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SPECIAL NEEDS SHELTERING STANDARD OPERATING GUIDE FOR LOCAL AND COUNTY LEVEL EMERGENCY MANAGEMENT November 2009 Developed by the Missouri Department of Health and Senior Services Center for Emergency Response and Terrorism Table of Contents Page I. Special Needs Shelters .............................................................................................................. 3 A. Definition ............................................................................................................. 3 B. Limitations of Special Needs Shelter ................................................................... 4 C. Triage ................................................................................................................ 4 D. Levels of Care ..................................................................................................... 6 E. Supportive Care .................................................................................................. 6 II. Staffing Recommendations......................................................................................................... 8 A. Staffing Levels ................................................................................................... 8 B. Staffing Guidelines .............................................................................................. 9 C. Suggested Initial Staffing Levels ......................................................................... 9 D. Other Recommended Staff ................................................................................ 10 III. Staff Duties and Responsibilities............................................................................................ 10 A. ESF-8 Coordinator ............................................................................................ 10 B. Medical Director ................................................................................................ 11 C. Nurse Manager – Supervisor............................................................................. 11 D. Nursing Staff ..................................................................................................... 12 E. Caregiver .......................................................................................................... 13 F. Respiratory Therapist ........................................................................................ 13 G. Physical and Occupational Therapists ............................................................... 13 H. Mental Health Staff............................................................................................ 13 I. Support Staff ..................................................................................................... 14 J. On-Site Volunteers ............................................................................................ 17 IV. Activation of Special Needs ................................................................................................... 17 A. Concept of Operations ...................................................................................... 17 B. Alert and Notification ......................................................................................... 18 C. Opening the Special Need Shelter .................................................................... 19 D. Walk Through and Survey the Facility .............................................................. 19 E. Physical Plant Requirements............................................................................. 19 F. Accessibility Standards ..................................................................................... 19 G. Securing the Facility ......................................................................................... 20 H. Set-up of Special Need Shelter Stations and Signs ........................................... 20 I. Registration Information Area ............................................................................ 20 J. Triage Area ....................................................................................................... 21 K. Nurses Station/Office Area ................................................................................ 21 L. Temporary Morgue Area ................................................................................... 21 M. Staff Sleeping Area ........................................................................................... 22 N. Arrival of Staff ................................................................................................... 22 O. Arrival of Volunteers .......................................................................................... 22 P. Arrival of Supplies ............................................................................................. 23 Q. Disbursement of Supplies ................................................................................. 23 R. Arrival of Visitors ............................................................................................... 23 S. Feeding Responsibilities ................................................................................... 23 T. Admission Process............................................................................................ 24 U. Maintenance Activities ...................................................................................... 25 V. Shelter Deactivation ....................................................................................................... 25 VI. Mitigation......................................................................................................................... 27 Attachments ............................................................................................................................... 28-45 Attachment 1 – Levels of Care for Special Needs Shelter Attachment 2 – Special Needs Sheltering Table of Organization Chart Attachment 3 – Public Health Volunteer Interview Form Attachment 4 – ARC 6564 Shelter Facility Survey Attachment 5 – Sheltering Space and Floor Plan Considerations Attachment 6 – Interior Signs Attachment 7 – ARC Intake Form Attachment 8 – Special Needs Shelter Volunteer Registration Form Attachment 9 – Suggested Supply List for Special Needs Shelters Attachment 10 – Flow of Shelterees in the SN Shelter Attachment 11 – Example of Color Coding SN Clients Per Care Category Attachment 12 – Special Needs Shelter Operation, Daily Situation Report Attachment 13 – Disaster Registration Log Attachment 14 – Acronyms SN Shelter SOG 2 November 2009 I. SPECIAL NEEDS SHELTERS A. Definition Special Needs (SN) Shelters are recognized as short-term shelters of last resort for those persons who are unable to stay in their homes post disaster with conditions that by definition can be supported in a SN Shelter. These individuals cannot make other provisions to have their needs met during an evacuation or displacement due to a disaster, whether natural or man-made. The level of services and care provided in SN Shelters are meant to sustain the health and well being of individuals with special needs during the response and recovery phases of a disaster and are not intended to provide acute and/or invasive care. Most shelters should be closed within seven to ten days of the start of the disaster recovery phase. SN Shelter occupancy will vary, depending on a variety of factors, and individuals with personal and/or medical special needs may be transferred into and out of a shelter as medical conditions, diagnoses, shelter capabilities and staff skill levels vary. SN Shelters are designed to care for individuals who need personal and/or medical assistance, such as: 1. Persons dependent on others or in need of others for routine care (eating, walking, toileting, etc.) and unaccompanied minors or children lacking protection less than 18 years of age. 2. Persons with physical, sensory, psychiatric, cognitive or developmental disabilities. 3. Persons requiring assistance with medical care administration, monitoring by a nurse, dependent on equipment (including dialysis), assistance with medications, and mental health disorders. 4. People with contagious health conditions that require precautions or isolation that cannot be handled in a general population shelter. Family members and caregivers accompanying the individual with personal and/or medical special needs should be accommodated per American Red Cross (ARC) Mass Care guidelines. Individuals who can be cared for by a family member are NOT automatically candidates for a SN Shelter. While they should be identified as possible potential occupants of a SN Shelter, they may be able to remain in the general population with support. A SN shelter may be co-located with an ARC or ARC-affiliated general population shelter, but there will be situations where stand-alone SN shelters may be opened. The staffing, management, and operation of a SN shelter are the responsibility of the local jurisdiction and are a shared responsibility amongst the local government, public health, health care and emergency management agencies, unless otherwise defined in the LEOP. Specific, clear delineation of duties and responsibilities with regard to SN SN Shelter SOG 3 November 2009 shelters needs to be pre-determined by local agencies and clearly stated in the local LEOP. Regional discussions concerning SN sheltering need to be initiated and appropriate mutual aid agreements put into place. Any gaps in service, including the service requirements necessary to meet surge capacity needs must be filled by establishing contracts and MOUs with other local and regional entities. In the event that emergency events overwhelm local/regional capacities to support SN sheltering, the jurisdiction would then contact the State Emergency Management Agency (SEMA) for assistance through the State Emergency Operations Plan (SEOP). Through the SEOP, the Missouri Department of Health and Senior Services (DHSS) is the state agency charged with coordinating the provision of services for the medical and personal care components of the SN shelters. The SEOP also charges the Missouri Department of Social Services (DSS) with coordination of the typical shelter support services common to both general population shelters and SN shelters. Local jurisdictions must be prepared for potentially long timeframes for DHSS and DSS to muster and move additional resources to local jurisdictions in support of SN shelters. B. Limitations of SN Shelters 1. Type of Facility: SN Shelters usually operate in school buildings, churches, or other community buildings. They are not equipped as medical care facilities. Some of the facilities may have some form of emergency power generation, although it may be limited or have none at all. Some may have some form of bedding that includes cots, while others require clients with special needs to bring their own if possible. 2. Staffing Limitations: Staffing is dependent on volunteerism of community health care providers. Many times, hospitals and home health care agencies cannot or will not assign staff to the shelters. 3. Expertise of Staff Providing Care: Staff who may be unfamiliar with the medical conditions, or the individual needs of the clients with special needs, and may lack the currency in skill requirements are left to care for persons who may experience increases in medical acuity and confusion due to transfer trauma. 4. Safety: Safety of clients with special needs and staff cannot be assured. The integrity of the building and the safety of performing some of the required medical procedures may be jeopardized in uncontrolled situations (e.g., peritoneal dialysis, oxygen therapy, etc) or without the required medical expertise. 5. Lack of Available Supplies: Persons with special needs do not always bring needed supplies with them and the ability to access from community during an emergency is limited. SN Shelter SOG 4 November 2009 C. Triage 1. Category 1 - Special Needs Shelterees Shelterees appropriate for placement in the SN Shelter should be ambulatory (with or without assisting devices, or independent in the use of assisting devices), may include a chronic medical problem, and may be accompanied by a caregiver. Level 1 - Shelterees dependent on others or in need of assistance by others for routine care (e.g. eating, walking, toileting, etc.) Level II - Shelterees needing assistance with medical care administration, monitoring by a nurse, dependent on electrical equipment, and/or assistance with medications. Shelteree who can safely sleep on a cot or mat. Shelterees with the following medical stable or non-complicated medical problems: Foley catheter maintenance Diabetes Medication maintenance (shelteree brings own supplies) Blood pressure monitoring Severe arthritis Naso-gastric or gastrostomy tubes (home maintenance) Ostomy shelterees Alzheimer's Disease Stable stroke cases Stable cardiac cases Stable cancer cases Stable oxygen and nebulizer therapy shelteree (e.g. COPD, Asthma) Dressings (must have nursing care plan and supplies) Hospice shelterees if no conditions listed in Category II Bedridden and total care shelterees will be accepted only if they are accompanied and cared for by a responsible caregiver and do not require a hospital bed 2. Category II – In-Hospital Shelterees Level III - Shelterees with the following conditions require more complex care than is available in the SN Shelter. Other arrangements need to be in place with their physician for admission to a hospital or nursing facility. It is advisable that the health SN Shelter SOG 5 November 2009 director discusses with area hospitals their capability to accept persons who cannot be admitted to the SN Shelter well in advance of a disaster. Infusion (IV) therapy Complex sterile dressing changes Hyperalimentation Oxygen dependent, medically complex End-stage, unstable non-DNR shelterees Level IV - These shelterees cannot be accommodated who need: IV chemotherapy Ventilator care Peritoneal dialysis Hemodialysis Life support equipment Hospital bed and total care Any person arriving at the SN Shelter by ambulance must be sent to an appropriate medical facility. 3. Category III - Shelterees for SN Shelter Shelterees with the following conditions may go to a SN Shelter: Blind Hearing impaired Amputee Any minor medical condition not listed D. Levels of Care Nurses and shelter staff will be available to provide basic supportive care to shelterees. The level of care to be provided is limited to the shelter staff's training, qualifications and scope of practice. (See Attachment 1 -- Levels of Care for Special Needs Shelters.) E. Supportive Care The following basic supportive care will be provided to shelterees seeking refuge in SN Shelters. 1. Triage - as listed in C. above: Initial assessment determines if placement in SN Shelter is appropriate. If the shelteree is to stay in the shelter, a history should be taken to include caregiver abilities, SN Shelter SOG 6 November 2009 name of physician, major health problems, allergies, and vital signs as baseline and location of placement in facility. 2. Shelteree Comfort: Shelterees are instructed to bring their caregiver (who will remain with them) and all of their own supplies. If they do not, the shelteree needs to be informed that this is a basic setting and that supplies are limited. (Identify where supplies can be obtained in your community – Request through LEOC/SEOC if local resources depleted.) 3. Activities of Daily Living (ADLs): The shelteree's caregiver should assume primary responsibility for assisting the shelteree to the bathroom, with meals, and care. The SN Shelter staff is available to provide additional assistance, only if needed. 4. Procedures: Shelterees and/or their caregivers must provide their own supplies (limited supplies are available in shelter) and assume responsibility for managing their own care for any procedures that they have been managing in the home setting. The SN Shelter nurse will provide supervision and additional assistance only if needed and as per protocol. 5. Medications: Shelteree or caregiver assumes responsibility for administering routine medications as in the home setting. The SN Shelter nurse may assist the shelteree if needed or administer medications as per protocol. (If a person's supply of medication is completely consumed during the course of a disaster, the on-call physician may prescribe a new supply.) 6. Oxygen: Shelteree or caregiver assumes responsibility for managing oxygen and equipment. Oxygen supply representatives or respiratory therapist, respiratory technician, EMT or experienced RN or LPN who are present will assist as needed. Those requiring 24-hour oxygen and/or who are electric dependent, should be evaluated for transfer to a skilled health care facility. Clients utilizing oxygen concentrators are encouraged to bring their equipment with them for use while electrical power is available. Whenever possible, concentrator patients should have battery backup and provide a small tank in case of power failure or switch to portable oxygen tanks for the duration of the shelter period. (Local oxygen providers should be identified and notified immediately upon opening a SN Shelter.) 7. Safety: Nurses assigned to SN Shelter are operating in an emergency situation and should exercise reasonable care and SN Shelter SOG 7 November 2009 judgment to assure shelteree safety. The following conditions and precautions are to be kept in mind when operating in a SN Shelter: a. Universal precautions and body substance isolation precautions are to be utilized. b. Smoking is not allowed. c. Caregivers are required to accompany shelterees and to assure responsibility for their care. d. Only limited numbers of folding cots and blankets are available in the SN Shelter. The cots may be hazardous for mobility and may not be suitable for shelterees who have diabilities. (Identify areas specialized cots be obtained if not available through ARC. Identify Special Needs Caches in your region. Request through LEOC/SEOC) II. STAFFING RECOMMENDATIONS The staff-to-shelteree with special needs ratios are recommended only as a general guidance for planning purposes and should not be construed as a minimum mandatory requirement. The following ratios were based in part on regulations for licensure of nursing homes and assisted living facilities under non- emergency conditions and do not reflect a standard evolved from actual disaster/emergency experience. Furthermore, these ratios do not imply or guarantee that any jurisdiction has the available personnel resources, either employed or voluntary, to be able to staff SN Shelters at the recommended levels. The population in the SN Shelter may justify an increase or decrease in the type and number of staff present. A. Staffing Levels 1. A licensed physician should be available for medical consultation by phone or in person through the SN Shelter operations. As soon as possible, but at a minimum of 72 hours of continued shelter operations, and every 24 hours thereafter, the physician should evaluate the persons with special needs and approve standard nursing protocols for the SN Shelter staff. It is recommended that a psychiatrist be designated on call for medication consultation to the shelter physician. 2. Each SN Shelter should be under the supervision of an on-site licensed registered nurse at all times. 3. Experienced caregivers including certified nurse assistants, personal care attendants, nursing aides, home health aides, companions, EMTs, physical and occupational therapists, medical or nursing students and orderlies may assist in providing care under the supervision of an RN. SN Shelter SOG 8 November 2009 4. At least one person currently trained in CPR should be within the shelter at all times, and it is recommended to have two persons if possible. 5. On-site recruitment of shelter residents/patients from the general shelter as volunteers to assist with non-specialized tasks in the shelter is encouraged; however, a designated RN shall supervise them at all times. The staffing pattern should be adjusted based on the actual numbers and needs of individuals with special needs in the shelter. SN Shelter nursing and staff members should not be scheduled to work for more than 12 consecutive hours in a 24-hour period. Medical/health professionals should only perform those duties consistent with their level of expertise and only according to their professional licensure and local protocols. B. Staffing Guidelines Realistic staffing guidelines should be in place to permit staff rotation out of the shelter, obtaining staffing assistance from a volunteer pool and identifying other shelter management needs. All SN Shelters should: 1. Establish a command and control standard. 2. Establish guidelines for SN Shelter staffing and team composition. 3. Establish recommended staffing guidelines and staffing team composition by shelter type and acuity of individuals with personal and/or medical special needs (i.e., number of staff per 25 patients). (See General Guidelines on Recommended Staffing for Special Needs Shelters listed below.) 4. Establish staffing guidelines for provision of services to individuals needing assistance with activities of daily living. 5. Identify staffing resources (public, private, schools of medicine, volunteer, federal). 6. Develop a deployment template that recommends mobilization, rotation and demobilization protocols. 7. Establish regional/local mutual aid agreements with schools of medicine for medically trained personnel to staff shelters. 8. Develop Memorandums for Understanding (MOUs) between like facilities regarding staffing and resident/patient support issues. (DHSS will grant waivers to in-home, home health and hospice agencies to serve patients located in counties contiguous to their approved service area. This waiver does not need to be obtained prior to responding to an emergency event.) SN Shelter SOG 9 November 2009 C. Suggested Initial Staffing Levels The table summarizes recommended initial medical and mental health staffing levels for providing care within SN Shelters. After an assessment of the specific needs of the particular shelter, these staffing levels may be modified. DAY NIGHT 1 RN Manager 1 RN Manager 1 RN/LPN per 25 shelterees 1 RN/LPN per 40 shelterees 1 Caregiver per 15 shelterees 1 Caregiver per 15 shelterees 1 Mental Health Worker per 75 1 Mental Health Worker per 75 shelterees shelterees/late night may have a person on call One additional person per shift should be designated as the supply clerk for medical supplies. D. Other Recommended Staff 1. It is recommended that at least one hospice liaison capable of advocating for hospice clients should be present in the SN Shelter, if needed. 2. At least one person familiar with the management of oxygen therapy is also recommended, if available. This person could be a respiratory therapist, oxygen company representative, RN, LPN, or respiratory therapy technician to handle all respiratory problems and adjust and monitor the oxygen. 3. Physical and occupational therapists may be needed to assist with transfer assistance, etc or if the shelter is open for an extended period of time. III. STAFF DUTIES AND RESPONSIBILITIES (See Attachment 2 - SN Sheltering Table of Organization Chart) A. Essential Support Function (ESF)-8 Coordinator (if available) A DHSS or LPHA designee assigned to the LEOC is the LEOC ESF-8 Coordinator (Health and Medical Coordinator) and is the contact point for the Nurse Manager of each SN Shelter. The ESF-8 Coordinator, if available, is responsible for the administration and oversight of the program. Duties include, but are not limited to: 1. Notifying home health agencies of impending events, status of event, and activation of SN Shelter staffing. 2. Notifying and assigning the Nurse Managers, home health agency staff members and volunteers to each SN Shelter when activated. SN Shelter SOG 10 November 2009 3. Acting as liaison for the Medical Director and the LEOC. 4. Procuring information on the health care status of the shelterees when requested by the LEOC. 5. Providing advice and support to the Nurse Managers. 6. Arranging for all necessary medical supplies that are not currently available at the SN Shelter. 7. Coordinating alternate sheltering arrangements for shelterees whose medical treatment exceeds the care limits of a SN Shelter. 8. Supervising the preparation of the requests for medications and supplies, which are required for the health care of the SN Shelter shelterees, through the LEOC. B. Medical Director The LPHA county physician or designee is professionally responsible and will help coordinate health/medical services provided in the SN Shelter. Duties include, but are not limited to: 1. Approving standard nursing protocols for the SN Shelter staff. 2. Approving all extraordinary medical procedures performed at the SN Shelter. 3. Providing diagnosis and treatment orders for acute illnesses that occur among shelterees of the SN Shelter, when attempts by nursing staff to contact the primary care physician are unsuccessful. 4. Consulting with the ESF-8 Coordinator or designee at the LEOC and/or Nurse Manager in the SN Shelter on shelteree care problems when required and attempt to provide resolution of these problems. 5. Arranging professional contact to each SN Shelter within 24 hours and each 24-hour period thereafter if possible to assess medical problems at the SN Shelter. C. Nurse Manager – Supervisor One Registered Nurse should be available 24-hours per day in each SN Shelter and provide oversight of all nursing services. The nurse should perform only those activities consistent with his or her level of practice expertise and only in accordance with his or her professional practice act and local protocols. Duties include, but are not limited to: 1. Overseeing the operation of the SN Shelter, including the opening and closing procedures, selection of treatment areas, the SN Shelter SOG 11 November 2009 disbursement of supplies, and the provision of information to the ESF-8 Coordinator or designee in the LEOC. 2. Becoming familiar with the building to be used, its size, facilities, layout and supplies available. 3. Assuring the food preparation, handling, distribution, and feeding of all SN Shelter shelterees, staff and family members. 4. Triaging all individuals brought to the SN Shelter who have health and medical problems to determine their most appropriate placement. 5. Referring individuals to skilled nursing facilities if necessary and working through the ESF-8 Coordinator or EMD in the LEOC to procure this placement. 6. Assessing the health care needs of the SN Shelter shelterees who are not acutely ill and ensuring implementation of the orders by the nursing staff. 7. Supervising the health care delivery services of the nursing staff. 8. Ensuring that approved protocols are utilized by nursing staff. 9. Ensuring that all CNAs (Certified Nursing Assistants) and support staff have appropriate supervision by an RN. 10. Providing administrative and logistical support to the nursing staff. 11. Preparing supply orders for medications and assuring proper utilization of all supplies. 12. Monitoring potential for infectious disease transmission. 13. Evaluating SN Shelter staff for signs, symptoms of stress reaction and poor coping. 14. Providing updates and requests for assistance to the ESF-8 or designee at the LEOC. (Note: A separate shelter manager and not necessarily the Nurse Manager may perform some of the above duties.) D. Nursing Staff The nursing staff includes hospital, home health agency and volunteer RNs/LPNs. The nursing staff delivers appropriate medical services within the SN Shelter under the supervision of the Nurse Manager. Duties include, but are not limited to: 1. Supervising and assisting in the administration of medications to the shelterees. 2. Assessing the physical condition of the shelterees on an on-going basis. 3. Maintaining the shelteree's medical update form and advising the Nurse Manager of any adverse change in the condition of a shelteree. 4. Monitoring those shelterees who are receiving oxygen - making referral to oxygen respiratory therapist if problems occur. SN Shelter SOG 12 November 2009 5. Delivering care and assistance to shelterees as required following approved protocols. 6. Determining if the people meet the SN Shelter admission criteria. 7. Sending people who do not meet the SN Shelter admission criteria to the general shelter (Nurse Manager to arrange transfer to nursing home or hospital as appropriate). 8. Determining what items are needed. If necessary, sends for the designated RN to help resolve the problem. 9. Referring to shelter physician and/or EMS if someone needs immediate medical attention. 10. Determining in which area of the SN Shelter individuals should be placed . 11. Maintaining universal precautions and infection control. 12. Determining discharge process. E. Caregiver The Caregiver may be CNAs, home health agency employees, nursing students, EMTs, orderlies, personal care attendants, significant others, family members, and/or daily companions working under the supervision of the nursing staff. Duties include, but are not limited to: 1. Assisting the shelteree with mobility impairments in ambulation and transfer. 2. Assisting the nursing staff as required. 3. Keeping the shelterees as calm as possible. 4. Monitoring shelteree conditions for changes and immediately reporting to the nursing staff. 5. Working within license or certification, or skills and abilities. 6. Following directions of licensed staff person in charge. 7. Reporting particular needs of shelterees. 8. Assisting shelterees to get settled in their space and answering questions regarding location of bathroom, etc. 9. Assisting in ambulating, toileting, transfers, and personal hygiene. 10. Keeping shelterees aware of time and inquire if assistance is needed with self-administered medications and treatments - informing a licensed nurse if help is needed. 11. Providing diversional activities, conversation, etc. 12. Assisting in acquiring food and/or feeding as needed. 13. Assisting in keeping area clean and free of trash. 14. Maintaining universal precautions and infection control. F. Respiratory Therapist (if available) Assist shelterees with oxygen equipment. The therapist in collaboration with the nursing staff should perform adjustments to oxygen flow rate SN Shelter SOG 13 November 2009 (prescribed by physician), and observations and evaluation of oxygen therapy. G. Physical and Occupational Therapists (if available) Assist with transfer assistance, etc or if the shelter is open for an extended period of time, provide physical therapy to individuals who have the need for these services. H. Mental Health Staff (if available) Duties include, but are not limited to: 1. Making rounds watching for signs of agitation, depression, confusion, etc. and responding to alleviate potential problems. 2. Assisting the staff in promoting diversions and activities, conversation, time orientation, etc. 3. Working with the shelterees who are experiencing mental health problems and guiding the staff as to how to be most therapeutic in the situation. 4. Reporting problems and potential problems that may need other intervention to the Shelter Operations Manager. 5. Planning for debriefing staff (paid and volunteer) before they leave the shelter. 6. Determining the efficacy of holding a debriefing session a week or two after the evacuation experience. 7. Working with both shelterees and staff. (If a shelteree or shelter staff member exhibits signs of behavior problems or stress, immediately request mental health staff through the LEOC/SEOC if not available.) I. Support Staff The following support staff will be available through the general population shelter managed by the ARC whenever a SN Shelter is co-located with a general population shelter, however, if the SN Shelter is set up separately, these support staff will be required. 1. Registrar Ensures that all shelter occupants (shelterees and staff) and family members are registered upon arrival. Maintains a system for checking occupants in and out when they leave for any period of time. Manages the system of record keeping for shelter registration. SN Shelter SOG 14 November 2009 Provides information services. Must be able to work well with people. Duties include, but are not limited to: a. Initial Actions 1) Setting up the waiting and registration area. Assisting Nurse Manager in set up of Triage Station 2) Ensuring that all shelterees are registered before they go into the main part of the shelter 3) Reporting to the Nurse Manager 4) Ensuring that orientation information is available to give to the shelterees when they arrive; alternate formats shall be available as necessary. 5) Posting orientation information in areas where it can be read by shelterees and family members b. Ongoing Actions 1) Supervising Registration Assistants 2) Instituting check-in and check-out system for shelterees 3) Keeping accurate count of number of shelterees in the shelter 4) Maintaining list of all shelterees 5) Providing information to shelterees and family members 6) Recruiting shelterees as volunteers and assigning them to appropriate areas to assist with shelter operations c. Closing Actions 1) Ensuring a list of all staff and volunteers is prepared so that proper thank you notes can be sent 2. Registration Assistant Duties include, but are not limited to: a. Initial Actions 1) Reporting to Nurse Manager 2) Registering shelterees as they come into the shelter 3) Giving shelterees brief orientation to shelter b. Ongoing Actions 1) Providing information to shelterees and family members 2) Alphabetizing and organizing all registration materials on shelterees c. Closing Actions 1) Ensuring that all registration materials and records of shelterees are gathered, stored in a secure location, and ready to ship 3. Clerical/Office (if available) SN Shelter SOG 15 November 2009 Clerical/office worker volunteers work under direction of the Nurse Manager providing support to nursing staff at the SN Shelter. Essentially performs clerical duties as assigned, assists shelterees with basic activities of daily living, and provides general support services for and with nursing staff. Duties include, but are not limited to: a. Maintaining paperwork b. Helping shelterees find right location and setting-up c. Keeping list of shelterees, caregivers, staff and family members d. Reporting shelteree information or shelter information and messages to RN e. Assisting shelterees with ambulation f. Assisting in distribution of food g. Providing comfort measures and emotional support to shelterees and families h. Obtaining refreshments and basic comfort measures for shelterees as needed (e.g. blankets, pillows, etc.) i. Maintaining orderly, clean area and dispose of trash j. Reporting any problems k. Helping maintain safety of area 4. Security Personnel (Provided through LEOC) Maintains the security and safety of the staff and shelterees and family members arriving at the SN Shelter. Works together with the local law enforcement agency. The role of security is flexible within the SN Shelter to insure the safety of the shelterees. Duties include, but are not limited to: a. Initial Actions 1) Checking in with the SN Nurse Manager 2) Posting Exterior Signs guiding traffic to the SN Shelter 3) Establishing one main entranceway for the flow of shelterees into the SN Shelter 4) Working with the SN Manager to set up schedule of security b. Ongoing Actions 1) Directing traffic coming to the SN Shelter 2) Monitoring parking and arrival/departure of SN Shelter shelterees 3) Ensuring that entranceway to SN Shelter remains clear and accessible 4) Directing emergency and supply vehicles to appropriate locations 5) Maintaining law and order, tries to ease problems that may arise among shelterees SN Shelter SOG 16 November 2009 6) Monitoring exits and restricted areas 7) Helping with parking and parking control 8) Ensuring that the building is secure to maintain the integrity of the building 9) Apprising Nurse Manager of any concerns or problems 10) Assuring the safety of all persons 11) Responding to emergencies at the center as needed c. Closing Actions 1) Directing traffic for the pick-up of shelterees, staff and supplies 2) Removing Exterior Signs J. On-Site Volunteers Volunteers will be needed to set up cots and to assist individuals who are medically fragile, ill and elderly into and out of the building. Assistance may be needed to help deliver meals and clean up after a meal. Family members of staff can be asked to volunteer. SN Shelter staff should be asked to look for potential volunteers while registering persons into the shelter. Additional professional staff may be available through the general shelter, if needed. The SN Nurse Manager can request volunteer help from the General Shelter Manager as needed. In order for volunteers to be covered by state liability protection and workers' compensation, they MUST complete a LPHA volunteer packet (See Attachment 3 – Public Health Volunteer Application) and document their hours. Always provide newly recruited volunteers as explicit instructions as possible regarding what they are to do and what they are not to do. If an individual volunteer proves to be questionable or in some way unreliable, thank them for helping and tell them that their services are no longer needed. Be firm, but not confrontational. Treat them the way you would want to be treated. If they begin to cause a disturbance seek assistance from a mental health staff person, if available. Try to prevent the situation from escalating. Keep calm and try to escort them out of the area. Law enforcement will usually be in the building if needed. If not, call 911. IV. ACTIVATION OF SPECIAL NEEDS SHELTERS SN Shelter SOG 17 November 2009 A. Concept of Operation The decision to activate is made by the local EMD, in coordination with the LPHAs and the Human Services Branch of the State Emergency Operation Center (SEOC). If the county/city is not capable of resourcing or standing up a SN Shelter, the Department of Health and Senior Services (DHSS), in coordination with the LEOC, will determine who has responsibility for medical supervision in a SN Shelter. B. Alert and Notification Depending on the nature of the disaster, there may or may not be advance warning of an event. In situations where warning is given, preparation for the event will begin with as much lead-time as possible. 1. The LEOC will send information on the nature of the disaster and response needed to all Emergency Response Partners. 2. The LEOC will: a. Determine the need to activate SN Shelter staffing when necessary b. Determine the availability of a DHSS or LPHA designee to be assigned to the LEOC as the LEOC ESF-8 Coordinator to be the contact point for the Nurse Manager of each SN Shelter c. Identify possible evacuation levels and affected populations d. Keep agencies updated on the status of the event, by phone calls, faxes and/or briefings e. Determine which SN Shelter will open f. Notify support agencies and personnel with estimated opening time and locations 3. The LPHA will coordinate the notification of partners, oversee opening the shelter, and maintain communications with LEOC. 4. Agencies who are notified by the LPHA will: a. Notify their staff of the possible threat of an event and place them on standby for SN Shelter operations b. Review their plans and Standard Operating Procedures (SOPs) and provide updated information as necessary c. Inspect, dispense and/or relocate equipment and/or supplies d. Mobilize available resources e. Notify the RN of any problems/deficiencies SN Shelter SOG 18 November 2009 f. Coordinate staff to report to the SN Shelter at designated time 5. Staff who are expected to report to work during an activation will implement their personal emergency preparedness plan by: a. Securing their home b. Making arrangements for family members/pets during their activation c. Locating their personal supplies that will be needed during the activation d. Ensuring that they have supplied up to date emergency contact numbers to their agency or the person who will be notifying them e. Ensuring that any vehicles and/or equipment that they will need is operational and that any supplies they may need during the event are on hand f. Reviewing the SOP manual and be familiar with their roles and responsibilities C. Opening the SN Shelter The designated person responsible for the building and the Shelter Operations Manager designated by the SN Shelter will open the SN Shelter. D. Walk Through and Survey of the Facility Once the SN Shelter is opened, the Shelter Operations Manager and LPHA representative should survey the area. The survey should document the condition of the facility and any facility equipment that will be utilized during the SN Shelter operation. E. Suggested Physical Plant Requirements 1. Use ARC 6564 Shelter Facility Survey as a guide (See Attachment 4 – ARC 6564 Shelter Facility Survey). 2. Accommodate ARC recommendations for shelter functions and organization including having an area for behavioral health activities. 3. Conform to applicable state and local building, fire safety code and related amendments. 4. Predicate occupancy based on 100 square feet per medical cot or bed. (See Attachment 5 – Sheltering Space and Floor Plan Considerations) F. Accessibility Standards SN Shelter SOG 19 November 2009 1. Meet Americans with Disabilities Act (ADA) accessibility requirements for both internal and external building access and utilization. 2. Meet ADA requirements for accommodating individuals with service animals. (Contact the LEOC/SEOC if non-service animals are brought to the facility and need sheltering.) 3. Possess adequate and redundant internal and external communication capabilities (e.g. phone, internet, radios, cell phones, etc.), including protocols for communication with individuals with sight, hearing and speech limitations. G. Securing the Facility In order to maintain the flow of personnel and shelterees coming into and out of the SN Shelter, it is important to establish one main entryway. The Shelter Operations Manager and security personnel should ensure that areas which are not being used during the SN Shelter operation are secured and identified as off limits. Interior spaces of the building that are not to be utilized should be identified with the ―Do Not Enter‖ signs. Universal signage is recommended. No secured doors should be allowed to be propped open for any reason. Any problems that cannot be resolved at the facility should be reported to the ESF-8 Coordinator at the LEOC to coordinate with the person responsible for the building. H. Set-up of SN Shelter Stations and Signs After the SN Shelter has been surveyed and properly secured, the staff should begin setting up to receive shelterees and supplies. The General Population Shelter Logistics Chief, or designee, is responsible for posting interior signs to identify the various stations and important locations within the SN Shelter. Any signs that are not listed but deemed necessary will have to be created by the SN Shelter staff. It is recommended that signs should be secured with painters tape to reduce facility damage. (See Attachment 6 – Interior Signs) Designated general population shelter personnel should post exterior signs, if appropriate, in pre-designated areas to guide traffic to the SN SN Shelter SOG 20 November 2009 Shelter. If SN Shelter is not co-located with general population shelter, than exterior signs will need to be posted. I. Registration Information Area The registration area for the general population shelter should be set up near the main entrance to ensure that all persons coming to the SN Shelter and general population shelter are screened and registered. The ARC Intake Form will be used for all populations (See Attachment 7 – ARC Intake Form). Some individuals with special needs may need one- on-one assistance in completing the intake form and may need to be relocated from the main flow of registration traffic. Shelterees should be directed to the nurse's station to have the medical portion of the intake form updated. At the nurse's station the shelteree will be assigned to an area of the SN Shelter based on the level of care that is required. The registration information area should be near the nurse's station/office and include an area where updates can be posted. The SN Shelter rules should be displayed in this area. Personnel should remain at the information area to provide updates to the people in the SN Shelter. J. Triage Area The special needs triage area should be located at the nurse's station. Medical information will be requested from the shelterees, and an initial examination may be performed, therefore, privacy of the shelteree should be considered when selecting a location. It is not advisable to utilize the registration area, as traffic flow may be extremely heavy at that area. K. Nurse's Station/Office Area The nurse's station/office should include a first aid station and medical supply area. A nurse should staff the first aid station and the Nurse Manager should oversee the operation. The medical supply area should be secured and monitored by the Nurse Manager. All pre-identified medical supplies will be delivered to the Nurse Manager and should be logged when received. The general supplies for the SN Shelter should be stored in an area away from the public areas. An Inventory Control Sheet will be maintained for recording any supplies used. Upon receipt of medical supplies, the Nurse Manager designee will verify items and quantities, noting any discrepancies on the inventory sheets. When the SN Shelter program is terminated the Nurse Manager or designee will complete a final inventory of the remaining supplies and SN Shelter SOG 21 November 2009 calculate the total quantity used. The inventory sheets are to be returned to the LEOC. L. Temporary Morgue A temporary morgue needs to be established in case of a death in the SN Shelter or general population shelter. The morgue area should be an isolated room, away from the general congregation areas. The deceased person should be shrouded with a blanket and have an identification band applied to the wrist and ankle, if possible. If no family member is available to take possession of personal belongings, the items should be inventoried and stored in a secure area. The Shelter Operations Manager should notify the ESF-8 Coordinator or Incident Commander at the LEOC, who in turn will notify the medical examiner and next of kin. The body should not be removed until released by law enforcement. M. Staff Sleeping Area This area should be located in a quiet area of the SN Shelter, preferably away from the main traffic. The area should be secure from outside entry for staff safety and lockable from the inside. The ideal area would be an area where there is limited or no natural light to allow for people to sleep during the day. N. Arrival of Staff 1. All staff reporting to the SN Shelter must report and sign in at the Shelter Registration Desk. 2. Report to the Nurse Manager or Shelter Manager for assignment after registration at desk. 3. Staff should be issued and wear SN Shelter identification, if available. 4. All staff should fill out the staff registration form and log the hours they work while the shelter is open. This information will be maintained and needed by the EMD following the event. 5. Staff is expected to report to the SN Shelter under the agreements and/or plans made by each agency. Agencies providing staff should consider two, twelve-hour shifts for personnel to relieve one another. 6. Staff should brief individuals relieving them before departing the shelter. 7. Nurse Manager or Shelter Manager should be notified upon departure. O. Arrival of Volunteers SN Shelter SOG 22 November 2009 1. All volunteers must report and sign in at the Shelter Registration Desk. LPHA and/or DHSS or designated agencies will screen and approve SN Shelter volunteers through the Volunteer Reception Centers, if open. 2. Volunteers should fill out a volunteer registration form (See Attachment 8 – Special Needs Shelter Volunteer Registration) and log the hours they work while the shelter is open. This information will be maintained and needed by the EMD following the event. 3. Volunteers should be assigned to an area of the SN Shelter where they feel comfortable. 4. Volunteers should be oriented and supervised by appropriate staff members. 5. All volunteers should be issued and wear identification. 6. Volunteers should brief other volunteers before departing the shelter. 7. Nurse Manager or Shelter Manager should be notified upon departure. P. Arrival of Supplies All supplies that arrive at the SN Shelter must be inventoried and kept in a secure area. Receipt of the supplies should be reported to the Nurse Manager who will be responsible for or designate someone to disburse and track the supplies. (See Attachment 9 – Suggested Supply List for SN Shelters) Q. Disbursement of Supplies It is the duty of the responsible personnel to ensure that supplies are disbursed appropriately. It is the responsibility of the Nurse Manager to determine who should receive cots and bedding supplies. These items may be limited in number and should be assigned to those who have the greatest need. Requests for specialized cots should be made to the LEOC if not available through the ARC. Medical supplies must be kept in a secured area that has been designated by the Nurse Manager. R. Arrival of Visitors It is probable that a SN Shelter will be visited by the media or by other people who are not there to stay or to assist. All visitors must sign in at the registration area and state their purpose. The Nurse Manager or Shelter Manager should be notified of all visitors on the premises. Visitors should be asked to wait in an area that does not interfere with SN Shelter SN Shelter SOG 23 November 2009 operations. Solicitation of any nature is prohibited. Media filming and photographing of individuals and facilities is not allowed without approval and individual consent. They should be treated in a kind and courteous manner and asked to wait for the Nurse Manager or Shelter Manager. The LEOC should be notified when the media arrive. S. Feeding Responsibilities The feeding responsibilities in a shelter include supervising on-site food preparation and service for SN shelterees, family and staff. The general population shelter staff will handle the food preparation. The Nurse Manager should advise the ESF-8 Coordinator of any special supplies that are needed, ensuring that safe food handling procedures are followed. The LEOC works collaboratively with the ARC or Salvation Army and other local resources to assure food source. T. Admission Process 1. Triage Before shelterees enter the SN Shelter, they should be assessed for appropriateness, based on level of care available, by the Triage Team. (See Attachment 10 – Flow of Shelterees in the SN Shelter) The mission of the triage team is to efficiently sort shelterees into treatment categories enabling medical teams to provide the best care possible to the greatest number of shelterees. The triage team does not provide direct shelteree care because it will slow the triage process. The exceptions are airway management, or other situations, which require immediate action to save life, limb, or sight. A triage team will make quick assessment and route shelterees to the appropriate location. The triage team will: Obtain a brief history and perform a nursing assessment (to include basic personal information, ongoing medical needs, and allergies, the presence of alcohol or drugs, or language barriers). Document physician's orders and prescriptions, if available. Determine whether the shelteree can be sheltered in a public shelter or should be assigned to the SN Shelter. Provide a list of shelteree information containing shelter rules to all shelterees and caregivers. SN Shelter SOG 24 November 2009 Place a wristband, if available, on all shelterees assigned to the SN Shelter. The band will state the shelteree's name, address, and phone number. A color-coded sticker placed on each wristband to identify type of care required is very helpful (See Attachment 11 – Example of Color Coding Special Needs Clients Per Care Category). The same colored sticker will be placed on the shelteree care forms, which will be given to the nursing staff. Those shelterees, who are critical and awaiting transportation to a medical facility, will receive a white wristband stating name, address, and destination for transport. All triage records will be forwarded with the shelteree, and the shelter registration form will be annotated with transfer information. Wristbands will not be issued to caregivers. Triage personnel will be assigned other duties after the initial surge intake is completed or as directed by the Nurse Manager. 2. Registration Each individual entering into the SN Shelter should have either a wristband with their name written clearly on it and/or a completed ARC intake form with their caregiver and medical information completed. Once this information is verified, they are directed to the appropriate care area. U. Maintenance Activities It is the responsibility of the Nurse Manager to keep the LEOC apprised of the events in the SN Shelter. (See Attachment 12 – Special Needs Shelter Operation, Daily Situational Report). The following items should be reported: 1. Staff Shortages: Staff shortages should be reported to the ESF-8 Coordinator in the LEOC. The ESF-8 Coordinator or designee will assign volunteers through the SN Shelter in need. If additional local resources cannot be identified, the SEOC should be notified. 2. Supply Shortages: Supply shortages should be reported to the ESF-8 Coordinator. The ESF-8 Coordinator will attempt to secure the supplies needed. Only essential supplies should be requested. 3. Number of Individuals with Special Needs in the Shelter: Each SN Shelter must report the number of SN shelterees to the ESF-8 Coordinator. When a SN Shelter reaches 80% capacity, every attempt will be made to start rerouting traffic to other shelters, if there is an alternate. Agencies providing food and other resources SN Shelter SOG 25 November 2009 must be provided daily census updates. Whenever possible, special needs shelters should be pre-identified and entered into the National Shelter System database. 4. Problems: Any problems arising in the SN Shelter that requires assistance should be reported to the ESF-8 Coordinator. The Nurse Manager should also provide updates and announcements to the SN shelterees. V. Shelter Deactivation The decision to deactivate the sheltering operation rests solely with the LEOC. At no time will a shelter be deactivated prior to the issuance of this order. Each shelter will receive approval to commence closing procedures through the LEOC. These instructions will be received either by telephone or the radio operator stationed at each shelter. SN Shelters will be scaled down as individuals are able to return safely home or to other appropriate living arrangements. If an area of the county/city receives damage, it may be necessary to return some individuals to the shelter for continuing care until further arrangements for long-term care can be made. In cases where individuals with special needs are unable to return to their homes, attempts will be made to identify alternate facilities, i.e., with family, friends or other accommodations. Consolidating SN Shelters populations may reduce the number of available shelters. At the time the SN Shelter closing is announced, the SN Shelter staff should determine the number of individuals of special needs needing temporary housing. The decision regarding closure of the SN Shelter will be based, in part, on the following: 1. Impact of the event on persons with special needs' homes or environment (i.e., person's home exists but rest of the neighborhood is gone, power out, etc.) 2. The urgency of the need to return the facility to normal conditions 3. Availability of transportation resources 4. Time of day Persons with special needs may be anxious to return to their homes and should be advised to wait for the ―all clear‖ to be given by the LEOC and/or EMD. Individuals with special needs may leave the shelter at will, except during the height of a disaster when opening doors may jeopardize the safety of the staff and other individuals with special needs. A. Discharge 1. Upon admission, the nursing staff will individually interview each individual with special needs, completing the ARC Intake Form if it has not been completed at registration. It is very important to SN Shelter SOG 26 November 2009 ascertain the names of family or friends' as well as home health agencies involved and to obtain information on how the individual with special needs arrived. 2. The name of the individual with special needs will be recorded on the Disaster Registration Log (See Attachment 13 – Disaster Registration Log). Individuals with special needs can be categorized according to departure plans (i.e., those by public transportation, those by friends, family, other means). 3. When it is time for departure, nursing staff and/or mental health workers, if available, will assist individuals with special needs with the necessary arrangements. Phone calls to public transportation, a home health agency, a family member, etc. may be required. For those who depend upon electricity, contact LEOC in order to verify an address for a client with special needs and the availability of power. 4. If no arrangements can be made to get the client with special needs home, or if the home is uninhabitable, the Department of Health and Senior Services or Department of Social Services may be notified to provide assistance in locating temporary housing. It may also be necessary to contact a local nursing home to arrange for temporary placement. Every effort should be made to insure that individuals are moved back to the least restrictive environment. 5. Upon departure, the time and date will be recorded on the Disaster Registration Log and notification will be provided to the lead nurse and to communications. B. Transportation Those individuals who are stable and have their own transportation may be released to their homes. Charts should be annotated as to the individual's condition and the Disaster Registration Log should reflect the time of departure. The number of individuals requiring ambulance transport will be reported to ESF-8 Coordinator in the LEOC in order to facilitate transport. Prior to departing the shelter, the individual's condition should be noted on his or her chart and the Nurse Manager will brief the ambulance personnel. Departure time should be noted on the Disaster Registration Log. The number of individuals who require bus and/or wheelchair assist vehicle transport will be reported to ESF-8 Coordinator in the LEOC. The SN Shelter SOG 27 November 2009 condition of each individual will be noted on the chart and the departure time will be noted on the Disaster Registration Log. VI. Mitigation 1. Review all of the above activities after the initial post-storm work has been done. Debrief all individuals involved and document activity assessment. 2. Analyze all registration and charting forms, logs, etc. Begin gathering information and data. Determine where all forms will be kept for future reference 3. Start making appropriate changes in future preparation plans. SN Shelter SOG 28 November 2009 Attachment 1 Levels of Care for Special Needs Shelter Examples American Red Cross Special Needs Medical Management Facility Or Local Mass Care Shelter Alzheimer's Disease (ALZD) Early Moderate, cooperative, Advanced. Bedridden; nonverbal Not a flight risk. Refusal to eat; totally dependent Ambulating Difficulty (walker, cane, crutches) If other information may indicate a need Ameliorating Lateral Sclerosis (ALS) wheelchair Wheelchair user, Advanced, bedridden, totally dependent able to transfer from chair to bed Aphasia (communication difficulty) Arthritis Self-ambulating Wheelchair user Bed bound, requires pain able to transfer from management chair to bed Asthma Nebulizer use but Requires nebulizer Treatments and Unstable, requires urgent medical evaluation, O2 sat below % monitoring not monitoring needed Bronchitis Nebulizer use but If requires nebulizer Treatments and Unstable, requires urgent medical evaluation, O2 sat below % monitoring not monitoring needed Cardiac Stable, oral meds Controlled with Med. Unstable –Having SOB & Angina Cerebral Palsy Stable Severe, bedridden, totally dependent Cerebrovascular Accident (CVA) Wheelchair user, Wheelchair user, Unable to transfer from Bedridden able to transfer chair to bed independently or with caregiver Chronic Obstructive Oxygen use if Oxygen Use but fragile Oxygen dependent, end stage Pulmonary Disease (COPD) concentrators and and monitoring needed electrical power secure Colostomy Assistance needed Post surgical ostomy Comotose Contagious, severe infection Hepatitis, Tuberculosis, Measles or mumps in adult Continuous Ambulatory Peritoneal Dialysis(CAPD) Cystic Fibrosis Stable Needs meds Respiratory Compromise Dementia Able to follow End stage, bedridden instructions, not a flight risk Diabetes/Hyperglycemia Insulin and diet Insulin Administration Brittle diabetic, glucose over on Controlled and able to Assistant monitoring or dialysis secure their supplies/ unable to secure their meds insulin supplies/meds Eating and Swallowing Disorders Eating disorder Stable anorexia/bulimia under treatment. No gag reflex, history of aspiration, requires suction airway under control Swallowing disorders management requiring thickeners SN Shelter SOG 29 November 2009 and gastric feedings. Edema Mild, related to Related to mild CHF and position Acute CHF or other metabolic condition requiring urgent medical position or non-acute management injury as in a sprain Examples American Red Cross Special Needs Shelter Medical Management Facility Evacuation Center Emphysema Not oxygen dependent Oxygen use, minimal Oxygen dependent, end stage monitoring Foley Catheter Stable Management & Foley Catheter management post Change surgical procedure Fractured Bones Pin site Care Dressing Changes Acute injury requiring monitoring and pain management High Blood Pressure/ Stable Monitor, assistance Uncontrolled, requires urgent Hypertension with medications medical management Hip Replacement >6 months <6 months Ileostomy Requires assistance in self-care Recent surgical procedures Knee replacement >6 months <6 months Medical Equipment G-Tubes IV, NG –Tubes, Central Venous Attachments Catheters or Tracheotomy Tube (newly placed or requires frequent suctioning) Migraine Headaches Multiple Sclerosis Self-ambulating Wheelchair user Bed bound Muscular Dystrophy Self-ambulating Wheelchair user Bed bound Neuromuscular Disorders Self-ambulating Wheelchair user Bed bound Osteoarthritis/Osteoporosis Self-ambulating Wheelchair user Bed bound Parkinson's Disease Advanced Psychosis Controlled & caregiver Controlled Uncontrolled Present to monitor Stress levels Respirator Ventilator Dependent Seizures Controlled Med Assistance Uncontrolled Needed Skin Rashes Sores/Non-Fluid Open sores; draining, Infectious dressing changes Sleep Apnea Non-electric dependent Electric dependent, CPAP Upper respiratory infection Checked for Isolation Requires urgent medical evaluation, Fever/O2 sat % increased infection Urinary Tract Infection Wheelchair Transferable Mobile with minimal Wheelchair user with Bed bound Assistance Other conditions SN Shelter SOG 30 November 2009 Attachment 2 Special Needs Sheltering Table of Organization Chart Special Needs Sheltering Table of Organization State or Local Principal Shelter Director Shelter Operations Shelter Operations Medical Logistics Officer Medical Director Manager Manager ESF 8 Coordinator Nursing Coordinator Triage/ Patient Tracking Registration Staffing Nurse Manager Supervisor Feeding Manager Resources Food Prep Security Nursing Staff Medical Resources Sanitation Child Care Caregivers Medical Equipment Medication Serving/Planning Volunteers Support Staff SN Shelter SOG 31 November 2009 Attachment 3 Public Health Volunteer Application Last Name First Name Middle Name Home Address City State Zip Code Home Phone Cell Phone E-mail Business Address Business City/State/Zip Business Phone Volunteer Experience: Please list volunteer experience, starting with the most recent. Organization Name Address Phone Organization Name Address Phone Organization Name Address Phone Work Experience: Please list paid work experience, starting with the most recent. Organization Name Address Phone Organization Name Address Phone Current License(s)/Certifications (Please include driver's license) Type: Number: State: Expiration Date: Type: Number: State: Expiration Date: Type: Number: State: Expiration Date: Education and Training: Begin with the most recent. Institution Name City/State Degree/Major Date Attended Fluent Language Skills: [ ] American Sign [ ] Albanian [ ] Arabic [ ] Armenian [ ] Bengali [ ] Bulgarian [ ] Chinese [ ] Czech [ ] Danish [ ] Dutch [ ] English [ ] Farsi [ ] Finnish [ ] French [ ] German [ ] Greek [ ] Gujarati [ ] Haitian Creole [ ] Hindi [ ] Hungarian SN Shelter SOG 32 November 2009 Public Health Volunteer Application [ ] Indonesia [ ] Italian [ ] Japanese [ ] Khmer [ ] Korean [ ] Laotian [ ] Malayalam [ ] Norwegian [ ] Polish [ ] Portuguese [ ] Punjabi [ ] Romanian [ ] Russian [ ] Samoan [ ] Serbo-Croatian [ ] Somali [ ] Spanish [ ] Swahili [ ] Swedish [ ] Tagalong [ ] Tamil [ ] Thai [ ] Tigrinia [ ] Turkish [ ] Twi [ ] Ukranian [ ] Urdu [ ] Vietnamese Geographic availability: Check the boxes for places you would be willing to volunteer. [ ] My county only [ ] Multiple Counties [ ] State-wide List: Level of participation: Select the level of participation you prefer. [ ] All the time [ ] Training [ ] Disaster Only [ ] I'll call you Availability: For daily and/or training participation Monday Morning Afternoon Evening Anytime Tuesday Morning Afternoon Evening Anytime Wednesday Morning Afternoon Evening Anytime Thursday Morning Afternoon Evening Anytime Friday Morning Afternoon Evening Anytime Saturday Morning Afternoon Evening Anytime Sunday Morning Afternoon Evening Anytime Emergency Contact Information B. Name Relationship Address Phone Personal Information: A "yes" or "no" answer to the following questions will not necessarily disqualify any applicant from becoming a local public health volunteer. Are you licensed to operate a motor vehicle in this state? Yes No Has your license to operate a motor vehicle ever been revoked? Yes No If yes, please explain. Have you ever been bonded? Yes No Has your bonding ever been revoked? Yes No If yes, please explain. Office use only Have you ever been convicted of a felony, or within the past 24 months, Yes No of a misdemeanor that resulted in imprisonment? If yes, please explain. Office use only Volunteer Affiliations: Please list volunteer organizations you are currently associated with: SN Shelter SOG 33 November 2009 Public Health Volunteer Application Volunteer Consent I verify that all information, provided in the Public Health Volunteer Application, is accurate to the best of my knowledge. I give the local public health agency (LPHA) permission to inquire into my character references, licensures, and employment and/or volunteer history. I also give the holder, of any such information, permission to release it to the LPHA. I hold the LPHA harmless of any liability, criminal or civil, which may arise as a result of the release of this information about me. I also hold harmless any individual or organization that provides information to the above named agency. I understand that the LPHA will use this information only as part of its verification of my volunteer application. I hold the LPHA harmless of any liability that I might incur during the process of my duties. I understand that I am volunteering on my own behalf and agree to operate within the scope of my responsibilities, be properly trained, and be licensed and certified by the appropriate agencies (if required). I will not be guilty of any willful or criminal misconduct, gross negligence or reckless misconduct in the course of my duties as a public health volunteer. Name—please print Social Security Number Signature Date Witness Date Parental Consent I verify that I am the above named individual's legal guardian, and he/she is under the age of 18. I, as the legal guardian, give the above named individual my permission to volunteer with the local public health department. I release the local public health department, and any individual and/or organization associated with the local public health department, of any liability the above named individual may incur. I understand that he/she is volunteering at his/her own risk. ____________________________________ ____________________________________ Name of legal guardian Social Security Number ____________________________________ ____________________________________ Signature of legal guardian Date ____________________________________ ____________________________________ Witness Date SN Shelter SOG 34 November 2009 Attachment 4 ARC SHELTER FACILITY SURVEY Please print all information. This form is generic to many types of shelters; some of the questions on this form might not apply to every site. In such cases, answer N/A (not applicable). Site Name: Street Address: Town/City: County/Parish: State: Zip Code: Mailing Address (if different): Phone: ( ) - Fax: ( ) - Email address (if applicable): EMERGENCY CONTACT INFORMATION: To authorize facility use, contact (Name[s], phone number[s], cell number[s]); include secondary contacts: __________________________________________________________________________ _ ______________________________________________________________ _____________ To open the facility 24/7, contact (Name[s], phone number[s], cell number[s]); include secondary contacts: ___________________________________________________________ ________________ __________________________________________________________ _________________ Directions to the facility from the nearest major highway evacuation route. Use major landmarks (e.g., highways, intersections, rivers, railroad crossings, etc.). Do not use landmarks likely to be destroyed or unrecognizable after the disaster. Include latitude and longitude if available (they can be obtained via GPS). Latitude: Longitude: CAPACITY Capacity for all shelters should be calculated using any space that could feasibly be used as sleeping space for an event. In an evacuation shelter, capacity should be calculated using 15 to 20 square feet per person. In a general shelter, use 40 to 60 square feet per person to determine capacity. Capacity Evacuation = at square feet General = at square feet LIMITATIONS ON FACILITY USE Some facilities are only available during certain times due to other activities. Please indicate the dates that the facility is available. This facility will be available for use at any time during the year. This facility is only available for use during the following time periods. From: to From: to This facility is not available for use during the following time periods: From: to From: to SN Shelter SOG 35 November 2009 Some facilities have specific areas that can be used as an emergency shelter. Please indicate restrictions on use of certain areas of the building or if the entire facility is available for use. GENERAL FACILITY INFORMATION FIRE SAFETY Some facilities that appear to be suitable for sheltering might not meet fire codes based on building capacity. This list of questions is not meant to be exhaustive. It is recommended that local codes be examined to determine if the facility meets them. In addition, contact can be made with the fire department to ensure compliance. Does the facility have inspected fire extinguishers? Yes No Does the facility have functional fire sprinklers? Yes No Does the facility have a fire alarm? Yes No If yes, choose one: Manual (pull-down) Automatic Does the fire alarm directly alert the fire department? Yes No Comments from fire department, if available: UTILITIES A major concern in running an emergency shelter is whether or not utilities can continue to run after a storm. This section is designed to evaluate the capabilities of the facility and to list the appropriate contacts in case the utilities fail. Emergency generator on site? Yes No IF YES- Capacity in kilowatts Power for entire shelter? Yes No If no, what will it operate? Operating time, in hours, without refueling, at rated capacity: Auto start Manual start Fuel type Utility company name: Contact name: Emergency phone number: ( ) - Generator fuel vendor: Emergency phone number: ( ) - Generator repair contact: Emergency phone number: ( ) - IF NO- Emergency generators do not have to be present in order to use the facility as a shelter. However, care must be taken to evaluate the appropriateness of the facility in emergency situations. For example, if there are no appropriate facilities in the area available for sheltering that have emergency generators, consideration should be made to use those facilities. Most pre-identified emergency shelters do not have generators. In addition, if a shelter does not have a generator on site, it is appropriate to pre-identify vendors so that a generator could be brought in if necessary. Heating Electric Natural gas Propane Fuel Oil Utility/vendor name: Contact name: Emergency phone number: ( ) - Repair contact: Emergency phone number: ( ) - Cooling Electric Natural gas Propane Utility/vendor name: SN Shelter SOG 36 November 2009 Contact name: Emergency phone number: ( ) - Repair contact: Emergency phone number: ( ) - Cooking Electric Natural Gas Propane No cooking facilities on site Utility/Vendor name: Contact name: Emergency phone number: ( ) - Repair contact: Emergency phone number: ( ) - See the Food Preparation section below. Telephones Business phones available to shelter staff? Yes No Phones available to shelter residents? Yes No Number of phones: Locations: Utility/vendor name: Contact name: Emergency phone number: ( ) - Repair contact: Emergency phone number: ( ) - Water Municipal Well(s) Trapped water If trapped: Potable (drinkable) storage capacity in gallons: Non-potable (undrinkable) storage capacity in gallons: Utility/vendor name: Contact name: Emergency phone number: ( ) - Repair contact: Emergency phone number: ( ) - Planning for Drinking Water The recommended amount of potable water to have on hand per evacuee is one gallon per day. Presuming that existing water supplies remain available, and that the goal for resources on hand is for three days after the shelter opens, you should strive to have three gallons on hand for each projected shelter resident. Projected population x 3 =projected number of gallons of water needed. Projected population x 3 -Total available Gallons of Water Needed MATERIAL SUPPORT COTS & BLANKETS During evacuation sheltering, it is often impractical to have cots and bedding for all evacuees. However, it is desirable to have some cots and bedding on hand to be provided on a case by case basis to shelter residents who could, for a variety of reasons, experience hardship by sleeping on the floor. A good planning target for the quantity of cots to have on hand for evacuation sheltering is enough for 10% of the projected population. Generally, it is recommended to have two blankets per person in the shelter. Projected population ÷10 = projected number of cots needed. Projected population ÷10 Projected population ÷ 5 - Total available - Total available SN Shelter SOG 37 November 2009 Cots needed Blankets needed ACCESSIBILITY FOR PEOPLE WITH DISABILITIES Many people with disabilities can be accommodated in general shelters. It is important to evaluate a building to determine if it is accessible to people with disabilities. No single deficiency in the following list makes a facility "out of compliance" or unfit for consideration. There are many acceptable temporary mechanisms that can make a facility accessible. For guidance in this area, contact your local building or safety department, an assisted living center or a disability advocacy organization. Access to building Curb cuts (minimum 35 inches wide) Accessible doorways (minimum 35 inches wide) Automatic doors or appropriate door handles Ramps (minimum 35 inches wide) Are ramps: Fixed Portable Level Landings Accessible and accommodating restrooms Grab bars (33-36 inches wide) Sinks @ 34 inches in height Stall (38 inches wide) Towel dispenser @ 39 inches in height Showers Shower stall (minimum 36 inches by 36 inches) Grab bars (33-36 inches in height) Shower seat (17-19 inches high) Hand-held spray unit with hose Fixed shower head (48 inches high) Accessible and accommodating cafeterias Tables (28-34 inches high) Serving line [counter] (28-34 inches high) Aisles (minimum 38 inches wide) Accessible telephones Maximum 48 inches high TDD available Earpiece (volume adjustable) SANITATION TOILETS The American Red Cross recommended ratio for toilet facilities is a minimum of 1 restroom for 40 people. Count only those facilities that will be accessible to shelter residents and shelter staff. Projected population ÷ 40 = projected needed number of toilet facilities. Number of toilets available: Men Women Unisex People with Disabilities Projected need: Men Women Unisex People with Disabilities - Total available: Men Women Unisex People with Disabilities Portable toilets needed: Men Women Unisex People with Disabilities SINKS The recommended ratio of sinks is one sink for every two toilets. Number of sinks available: Men Women Unisex People with Disabilities Projected need Men Women Unisex People with Disabilities SN Shelter SOG 38 November 2009 Total available: Men Women Unisex People with Disabilities Portable sinks needed: Men Women Unisex People with Disabilities SHOWERS The best case scenario for showers is 1 shower for every 40 residents. In the case of evacuation shelters, the ratio can be higher. However, if it is determined that an evacuation shelter will be open longer term, alternative arrangements will have to be made. There might be a nearby facility that, while it couldn't be used a shelter, might have showers available. Consider requesting transportation through partner agencies; when a Disaster Relief Operation (DRO) has been set up, requests can go through Partner Services at the DRO. Portable showers might need to be acquired. Number of showers available: Men Women Unisex People with Disabilities Number of showers needed: Men Women Unisex People with Disabilities Are there any limitations on the availability of showers (time of day, etc.)? Yes No Alternatives for showers on-site: Alternatives for showers off-site: FOOD PREPARATION None on site Warming oven kitchen Full-service kitchen (If full-service meals, "per meal" number that can be produced): Facility uses central kitchen — meals are delivered Central kitchen contact: Phone Number: ( ) - Planning for shelter feeding While people coming to evacuation shelters are encouraged to bring food with them, for a variety of reasons this doesn't always occur. Therefore, it pays to be prepared to feed shelter residents. For planning purposes, it is helpful to think in terms of three to five days of meals with no outside assistance. This covers the possibility of widespread damage to commercial food sources and infrastructure. Meals can range from freshly prepared food at shelter facilities that have adequate kitchen facilities to prepackaged shelf-stable meals (military-style Meals Ready to Eat [MREs], Heater Meals, etc.). The planning target should be 5 meals worth of food in inventory for each projected shelter resident. Projected population x 5 = projected number of meals needed. Projected need - Total available Meals Needed Equipment (Indicate quantity and size [sq. ft.] as appropriate). Refrigerators Walk-in refrigerators Ice machines Freezers Walk-in freezers Braising pans Burners Griddles Warmers Ovens Convection ovens Microwave ovens Steamers Steam kettles Sinks Dishwashers FEEDING AREAS None on site Snack Bar (seating capacity: ) Cafeteria (seating capacity: ) Other indoor seating (describe, including size and capacity estimate): SN Shelter SOG 39 November 2009 Total estimated seating capacity for eating: Comments related to feeding: OTHER CONSIDERATIONS ARC 4496 "Standards for Selection of Hurricane Evacuation Shelters," or ARC4496, is a document published by the American Red Cross. Planning considerations for hurricane evacuation shelters involve a number of factors and require close coordination with local officials responsible for public safety. Technical information contained in hurricane evacuation studies, storm surge mapping, flood mapping and other data can now be used to make informed decisions about the suitability of shelters. Anyone considering using a facility as a hurricane evacuation shelters should carefully review ARC 4496 and consult with local officials to ensure safety of the facility is considered. HEALTH SERVICES Number of rooms available: Number of beds or cots available: Number of rooms needed: Number of beds or cots needed: Total square footage of available health care space: BABY AND INFANT SUPPORT SUPPLIES Diaper changing tables are extremely important due to health safety considerations. While there is not a recommended number of tables by population, there should be changing tables available. Beyond diaper changing, it is helpful to know in advance what baby supplies are available, if needed. # of diaper changing tables: # of diapers available: Cans of formula available: LAUNDRY FACILITIES Generally, shelters do not have access to laundry facilities. Availability of such facilities would be considered an extra and not a necessity. These facilities would be especially useful for a shelter open longer than a week. Number of clothes washers: Number of clothes dryers: Will the shelter worker or shelter residents have access to these machines? Yes No Are laundry facilities coin operated? Yes No Special conditions or restrictions: ADDITIONAL INFORMATION Does the entity that plans to manage the shelter own the building? Yes No If NO- is there a current written agreement to use this site? Yes No Is this facility within five miles of an evacuation route? Yes No Is this facility within ten miles of a nuclear power plant? Yes No Groups associated with this facility Facility staff required when using facility? Yes No Paid feeding staff required when using facility? Yes No SN Shelter SOG 40 November 2009 Church auxiliary required when using facility? Yes No Fire auxiliary required when using facility? Yes No Other: Required Yes No Other: Required Yes No Will any of the above groups be trained or experienced in shelter management? IF YES, please list: RECOMMENDATIONS/OTHER INFORMATION (Be specific): ••••• Attach a sketch or copy of the facility floor plan ••••• Survey completed/updated by ______________________________ Printed Name Signature Date completed ______________________________ Printed Name Signature Date completed SN Shelter SOG 41 November 2009 Attachment 5 Sheltering Space and Floor Plan Considerations American Red Cross (ARC) Sheltering guidelines recommend that 20 square feet per person be made available for short-term, or ―evacuation‖ sheltering, and up to 40 square feet per person for ―long term‖ sheltering. ―Long term sheltering‖ is generally defined as any period longer than seventy-two hours. Typical ARC or military surplus cots require about 21 square feet (7ft X 3 ft) of floor space. By allowing space for maneuverability around the cot, expanding the assigned space to approximately 4 feet X 10 feet, you can arrive at the recommended floor space of 40 sq ft per occupant. The relatively narrow, long space allotment allows for the storage of belongings at the foot of each cot. In most cases, accommodating the needs of people with disabilities in shelters requires only minor modifications of the standard operating guidelines and some forethought concerning the floor plan of the shelter facility. Some additional equipment considerations are also worth considering. A detailed assessment of your local population, as well as a close working relationship with local advocacy groups, can help you determine the exact type and quantity of equipment that may be required in your shelter, in addition to resources for obtaining those supplies. Following is a brief discussion of some of these considerations. Space issues are always of great concern when it comes to sheltering large populations. The idea of accommodating individuals with wheelchairs, lift equipment, personal care assistants, and service animals can, at first, seem unreasonable. However, some experimentation with floor planning shows that even one individual who brings all of these needs to a shelter can fit into about 100 square feet. That translates to 50 square feet per person—only ten square feet more than the Red Cross per-person allotment for long term sheltering. Some particular features of this layout need more detailed explanation. Starting with the motorized wheelchair, careful consideration should be given to placement of individuals with power needs within the shelter. While many motorized wheelchairs can go several days between charges, remember that sudden disasters may bring people to your shelter whose chairs may need immediate charging, and as days wear on nearly all people relying on wheelchairs will need to charge them. It should be emphasized that motorized wheelchairs are not simply wheelchairs that move on their own. While implying that these apparatus are ―life support‖ equipment would be an overstatement, they are certainly ―quality of life support‖ equipment. Not just providing mobility, they are custom made, 400+ pound, sophisticated pieces of medical equipment that also prevent skin degradation and ulceration, prevent circulatory disorders and respiratory infections, and help individuals care for themselves. With that in mind, motorized wheelchairs can create a significant draw on electrical circuits while charging. This is an important consideration, and should be coupled with other power demands, such as breathing SN Shelter SOG 42 November 2009 machines (CPAP, BiPAP) or other equipment that may be in use. In general, consider distributing your power-consuming shelter residents across multiple walls and/or circuits. Even relatively large chairs can be parked for the night without taking up too much space. Placing the chair at the head of its owner's bed not only creates a compact storage area, it also provides a sense of security (as opposed to having to ―surrender‖ the chair to a common storage area) as well as a platform for personal effects, perhaps including assistive breathing equipment. Spacing individuals with disabilities throughout the shelter to distribute power demand, and integrate the entire population, presents some challenges. While individuals who are ambulatory can walk to bathrooms, perform personal hygiene, and change clothes, persons with certain disabilities cannot. Portable privacy screens may be a suitable option for providing privacy at the individual's cot. Alternatively, if the shelter is a school, the nurse's office can be designated as a private room for addressing personal needs of persons with disabilities. Such a room should be at least 100 square feet and should include an examination table or massage-type table to help facilitate change of clothing or addressing other personal care needs. Cots that provide a wider sleeping surface, a thicker mattress pad, and a higher surface can be found at (www.emergencyresources.com). This makes the cot more versatile when dealing with populations that may have trouble getting in and out of low beds. Eighteen inches is generally not, however, high enough for self-transfer in and out of wheelchairs. Many individuals with disabilities rely on family members, friends, or personal care assistants to provide support with activities of daily living to live in and participate in the community. Therefore, to live independently within a shelter, persons with disabilities will likely bring more than one family member or personal care assistant with them to a shelter. However, only one family member or personal care assistant can stay in the 100 square foot area at a time. Other family members or personal care assistants may stay in the general population section of the shelter and rotate into the 100 square foot area as needed. An additional consideration that leads to the 100-ft2 floor space requirement is the need to access the bed area by wheelchair, and the potential need for lifting/moving equipment such as a Hoyer Lift. Alternatively, Hoyer Lifts made available at the shelter for general use may help minimize both equipment storage concerns as well as the need for individuals to transport their own lift during an evacuation. Emergency planners may consider arranging memorandums of understanding (MOUs) with companies to supply equipment such as Hoyer lifts to enhance accessibility, should the need to open a shelter arise. Some other equipment to consider having available by MOU might include: • Portable showers for people in wheel chairs • Shower chairs • Egg crate mattress pads SN Shelter SOG 43 November 2009 Finally, space is needed to accommodate a service animal. A minimal amount of floor space (6 square feet) may be required, or the service animal may even sleep on the bed with their owner. In order to assess the number of specialized cots, amount of space dedicated to accessible sheltering, power supply requirements, etc. needed in each community, local officials should review available demographic or statistical data for their community. Working closely with community partners (area agencies on aging, disability advocates, etc) during the planning stages will help to better prepare both the emergency management staff as well as people with disabilities for a disaster. If no estimation of local requirements is available, it is recommended that a figure of 10% of the shelter population be used in calculating the need for specialized cots and space. SN Shelter SOG 44 November 2009 Attachment 6 Interior Signs Type of Sign Quantity Placement Picture Board 1 Near the registration/information areas. To be used to help persons who have difficulty verbalizing their needs. SN Shelter Registration (if 2 On the wall or on the table of the registration area. separate from general registration) SN Shelter Information 2 1 near the entrance/registration area with an arrow and 1 near the information area. SN Shelter Office/Nurses 2 1 near the entrance/registration areas with an arrow Station and 1 near the Office. Day Care Facility - Restricted 1 Area for children of emergency workers, if any. Entry Enter/Do Not Enter 4/4 Post these signs to indicate the areas that people may or may not enter or use. Security will need to ensure that people stay out of areas designated as off limits. Exit 3 Use these signs to indicate the main exit. Especially during the height of a storm it is imperative that control is maintained over the exterior doors. Service Animals 1 An area (if one is designated) for persons with service animals. Supervised Area 1 Area for oxygen, behavior shelterees. Treatment 1 Area for medication assisted shelterees. Isolation – Do Not Enter 1 Area for shelterees with contagious conditions. Hospice 1 Area for hospice shelterees. Pediatrics 1 Area for children who are special needs shelterees. Triage Area 1 Area for screening persons with special needs. Animal Holding 1 Refer to LEOC to determine what the ESF-17 policy regarding sheltering animals in the SN Shelter is and what options are available. Staff Only 2 No Smoking 8 Exit areas and bathrooms Oxygen in Use 4 SN Shelter SOG 45 November 2009 Attachment 7 ARC Intake Form SN Shelter SOG 46 November 2009 SN Shelter SOG 47 November 2009 Attachment 8 SPECIAL NEEDS SHELTER VOLUNTEER REGISTRATION SNS Name: ________________________________ Date: _______ Time Open: ________ Time Closed:_________ Volunteer Name Address, City, Zip License # Assignment Time Time Time Time Time Time Total Please PRINT In Out In Out In Out Time SN Shelter SOG 48 November 2009 Attachment 9 Suggested Supply List for Special Needs Shelters Items highlighted in Bold are priority supplies Item # Item Description Estimated Quantity per 100 individuals with special needs for 3 days 1. 2-way radios 12 2. 3x3 gauze sponges – 2 sterile per pack 50 3. 4x4 gauze sponges – 2 sterile per pk 100 4. Activated charcoal/bottle 2 5. AED with pads 1 6. Alcohol – isopropyl 1 pint 7. Alcohol-based hand sanitzer 8. Alcohol swabs 3 boxes (100 each) 9. Alphabetical files w/ flaps 2 10. Ammonia inhalants 2 boxes 11. Antacid – low sodium 24's 2 boxes 12. Antibacterial hand wash 3 bottles (refill) and 18 small bottles for staff 13. Anti-septic foam alcohol 2 bottles 14. Anti-septic germicide pre sol (iodine) 8 bottles of 1 fl oz 15. Applicators cotton tipped 200 (box) 16. Arm sling 1 17. Aspirin 5 gr tablets 250 tablets 1 bottle 18. Bag Valve Mask (BVM) Adult 2 19. Bag Valve Mask (BVM) Pediatric 2 20. Ball point pens 1 box of black and blue each 21. Band-aids (non-latex) 5-10 boxes assorted size 22. Batteries assorted sizes 23. Bed pans 10-20 24. Bedside commodes 10 25. Benadryl Cream – antipruritic 1 ox. 2 tubes 26. Benadryl/generic syrup 4oz 2 27. Betadine scrub 1 bottle 28. Biohazard Red Bags Large 1 box 29. Biohazard Red Bags Small 1 box 30. Blankets 118 31. Blood Glucose Monitor 1 32. Blood Glucose Strips 2 boxes 33. Body Lotion 2 bottles 34. Box to Store/Lock Medications 2 35. BP Cuff Set - non-mercury (adult sizes and 3 pediatric) 36. Bucket – 2 gallon 2 37. Bulb Syringe 2 38. Calamine Lotion (6 fluid oz) 2 39. Can Opener 1 40. Chlorine Bleach 1 quart 41. Chux Underpads 150 42. Clipboards 15 43. Cloth Towels – Large 100 44. Cloth Towels – Small 100 SN Shelter SOG 49 November 2009 Item # Item Description Estimated Quantity per 100 individuals with special needs for 3 days 45. Cold Pak (Reusable) 2 pak 46. Color Highlighters 1 pack 47. Colostomy Bags 1 box 48. Communication boards (individual) 2 49. Cots 118 (includes staff) 50. Cotton Tip Applicators 1 box 51. CPR Face Mask – Pediatric 3 each 52. CPR Face Mask – Adult 3 each 53. Diapers – Adult 50 54. Diapers – Infant/toddler 50 55. Dressing (and pad) 24 56. Dressing paper for tables 2 rolls 57. Duct Tape 2 rolls 58. Elastic Ace Bandages (non-latex) 5 – 10 59. Elastic Band – 2 inch 6 packages 60. Elastic Band – 6 inch 6 packages 61. Extension Cords 10 62. Eye Pads 12 63. Face Shields – Disposable 12 64. Facial Tissue 10 boxes 65. Feminine Products Assorted 66. First Aid Tape Roll (10 yd roll) 10 67. Flashlights 10 68. Forceps/Tweezers 2 69. Garbage Bags 1 box 70. Gauze Bandages 5 10 boxes 71. General first aid kit 1 72. General Sponges 12 73. Germicidal Wipes 4 containers 74. Gloves, Non-Latex – Large 3 boxes (100 each) 75. Gloves, Non-Latex – Medium 3 boxes (100 each) 76. Gloves, Non-Latex – Small 3 boxes (100 each) 77. Goggles 2 78. Gowns 3 79. Hospital ID Bracelets 75 yellow, 50 green, 20 light blue, 15 white, 25 dark blue, 10 red, 25 orange 80. Hydrocortisone 0.5% cream/ tube 2 81. Hydrocortisone 1% cream/tube 2 82. Hydrogen Peroxide 4 bottles 83. Ibuprophen 200ml Tablets 100 1 bottle 84. Infant Formula 2 cases 85. In-Line Nebulizer 10 86. Instant Glucose/Tube 2 87. Insulin Regular, NPH & 70/30 10ml. 10 vitals of each 88. Insulin Syringes (small) 25 89. Inter-Office Envelopes 20 90. Ipecac Syrup 1oz 2 91. Irrigation Kit 2 92. Kaopectate 12 oz 2 93. Lancing Device 25 94. Leg/Arm Splint – Small/Medium /Large 1 each 95. Letter Size Paper Pads 20 SN Shelter SOG 50 November 2009 Item # Item Description Estimated Quantity per 100 individuals with special needs for 3 days 96. Loperamide 2mg tablets 24's 4 97. Loperamide Liquid 4oz Bottle 2 98. Maalox Antacid Suspension 12 oz. 2 bottles 99. Manila Envelopes, 9 x 12 20 100. Markers 5 101. Masking Tape 2 rolls 102. Medication cups /dosage spoons /syringes 75/12/12 103. Message Pads 5 104. Name Tags 1 box 105. Nasal Cannulas 5 106. Neck Brace 1 107. Obstetrical Kit 1 108. OTC Anti-Diarrheal Medicine e.g. bismuth 2 boxes of 12 subsalicylate 109. Oxygen Connectors 5 110. Oxygen Mask with Regulators/Wrench 5 (1 pediatric) 111. Oxygen Tanks (Emergency Use) 5 112. Paper Disposable Gowns 100 113. Paper Towels 5 – 10 rolls 114. Paperclips, Small and Large 1 box large, 1 box small 115. Pedilyte – 12 oz bottles 20 116. Petroleum/Vaseline 1 tube 117. Pharmaceutical counting tray and knife 1 118. Pillows 118 (includes staff) 119. Plug Strips 10 120. Reference Material (i.e. Packet PDR, etc.) 2 121. Rubber Bands 1 bag 122. Saline eye drops 2 bottles 123. Salt Substitute 1 box 124. Scissors 4 125. Sharpie Fine Point Marker 10 126. Sharpie Regular Point Marker 10 127. Sharps Container 1 (gallon) and 6 quart portable 128. Signs 1 bag 129. Splint Board 1 130. Sterile Water – 500 ml (irrigation use only) 4 bottles 131. Stethoscope 10 132. Storage Containers 10 133. Straws for drinking beverages 1 box 134. Sugar 1 bag 135. Surgical Masks 1 box of 35 136. Surgical Masks w/Shield (Latex Free) 12 137. Table Salt 1 box 138. Tape – 1 inch paper 5 – 10 boxes 139. Tape – Silk, 1 Inch 1 box 140. Tape, Hypoallergenic – 1 Inch 1 box 141. Thermometer - non-mercury 12 142. Thermometer - non-mercury covers 200 143. Thermometer - Aural 1 144. Thermometer - Aural Replacement Tips 1 box 145. Thickening substance for liquids 1 box 146. Tongue Depressors 1 bag or box SN Shelter SOG 51 November 2009 Item # Item Description Estimated Quantity per 100 individuals with special needs for 3 days 147. Triangular Bandages 148. Triple Antibiotic Ointment (144 units) 1 box 149. Tylenol - Adult Extra Strength – 500 mg. 1 bottle of 250 pills 150. Tylenol - Children's Soft Chew – 160 mg. 1 bottle of 60 pills 151. Urinals with Covers 10 – 20 152. Urinary Catheter Bags 10 153. Urinary Drainage Bag 2 154. Vinegar 1 bottle 155. Wash Basins 20 156. Wheelchairs 5 – 10 157. Wrist Bands 1 box of 855 158. Zinc Ointment 1oz 2 tubes 159. Ziploc Bags Assorted Sizes The following three tables include all of the items listed above, but are divided into categories to assist in the planning process. Those categories are: a suggested list of supplies needed when opening a special needs shelter; a suggested list of consumable supplies needed while operating a special needs shelter; and a suggested list of ―over the counter‖ medications to have on hand to assist with minor discomforting conditions frequently encountered in a shelter. Shelter Set-Up Portion Item # Item Description Estimated Quantity per 100 individuals with special needs for 3 days 1. 2-way radios 12 5. AED with pads 1 9. Alphabetical files w/ flaps 2 12. Antibacterial hand wash 3 bottles (refill) and 18 small bottles for staff 18. Bag Valve Mask (BVM) Adult 2 19. Bag Valve Mask (BVM) Pediatric 2 20. Ball point pens 1 box of black and blue each 22. Batteries assorted sizes 24. Bedside commodes 10 30. Blankets 118 31. Blood Glucose Monitor 1 32. Blood Glucose Strips 2 boxes 34. Box to Store/Lock Medications 2 35. BP Cuff Set - non-mercury (adult sizes and 3 pediatric) 36. Bucket – 2 gallon 2 39. Can Opener 1 42. Clipboards 15 43. Cloth Towels – Large 100 44. Cloth Towels – Small 100 45. Cold Pak (Reusable) 2 pak 46. Color Highlighters 1 pack 48. Communication boards (individual) 2 49. Cots 118 (includes staff) 57. Duct Tape 2 rolls 61. Extension Cords 10 SN Shelter SOG 52 November 2009 Item # Item Description Estimated Quantity per 100 individuals with special needs for 3 days 67. Flashlights 10 68. Forceps/Tweezers 2 69. Garbage Bags 1 box 71. General first aid kit 1 89. Inter-Office Envelopes 20 95. Letter Size Paper Pads 20 99. Manila Envelopes, 9 x 12 20 100. Markers 5 101. Masking Tape 2 rolls 103. Message Pads 5 104. Name Tags 1 box 114. Paperclips, Small and Large 1 box large, 1 box small 117. Pharmaceutical counting tray and knife 1 118. Pillows 118 (includes staff) 119. Plug Strips 10 120. Reference Material (i.e. Packet PDR, etc.) 2 121. Rubber Bands 1 bag 124. Scissors 4 125. Sharpie Fine Point Marker 10 126. Sharpie Regular Point Marker 10 128. Signs 1 bag 131. Stethoscope 10 132. Storage Containers – Assorted Sizes 10 155. Wash Basins 20 156. Wheelchairs 5 – 10 157. Wrist Bands 1 box of 855 159. Ziploc Bags Assorted Sizes Consumables Portion Item # Item Description Estimated Quantity per 100 individuals with special needs for 3 days 2. 3x3 gauze sponges – 2 sterile per pack 50 3. 4x4 gauze sponges – 2 sterile per pack 100 7. Alcohol-based hand sanitzer 8. Alcohol swabs 3 boxes (100 each) 15. Applicators cotton tipped 200 (box) 16. Arm sling 1 21. Band-aids (non-latex) 5-10 boxes assorted size 23. Bed pans 10-20 28. Biohazard Red Bags Large 1 box 29. Biohazard Red Bags Small 1 box 33. Body Lotion 2 bottles 37. Bulb Syringe 2 40. Chlorine Bleach 1 quart 41. Chux Underpads 150 49. Cotton Tip Applicators 1 box 50. CPR Face Mask – Pediatric 3 each 51. CPR Face Mask – Adult 3 each 52. Diapers – Adult 50 53. Diapers – Infant/toddler 50 54. Dressing (and pad) 24 SN Shelter SOG 53 November 2009 Item # Item Description Estimated Quantity per 100 individuals with special needs for 3 days 55. Dressing paper for tables 2 rolls 57. Elastic Ace Bandages (non-latex) 5 – 10 58. Elastic Band – 2 inch 6 packages 59. Elastic Band – 6 inch 6 packages 60. Extension Cords 10 61. Eye Pads 12 62. Face Shields – Disposable 12 63. Facial Tissue 10 boxes 64. Feminine Products Assorted 65. First Aid Tape Roll (10 yd roll) 10 69. Gauze Bandages 5 10 boxes 71. General Sponges 12 72. Germicidal Wipes 4 containers 73. Gloves, Non-Latex – Large 3 boxes (100 each) 74. Gloves, Non-Latex – Medium 3 boxes (100 each) 75. Gloves, Non-Latex – Small 3 boxes (100 each) 76. Goggles 2 77. Gowns 3 78. Hospital ID Bracelets 75 yellow, 50 green, 20 light blue, 15 white, 25 dark blue, 10 red, 25 orange 84. In-Line Nebulizer 10 90. Irrigation Kit 2 92. Lancing Device 25 101. Medication cups /dosage spoons /syringes 75/12/12 104. Nasal Cannulas 5 105. Neck Brace 1 106. Obstetrical Kit 1 108. Oxygen Connectors 5 109. Oxygen Mask with Regulators/Wrench 5 (1 pediatric) 110. Oxygen Tanks (Emergency Use) with 5 regulators and wrench 122. Salt Substitute 1 box 126. Sharps Container 1 (gallon) and 6 quart portable 128. Splint Board 1 130. Sterile Water – 500 ml (irrigation use only) 4 bottles 133. Straws for drinking beverages 1 box 134. Sugar 1 bag 135. Surgical Masks 1 box of 35 136. Surgical Masks w/Shield (Latex Free) 12 137. Table Salt 1 box 138. Tape – 1 inch paper 5 – 10 boxes 139. Tape – Silk, 1 Inch 1 box 140. Tape, Hypoallergenic – 1 Inch 1 box 141. Thermometer - non-mercury 12 142. Thermometer - non-mercury covers 200 143. Thermometer - Aural 1 142. Thermometer - Aural Replacement Tips 1 box 146. Tongue Depressors 1 bag or box 147. Triangular Bandages 151. Urinals with Covers 10 – 20 152. Urinary Catheter Bags 10 153. Urinary Drainage Bag 2 SN Shelter SOG 54 November 2009 Item # Item Description Estimated Quantity per 100 individuals with special needs for 3 days 154. Vinegar 1 bottle Other The Counter Medications and Supplies Portion Item # Item Description Estimated Quantity per 100 individuals with special needs for 3 days 4. Activated charcoal/bottle 2 6. Alcohol – isopropyl 1 pint 10. Ammonia inhalants 2 boxes 11. Antacid – low sodium 24's 2 boxes 13. Anti-septic foam alcohol 2 bottles 14. Anti-septic germicide pre sol (iodine) 8 bottles of 1 fl oz 17. Aspirin 5 gr tablets 250 tablets 1 bottle 25. Benadryl Cream – antipruritic 1 ox. 2 tubes 26. Benadryl/generic syrup 4oz 2 27. Betadine scrub 1 bottle 38. Calamine Lotion (6 fluid oz) 2 79. Hydrocortisone 0.5% cream/ tube 2 80. Hydrocortisone 1% cream/tube 2 81. Hydrogen Peroxide 4 bottles 82. Ibuprophen 200ml Tablets 100 1 bottle 85. Instant Glucose/Tube 2 86. Insulin Regular, NPH & 70/30 10ml. 10 vitals of each 87. Insulin Syringes (small) 25 89. Ipecac Syrup 1oz 2 91. Kaopectate 12 oz 2 95. Loperamide 2mg tablets 24's 4 96. Loperamide Liquid 4oz Bottle 2 97. Maalox Antacid Suspension 12 oz. 2 bottles 107. OTC Anti-Diarrheal Medicine e.g. bismuth 2 boxes of 12 subsalicylate 114. Pedilyte – 12 oz bottles 20 115. Petroleum/Vaseline 1 tube 121. Saline eye drops 2 bottles 145. Thickening substance for liquids 1 box 148. Triple Antibiotic Ointment (144 units) 1 box 146. Tylenol - Adult Extra Strength – 500 mg. 1 bottle of 250 pills 150. Tylenol - Children's Soft Chew – 160 mg. 1 bottle of 60 pills 158. Zinc Ointment 1oz 2 tubes SN Shelter SOG 55 November 2009 Attachment 10 Flow of Shelterees in the Special Needs Shelter Shelteree Arrives Reception staff will direct clients to triage area, general shelter, or hospital depending on whether they meet criteria Triage Team determines initial suitability for shelter Appropriate Inappropriate for SN Shelter for SN Shelter Escort or direct to SN Shelter Registration Does not require Requires assistance assistance beyond SN Shelter level of care Client is registered and proceeds to medical assessment Send to medical holding Refer to general area awaiting transport to population Red Cross appropriate medical Assigned to appropriate area in Shelter facility. Refer to LEOC. shelter. OR Send to medical holding area awaiting transport to appropriate medical facility. Refer to LEOC. SN Shelter SOG 56 November 2009 Attachment 11 Example of Color Coding Special Needs Clients Per Care Category Color Type Definition Red Supervised Persons with special needs with the potential for deterioration or requiring regular supervision (i.e., oxygen, post operative special needs, behavior issues) Green PRN Persons with special needs requiring PRN treatment or therapy, but who require assistance with activities of daily living or requiring care, therapy, or assisted medications at least once daily. Lt. Blue Isolation Contagious persons with special needs who may be quarantined to ensure the health and safety of other shelterees (i.e., chicken pox, measles, etc). Also persons with special needs who may be quarantined to ensure they own health and safety (i.e., organ transplant recipients, chemotherapy clients, or other immune compromised individuals). Yellow Hospice Because an individual could expire in a SN Shelter, hospice individuals should be housed separately from other persons with special needs. Hospice personnel and caregivers will be assigned to care for their needs. Dk. Blue Pediatrics Children with special needs who may need to be separated from adults with special needs. White Critical Some persons with special needs may arrive whose physical condition requires medical assistance beyond the capabilities of the SN Shelter. As conditions permit, those persons will be referred to an appropriate medical facility, but due to severe weather conditions or transportation shortfalls, may need to be sheltered until such time as they may safely be transported. It is recommended that family members and children of persons with special needs be given an identification wristband, if available, to identify all members of the same group. SN Shelter SOG 57 November 2009 Attachment 12 SPECIAL NEEDS SHELTER OPERATION Daily Situational Report SEND TO LOCAL EMERGENCY OPERATIONS CENTER AND RETAIN COPY AT SHELTER Reporting to: _________________________ From: ___________________________ Date: _____________________________ Time: ______________________________ Location:______________________________________________________________ Population of Persons with Special Needs residing in shelter: _____________________ Contact Person: _________________________Contact Number: _________________ Is number of Medical Staff sufficient at time of Report: YES NO If ―No‖ report your needs below. REPORT NEEDS IN THIS SECTION Food/Water/Nutritional Issues: Immediate Staffing Needs/Issues/Supplies: Immediate Request for Assistance/Resolution/Supplies: Shelter Operations Issues: Medical Issues: ______________________________________________________________________ ______________________________________________________________________ Security Issues: ______________________________________________________________________ Other: ________________________________________________________________ SN Shelter SOG 58 November 2009 Attachment 13 DISASTER REGISTRATION LOG Arrival Name Address Phone Shelteree Method of Emergency Contact Cot # Trans. Departure Time & S-Shelteree Diagnosis Arrival and Phone Number Type Date & Date C-Caregiver Time TRANSPORTATION TYPES: T1 - Private Vehicle T2 - Public Transportation T3 - Standard Bus Pick-up T4 - Wheelchair Accessible Vehicles SN Shelter SOG 59 November 2009 Attachment 14 Acronyms ADLs – Activities of Daily Living ARC – American Red Cross CNA – Certified Nurses Aid COPD – Chronic Obstructive Pulmonary Disease DHSS – Department of Health and Senior Services DSS – Department of Social Services EMD – Emergency Management Director EMS – Emergency Medical Services EMT – Emergency Medical Technician ESF – Essential Support Function LEOC – Local Emergency Operation Center LOEM – Local Office of Emergency Management LPHA – Local Public Health Agency LPN – Licensed Practical Nurse MOUs – Memorandums of Understanding RN – Registered Nurse SEOC – State Emergency Operation Center SN – Special Needs SOGs – Standard Operating Guidelines SOPs – Standard Operation Procedures SN Shelter SOG 61 November 2009
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