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Transcript
The Role of Public Health Nurses in a Shelter
Cape Cod Medical Reserve Corps
2014
Jean M. Roma MSN, APRN-BC
“One of the true tests of leadership
is the ability to recognize a problem
before it becomes an emergency.”
Arnold Glasgow
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40,000 Public Health jobs eliminated
Federal conference partners unable to attend
Restrictions on travel to educational events
Transition to virtual environment is not equal
to attending conference
Five Days At Memorial
Life and Death in a Storm Ravaged Hospital
Sheri Fink
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Katrina strikes
Mayor exempts health care facilities from mandatory evacuation
Flood waters rose and surrounded the hospital
Power failed
Extremely hot …no air conditioners
Back up generators supported six outlets when they had 50 ICU patients.
They were not required to retrofit the generators.
• Questions
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Who do we evacuate first? Neonates? Walkers? Vent patients?
What do we do with those that we can’t evacuate?
What do we do with those who have DNR orders?
What do we do if there is conflict in a treatment plan?
What do we do if we have a 100 page bioterrorism plan and an 11 page hurricane
plan?
Are we prepared as health care
providers?
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Personal emergency preparedness plans
Education
Training
Crisis Standards of Care
Ethics
Is our infrastructure prepared?
What saved lives?
Review
Preparedness
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Focus ?
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Natural disasters, and man-made attacks
Who takes the lead ?
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Government
What length of time is covered ?
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Focus ?
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Strong connections between people
Where does it start ?
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Improvement in day to day activities
With a plan
What is considered a disaster ?
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Prepared households, plans, and supplies
Where does it start ?
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Resilience
Preparedness, response, and immediate
recovery
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What is considered a disaster?
-All community stress, including climate change
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Who takes the lead?
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Government and non-government
What length of time is covered?
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Preparedness, response , and long term
recovery
Resilience Baseline
• In 2009, FEMA changed the paradigm in national
preparedness. The mantra was “there will never be
another Katrina”.
• Prior to 2009, the federal governments’ focus was
simply responding within 72 hours.
• After 2009, it changed to stabilizing and incident within
72 hours.
• To achieve this we started thinking in terms of “whole
community response”.
• Only 10 % of the workforce is from the public sector,
the other 90 % is from the private sector, nongovernmental agencies, or faith based organizations.
Resilience
• Understanding the value of what we have and
what we wish to preserve and improve
• Whole community approach in all phases
• Goal of resilience is to absorb and minimize
the impact of a disaster
• Resilient organizations are able to maintain
essential functions under duress and recover
rapidly from disruptions
Building Resilience
• Community coalitions
• We need to work on social determinants of
health
• Identify key priorities and measure them over
time
• Reduce our vulnerability
• Build trust with partners
– It is not one agencies responsibility or job
– We need to collaborate, build relationships, social
cohesion and a unified purpose
– We need to establish new partnerships
Best predictor of resilience is
resilience prior to the event.
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Look at our challenges.
Look at our data points.
Look at the “boots on the ground”, do they know the plan?
We need to plan deeply so people know what to do
without being told.
• Look at the public, the private, the everyday citizens to
make the plan!
Presidential Policy Directive 8
• Road map by requiring development of a National Preparedness Goal,
National Preparedness System, and annual National Preparedness Report.
• In December, the National Health Security Preparedness Index was
released. This is done through a partnership with CDC and Association of
State and Territorial Health Officials. It measures how well the nation is
prepared for emergencies that have potentially negative health
consequences. MA scored very well. In the are of Management of
Volunteers During Emergencies, MA scored 9.9 out of a possible 10. The
national average was 3.7.
Becoming more resilient…
1. Learning from the past
2. Accounting for Assets
3. Taking Action at Every Level
4. Shortening Recovery Time
FEMA uses a whole community
approach to emergency
management.
Assess the needs of the community as the events unfold
IMPACT on PLANNING
Volunteers
Clients
Type of Activities
Cape Cod
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Senior Health Challenges
Increased demand for health services
Seniors are living longer and facing
chronic disease
More likely to require home care
Increased rates of neurological disease
Increased demands on care takers
Nearly 40% households include a
resident over 65 yrs. (State average is
26%)
Increase in number of people living
alone resulting in increased risk of
isolation, depression, and injury
Community Needs Assessment Report
and Implementation Plan 2014-2016
Community Assessment
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Anticipated Event
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Weather
Impacted areas
Power failures
Vulnerable populations
Resources
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Shelters
Warming Centers
Faith based communities
Food
Transportation
Communication
Animal planning
Staffing (non-medical and medical)
Group facilities (hospitals, nursing homes, group homes)
Behavioral Health
Equipment
People with access or functional needs
includes individuals who need
assistance due to a condition that
limits their ability to take action.
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Individuals with disabilities
Seniors
People with limited English proficiency
People with limited transportation
People with limited financial ability to prepared
for a disaster
Hearing Impaired
• 36 million people have a hearing disability
• 10 % of U.S. population can not receive
audible information from TV or radio
• Test and printed material may not give equal
access to someone with a hearing disability
• May not hear the warnings being sent out
prior to an event
Vision Disability
• More than 10 million people have a vision
disability
• Low vision-may be able to see with assisted
technology
• May be able to read a 18-20 point bold face
type
• Cannot see a map on TV that shows
evacuation routes
• Alerts need to be in multiple formats
Speech Disability
• Interferes with two way communication
• 500,000 do not have speech that is
understood by others
Mobility Disabilities
• 14 million people have mobility disabilities
• 3.3 million over the age of 14 yrs. Use a
wheelchair
• 10 million use a cane, crutches, walker for 6
months or longer
• Architectural access, durable medical
equipment, PCA’s make the difference
between independence and dependence.
Cognitive, Intellectual and
Developmental Disabilities
• 16.1 million people have cognitive, intellectual
or developmental disabilities
• Instruction needs to be broken down to small
steps, repeated, or written down.
• Lack of understanding of the event
• Use plain language and concrete terms
Mental Health Disability
• 6.7 million people have a mental health
disability
• May loose access to medications and services
during a disaster
• Stress may adversely affect their mental
health stability
Brain Injuries
• 5.3 million people live with a long term
disability as a result of traumatic brain injuries
• Most frequent causes of brain injury are falls
and motor vehicle accidents
• May need assistance understanding
directions, reporting events, filling out forms,
• Disruption of routines
Health Maintenance Needs
• 48% of Americans report they are taking
prescription medication
• 1 in 3 Americans takes prescription medication to
treat long term conditions
• 6% of children younger than 12 use
bronchodilators for asthma
• Age 20-29 , antidepressants are the most
common medication
• May not have access to medication and supplies
in a disaster
Appropriate Supplies
Functional Needs
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Walkers
Wheelchairs
Commodes
Raised Toilet Seats
Canes
Low vision supplies
Show Me
Sharps containers
Gait belts
Special Need Cots
Oxygen
Food
Warming kits
First Aid
AED
Access to generator power
How many pieces of equipment can this plug
support?
Drill and Just in Time Training
Maintain communication to ensure accurate dissemination of
information to colleagues and the public.
Educate the Community
Communication
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Where do I get information prior to storm?
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Ping 4Alerts-Websites –REPC, FEMA, Town, Radio, TV, 211,Council of
Aging, Supply vendors, Home Health Agencies, Special Services such as
Community Connections, Cape Abilities, Kennedy Donavan, CORD
Where do I get storm related information during the event?
flooding, lack of power, surge, inaccessibility to help
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Battery operated radio, police and fire, neighbors, two way radios,
telephone, texting
How do I get help?
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Regional transportation, neighbors, family, police and fire, faith
based organizations, Council of Aging
Where are my children, my husband, my parents?
Lack of telephone service
Communication plan prior to event
Learn to text-ok or help
Shelter in Place
• What do I need?
Need to go to a Shelter
• When it is not safe to stay in your home, you
need to go to a shelter.
– No heat in the winter
– No power with medical equipment
– No assistance with ADL’s
– No safe way to get out of the home
– No safe water, food, or air
What do I bring to a shelter?
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Medications
Medical equipment
Medical supplies
Contact information
Three days worth of clothes
Cell phone and charger
Reading materials
Special foods
Cash
What happens at a shelter?
• Registration
– Observation-Does the client need immediate
medical attention, appear too overwhelmed to
complete registration or is a threat to themselves
or others?
If yes, contact health services, mental health worker
or 911
Questions
• Is there anything you or a family member
needs right now to stay healthy while in the
shelter? If no, is there anything you will need
in the next 6-8 hours?
• Do you/family member have a health, mental
health, disability , or other condition about
which you are concerned?
What is cot to cot assessment?
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Way to identify access and functional needs in a
community disaster shelter.
Designed by Janice Springer DNP, RN, PHN based on her
experiences with Hurricane Katrina and Hurricane
Sandy
Provides for Capability 7-Mass Care Responsibility of
Public Health
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Determines Public Health role in operations
Determines Mass Care needs of populations
Coordinated public health, medical, and mental health mass
care services
Monitors mass care population health
New Model-CMIST
• Moves away from defining functional needs in
medical terms
• Addresses medical and non medical needs in an
integrative setting
• Designed to reduce and prevent decompensation
and development of acute conditions
• Describes barriers and strategies to achieve
inclusion, integration, self determination, health,
safety and independence
Cot to Cot Assessment
What does health care in shelters include?
Assessment
Evaluation
Treatment
Replacement
Referral
Provide on site triage as needed
Identify Access and Function through CMIST
Reminder
Community Member not Patient
C
M
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T
Communication
Maintain health
Independence
Safety, Support Services, and Self-determination
Transportation
Communication
• Access to auxiliary communication
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Written materials in alternate format
Provide visual public announcements
Provide qualified interpreters
Language lines
Access to communication device (teletypewriter, skype, cell phones)
Replacement of communication equipment
• Batteries for hearing aid
• Replacement eye glasses
• Low vision aids
Maintaining Health
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Special diets
Allergies
ADL assistance
Access to quiet areas
Access to temperature controlled area
Medical supplies
Manage behavioral response to stress
Independence
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Durable medical equipment
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Bariatric accommodation
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Provisions under the law
Area for exercise, feeding, and relief
Not involved with animal shelter
Infants
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Special need cots and wheelchairs
Service animals
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Wheelchair, walkers, canes, raised toilet seats
Diapers, supplies, formula, nursing area
Children
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Safety, supplies, toys, activities, supervision
Services, Support, Self
Determination
• Personal Assistance
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Bring support services to shelter
Family provides support services
Group homes bring staff
• Observation of Needs
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Grooming, assistance with ADL
Unmet needs
Transportation
• To a facility for medical care or
treatment
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Coordinate with shelter manager and
health care provider on site…may use
rescue, family, accessible van
• To a non-medical appointment
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Coordinate with shelter manager
Coordinate with local community resources
Prevent and control the spread of disease
Surveillance for communicable
disease and unmet needs.
Public Health Nurse Functions
Ensure the health and safety of self, colleagues,
and the public.
Assessment
Monitoring
Education
Intervention
Planning
Document events and interventions
Hot Wash and After Action Report
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Biggest challenge were the elderly guest
550 people in D/Y – “I remember only about 15 people under 75 and
they were disabled”.
The rooms to isolate people were a challenge because they weren’t
heated-2 week old preemie; infectious disease; incontinence
Meds-didn’t bring them; brought 2 bottles of Oxycodone and 2 bottles
of Oxycontin-no safe storage; on blood thinners but didn’t identify until
day shelter closing; meds storage under pillows
People not sleeping; increase in disorientation; increase in falls
Half the people couldn’t get to the shelter without assistance and were
exhausted, hungry, and wet when they arrived
Safety was compromised
Low vision problems
I saw clients with breathing issues, hospice patients, dizziness,
confusion, falls, conjunctivitis, hypertension, depression, anxiety,
incontinence, shortness of breath, patients on oxygen, j-tube feedings,
c-pap; nebulizers, vomiting, chills, dementia, back pain, neck pain,
headaches, upset stomachs, nausea, cuts, agitation, people needing
assistance with walking, transferring, and toileting.
What would have helped?
• Volunteers to sit with people and assist them to the bathroom, dining area
etc.
• People letting their family/friends know they went to the shelter
(communication plan)
• Increase in our behavioral health providers being available
• Better communication with the hospitals
• People knowing how they can get transported to the shelters
• People knowing what to bring to the shelters
• Improved job action sheets
• Case management for leaving the shelter
• People leaving the porch light on when they go to the shelter
• Improved Medical Reserve equipment
– Cold weather kits
– Low vision kits
Key Concepts
• Nurses play an important role in all phases of
disaster response.
• All practicing nurses should be familiar with disaster
phases and their role during an event.
• Public health nurses practice principles of disaster
on a daily basis.
• Vulnerability assessment can reduce the impact of
disasters on a community.
• Properly implemented triage models minimize the
morbidity and mortality of people impacted by an
event.
• Disaster phases and nursing process are closely
aligned.
• We remember…
• We celebrate…
• We believe…