SHELTERING ISSUES | Population

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.

Public Shelters

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).

Shelter-in-Place

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. 

DISASTER-RESPONSE ISSUES

Your facility disaster-response plan is vital to the safety and well-being of special-needs residents and staff during and following any emergency or disaster. How you organize and assign responsibility for these functions depends on your staffing pattern, the number of residents under your care, their level of physical mobility, and the size of your facility.

Be sure to address and assign responsibility for each function in terms of a staffing schedule. Adapt procedures to fit your needs—daytime, evening, and nighttime coverage or by alternative shift schedules, according to your facility. When a disaster response is activated, each shift should plan at least six hours ahead so the next shift will be able to continue the work already underway and have the benefit of the information posted on the walls to provide a picture of the most current situation (e.g., number of residents injured, locations of damage, availability of drinking water, etc). It is important to remember that the situation will be changing, and planning must be flexible to adjust to and reflect these changes.

Command Center

The command center should be located in a secure area and have sufficient space to accommodate necessary staff. An alternate site should also be selected as a backup. Communications equipment should include telephones, fax machines, cellular phones, and two-way or ham radios, if available. A status board—white board, flip chart, bulletin board—must be available to track response actions, decisions made, staff schedules, status of facility/resident needs, and other disaster- and facility-specific information. Laptop computers and printers are helpful tools, as long as power is available to operate them. A conference room can easily be converted into a command center with the equipment and supplies prepositioned and stored until needed.

Staffing Priorities

If adequate staff are available, disaster-response activities should be undertaken simultaneously, as appropriate depending on the incident, with staff preassigned their primary responsibility. You may wish to establish a preparedness committee of residents, if their physical condition allows, and include members of this committee in both preparedness and response planning for the facility. Involving interested and capable residents and assigning them responsibilities in planning efforts and organized response functions can greatly enhance your overall capability.

If adequate staff members are not available to undertake response functions simultaneously, those functions should be carried out in the following order:

1. Direction and control Determine who is in charge of the emergency response at the time of the disaster. Evaluate the situation and activate response staff as needed. Activate the command center to coordinate emergency activities.

2. Site security. Check and turn off gas and/or electricity. Make sure the emergency generator is functioning and emergency power is on. Turn off the water supply if pipes are broken or leaking.

3. Fire suppression. Check for fires and suppress small fires. Notify the fire department.

4. Search and rescue. Quickly search the facility for people who may be trapped or injured. Assist if possible. Note and record the situation for other responders, including name and location of those trapped.

5. First aid. Administer first aid to injured persons. Note and record injury for assistance from other responders, including name and location.

6. Damage assessment. Inspect facility. Record damage and report to the command center. Request barricades, off-limits signs, and additional support from security or law enforcement as needed.

Community resources will be overwhelmed in a major disaster, and you could be on your own for a long time. Self-sufficiency is required.

Considerations for Handling Special Populations During a Catastrophic Event

Regardless of the size and type of facility, a catastrophic event that requires an evacuation of clients will challenge facility staff in many ways. By thinking of the worst-case scenarios, safeguards and redundancies can be included in your planning that will make the experience much easier for you, your staff, your clients, and the receiving facility. The following are provided for consideration as you plan to manage clients and provide necessary resources and supplies when evacuating from special-care environments.

Planning should ensure

• proper identification and monitoring of patients or clients once they are relocated;

• mechanisms for patient data transfer to continue regularly scheduled treatments and medications after relocation;

• sufficient number of caregivers to ensure proper care of relocated patients/clients at the receiving facility; and

• sufficient support of staff in stressful conditions with time off for proper rest and time with families. Remember: staff at both the receiving and sending facility may be victims of the disaster, too.

Be aware and plan for lack of services and other problems, such as

• water, sewer, gas, and electrical services;

• supplies such as linens, food, medicine, and water for days;

• creative planning for proper nutrition in lieu of hot meals for several days;

• delivery of meals and provision of services in multistory facilities if elevator not operational;

• assistance for patients who need help with activities of daily living;

• fluid loss in patients and staff due to lack of power, air conditioning and/or heating; and

• communication within the facility and to the outside if phones lines or cell connections are down.

Needs of Pediatric Patients

HRSA reiterates that a host of special anatomical, physiological, and psychological considerations leave children more susceptible to the effects of disasters and acts of terrorism. Planning must consider, but not be limited to, special treatment areas for mass pediatric casualties in hospitals, triage areas, and health centers; development of pediatric response protocols, paying special attention to appropriate medications and dosages; pediatric-specific training and exercise procedures; and provision of psychological support to children and families, including methods to ensure reunification of children with family members, as needed (HRSA 2003).

MITIGATION ISSUES

An all-hazards approach for the domestic and international emergency management framework applies to the threat of terrorism. Better plans, more training, and greater awareness enhance capabilities to manage natural and technological disasters, day-to-day emergencies that may occur, as well as terrorist incidents. A course recently developed for the Federal Emergency Management Agency’s Higher Education Project, “Social Vulnerability Approach to Disasters,” is an excellent tool to help in understanding our vulnerability while suggesting strategies and actions (Enarson et al. 2003).

The course describes structural and nonstructural mitigation strategies. Both provide security measures that may be taken to prevent or reduce loss of life and property from terrorist events and acts of violence. The distinction between structural mitigation techiques and nonstructural mitigation techniques is often made in terms of reducing potential loss (nonstructural) rather than in terms of reducing hazards (structural).

It is relatively easy to provide physical or structural mitigation measures to secure a facility or person by providing guards, iron bars, eleo trified fences, surveillance cameras, and other physical security measures. But these measures are often consuming and are most effective in controlled-access areas; they may be less effective in areas where large numbers of people have access (Enarson et al. 2003).

Nonstructural mitigation measures include training to reduce vulnerability and implementing measures into response plans to reduce the likelihood of losses and to speed recovery. These measures may be easier for public agencies to fund and implement than are physical or structural changes to a building (Enarson et al. 2003). For example, facility staff members who are keenly aware and trained to alert their supervisor or shift leader to anything out of the ordinary—a suspicious package or vehicle, someone in the building without a visitor’s badge—enhance your facility’s safety factor.

Staff skilled in the tools necessary to handle emergency and disaster situations are valuable assets and increase your chances of responding to and recovering from any disaster in a more expedient and timely manner. Training reduces your vulnerability while building capacity and confidence among your facility team players. If residents are competent and willing to help with disaster management and facility security, they can be trained as well. This type of cooperative effort and vested interest in the mutual safety and security of your facility is wise and cost effective. Its benefits are immeasurable in terms of your facility’s greatest asset—human resources—and personal self-sufficiency and pride.

In keeping with all-hazards, or “dual purpose,” emergency management planning, it is significant to note that terrorism is not the only form of violence common to institutions, workplaces, and all aspects of American society. The primary justification for preparedness is to ensure the readiness of your facility for the potential unknown that may be faced at any time. In addition to terrorism, Americans daily face threats of criminal (physical and sexual), domestic (spouse, family, or other intimates), and other common types of violence (Enarson et al. 2003).

These same threats of violence are present in healthcare facilities and patient care environments. The size and nature of the facility, number of residents and staff, physical location, population and demographics of the area, and many other factors may determine the amount of security measures implemented. Many mitigation actions that reduce vulnerability to all types of violence can be accomplished at little or no cost.