospital for
care
 When three
or more
residents
with similar
symptoms
report for
care in a 24
hour period
6
Objectives
Post Test &
Evaluations
Content
Teaching
Method
Time
10
Minutes
Total
Time:
60 – 85
Minutes
Time
Assessment
Taken
5 Minutes
Approx.
82
Minutes
*Time Taken indicates the amount of time it took during a real-life training with a MRC unit.
7
Patient Scenarios
8
Case #
#1
#2
Clinical
Presentation
A 29 yo
female
shows up at
the
registration
desk with
red, watery
eyes and
states that
she has
some muscle
aches. She
has 3
children, the
youngest is a
9 mo who is
breast
feeding and
has loose
stools.
Initial
Follow Up
This
person is
referred
from
registration
to the
medical
station.
A 12 yo
comes in to
the medical
station with a
diffuse rash
and an oral
temp of 99.9
deg F. Rash
is itching and
started 2
days prior to
coming to the
shelter.
This
person is
already at
the
medical
station.
Clinical
Follow Up
At the medical
station they are
found to have a
semi
productive
cough and a
fever of 100.4
degrees F. She
is given a mask
to wear and
encouraged to
call her doctor.
The 9 mo year
old is afebrile
and has no
other
symptoms. The
mother is
educated on
hand hygiene
and states she
has enough
diapering
supplies for the
night.
Questions to
this patient
include other
symptoms
present,
allergies,
immunization
history, health
of family
members, and
occupation. If
differentials do
not lead to
diagnosis, then
patient is
encouraged to
call physician.
Clinical
Documentation
Under “Acute
Illness/Symptoms”
Fever and muscle
pain and
productive cough
are checked off for
the mother. ILI is
checked off at the
bottom of the
page. A separate
form is completed
for the 9 month
year old, and
watery diarrhea is
checked off.
Disposition is
discharge to self
care for both
mother and child.
Shelter
Considerations
The family is
given their own
room to stay in.
Rash is checked.
Disposition is
either discharge to
self care or refer
to other care,
physician.
This person is
monitored by
shelter medical
staff, and they
are encouraged
to return to the
medical station if
symptoms
change.
9
Case #
#3
#4
Clinical
Presentation
The first
lunch is
being served
since the
shelter
opened; it is
hamburgers
and salad.
The
hamburger is
properly
cooked, but
the lettuce is
packaged.
About 48
hours after
this lunch, 4
shelter
residents
start
complaining
of nausea,
vomiting and
diarrhea
A 68 year old
male using
portable
oxygen
arrives at the
medical
station
complaining
of a cough
and runny
nose. He has
a productive
cough and is
short of
breath,
unable to
complete
whole
sentences.
Initial
Follow Up
These
residents
are
directed to
the
medical
station.
Clinical
Follow Up
Noticing a
pattern of
similar
symptoms, the
workers at the
medical station
notify their
Medical Unit
Leader.
Clinical
Documentation
(We can tally this
any way.)
Shelter
Considerations
Since more than
3 shelter
residents with
similar
symptoms in a
24 hour period,
the shelter
manager calls
NH DPHS at
603-271-4496 or
(NH only) 1-800852-3345 ext.
4496
(weekdays) or
ext. 5300 (after
hours), as it is
indicated in the
guidance
(page3).
This
person is
already at
the
medical
station.
The breathing
issue is priority
over the
infectious
disease
symptoms. 911
is called. The
client is
encouraged to
sit down and is
monitored
continuously by
medical staff
until EMS
arrives.
Under respiratory
section,
congestion, runny
nose, sinusitis is
checked off with
productive cough
and shortness of
breath/difficulty
breathing.
Disposition is
admit/refer to
hospital.
The shelter
manager is
made aware that
911 has been
called. A shelter
volunteer is sent
to the parking lot
to receive EMS
and direct
responders to
the patient.
10
Case #
#5
#6
Clinical
Presentation
A 32 yo food
worker
comes into
the shelter
c/o fatigue
and joint
pain. Staff
notices that
the sclerae
are not clear
white.
Initial
Follow Up
He is sent
to the
medical
station.
59 to diabetic
with
neuropathy
c/o ear ache
and sore
throat.
This
person is
referred to
the
medical
station.
Clinical
Follow Up
He tells the
nurse that the
discoloration in
his eyes is
new, and he
noticed his
stools were
“grayish” in
color. He has
been working
at your shelter
for a week
feeding
residents. He is
encouraged to
call his doctor.
This person is
afebrile. He is
encouraged to
cough into his
arm and
frequently
wash his
hands. He is
provided with
education
related to
diabetes
management
and acute
illness.
Clinical
Documentation
Jaundice is
checked under
acute
illness/symptoms.
muscle or joint
pain is checked.
Disposition is refer
to other care.
Shelter
Considerations
The shelter
manager is
made aware a
food handler has
hepatitis like
symptoms.
Cough and sore
throat are checked.
Disposition is
discharge to self
care.
This person only
requires
standard
precautions, and
does not require
spatial
distancing at the
shelter.
11
Pre/Post Test
Health Surveillance in Emergency Shelters
*Pre* / Post Test
MRC
1. In shelters opening after Hurricane Katrina and Hurricane Sandy, health surveillance was
used to identify acute illness symptoms and management of chronic illness, and injury in
residents.


True
False
2. The goals of conducting health surveillance in emergency shelters include (circle all that
apply):



Prevent outbreaks or implement infection control measures at the onset of an outbreak
Prevent the spread of communicable diseases
Implement measures to prevent injuries
3. Prevention measures to decrease the spread of illness include all of the following except:

Triage


Reporting signs and symptoms associated
with communicable disease
Hand hygiene


Use of personal
protective
equipment
Isolation

Calling 911

Quarantine
4. When should the “Environmental Health Assessment Form” be completed during shelter
operations?



24 hours prior to opening a shelter, and then every 12 hours during shelter operations
Prior to opening a shelter or within 24 hours of opening a shelter, once per 24 hours and as
needed during shelter operations
As needed after an environmental hazard has been identified
5. What is an example of a trigger for the shelter manager contact NH DPHS to discuss shelter
surveillance:



When a patient has an oral temperature of 100.4 degrees F or greater
When a patient has been transported to a hospital for care
When three or more residents with similar symptoms report for care in a 24 hour period
12
Health Surveillance in Emergency Shelters
Pre /
*Post* Test
MRC
3. In shelters opening after Hurricane Katrina and Hurricane Sandy, health surveillance was
used to identify acute illness symptoms and management of chronic illness, and injury in
residents.


True
False
4. The goals of conducting health surveillance in emergency shelters include (circle all that
apply):



Prevent outbreaks or implement infection control measures at the onset of an outbreak
Prevent the spread of communicable diseases
Implement measures to prevent injuries
3. Prevention measures to decrease the spread of illness include all of the following except:

Triage


Reporting signs and symptoms associated
with communicable disease
Hand hygiene


Use of personal
protective
equipment
Isolation

Calling 911

Quarantine
4. When should the “Environmental Health Assessment Form” be completed during shelter
operations?



24 hours prior to opening a shelter, and then every 12 hours during shelter operations
Prior to opening a shelter or within 24 hours of opening a shelter, once per 24 hours and as
needed during shelter operations
As needed after an environmental hazard has been identified
5. What is an example of a trigger for the shelter manager contact NH DPHS to discuss shelter
surveillance:



When a patient has an oral temperature of 100.4 degrees F or greater
When a patient has been transported to a hospital for care
When three or more residents with similar symptoms report for care in a 24 hour period
13
Pre/Post Test Answers
Health Surveillance in Emergency Shelters
Pre / Post Test ANSWERS
5. In shelters open after Hurricane Katrina and Hurricane Sandy, health surveillance was used
to identify acute illness symptoms and management of chronic illness, and injury in
residents.


True
False
6. The goals of conducting health surveillance in emergency shelters include (circle all that
apply):



Prevent outbreaks or implement infection control measures at the onset of an outbreak
Prevent the spread of communicable diseases
Implement measures to prevent injuries
3. Prevention measures to decrease the spread of illness include all of the following except:

Triage


Reporting signs and symptoms associated
with communicable disease
Hand hygiene


Use of personal
protective
equipment
Isolation

Calling 911

Quarantine
4. When should the “Environmental Health Assessment Form” be completed during shelter
operations?



24 hours prior to opening a shelter, and then every 12 hours during shelter operations
Prior to opening a shelter or within 24 hours of opening a shelter, once per 24 hours
and as needed during shelter operations
As needed after an environmental hazard has been identified
5. What is an example of a trigger for the shelter manager contact NH DPHS to discuss shelter
surveillance:



When a patient has an oral temperature of 100.4 degrees F or greater
When a patient has been transported to a hospital for care
When three or more residents with similar symptoms report for care in a 24 hour
period
14
Evaluation
Conducting Health Surveillance in Emergency Shelters
Thank you for attending today’s training. We welcome your feedback on how to improve
by taking a few minutes to fill out this evaluation form.
Strongly
Disagree
Disagree
Neutral
Agree
Strongly
Agree
The objectives of this training were achieved:
Describe how shelter surveillance has been used in
national disasters, such as the response to Hurricane
Sandy.
Understand how health surveillance can be conducted in
an emergency shelter to increase situational awareness of
disease and illness during disasters.
Gain a basic understanding of protocol and process for
conducting health surveillance in New Hampshire
emergency shelters.
Gain knowledge in preventing and managing disease
outbreak in shelters.
Understand how facility-specific environmental health and
safety assessments are performed at emergency shelters
during disasters.
Describe how to use the surveillance forms.
The timeframe for this training was appropriate.
The presenters were knowledgeable, organized and
effective in their presentation.
The teaching strategies/resources were effective.
The following were satisfactory: food, facilities, and
parking.
What did you like best about this session?
What would you do to improve this session?
Additional Comments/Suggestions:
THANK YOU!
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