Challenges When Sheltering
Displaced Populations During
Natural & Manmade Disasters
July 15, 2010
Webinar
Sandra Schoenfisch, RN, PhD
Nursing Consultant
Tallahassee, Florida
picsas@comcast.net
Learning Objectives
Upon completion of the program, participants will be
able to:

Identify needs of displaced populations
 Describe strategies to address special needs &
appropriate triaging
 Discuss individual roles and responsibilities of
shelter staff
 Identify training and educational needs for staffing
the shelter
 Describe the importance of partnerships, discharge
planning & case management
 Incorporating lessons learned
2
Displaced Population Needs
Housing
 Food/Medications
 Clothing
 Funds
 Transportation
 Employment
 Other
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3
Clients’ Perspective
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Expectations
Level of Need
Care Givers/Family Needs
Complex Medical Regimens
Special Equipment
Accommodations
Pets
Safety
Other
4
Partnerships
 Emergency Management
 Community
 Other state agencies
 Faith based
 Other
5
Shelters
 Refuge of last resort
 Not a hospital, nursing home,
rehabilitation center or a hotel
6
Types of Shelters
General Shelters
 Special Needs/Medical
 Combination
 Pediatric
 Special Sub-populations
 Pet Friendly
 “Gypsy” Shelters
 Other (hotels, community centers, etc.)
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7
Emergency Management Role
 Identify locations appropriate for
special needs shelters
 Maintain Client Registry
 Supplies
 Staffing (non-medical)
8
Shelter Checklist
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Connect with local emergency management
Ensure shelter sites are still acceptable & will
accommodate client population
Ensure equipment & supplies are available
Review your staffing plan
Request any needed training and/or updates
Review any unique provisions for your area
9
Public Health Roles
 Community & responder education
(on-going)
 Health & Medical (ESF8 response)
 Medical & support staffing of special
needs shelters
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Coordination of Health & Medical
Assessment of health/medical needs*
 Health/medical personnel & supplies*
 Patient evacuation*
 Emergency Medical Services
 Mental health & crisis counseling for
responders*
 Victim identification/mortuary services
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*Key roles and responsibilities that public health nurses fill.
11
Types of Special Needs Evacuees
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Dialysis
Oxygen Dependent
Electrical Dependent
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– CPAP, Nebulizer
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Non-Ambulatory
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– Walkers
– Wheelchairs, Scooters
– Bed bound
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Wound Care
Complicated medication
regimens
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Hospice
Trach Care &
Suctioning
Incontinent
Various stages of
dementia
Special Needs Children
Many very frail elderly
12
Special Needs Shelter Triage
 Initial rapid assessment determines
placement
 Respiratory illness triage
 Obtain client history once special
needs placement is determined to be
appropriate
13
Triage Suggested Tools

Color coding of identification bracelets

Link between color coding and
interaction with other health care
providers

Triage Tags
14
Appropriate Clients
 Ambulatory (with or without assistive
devices)
 Dependant on others for routine care
(eating, walking, toileting, etc.)
 Need assistance with medical care
(medication administration, nurse
monitoring, dependant on electrical
equipment)
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Questions for Consideration
 Can the client sleep on a cot or mat?
 Does the client have a stable medical
condition?
 Does the shelter have power backup for
electrically dependant clients?
 Does the client have disabilities?
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Special Needs Shelter Operations
 Group similar patients together if able
 Use standard precautions
 Isolation
 Caregivers
 Supplies
 Cots
17
Staffing Special Needs Shelters
 Asset typing
 Guidelines
 Volunteers
Medical Reserve Corps
Student volunteers
Retired persons
 Strike teams
 Local, Regional, State Resources
 Federal Resources (US Public Health
Service)
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Special Needs Shelter Training
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Special Needs Shelter Operations Training
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Special Needs Shelter Management Training
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Skills Refresher Training for PHNs
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Team Leader Orientation
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Psychological First Aid
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Other
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Education & Training
 Basic Training for All Staff
 Refresher Training for All Staff
 Seek Assistance from Partners
 Operations/Management
 NIMS
 Attendance: required, strongly
recommended, strictly voluntary
20
Challenges & Issues
 Changing Scenarios
 Equipment (satellite phones,
direct connect, 800 MHz radios)
 Decreased Comfort Zone
 Adverse environments
21
Challenges & Issues cont.
 Need to recognize limits of one’s
own knowledge
 Creative problem solving & flexible
thinking
 The need to participate in
drills/exercises is important and
needs to be done
22
What DOES Work?
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Training for new staff & partners
Just in time training
Triage
EMT onsite
Security
Mentoring/Coaching
Shifts/Rotations
Translators/ASL onsite
Other
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Other Things That Work!
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Case Managers/Discharge Planners
– Placement of all that are financially & medically
eligible
Work to get FEMA dollars for temporary placement in
Assisted Living Facilities, Skilled Nursing Facilities,
& congregate adult living facilities
Use of Nursing Home Administrators to Expedite
Placement (contracted)
Client Tracking System – who came in, who left, and
where did they go…
24
Discharge Planning/Case Management
Should start when you plan to open a
shelter!!
 Partners are essential
 Short-term & Long-term solutions
 Think outside the box
 Points for creativity 
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25
Placement Options
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FEMA Funding for 90-180 days, with possible
expansion to 18 months.
 Level 1 – In home with health/personnel care
services
 Level 2 – Hotel with home health or wrap around
services
 Level 3 – Mobile home, no wrap around services
 Level 4 – Mobile home, wrap around services
 Level 5 – Respite Care / Adult Day Care
 Level 6 – Assisted Living
 Level 7 – Skilled Nursing Facility
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Mental Health Issues
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Crisis Response Teams
– CISD – Department of Health
– Community Mental Health – Department of
Children & Families
 Served both at the special needs & general shelters
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Medication needs
 Mental Health Infrastructure destroyed
– Counseling centers damaged
– Crisis lines down – forwarded to call centers for
mental/behavioral services
27
Addressing Safety/Security
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Staff safety issues – body mechanics, fatigue,
hydration, and injury
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Elderly issues – mobility, medication security, conflict,
stress, fatigue
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Transportation issues – feed and medicate prior to
transport, bring snacks & fluids
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Equipment issues – trip risks, wet surfaces, oxygen
tank security, generators, extension cords
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Uncooperative evacuees
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Other
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Staff Augmentation
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Medical Reserve Corps
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Regional Public Health Response Teams
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Emergency Management Assistance
Compact (EMAC)
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Federal Assistance
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Provide emergency
health advisories
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Boiled water notices
Carbon Monoxide Poisoning
Mold
Flood Waters
Special Needs Updates
DEET Distribution & Mosquito
Protection
Food Safety
Heat Exhaustion
Home Repair Safety
Evacuation Routes
Resource Access
Other
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All Hazards Preparedness
Rules of Engagement
1. Meet the Needs of Victims
2. Meet the Needs of the Responders
3. See Rule #1
31
PREPAREDNESS CYCLE
Plan
Evaluation
Train
32
Association of State and Territorial Directors of
Nursing (ASTDN) Position Paper
The Role of Public Health Nurse (PHN) in
Emergency Preparedness and Response first
version in 2002, revised 2007

Applied twelve (12) selected EP core
competencies to PHN practice
33
Phases of Disaster Linked to the Nursing Process
Disaster
Phase
Mitigation
Preparedness
Response
Recovery
Definition
Assessment
Planning
Implementation
Evaluation
Prevent a disaster
or emergency;
Minimize
vulnerability to
effects of an event.
Assess a group of
elderly citizens for
their awareness
about preventing
heat stroke.
Develop community
education plan to
increase awareness
about preventing
heat stroke.
Conduct community
education activities
to increase
awareness about
preventing heat
stroke.
Evaluate community
education activities
on preventing heat
stroke.
Assure capacity to
respond effectively
to disasters and
emergencies.
Assess the
populations at risk
for special needs
during a disaster.
Develop plans to
care for special
needs populations
during a disaster.
Conduct training,
drills and exercises
related to care of
special-needs
persons.
Evaluate plans for
serving populations
with special needs.
Provide support to
persons and
Communities
affected by
disasters and
emergencies.
Serve on a response
team to determine
the impact and
specific health needs
of hurricane
survivors. Triage
victims.
Develop plans to
rotate staff on
response teams to
prevent stress and
burnout among
responders.
Deploy staff to
shelters after a
hurricane, in
accordance with
local and/or state
emergency response
plans.
Participate in after
action reviews
and/or debriefings to
evaluate quality of
health services
provided and
lessons learned.
Restore systems
to functional level.
Serve on team to
assess community
assets and potential
for recovery from a
recent flood.
Collaborate with
partners and
community leaders
to plan long-term
recovery priorities
after a flood.
Participate in
restoring community
services after a
flood.
Serve on team to
evaluate long-term
impact on persons
displaced by a flood.
34
Documents & Forms
 Special Needs Shelter Walkthrough Survey
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Supply & Equipment List
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Oxygen Packs
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Staff & Volunteer Line list
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Shelter Isolation Precautions
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Shelter Guidance Respiratory
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Shelter Intake Form
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Daily Census Report
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Media Relations Guide
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Job Action Sheets
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Level of Care Matrix
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And Much More
http//:www.doh.state.fl.us/PHNursing/SpNS/SpecialNeedsShelter.html
35
Leadership & Management in
Shelters
Resources

252, F.S.; 381, F.S. www.leg/state/fl.us/statutes

64-C, F.A.C. www.flrules.org

Regional Public Health Response Teams Recruitment and Deployment Guidelines for CHD

Public Health Preparedness Training Catalog www.doh.state.fl.us/demo/PHPTrainingCatalog

Columbia University School of Nursing Center for Health Policy. (2002). Bioterrorism and
emergency readiness competencies for all public health workers. Atlanta (GA): Centers for
Disease Control and Prevention.

Council on Linkages Between Academia and Public Health Practice (2001). Core competencies for
public health professionals. Retrieved April 29, 2007 from
http://www.phf.org/competencies.htm#view

Incident Command and NIMS Training/FEMA http://training.fema.gov/emiweb/IS/crslist.asp

American Red Cross

Medical Reserve Corps http://www.medicalreservecorps.gov
http://www.redcross.org
37
Recommended Reading

Gebbie, KM & Qureshi, K. (2002). Emergency and disaster
preparedness: Core competencies for nurses: what every
nurse should but may not know. American Journal of
Nursing.102:46 Medical Reserve Corps

California Public Health Nursing Disaster Handbook
www.phncalifornia.org

ASTDN Position Paper “The Role of Public Health Nurses in
Emergency Preparedness and Response” www.astdn.org
38
Recommended Reading

Columbia University School of Nursing Center for Health Policy. (2002).
Bioterrorism and emergency readiness competencies for all public health
workers. Atlanta (GA): Centers for Disease Control and Prevention

Council on Linkages Between Academia and Public Health Practice (2001).
Core competencies for public health professionals. Retrieved April 29, 2007
from http://www.phf.org/competencies.htm#view

FEMA. (21 March, 2006a). State and Local Guide (SLG) 101:Guide for AllHazard Emergency Operations Planning. Retrieved April 29, 2007 from
http://www.fema.gov/plan/gaheop.shtm

US Department of Homeland Security. (2006). National Response Plan.
Retrieved April 29, 2007 from
http://www.dhs.gov/xprepresp/committees/editorial_0566.shtm
39
Contact information for
Dr. Sandra Schoenfisch
Sandra Schoenfisch, RN, PhD
Nursing Consultant
Tallahassee, Florida
Email: picsas@comcast.net
40
Acknowledgements
 New
England Alliance for Public Health
Workforce Development
 Boston
University School of Public Health
 Massachusetts
Association of Public Health
Nurses (MAPHN)
41