Presentation on theme: "Health Surveillance in Shelters"— Presentation transcript:
1 Health Surveillance in Shelters Shelter Surveillance Work GroupJanuary 21, 2014MMRS
2 ObjectivesDescribe how surveillance can be conducted in an emergency shelter to increase situational awareness of disease and illness during disasters.Describe how shelter surveillance has been used in national disasters, such as the response to Hurricane Sandy.Explain protocol and process for conducting surveillance in emergency shelters and gain knowledge in preventing and managing outbreak situations in shelters.Understand how facility-specific environmental health and safety assessments are performed at emergency shelters during disasters.Demonstrate the use of the shelter surveillance forms by reviewing case studies.
3 How do you know when you have a health problem in your shelter?
4 Eric Noji, book editor – The Public Health Consequences of Disasters “Disasters are defined by what they do to people. Otherwise, they are simply interesting geological or meteorological phenomena.”Eric Noji, book editor – The Public Health Consequences of Disasters
5 Public Health Capability – 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.
6 Shelter Syndromic Surveillance – Hurricane Katrina Aug 29, shelters established in GeorgiaData collected:Census dataSymptoms consistent with outbreak potentialChronic conditionsInjuriesMedical referralsSingle day maximum residents - 1,504 persons; average of 122 peopleSource: Advances in Disease Surveillance 2007: 2:148.
7 Hurricane Katrina 13 shelters assessed over a 21-day period Norovirus outbreak in 1 shelterHypertension (33 cases/1,000 resident-days)Diarrhea (9 cases/1,000 resident-days)Cough (9 cases/1,000 resident-days)Skin infections (8 cases/1,000 resident-days)
8 It’s getting closer…Hurricane Sandy NY Response & Shelter SurveillanceMost common reason for visits were follow-up care, mental health and exacerbation of chronic conditionsNJ ResponseField team focused on largest shelters, those expecting to remain open the longest and those with Red Cross Health Services (21 shelters)About 50% presented with acute symptoms; 33% follow-up care
10 What is health surveillance in shelters? Collecting health information on illness and injury to monitor the health of individuals in an emergency shelterGoals:Prevent outbreaks or implement infection control measures at the onset of an outbreakPrevent the spread of communicable diseasesImplement measures to prevent injuries
12 Conducting Health Surveillance Recommended that it starts within 24 hours of shelter activationRequest for assistance can be made to the State Emergency Operations Center (SEOC) Emergency Support Function (ESF) 8 DeskThree forms to assist with surveillance
13 Prevention Measures Triage Encourage hand hygiene and cough etiquette Give symptomatic evacuees with a cough a mask and direct to the Medical Unit or a separate area for registrationEncourage hand hygiene and cough etiquettePlace hand sanitizer by the food, make sure there is soap in the restroomsPlace posters and educational materials in high traffic areas
14 Prevention MeasuresProvide personal protective equipment (e.g. gloves, masks) to shelter workers when in contact with sick residents or in contact with bodily fluids
15 Illness and Outbreaks in a Shelter Signs and symptoms associated with communicable diseases:Vomiting, fever, diarrhea, cough, sore throat, rash, stiff/sore neckWhen illness is suspected:Escort the resident to the Medical Unit or notify the unit and stay with the resident/worker until medical support arrivesCall 911 if it is an emergency
16 Illness and Outbreaks in a Shelter If a resident or worker is suspected to have a communicable disease of concern (e.g. cough with blood) or there are 3 or more residents/workers with similar symptoms within a 24 hour period:Document incident in the Medical Unit Activity Log and the Medical Unit Leader should consult with the Shelter ManagerShelter Manager contacts NH Division of Public Health Services by phone and works with them to implement control measures
17 Guidance for Medical Unit A table from the “Infection Prevention and Control for Shelters During Disasters” is includedProvides recommendations for isolation and contact precautions
18 Infection Control Triage Individual Placement/ Symptoms/SyndromeIsolationPrecautionCategory1Individual Placement/SeparationRequiresmedicalprofessionalassessmentRespiratoryCough, runny nose, watery eyesStandardNoneNoFever (Temp > 100F*) & cough inadultsDropletCohorting;Spatial distancing2YesFever (Temp > 100 F*) & cough inchildrenContactFever (Temp > 100F*), coughwith bloody sputum, and weight lossAirborne3AIIR^ or negativepressure area/room;Diarrhea or VomitingVomitingSocial distancing3Loose or unformed stoolsWatery or explosive stools, with orwithout blood
19 Conducting Health Surveillance FormsNatural Disaster Morbidity Surveillance “Individual Form”Natural Disaster Morbidity Surveillance “Summary Report”Environmental Health Assessment FormForms were developed by the Centers for Disease Control and Prevention
20 Environmental Health Assessment Form Completed each operational period by the municipal Health Officer or other designated Environmental Health Specialist and submitted to the shelter manager for reviewDoes not need to be sent to the SEOC, for local/regional use for environmental assessments
21 Pass out form. Talk through the form, noting each section Pass out form. Talk through the form, noting each section. Address any specific question. Mention that in NH, shelter manager or health officer typically completes form BEFORE shelter opens. Highlight benefits of conducting assessment before opening, and its relationship to infection prevention. Discuss Red Cross variation of using Environmental assessment form, including fact that ARC volunteer may be both shelter manager and running health station.
22 “Individual Form”Completed for each individual that visits the Medical Unit of First Aid Station by the staffConsidered a confidential documentCan be attached or included with the narrative or notes on the patient visitDo not post to WebEOC and do not send to the SEOC
24 “Summary Report”Completed using the information from the “Individual Forms” by the Medical Unit Leader or designeeSubmitted each operational period to the SEOC ESF 8 desk by phone or HAM radioNot a confidential document because it does not contain personal identifiers and is aggregate data
25 Pass out form. Keep description brief- we will return to this after individual case studies.
26 Case Study #1A 29 yo female shows up at the registration desk with red, watery eyes and states that she has some muscle achesShe has 3 children, the youngest is a 9 mo who is breast feeding and has loose stoolsThis person is referred from registration to the medical station
27 Case Study #1 Cont.At the medical station the 29 yo is found to have a semi productive cough and a fever of 100.4F.The 9 mo year old is afebrile and has no other symptoms
28 Questions What type of precautions should be taken for the mom? What type of precautions should be taken for the baby?Where should they be housed within the shelter?What type of education is needed for the family?
29 AnswersThe mom is given a mask to wear and encouraged to call her doctorMake sure the mom has enough diapering supplies for the nightThe family is given their own room to stay inEducate the mom on hand hygiene and cough etiquette
30 Filling out the individual form – 29 year old mom Walk through ALL FIELDS including demographic information, city, etc. Note the star notations and their instructions at bottom of form.
41 Case 3A 68 year old male using portable oxygen arrives at the medical station complaining of a cough and runny noseHe has a productive cough and is short of breath, unable to complete whole sentences
42 QuestionsWhat immediate actions need to be taken with this shelter resident?How should this be documented?Who should be notified about this incident?
43 AnswersThe breathing issue is priority over the infectious disease symptoms, call 911The client is encouraged to sit down and is monitored continuously by medical staff until EMS arrivesThe shelter manager is made aware that 911 has been calledA shelter volunteer is sent to the parking lot to receive EMS and direct responders to the patient
46 Case 4 The first lunch is being served since the shelter opened It is hamburgers and saladThe hamburger is properly cooked, but the lettuce is packagedAbout 48 hours after this lunch, 4 shelter residents start complaining of nausea, vomiting and diarrhea
47 Questions What actions should be taken with the food staff? What actions should be taken in the kitchen/ food prep area?What precautions should be taken for the 4 ill shelter residents?Who should you notify about this incident?
48 AnswersCheck to see if any of the food handlers and ill and if they are, ask them to stop handling and working with foodMake sure workers aren’t touching ready made food with their bare handsMake sure the food prep area is cleaned and proper food handling procedures are being followedSend the 4 residents to the Medical Unit and isolate them into classrooms or a separate area of the shelter; ideally, give them a separate bathroom to use from the general shelter residentsEducate the residents on hand hygieneSince more than 3 shelter residents with similar symptoms in a 24 hour period, the shelter manager calls NH DPHS