1. Medical Sheltering: The Local Perspective Multiple Roles and Responsibilities for Local Health Departments

2. A Brief History of Medical Shelters in Smith County 2005 Katrina and Rita 2005 Katrina and Rita Located at Tyler Jr. College Located at Tyler Jr. College

3. A Brief History of Medical Shelters in Smith County Total patients: 328 Total patients: 328 Highest number of evacuees at one time: 284 Highest number of evacuees at one time: 284 A community project A community project Tyler Junior College gymnasium and faculty Tyler Junior College gymnasium and faculty North East Texas Public Health District North East Texas Public Health District Physicians from community / Smith County Medical Society Physicians from community / Smith County Medical Society Family Practice residents from UTHCT Family Practice residents from UTHCT Nursing students from UTT and TJC Nursing students from UTT and TJC Texas Medical Rangers Texas Medical Rangers Football and baseball team of TJC Football and baseball team of TJC Volunteer nurses, respiratory therapist, others Volunteer nurses, respiratory therapist, others Hospice of East Texas Hospice of East Texas Durable Medical Equipment from CPS Durable Medical Equipment from CPS UTHCT, TMF and ETMC UTHCT, TMF and ETMC

4. A Brief History of Medical Shelters in Smith County Described by United States Public Health Service as: Described by United States Public Health Service as: Military Field Hospital Military Field Hospital Best Practice Model Best Practice Model

5. A Brief History of Medical Shelters in Smith County Lessons learned Lessons learned Tyler Jr. College is no longer a Medical Shelter Tyler Jr. College is no longer a Medical Shelter Developed a corporate shelter for a nursing home group Developed a corporate shelter for a nursing home group Loss of this site spurred better planning Loss of this site spurred better planning

6. A Brief History of Medical Shelters in Smith County 2008 Gustav and Ike 2008 Gustav and Ike 1 Federal Medical Station 1 Federal Medical Station 4 BCFS church sites 4 BCFS church sites Tyler Jr. College private shelter Tyler Jr. College private shelter University of Texas at Tyler Patriot Center University of Texas at Tyler Patriot Center Hospital evacuees Hospital evacuees

7. A Brief History of Medical Shelters in Smith County

9. Lessons learned Lessons learned Needed stronger shelter facility agreements Needed stronger shelter facility agreements Non-locally operated shelters still make demands on local resources Non-locally operated shelters still make demands on local resources Special item supply caches need to be locally owned Special item supply caches need to be locally owned General population shelters require a high degree of surveillance and response General population shelters require a high degree of surveillance and response Utilize non-clinicians for problem solving Utilize non-clinicians for problem solving Create your own message or others will do it for you Create your own message or others will do it for you

10. A Brief History of Medical Shelters in Smith County

11. Current Planning and Response Local Medical Shelter Locations Local Medical Shelter Locations University of Texas at Tyler Patriot Center University of Texas at Tyler Patriot Center Churches-BCFS Churches-BCFS Tyler Jr. College (private) Tyler Jr. College (private) Hospitals Hospitals Glass Recreation Center-FMS Glass Recreation Center-FMS Closer partnerships with evacuating jurisdictions Closer partnerships with evacuating jurisdictions

12. Current Planning and Response Planning Partners Planning Partners RAC-G Medical Operations Center RAC-G Medical Operations Center University of Texas at Tyler’s Nursing Program University of Texas at Tyler’s Nursing Program City of Tyler and Smith County EMC’s City of Tyler and Smith County EMC’s Northeast Texas Public Health District Northeast Texas Public Health District Hospitals Hospitals Medical Reserve Corps Medical Reserve Corps Texas Medical Brigadee Texas Medical Brigadee

13. Current Planning and Response Current Planning Current Planning Alternate Care Facilities Alternate Care Facilities Medical Operations Center sustainment Medical Operations Center sustainment Preparing for Functional Needs changes Preparing for Functional Needs changes

18. Current Planning and Response Building upon past experience Building upon past experience Grant applications Grant applications Grouping similar patients Grouping similar patients Developing training and exercises Developing training and exercises Funding for volunteer management Funding for volunteer management Reimbursement from/to CDC Foundation Reimbursement from/to CDC Foundation

19. Future Planning and Response Coalition Building Coalition Building H1N1 Lessons H1N1 Lessons Volunteer Involvement Volunteer Involvement Training and Exercising Training and Exercising Comparative Studies Comparative Studies

20. http://www.uttyler.edu/nursing/ msns/index.html http://www.uttyler.edu/nursing/ msns/index.html Deal, B., Alfred, D., Fountain, R., Ford, T., & Chilton, J. (2010). Educational opportunities: A nursing school model for medical special needs sheltering. Nurse Educator. (May-June 2010 Issue). Deal, B. J., Fountain, R.A., Russell-Broaddus, C.A., & Stanley Hermanns, M. (2006). Challenges and opportunities of nursing care in special-needs shelters. Disaster Management Response, 4, 100-105. Missildine, K, Varnell G, Williams J, Grover KH, Ballard N, Stanley- Hermanns M. (2009). Comfort in the eye of the storm: A survey of evacuees with special medical needs. Journal of Emergency Nursing, 35 (6), 515-20. http://www.uttyler.edu/nursing/ msns/index.html