Disaster Health and Sheltering Part I: Independent Study National Student Nurse Program Narration by: Janice Springer, Red Cross Disaster Health Services Advisor Cheryl Schmidt, Red Cross Nursing Education Subject Matter Expert

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Red Cross Principles Humanity Impartiality Neutrality Independence Voluntary service Unity Universality

Red Cross Nursing: Our Legacy and Future

Mississippi Flood Response, Courtesy of American Red Cross, May 2011

6 Red Cross Shelters

Joplin Missouri Tornado Response, Courtesy of American Red Cross, May 2011

PANDEMIC RESPONSE 8

Course Purpose To familiarize student nurses with Red Cross Disaster Health Services through Disaster Health and Sheltering, promoting volunteerism and community preparedness and post disaster resiliency. 9

Representing the Red Cross To each individual with whom you come in contact, you are the Red Cross! 10

Personal Preparedness You might be better prepared to help in your community if you have your own preparedness plan. STOP and take a minute to review some of the must haves in personal preparedness, both for your family and in your workplace.personal preparedness

What’s In YOUR Go Bag?

Role of Disaster Health Services  Provides health assessments, treatment, and referrals as needed to people affected by disasters.  Coordinates with local public health authorities and local medical, nursing and other health resources. 13

In Certain Instances: Disaster Health Services may supplement existing service delivery systems for community health care. 14

Disaster Health Services Competencies 15  Critical thinking  Assessment  Technical skills  Illness and disease management  Information and healthcare technologies  Ethical behavior  Character based on values  Confidentiality

Client Commitments for Disaster Health Services 16  Respect confidentiality  Accommodate diverse needs  Follow Disaster Health Services Guidance  Make effective referrals  Identify and prevent potential health problems  Maintain ethics  Document accurately and appropriately  Work as a team  Involve community partners  Use resources wisely

Individual Injury and Illness: Sudden Onset HS Workers Assess and Treat/Refer Clients most often for:  Bone, muscle, and joint injuries  Respiratory distress  Lacerations and puncture wounds  Exposure to extreme weather conditions  Rashes  Burns 17

What HS Workers Assess and Treat/Refer (cont.) Stress-related Symptoms  Fluctuation in normal vital signs  Gastrointestinal upset  Headache  Labor can begin earlier than expected  Irritability  Exhaustion  Presenting symptoms may vary  Malaise  Pain 18

Mini-Case #1 What will you be considering for care of this client and her family? 19

Mini-Case Study #2 One shelter couple has slept pretty much continuously for 3 days. You are concerned as the shelter nurse, as is the Disaster Mental Health worker. As the couple gets up on the 4 th day, both of them have respiratory viral infections. Both Disaster Health Services and Mental Health reach out to them and help them move to a better sleep/exercise schedule. What are your concerns related to this ongoing for 3 days? 20

Mini Case answers Concerns include: depression overwhelmed exhausted at risk for pneumonia blood clots dehydration 21

More disaster-related client needs… Aggravation of Chronic Health Conditions  Hypertension  Cardiac problems  Respiratory problems (e.g., asthma)  Gastrointestinal problems  Diabetes  Allergies  Mental health changes 22

What HS Workers Do...  Screen and assess clients to meet access/functional needs.  Care for disaster-related or -aggravated injuries or illnesses.  Assist to provide durable medical equipment, consumable medical supplies, personal care assistance for health maintenance.  Provide casework for disaster related health needs, to include fiscal assistance for health and/or medical needs.  Replace immediate-need prescriptions.  Replace essential eyeglasses, prosthetic devices, hearing aids and other equipment lost as a result of the disaster.  Provide referrals to community health agencies. 23

What HS Workers Do (cont.)  Determine whether the condition or loss of DME is disaster- related and to what extent client resources are available for immediate needs.  Use other available resources first before Red Cross donated dollars are spent. 24

Client Interview Sample Questions for Replacement Assessment:  What happened to the glasses, medication, equipment?  Is the loss or need disaster-related?  Does the client need help with replacement?  Is third-party coverage available?  Who is the health care provider who ordinarily cares for the client? (Is there a prescription?) 25

Who are Red Cross Clients? All members of the affected community, which include: Non-English speaking Persons with Disabilities Clients who come with or without care-givers Affluent communities Culturally diverse communities ** Disaster Health Services may also care for Red Cross workers when Staff Wellness volunteers are not available 26

Where HS Workers Are  Integrated Care Teams (for condolence or in-patient visits)  Emergency Aid Stations  Outreach  Community Settings (e.g., bulk distribution sites, Service Centers)  Home Visits 27

Other HS assignment settings (cont’d)  Emergency Operations Center (EOC) Liaison  Aviation and Transportation Disaster support  Repatriation Team 28

HALFWAY THERE!

Sheltering  Short term housing with sites determined by a pre- disaster shelter survey tool  Sites frequently in churches, schools  Shelter becomes a disaster community where individuals/families/groups receive mass care services (e.g., eating, sleeping shelter) as well as disaster health and mental health services  Accommodation made to meet needs of persons with disabilities and/or access and functional needs  Partnerships between the local Health Department and Disaster Health Services is key 30

Add another photo here 31

Possible answers: (These are a few of many possible.) A tent only provides minimal protection from the environment (think temperature, incoming storms, etc.). Rain/mud may impact mobility-restricted clients from access to restroom facilities. Tents can be confining. Often have no floors in the tent. Accessibility is a concern for individuals with functional limitations. 33

Shelter Considerations for Disaster Health Services  Registration: Assessment for vulnerabilities or need for extra health or mental health support  Dormitory set-up and its impact on families, persons who will need extra care, bathroom proximity  Communicable disease management  What other things come to mind??? 33

Identifying client needs Begins at Registration –Staff makes two observations and asks two questions Observations for 1. Ability to proceed with registration-medically or behaviorally incapable of proceeding 2. Support needs-do they use a wheel chair, have a service animal or need hearing support.

Two questions: Is there anything you or a member of your family needs right now to stay healthy while in the shelter? Yes / No If NO, is there anything you will need in the next 6-8 hours? Yes / No Do you/family member have a health, mental health, disability, or other condition about which you are concerned? Yes / No

Process Steps Cot-to-Cot methodology CMIST as a framework for assessment Includes principles of surveillance

CMIST CMIST is an acronym that describes a system to help identify access and functional needs of clients in shelters. C = Communication M = Maintaining Health I = Independence S = Services, Support and Self-Determination T = Transportation

Communication Need: Action:

Maintaining Health Need Action

INDEPENDENCE NeedAction

Services, Support and Self-Determination Need: Action:

Transportation Need:Action:

Follow through Actions:  No needs identified  Contact Shelter Manager  Contact Disaster Mental Health Services  Agency, please provide agency name ___________________________________________________________  Other_________________________________________________________ _______________________________________________________________ Follow-up/Resolution/date___________________________________________ _______________________________________________________________ Disaster Health Services print name/signature/date______________________________________

Cot to Cot Proceed with a systematic plan to meet each family within a reasonable time frame. –The ideal time frame is 6-8 hours, however, due to immediate needs, it may take a full 24 hours to begin to “know” your shelter community. –In a shelter of large population, consider assigning “neighborhoods” or sections for client support. –Illness and injury reports use a Client Health Record. Functional support, such as communication, can be documented on the CMIST job form which is kept by Disaster Health Services.

Case study A shelter has been opened in a community that has just experienced a flood. Over 80% of the homes and businesses in the downtown area have been affected. You are currently assigned to work at the registration desk of the shelter to assist in interviewing and registering community members as they enter the building. Mr. Jones, a single male who lives independently in the community, enters the shelter. He uses a wheelchair for mobility and has great difficulty hearing. In interviewing Mr. Jones, you learn that he has to catheterize himself to empty his bladder and requires dialysis twice a week at a local facility unaffected by the flood.

Mr. Jones  What are your immediate concerns as a nurse?  What are his risk factors?  What are his equipment needs?  Will he have transportation needs?  Can he be safely accommodated in this shelter?

CMIST model and Mr. Jones Communication---he is hard of hearing Medical—health needs include catheterization –Behavioral Health—does he have risk factors?? Independence-what is he going to need to remain independent? Perhaps a care-giver? –Mobility—will he need help inside the shelter with w/c? Supervision—will he be able to self-cath in this setting? Transportation—how will he get to dialysis?

Behavioral health situations that might require higher level of care Clients with serious symptoms, e.g., acute anxiety or severe depression symptoms, clients who are disruptive to other residents Client disclosure of psychiatric condition or past experience that would make staying in the shelter unsustainable Clients experiencing significant distress due to the shelter environment, even after accommodations have been made (e.g., increased staffing, medications management) Active use of illegal drugs or alcohol in the shelter, which is against Red Cross sheltering policy 50

Prioritizing and Triage In a shelter that opens immediately after a disaster, you may need to prioritize clients and determine who needs care first, and who may need referral to either the emergency room or to a medical clinic. In a shelter that opens pre-landfall, you may have different levels of urgency but may still need to prioritize needs. Link here to learn more about principles of triage

Integrated Community Health Response: PARTNERSHIPS  Red Cross Disaster Health Services  Local Public Health Department  Local clinics and agencies  Agency on Aging/AARP  Veterans Administration  Local hospitals  Advocacy groups  Schools/Universities  Hospice/Home Health agencies  Voluntary Organizations Active in Disaster (VOAD) 52

YOUR Community Partners

Disaster HS Guidelines 54

Case Study You have been assigned to a shelter with a capacity to house 750 residents. A 13-year-old teenager, accompanied by her mother, arrives at the Health Services area complaining of itching, headache, poor appetite, and cold-like symptoms. Upon assessment, you find that her temperature is 102 o F and her back looks like this photo. Photo permission from DERMNZ, 2011) 55

Case Review  What communicable disease do you suspect?  Does anyone need to be notified?  What are the immediate actions that need to take place inside the shelter?  Possible alternatives to sheltering? 56

Documenting in Disaster Health Services Client Health Record Initial Intake Screening form Aggregate Morbidity (Surveillance) Client Assistance Memorandum--a referral form for internal partners Release of Confidential Information CMIST job guide 57

HS Work is a Public Health Wheel FIT 58

Surveillance A systematic : Way to assure early identification of illness or outbreaks Process to capture illness and injury patterns over longer time and multiple disaster to look for patterns and trends, A way to monitor the categories of CMIST over the length of the shelter operations.

Course Summary  Public Health Nursing involves assessment and care of individuals, families and communities.  HS response in Red Cross shelters is based in public health nursing.  Connect with your local Red Cross Chapter if you are interested in making a disaster response difference in your community. 60

Where can I go from here? Take classes (mixture of required and recommended):  Shelter Operations and Shelter Simulation  Mass Care  CPR (Professional) and First Aid (often free to volunteers)  Health Services Response Workshop—core course for HS activity  Psychological First Aid  Client Casework: Providing Emergency Assistance 61

Questions about nursing in the American Red Cross? Find your State Nurse Liaison: files/Documents/pdf/Nursing/State_Nurse_ Liaisons.pdf Find your local Chapter: Input your zip code in the top right-hand corner 62

Red Cross Nursing: A future opportunity. 63