In some incidents, it may be wiser and safer to remain inside. To “shelter-in-place” means to make a shelter out of the place you are in. It is a way to make the building, or a portion of it, as safe as possible to protect your residents and your staff (CDC 2003). The decision to shelter-in-place or evacuate may be mandated or may be determined by the nature of the threat and the amount of time predicted before disaster strikes.
It is unlikely that patients with special needs can be adequately cared for and monitored in hastily prepared shelters, randomly located and with untrained personnel, in the aftermath of a natural disaster. The best care for the frail elderly during such a crisis would be provided by a facility such as a long-term-care facility that already has in place the resources necessary for all aspects of proper care.
For the frail elderly to be sheltered successfully, their logistical, dietary, communications, staffing, and patient physical and psychiatric care needs must be addressed. None of these areas can be dismissed as trivial or unimportant. Whether concerned with the capacity to maintain climate control, nutritional requirements, adequate hydration, or communications in-house and outside, appropriate staffing is crucial in all areas when the safety and health status of the facility’s residents are at stake. This can be applied to other special populations when planning for any large-scale disaster situation.
To ensure adequate staffing to handle the regular population in addition to an influx of new patients, facilities must provide a host of services and benefits for employees as well as for families; everything from food and bedding to legal assistance should be available (Silverman et al. 1995). During crises that overwhelm resources, staffing will fall below desirable levels. To prepare for these contingencies, train all employees and equip them to aid in the basic care (such as feeding) of individuals who require assistance in their activities of daily living (Silverman et al. 1995).
Sheltering-in-place may be the only choice when there is little or no time to warn or evacuate residents and staff. Furthermore, it is the only proper protective action in situations such as a hazardous-materials spill or a tornado warning. Sheltering-in-place can have many advantages, including the following:
§ Immediate protection. Sheltering-in-place involves little time required after the warning, and it is less disruptive to residents.
§ Ideal life-support systems. The facility has food, water, sanitation, medicines, bedding, clean air, communications, and medically prepared surroundings.
§ Less staff burden. Sheltering-in-place requires considerably less emergency staff support than evacuation, without the transportation problems or need for additional security personnel.
MAAs for Evacuation
Establishing mutual-aid agreements, or informal arrangements when appropriate, for the staffing, equipment, and other resources you may need in a disaster will expedite facility response and recovery when disaster strikes.
If you are in a small community, an informal agreement to use a building as a temporary shelter for your facility residents may be sufficient. However, once moved, it is imperative that the residents are not disrupted unnecessarily or forced to encounter multiple moves. Transportation of residents during an evacuation may also be an informal arrangement with staff members, family or friends of residents, or other persons willing to help. It is a good idea to recruit more people and vehicles than you will actually need to ensure a sufficient number when the circumstances require evacuation of residents.
Formal agreements for the deployment or utilization of another jurisdiction’s or political subdivision’s staffing or equipment in an emergency or disaster situation, or MAAs.
To be effective, MAAs should
§ be in writing,
§ be reviewed by legal counsel,
§ be signed by responsible parties from all agencies involved,
§ define liability, and
§ detail the cost involved.
Other Contractual Agreements
Contracts and agreements can be used to ensure the provision of resources or services that go beyond immediate disaster-relief provisions. Contracted agreements should include the costs, estimated time to provide the service, and duration of the service contract. Examples of contracted services include emergency generators, cleanup and debris removal, food and water services, pharmaceutical supplies, medical and surgical supplies, and oxygen and special gases.
A projection of potential disaster resources should include a roster of specific resource providers or vendors, with current telephone numbers and multiple methods of emergency communication with suppliers. To expedite requests, the roster should also include the business name; location; contact name and title; phone, fax, and cell or beeper numbers; order number or item number of supplies most likely to be requested; and other pertinent information.
